Biomedical Engineering Reference
In-Depth Information
The SLP may be asked to assume the role of case manager or team leader because the
domains of communication are frequently areas of concern for many AT cases (ASHA
2004b). The life experience of individuals who are AT speakers and/or writers is affected
by their achieved communication competence. Consequently, the SLP is in the position of
discussing how communication influences all other aspects of daily living and life skills.
The SLP is the professional who frequently works with the various other professionals,
delivers services to the individual and/or family, and expresses the expectation to optimize
communication to promote or maintain the highest quality of life.
14.1.2 evidence-Based Practice and SLPs
Authority-based approaches to making AT decisions have historically placed teams in the
position of relying on “expert opinions” and hierarchical approaches to matching persons
with technology (Hill and Romich 2007). Historically, teams subscribed to an established
“authority” rather than feeling bombarded by the full range of options and endless list of
features and components in selecting an AT intervention. However, today SLPs apply the
principles of evidence-based practice (EBP) to their decision-making with the incorpora-
tion of data collection and outcomes measurement in guiding the provision of services
(A SH A 20 01).
Dollaghan (2007) states that the goal of EBP is to reduce uncertainty about clinical deci-
sions. Uncertainty is reduced by having a fully informed patient, identifying his or her
preferences, and using the best evidence. Best evidence has been identified and described
by several authors (Sackett et al. 2000; Dollaghan 2007; Law and MacDermid 2008) to
include (1) external or research evidence, (2) internal or clinical evidence, and (3) personal
evidence. The ability and experience to fully inform individuals and families and appraise
and integrate these three critical types of evidence requires competence in the following
domains (ASHA 2002a):
• Knowledge and skill in using systematic observation;
• Knowledge and skill in identifying and measuring outcomes;
• Skill in preparing, monitoring, documenting, and analyzing goals, objectives, pro-
cedures, and progress; and
• Knowledge of performance ratings for technology interventions.
The experienced SLP supports the AT team in applying EBP to the assessment and inter-
vention processes. Figure 14.2 (Hill and Romich 2003) serves as a system model for AT
service delivery that starts and ends with the interests of the individual with a disability
and their family. The process starts with characterizing the individual. Characterizing
the individual is a crucial process that identifies, classifies, and prioritizes the areas and
problems associated with a disability and an individual's level of functioning. Given the
compiled profile, the team may need to gather additional assessment data. The SLP may
realize that additional evaluation of the individual's receptive and expressive language,
written language skills, and literacy abilities will be needed to proceed through the EBP
steps. If individuals are using any AT currently for oral and written communication, then
baseline performance data will also need to be collected by the SLP.
All too frequently, adding procedures to collect diagnostic clinical and educational
data is overlooked or considered too time-consuming by AT teams. However, without
a complete picture of the individual's capabilities the entire EBP process is threatened.
