Strategies to Engage Infants & Toddlers Using SwitchesNancy Bolden,Assistive Technology SpecialistNorth Central A.T. Access Site

ATK: MISSION Increase awareness and knowledge of

Assistive Technology (A.T.) devices and services for people of all ages and disabilities

Help people of all ages and disabilities acquire the devices they need for education, employment, living in their home, and participating in the community

DEVICE LOAN ATK Device Loan

System has an inventory of devices appropriate for infants, toddlers, and young children with disabilities

Convaid Carrot – reclining car seat

Zipzac I (possibly II also)

ATK Services Acquisition of needed devices and

services through: Refurbishing donated, lightly used durable

medical equipment to give to Kansans with disabilities and health conditions

Reviewing possible funding options (public and private), determining eligibility, and assembling needed funding justifications

KEE is funded by KS Medicaid to provide refurbished lightly used DME

ATK accepts other lightly used devices for reuse although lacks refurbishing funds

Otter Bath Chair

Pediatric Commode

Dreamer Stroller

KEE: Device Reuse

How to Fund Assistive Technology

Acquisition of needed A.T. devices and services is the priority

Options vary depending on the device or service needed Medicaid – EPSDT Private insurance Private funds/charitable supports Part C funds Part B funds (during transition) Financial loan programs

Other Assistive Technology Services

Call 800 – KAN DO IT (800-526-3648) to request a device demonstration, borrow a device, get a refurbished device, get help funding a device, request product information, learn how to use a device, or request help in conducting an A.T. assessment

What is Assistive Technology?

Any item that helps a child actively participate in an activity or supports their ability to learn in their daily routines across natural environments.

IDEA 2004: "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 functional capabilities of a child with a disability. Exception. - The term does not include a medical device that is surgically implanted, or the replacement of such device.” (§ 602(1)).

"any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device." (§ 602(2))

Types of Assistive Technology Devices SELF HELP: weighted

or curved spoons, dressing tools

HEARING: items that amplify sound, hearing aids, ear protection

MOTOR: built up grips on colors, dycem, switches, trays/slant boards

LEARNING: built in switch toys, e-books & apps, raised pages in a book

Ear Bandit

Adapted Book

Crayon Rocks

Types of Assistive Technology Devices

MOBILITY: adapted strollers, walkers, ride-on toys, wheelchairs

POSITIONING: corner chairs, positioning harness, pillows

VISION: Magnifiers, color contrast/textured items

Embrace seating system

Boost magnifier

Types of Assistive Technology Devices

COMPUTER ACCESS: digital tablets, switches, adapted keyboards

ENVIRONMENTAL ACCESS: ramps, remote controls, van lifts

COMMUNICATION: picture boards, single message devices, electronic communication devices

New Blue 2 for iPad

Step by Step Communicator

HOW TO DETERMINE IF Assistive Technology IS NEEDED

A comprehensive assessment is typically an ongoing process that involves input from key people including the family, caregivers, Request support from ATK on possible solutions Examine daily routine – think least intrusive

(environment, how child does it himself, how child partially participates – assist by peer, sibling, then adult)

Trial use of devices and evaluate its effectiveness ATK Device Loan System Local or national vendors

DOCUMENTING Assistive Technology ON THE IFSP A.T. can be on a separate sheet of an IFSP or

it can be embedded in existing components of the IFSP Present level of development: child currently

uses picture symbols to communicate words and phrases

Family priorities/concerns: parents want child to sit at dinner table with family (different chair? adapted seating system?)

Measurable outcomes: Child will read books before bed with his sister and participate by turning pages of cardboard books with page fluffers.

WHAT DOES Assistive Technology LOOK LIKE ON THE IFSP

Outcome examples across areas of development and learning will be provided

Implementation – quality standards Frequency & length appear adequate for child

and family’s needs Outcomes need to be functional, specific, in

family friendly language and reflecting their priorities

WHAT DO Assistive Technology SERVICES LOOK LIKE

A.T. is not the goal – how do we know it works? Is it being used? Is it still needed? Is it helping child learn, be more

independent? What are the family’s concerns,

comments?

EXAMPLES OF ASSISTIVE TECHNOLOGY

The appropriate A.T. solution is often the simplest one. Rearrange the environment – move an activity to a

table so the child can be seated and have better use of his hands

Material selection – use building blocks on a play mat with better color contrast so the child can see the individual blocks

Is more support is still needed? Try to find the one that lets the child participate independently. Peer and adult help is the next option.

LEGAL RIGHTS & RESPONSIBILITIES

A.T. must be provided in natural environments to meet a child’s needs (34CFR§ 303.13(a)(8)).

A.T. needs must be addressed during transition planning conference (34CFR §303.209(c)) and be included on the IEP.

A.T. services (assessment, recommendations, teaching use and maintenance) should be conducted by qualified professionals with active involvement by the family. Family members have unique information about

the child’s strengths and abilities, interests, daily routines, environments, and family priorities.

A.T. needs to meet the needs of child and family.

Why we teach switch use to young children with disabilities:To help a child understand that they are

able to extend influence and control over their immediate environment

As a foundation for future learningFor children with severe physical

disabilities, as a way to interact with the world (may be their only access method)

Assistive technology for young children: Evidence-based practice

o Campbell, P., Milbourne, S., Dugan, L., & Wilcox, M. J (2006). A Review of Evidence on Practices for Teaching Young Children to Use Assistive Technology Devices, Topics in Early Childhood Special Education, 26(1), 3-13.

o Reviewed articles about assistive technology published between 1980 and 2004 focusing on children birth through 6 years of age

o The largest number of empirical articles were published more than 15 years ago

o 12 studies focused on teaching switch activation use to young children with disabilities

o Strong evidence that children younger than a year old with disabilities may be successfully taught to operate switches to activate toys

o Light, J. (1993). Teaching automatic linear scanning for computer access: A case study of a preschooler with severe physical and communication disabilities. Journal of Special Education Technology, 12, 125-134.

o A single case study of an instructional protocol to teach automatic linear scanning for computer access to a child with severe communication and physical disabilities (cerebral palsy). The child was successful in learning to scan using the experimental protocol.

o Several empirical studies have been published investigating the instruction of single and two-switch scanning in older children with physical disabilities.

Assistive technology for young children: Evidence-based practice

How I Know My Child Can Use a Switch To Make Things Happen:

I have identified a reliable, repeatable and consistent movement that my child uses to activate their switch

I know what position works best for my child’s body and for their switch

My child is pro-active and engaged in what is happening when the switch is activated

Resources for Beginning Switch Users

The child’s physical and occupational therapists Switch Progression Road Map by Inclusive

Technologies (free) www.inclusive.co.uk/articles/switch-progression-road-map

Utilizing Switch Interfaces with Children who are Severely Physically Challenged (Goossens’ and Crain, 1992)

Different kinds of switches and switch mounts available from Assistive Technology for Kansans equipment loan library (785-827-9383)

Different Ways to Use a Single Switch

Press and hold (direct) Press and let go (timer) Press it again (switch

building, sequencing) Turn things on and off

(latched)

Switch Latch and Timerfor Battery Operated Items

Switches with Built In Latch and Timed Features

Powerlink Switch Interfacefor Electric Items

When Wires Are a Problem

Ablenet Jelly Beamer Switch

Adding Speech Output toSwitch Activation

Plug that extra little wire into the toy/appliance jack . . .

Strategies for Extending Single Switch Use After the Child Has Learned Cause/Effect:

Activate many things across the day 60 Things to do with a Switch and a Battery

Interrupter (Kate Ahern) Ideas on How to Use the PowerLink at Home

and at School (Northcott) Use familiar adapted toys in new ways

25 Things to Do with a Switch Activated Pouring Cup (Kate Ahern)

Fifty Fun Ideas for Simple Switch or Low Tech Activities (Molly Shannon)

Build opportunities into the curriculum Ablenet Play and Learn preschool curriculum

Increase control of the environment Electric toothbrushes, hair driers, personal

fans, night lights and lamps, TV remotes

Using Two Switches

Start and Stop One switch starts

activity Other switch stops

This or That One switch activates

one option Second switch does

something else

Using the Switch with a Computer

Wireless Computer Interfaces

Super Switch

IntelliSwitch

QuizWorks

Using a Switch with the iPad There are switch interfaces for iDevices

(Ablenet Blue2, RJ Cooper Bluetooth interface and more)

At this time there is no full scanning and switch access option available that works with all Apps

Scanning is available within individual Apps only

Not all AAC apps will scan (Sounding Board, Predictable, TapSpeak Choice); more are coming

Switch apps list from Helpkidzlearn.com, enablingdevices.com, janefarrall.com and others

How Scanning Works

One switch Auto Scanning Software/hardware determines speed

Two switch Step Scanning Child controls the speed

One Switch Scanning Positional Scan moves across

row – left to right, top to bottom

Each item is highlighted in sequence

Child presses switch when desired item is highlighted

One Switch Scanning Popup

Child responds to on screen cue Timing can be a

challenge May cause a

startle

Two Switch Scanning

Move and Choose 1 switch moves through options 1 switch selects

http://www.bltt.org/switch/ani_tss.htm

Introducing Formal Scanning

Introducing the colored box to highlight on-screen choices Use a “real” scan box Choose a color that the child can easily

see Making choices with no wrong answer

The child chooses from 3 or more onscreen options

Whatever the child chooses, they receive the reward of activating that option

Choosing IndependentlyNothing here

Choosing from a row with empty cells

“finding” activitiesFinishing a sequence

Can involve empty or filled cellsFind the right one

Choose the answer to the questions or requests

Resources for Switch Activities on the Computer

www.helpkidzlearn.com www.papunet.net www.northerngrid.org/index.php/

component/content/article/81-sen/271-sen-switcher

www.priorywoods.middlesbrough.sch.uk www.lburkhart.com/hand2sw4s.htm www.cricksoft.com www.rjcooper.com www.switchintime.com www.judylynn.com

HOW TO CONTACT US? ASSISTIVE TECHNOLOGY FOR KANSANS

1-800-KAN-DOIT 1-800-526-3648

OCCK, Inc., Solution Outreach Center Nancy Bolden 785-827-9393 1-800-526-3648