Assistive Technology in School-Based Practice

Assistive Technology Device definition (under the IDEA law)

means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability; the term does not include a medical device that is surgically implanted, or the replacement of such device

Areas of Use in School Based Practice

• Academics

  • tend to be the biggest in a school system

  • e.g., academic AT= for reading, written expression, handwriting, computer access, oral communication, organization and planning, and math

  • e.g., other AT considered on an IEP= for behavioral transitions, aerials, vocational skills, and seating and mobility, depending on the student and their needs

• Play/Leisure

• Executive Functioning

• Self-Care

• Pre-Vocational/Vocational

• Seating and Mobility

AT in School Based Practice

• 30% of students with disabilities (within this study) reported using assistive technology

  • 17,000 students

  • Across all IEP disability categories; IEP disability categories

    • Specific learning disability

    • Speech or language impairment

    • Other health impairment

    • ASD

    • Intellectual disability

    • Emotional disturbance

    • Developmental delay

    • Multiple disabilities

    • Hearing impairment, including deafness

    • Orthopedic impairment

    • Visual impairment, including blindness

    • Traumatic brain injury

    • Deaf-blind

• The most reported device was a computer or a calculator

• As technology is used more often in schools, there might be an increase in the usage of AT overall

  • A need for further training on AT

    • Think of all of the accessibility features that exist on a laptop or a phone, and how much AT is currently being missed because students, staff, or parents don’t know it exists

    • Leads to a need for more training to access these features

High and Low Incidence Disabilities

• High

  • Occur more frequently

  • Make up 80% of students with disabilities

  • Include

    • ASD

    • Communication disorders

    • Specific learning disabilities

    • Emotional or behavior disorders

    • Physical and sensory needs

• Low= Any impairment for which a small number of personnel with highly specialized skills and knowledge are needed for children with that impairment to receive early intervention services or a free appropriate public education

  • Most likely to report AT use – higher use for sensory impairments (deaf blind, visual impairment) than any other disability category

  • Occur less frequently

  • Make up 20% of students with disabilities

  • Include

    • Blind/low-vision

    • Deafness/hard of hearing

    • Deaf-blind

    • Significant developmental delay

    • Complex health issues

What governs AT use?

• The Assistive Technology Act

• Americans with Disabilities Act (ADA)

• Every Student Succeeds Act (ESSA)

• Individuals with Disabilities Education Act (IDEA)

The Assistive Technology Act

• 1988, amended in 2004

• Passed to increase access to, availability of, and funding for assistive technology for all individuals with disabilities, including very young children

The Americans with Disabilities Act

• 1990, amended in 2010

• Children with disabilities, even those who are not eligible for special education under IDEA may have a right to assistive technology under Title ll and Title lll

• Further clarified a public accommodation's obligation to provide appropriate auxiliary aids and services for people with disabilities

Every Student Succeeds Act

• 2015

• Supports the effective use of assistive and instructional technology to enhance teaching and learning

Individuals with Disabilities Education Act (IDEA)

really impacts schools

• Devices and services now known as assistive technology (AT) have been included as a part of the free and appropriate public education (FAPE) since 1975

• 1991: they changed the language to include assistive technology device and assistive technology service

• 1992: AT devices and services are made available to any child with a disability, if required as part of the child's special education, related services, or supplementary aids and services

IDEA – Assistive Technology Service

• The term “assistive technology service” means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device

  Such term includes—

  • Evaluation of the needs of such child,

  • Purchasing, leasing, or otherwise providing for the acquisition of AT

  • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing AT

  • Coordinating and using other therapies, interventions, or services with AT

  • Training or technical assistance for such child and the family

  • Training or technical assistance for professionals, employers, or other individuals who involved in the major life functions of such child.

IEP – Individualized Education Plan AT Consideration

the only 2 questions addressing/asking for AT in the IEP form; often gets overlooked!

IEP form

• This form could help new grad OTs to guide conversation about AT

• It breaks down the conversation into manageable pieces

  • Instructional area

  • Accommodations/modifications used

  • Assistive technology used

  • Consideration outcomes

Common IEP Errors

• AT is only considered for students with severe disabilities

• An assumption that no one on the team knows about AT

  • why this secton of the IEP often gets skipped

• IEP team fails to consider access to the general education curriculum in the process

  • if it doesn’t fit within a teacher’s curriculum or the process that occurs in the classroom, it’s not going to be used

• AT considerations and conclusions aren't documented in the IEP

  • This is a legal document and it needs to be written down!

When is an AT eval needed?

• When a student has never had an AT evolution

• More information is required to make a decision about AT

• Re-evaluation is necessary

  • Change in student health

  • Change in educational needs

AT Eval Process

• Multidisciplinary team

  • School team, parents/caregivers, and student

• Review how the student currently performs tasks

• Determine barriers and tough tasks for students (through completing a task analysis of the area)

• Compile data

  • Consider tools

  • Match needs tools

SETT Framework

Student

• What do they need to do to be able to do

• Strengths

• Areas of need

Environment

• Supports and barriers

• Materials and equipment

• Access issues

Task

• What tasks are part of being actively involved in the learning environment?

Tools

• What is needed to enable the student to participate?

AT is a Continuum

Least restrictive —> Most restrictive

• Accommodations » Low tech (e.g., pencil grip) » Mid tech » High tech (e.g., speech-to-text tech; might have to step outside of class to use)

Assistive Tech Form

• Basics for comparing

  • Environment

  • Typical classroom materials

  • Accommodations/modifications

  • Assistive Technology

• Areas this form addresses

  • Writing/written communication

  • Spelling

  • Reading

  • Math

  • Study/organizational skills

  • Hearing/listening

  • Oral communication

  • ADLs

  • Recreation and Leisure

  • Vocational

  • Seating and Mobility

Writing/Written Composition

Reading

Math

Study/Organizational Skills

Activities of Daily Living

Recreation and Leisure

General Considerations for AT

• Positioning (should be the main consideration for AT and access/use of AT!)

  • Should be the main consideration for AT

    • Can be simple – dycem or pillows to support the student/get them into a position where they can access their AT more easily

  • Flexibility with table and chair height

    • e.g., do they need to do their activities standing? can they be seated? do they need to be sitting on the floor? does the table need to be angled so they can reach something?

  • Considering tilt or angle of materials (often so child can see better)

    • e.g,. tilting a table, using a slantboard

• Accessibility Features

  • Sticky Keys

    • Allows users who can only press one button at time to use modifier keys (e.g., for control, alt, delete)

  • Computer modifications

    • High contrast

    • Size of the mouse

    • Screen magnification

Universal Design for Learning

• Multiple Means for Engagement –"why"

  • How we spark interest and motivation (in what we’re teaching + students wanting to learn it)

  • Looking at how students can express how they learn

• Multiple Means of Representation - "what"

  • Provide students multiple ways to acquire information

  • Offering content in multiple formats

    • e.g., visual, auditory, hands-on

  • Making learning accessible

• Multiple Means of Action and Expression - "how"

  • How students show what they are learning

  • Offering multiple ways to demonstrate what they learned

    • e.g., writing, drawing, AAC device, speaking

Switches

• Types

  • Mechanical – requires force to activate

    • must press “down” on the switch for it to go

  • Proximity – activated by movement

    • move your hand or body part over the switch for it to go

  • Pneumatic – activated by respiration

    • e.g., sniff and puff switch

  • Electromyography (EMG) – electrical activity with activation of a muscle group

    • activates when a muscle group activates

Switch Scanning

• Direct selection is a method of access where an individual selects a specific target directly, without a set of choices

• Indirect selection is a method of access where the individual selects a specific target after navigating through a set of choices

  • Automatic scanning – device moves through choices automatically

    • when the switch is activated at the desired choice, it clicks on it

  • Step Scanning – user activates the switch repeatedly to move through each choice

    • To select the desired choice, another switch or a prolonged press is used

  • Inverse Scanning – user holds the switch down to move through choices

    • When desired choice is reached, the user lets go of the switch

Switch Scanning: Indirect Scanning Patterns

• The scanning method (automatic, step, inverse) + the pattern (linear, circular, row-column, etc.) work together to shape how the user interacts with a device

• Linear Scanning

  • Highlights items in a straight line (left to right, top to bottom)

  • Simple and predictable, but can be slow

  • Best for: beginners

• Circular Scanning

  • Highlights items in a circle or loop, moving continuously

  • User selects when the highlight is over the item

  • Best for: small sets of items

• Row or Column Scanning

  • First, the device scans the rows; then, when the user clicks the switch/activates it, it moves across the items in that row

  • Much faster than linear scanning

  • Best for: larger displays

• Group-item scanning

  • Items are divided into groups or blocks

  • when the desired block is highlighted, the user activates the switch; then, the device scans that group, and the user activates to select a button

  • Best for: very large sets (maybe on an AAC device)

• Directed (or controlled) scanning

  • The user has multiple switches to control the direction of scanning

  • Provides more control but requires more motor activation and cognitive function to be able to use

  • Best for: users who can manage multiple switches and want faster activation

Switch Latch Timers

Switch latch timers act as a link between the switch and the device being used and can run several functions by tapping the switch; they are made for AC (household current, i.e., plugged in) or DC (battery current, i.e., run through a battery system):

• Momentary or direct - the device runs while the switch is activated, or the connection is “closed.”

  • This is useful for teaching basic cause and effect or short actions, such as turning on a blender for a few seconds

• Latched - switch activation will turn the device “on”, and a second activation turns the device “off.”

  • This is useful for those who are not able to keep a fixed activation of a switch, or for those actions where an “on/off” switch is needed, such as turning on and off a bedroom light

• Timer feature – has a set length of time (in seconds or minutes) that the device will run before needing reactivation

  • This is useful when the person is unable to maintain contact with the switch, so it turns “on” for a set period; but requires reactivation to turn “on” again.

Switch Considerations

• Switch

  • Physical characteristics

    • Size, shape, weight, waterproof?

  • Feedback (that the swith is providing)

    • Audio, visual, tactile, proprioceptive/kinesthetic

  • Functional features

    • Mounting, durability, washability, cost, maintenance, aesthetics, trainings

  • Location variables

    • Angle, gravity, and body part being used

• Person

  • Range of motion

  • Muscle and endurance

  • Speed and accuracy

  • Reaction time

  • Impact of reflexes, righting responses, equilibrium reactions, and muscle tone might have on switch use

Hierarchy of Control Sites

• Bottom is most precise/accurate

  • —> goes up; top is where you have a little bit more freedom to complete