Cerebral Palsy Communication Devices

• Cerebral Palsy
• Cerebral Palsy Treatments
• Cerebral Palsy Communication Devices

AAC For Children With Cerebral Palsy

Cerebral palsy occurs when a baby’s developing brain suffers damage (usually during pregnancy, childbirth, or shortly after birth), which impairs the brain’s ability to exercise muscle control. In addition to the physical impairments resulting from this condition, children and even teenagers with cerebral palsy caused by a birth injury or neonatal injury will often have impairments related to speech, hearing and/or vision.

Generally, sign language is generally useful for people with communication disabilities. But children that suffer from cerebral palsy may not have the coordination and dexterity needed for sign language due to the damage to the brain that controls motor skills. As a result, children suffering from cerebral palsy made need augmentative and alternative communication (AAC) devices in order to help them interact with others.

What is AAC?

An AAC is any tool that helps an individual express themselves including all augmentative and alternative communication devices. For example, facial expressions, hand gestures, pictorial communication, and writing or typing would all constitute different types of AAC on the most basic levels. Augmentative and alternative communication can be aided or unaided.

Unaided AAC includes all types of non-verbal communication that takes place without the involvement of assistive devices or technology. Historical basic examples include making faces, waving hands, or using sign language. With technological advances, Aided AAC now includes communication that involves the use of assistive equipment or technology. Examples include communication boards, speech generating devices, hearing devices, and software based devices.

AAC Devices for Children with CP: What does the Research Say?

The National Institutes of Health (NIH) published a case study, which evaluated the efficacy of augmentative and alternative communication equipment for a high school junior with cerebral palsy who started using it to communicate with others. Researchers found that:

• The intelligibility of the student improved
• The student developed more productive relationships with peers
• The student began to socialize in a better way
• The teaching staff was able to engage more comfortably with the student

Another research study conducted by the professors at the California State University at San Marcos and the University of San Diego along with AssitiveWare examined the benefits of Apple devices related to AAC. The results showed that up to 80% of the users of augmentative and communication devices experienced improvements in behavior, independence, and general well-being.

Types of AAC Devices for Children with Cerebral Palsy

Symbols

Symbols are a type of representation system used in augmentative and alternative communication for children and teens with cerebral palsy. Symbols may include gestures, hand signals, line drawings, pictures, images, letters, and words. Based on the abilities of the AAC user, an appropriate symbol system can be chosen. In many cases, different symbol systems may be used in different situations.

• Blissymbolics: It is one of the major symbol systems involving linguistic characteristics. This graphical language comprises over 5,000 authorized symbols (known as Bliss-words or Bliss-characters). Children and teens with CP who have severe physical and speech impairments can use this generative language to communicate with others.

• Picture Communication System (PCS): This system relies on realistic images in black & white or color, or line drawings for communication. Depending on the user’s ability, they can choose line drawings or detailed images in color to communicate. The symbols in PCS are usually located on traditional communication boards or electronic screen displays.

• Picture Exchange Communication System (PECS): In this system, pictures in tactile form are used. The images are imprinted on cards, and the child with CP can move them around to create a message. Other tangible things or miniature objects that represent a real item can also be a part of this symbol system.

Manual Communication Board

This is a low-tech solution that enables children with CP who have speech limitations to communicate by selecting symbols, words or pictures from a laminated sheet. The board will include items that are appropriate to the child’s abilities and skills. Boards for school activities, meal time and bedtime can enable faster and more effective communication between the child and the caregiver.

The child may begin with a singular communication board, and then graduate to using a flipbook. A flipbook comprises multiple boards, including the alphabet, parts of speech, core vocabulary, common responses (yes or no), descriptive words (hot or cold), punctuation, common feelings (happy or sad), and frequent questions. Boards can be color-coded and their layout can be customized with help from a therapist, teacher or aide.

Using manual boards as an additional augmentative communication device is often helpful even when the child is using an electronic communication board.

Electronic Communication Board

An electronic communication board is basically a digital tablet device. It contains symbols, photos and letters that a child with CP can point to using a pointer tool or a finger. The board enables the child to express their needs, emotions, or thoughts by choosing items from an interactive screen. The board will convert the selected symbols, pictures or words into coherent sentences and vocalize them aloud for others to hear.

In general, an electronic communication board can generate up to 12 words per minute. The child or teen with CP may have to be provided with some training to operate the device. Some high-tech electronic boards also come with pre-recorded messages or the device may allow the user to record core words or messages for every picture. The message can be played back with the press of a button.

A Speech Language Pathologist (SLP) may be required to teach the child how to communicate using this assistive device. Recently, children have been able to use certain tablets or a smartphones with assistive communication apps as substitutes for an electronic communication board.

Aids for Writing and Typing

Young children or teens with cerebral palsy may sometimes be more comfortable using writing and typing aids to communicate through written words. But due to common motor skills deficits experienced by children with CP, using a regular keyboard or holding a normal pen may not be viable in many cases. Specific aids are now available to provide the user with better control to write or type out their message.

• Pencils with Grip: Pencils with special grips in different shapes are available for children with CP. The device allows the user to correctly position their fingers and maintain some degree of movement control, and write without excessive hand fatigue.


• Wrist Support: This assistive device is designed to hold the child’s hand in extension in order to give support to a weak wrist. A special writing instrument can be used with wrist support to write a message. Wrist support designs are usually similar to splints or full braces.


• Typing Aids: A child or teen with CP who has limited hand or arm mobility might use typing aids. The device is fastened with an elastic brace or Velcro around the child’s hand. It includes a metal pointer, which can used to steadily push buttons on a phone or press down the keys on a special keyboard.

Voice Output Communication Aids (VOCA)

VOCAs are augmentative and alternative communication devices that make use of digitally stored speech as a means of communication. Individual words or phrases can be pieced together to form sentences or extended messages using the vocabulary stored in the device memory. Depending on the device, the speech output may utilize pre-recorded (digitized) or artificial (synthesized) speech, or a combination of the two.

Synthesized or artificial speech is computer generated, while digitized speech includes spoken words recorded directly into the VOCA. A child with cerebral palsy can operate a VOCA according to their ability by:

• Using a touchscreen
• Pressing buttons
• Typing text
• Scanning grids using different inputs
• Operating switches with any controllable body movement

Some VOCA models are handheld, while others can be mounted on a wheelchair or set up with a desktop. Touchscreen VOCAs typically allow the user to adjust the layout and content of the display according to individual preferences. Some of the more advanced VOCA touchscreen models provide superior processing power and features.

Children and teenagers with cerebral palsy can satisfy many of their AAC needs using VOCAs. Some of the contemporary VOCA models may also offer:

• Internet browsing
• Bluetooth connectivity
• Social media access
• Phone call, texting, and email
• Infrared control of TV
• Accessible apps for images, videos, and music

Eye Tracking Devices

Eye tracking technology is taking augmentative and alternative communication for children with cerebral palsy to the next level. Eye tracking devices enable the child or teen with limited physical movement as well as speech impairment to use the iris of their eye to give commands to a software system, which in turn speaks for them.

A cerebral palsy patient who finds it difficult to move hands, fingers, wrists, and arms can simply use their gaze instead of physical movements to control computerized devices for communication. Using their gaze on the computer screen, the child or teenager can select, zoom, scroll, or carry out other mouse functions. In addition to using a computer, eye trackers can also be used to operate electronic communication boards and select the desired words and sentences to communicate.

When combined with other software programs or apps, eye tracking or eye gazing technology can also be used for phone calls, dictation, emails, texting, gaming, and social media networking. While assessing the candidates for eye tracking devices, the therapist should take into consideration their visual and cognitive abilities, positioning, and other physical aspects.

Eye Control Feature in Microsoft Windows OS

Eye control feature in MS Windows 10/11 can enable a child or teen with cerebral palsy to communicate using text-to-speech, type using the on-screen keyboard, and control the mouse cursor. A built-in hardware based camera is included, but a compatible eye tracker must be separately purchased to use this feature.

To operate the Eye Control feature, the user will turn it on in their laptop or PC. A Launchpad will appear on the screen, and the user is required to gaze at the screen to activate it. Once the Eye Control is activated, the user can operate the mouse cursor from the Launchpad. They can simply position their eyes on the spot where they want the cursor to show.

Similarly, using the gaze an on-screen keyboard can be activate from the Launchpad. Thereafter, the user just has to look at the characters they wish to type. When the user wants to read the content on the screen, they can use the text-to-speech button with Eye Control, simply by gazing on the button on the Launchpad. Once the Play button is activated in the on-screen keyboard, it will read the text aloud.

Cochlear Implants

Addressing hearing loss that occurs with Cerebral Palsy

For a child or teen with cerebral palsy, hearing impairment can create additional complications apart from their physical and cognitive challenges. In many cases of cerebral palsy, hearing impairment is a permanent condition, which cannot be corrected with therapy. However, a cochlear implant is a cutting-edge assistive device for those who are coping with severely impaired hearing.

A cochlear implant is an intricate device that combines microphones, stimulators, transmitters, and speech processors to deliver messages to the auditory system. The implanted device enables the auditory nerve to sense sound. It may allow the hearing-impaired child to hear loud noises, and in some cases, provide them the ability to hear and comprehend speech.

The device constitutes two parts: an implant that is surgically inserted underneath the ear tissue, and an external device that is placed discreetly behind the ear. A cochlear implant is different from a hearing aid (which merely amplifies the sound to audible levels). The implant is designed to bypass the damaged parts of the ear by stimulating the auditory system, which interprets the incoming signals as sound. Here’s how it works:

• The microphone in the cochlear implant picks up the sounds
• The speech processor component organizes different sounds to assist the user in discerning sound
• The receiver and transmitter (external component) receives the speech processor’s signals and converts them into electric impulses
• The electrodes in the cochlear implant collect the impulses and deliver them to the auditory nerve

The FDA has approved the use of cochlear implants for children who at least one year old. This device is more appropriate for children or teens with severe hearing loss. In case of moderate hearing impairment, the child may benefit from less invasive devices or external hearing aids.

Accessibility Features in Apple Mobile Devices

The popular Apple mobile devices, such as the iPhone, iPad and Apple Watch include certain accessible communication features that may help children and teens with cerebral palsy communicate. Some of these features include:

• VoiceOver: For kids and teens with vision impairment resulting from cerebral palsy, this innovative screen reader can inform what is happening on the device. VoiceOver describes text, graphs, objects, and people in detail. Auditory descriptions of various device elements enable the user to navigate the screen easily using simple gestures on a trackpad or touchscreen or with the help of a Bluetooth keyboard.


• Voice Control: Users with mobility issues due to cerebral palsy can navigate the Apple device simply using their voice. Vocal commands, such as click, tap, and swipe can enable easy interaction with various apps. Voice Control also provides a more convenient option to write and edit by text dictation and verbal commands.


• AssistiveTouch: This feature allows a kid with cerebral palsy to adapt the device touchscreen to fit their unique physical needs. If the user is unable to work with gestures like tap or pinch, they can substitute with another gesture or even create a touch of their own. Children with upper body limb difficulty can use this feature on Apple Watch to navigate a motion point or answer phone calls.


• Siri: With Siri, the user can perform multiple communication activities on any Apple device without having to pick up the device or even having to lift a finger. Just a simple voice command, such as “Good Morning” can show the weather, pull up directions, send a message, and start a podcast – all at once. The feature works in multiple languages.


• Sound Recognition: Young kids and teens with hearing impairment due to cerebral palsy can use this feature to become aware of certain sounds. Sound Recognition leverages on-device intelligence to listen to specific sounds and notifies the user when a particular sound is detected. The user will get a notification when a particular sound, such as the crying of a baby or the ringing of a doorbell, is detected.


• Sensory Alerts: For users with cerebral palsy who have hearing impairment, it is possible to receive vibrating or visual alerts for incoming calls, emails and text messages. Sensory alerts, such as an LED flash light can also be set up for calendar events. The feature works on all Apple devices, including the iPhone, iPad, Mac, and Apple Watch.


• Spoken Content: Children and teens with cognitive impairment can enhance their reading and writing ability with Spoken Content. Its Speak Screen feature allows the user to hear the complete screen read aloud. The Speech Controller feature enables them to control the playback of speech. The user can have a particular section of the text read out to them with the Speak Selection feature. The user can also have each letter they type spoken aloud to them using the Typing Feedback feature.


• Background Sounds: To mitigate cognitive dissonance, this feature can allow a young person with cerebral palsy to cut down distractions and improve their calmness and sense of focus. The user can choose from calming background sounds, such as distant rain, soothing stream, or ocean waves to mask external noises.


• Guided Access: Children or teens with cognitive difficulties can use the Guided Access feature to stay focused on the app they are using or the particular task at hand. With this feature, the Home button can be disabled so that the device stays confined to a single app at a time. Access to the touch input or keyboard can be restricted to ensure that wandering gestures or taps do not distract them from learning.

5 AAC Apps for Kids and Teens with Cerebral Palsy

Here are five popular augmentative and alternative communication apps to consider for kids with cerebral palsy:

Proloquo2go

This app for iOS is a full-featured AAC solution for children with speech difficulties due to cerebral palsy. It offers high-resolution symbols, natural sounding voices (text to speech), and an expandable vocabulary of more than 7,000 items.

SoundingBoard

This is a free augmentative and alternative communication mobile app for children with limited or no speech to help them communicate. The app includes preloaded communication boards with recorded messages and symbols to enable verbal messages.

Touch Voice

Medical grade AAC apps are available from Touch Voice, which enable communication through speech synthesis by clicking on or touching buttons. Touch Voice apps are designed for both iOS and Android platforms and work on phones, tablets, and laptops.

Tobii Dynavox Compass

Children in all age groups who are unable to use their natural voice due to cerebral palsy can benefit from this research-based communication app. It offers dynamic and easy-to-use options for communication in order to participate in everyday activities.

ArtikPix

ArtikPix enables speech articulation practice for children with CP through the use of flashcards and other matching activities. The app allows the users to create or share their own cards and features a built-in scoring system. Visual and audio customization is possible to match with the child’s needs.

Google’s A.I. Project Euphonia for Speech Recognition

Google artificial intelligence research initiative called Project Euphonia is focused on helping individuals with speech impairments caused by conditions such as cerebral palsy communicate better. While automated speech recognition (ASR) is becoming increasingly sophisticated, it still does not work well for atypical speech.

With Project Euphonia, Google aims to increase the scope and performance of its speech recognition software so that individuals with speech impairment can also utilize this technology. With the assistance of artificial intelligence, Google’s research teams hope to improve the ability of computers to recognize diverse speech patterns, including impaired speech.

Technology is changing fast and advances in artificial intelligence provide an array of devices likely to be available in the near future to be able to increase the quality of life of all children that suffer birth injuries leading to cerebral palsy.

Is Your Child’s Cerebral Palsy the Result of Medical Malpractice?

Parents whose children suffer from cerebral palsy deserve an answer to how their child developed this condition and whether the hearing loss or communication difficulties their child is currently experiencing were preventable. Our dedicated birth injury lawyers want to help you find those answers and obtain monies necessary to purchase devices that can help improve the quality of your child’s life.

If your child has been diagnosed with cerebral palsy, and you suspect this may have been caused in part by medical mistakes, Miller Weisbrod Olesky will thoroughly investigate the facts and hold responsible medical providers accountable by pursuing medical malpractice claims against them. The compensation our clients receive helps them pay for their child’s current and future medical treatment, assistive devices needed to help child adjust to living with communication deficits whether they are verbal, hearing or vision deficits, and to be able to pay for these cutting edge devices.

Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. Other parents feel overwhelmed by their circumstances and worried that they will not be able to help out in a lawsuit involving their child’s birth injury.

Miller Weisbrod Olesky is different from most law firms.
We provide help NOW.

Many attorneys focus only on pursuing their client’s legal case. At Miller Weisbrod Olesky, we know your child needs help today – not just when your birth injury lawsuit is settled. We have a team focused on helping our clients NOW when they need it most.

We know that children with birth injuries like hypoxic-ischemic encephalopathy (HIE) and cerebral palsy often require intense therapy, specialized medical treatment, and assistive care. The stress of providing for a birth injured child’s needs can be both emotionally and financially draining.

But just ‘knowing’ this is not enough. We act on this knowledge by providing exceptional services to birth-injured children and their families.

While Miller Weisbrod Olesky’s birth injury attorneys aggressively prepare each legal case, another department goes into action to help the families of children we represent. Led by a nurse-attorney, this department acts as a medical case manager for our birth injury clients by:

• Regularly monitoring the child’s medical treatment status,
• Helping facilitate medical treatment and therapy, and
• Arranging transportation and services.

Where necessary, we also help families locate local medical providers specializing in the care and treatment of children who have suffered a birth injury. With Miller Weisbrod Olesky, you’re not just a ‘case’. And that’s important when you’re looking for a lawyer who can help you cope with your child’s needs today.

Please call or email us today to get started.

Registered Nurses and Nurse-Attorneys Are a Vital Part of Our Birth Injury Team … and Yours

Most national birth injury law firms will employ one or two nurses to assist the review of cases and medical research. But Miller Weisbrod Olesky offers an unmatched number of nurses and nurse-attorney employees support to both the birth injury attorneys and our clients.

Our team of registered nursing staff and nurse-attorneys bring a deep level of medical and personal insight to every client’s case. Our nursing team includes both an experienced labor and delivery nurse as well as an ICU nurse. Working closely with the rest of the team, they investigate the reasons behind a birth injury and how medical professionals breached their standard of care.

Why Should You Talk with the Knowledgeable Attorneys at Miller Weisbrod Olesky?

The only way to find out if you have a birth injury case is to talk to an attorney who understands birth injuries leading to a delay or failure in developmental milestones including birth injuries that cause cerebral palsy. The leading cause of cerebral palsy is hypoxic ischemic encephalopathy (HIE). Many times HIE is a preventable birth injury, but it takes a detailed expert review of the facts and circumstances of your child’s birth to determine the birth injury was the result of medical malpractice.

At Miller Weisbrod Olesky, a team of committed attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential birth injury claim. We start by learning more about you and your child and the status of meeting or missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery. We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child’s injuries.

If we feel medical negligence caused or contributed to your child’s injuries, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do.

Contact Our National Birth Injury Lawyers