Software developers at the CHI Centers, based in Silver Spring, MD, have introduced 1-2-3 Speak©, a customizable program that allows people who are nonverbal or unintelligible to communicate. CHI Centers is an organization serving individuals with a variety of disabilities in employment, vocational training, and residential, therapeutic and recreational services
Harold Blank, DDS, a board member at the private, nonprofit organization, which works to promote self-reliance and independence in people with developmental disabilities, began developing software in the early 1980s to enable his son, who has cerebral palsy and is nonverbal, to communicate. The idea for the software came to him while he was at McDonald's, where the cashier pressed a button with a picture of the customer's desired food item to place an order. He created a similar program that allowed his son to communicate his needs for everyday items.
"We saw big differences in his ability to get along and do everyday things," Dr. Blank told ADVANCE. Though the program was limited to home or school, "it was a first step."
After seeing the positive effects of the software program on his son's communication abilities, Dr. Blank decided to expand the program to aid the rest of the CHI Centers population of nonverbal individuals.
"It's amazing that it's just accepted they don't speak," he said.
"The notion that you can go your whole life without ever .being able to communicate your wishes or thoughts is mind- .boggling," said Susan Levine, MA, CCC-SLP, who works at CHI Centers via Rehabilitation Services Inc. and served as a consultant during the development of the software. "We want whoever needs this software program to have it."
CHI Centers serves adults with disabilities age 21 and over, a population with many and varied needs, according to Dr. Blank. As their parents age, individuals with developmental disabilities often reside in group homes. While their parents knew what they wanted, when and where, facilities have a difficult time because their new clients never learned to sign.
"They have no real communication," he explained.
Taking advantage of current technological advances, he began to work with multimedia designer Sonha Son Mason to build a program that addressed the specific needs of the CHI population. The result was a grid of 16-by-16-by-16, with more than 4,000 possible words or phrases separated into 16 illustrated categories of 16 groups containing 16 items.
"The content basically covers everyday life, from food and clothing to health and body parts," Son Mason explained. Areas such as school and family life and personal hobbies also are included. Thousands of additional icons, words and phrases can be stored in the database, allowing for a full selection of language.
The first program was designed to meet the needs of Patty, a CHI client with cerebral palsy. Her software is accessible through a wheelchair-mounted monitor. The hardware is plugged into her wheelchair battery. Patty recently began classes at a community college, and her software is designed specifically to cater to her classroom needs.
"When Patty goes to school, she can choose from a lot of options that relate to 'I don't understand,' 'Can you repeat that for me?' and 'What is the homework assignment?' These are relatively important things that we just take for granted," Dr. Blank said.
The software can be customized to meet the specific vocabulary needs of the individual. The voice, word, phrase, category order, group, item on the screen, and which icons appear on screen can be selected by or for the client utilizing a simple set-up program. The software can be utilized on a touch-screen laptop, pen-tablet, standard computer and a wheelchair-mounted touch-screen computer, all operating on Microsoft® Windows®.
More specific software gives clients a greater communicative advantage, Dr. Blank said.
"In 1985 I went to Japan. Before I went I bought a book of 100 phrases. If I learned those 100 phrases, I was told, I could get by," he said. "I didn't learn 100 phrases, unfortunately, but it's amazing that if you learn 100 English phrases, you can get by. You can find something to eat and transportation; and as you get more, the conversation can be more exacting."
"The goal of the software is to figure out what it is individuals need," said Levine.
Some clients may not have the dexterity to use the traditional software set-up, where icons are spread across the screen, and may only be able to grab the side of the screen; so the icons are arranged in the corners or wherever their dexterity allows them to access.
"You have to look at your client," Dr. Blank emphasized. "We have no problem saying, 'There are too many icons.' We can redo the software and have fewer or more icons on any given screen."
More icons and verbiage also may be added to address the needs of the stroke population, who may have the same communication challenges but more dexterity.
The software program boosts clients' self-reliance, Son Mason said. "They gain confidence because they feel they have back-up if they want to communicate."
When implementing the software with CHI Centers clients, Dr. Blank said, three fundamental issues are addressed: intellectual challenges, physical disability, and a lack of ambition to try to communicate due to age.
"The hardest thing for Susan, as a speech therapist, is to have to go to somebody and motivate them to want to communicate," said Dr. Blank. "That's a really big issue."
Motivating clients is challenging, Levine acknowledged, but some overcome this issue by responding well to the software during speech therapy sessions at CHI. Clients often feel empowered to communicate more because of the program.
"When some of the people in speech therapy who don't talk much start to use these devices, they actually begin to talk more; so it actually has a positive impact on their verbalizing as well," she said. "That's been a nice added bonus."
However, it can be challenging to educate families about the benefits of the software, Levine said, because many families and caregivers are not completely comfortable with technology.
In addition, "they're not used to having their loved ones communicate that much," she said. "They may think it's great that their child is using the device in speech therapy, but the biggest part is getting them to want their son or daughter to actually have it all the time."
Levine tries to introduce the software to clients as part of their therapy sessions, especially if they are nonverbal.
"Nonverbal individuals actually are good candidates because they suddenly realize that speech comes out when they touch an icon and they can communicate," she said. "As soon as you see somebody get turned on by being able to do that, they are good candidates."
To further encourage students to use the software, Levine often asks family members or friends to record their voices to be used on the program.
Another component that is available to supplement the software is a simple word processor, which can be connected to a printer in class or at home so the user can print a typed message or school assignment. A basic calculator and a money calculator also can be used in a grocery store or other setting.
Because 1-2-3 Speak was developed using grant money, CHI Centers clients have unlimited use of the software. The software is available to others for a fee, which is used to fund its continued development.
"We need to be able to sell some in order to keep developing some of the ideas we have, such as using it for individuals with other neurological disabilities such as aphasia and apraxia," Dr. Blank stated.
The price of the basic software package is $695. Auxiliary software available for purchase is a digital calculator, a digital keyboard and a digital money calculator. People can buy one auxiliary item for $19.95, two for $33.95, or all three for $49.95. The software also is available preloaded on a ViewSonic® PC V1100 PenTablet for $2,795 or on a Stealth wheelchair-mountable computer system for $4,945.
A text-to-speech version of the software utilizing advanced speech synthesis technology from Microsoft will be available this summer.
For More Information
1-2-3 Speak, online: www.1-2-3Speak.com
Harold Blank, DDS, e-mail: hblank@CHICenters.org
CHI Centers, online: www.chicenters.org
Susan Levine, e-mail: firstname.lastname@example.org
Sonha Son Mason, e-mail: 123speak@CHICenters.org
Alyssa Banotai is an Editorial Assistant at ADVANCE. She can be reached at email@example.com.