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OT and AT - NCATP

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OT and AT - NCATP Powered By Docstoc
					Occupational Therapy and
 Assistive Technology:
      A Vital Link


       Molly Shannon, OTR/L, ATP
North Carolina Assistive Technology Program
       Charlotte, NC 704-355-2703
           mshannon@ncatp.org
              www.ncatp.org
     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
Overview of Presentation
 Definitions,   compare and contrast
  OT/AT
 OT Role
 Categories of AT and examples
 Resources
 Case studies
 Door Prizes
“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”
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
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
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.
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.
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)
 Inclusion Levels   Tasks               Location       Examples or AT
Full: Level 1       Same            With peers         Eqpt for physical

Full: Level 2       Same with    With peers            Increased time,
                    accommodatio                       decreased
                    ns                                 quantity, etc.

Full: Level 3       Same with       With peers         Varied input/
                    adaptations                        output on CPU,
                                                       format shift

Moderate: Level 4   Same with       With peers         Books on reading
                    content shift                      level, highlighted,
                                                       decreased grade
                                                       level

Moderate:Level 5    Same at         With peers or      Ex: coloring map
                    times:          separate part of   and tracing
                    Develop-        room               names of states
                    mental                             or name
Limited: Level 6    Functional      Separate           Functional words,
                                                       sorting,daily tasks
Limited: Level 7    Separate        Separate           Ex:IEP,cause
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
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
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.
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/ATConsidGuideADJ
    Zcomp.doc Principles:
    http://sweb.uky.edu/~jszaba0/Joyshandouts.html
Categories of AT

   Computer Access
   Augmentative communication
   Activities of Daily Living
   Environmental Controls
   Seating, Mobility and Positioning
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!
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
Hierarchy of
AT Computer
                         Least Restrictive Access
Access
Keyboard
Mouse Technology
Proportional Joystick
Switched Joystick
4 switches
3 switches
Single switch scanning
2 switches
Single switch
                           Most Restrictive Access
  Regular Keyboard Use



                                   Keyboard Labels or Keycaps,
                                   ~$20, various large print and
Slip-on Typing Aid, $16
                                   Braille,www.donjohnston.com,
www.beabletodo.com, various




Keyguards, $140
www.turningpointechnology.com,
                                 Low Vision Keyboard, $60,
various                          www.maxiaids.com
  Regular Keyboard Use: Typing Aids




Lefthanded Keyboard,
various, $99, www.fentek-         Page Turners, $28, $18,
ind.com                           www.maddak.com

                    Mouthsticks,
                    www.wisdomking.com,
                    $62 and Headpointer,
                    $112
Portable Word Processors:
Alphasmart 3000 $199        PC6 from Perfect Solutions
with Co:Writer Applet add   www.perfectsolutions.com
$139 or DANA                $290 plus a text to speech
www.alphasmart.com          component available for $99
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
     Trackballs, Joystick or Mice Examples




Kid-Trac or PC Trac/Max
                           Roller II Joystick or
trax, $69-79 (Microspeed)                            Logitech
                           trackballs, $309
various sources and                                  Trackman, $40,
                           www.enablemart.com        Infogrip
Infogrip, www.infogrip.com

                    Vertical Mouse, left or
                   right-handed,
                   www.sforh.com $72


                                       HelpiJoy Mouse, $199, Infogrip
                   Magi-Mouse, www.magitek.com ,
Mouse Emulation:   wireless computer/AAC control


QuadJoy $540
www.quadjoy.com




                         IntegraMouse, $2200,
                         www.infogrip.com
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
Computer Software: Onscreen Keyboard Example:
REACH Interface Author (329 to 549.00) www.ahf-
net.com, free 30 day trial, WIN
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
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
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
Software: Talking Word Processors
   Example, Write:Outloud, $99,
    www.donjohnston.com
More Writing software…
   Clicker 5, $199, www.enablemart.com
Writing Support Software
     Inspiration or Kidspiration, $55,
      www.enablemart.com, 30 day free trial from
      publisher www.inspiration.com
Voice Recognition:
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.
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
Hierarchy of Access Sites: Can Have
Multiple Sites for Access

Hands
Head/voice
Arms/elbow
Legs/knees
Feet
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%
Ideas for Feature Matching with
Switches: Varies with Clients!
Cerebral Palsy: coordination is    Pressure, rocker, wobble
key                                switches. Mounting!
Neuromuscular (ALS, MD,            Spec, light touch, blink, P
SMA): strength, ROM, fatigue       switch, cup, microlite
Spinal Cord Injuries: high level
quads                              Sip and puff, tongue, head
                                   controlled
DD/MR:
 bright, big, sturdy
                                   Big Red, Bass, wobble,
                                   auditory
Visual Impairments:                Texture switch, auditory
                                   feedback
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
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
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
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/Curriculu
  m/Writing/speechRecognition.php
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
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.
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
Environmental Control:ECU
or 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
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
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
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
Low Tech Toys and Learning
 My Handout
 Great research summary article about using AT with
  infants and toddlers:
www.asu.edu/clas/tnt/presentations/UsingAssisTechInfTodE
  BP.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!
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
More Toy Tidbits…

•Some call adapters, but adapters are the way
       to change from a 1/4 inch plug to a 1/8
       plug or vice versa
•Note can buy both from Enabling Devices, just
       not shown in catalog. Also from Radio
       Shack and others
•Many toys have multiple operations and may
       not be easy to adapt
•Some battery compartments are too tight to
       place copper disk in
•Rasp to notch edge of cable
•Key! One adapter for one toy! Last much
       longer, easily used…
Vision AT Examples
   Magnifiers, handheld, lighted
   ADL aids:many talking ones
    now for blood pressure, color
    and money detection (Voice
    It All, $250,
    www.maxiaids.com ,
    scientific calculators,hobbies!
   CCTVs, ex. Quick Look color
    portable, $745, Maxiaids
   Software for screen
    enlargement (Zoomtext) or
    screen reading (JAWS,
    $900-1100, Maxiaids) or
    Braille input/output
    Telephones and Cell Phones:

  Ameriphone RC 200 Handsfree telephone, $400,
 Picture Phones, $60, www.101phones.com
 Bluetooth technology advances
 Amplification,Headsets
 TTY, Relay services,Speech to Speech/Sprint
 Alltel Disability Access cell phone reference:
http://www.alltel.com/phones/disability-access.html
 Engineer who specializes in adapted cell phones for
   all disabilities, Ray Gonzales,
   919-523-0205
http://www.etoengineering.com/quadriplegic.htm
Mounting
Mounting Systems:
For Switches or AAC:
Cost varies with weight can hold, features


E-mount $99 or Magic Arm $190 from
www.adaptivation.com. Articulating
Arm from www.rjcooper.com $115.
Profiler-Lite $210, Slim Armstrong $191 ,
USMS $200 from Ablenet. MightyMount
$125 plus $90 for arm from TASH.

MAXESS switch mounting system, $55 from
www.inclusivetechnology.com
Early Positioning AT
 Bumbo Seats, $40, www.bumbo.com
 Ladybug corner chairs, $770
www.adaptivemall.com
 Tomato, ~2K,
www.adaptivemall.com
 Giraffe standers,
~1500,
www.adaptive.mall.com
 Upper Extremity Support




 Powerboard, www.sforh.com, $115    Zonco Mobile Arm Valet,
                                    www.zoncoarm.com, $838 plus
                                    for various attachments




Ergorest, www.infogrip.com, $119-   Morency Rest, www.sforh.com,
199                                 $115
Electronic Page Turning: Worth it?
Book holders and mouthsticks easiest! Cheapest as well.
Electronic: GEWA (Winsford) and Touch Turner




                               www.touchturner.com $980



 www.zygo-usa.com
                               Roberts Book Holder, $19,
                               www.activeforever.com
Low Tech Book Holders or Page Turning
   Handout: A-Z of Adapting
    Books
   Books on CD or tape, spiral
    bound for SCI is easier
   Book holders, nice ones from
    Bible stores
   Magnetic Page Turner, $60,
    www.augresources.com
   BookWorm, $239,
    www.ablenetinc.com switch
    access and voice output
I Love Cats!
Our Field Trip to Big Cat Rescue
Big or small…. I love cats!




  Link to how to adapt Powerpoint for switch books,
  various sites
  www.everhart.leon.k12.fl.us/downloads/Powerpoint%20V3.
  pdf
Power Mobility and Driving
 These are true specialty areas.
 Karen Kangas, OT, great resource for
  power mobility, 13 page article about
  LMN for head access for power mobility
  www.asl-
  inc.com/PDFS/overallhead.pdf#search='
  karen%20kangas%20AND%20assistive
 Peggy Barker, P.T. website with sources
  for AT for power mobility
  www.atole.com/
 Adaptive Driving, An Introduction
www.infinitec.org/live/driving/dealers.htm
                                             Melanie, from film
 Adaptive Driving and Vehicle
  Modifications, sources
                                             www.freedommachines.
  www.familyvillage.wisc.edu/AT/Driving.h    com
  tm
Service Provision Setting and
Examples of Possible AT
•   CP
•   Autism
•   MD/ALS
•   SCI
•   CVA
•   Learning Disabilities
•   Visual Impairments
•   Arthritis
•   Traumatic Brain Injury
Cerebral Palsy and AT
   Varies with type of CP: spastic, athetoid, etc.
   Athetoid connect most with AT with my
    experience
   AT to support overall independence, community
    skills, communication, work, leisure
CP: AT to Consider
   Adapted computer keyboards (mini, king,
    keyguards, alternate, virtual onscreen)
   Mouse emulation via trackballs
   Head based controls
   AAC
   Environmental control/EADLs
   Switch access for cause and effect, toys, leisure
   Word prediction and talking word processors
Autism and AT
   Varies greatly with level of autism and
    overall developmental level
   AT to support learning and
    communication, community skills, and
    leisure.                                  President Bush hugs
   Can assist with classroom behavior plan   Jason McElwain, the
    and goals as a motivator.                 autistic basketball
   Can work with perseveration and make it   manager who drew
    a functional and motivating activity.     national cheers by
                                              scoring 20 points in
                                              four minutes for his
                                              high school team.
Autism: AT to Consider
   Talking word processors
   Creative structured software for leisure: Ex: KidPix
   AAC support: devices or software based
   Possible touch screens initially
   Electronic books (audiocassettes or CD-ROMs) Ex: Living
    Books
   Educational support via special needs software: example
    Early Learning from Marblesoft www.marblesoft.com
Muscular Dystrophies, ALS and AT
   Various types: Duchenne‟s, Spinal Muscular
    Atrophy, ALS
   Age and needs of clients vary of course
   AT to support maintaining independence in
    writing, computer access, environmental
    controls/EADLs, feeding, leisure, communication
   Funding is possible with ALS/MD Associations at
    times
Stephen Hawking,
A Brief History of Time


“For a time after the tracheostomy operation
the only way I could communicate was to spell
out words letter by letter, by raising my
eyebrows when someone pointed to the right
letter on a spelling card. It is pretty difficult to
carry on a conversation like that, let alone
write a scientific paper.”
MD/ALS: AT to Consider
   Alternate keyboards: mini or Magic Wand
   AAC devices
   Switch access
   Trackballs
   Word prediction
   Electronic page turners and feeders
   Eye gaze systems
   Environmental Controls
SCI: AT to Consider
   Head based or sip and puff mouse access via
    QuadJoy, HeadMouse, SmartNav
   Dragon Naturally Speaking
   PC Trac trackball
   Adapted desks
   Voice activated telephones and environmental
    controls/EADLS
   Alternate keyboards: onscreen or mini
   Keyboard trays, lapboards, forearm supports
   Possible eyegaze computer access for highest level
    of injury
                       www.scipilot.com




“I should be approached with the best [assistive
technology] that is available and find a way to get it
[funded]. And if I can’t, I can [downgrade], but I should
be able to see what’s available.”
- Marilyn’s story
SCI Functional Independence Guide

     Activity         C1-4       C5         C6          C7          Para

     Feeding          N          A          Y           Y           Y
     Dressing:U       N          A          Y           Y           Y

     Dressing:L       N          A          A           A           A
     Bladder          N          Y*         A           Y           Y
     Bowel            N          N          A           Y           Y
     Transfers        N          N          Y*          Y           Y
     Manual WC        N          Y*         Y           Y           Y

     Power            Y          Y          Y           X           X
     WC
     Driving          N          Y*         Y           Y           Y

     Key: N= Not independent, Y= Independent, A= Independent with assistive
     devices, Y*= May be independent, but not expected, X= Not usually needed
    SCI AT Products of Note
 Quad Desk, $975 plus
Various components
www.enablemart.com

Quad Reacher,Vee-Zee C5
 Reacher,$182,
www.allegromedical.com
                    Psychosocial Aspects of
                    Recovery
I’ve often talked about the transition I have to make
almost every morning. I have to emerge from the
dreams in which I’m completely healthy and able to
do anything and adjust to the reality of paralysis.
Once that moment passes, I begin my day rationally
and hope returns.
Learning Disabilities and AT
   Underutilized area for AT is with those with
    learning disabilities

   Usually can see the most opportunity for
    improvement

   AT allows to level the playing field or impact of
    disability no matter what the age
LD: AT to Consider
   Handwriting aids
   Software to support writing such as word
    prediction or voice recognition
   Outline or organizer software
   Organizers (software or PDA)
   Electronic or handheld spellcheckers
   Reading support via OCR assistance such as
    Kurzweil 3000
    Visual Impairments and AT

   Visual impairment vs. blindness

   Different organizations and
                                               Stevie Wonder
    professionals can really help us provide
                                               Unveiled Breakthrough
    best services
                                               Music Video Using
                                               Description
   AT to increase independence in writing,    Technology For Blind
    reading, vocational, community and         And Low Vision Music
    leisure skills                             Fans
                                               http://sev.prnewswire.c
                                               om/entertainment/200
                                               50514/NYF058130520
                                               05-1.html
VI: AT to Consider
   Depending upon age and degree of visual loss
    and Braille or not
   Talking word processors
   Screen reading programs
   Screen enlargements
   Portable Braille devices
   Internet access
Arthritis and AT
   Standard OT methods of energy conservation and
    activity modifications

   AT to improve independence in self-care, cooking,
    writing, computer access, leisure

   AT to consider: minikeyboards, trackballs, voice
    recognition, ADL devices, leisure AT products
CVA and AT
   Obvious left vs. right CVA
    differences lead to different AT
    needs
                                            "My stroke changed me
   AT to increase independence in          into a better person — a
    functional upper extremity skills for
    communication, writing, reading,
                                            person whom I like. We
    feeding, self-care, leisure             all want happiness. I've
                                            learned we achieve
   Big impact with augmentative and        happiness when we
    written communication, return to        seek the happiness and
    work or other life roles.               well-being of others."
                                            from My Stroke of Luck
                                            by Kirk Douglass
CVA: AT to Consider
   AAC devices

   One handed keyboards

   Onscreen keyboard

   ADL devices

   Writing aids
Traumatic Brain Injury and AT
   One of most complicated areas of AT provision as
    there are so many different areas affected:
    cognitive, motor, visual, sensory, communication
    and psychological

   AT to increase sensory stim and cause and effect,
    motor control for writing, communication, cognitive
    skills
TBI: AT to Consider
   Switch access for toys/leisure/ECU/AAC

   Augmentative communication

   Computer access via mouse emulation with switches or
    touch screen, etc

   Cognitive supports via electronic reminders, software,
    organizers
Orthopedic and AT

   Temporary Injuries or Post-Surgery needs
    for low tech ADL is standard.

   One handed needs for keyboarding or self
    care.
Case Study: Kelly, CP, age 11
   Home schooled now by mom who is a teacher
   Using an AAC device to clarify speech
   Using roller ball joystick and some regular and spec ed
    software
   Trying adapted cooking items already
   Attempting to handwrite and cut, very motivated still
   Using a book holder and magnetic page turner for a trial
    now
   Exploring various software
Case Study: Michael, CP, teen-adult,
transitions in life
     Originally seen in middle school as school district OT,
      computer access in school goals at that time and aide
      training and support
     When began college, called in for AT and accessibility
      study by Voc Rehab
     Two years later, CAP Medicaid Waiver case manager has
      requested help
     Has tried many types of AT for computer access, but
      prefers head pointer. Uses laptop, hands-free Ameriphone
      RC 200 with a headset, ordering an accessible/adapted
      mobile phone with Bluetooth capability for hands free
      calling and answering from wheelchair. NC contact:
     Will have seen in public school setting, college and will
      help transition into work world and independent living
      settings in the future.
Case Study: Allen S, CVA, 19 years
old
   Initially thought he was locked-in syndrome
   Have seen him from ICU through getting him
    ready for college
   Areas assisted: augmentative communication
    trials/ordering/loaner/training, computer access,
    positioning of keyboard with lapboard, advocate
    for helping him get going with college application
    and coordination with other agencies for funding
Case Study: Carla, C6 SCI, 28 y/o
    Initially saw in rehab for voice recognition
     software which her family purchased along
     with a laptop for her
    Did work site eval for AT
    Technology using now: Quad Desk, Dragon
     Naturally Speaking, lapboard,
     mike/headphone switch kit, slip-on typing
     aid, mini-keyboard
    Returned to work with DSS
Case Study: Jo, ALS, 52 years old,
former RN
   Assisting ALS clinic with head based mouse
    control and some environmental control
   Very computer literate and participating in an
    online research project with a doc for ALS
   Technology using: laptop computer with Head
    Mouse Extreme, REACH onscreen keyboard,
    Ameriphone RC 200 Handsfree telephone,
    Dynamyte AAC device and for environmental
    control
AT Resources
  •   RESNA Technical Assistance Projects, state
      listing, www.resna.org
  •   Alliance for Technology Access
      www.ataaccess.org
  •   Abledata www.abledata.com, major source of
      AT info in a database
  •   Family Center on Disability and Technology,
      www.fctd.info/
  •   Wisconsin AT Info, www.wati.org/ great
      resources for educational AT, free eval and
      data forms
  •   Frticschi‟s AT Tool Chart, great wealth of info!,
      http://fritschi.home.mindspring.com/tools.html
More great resources…
  •   AT Training Online Project, Univ of Buffalo,
      http://atto.buffalo.edu/
  •   Let‟s Play Project, fantastic AT info for children
      http://cosmos.ot.buffalo.edu/letsplay/AT/at.html
  •   Boston Schools, Strategies and Tools for Adapting Books, 15
      pages,
      http://boston.k12.ma.us/teach/technology/emmanuel/Modifyin
      gBks.pdf
  •   JAN, Accommodation Guidelines by Disability,
      http://www.jan.wvu.edu/media/atoz.htm
  •   AAC resources http://aac.unl.edu/yaack/toc.html
  •   Family Center on Technology and Disability
      www.fctd.info/resources/
Disability or Age Specific Resources
   Extra Hands for ALS, great website with AT and
    other info http://extrahandsforals.org/mt/
•   SCI Pilot, www.scipilot.com
   Chicago Lighthouse for the Blind has launched an
    AT support line. Individuals who are blind,
    teachers, and others can call (888) 825-0080 for
    help in resolving issues
   Brain Injury and use of PDAs resource
    www.vcu.edu/partnership/pda/documents/Product%
    20Reviews.html
   LD and AT
    www.ldonline.org/ld_indepth/technology/technology.
    html
More…..
   AT for young children www.abilitynetwork.org/links.html
   Universal Design
    www.extension.iastate.edu/Pages/housing/uni-design.html
   College and AT Resource Guide
    www.htctu.fhda.edu/publications/articles/cahe/cahe.htm
   Home Modifications and other AT info
    www.atnet.org/education/homemod.htm
   PaTAN 13 pg guide “ AT: A Focus on Accommodations for
    Learning” includes method and material accommodations and
    accomodation technology ideas for various skill areas
    including, writing, organization, etc.
    www.westernwayne.org/instserv/resources/learningaccomodati
    ons.pdf#search='accommodation%20Technologies
   Baltimore Schools 500 books for which Boardmaker
    communication boards have already been made (have to have
    current version of BM)
    www.bcps.k12.md.us/boardmaker/adapted_library.asp
Conferences, Trainings
   CSUN, March, Los Angeles,California
    www.csun.edu/cod
  Handouts from previous conferences
  www.csun.edu/cod/conf/proceedings_index.htm
     RESNA, June, cities vary www.resna.org
     Closing the Gap, October, MN www.closingthegap.com
     ATIA, January in Orlando www.atia.org
 Freebies!!!!
 Click „n Type: free onscreen keyboard,
  http://www.lakefolks.org/cnt/
 DASHER: unique text entry!,
  http://www.inference.phy.cam.ac.uk/dasher/
 E-triloquist: free PC talking program,
  http://www.etriloquist.com/
 ATA: We Can Play series,
  http://www.ataccess.org/resources/wcp/endefault.html
 National Cristina Foundation: donated computers to non-
  profits, schools or agencies, http://www.cristina.org/
 Learn to Type, free online typing test and tutor,
  http://www.learn2type.com/
 Jim Mullen Foundation, free computers and software for
  persons with disabilities,
  http://www.jimmullen.com/ZoomSeq.asp?id=7948
 List of freeware and shareware on our website
www.ncatp.org/Celeste/west1.html#abbreviation
Top Ten Things to Not Say About AT/AAC

   1. It‟s not my job!
   2. I don‟t know anything about AAC or AT.
   3. He‟s just not ready developmentally for it.
   4. It‟s broken!
   5. It costs too much.
   6. It takes too much time.
   7. He won‟t use the device.
   8. I am not a computer programmer!
   9. Switch toys are so boring.
   10. There is not training or support for me!
When we do the best that we
  can, we never know what
miracle is wrought in our life, or
     in the life of another.
           Helen Keller

           Door Prizes!

				
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