Evaluation for Speech Generating Device (for Medicare)

SPEECH-LANGUAGE PATHOLOGY EVALUATION FOR SPEECH GENERATING DEVICE (SGD)

 

 

II. CURRENT COMMUNICATION IMPAIRMENT

 

Impairment Type, Severity

                                    

The patient presents with   due to      .      

      Given the severity of the communication impairment as described above the patient is functionally nonspeaking.

      As indicated above, the patient’s speaking rate was       words per minute (WPM). Research on speaking rate and intelligibility in degenerative diseases has found speaking rates less than or equal to 50% of normal (range 190 – 220 WPM) are predictive of imminent precipitous decline (e.g., to the point of no usable speech in less than 3 months) in speech intelligibility.

 

Anticipated Course of Impairment

The patient’s condition is  in nature and  is expected to . Therefore it is anticipated that the patient’s natural speech will not be sufficient to meet daily communication needs for

Comprehensive Assessment

 

Hearing Status

The patient has  of hearing impairment. The patient’s  has  of hearing impairment. Informal observation of functional listening performance during the SGD assessment revealed the patient and/or caregiver required the following modifications regarding auditory output to use a SGD effectively. 

Modification

Patient Caregiver
No modifications    
Headphones    
Use of dual visual display to read messages    
Specific speech output options.          
         

With modifications as listed above, the patient demonstrates adequate hearing ability to use a SGD to communicate functionally.

 

Visual Status

The patient has a history of . The patient’s  has a history of . Informal observation of functional visual performance during the SGD assessment revealed the patient and/or caregiver required the following modifications to use a SGD effectively given current vision status.

Modification

Patient Caregiver
No modifications    
Font size used on SGD display and/or symbol labels (“gloss”) should be:           
Picture-symbols and/or icons should be the following size:           
A flat display is required to reduce visual tracking requirements(e.g., need to alternate focus between keyboard and display to monitor selections)    
Color contrasts are needed to enhance text or symbol discrimination such as:          
Number of items per display should be:          
Auditory feedback from device is needed to assist in message preparation/selection.    
         

With modifications as listed above, the patient demonstrates the visual abilities to use a SGD to communicate functionally.

Physical Status

The patient was able to successfully access SGDs presented at the evaluation with the following selection technique/modifications.

Students – When the report asks for Additional Information and you have checked the box you must provide justifications and information about trials you did with the client. I.E. The client requires manual direct selection on a communication device. The client demonstrated the skill to directly select keys on the XXX device, the XXX device and the XXX device. The client was 90% accurate with this method and it is anticipated that the client will develop 100% accuracy skills within 4 weeks of obtaining a device.

Check

Selection Technique

Type

Additional Information

  Manual direct selection        
  Optical Direct Selection            
  High Tech Eye Gaze Direct Selection            
  Scanning ,      
  Morse Code        
  Requires access modifications over time due to degenerative condition            

The patient uses  for mobility. Therefore, a wheelchair mounting system  to transport the patient’s SGD.

With the above modifications/considerations, the patient possesses the physical abilities to effectively use a SGD and required accessories to communicate.

 

Language Skills

The patient presents with  impairment in language functioning as it relates to using an appropriate SGD. Based on patient report and observation of the patient’s language and literacy skills during the evaluation, the patient possesses the following skills/abilities.

Students – When the report asks for Additional Information you must provide justifications and information about trials you did with the client. I.E. The client was able to follow general conversation within the context of the evaluation. The client looked to the speaker, comprehended conversation, and responded to conversation approproiately. OR The client was unable to read materials presented during the evaluation. The client was asked to decode words and phrases using the XXX. The client was only 10% accurate in completing this task.

Skill/Ability

Mastery Additional Information
Follows simple instructions (e.g., “Look at me.” “Turn your head.” “Open your mouth.”)    
Follows complex instructions    
Follows general conversation    
Reads/comprehends common words    
Reads/comprehends simple sentences    
Reads comprehends short paragraphs    
Reads the newspaper    
Spells common words    
Generates basic messages using writing/spelling skills    
Generates complex messages using writing/spelling skills    
Generates basic messages by using pictographic symbols    
Generates complex messages using pictographic symbols    
Generates messages using generative symbols (e.g., MinSpeak™)    

Given the patient’s language/literacy functioning, a SGD that provides message production using  will be required. Following  instruction, the patient demonstrated the linguistic capacity to generate  messages on an SGD with.      

The patient’s linguistic performance with the SGDs presented during the evaluation indicated the necessary language skills to functionally communicate using a SGD.

Cognitive Skills

The patient presents with  impairment in cognitive functioning as it relates to ability to use an appropriate SGD.       The patient’s attention, memory and problem solving skills observed during the evaluation appeared functional to learn to use a SGD successfully. For example, during the  assessment/training trials, the patient demonstrated independence or progress in mastering the following SGD features.

Again please provide additional information!!!

Feature

Mastery

Additional Information

Turns SGD on and off                                                                       
Navigates within and between display pages on a dynamic display SGD    
Uses dictionary features to locate vocabulary not available on pre-programmed displays    
Uses word-prediction    
Retrieves messages stored under letter codes or symbol codes    
Stores messages under letter codes    
Stores messages under picture symbols    
Learns icon-code sequences to retrieve words on SGD (e.g., Unity™ Core)     
Navigates within SGD “Menu” options to modify device options (e.g., voice, scan rate, feedback).    

The patient demonstrates the necessary cognitive abilities (i.e., attention, memory, and problem-solving) skills to learn to use a SGD to achieve functional communication goals.          

III. DAILY COMMUNICATION NEEDS

Specific Daily Functional Communication Needs

The results of a communication needs interview conducted with the patient, relevant family members and caregivers revealed the following communication needs.

Communicative Activity. Communication to:

Communication Partner(s)

Communicative Environment(s)

Is Need Met with Natural Speech and/or Low Tech?

Express basic physical needs/wants. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
Express needs/wants in emergences. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger                  home                      medical facility        community              support group         work/school               telephone yes noNA
Express detailed physical needs/wants. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
Participate in decision-making (e.g., discuss choices for end-of-life care). spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone        yes noNA
Participate in conversation. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
Tell personal stories and anecdotes. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
Report medical status and complaints. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
Ask questions. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
Give responses. spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
      spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired      visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA
      spouse                    immediate family    extended family      friends                     healthcare provider non-reader              hearing impaired     visually impaired     stranger home                      medical facility        community              support group         work/school               telephone yes noNA

Ability to Meet Communication Needs With Non-SGD Treatment Approaches

Speech therapy to improve/increase functional speech is not a viable option to meet the patient’s communication needs because:

      The patient’s has a degenerative condition for which speech/language therapy is not effective.

      The patient received speech/language treatment for       with no significant changes in speech/language functioning.

      The patient’s speech/language functioning has been static for       and no improvement is expected.

The results of the communication needs assessment as documented in the previous section indicate the majority of patient’s daily functional communication needs cannot be met with natural speech and/or low tech communication devices. Therefore the patient requires a SGD to achieve and/or maintain functional communication ability in activities of daily living.

IV. FUNCTIONAL COMMUNICATION GOALS

The patient’s immediate, short term and long term goals and estimated times to completion following receipt of the recommended SGD are listed below.

Functional Communication Goals                                                        Patient will use SGD independently to:  Immediate Short Term Long Term
Call for help from a spouse/caregiver in another room in emergency.      
Contact a family member, friend or public agency for help on the telephone in emergency.      
Communicate physical needs and emotional status to spouse/caregiver on a daily basis, as needed.      
Describe physical symptoms and ask any questions when interacting with physician and other health care professionals as needed.      
Engage in social communication exchanges with immediate family members in person.      
Engage in social communication exchanges with extended family members and friends by use of the telephone.      
Engage in social communication exchanges with friends at their homes and in other community settings.      
Use the telephone to make contact friends and extended family to interact socially.      
Ask questions and provide responses in community-based transactions (e.g., ordering a meal in a restaurant, asking directions, etc.)      
Instruct caregivers on the care requirements (e.g., transfers, bathing, moving from wheelchair to the car.)      
Participate in family planning decisions (e.g., household management, finances, childrearing, etc.)      
Participate in support groups.      
           
           
           

V. RATIONALE FOR DEVICE SELECTION

This individual requires a speech generating device with the following features to meet functional communication goals as stated in the previous section of this report.

Input Features/ Selection Technique

Check

Selection Technique

Type

Rationale

  Manual direct selection        
  Optical Direct Selection            
  High Tech Eye Gaze Direct Selection            
  Scanning ,      
  Morse Code        
  Provides multiple access technique options  to accommodate changing physical condition            
  Keyboard            
  Dynamic display            
                   

Message Characteristics/Features

Check

Characteristic or Feature

Rationale

  Message generation using spelling      
  Message generation using a combination of pre-programmed whole words and spelling      
  Message generation using pictographic symbols (e.g., PCS, Dynasyms, custom symbols)      
  Message generation using multi-meaning icon coding (e.g., MinSpeak™)      
  Message selection using photographs and/or tangible symbols      
  Ability to adjust font/symbol size to accommodate visual needs      
  Flat display to reduce visual tracking requirements      
  Ability to adjust color and contrasts to accommodate visual or cognitive needs      
  Ability to adjust number of items per display to accommodate visual, physical and/or cognitive needs      
  Ability to store/edit/retrieve whole messages under word/symbol buttons      
  Ability to store/edit/retrieve narrative messages (e.g., stories, reports, speeches) from message files      
  Provides word/symbol prediction rate acceleration techniques      
  Provides abbreviation expansion (letter coding) rate acceleration techniques      
             
             
             

Output Features

Check

Feature or Option

Specifications if Applicable

Rationale

  Synthesized speech       Essential for:                             message generation using spelling                                     telephone                              non-reading partners             visually impaired partners                             
  Digitized speech   Essential for:                             telephone                              non-reading partners             visually impaired partners                              
  User display size        
  Dual display (user/listener)       Essential for:                             hearing impaired partners               noisy environments
  Auditory feedback from device to assist in message preparation/selection        
                   

Other Features

Check

Feature or Option

Specifications if applicable

Rationale

  Wheelchair mounting System            
  Small/lightweight for carrying by user            
  Length of use after battery charged            
  Display viewable in direct sunlight            
                   

Recommended Speech Generating Device Code

Based on the patient’s communication needs and considering the patient’s visual, hearing, physical, language and cognitive status as well as specified features as described in this report, SGDs in the  Medicare/CPT code category were evaluated to determine the most appropriate SGD to meet the patient’s functional communication goals. 

Equipment and Procedures Used in Assessment

 

Speech Generating Devices and Accessories Evaluated

The following SGDs and accessories were presented for evaluation.      

Procedures Used in SGD Trials

To assess the patient’s ability to use the selected SGDs the following procedures were used.      

 

Outcome of SGD Trials

For the following reasons the       was selected as the most appropriate SGD for the patient.       The other SGDs evaluated were ruled out for the following reasons.      

 

Speech Generating Device and Accessories Recommended

The individual’s ability to achieve functional communication goals requires the acquisition and use of the SGD, mounting/carrying devices and accessories listed below. This SGD represents the clinically most appropriate device for (     ).

SGD, Mounting System, or Accessory

Medicare/CPT Code

Manufacturer/Vendor

             
             
             
             
             
             

      Important: Contact family for specifications regarding tubing size for wheelchair mounting system.

Patient/Family Support of Speech Generating Device

The patient’s  was present at the evaluation. The  was supportive of the patient using the SGD and agreed to the necessity of the SGD for meeting the patient’s communicative needs in activities of daily living.

Physician Involvement Statement

This report was forwarded to the treating physician       on      .  The physician was asked to write a prescription for the recommended SGD and accessories.

VI. TREATMENT PLAN

Following receipt of the recommended SGD and accessories, it is recommended the patient receive       of treatment sessions addressing the acquisition of the functional communication goals described in part IV of this report. The patient’s family and/or primary caregivers are encouraged to participate in the treatment sessions so they may learn to assist the patient in the use of the SGD as needed. The patient’s treatment goals would best be met in  setting. Following discharge from treatment, the patient will be reevaluated as needed (at the request of the patient, physician, or family) to determine the need for updates/modifications of the SGD.

VII. SLP ASSURANCE OF FINANCIAL INDEPENDENCE AND SIGNATURE

The Speech-Language Pathologist performing this evaluation is not an employee of and does not have a financial relationship with the supplier of any SGD.

Evaluating SLP name:      
ASHA Certification #:      
State License #:      
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