Stage 3
calibration had become misaligned when her new head support was placed, and she had been rejecting the system since she perceived that it no longer worked for her. This was in spite of all the efforts from the Gompers staff, professionals and caregivers to recalibrate the system and make her device and expressive language available to her. My observations, through my OT lens and thoughts previously described regarding perceptual motor access, saw possibilities for scanning that could potentially af- ford faster communication and easier, more fail-safe set-up in the environment. I suggested the possibility and educated as best I could: In the climate of disappointment and unsuccessful access, Laroncita did not yet trust me and we ended our time together. One week later, after additional collaboration, the yet more determined Candice and froma tag team (OT and Speech) re-ap- proached. Laroncita also had had time to reconsider her access and need for reliable repeatable access methods to meet her communication needs through the day and across all areas of occupation. When she gave us the go ahead to show her ad- ditional access methods, it was all systems go full steam ahead. Within 45 minutes, she had a second access method, which at this emerging stage was faster and more client satisfying than her initial method; one switch row column scanning with dwell including a rigid mount for the device, flexible mount for the switch and micro light switch to the left side of the face. Professionally relinquishing all roles in the client-centered arena, Laroncita, her body (posturing, tone and reflexes) cou- pled with her communication needs, guided the process. The professional brain goes on automatic, drawing on the evidence and professional experience. I would like to think I reflected and professionally referred to the articles otherwise referenced and the Occupational Therapy Practice Framework, but all I could think is “Laroncita is trusting us to get this right and we better surpass her expectations!’ This is the process and professional reasoning as per best recall: 1. Visually scan the environment and understatedly gather en- thusiasm and support: This is the team ultimately respon- sible for making communication available to Laroncita on a daily basis. 2. Appreciate and respect my professional partner, fully un- derstanding that she and the client are trusting my eyes and professional experience. This is done with the mutual re- spect that I bring fresh eyes/thinking, and she is the expert on the client and what is pragmatically available within the environment. 3. Watch and observe. At this junction, my eyes watched the member’s tone, reflexes, motions and motor patterns as we engaged in no tech total communication strategies. While her gross posture shifted and she appeared to demonstrate numerous unintentional motions, she seemed to have reli- able, intentional, repeatable ability to move her head to the side and to the left. It also appeared that she could return to
I met Laroncita when I was at Gompers Habilitation Center, Phoenix, Arizona, visiting with the members to gather occupa- tional narratives as part of a case study project in a community based learning environment for my graduate level OT students at Midwestern University - Glendale. Candice M. Steel, SLP-L, ATP and I were teaming to demonstrate the transdisciplinary approach within the SETT mindset to enhance engagement in meaningful occupations with persons who use augmentative and alternate communication strategies. Having known Laron- cita from previous visits, I expected she would be using eye gaze to input her AAC device. Prancing towards the area I expected to find this self-directed woman, I so eagerly expected an interaction that would provide my graduate students insight into the intentional relationship and example after example of how this member enjoys and par- ticipates in activities across all areas of communication. Instead, we found a young woman sitting asymmetrically in her wheel- chair, without her device or mounting system: Her head was supported by a pillow placed about six weeks previously and her communications were limited to no tech strategies. Candice and I tag teamed, demonstrating complete role transparency had there been a trained observer and explaining the purpose of our visit to Laroncita, while attempting to under- stand rationale for the absence of her device. She, using total communication strategies, told us she did not want to speak with us and did not want to use her high tech eye gaze input system. Candice and I respectfully listened but picture three self-directed persons in this interaction, two trying to under- stand ‘what is going on here and how can we fix it?’ Laroncita, through education and advocacy attempts from the profession- als, acquiesced and allowed us to charge and mount her device that we found in the transport bag across the room. Through the discovery process, we concluded that her eye
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October / November, 2019 | www.closingthegap.com/membership Closing The Gap © 2019 Closing The Gap, Inc. All rights reserved.
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