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AT for Motor Access: Switch Access - WATI - Part I & II
AT for Motor Access: Switch Access - WATI - Part I & II
Objective 1: Describe the mechanics of switch access.
Switch access is fairly complex, requiring knowledge, tools, time, trial and error, practice, failure and success, patience, communication and, finally, implementation. Specifically, the equipment set-up usually includes a switch, switch interface, device and program. The learning process includes motor skills requiring range of motion, strength, coordination and motor planning to succeed at timing and hitting a target as well as cognitive skills to make a choice, master scanning techniques and navigate a device or program. The time it takes to master one goal may be lengthy and is met with a new goal, a different switch, different switch positioning or a different program or app. The student's instructor needs to be knowledgeable about the switch mechanics for teaching the most efficient method of switch access. As the student becomes adept at switch access, the process of implementation into the classroom and home environments must be addressed.
Objective 2: Describe characteristics of students who may benefit from switch-accessible learning.
Not all students are able to access a computer or mobile device using the conventional methods of keyboard, mouse or direct touch. For some students, switch access to technology offers an alternative way of responding to learning activities by providing the tools for communicating, making choices, reading, demonstrating knowledge and gaining access to leisure activities that are otherwise not accessible. Motor considerations:
Range of motion
Strength of motion - use of gravity or lift action
Accuracy of motion
Steadiness and endurance of motion
Reliability of access site
Objective 3: List the first three components and supporting tools of the WATI AT assessment process.
This section will address the first three components of the WATI AT assessment process for switch access. The AT assessment is initiated with the Referral/Question Identification Guide. In response to the referral, appropriate sections of the WATI Student Information Guide are selected to assist the team in gathering information. Following information gathering, a team meeting guided by the WATI AT Decision-Making Guide for Switch Access will lead to tool selection and an implementation plan.
Objective 4: Identify resources for gaining a deeper understanding of switch-accessible learning.
Two Switches for Success: Access for Children with Severe Physical and/or Multiple Challenges
Objective 5: Apply the WATI assessment process to guide the selection of switch access equipment matched to a student's needs, environments, and tasks.
Objective 6: Explain the complexities of the equipment used for switch access.
Switch accessibility is multifaceted involving complex tools and training. Thus, understanding, learning, and teaching switch access is a process that requires knowledge, tools, time, trial and error, practice, failure and success, patience, communication, and implementation. Success is generally not achieved overnight, but is gradually accomplished as the student learns the motor components necessary to activate a switch and the cognitive aspect of timing, selection, and navigation of the program or device. Attainment of success on one goal is met with new possibilities and new goals, and the process is ongoing while the student continues to make progress. New tools and activities must be added to the plan as time goes by, and with each new tool or strategy, the process is repeated requiring additional knowledge, practice, trial and error, implementation, and training of staff.
Objective 7: Name four levels of the continuum in learning switch access.
Positioning of student and equipment
↓
Hardware
(switches, switch interfaces, mounting devices)
↓
Scanning modes and selection sets
↓
Switch access instruction
(prompt hierarchy, learning continuum, activities, software/apps,
implementation strategies, goals & objectives)
Objective 8: Name four implementation strategies to promote successful switch access in the classroom.
Demonstration - Begin an implementation schedule with 1:1 training sessions held in the classroom so that staff might observe what the student is capable of while using switch access.
Staff training - Schedule a training session for staff that will be working with the student. The training should include hands-on practice connecting switches, adjusting settings, and performing activities using switch access. An important part of this training needs to focus on the prompt hierarchy and strategies that encourage the student's independence.
Follow-up with staff - Communicate with staff and family. Share success stories, plan for advancing goals, and brainstorm motivating and educational tasks.
Ongoing student training - As the student strengthens his/her switch access skills, continue to challenge with new and motivating tasks. Repetition is important in learning new motor patterns but too much of the same may cause the student to lose interest. Refer to the Switch Progression Road Map and gradually move the student up the continuum from single switch to dual switch to scanning mode. Continue to challenge and progress the student's choice-making skills with activities related to academic content areas.
Objective 9: Identify three resources for gaining a deeper understanding of switch access.
AT for Motor Access: Mobile Device Access - WATI - Part I & II
AT for Motor Access: Mobile Device Access - WATI - Part I & II
Objective 1: Identify and describe a minimum of three mobile devices used in education today.
Chromebook: A Chromebook is a laptop running the Google Chrome web browser as its operating system.
iPad: An iPad is an iOS (operating system)-based line of tablet computers designed and marketed by Apple, Inc.
Android: Android refers to an operating system developed by Google for mobile devices.
Objective 2: List the first three components and supporting tools of the WATI AT assessment process.
A general overview of the process includes initiation of the assessment with the WATI Referral/Question Identification Guide form. The Referral/Question Identification Guide will assist the team in selecting the appropriate sections of the Student Information Guide. Following information gathering, a team meeting guided by the WATI Assistive Technology Decision-Making Guide will lead to tool selection and an implementation plan. The WATI Student Information Guide for Computer and Device Access will assist the team in gathering information, but the assessment process should not be limited to this section.
Objective 3: Describe the pros and cons of mobile device access as they relate to various student characteristics.
For some students, the mobility, accessibility features, hardware, apps and extensions of mobile devices offer an alternative way of responding to learning activities by providing the tools for written expression, spelling, calculation and reading that were otherwise not accessible to them. However, not all students are able to access a mobile device using conventional methods such as direct touch or keyboard input. For them, some mobile devices are able to accept bluetooth hardware such as an external keyboard or a switch interface. At this time, the computer may offer advantages over mobile devices in terms of switch access dependability and software options that run with switch access. The decision to choose a mobile device will depend on the student's ability, the environment and the tasks required. Mobile devices can help with cognitive impairments, learning impairments, motor impairments, vision impairments, and hearing impairments.
Objective 4: Identify resources for gaining a deeper understanding of mobile device access.
The SETT framework: critical areas to consider when making informed assistive technology decisions.
Objective 5: Use the WATI assessment process to select mobile devices that match a student's needs and plan for device implementation.
Objective 6: Identify and describe accessibility features of Chromebook, iPad and Android devices.
Depending on the device, the options may be minimal or very comprehensive, providing features for vision, hearing, learning and physical access. Vision features that are easily turned on in the settings and require no further set-up include large text, bold text, large cursor, high contrast and magnification. An example of a hearing accessibility feature is the ability to turn on flash notifications or subtitles and captions. For physical access, the click speed can be adjusted or shortcuts can be programmed. Features that may assist learning include speak text, spelling and grammar check and word completion, which is included with many of the on-screen keyboards.
Objective 7: Identify and describe a minimum of three accessibility features available through settings, apps or extensions on a mobile device.
Large cursor: Making the indicator larger to be easily seen on a screen.
Flash notifications: Phone will flash the flashlight when getting a call or text notification.
Text to speech: Speak into the phone and will write the words you speak to it.
Objective 8: Identify steps and staff responsibilities for the implementation of tools for mobile device access.
Training - Identify at least two staff and a family member to be trained (along with the student) by a person knowledgeable about the AT device. Training should take place in the environment where the device will be used. Several training sessions may be necessary, depending on the complexity of the chosen technology. Indicate the training required and the dates when the training is initiated and completed in the Training section of the AT Trial Use Guide.
Management/Support - The management/support section of the AT Trail Use Guide allows the team to identify what supports are needed throughout the use of the identified AT. This includes the locations where the support is needed, persons responsible and specific supports such as troubleshooting, charging schedule and logistics, and programming needs.
Data - Collecting data helps determine the effectiveness of the AT. First, identify what objectives you will measure. For example, you could collect samples of written work before and after implementation to look at the quality and quantity of work or to identify level of independence in device access before and after implementation. Such data is recorded in the Student Use area of the AT Trial Use Guide.
Objective 9: Identify resources for gaining a deeper understanding of mobile device access, tool features and functions.
AT for Motor Access: Computer Access - WATI - Part I & II
AT for Motor Access: Computer Access - WATI - Part I & II
Objective 1: Describe the first three components of the WATI assistive technology assessment process.
A general overview of the process includes initiation of the assessment with the WATI Referral/Question Identification Guide. The Referral/Question Identification Guide will guide the team in selecting the appropriate sections of the WATI Student Information Guide. Following information gathering, a team meeting guided by the WATI AT Decision-Making Guide will lead to tool selection and an implementation plan.
Objective 2: Describe the first three components of the WATI Assistive Technology Decision-Making Guide.
The WATI Student Information Guide for Computer Access will assist the team in gathering information but should not be limited to this section alone. Depending on the tasks indicated on the WATI Referral/Question Identification Guide, multiple sections of the WATI Student Information Guide may have to be completed. Computer access is a tool to perform other tasks such as writing, reading, math, or leisure activities. The focus of an AT assessment would most likely not be computer access in isolation but the context of another task. Therefore, it may be necessary to complete several sections of the WATI Student Information Guide in order to gather all pertinent information as it relates to computer access.
Objective 3: Identify 3-5 of the guiding questions for computer access tasks.
Is the student able to access educational/special software to enhance participation in the curriculum?
Is the student able to navigate the computer login, menus, and the Internet?
How are the student navigating? Regular mouse/keyboard?
Is the current method of navigation productive or could it be improved with alternate access?
Is the student able to read the text on the computer screen?
Is the student able to independently complete written work (reports, worksheets)?
Would written work be more productive if completed on the computer?
How does the student take tests?
Is the student able to take notes?
Objective 4: Identify resources for a deeper understanding of computer access.
Objective 5: Describe the last four components of the WATI Assistive Technology Decision-Making Guide, including solution generation, solution selection, implementation planning, and follow-up.
This module will address the last three sections of the WATI AT Decision-Making Guide for Computer Access: solution generation, solution selection, and the implementation plan. The guide should be used during the team meeting with each topic written in large print in a place everyone can see (i.e., on the flip chart, board, digitally projected on a screen, or real-time collaborative word processors). Information should be transferred to paper or digital text for distribution, filing, and future reference.
Objective 6: Identify and describe AT tools for computer access following the AT continuum for computer access.
Objective 7: Identify steps and responsibilities of implementation of tools for computer access.
The WATI Assistive Technology Trial Use Summary helps the team summarize data from the WATI Assistive Technology Trial Use Guide to be shared with the team at the follow-up meeting and assist in formulating recommendations for the student's IEP.
Documentation - Keep good records on the AT (vendor, tech support, date of purchase, warranty, instructions) and its use by the student to be passed on during transition to another teacher, grade, or school.
Writing AT Into the IEP - Following trials and successful selection of AT, it is important to write this information into the IEP. AT may be included in the IEP in a number of ways, including consideration of AT under special factors, documentation of the student's progress in the present levels of educational performance, a goal statement, service delivery, and/or supplemental services.
Objective 8: Identify resources for gaining a deeper understanding of computer access tool features and functions.
AT for Motor Access: Mobility - WATI - Part I & II
AT for Motor Access: Mobility - WATI - Part I & II
Objective 1: Describe the rationale for AT for mobility.
As illustrated in the discussion of wheeled walkers for infants, there are many schools of thought about the use of mobility devices for children. The factors that can influence the use of mobility devices and the rationale for using them vary from user to user as well as from professional to professional.
Objective 2: Describe the multiple variables issues/barriers that affect mobility.
From a parental perspective, use of mobility devices is often seen as a last resort when the child has exhausted all other means of independent ambulation. Parents may think that by providing mobility they are giving up on ambulation. As is often the case with voice output devices, parents and even professionals have made the assumption that if the device does the talking (or walking) for them, the children will not learn to do it for themselves. Another barrier in acquiring a mobility aid is that it is also a major milestone in parents' adjustment to and acceptance of the child's disability. Along with thoughts of "giving up" on walking, use of a mobility device is a visual indicator that a child has a disability. While it may be hard for a parent to decide it is time to utilize powered mobility, the use of such AT may provide increased opportunities for a child to interact with their peers and participate in social and educational activities.Barriers to the therapists' selection of power mobility included lack of confidence, lack of consistent assessment tools to assist the therapists in their selection of powered mobility, lack of trial equipment, difficulty in setting up access to powered devices for students with complex issues, lack of knowledge of whether or not the power mobility could or would interfere with self-ambulation, and very long wait time (up to a year) to get funding for power mobility devices.
Objective 3: Describe typical motor development as it relates to mobility.
Let's look for a moment at wheeled walkers for typically developing infants. These walkers have fallen out of favor due to safety issues such as injuries when falling down stairs. However, how did a wheeled walker affect mobility? Opponents claimed that the child becomes frustrated when put on the floor after being in a wheeled walker because he/she no longer is able to move as previously possible in the wheeled walker. Others thought that this early movement might interfere with the acquisition of the developmental milestones since the child was getting more practice with the motor movement for walking before crawling. Although each view had supporters, regardless of your thinking, these types of walkers did increase independent movement and allowed children to move around and explore in their environment.
Objective 4: Describe how AT for mobility may have different purposes and requirements depending on the task or outcome.
When considering the task that mobility is supposed to assist, it is important to consider the purpose of the movement. Does the student need to move between classes, around the room, or get to a preferred toy, activity, or person? Answers to these questions will help guide the team as they consider what mobility will best assist the student. As a team, discuss and record the mobility tasks that the student has to carry out. For students with intact cognitive skills, this may be easier than for students with significant or multiple disabilities.
Objective 5: Describe how assessment of mobility is an ongoing process that will change as the student grows and the tasks and environments change.
Understanding the issues, barriers, and rationale of AT for mobility previously discussed will help the team to have sufficient knowledge of these issues before beginning assessment of AT for mobility. This process follows the WATI assessment format, which is fully explained in An Overview of Using the WATI AT Assessment Process. Once the Student Information Guide for Mobility has been filled out, the team is ready to use the WATI AT Decision-Making Guide for Seating, Positioning, and Mobility to address the following areas: student's strengths/deficits; environment, tasks, and technology.
Objective 6: Complete the Student, Environment, and Tasks components of the WATI AT Decision-Making Guide for Mobility to address a student's need for mobility technology tools.
The AT Decision-Making Guide for Mobility follows the SETT (Student, Environment, Task, and Tool) format with a subcategory of sensory considerations included with Student and Environment. The following are additional categories found in the guide:
Narrowing the Focus to help identify a specific task in order to select appropriate assistive technologies
Implementation Plan to assign trials, dates, responsibilities, and data collection
Follow-Up Plan to set a date for the team to reconvene and review the student's progress
AT Decision-Making Guide for Mobility
Objective 7: Complete the solution generation, selection, implementation, and follow-up plan components of the WATI AT Decision-Making Guide as it relates to mobility.
The continuum is generally organized from common tools (already available in the environment) to more specialized AT tools, and may also go from low- to high-tech. It is not intended to be used as a step-by-step protocol for selecting AT tools for a student but as an organizational continuum of types of AT tools that are available for mobility.
The team may use a feature matching process to discuss and select the ideas, tools, and strategies that were generated during the solution brainstorming and to select the features that best match the student, the environment, and the tasks the student needs to perform. Limit the selections to a reasonable number and prioritize them according to those that can be accomplished (a) immediately, (b) in a reasonable length of time, and (c) those that will be considered at a later time or require additional or significant staff training. Enter this information in the Solution Selection, Tools & Strategies section of the WATI AT Decision-Making Guide.
Objective 8: Describe the continuum of AT for mobility for students.
The Continuum of Considerations for AT Mobility shows AT options for mobility arranged in a hierarchy from simple to complex solutions. It is not necessary to progress sequentially from low- to high-tech or from common to specialized solutions. The specific student's needs will determine the point of entry on the continuum. Finally, the continuum is intended to serve as a framework to encourage the team to consider low- as well as high-tech items. Some students may use multiple means of mobility such as a cane or walker within the classroom and a wheelchair for long distances.
Objective 9: Describe multiple ways to select and provide mobility devices to meet a student's needs.
Ambulation aids, also known as walking devices, include items such as crutches, walkers, and canes. Students who have difficulty with strength, balance, or coordination may benefit from using external devices to support and stabilize them while they learn to walk or move from place to place. Starting with grab bars or rails, some students may only need a little assistance to help with balance or strength. A PT will be able to assist the team with the variables to consider when selecting walking aids.
Objective 10: Describe assessment of mobility as an ongoing process that will change as the student grows and the tasks and environments change.
As students grow and develop, the team must be constantly aware of changes and make accommodations to mobility devices accordingly. Frequent, ongoing communication between team members is essential to determine if changes are needed to the student's mobility devices. Parents and paraprofessionals or 1:1 assistants may be with the student more often than any other staff and may have unique insights into the student's mobility needs. Consequently, their input should be sought to help determine if mobility areas need to be reassessed, changed, or tweaked. Setting up methods for ensuring communication between team members greatly facilitates the timeliness of making changes, including trying new equipment. Such methods can be informal or more formal, depending on the team's preferences.
AT for Motor Access: Seating and Positioning - WATI - Parts I & II
AT for Motor Access: Seating and Positioning - WATI - Parts I & II
Objective 1: Describe the rationale for seating and positioning for students with mild to severe disabilities.
Some students with mild disabilities have seating and positioning issues that are often overlooked since the focus of their program is on academics. However, these children may benefit from a consideration of their seating and positioning and how it impacts learning. Some of the behaviors that indicate a need for better seating and positioning supports include falling out of the chair, frequent changes of position, getting in and out of the seat beyond what is allowed, slumping over the desk, sitting with their feet tucked under their body, supporting body parts on other surfaces such as the desk or propping the head with the hand/s. These behaviors may reflect issues with core strength, muscle tone, fatigue, vision or other problems. Students with significant disabilities often have one or more positioning/seating devices. For example, they may use a walker, wheelchair, stander or other positioning device. As stated, traditional seating guidelines (anatomical) have focused on 90-90-90 position. The 90-90-90 position provides anatomical and symmetrical positioning but may not be the best position for active engagement. Students with significant disabilities may not be able to maintain the anatomical position due to difficulties with movement control and/or physical limitations.
Objective 2: Describe how stability and mobility can affect a student's ability to access tasks.
Seating and positioning are important components and supports for learning that are often overlooked. It is important to understand that students need a stable, firm base to support use and mobility of their arms, hands and head. This concept is known as stability supporting mobility. Without some type of stability, the movements a student may be trying to use may be compromised or difficult to control. Visual attending may also suffer if the student lacks the stability to hold the body and head in an upright and steady position. Think of trying to write while you are in a moving car. Your base is constantly moving, and this makes it difficult to control your hand to write without conscious thought. Thus, to write in a moving car, you must constantly try to compensate for the movement of your body by writing larger, using fewer words or stabilizing the work materials or your body. Further, you must try to hold the paper steady with one hand and use the other to write. However, even on the smoothest roads, minute changes in direction cause slight position changes to the body, which in turn create difficulties in controlling the hand for writing. Writing a quick note is easier than writing full sentences. It is hard to control arm movements much less the small muscles of the hand, which are required for handwriting. This illustrates what seating and positioning is trying to provide for our students who lack the ability to hold their body in a steady position. The hips, trunk, legs and feet need to be stabilized in order to provide a stable base. This can be accomplished in many different ways.
Objective 3: Describe how assessment of seating and positioning is an ongoing process that changes as the student grows and the tasks and environments change.
In addition to observations and analysis of the student's daily seating and positioning needs, it is important to understand that seating and positioning are not static but are constantly changing based on the task, the student's individual needs and the location or environment (outside/inside, art, music, PE, floor sitting, etc.). The student's environment changes significantly throughout the day and, therefore, must be taken into consideration. Other factors to consider are the student's growth and ever-changing needs. What works in one environment may not work in another. The process for discovering what works best is ongoing and may change weekly or even daily. Trials of various solutions are, therefore, needed. Data collection of trials ranging from simple observation or tallies to complex time sampling can help determine what works best.
Objective 4: List the multiple variables that affect seating and positioning.
Medical
Physical
ADL (activities of daily living)
Environmental
Mobility
Posture evaluation and body measurement
Objective 5: Apply the student, environment and tasks components of the WATI AT Decision-Making Guide to address a student's need for seating and positioning tools.
The team may want to gather information about the student prior to the assessment meeting. Observation of the student in several different environments will help the team see what positions the student is currently using as well as environmental factors that may influence those positions such as time of day or content presented. If a student requires special positioning, seating and mobility, an OT or PT may be the best person to take the lead in determining the appropriate options. Other team members will also need to be involved, especially when the seating and positioning are combined with various types of learning that take place throughout the student's day. In addition to observations and analysis of the student's daily seating and positioning needs, it is important to understand that seating and positioning are not static but are constantly changing based on the task, the student's individual needs and the location or environment (outside/inside, art, music, PE, floor sitting, etc.). From simple reading or math tasks to complex writing, the purpose of the seating and positioning in the educational setting is to support EDUCATION. Some students may be learning self-help or independent living skills while others are figuring complex algebraic expressions. Despite these wide variances in learning goals, a functional seating and positioning system will enhance the student's access to educational experiences.
WATI AT Decision-Making Guide: Seating and Positioning.
Objective 6: Understand the continuum of AT for seating and positioning for students with mild to severe disabilities.
Some students with mild disabilities have seating and positioning issues that are often overlooked since the focus of their program is on academics. However, these children may benefit from a consideration of their seating and positioning and how it impacts learning. Some of the behaviors that indicate a need for better seating and positioning supports include falling out of the chair, frequent changes of position, getting in and out of the seat beyond what is allowed, slumping over the desk, sitting with their feet tucked under their body, supporting body parts on other surfaces such as the desk or propping the head with the hand/s. These behaviors may reflect issues with core strength, muscle tone, fatigue, vision or other problems. These other areas may need to also be explored to understand their impact on seating and positioning.
Objective 7: Describe multiple ways to change and modify seating and positioning to meet a student's needs.
Story time on the floor, to independent reading in a beanbag chair, to a variety of chairs or stools at seated or standing desks, the children have many seating options. Even with all of these options, the workstation will need to be addressed. A workstation consists of many components and you must consider all to achieve an optimal workstation.
90/90/90 rule cant apply for everyone
A single seating solution is not adequate because students cross environments within and outside the primary classroom. Multiple seating and positioning options must be identified, each providing a dynamic situation that allows the student to progress toward independence.
Medical, physical, ADL (activities of daily living), environmental and mobility variables all impact a student's positioning needs. The seating and positioning evaluation is a tool that can address these needs. Other considerations include positioning accessories such as tilt-in-space or recline options to address circulation and pressure relief, as well as alternative seating options such as sidelyers, prone standers and floor sitters, to name a few, which all allow for alternatives to the traditional chair seating positions. The following sections will help the team gather information for the Student Abilities/Difficulties section of the WATI AT Decision-Making Guide.
Objective 8: Understand that assessment of seating and positioning is an ongoing process that will change as the student grows and the tasks and environments change.
In addition to observations and analysis of the student's daily seating and positioning needs, it is important to understand that seating and positioning are not static but are constantly changing based on the task, the student's individual needs and the location or environment (outside/inside, art, music, PE, floor sitting, etc.). The student's environment changes significantly throughout the day and, therefore, must be taken into consideration.
As a team, discuss and write environmental considerations that might impact the student's seating and positioning in a place where all team members can view them simultaneously. The environmental considerations may include auditory or visual distractions, placement in the classroom, number of different environments or any other environmental impacts.
Other factors to consider are the student's growth and ever-changing needs. What works in one environment may not work in another. The process for discovering what works best is ongoing and may change weekly or even daily. Trials of various solutions are, therefore, needed. Data collection of trials ranging from simple observation or tallies to complex time sampling can help determine what works best. For more information about data collection, refer to the Implementation section of the ATIM module AT Assessment in the School Environment.
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