Appropriateness and Impact of a Vocal Cord Vibration Switch for Children with Complex Communication Needs: Case Series.

Background: 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 and adolescents. However, implementation of a vocal cord vibration switch with younger, school-aged 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" (Holland Bloorview) with school-aged children who have complex communication needs and their mothers and teachers, using an individualized, collaborative, and iterative assistive device implementation protocol. Methods: The Hummingbird was evaluated with 3 school-aged children, across educational and health-related contexts, over a 2-year period. Baseline, midterm, and final assessments took place at home or school 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 mothers and teachers was collected via questionnaires (Pictorial Children's Effort Rating Table, Quebec User Evaluation of Satisfaction with Assistive Technology, and the Family Impact of Assistive Technology Scale) to ascertain the Hummingbird's appropriateness and its impact. Results: Appropriateness data indicated the suitability of the Hummingbird across settings. Compared to the child's prestudy devices, mother and teacher participants reported that the physical effort required by all 3 children to use the Hummingbird was lower (scores on the Pictorial Effort Rating Table decreased from 8 and 11 to scores of 4-6). The switch efficacy assessment of the Hummingbird indicated moderate-to-high specificity and high sensitivity at midterm and high sensitivity (0.91-0.94) and specificity (0.92-1) at final assessments. Total satisfaction scores increased from baseline (prestudy device) to the 2-year assessment for all 3 children. While data on the impact on family and communication were incomplete for 1 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 (eg, 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). Conclusions: Overall, the Hummingbird was appropriate across home and school settings for our case study participants, all of whom had complex communication needs. The device was well-received by children and their mothers or 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.