New and emerging access technologies for adults with complex communication needs and severe motor impairments: State of the science.
Susan Koch Fager, Melanie Fried-Oken, Tom Jakobs and 1 others
PMID 30663899WHAT IT FOUND
For adults with severe motor impairments, new AAC access tools may reduce positioning, fatigue, or typing effort in reported cases, but evidence is too preliminary to show they work.
Key findings
01In a study of 39 individuals with ALS, 14 participants became home users of a BCI system and seven chose to continue using the system after the 18-month study ended.
02In the single-subject comparison, the participant averaged 63% first attempt accuracy with eye tracking alone and 91% with multi-input, and averaged eight errors per sentence with eye tracking alone and two errors per sentence with multi-input.
03Five literate adults tested Smart Predict; one participant reduced selections per word by 12% and another participant reduced selections per word by 21%, while three other participants did not demonstrate significant efficiency savings.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The paper is a review and case illustration report, not a controlled clinical trial. Most technologies are prototypes, and some have not been tested by adults with severe motor impairments as AAC access methods. Several positive results come from one participant or a very small group, so they cannot show that a technology works. Some studies included only people without disabilities, so their findings may not apply to clients with severe motor impairments. BCI use remains limited by long calibration and training, unreliable signals, and unmeasured cognitive demands. The paper excludes children and does not address learning, cognition, or language development. Smart Predict results were equivocal because of the motor demands of typing.
Declared interests
The supplied text does not include a conflicts-of-interest declaration. The article metadata lists NIH extramural and U.S. government non-PHS research support.
The easy way to misread this
Do not read the 91% accuracy result as evidence that multi-input access works for your patients. It came from one participant, and the paper says more research with individuals who have severe motor impairments is needed.