Biomedical Engineering Reference
In-Depth Information
compatible with moderate intellectual deficits. John's answers were perseverant, albeit
contextualized, also revealing difficulties with mental flexibility, planning, and abstraction.
12.6.2.4 Communication Strategy
Initially, John exhibited contextualized smiling and crying, sought visual contact and joint
attention, and gave consistent responses to some of the questions he was asked by directing
his gaze. He was able to vocalize some sounds but did not yet use them to effectively
communicate. He had verbal comprehension of contextual events, but his capacity for
verbal expression was compromised to the point of being unintelligible because of facial
paralysis and severe dysarthria.
12.6.2.5 Evaluation of Visual, Auditive, and Perceptive Functions
John had visual deficits, characterized by limited field of vision and mild loss of visual
acuity, with better performance on the left side. He was able to adjust the position of his
head to improve his visual focus. He did not present any other sensorial impairments.
12.6.2.6 Neurorehabilitation Team Approach
AT tools were gradually introduced into John's neurorehabilitation process, during periods
of inpatient treatment, according to his neurological progress and communication and
social needs.
During his first inpatient stay at SARAH, the family was given a wheelchair, as per
the rehabilitation team's indication, to attend to John's needs and functional level. The
chair was customized with anatomical seat and backrest, enabling better inclination for
his degree of neck and trunk control; the chair also had a headrest, seatbelts, and support
for a table-board. This resource fostered better positioning and permitted greater stability
during transport, playtime, and learning and eating activities; it also made it easier for
the family to participate in these tasks. With better positioning in the wheelchair and the
ability to actively move his upper limbs, John was able to get around more independently
at home because he could manage the wheelchair back and forth for short distances over
flat terrain using verbal commands.
With regards to communication, the team's initial goal was to re-establish a consistent
pattern of affirmative and negative responses. Because he was able to say “e” for “yes”
answers and a subtle movement of his head for “no,” these were the conventionalized
signs. His communication and cognitive progress were aided by the introduction of
other AT devices: sound switches, boards with illustrations and, later, with letters, which
were selected by using his communication signs or by having others do an oral sweep
through the letters. The use of a sound switch was aimed primarily at greater control of his
environment: John used it to call family members and became accustomed to it, later using
it in computerized communication systems. The figure boards added to the possibilities
of John's expression and speed in conversations. They were enlarged because of his vision
impairment and allowed him to make an unlimited amount of words. To write, he would
point at the letters with his right index finger. A special support was designed for adding
the boards and reading materials onto the wheelchair, making it easier for John to engage
in these activities. When he was discharged from this first inpatient stay, the family was
guided through his return to school because he now possessed ways of communicating
and getting around.
