JMIR Publications

ABSTRACT

Background:

Ensuring participation in all facets of life for children who have complex disabilities requires parity with others in terms of opportunity and engagement. As communication is an essential component of participation, communication impairment restricts full participation for children who have unintelligible speech. A vocal cord vibration switch offers an avenue for meaningful interaction to children who cannot rely on speech or voluntary limb movement but have some control of their vocal cords. Previous evaluations of the vocal cord vibration switch have been conducted primarily with adults, youth, and older children. However, implementation of a vocal cord vibration switch with younger children in their natural environmental contexts can potentially foster the development of early communication skills.

Objective:

This case series evaluated the appropriateness and impact of a vocal cord vibration switch, the “Hummingbird” with school-aged children who have complex communication needs and their parents and teachers, using an individualized, collaborative and iterative assistive device implementation protocol.

Methods:

The Hummingbird was evaluated with three school-aged children, across educational and health-related contexts, over a two-year period. Baseline, midterm and final assessments took place at home, school, or hospital in the first year with a follow-up assessment in the second year. In addition to field observations and device performance assessments by the research team, feedback from parents and teachers was collected via questionnaires to ascertain the Hummingbird’s appropriateness and its impact.

Results:

Appropriateness data indicated suitability of the Hummingbird across settings. Compared to the child’s pre-study devices parent- and teacher-participants reported that the physical effort required by all three children to use the Hummingbird was lower. The switch efficacy assessment of the Hummingbird indicated moderate to high specificity and high sensitivity at midterm and high sensitivity and specificity at final assessments. Total caregiver satisfaction scores increased from baseline (pre-study device) to the two-year assessment for all three children. While data on the impact on family and communication were incomplete for one participant, generally favorable effects were reported. The field notes underscored the value of an individualized protocol, where the implementation and evaluation phases were adapted to accommodate the health-related characteristics (e.g. seizure disorder and sleep deprivation), evolving school contextual factors (new school and teacher) and unique family environments (involving the child-participant’s toddler-sibling in Hummingbird sessions) of the children and their caregivers.

Conclusions:

Overall, the Hummingbird was appropriate across home, school and hospital settings for our case study participants, all of whom had complex communication needs. The device was well received by children and their caregivers/teachers, providing an effective, setting-agnostic option for communication support. Modifications to both the device and its implementation process were required to address unanticipated health, family, and school challenges. Future studies should consider a more expansive set of impact measures in light of these real-world circumstances.