Communication Device Trials Checklist
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1Communication Device Trials Checklist
Name:
Therapist: _______________________
School:
Teacher: ________________________
Dates of Trials: ___________________________________________________
Considerations
Vision:
normal
corrected
mild-mod impaired
profoundly impaired
needs auditory scanning Comments:____________________________________
Physical:
adequate for direct access
isolates finger
alternative access:__________
needs keyguard
needs switch scanning
will be carrying own device
ambulatory
uses walker
wheelchair *
*
needs device mount for wheelchair
*
Wheelchair – Type_______________________
Frame dimension___________
Company Supplier/Rep Name & Contact Info: _____________________________
Cognitive/Language:
above normal range
normal
mild
moderate
severe
at object level
needs digital pictures
draws meaning from line drawings
knows/uses sign language
few gross approx.
proficient
produces signs accurately
Comments: ___________________________________
writes/spells
legible
accurate
non-communicative
Uses device to:
primarily respond to ?’s
initiates with it
uses it socially
follows dynamic screen changes
independently
prompts/cues needed
navigates independently between pages
How many pages/screens: _____
can return to main page independently
clears screen independently
Devices Trialed:
Pros
Cons
1.
2.
3.
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Parent category: Life