Case Eero: Ordering a taxi with Imagetalk

Eero Saarnivaara is a 59-year-old male who suffers from severe aphasia and right-side paralysis due to a stroke five years ago. His speech consists of a very limited jargon, but he understands everyday conversation rather well. He can read short sentences and complete individual letters into words, but not write whole words or sentences.

Eero worked as a pilot in the Finnish army until he retired at the age of 40. After that he made a career in sales and marketing until the sudden change of life five years ago.

The cooperation between Eero and Minna Vanhala, a speech therapist at the Finnish Stroke Association started in autumn 2002. Already long before that, his speech therapy was directed towards augmentative and alternative methods, for instance the use of mimics and gestures as means of expression. Eero is also quite skilled on simple drawings. He can utilize written or drawn answer alternatives as well as communicate with symbols. He occasionally still tries to rely on his vocabulary, and needs reminding from his conversation partners to use alternative methods.

As Eero is skilled at using mimics and gestures, the training has also included signs. Eero’s children have also received sign teaching. Even though he produces individual signs quite well, it seems to be difficult for him to use signing in spontaneous conversation.

The need for assistive technology

In January 2003, Minna and Eero started to think about a technical solution to improve communication. The idea was that Eero could gain from a technical device, for instance in daily activities like shopping and health care. The purpose was also to enable contacts with new people, since not everyone understands mimics and signs. With a communication device, Eero would be able to express himself more straightforward in many situations.

-- A new, small-size device called B.A.Bar seemed to interest Eero, and we tried it for a couple of weeks. At the end of the speech therapy round, we made a recommendation to TYKS-Tikoteekki (the regional resource center for augmentative and alternative communication, based in Turku) for a more profound evaluation of the device.

In spring 2003 Eero’s speech therapy with Minna continued for one more round. By that time a new communication solution, Imagetalk, had emerged on the market.

-- I wanted to try Imagetalk with Eero, since it would enable distant messaging as well. I contacted Tikoteekki, and we agreed to test Imagetalk in our therapy framework, because Eero would still have to queue for evaluation at Tikoteekki quite a while.

Even a short test period can tell a lot

Minna contacted the Imagetalk company, and explained the situation. Eero received a test device (Loox 600) for a two-month evaluation. Minna built an icon book based on category folders, such as persons, actions, numbers and quick messages, and added some close friends, relatives and herself as communication partners. Thus, Eero could start to learn sending and receiving messages.

-- Eero learned the program quite quickly. It was sometimes difficult for him to include the verb into a sentence, but the messages were mostly clear and understandable even without the verbs. Eero can use the device with one hand, because the non-paralytic left hand has good motorics.

During the test period, Eero experienced that he could benefit from Imagetalk also in face-to-face conversations, even though the test book was quite limited. He also found it more useful and powerful than printed symbol folders when going shopping, to the bank, health care and other activities. One downside was the rather poor volume of the synthesized speech, which limited its usefulness in conversation. Of course, the volume could be increased with an external power speaker.

-- Eero finds it very difficult to use an ordinary phone. Therefore, he was very excited about the possibility to send and receive SMS-messages with Imagetalk, and considers it to be the most suitable alternative for him, says Minna Vanhala, who submitted a recommendation to TYKS-Tikoteekki. She already agreed with Eero to expand the icon book and the amount of communication partners if they were to get a positive decision.

Joint venture with speech interpreter

The speech therapy round ended in January 2004, and Eero was in queue to receive the assistive device from Tikoteekki. Meanwhile Eero experienced a change in life and moved to live alone. He felt that he needed a speech interpreter, and so the cooperation between him and Minna continued, as Minna was a coach for interpreter service personnel.

-- Eero now had an acute need for a mobile communication solution, with which he could be in contact with his community. I contacted Tikoteekki, and got the message that Eero could get his Imagetalk quicker, if there was someone to coach him in using the device, and who could build and update the icon book according to Eero’s needs. I responded that the speech interpreter and I myself could act as such persons.

Eero received his Imagetalk-enabled device relatively fast from Tikoteekki, and Minna built an icon book for him. As part of the coaching of the speech interpreter, Minna had taught her to use Imagetalk Assistant and the Imagetalk end-user program.

-- Luckily Neurocity arranged a training session on using Imagetalk Assistant for therapists at my workplace, the Finnish Stroke Association, and after that, I met with the interpreter and Eero to receive a more detailed training in using Imagetalk. Eero has good technical skills, and our aim is that he and the interpreter together take care of updating Imagetalk in the future.

Independence and self-confidence

Imagetalk is not a substitute for the speech interpreter’s services, which Eero needs for demanding situations and for written communication, etc. Tikoteekki will invite Eero for a follow-up session when his turn comes up in the queue. They will evaluate how well Imagetalk suits Eero’s needs and how useful it has been.

-- After a couple of weeks using Imagetalk I have decided to try to get Eero one more short speech therapy round, during which we will study the principles of composing messages so, that it would be as easy as possible for Eero to make conversation and form well-structured messages. Eero’s Imagetalk also contains contacts to old friends, with whom he hasn’t been able to keep in touch, while lacking the ability to speak and write, Minna contemplates.

She tells that Imagetalk has become important for Eero for example when ordering a taxi. Eero sends a message to a driver he knows well. If the driver is unavailable, he forwards the message to the taxi center for processing. Eero can also cancel the taxi with Imagetalk.

-- He has a taxi folder in his Imagetalk icon book, containing the icons and ready-made longer sentences he needs for ordering a taxi and for communicating with the driver, for instance places he often drives to. The taxi folder is still under construction, but has already proven to be very useful.

Photos of Eero Saarnivaara and Minna Vanhala by Marja Vaiste/Viestintäfree
A story about Eero Saarnivaara and Imagetalk appeared in AVH Magazine 2/2004 (in Finnish)