Publication Date


Document Type

Doctoral Dissertation

Academic Program



Department of Anesthesiology

First Thesis Advisor

Dr. Robert Brown


AAC, Augmentative and alternative communication, Communication aid, Critical care, Intensive care, Rehabilitation, ICU, Intensive Care Unit, ICU patient communication, Assistive technology


Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing.

In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses.

Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.



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Available for download on Friday, August 25, 2023