Case Study: Transdisciplinary approach to keep Rupert at work.
Abstract:
This study illustrates how effective transdisciplinary collaboration (speech and
language therapy and occupational therapy) facilitated a person’s wish to
maintain a contribution at their place of work despite the progression of his
MND and related disabilities. The study indicates the importance
of patient-led intervention, knowledge of which serving disciplines may be
best placed to lead our response, and the need for technology, on occasions,
to be immediately available.
Presentation:
Rupert was referred to a specialist AAC/assistive technology centre some months subsequent to receiving his formal diagnosis of MND. He was 42 years old. He presented with a progressive dysarthria (speech problem) affecting intelligibility, and other loss of function associated with MND. For some years, he had occupied a senior post in a firm of city accountants. Rupert thoroughly enjoyed his work, and he wished to continue his professional career for as long as possible.
At home, Rupert used an eye-transfer or E-Tran frame to clarify his speech. At work, he used no formal means of achieving the same, but reported that this was not his primary concern. More significant for Rupert was that he was no longer able to write using pen and paper, and his keyboard skills were deteriorating. Because of this, he was unable to maintain a contribution to various tasks involving data entry on the computer (a requirement essential to his role).
Rupert and his partner were emphatic that, despite difficulties with speech, their communication was satisfactory in functional terms. As such, the team at the centre focussed upon devising a solution to Rupert’s expressed priority: keeping him productive. This need necessitated a move towards an emphasis upon facilitating Rupert’s ability to operate the computer (i.e. operational competence) within the context of rapidly deteriorating motor ability. As such, the OT on the team at the centre led a transdisciplinary effort to meet Rupert’s needs. Alternatives to the keyboard were trialled, including a range of manually operated switches, and a head operated mouse. None of the above was satisfactory, as their use not only precipitated fatigue, but were very slow as a means of access. Eventually, Rupert experimented with an eye-gaze system, the MyTobii C-15. This system liberated Rupert’s use of the computer. Although he reported fatigue after lengthy sessions on the system, he found that the gain in terms of direct selection through gaze, and the productivity that it subsequently enabled, was a worthwhile compromise.
Significantly, as Rupert’s knowledge of the Tobii system grew, he began to use the voice output and prediction functionality available with Communicator 4, software supplied with the device primarily to augment communication. He continued to use the Ettran in some situations, primarily those involving his partner at home. However, at work he used the voice output attribute of the Tobii with increasing effectiveness.
Discussion
Rupert’s priorities were not those which the team at the centre anticipated. However, by ensuring that Rupert led the intervention, his preferences were met by a system that by default enabled more effective interpersonal communication concurrent with his professional role operationally. This was possible because professionals within the team were able to employ a transdisciplinary approach to Rupert’s needs, and because access to the technology required was immediate. Once the type of technology that Rupert needed had been provided, and according to his stated priorities, he was happy to consider the additional benefits such technology might offer (i.e. voice output). People learn most effectively at their own speed, and manage their needs best according to their own, familiar priorities.