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Spring 2003 Table of Contents
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Using Assistive Technology For a Student with Multiple Disabilities

Holly Cooper, Ph.D., Technology Consultant, TSBVI Outreach

In this article, I will introduce you to a young lady I have had the pleasure of working with for several years, a student named Alyssa, and her mother Sarah and father Jim. Originally I worked with Alyssa as her itinerant vision teacher, and as a team member on our school district's assistive technology team. Now I have continued my relationship with Alyssa, her family and educational staff as a technology consultant at TSBVI Outreach. This is one student's story, but assistive technology is about the people. For us to make better use of technology, we must know the people with disabilities who use it, the families and educational staff who must support it, and the people who interact with the student with disabilities through or with the aid of the technology.

Readers may think of technology for students with visual impairments as screen reading applications (JAWS and the like), computer screen magnification software, computer braille translation, braille note takers and video magnifiers (CCTV's). This type of technology is widely used with students with visual impairments across Texas and other areas. However, there are many more students who are visually impaired who have additional disabilities and do not benefit from access to all the amazing braille and low vision technology. There are currently a number of computer programs that teach switch use with simple cause and effect activities, but for blind and visually impaired users who are more advanced, finding useful software and devices can be a real challenge.

Alyssa is 18 years old and attends high school in a suburban school district in the Dallas-Fort Worth area. Her mother works as a school librarian for the same school district and her father works as a systems analyst. Alyssa spends part of her day in a class for students with multiple disabilities, and part in a class for students with mild and moderate developmental disabilities. She attends an adaptive physical education class, and some semesters is able to attend a general education class such as Spanish or Home Economics.

Alyssa is legally blind, and her vision is complicated by cortical visual impairment and visual field losses. We have not had success with enlarging icons on the computer or using picture symbols for communication or pre-literacy because of her vision loss. She can recognize letters of the alphabet and numbers if they are large enough, and can sight read a few words, but forgets them if she doesn't use them often.

Alyssa has cerebral palsy and uses a motorized wheelchair with switches built in to the headrest to control the forward, left and right turn functions. She has a switch behind her elbow that changes the direction to reverse. The switches can be disconnected from the motor and used to operate the computer with a switch interface, or electrical appliances with a transformer. Alyssa is able to travel independently indoors in her wheelchair, and knows how to travel to familiar locations around her school. She has some difficulty with depth perception relating to travel and requires supervision.

Alyssa's cerebral palsy also effects her speech articulation. She is able to communicate verbally, and familiar people can understand much of what she says if they know the context or topic about which she is talking. However, she does have significant difficulty getting her point across when the listener does not know something about what she is trying to say.

Alyssa's parents have been energetic advocates for appropriate educational interventions for her, and being knowledgeable computer users, have taken the initiative to try many things with her, and seek out specialists and evaluations outside of the school district as well as in.

Remember that this is one student's story. Each student has different abilities in cognition, vision, motor control, and the support of the family and school environment. This article was compiled and paraphrased from email exchanges and discussions over several months' time.

Holly: What are the types of technology that Alyssa has used in her life both at school and at home?

Sarah: Alyssa uses a switch activated remote control for the TV from Ablenet. We program in the channels that Alyssa is likely to want to see; six channels at this time. Alyssa scrolls through them to decide what she wants to watch. She uses this totally independently. She uses a cordless big red switch with an X-10 system. This controls the mixer and the blender. That is Alyssa's part of cooking. This can control lights and other small appliances. Her power chair is controlled with head switches. These can be unplugged to control the big red or the computer.

Her computer is used everyday (at home). Alyssa does e-mail with friends and family, keeps a diary, scans her recipes for her cookbooks, and listens to her textbooks when they have been typed in. She also has a switch activated telephone. It has 5 numbers stored in it, so she can call these people and hang up by herself.

Her computer hasn't been adequately used at school. There are several reasons. One reason I think is that the teachers she has had haven't been particularly computer literate. There has been a high turn over in teachers and aides every year, so as soon as someone gets comfortable with her computer they are gone. I think one of the major problems is that the teachers haven't actually ever seen a computer integrated in the classroom. One of the teachers liked having Alyssa's computer read the chapters to the whole class. Alyssa enjoyed that also. Unfortunately, this teacher didn't come back this year. Alyssa has used CCTVs since third grade. She isn't using one now. They have tried using communication devices with Alyssa. I think the main problem with them is that Alyssa has a good vocabulary, and likes to talk. She would rather wait and talk to people who understand her.

Holly: How do you find out about the technology that you have used with Alyssa? How do you find out about the technology assessments that you have had done at C-CAD (The Center for Computer Assistance for the Disabled) and UCP (United Cerebral Palsy)?

Sarah: I think there were several ways that we found out about technology. It wasn't in our local school district yet. In 15 years Alyssa has never had a computer literate teacher in her Developmental (multihandicapped) classes. Exceptional Parent had articles on children and technology for years. We began getting catalogs from companies that sold technology. The rehab center Alyssa went to spent years trying to set up a lab, and since I worked for a school district I knew that the Regional Education Service Center had software to lend and an assessment team. I went to meetings for parent groups that talked about technology. I had looked at the Dallas UCP web site, and saw they did computer evaluations. The problem is that they weren't equipped for a child with vision problems. The optometrist at the low vision clinic for children told us to go to C-CAD.

Holly: How do you get the tech Alyssa uses?

Sarah: Alyssa's first laptop was from TSBVI (Outreach Technology Loan Program). She now has one from the vision department of our school district. A laptop works much better for a child with CP than a regular computer. I can position the laptop and switch on her tray or the table to accommodate how she is comfortable sitting at the moment. If she wants to stretch out, she gets on a mat and still use her laptop. And it can go back and forth to school, vacation, etc.

The district supplied the Clicker 4 and Zoomtext. We have supplied Juno (email), and (mass market) screen readers and a version of Clicker 4. We have bought the switch activated TV remote and the cordless Big Red (switch) and X-10 (cordless environmental control) system, switches (from Ablenet) and an improved switch interface for the laptops. Insurance has paid for the power wheelchairs. A state program that provides phones for the disabled supplied the telephone.

Holly: What were some of the first things you tried with her, how did they work?

Sarah: Alyssa tried some communication devices at school and we would practice at home. The speech therapist in high school decided that it was too frustrating for her. I think the problem is that she would rather talk, and she has a great vocabulary. I would like her to be able to use a communication device with strangers who don't understand her. They will try using a simple communication device to use on field trips next year. Alyssa doesn't like to talk to strangers, so this might help.

The teachers in grade school and middle school did not use computers in the classroom with her. I don't think they had the knowledge and had not ever seen computers used in a Special Ed classroom. We purchased an Apple computer when Alyssa started Early Childhood, since we were told there would be one in the classroom. The computer in Alyssa's classroom did not ever get out of the box. The teacher didn't have any knowledge of computers, so she didn't push it. At that time, I think the technology department was setting up the computers in the district, and they were overworked and things sometimes got overlooked. I borrowed switch accessible software from the Regional Education Service Center. Alyssa liked it, and was good at the simple programs that didn't require reading.

This worked for a couple of years. The problem was that the programs became boring for her. Alyssa mastered cause and effect and the bigger than/smaller than type of software--I guess I mean basic concepts types of programs. This took awhile. It then seemed like she had mastered nonverbal programs, and the school began to work on communication devices. The more complicated programs were either too busy visually so she couldn't handle them, or required reading, which Alyssa couldn't do. So Alyssa's computer use was put on hold for awhile. I tried to find out about programs that might work for her.

When we moved here e-mail and good screen readers made computers useful for Alyssa again. If Clicker 4 had been available when Alyssa was in grade school it would have been great. The computers available then probably couldn't have run programs like that. Alyssa never really liked the simple switch toys. After operating them once or twice, they seemed to bore her.

Holly: Tell me about technology and applications on the computer that have been used with Alyssa for communication over the years. How has that worked out? What are some of the problems?

Sarah: There are problems finding computer software for a child that needs switches and is low vision. Most of the commercial software for children seems to be very busy with small pictures. So they may work with switches but they don't work with a child with low vision.

When we moved here, Alyssa needed a way to communicate with her relatives. We began to use e-mail. At first, Alyssa would dictate a couple of sentences (I would type them); I would read them back, and she would be done. Then we discovered free screen readers, like ReadPlease. This made a world of difference. When Alyssa could hear back what she had written, the whole process became more relevant to her. She then began sending a page instead of a couple of sentences. E-mail became very important to her, and she began writing friends as well as relatives. She still dictates. We did dictate into Click4, using a one-cell grid with a "read all" command as a screen reader. We have tried setting up scanning grids, but she likes to say so much and the grids would be too complicated.

We now use ZoomText (document reader function) while using Juno to read back what Alyssa has written. We also used JAWS the same way. Alyssa loves to e-mail. She does this as soon as she gets home from school, and again after dinner.

Alyssa then began dictating a diary on Clicker 4. She enjoys hearing back what she had done. Alyssa's class was making a cookbook of the scrambled eggs and toast kind of recipes. The physical therapist told Alyssa she could make her own cookbook. Alyssa told me, so we did. Alyssa picks out the recipes, we try them out, she runs the mixer. I type the recipe into grids, which Alyssa scans into the correct order (she uses auditory scanning to select the steps of the recipe and put them into the correct sequence). Alyssa gave them out as Christmas presents. The ARC contracted with the job coach at school to make 25 copies of the cookbook, which they will sell at a meeting, where Alyssa will autograph them. Alyssa has listened to chapters in short textbooks after they were typed into Clicker 4. We are now using ZoomText with chapters scanned into (Microsoft) Word (by the vision teacher or braillist who uses an optical scanner), which will work better. I have made worksheet type activities on Clicker 4 to go along with Alyssa's schoolwork. The teachers have liked them, but not made any of their own.

Holly: Talk about the different settings of her life now, and how the computer, JAWS and ZoomText (or similar things) Clicker 4, switches, communication strategies are used now?

Sarah: We were using JAWS with Juno, but the district took off JAWS and put on ZoomText. I have had trouble with ZoomText reading web pages. The next time Alyssa cooks in her home economics class she will have the recipe in Word, and use ZoomText and a switch to read it. The teacher didn't like the recipe in Clicker 4, because if you stop, the program always begins reading from the top. Alyssa will continue to use Clicker 4 at home for making cookbooks and her diary. I will also try to get the teachers to use worksheets on it, instead of doing them orally next year.

Alyssa uses her power chair controls as a switch if she is in that chair. I purchased a head switch on a gooseneck with a c-clamp that fastens to her manual wheelchair to use if she is in that chair. She uses a Jelly Bean switch (from Ablenet) if she is lying on the floor. We just purchased a Don Johnson switch interface that plugs into the USB port, so the computer can still use the mouse.

Alyssa's IEP calls for some low-tech communication devices to be used next year because Alyssa doesn't like to talk to strangers, even though she talks continually to people who understand her. So she will use prerecorded messages in simple switches on community outings and while picking up and delivering things at school to try to get her to initiate communication.

Holly: What are your dreams for how Alyssa could use tech in her adult life: work, recreation, participation in community settings, and other purposes?

Sarah: Alyssa wants to go to the special ed. program at (a local junior college). She loves her job, working at the special education office of her school district, shredding and doing things like that. She understands that it is a real job that needs to be done. A job like that in the community would be great.

I think she will always love to e-mail. Recreation is hard, because she doesn't like the Special Olympic activities. She loves to hang around with (her regular ed. friend) and go out to eat or shop. Her friend will go to college next year. I hope that Alyssa will make friends at (the junior college) who like to do the kinds of activities she enjoys. Alyssa plans to live at home. I had talked to someone at an ARC meeting who was in charge of group homes in our County. She felt that Alyssa would not be a candidate for the homes because of her physical disabilities. So there is a real worry of where Alyssa will live when Jim and I can't take care of her due to our age.

Technology has made great strides since Alyssa was born. It has made a real impact in Alyssa's life. I expect that there will be similar improvements. One thing that will be a big help for Alyssa will be when speech recognition programs get to the point where they can recognize speech that is as inconsistent as Alyssa's. She would no longer have to dictate, and could control the computer with her voice. I think there will be improvements in technology that I can't even imagine that will greatly improve Alyssa's life.

References

The best place to learn more about technology that is currently available and how is it used, is on the internet. If you don't have internet access, check with your local public library for availability of computers with internet access. Below are web and postal addresses for the resources mentioned in this article.

Ablenet, Inc: 1081 Tenth Avenue SE, Minneapolis, MN 55414, web address: http://www.ablenetinc.com/home.html

The Arc of the United States, (formerly known as the Association for Retarded Citizens), 1010 Wayne Avenue, Suite 650 Silver Spring, MD 20910, web address: http://www.thearc.org/

The Center for Computer Assistance for the Disabled Inc. (C-CAD): 1950 Stemmons Freeway - Suite 2019 Dallas, Texas 75207, web address: http://www.c-cad.org/

Clicker 4, available from Crick Software: 50 116th Ave SE, Suite 211, Bellevue, WA 98004: web address: http://www.cricksoft.com/us/

Don Johnston Incorporated 26799 West Commerce Drive Volo, IL 60073, web address: http://www.donjohnston.com/

Exceptional Parent Magazine: 65 East Route 4, River Edge, NJ 07661, web address: http://www.eparent.com/

ReadPlease Corporation, 121 Cherry Ridge Road, Thunder Bay, ON, Canada, P7G 1A7, web address: http://www.readplease.com/

United Cerebral Palsy (UCP), 1660 L Street, NW, Suite 700, Washington, DC 20036, web address: http://www.ucpa.org/


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