A Beginning…

1. Occupational Therapy and Assistive Technology: A Vital LinkMolly Shannon, OTR/L, ATPNorth Carolina Assistive Technology ProgramCharlotte, NC 704-355-2703mshannon@ncatp.orgwww.ncatp.org

2. A Beginning… • I drew it, the letter A. There it was on the floor before me. I looked up. I saw my mother’s face for a moment, tears on her cheeks. I had done it! It had started, the thing that was to give my mind it’s chance of expressing itself. That one letter, scrawled on the floor with a broken bit of yellow chalk gripped between my toes, was my road to a new world, my key to mental freedom. Christy Brown, 1954 My Left Foot, movie and book

3. Overview of Presentation • Definitions, compare and contrast OT/AT • OT Role • Categories of AT and examples • Resources • Case studies • Door Prizes

4. “Molly, Why Did You Stop Being an OT?” WRONG!! • I have never stopped being an OT. • I am an OT that specializes in AT. • AT professionals come from all backgrounds, but OT is a logical choice. • Apple and AOTA in New Orleans years ago, “AT and OT: Changing Lives One Day at a Time”

5. Why Should O.T.s be Using AT? • Why not? Hasn’t OT always dealt with adaptive devices? AT is just an extension of this • Best practice! OT Practice Framework: ADL, IADL, Education, Work, Play, Leisure, Social Participation….AT touches all of these! • Different settings are demanding increased knowledge of AT: schools and rehab • Increased media coverage of AT increases knowledge base of consumers and families

6. Why Aren’t O.T.s Using AT? • Lack of experience and/or confidence • Too little time for additional training • Little access to AT in particular settings • No mentors • Just don’t get it, no buy in yet or “ah-ha” moment or client • Lack of institutional or supervisor support • Lack of resource information

7. Definitions of OT and AT • From AOTA website: Skilled treatment that helps individuals with disabilities achieve independence in all facets of their lives. It gives people the “skills for living” necessary for independent and satisfying lives. • AT Definition from PL 100-407: • AT Device: Any item, piece of equipment or product system whether acquired commercially off-the-shelf, modified, or customized that is used to increase or improve functional capabilities of individuals with disabilities. • AT Service: Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.

8. Compare and Contrast • AT: goal is to increase function. If a person cannot perform a required activity, then may need AT to accomplish. • OT: use functional tasks to increase independence in self-care, work, school, play and leisure. • Do they overlap? Yes.

9. Terminology/Topics to Consider • Least restrictive environment • No prerequisites to try AT! Continuum of access concept across lifespan. • Universal Design. • Jargon: medical vs. educational vs. community. For funding issues mainly. • No, low, and high tech: based upon cost or degree of difficulty • Method vs. material accommodations vs. accommodation technologies (seating, large print, software for vision limitations)

10. Inclusion Levels Tasks Location Examples or AT

11. Settings for OT using AT • Educational: all ages • Private, charter schools • Non-profit settings • Hospital or rehab • Private OT • Home Health, nursing homes or assisted living • Specific AT sites: Tech Act, school team, Voc Rehab

12. OT Role in AT Evaluation • Functional range of motion • Strength • Sensory • Cognitive, depending upon team • Coordination • Reach • Hand Strength and finger isolation or other isolated access control • Functional skill levels

13. Typical OT Roles in AT vs. Generalist in AT • Assist in seating and positioning and ECU integration possibly • Switch access • Mounting • Writing assistance tools and sottware • But as an OT gains more expertise in AT, the roles between service providers blend. For example, I do quite a bit of AAC consultation for low tech.

14. Assessment Assistance: few formal evals out there • Online typing tutor and AT assessment, $6 month for individuals, free 4 wk trial at www.customtyping.com • WATI free AT eval form (37 pages) and other materials online, www.wati.org • SETT (Student, Environment, Task, Tools) online form from Joy Zabala and Denham: http://sweb.uky.edu/~jszaba0/ATConsidGuideADJZcomp.docPrinciples: http://sweb.uky.edu/~jszaba0/Joyshandouts.html

15. Categories of AT • Computer Access • Augmentative communication • Activities of Daily Living • Environmental Controls • Seating, Mobility and Positioning

16. Low or No Tech: Do Not Dismiss the Importance! • Laptrays, adapted desks • Typing aids, splints • Book holders, 3 ring binders, slant boards • Built-up handles, grips, new Crayon TwistUps, etc. • Reachers, mouthsticks and head/chinpointers • Hand held magnifiers • Raised line paper, writing guides • Homemade devices! Client or therapist!

17. Overview of AT Products • Not meant to be all encompassing • Just representative, novel products • Trying to put a name to a product to help with recognition later • Sources listed on slides on handouts or email for more info, some fav sources so becomes resource list for you

18. Hierarchy of AT Computer Access Keyboard Mouse Technology Proportional Joystick Switched Joystick 4 switches 3 switches Single switch scanning 2 switches Single switch Least Restrictive Access Most Restrictive Access

19. Regular Keyboard Use Keyboard Labels or Keycaps, ~$20, various large print and Braille,www.donjohnston.com, Slip-on Typing Aid, $16 www.beabletodo.com, various Keyguards, $140 www.turningpointechnology.com, various Low Vision Keyboard, $60, www.maxiaids.com

20. Regular Keyboard Use: Typing Aids Lefthanded Keyboard, various, $99, www.fentek-ind.com Page Turners, $28, $18, www.maddak.com Mouthsticks, www.wisdomking.com, $62 and Headpointer, $112

21. Portable Word Processors: • Alphasmart 3000 $199 with Co:Writer Applet add $139 or DANA www.alphasmart.com PC6 from Perfect Solutionswww.perfectsolutions.com $290 plus a text to speech component available for $99

22. Alternative Keyboards: small, large, one hand, chorded, Kid Keys Keyboards, $169 www.enablemart.com Intellikeys Keyboard $395, www.intellitools.com Mini Keyboard, various, $60, Fentek Half QWERTY keyboard, $595, www.half-qwerty.com

23. Trackballs, Joystick or Mice Examples Kid-Trac or PC Trac/Max trax, $69-79 (Microspeed) various sources and Infogrip, www.infogrip.com Roller II Joystick or trackballs, $309 www.enablemart.com Logitech Trackman, $40, Infogrip Vertical Mouse, left or right-handed, www.sforh.com $72 HelpiJoy Mouse, $199, Infogrip

24. Magi-Mouse, www.magitek.com , wireless computer/AAC control Mouse Emulation: QuadJoy $540 www.quadjoy.com IntegraMouse, $2200, www.infogrip.com

25. Using Your Head:Many Choices • Infrared products: ex. Headmouse Extreme, www.enablemart.com $1000 • HandiEye, www.freedomofspeech.com, $699 • Eye gaze systems, ex. Quick Glance, www.enablemart.com $4500-6500

26. Computer Software: Onscreen Keyboard Example: REACH Interface Author (329 to 549.00) www.ahf-net.com, free 30 day trial, WIN

27. Word Prediction: (example) Co:Writer $325 www.donjohnston.com. Great article from LD Online about word prediction,http://www.ldonline.org/ld_indepth/technology/word_prediction.html

28. Sorting Through Word Prediction and Onscreen Keyboards • Onscreen Keyboards: physical issues, with or without word prediction, variables • Word Prediction: • Applet for Alphasmart or software • Increases rate of writing as decreases number of keystrokes required, >12 wpm may not be effective unless need spelling/language support too • Have to visually monitor screen to be effective • Works nicely with onscreen keyboards or if keyboard is mounted upright

29. Writing Support Software many choices! • Kurzweil 3000, www.enablemart.com , $1100-1500, new prod for Windows called ClaroRead for $395. • Read and Write, Enablemart, $695

30. Software: Talking Word Processors • Example, Write:Outloud, $99, www.donjohnston.com

31. More Writing software… • Clicker 5, $199, www.enablemart.com

32. Writing Support Software • Inspiration or Kidspiration, $55, www.enablemart.com, 30 day free trial from publisher www.inspiration.com

33. Primarily using Dragon Naturally Speaking Depends upon individual, yet many clients with SCI depend upon VR Students with LD, neurological like MD, some CP Doctors, lawyers, public safety Bottom line: what tasks need to do? May use VR for some and type via other methods for others Where to use in public school settings? What grades? Cognitive load. Voice Recognition:

34. Switch Interfaces and Switches • Have to have an interface to use switches to operate computer • Several sources, including www.donjohnston.com and others for about $100 • Switch software commercially available or can do some customization if needed

35. Hierarchy of Access Sites: Can Have Multiple Sites for Access Hands Head/voice Arms/elbow Legs/knees Feet

36. Top Tips for Switch Selection: compiled from Dr. Jennifer Angelo source, Univ of Pittsburgh Movement Issues: naturally occurring, volitional, social and communication issues, motivation is key Positioning and Environmental Concerns: team assessment helps, space constrictions, reflexes, mounting, different locales/times different access? Performance Variables: Target size, Force,Timing, Accuracy, Efficiency, Durability, Safety and Fatigue User Input:Interest and acceptance, Fun for younger users, Increases independence, Comfortable, Ease of use, Reliability, Cost issues Professional or Family Support Pointers: Wait!, consider previous attempts, try it yourself!, ease and reliability of set-up by staff/families http://www.vard.org/jour/00/37/5/angelo.pdf#search='jennifer%20angelo%20AND%20switch%20selection‘

37. Ideas for Feature Matching with Switches: Varies with Clients! Cerebral Palsy: coordination is key Neuromuscular (ALS, MD, SMA): strength, ROM, fatigue Spinal Cord Injuries: high level quads DD/MR: bright, big, sturdy Visual Impairments: Pressure, rocker, wobble switches. Mounting! Spec, light touch, blink, P switch, cup, microlite Sip and puff, tongue, head controlled Big Red, Bass, wobble, auditory Texture switch, auditory feedback

38. My Favorite Switches • Ultimate Switch, $95 www.enablingdevices.com • Microlite Switch, $59, www.tashinc.com • MiniCup, $50, TASH • Jelly Beamer, wireless Switch, $129, www.ablenetinc.com

39. Scanning: Techniques and Patterns The most laborious and mentally straining form of access is auditory scanning so is usually a last resort for access! Visually scanning is easier. Scanning Techniques: Automatic, Step, Directed or Inverse Patterns: Linear, Circular, Group , Customized

40. Morse Code Issues • Great if ham radio or military experience • Expressive, not receptive • Which devices or software: JOUSE, • EZ morse, DARCI, doublecheck • Book, Modern Morse Code in Rehab and Education by Thomas King • Website of user and links: www.makoa.org/jlubin/morsecode.htm • Book, Denis Anson,OTR: Alternative Computer Access • Speed is key, can get up to 30 wpm • Codes become automatic so reduces cognitive effort to write and can concentrate on writing • Takes many hours to learn, audio learning best • Try at very early age; same age as peers learning to write

41. Voice Recognition • Example:Dragon Naturally Speaking, various versions from $100-1000, various sources including www.image-management.com/ • Powerful product that has replaced some other methods for some clients • Use a great deal with SCI and RSI • Can be operated totally hands free if needed • Source for resources for voice recognition: http://atto.buffalo.edu/registered/ATBasics/Curriculum/Writing/speechRecognition.php

42. Augmentative Communication • OT plays vital role as part of assessment team • Become a generalist with experience! • Should be using their devices in OT sessions, not just in Speech or in class • Linda Burkhart great resource site www.lburkhart.com/ • Speech to Speech Relay service,state numbers listed at website http://www.fcc.gov/cgb/dro/sts.html

43. 10 things I wish my teacher knew about AAC (insert AT or therapist, parents, etc) Callier Center/ ASHA http://www.callier.utdallas.edu/ACT/res.html#C 1. I wish my teacher would joke with me. 2. I wish my teacher would learn how to work my communication device. 3. I wish my teacher would stop shouting at me like I can’t hear. 4. I wish my teacher would remember that I don’t always spell very well. 5. I wish my teacher wouldn’t have a heart attack when my device doesn’t work. 6. I wish my teacher would have more patience with me. 7. I wish my teacher wouldn’t hit my machine when it doesn’t work-that’s my mouth she’s hitting! 8. I wish my teacher would call on me for Share Day. 9. I wish my teacher would give me enough time to say what I’m thinking. 10. I wish I could walk and talk like my sister and brother.

44. AAC with Environmental Controls • Dynavox and Prentke Romich products have had infrared access for years with high end AAC devices. • Use for electronics in home or for operating toys for children. • No antennae or is radio Controlled device or toy. • AMDI Tech Talk ECU, $795

45. Environmental Control:ECUor EADLs • Simple large remotes,$39,various sources, Wal-Mart or Large remote with switch jacks, $119www.adaptivation.com • Jumbo Universal Remote, $189,www.enablemart.com • Powerlink 3,$189, www.ablenetinc.com • More complex with scanning Switch access start at $250-600 from www.tashinc.com for Relax units and up to 5K-15K for Quartet Simplicity voice/switch ECU and components, www.freedomofspeech.com

46. Popular ADL Products • New products: Soap Genie,$40 www.skymall.com • Autoflip Spatula, $17, www.independentliving.com • Adapted Gardening, Fishing and Hunting: http://www.accesstr.com/ • Drink Aide, $39 from www.gstsdesigns.com • Half gallon carton holder, $8, www.dynamic-living.com

47. Various Newer AT products • PDAs for augmentative communication and cognitive support • Bluetooth cellular phone for hands free answering and calling • Smartphones with Bluetooth and GPS and alarms • Infrared plumbing: Pros and Cons! • Adjustable shelves and stovetops, Approach Cooktop and Countertops, $1564 each www.enablemart.com

48. Self Feeders Neater Eater, www.sammonspreston.com, $3796.00 Winsford Feeder, Sammons, $3746 or www.activeforever.com at $2795!! Steady Spoon, Sammons, $40-50.00

49. Low Tech Toys and Learning • My Handout • Great research summary article about using AT with infants and toddlers: www.asu.edu/clas/tnt/presentations/UsingAssisTechInfTodEBP.pdf#search='toddlers%20AND%20power%20mobility‘ • Spice up use of switch toys by being creative, using in units, cooperative activities, encouraging language and motor skills • Look wherever you shop for battery operated, current toys can add a battery interrupter to. Cracker Barrel, $1 stores.. • Best sources of adapted switch toys remains www.enablingdevices.com, but try Ebay as well!

50. The Low Down on Battery Operated Toy Adaptation • Battery interrupters, $8-14 from • AAA-D battery sizes • Make own, directions online. Cold solder • is now available • Buying toys already adapted is more expensive, but some benefits • Adding own interrupters to cheap toys allows to increase interest with current toys, like Curious George or Dora • Great holiday workshops to make switch, adapt toys • Single Switch Latch Timer, $75, www.enablingdevices.com , adds control options