Assessment and Intervention Considerations

All bedside evaluations at Boston Children’s Hospital begin with careful review of the patient’s medical chart, communication with key providers, and a feature-matched assessment.  A feature-matched assessment is, “a systematic process by which a person’s strengths, abilities, and needs are matched to available tools and strategies” (Shane and Costello, 1994).  In the ICU/acute care environment, a variety of factors, strengths, skills, and needs are evaluated to ensure proper provision of strategies throughout the continuum of care.  Ongoing reevaluation in this environment is essential given patients’ often changing medical statuses and subsequently, their changing abilities to access different tools and strategies as they recover.

Domains of assessment typically include:

  • Cognition
  • Communication and language skills
  • Sensory abilities
  • Speech production
  • Motor skill
  • Vocabulary selection
  • Environmental assessment
  • Communication partners
  • Team members
  • Medical and pharmaceutical interventions

Intervention Strategies and Considerations

Upon completion of a bedside assessment, the speech-language pathologist may provide the following interventions:

  • Support use of a baseline communication systems in the hospital setting
  • Adjust or enhance current communication systems as needed to add new vocabulary, explore bedside mounting options, and adjust physical access needs.
  • Design and construct communication systems to meet new onset communication challenges
  • Provide visual aids to enhance comprehension, anticipation, and participation
  • Explore optimal access options
  • Educate and train communication partners
  • Set up adapted nurse call system and tools for gaining nurse or family attention 
  • Educate staff and document about how the patient communicates
  • Identify patients who are appropriate for referral to our outpatient department

Partner-Assisted Scanning

Partner-assisted scanning is a strategy used by the communication partner to help a patient quickly scan through message groups and choices in a communication system.  This strategy is often encouraged when the patients’ ability to independently point to letters or messages on a communication board or system is challenging due to physical or visual impairments.


Some patients with reduced physical skills may opt to utilize switch-scanning to access a speech-generative device.  By activating one or two switches, a patient can scan through messages on a communication system, make a selection, and communicate messages using digital or synthesized voice output.  Switches and communication systems are carefully mounted and placed at the bedside to ensure timely and appropriate activation.

Adapted Nurse-Call Systems

The ability to reliably access the nurse-call system while inpatient is of utmost importance for patients, families, and staff.  Patients who are unable to physically access the standard nurse-call buttons may be provided with alternative access methods and assistive technology solutions to ensure the ability to call out for one’s nurse is preserved.  Various switch sizes, mounting tools, and set up options are available following a bedside assessment.

Bedside Signage

Often, displaying information related to how a patient communicates on the room door (with patient or guardian permission) can change the entire dynamic of a bedside conversation.  Alerting providers about a patients’ communication skills and needs as well as displaying information related to equipment provision and set up, can help ensure successful interactions.

Unaided Communication Strategies

For many pediatric patients, use of external tools and systems may not be appropriate or accessible during their time in the hospital. Rather, use of unaided communication strategies, including gestures, facial expressions, sign language, body movements, eye movements, and others, may be the most suitable strategy.  

Low-Tech Strategies

Often, technology is not required for a patient to effectively communicate a wide variety of messages in the hospital setting.  Our speech-language pathologists strive to customize and individualize all low-tech materials to meet the needs of our patients, as years of service delivery have revealed that a “one size fits all” model does not always apply to this setting.  Communication boards, visual aids, picture-symbol cards, written text, and other low-tech materials are readily available to our patients throughout the inpatient hospital.

High-Tech Strategies

With the ever-changing and evolving use of higher technology systems in AAC, we are committed to having a broad range of high-tech communication systems readily available to patients for whom technology serves as the best feature-matched communication tool while inpatient.  These tools range from voice-output communication aids, multi-level speech-generating devices, dedicated dynamic speech-generating devices, text-to-speech systems, and tablets with a myriad of communication applications.  

My Hospital Stories

For many children and young adults, a visit to the hospital can be a scary and worrisome experience.  Children with complex communication needs often benefit from accessing developmentally appropriate information prior to the inpatient hospital stay to enhance understanding and anticipation of predictable events or experiences.  Our inpatient speech-language pathologists worked with various providers across the hospital to create a variety of Social Stories™, known as My Hospital Stories. These stories, which can be found and downloaded from the hospital’s Autism Spectrum Center website, provide a visual guide to patients’ hospital visits. 

Since some children with complex communication needs comprehend information in different ways, customized Social Stories™ can be created by contacting our inpatient team prior to your child’s hospitalization.

Equipment and Tools

At Boston Children’s Hospital, we strive to have a wide variety of tools and strategies available for patients’ use during a hospitalization of any length.  Recommended strategies may include high-tech systems, low-tech systems, or no-tech systems.  Recommendations are always determined relative to a patients’ current level of skill and need based on a feature-matched assessment and may change throughout the recovery process.  Depending on a patient’s status, the following communicative functions may be addressed using a variety of tools and strategies:

  • Gaining attention, for example calling a nurse or loved one for help
  • Expression or comprehension of medical needs
  • Social interaction
  • Making choices & indicating preferences
  • Feeling in control
  • Asking questions
  • Communicate to regulate the task
    • Opt in/out
    • Take a break
  • Commenting
  • Expressing one’s personality

Mounting Equipment

Patient rooms, especially in the ICU, are typically dense with medical equipment and require space for nurses and physicians to quickly and easily access patients and their medical devices.  Provision of communication systems therefore requires careful placement and access at the bedside.  A wide range of mounting systems is available for patient use including:

  • Bedside arms to mount switches and light-weight communication systems
  • Wedges and angled mounts for proximal switch placement in beds
  • Rolling over-the-bed floor mounts for larger and/or heavier speech-generating devices
  • Sip and puff switch and mounts for patients with limited mobility, quadraparesis, or quadraparalysis
  • Eye gaze frames and related display mounts
  • Tablet brackets and bedside mounting arms