A diagram showing four circles surrounding a central circle. The outer ones have the words switch, AAC, seating and controls written in them and the central circle has the word mount.

The drive for a holistic approach to mounting communication equipment.

THE JOURNAL OF COMMUNICATION MATTERS / ISAAC (UK)| journal-article ISSN: 0969-9554

by Esther Dakin-Poole and Billy Hunter of Smile Smart Technology.

Talk given at Communication Matters Conference, Leeds University, Sept. 2016

Abstract

Collaboration between professionals to provide effective mounting is essential to establishing maximum capacity for user independence.

This article will emphasise the ‘nexus’ quality of mounting and its now pivotal role in the growing interdisciplinary world of contemporary assistive technology.

Introduction

The progress in technological advancement and complex provision makes the need for a coordinated approach to mounting increasingly crucial. Whether using mounted devices for teaching, access or environment the fundamental tenet of today’s mounting theory must be to enable the greatest access, with the least encroachment upon the natural movement of the individual. Product advancements now require greater communication between practitioner teams to fully support users through effective installation.

In this article we encourage the move to using the most discreet mounting options available, with the practice of ‘minimal mounting’. We champion the notion of ‘NEAT, DISCREET & PRACTICAL’.

Product

The move to lighter weight mounting systems as pioneered by the German manufacturer, Rehadapt has led the way to enabling ‘more amenable’ optimizations of function. Initially brought into the UK in early 2009 by Smile Rehab, now Smile Smart Technology, the Rehadapt mounting systems are lighter weight than those previously available on the market and highly versatile. This range allows the mounting of a wide range of products, from a sizable Tobii I-15 down to the delicacy of a mo-Vis joystick with the least encroachment upon natural movement.

Prior to the advent of Rehadapt’s emergence into the UK market, the dominance of the Daessy mounting system had been borne out of its superb sturdiness and robust nature, which it continues to provide today.

Another strong line is Mount ‘n’ Mover from the USA. A highly sophisticated mounting system for electronic devices that allows for considerable customization and has compatible adapter plates to work with existing Daessy hardware. These are a strong product for those requiring particularly high levels of position provision.

 ‘Minimal mounting’ is arguably driven by the natural response to developments in lighter-weight and streamlined AAC devices.  The extraordinary advances that now allow access to communication through technology as diminutive as iPhones, can transform lives, if mounted correctly. The incentive to use the Rehadapt system in these cases is two-fold, as there is minimal mount to impinge upon movement or sight, and its versatility allows for accurate adjustment without excessive weight or metalwork to surround a small sleek object. Where larger devices are used, the high-tensile strength, combined with adjusting clamps provide steady support and versatility.

Head switch mounts have been an increased focus area at Smile Smart Technology as Roger Dakin believes that to motivate effective switch use, ‘comfort is king’. His new ‘Softytops’ soften the impact of using switches such as of Piko Buttons and Buddy Buttons. Softytops are hygienic as they can be wiped clean and dried, and due to their soft composition, have been shown to encourage switch use due to the comfort they provide when switching against x head regions and delicate skin.

Coupled with the also new, ‘Flexirod’ a mounting rod, that flexes gently when pressed and immediately returns to position, there is a new more pliant and encouraging experience emerging in switch access – made possible by ‘minimal mounting’ and strongly empathetic design.

From 2009, the challenges of adapting imported products to the UK market was a team effort between Smile and Rehadapt. Despite the flexibility of all systems, it is the skill of the installer that defines the practicability of the mounting solution. Specialist centres such as the ACE Centre, CASEE (Communication Aid Service East of England) and Chailey, excel in good installation practice and their collaboration with engineering partners ensure optimum results. Experience has shown that the very nature of specialist mounting requires a high-level of installation knowledge and that where these services are not used, problems most often occur. This wastes time and budgets. If mounts are not installed well, device use is impaired, either through poor access or excessive additional mounting – leading to ‘the Christmas tree effect’.

Therefore, the practice of good ‘minimal mounting’ requires specialist mounting installers to achieve a ‘NEAT, DISCREET & PRACTICAL’ result.

Practice

Strong communication between the user, care team and specialists is the key component in the installation process. As the mounts themselves are the technical nexus between device, seating, controls and switches, so equally is good communication between all involved to facilitate a comfortable and encouraging installation outcomes.

To expand upon this further, we press for the need to reform the regressive perception of wheels and health on one side of support, against speech and education on the other. Progressive provision for optimum care requires an essential shift to maintain momentum with the technology we use, for a collaborative ‘holistic’ approach and a move away from now outdated divides.

A message from Roger Dakin

‘The mounting of communication equipment onto wheelchairs has historically been a somewhat hit and miss affair, with all parties making their best attempt and with varied levels of success. Depending upon the variance of who owns the wheelchair, who installs the mount and who does the final setup of the device – it can be a lengthy and time-consuming process. Any user wishing to make use of a communication device is also subject to the skill of the seating supplier, prescribing Occupational Therapist or Physiotherapist, all of whom create the correct postural support with which to operate the device. If the client has too much postural movement, the switch positioning, or eyegaze calibration will be thrown into disarray, much to the frustration of the user, instructor or teacher who hopes for optimum use of the equipment at the earliest opportunity.

In this process, if the seating is correct the initial stage one is complete. Stage two is ensuring good access and positioning of the device. If the user intends to operate switches, either by head operation, hand, knee, feet or other means, it is imperative that the switch or switches are sited where they might be easily be set up and operated on a continuous basis, with trouble free operation. Ensuring switches are sited so as not to make them liable to damage or inadvertently disconnected by care staff during the various day-to-day routine is a key factor in siting switches. A primary question that should be considered is: are the switches comfortable? because hitting your head against a piece of cold, hard plastic when your tone goes high (episodic dystonia) is painful and yet completely preventable. Discomfort and pain of this kind is the main disincentive in access to this type of control. Having sufficient empathy with the user is key to success. Equally, ill-positioning may also lead to unintentional operation which additionally gives rise to great frustration for the user.

There are now many ways to mount switches other than having bespoke ironmongery welded and created by an engineering department. In the past it would seem that some engineers believed that humans were themselves machines and that all their movements were symmetrical, particularly with head switches. Today we provide more flexible engineering technology, with switches that can be made soft to the touch [using Softytops for example] and mounts that can be made to give under pressure and return to their original position [using Flexirods]. Their individual siting can be adjusted independently, and can all be swung away when hoisting, so avoiding damage.

If direct switching is not called for then eyegaze may well be the desired mode of operation, which in turn requires a greater degree of accuracy in seating and mounting the device. To be able to set up and adjust an eyegaze device requires a considerable degree of skill on the part of the installer. Pivotal to the swiftly effective access to these highly progressive devices is the skill of those setting-up the entire user system. The more accurately that the whole installation process is accomplished, the sooner the client will start to use the device.

Unlike a floor or table stand, a mount fitted onto a wheelchair must also take into consideration the seating and positioning of the client, as I have already mentioned, otherwise  their legs and arms are likely to hit or pull the mount accidentally through voluntary or involuntary movement. If the mount is to be fitted onto a powerchair the other fundamental concern should be how might the position of the mount on the chair hinder or impede the ability of the user to drive. As the user is driving or being driven, the positioning of mounts and their devices should also be taken into careful consideration. They must be kept within the curtilage of the chair to avoid damage, as you could be forgiven for thinking that often mounts and communication devices are also designed for pushing open doors…which they are not!

In the dark age of wheelchairs, they were all made of tubular steel or aluminum with canvas seats and backs, very much akin to the style of a director’s chair, seen on film sets. This design left little room to mount additional equipment and due to the weight of the early computers/or communication devices, like early Liberators or Camelions, the centre of balance was paramount when fitting a device onto a chair. Since all this equipment was of its time, rules and procedures were created to ensure that the stability of the chair was not compromised and tests like stability decks were required. Slowly, as in motor car design heavy structural steel has been replaced by light-weight structural aluminum, as used in aircraft design. This together with the remarkable reduction in size and weight of communication devices, has led to a far more user-friendly approach to mounting onto modern wheelchairs. The design of contemporary wheelchairs has also now taken into account fitting additional equipment onto the chair; the overall centre of gravity has been lowered and as such the mounting positions available are far more flexible.

The ideal mount is light and tight to the chair, the device is removed easily and stowed at the rear of the chair in a total of 10-15 seconds.  Damage is reduced, vision unimpeded and there is little to hinder the driver. The same can be said for manual chair users and more so today, classroom chairs.

Since the advent of these lightweight mounts we have mounted devices onto classroom chairs and even buggies, enabling even the very young to get started on these new generation of devices such as iPads and their like upwards. The simplicity of their installation, being light weight and low cost has improved the use of communication devices by an unprecedented degree.

With such wide access now available in AAC devices through technological advancements, the correct and lasting use of the devices themselves and their allied products, it stands to reason that we should be looking at the client in a more holistic way to ensure that each element is prescribed and operating correctly. Not as is often the case, where we see the poor installation of one part severely compromising the use of others. We should be free to discuss the client’s needs as a whole and end the historical departmentalism of our specialist area, with professionals each playing their own part in isolation. Too often it is only when the client is at the end of their wits with frustration that the holistic approach is taken. It would be far more cost effective in the long run and save a great deal of time and effort if we all worked together from the outset.

Today’s communication devices provide the brightest access to the future that we have ever seen. Younger users have the most incredible potential today, all they need is great access to achieve great things.’

Conclusion

Interdisciplinary practice became a progressive movement in academia and industry some ten years ago. It is time that our industry and professions follow this mindset. Stronger and more inclusive teamwork is pivotal given the technological advancements that touch so much of an AAC user’s life and those around them. An improvement in our professional collaboration is key to good mounting results, as mounts are the nexus that facilitates effective AAC use.

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