Pediatrics: Assistive Technology

assistive technology

low-tech and high-tech devices that are used to increase, maintain, or improve functional capabilities of individuals with disabilities

• low-tech

  • inexpensive

  • simple to make

  • easy to obtain

  • e.g., pencil-and-paper communication boards

• high-tech

  • more expensive

  • more difficult to make

  • may take longer to obtain

  • e.g., wheelchairs, augmentative communication devices

AT evaluation

• first identify activities that the child or family needs/wants him/her to do

  • Canadian Occupational Performance Measure (COPM)

• observe in the natural environment

• consider all factors influencing participation in activities

  • motor, sensory and perceptual, cognitive and communication, psychosocial, context

• trial period to find a good match

  • careful documentation during the trial periods to show how the system helps improve function

• the family and team make the final decision as to which AT is used

AT funding

can come from various sources, therefore strong supporting documentation is needed to show medical necessity

universal design (UD) + 7 principles

concept of making all products and the environment physically pleasing and usable to the greatest extent possible by everyone, regardless of their age, ability, or status in life

1. equitable use— useful to people with diverse abilities

2. flexibility in use— accommodates a wide range of abilities

3. simple and intuitive use— easy to understand

4. perceptible information— communicates necessary information effectively to the user

5. tolerance for error— minimized hazards

6. low physical effort— can be used with a minimum of fatigue

7. size and space for approach and use regardless of user’s body size, posture, or mobility

universal design of learning (UDL)

educational standpoint where multiple options of how to learn, demonstrate learning and engage with learning are used to match diverse student abilities

alternative and augmentative communication

(AAC) allows communication that does not require speech with the purpose of enabling communication; supports the development of…

• language

• literacy skills

• enhances participation

• facilitates friendships

• supports interactions with people

grading— lowest tech solution

make sure to not go overboard with the assistance and limit their ability to develop their own skills

• because of this and other considerations like price, we always try to use the LOWEST TECH SOLUTION POSSIBLE

the 3 C’s

the 3 C’s are what we use Assistive Tech for (CCCAT)

• Communicate (alternatives to speech)

• Control (controlling/interacting with the environment— switches)

• Compute (using a computer)

***”Com, Con, Com” (come, come, come kitty!)

assessments

• Efficiency of Assistive Technology and Services (EATS)

• Matching Person and Technology (MPT)

• Psychosocial Impact of Assistive Devices Scale (PIADS)

• Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)

picture based communication

for kids with trouble communicating, we can use symbols instead of words

• pictures

• even simpler, for children who have trouble with pictures, we can use physical objects to represent ideas

  • e.g., a circular hair tie for circle time, a small chain for recess

• pictures can be presented on a board or book called a Picture Exchange Communication System (PECS)

AAC devices

need to pick a device a child can use based on their abilities

• require motor ability

  • pointing, touching, keyboarding, switches, joysticks, or mouses

• indirect methods

  • for significant physical impairments

  • voice recognition or visual scanning

switches + 2 types

for kids with physical impairments who need help interacting with their environment

• initially try a low-tech AT like a switch

• simple switches can be used for turning devices on and off, such as a toy for play or electronics in a room

• EADL— Electronic Aid of Daily Living

• ECU— Environmental Control Unit

• button switch

  • minimal control of UE; just press down (though requires more force than a plate switch)

  • can be paired with a PECS to make it an electronic communication device (e.g., press shirt to indicate they want their shirt)

• plate switch

  • same, but better for those with poor strength and/or minimal hand movement

  • very light touch

high-tech electronic communication

• speech-generating devices (SGDs)

  • synthesized speech (e.g., computer voice, like Siri)

  • digitized speech (e.g., human voice, more natural)

• cell or smart phones

• tablets or computers

computers

computers are flexible and allow students to complete high-quality work like their peers

• kids with UE impairments may use a computer instead of handwriting altogether

• “least change” principle means we change as few things as possible (so that children don’t feel as isolated/different)

• we can interact with computers through:

  • keyboard

  • mouse

  • screen (monitor)

computer: keyboard

difficulty due to limited UE function? —> interventions…

• change positioning of keyboard

• adapting keyboard:

  • key sensitivity, keyguard or expanded keyboard w/ larger keys, sticky keys, mouthstick, headstick, voice recognition

• typing speed:

  • word prediction, macros and abbreviation expansion (allows you to use initals (e.g., “SL” —> “Sharon Lim”)

computer: mouse

difficulty due to limited UE function? —> interventions…

• change positioning

• change sensitivity

  • trackball

    • does not require much UE function; just requires movement of the palm or fingers

  • trackpad

    • does not require much UE function; just requires movement of fingers

computer: screen (monitor)

difficulty due to visual issues? —> interventions…

• reduce glare, overhead lighting

• increase contrast, font size

• screen magnifier

• voice output tool

instructional technology

• literacy skills —>

• reading skills —>

• writing skills —>

• math —>

• cognitive prosthetic —>

• literacy skills —> text reader, electronic books

• reading skills —> adapted books, electronic books

• writing skills —> adapted paper, keyboard, word prediction

• math —> grid paper, handheld calculator

• cognitive prosthetic —> watch with alarm, GPS, earphone