This Case Study Highlights That MND Is a Complex Illness

Case Study: The involvement of different professionals in enabling Susan to use a high tech communication aid.

Abstract:

This case study highlights that MND is a complex illness and requires the input of many different professionals to address the issues experienced by individual patients. The case study also identifies that different types of AAC will be useful for patients at different stages of the disease and in different communication environments.

Presentation:

Susan was diagnosed with MND after a 6 month history of progressive dysarthria (speech problems) and dysphagia (swallowing problems). She began to rely more on writing to communicate and used a small whiteboard and marker pen to write messages. Her speech continued to deteriorate and at the same time she developed muscle weakness in her arms and legs meaning that she soon became dependent on a wheelchair and could no longer grip a pen. She also started to develop weakness in her neck muscles.

The speech and language therapist (SLT) introduced alphabet boards as Susan was able to point to letters. Susan became frustrated with this style of communication because he found it took a long time to get her message across and she was heavily reliant on the attention and concentration skills of her communication partner. However, when trialling a Lightwriter, Susan found it difficult to press the buttons effectively. He also found that he had difficulty maintaining her gaze and focusing on the communication aid as her head would drop due to neck muscle weakness.

A switch was introduced with a scanning Lightwriter so that the light touch of Susan’s finger would register her choice of letter and enable her to communicate with a scanning system. The SLT enlisted the input of an occupational therapist as the communication aid and the switch needed to be placed securely within Susan’s reach and be in a comfortable position to use whilst Susan was in her wheelchair. A physiotherapist assessed Susan’s neck muscle weakness and provided a collar to enable Susan to maintain a good head position so that she could easily view and focus on his communication aid, even when using it for a prolonged period.

Susan was able to use the Lightwriter effectively when both it and the switch were mounted properly on her wheelchair and she was wearing his neck collar. She preferred this method of communication to the alphabet board as she found it easier to control the switch than to point to different letters and she made use of programming in her own set phrases. However, she also found that when she was alone at home with only her husband, they could often communicate effectively by using a simple eye blinking system for yes and no along with Susan’s limited facial expressions. Susan continued to use the Lightwriter with carers, healthcare professionals, friends and for conveying complex messages.

Discussion:

This example is common in working with people with MND. The problem solving approach of the multidisciplinary team was necessary to provide Susan with a suitable communication system. This example does highlight though that people will require more than one method of alternative communication depending on who the communication partner is and the context and content of communication as well as personal preference.