PAL blog

The iPad scored a major hit in 2010 and 2011 could be the year that the tablet truly becomes a ubiquitously adopted device....maybe? Although many tablet makers may be incredibly vested in the hopes that their products ride successfully on the coat tails of the iPad, one has to wonder if we really are going to see mainstream adoption of the tablet. As anyone who has followed tablets in the past can tell you, they have always been somewhat of a niche product, with little functional use for most people, aside from the cool ability to manipulate onscreen items through by touching them.

The iPad definitely got the recipe right, and many of the tablet makers that followed Apple in 2010 simply missed the mark, with some notable exceptions of course. With underpowered processors, restricted operating systems, and flimsy hardware the tablets of last year were much more toy like than the iPad could ever hope to be (has anyone seen the Target tablet?). In spite of that, manufacturers are gearing up for the mass adoption of tablets by individuals everywhere. Let's just wait and see if they hit the mark.

Check out this articles from the NY Times

If 2010 was the year of the iPad, 2011 looks to be the year that PC tablet makers play catchup. In addition to many other makers, ASUS has announced several new tablets, with some really interesting features. Ranging from 7" to 12", the new tablets offer a mix of Android and Windows OS's. One of the coolest models is undoubtedly the Eee Slider, which offers a slide-under keyboard instead of the typical fold-over and turn-around keyboard offered one many tablet PC's. Additionally, the Eee Pad Transformer offers a completely detachable keyboard.

Check out this article on Liliputing

The trouble with tablet technology is not necessarily the functionality or usability of the tablet computer in itself, but rather what we, the users, want it to and think it should be. Is a tablet computer a fully functional device touchscreen minus the keyboard, or is it something else that we cannot quite conceptualize, and only discover through experimentation. No one can deny what the iPad has done for augmentative communication, and tablet computing in general, but is that it? Can no more be done in the area of touch-screen augmentative computing? And, more importantly, is the iPad all that it can be?

Knowing full well that I risk alienating a wide range of colleagues and professionals who are deeply vested in the use of iOS devices, I must attach the following disclaimer: the iOS development environment and its associated form-factors are fantastic AAC outlets in their own right. The nearly universal adoption of the iPad as an acceptable augmentative communication device upon its release most certainly demonstrates the benefits that it offers. We have heard a lot of praise in relation to the iOS devices out there, but what remains to be addressed are some of the alternatives.

In my ventures of advocacy in the realm of augmentative communication, I have found many individuals and organizations to be entirely clueless to the basic and more advanced alternatives to the iPad. Chalk it up to an incredibly successful marketing campaign, a number of foolproof AAC software applications, and a shiny capacitive touchscreen, and you’ve got an instantaneously ubiquitous device. As an augmentative communication solution, the iPad is in fact so ubiqituous that many individuals may see it as the only solution in existence.

As a software developer, I feel that it necessary to educate the world on every possible alternative out there. And for many adult users, and more high-functioning children, a more fully featured device really is more appropriate. When it comes to comprehensive, powerful, fully-featured devices, dare I say that Windows-based machines may have the upper hand? It may seem unfathomable, but the hard facts cannot be ignored. There are many reasons why I would not recommend an iPod or iPad as an augmentative communication solution for a number of individuals from various populations.

In the coming months we are going to see a slew of Windows-based tablets hit the market. Some are already out there, but popularity and adoption are low. What follows are some of my upcoming favorites:





Obviously, the Windows environment is far more complex than the iOS, which in itself is a major deterrent for its use as an augmentative communication interface. That being said, one really has to look at what you are getting when you have an augmentative communication interface that is also a fully functional Windows-based machine. Adults, and high-functioning individuals in general, may prefer to do their communication on a tablet that device that also has their email, internet, word-processing, and spreadsheet software in the same place. Let’s not forget that the true multitasking power of Windows-based devices allows you do all of those things at the same time. Essentially, what you are getting when you purchase a Windows tablet is a portable touchscreen version of your home computer. Tack on some powerful communication software and you’ve got the best AAC device around.

Let’s not forget about a legitimate physical keyboard either. Maybe it’s just me, but I actually like having some tactile feedback as I type; my touchscreen typing ability at this point is pretty laughable. I know only of Windows-based touch screen devices that offer that kind feature.

I may very well be in the minority when I say that I actually prefer other augmentative communication solutions to iOS based devices, but having worked extensively with a variety of special populations with varied communication needs, I think I have enough evidence to support my opinions at the very least. In any case, only time will tell what type of product will eventually find mass-adoption….and by that time, it will surely be outdated and quickly replaced by some new technology.

Happy computicating!

The American Speech-Language and Hearing Association 2010 Convention in Philadelphia, PA is officially over and it was quite amazing to meet some of the faces behind the creations out there this year. Although in the past there has been no lack of technological offerings, this year’s convention showcased a far greater number of do-it-yourselfer technophile clinicians and advocates showing-off the fruits of their labor. As a clinician turned software developer, it is inspiring beyond to words to find myself surrounded by like-minded individuals who share equally as much as passion and dedication.

This year’s convention showcased some incredibly innovate and interesting new products/advances from some really interesting individuals. The gentle trickling of iOS (iPod, iPad, iPhone) apps in the past, has turned into a full-blown monsoon of new treatment and assessment applications for said devices. Companies like Smarty Ears, Assistyx, and AssistiveWare have taken great advantage of the market’s seemingly incessant appetite for anything iOS. Although larger companies continually, and expectedly, churn-out new products, it is amazing to see how much work one person is willing to put in order to keep up with demand (i.e. Barbara Fernandes).



In addition to all of the specific technological offerings at this year’s ASHA convention, I found it extremely inspiring to meet a number of self-starters with a passion for what they love: technology. ASHA 2010 may be best remembered as the year that the technology buffs came out to the world to proclaim their zeal for technology in the world of speech pathology. Can anyone deny the enthusiasm that Chris Bugaj has for his work after witnessing his impassioned performance describing the intricacies of advocating for enhanced technological resources in the classroom? Did Sean Sweeney’s presentation not make you want to incorporate as many Web-based learning tools as possible into your treatment sessions?



Perhaps it was the 7am Tweetup in the overlook café that provided me with the impetus to write so fondly about my colleagues. Or maybe it was some of my peers’ responses to seeing my own interest in augmentative communication that excited me. I think what really stood out to me is that behind every web-post, or every line of code, there is a human who is working himself/herself to the bone to create something for the world to use and enjoy. I appreciate all of the work of my peers and colleagues, and look forward to ASHA 2011.

Happy Communicating!

I will be representing PAL will be the 2010 ASHA Convention in Philadelphia this year. I will be showing off Simple Speech live, so come and check it out. Anyone who wants a personal demo of Simple Speech, send me a tweet. There will definitely be some freebies, so make sure not miss me there!

Jose

We have a new twitter page! Follow PAL for all kinds of updates and info. Check out PAL on twitter.

I just posted a video tutorial for Simple Speech. It goes through the basic features of the program. Check it out below.



Happy communicating!

Reimbursement is by far one of the important and challenging aspects of working with augmentative communication. In the world of AAC Medicare and Medicaid billing is a common topic of discussion and head-scratching; the fairly straightforward process of evaluation and selection of an appropriate device becomes a tedious and oftentimes extremely challenging task when we seek reimbursement through Medicare or Medicaid. One of the major benefits of billing through these routes is that you will likely receive your approval within 30-60 days. This turnaround time is much quicker than the devices that many departments of education and school systems provide.

Step 1 – Have an augmentative communication evaluation done
It is absolutely essential to have a qualified speech-language pathologist perform an augmentative communication evaluation to assess the needs and current level of functioning of the client. The speech pathologist will try out different devices and make a determination as to which is most appropriate for the client. The clinician will follow-up with a detailed report on his/her findings. A clinician who is well-versed in AAC will be able to guide you through the rest of the process.

Step 2 – Find an appropriate device
When you are looking for devices there are a multitude of different options. Thankfully, this process is made significantly easier by utilizing the knowledge and skills of a speech-language pathologist. There are a lot of considerations to be aware of, so it is very important that a qualified professional select the appropriate device. That being said, many caregivers have recommendations on different devices that they have seen, or think are appropriate; such information is always useful when selecting a device. Once you have found a device that may be appropriate for the client’s needs and current abilities, the speech-language pathologist must contact the vendor/manufacturer of the device.

Note: If the client has any physical limitations/mobility issues these need to be factored in during the device selection process. Wheelchair mounts, eye-tracking systems, etc, are all very import considerations to be aware of. A consultation with an occupational therapist may be needed for any of these types of issues. It is important to get this done before you order the device from manufacturer as mounts are usually device-specific.

Step 3 – Take care of your documentation
Getting the appropriate documents together is by far the most important step in the process of Medicare/Medicaid billing. There are a number of documents that need to be submitted for a valid claim, and a mistake on any of those could be justification for rescinding reimbursement on the device. Typically you will need the following documents:
- A letter of medical necessity co-signed by the speech-language pathologist and the client’s primary care physician.
- A prescription for the specific device by the client’s primary care physician.
- A augmentative communication evaluation conducted by a speech-language pathologist.
- Any other documents requested by the vendor.

Once you have got all of your documentation together, you must submit it for reimbursement. In most cases, you will simply submit all to the device vendor. The vendor will submit every to Medicare/Medicaid for reimbursement.

Step 4 – Setting up the device and training
If all goes well, you should receive your device within 30-60 days. The speech-language pathologist who is working with the device will set it up and begin instruction immediately. This is a long process, and only long-term repeated exposure to the device as a communication tool will ensure an adequate level of competence. It is vital that a persistent and patient approach is taken with AAC, as with any speech-language remediation. Progress must be demonstrated over the course of treatment.

For caregivers: Training does not end when the speech treatment session ends. The AAC device that was provided must be accessible at all times. A communication device that is out of reach of the client serves no one.

Caution – Avoid these common pitfalls
Documentation: Medicare and Medicaid auditors want to save money, and they will look for any missing documentation as a reason for rescinding payment for the device. There are some very important things to remember when billing Medicare/Medicaid. Make sure your documentation is tight. Ensure you have got all of the documents mentioned above, and that every form is filled in. Be confident that your evaluation is, for lack of a better word, perfect.

Accuracy: Ensure that everything that is on the evaluation is accurate and representative of the client’s current level. As a clinician, you are not doing anyone any favors by over or understating the current level of functioning of the client. Be accurate, and if an accurate description of the speech and language abilities of the client does not appear to justify a device, then consider the possibility that client does not need a device.

Training: Obviously training is a more long-term goal; full proficiency cannot be reasonably obtained in a matter of days or weeks. In spite of this, a reasonable level of proficiency cannot be expected in a short period. It is of utmost importance for a speech-language pathologist to provide services to help the client attain a modest level of proficiency right from the start. The device must be practical and functional for the client, and so if the device is not being taught to him/her, a Medicare/Medicaid auditor may question the usefulness and need for the device. In short, if the client cannot use the device functionally after a reasonable period of training time (say 2 months), then Medicare/Medicaid may take it away. A note to clinicians: ensure that treatment for training on the device documents progress in transparent terms (i.e. percentages, clear measures, etc.)

Disclaimer: The text above is not intended to be a comprehensive manual to Medicare / Medicaid billing, but rather a guide to assist you in obtaining an AAC device; it is intended for educational purposes only. The steps here are not guaranteed, but represent the practices that many clinicians have used to successfully obtain an AAC device through Medicare and Medicaid.

In previous posts, I have discussed how to create and AAC device using different hardware and software, but I thought it was time for a more detailed description of the process. What follows is a step-by-step guide that anyone can use to create their own augmentative communication device. Although other options are available, all of the options outline here are Windows-based solutions.

Step 1: Hardware
The first thing to consider is the hardware that you will be using. In order to make a practical AAC device, you are going to need a touchscreen. Although you can use a mouse to control your AAC device, touchscreen is something that makes augmentative communication uniquely functional and easy-to-use. There are several hardware options on the table.


Touchscreen Overlay – This is by far the cheapest option if you already own a laptop that you are willing to convert into a communication device (an easily reversible process). The concept on a touchscreen overlay is simple: you strap it onto your existing screen then plug it in to your USB port. That’s it. You now have full touch functionality on your laptop computer. The major downfall of this type of setup is that the user still has access to the full keyboard, which may mean unintended modification. Take a look at the following touchscreen overlay options: Keytec Touchscreen Add-on kit ($179), Keytec Touchscreen Add-on kit ($169), WinTouch Touchscreen Kit ($129).


Touchscreen Notebook/Netbook – Touchscreen laptops (tablets) have been around for years, but we have only recently seen the advent of more affordable touchscreen computers come to light. When you purchase a separate touchscreen device for communication purposes, you definitely get a little more flexibility. There are some great little touchscreen notebooks and netbooks out there for very reasonable prices. Tablet slate PC’s (sans keyboard) have become more and more popular, so expect to an increased number of keyboardless devices on the market. As far as size goes, you don’t need anything larger than a 9” or 10” screen, but some users may prefer a larger screen. Remember that you are essentially purchasing a fully featured computer, so make sure you have a nicely updated and modern operating system (i.e. Windows 7). Take a look at the following options: Asus Eee PC T101MT ($450), Archos 9 PC Tablet ($399), TegaV2 ($799).

Hardware Considerations – There are some important hardware considerations that need to be taken into account. Processer speed and memory are one of the areas of computing that we tend to focus on with consumer-oriented computers, but for AAC purposes, you do not really need a super-fast processor, loads of RAM or storage space. What follows are some of the more import hardware considerations:

Battery – Possibly the most important consideration is the battery life of the computer that you are using. A device can only serve communication purposes, when it can run, so having a long-lasting battery is absolutely essential. Some tablet PC’s may get 3 hours on a single charge, while netbook-based tablets can get as much as 6 hours. Be very conscious of this as you are shopping arouund.

Weight – Weight is one of those interesting things that doesn’t ever seem to have been a consideration for the major device makers; anyone who has picked up a typical AAC device in the past 5 years know can liken the feeling to lifting a stack of bricks. This is no longer the case with modern tablet PC’s and netbooks. Anything over 3 lbs is really over the limit of a reasonable weight.

Screen Size – In the past, the mentality has always been ‘bigger is better.’ This is no longer true, as has been proven by the popularity of netbooks as a computing solution. Smaller screen size typically means smaller weight, but obviously smaller picture symbols and text as well. Some people prefer iPod sized devices, while others like a more computer-sized device. Size really depends on the needs of the user (visual deficits, dexterity issues, preference, etc).

The list above is not comprehensive; take a look at our device database for a more comprehensive list of available devices, including quick specs, prices and where to buy.


Step 2: Software
Once you’ve got your hardware taken care of, you will need an augmentative communication software program to create a true AAC solution. There are a number of programs on the market today, with an incredibly wide range of prices. The more expensive communication software programs can be had for just around $1000, but some great programs can be had for significantly less money. Costs tend to be high for AAC software, but this is definitely changing and we are going to continue to see cheaper and cheaper software on the market. I created Simple Speech, which clocks in at $50, to offer a cost-effective solution to users who need the functionality of the more expensive programs but for significantly less. A few other options include: Boardmaker SD Pro ($749), Say it Sam($1395), Speech Pro ($895).

Step 3: Customization
This often-overlooked step is critical to creating a functional communication device. Many users expect to simply open a box have a complete device immediately. Although the simplicity and ease-of-use of many of the software programs on the market today has come a long way, customizing the setup to the specific user’s needs is essential. It is absolutely vital that customizing an augmentative communication device be done in coordination with a speech-language pathologist or other communication professional. A speech pathologist can offer valuable insight into organization and categorization of picture symbols for ease-of-access and over functionality.

Some of the questions that need to be answered are:

How many picture buttons should be on each page?
Does the user need enhanced visual or auditory feedback?
Can the user navigate through multiple menus/pages?
Is expressive syntax/sentence formulation a reasonable goal?
What specific types of items will the user be requesting?

This is only a sampling of some of the considerations that need to be taken into account, but they are some of the more relevant questions.

Although this is not intended to be a comprehensive guide to devices and such, there is not a whole lot else to know when creating your own communication device. There are a multitude of hardware options available, but pretty much any touchscreen tablet PC will get the job done well. Building an augmentative communication is not the most difficult task in the world, but there are some very important things to consider when doing it yourself. The information above will help you to select a device that appropriate for your needs.

We have seen an amazing slew of dirt-cheap Android-OS tablets come out this year, but the Windows tablet market has been a bit slower in hitting the mainstream. It looks like many manufacturers are banking on holiday shopping to get their products out. What we are seeing this generation of tablets is more capacitive screens, built-in accelerometers and bigger solid state drives. With AAC software programs like Simple Speech, one can create a very cool communication device on the cheap. Check out the following Windows tablet PC's that would make fantastic AAC devices.

ExoPC Slate - This Windows 7 touchscreen only device was just recently released in Canada and Portugal, and hopefully the US soon. The ExoPC has got an 11.6" capacitive screen, wifi, mic and headphone jacks, SD card slot, stereo speakers. One cool feature of this touchscreen device is that it has an accelerometer, so you can rotate the device to your heart's content. The ExoPC has a 1.66GHz Intel Atom N450 processor, 2GB RAM with a 32GB or 64GB solid state drive.

CTL 2goPad SL10 - This little Windows 7 tablet sports a 10" screen, a 1.66Ghz Intel Atom processor, a 250GB hard drive, 2GB of RAM, speakers, built-in mic, etc... Being that this little tablet is only a 10", we can expect a reduction in weight (weighing in around 2.5lbs). Battery life is around 5 hours, as reported by the manufacturer. Again, we have a the nice feature of having an on-board accelerometer. I like this trend.

Nav 9 - The Nav 9 is slate PC with some interesting features. With an 8.9" resistive touchscreen, this is the smallest tablet featured here. The Nav 9 features an Intel Atom 1.66Ghz processor, and a 1-2GB of RAM. The storage comes in three flavors, 16, 32, and 64GB. This tablet weighs in around 2lbs.

TegaV2 - The TegaV2 is a very interesting tablet PC that I have been anticipating for quite awhile now. This tablet has a 10" capacitive touch screen. It has recently been released for around $799, and poses itself as a direct competitor to the iPad (check out this comparison chart on the Tega website). While the Tega V2 sports pretty much the same specs as the other tablets, Tega has modified the software a bit in order to make the Windows 7 touch experience a bit more user friendly.

This is not a comprehensive list, and I expect quite a few more Windows 7 Tablet offerings in the coming months and years. One of the reasons that I like having Windows on my tablets, as opposed to a simpler OS, is that I like having the ability to use my tablet as a creative tool and not just a media consumption tool. The lack of physical keyboards may deter some users, but having a well-integrated on-screen keyboard is a huge plus. And as far as AAC goes, we have been surviving without physical keyboards for a long time, so many of use are already used to it.