Finding Her Voice

Allison
Eatough
February 1, 2006
Assistive Technology Clinic Enhances Communication for Those in Need

Maggie PietMost 18-year-old girls love to talk. Maggie Piet is no exception. She just uses modern technology to do so.

Maggie lost her ability to speak four years ago when she suffered a traumatic brain injury during a serious car accident. After four months in a coma, Maggie began rehabilitation at Kennedy Krieger Institute. It was a slow process, but through intense occupational, speech, and physical therapy, she began to smile, nod, and point again. Still, she could not speak.

Nancy Inman, M.A.T., CCC-SLP, manager of Kennedy Krieger's Assistive Technology Clinic, visited Maggie during one of her rehabilitation appointments to see if she could help.

Along with Inman, the Assistive Technology Clinic features a team of speech, occupational, and physical therapists who work with rehabilitation technology vendors to help clients improve their ability to communicate. The clinic focuses on three areas: augmentative communication, computer access, and power mobility.

Augmentative communication uses tools to facilitate communication for clients who cannot speak. Computer access relies on special software and keyboards to help clients who have difficulty accessing computers in the traditional way, including those ranging from subtle learning disabilities to spinal cord injuries. Power mobility uses equipment, such as power wheelchairs, to help clients with movement challenges.

Some clients, like Maggie, benefit from all three areas, notes Inman. "More than 50 percent of clients have team appointments, meaning they work with more than one therapist," she says. The clinic meets with 12 to 20 clients each week, and its staff members can follow clients for years.

Inman began working with Maggie in November 2003. Like most clients, Maggie underwent in-depth assessments with Assistive Technology Clinic staff to determine the best course of action.

Initially, Maggie used flip boards, with photos and simple phrases like "Hello," "I want," and the alphabet to augment her communication. The boards were attached to Maggie's wheelchair, and she would point to the phrases as needed. Within weeks, Maggie was spelling words and sentences. She was ready for a new challenge. "Maggie was a good speller before the accident," says her mom, Gail Piet. "She's determined and she's always been stubborn."

In Spring 2004, Inman and her clinic colleagues reassessed Maggie's progress and her physical condition. They needed to find a device that would work with Maggie's right hand, which still shakes occasionally as a result of the accident.

The Pathfinder a voice output device that features a keyboard with letters, words, and a dynamic color display seemed like a perfect fit. The device is mounted on Maggie's power wheelchair, which she also acquired in consultation with the Assistive Technology Clinic.

With her Pathfinder, Maggie can generate her thoughts using her hand. The device uses WordPower, software that maintains a vocabulary based on high frequency words, spelling, and word prediction. The Pathfinder then vocalizes the terms for her with a female voice that Maggie selected. She can even use the Pathfinder as a journal, documenting and storing her thoughts whenever she wants.

"It's definitely given Maggie her voice back," her mother says. "The Pathfinder's the best," adds Maggie, through the device. "I love it."

Inman, who has worked at the clinic for more than eight years, says she enjoys matching individual clients' needs with the right devices. "I love this field because it's very challenging," Inman admits. "I like the technical side of it. And I find it very gratifying to open up the world of communication to people who can't speak."

Inman stresses that while the clinic works with occupational, speech, and physical therapists, clinic staff do not make diagnoses. "We're just coming in to see where we can help," she says. In addition to technical expertise, clinic professionals often work with clients and their insurance providers to access funding for necessary equipment.

Maggie's recovery hasn't been easy. She still has trouble speaking and has lingering nerve damage in her left eye. But her power wheelchair allows her to keep up with her dog and three brothers, and her Pathfinder has reopened her world of communication. In fact, her progress through the Assistive Technology Clinic seems to motivate her more every day.

"We're great Kennedy Krieger fans," Gail Piet explains. "They've helped us all the way through this. Maggie's train of thought is, Now that this has happened to me, how can I help others?' She wants to walk again, and she is determined. She'd be glad to give her wheelchair to someone else who needs it."

The next step for the Assistive Technology Clinic and Maggie? Adapting Maggie's Pathfinder so she can have phone conversations with family and friends.

After all, teenage girls love to talk especially on the phone.