AT in the Classroom: SETTing the Example for using Assistive Technology

Sometimes I take for granted what I have learned about assistive technology, so let me start out by sharing and defining it before diving into examples...

Assistive Technology (AT) is defined in the Individuals with Disabilities Education Act (IDEA) as 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. It does not include medical devices that are implanted, such as cochlear implants.

As part of every Indvidualized Education Plan (IEP), Assistive Technology should be "considered" as part as the child's ability to have access to a Free and Appropriate Public Education (FAPE).

With all that in mind, in this alphabet soup of educational acronyms, how can parents, educators, and therapists search, select, and support children with complex needs?

Using the SETT Model, as developed by Joy Zabala who is a leader in Universal Design for Learning (UDL) concepts, it is recommended to look at four components: Student, Environment, Task and Tool.  First, you look at the Student: what are their strengths, needs, and motivating factors.  Then, look at the Envirnoment: where is the student going to be completing the task?  Third, name the Task: what does the student need to do or learn? Last is the Tools: how is this child going to access the task at hand, as independently as possible?

When I am working with students, I collaborate constantly with a group of amazing therapists and educators.  We try to look at all options from no tech to high tech. You don't want to jump to the iPad with ProLoQuo2Go if it's not going to work to the child's strengths and meet their needs.  Let me give you a few examples:

Example: 

The Student: A preschool student with significant physical and cognitive disabilities. S/he is able to reach, grab and release with both hands.  S/he is motivated by sensory exploration, food and music.  

The Environment: Student will be completing tasks in the OT room, the classroom, and academic specials like gym, art, and music.  

The Task: develop a means of communicating needs and wants.   

The Tools: 
No Tech: Incorporating the use of gestures, eye contact and vocalizations into activities

Low Tech Option- pictures, like Boardmaker, SymbolStix, or downloaded pictures from the internet.  

Mid Tech Option- voice output single switch with a picture indicating what it says or a swtich activated toy (available through specialty vendors such as Enable Mart  or Able Net or potentially Amazon).

High Tech Option- iPad with Cause and Effect music based play apps such as Inclusive Tech, with a switch and Blue tooth switch interface for the iPad such as the Pretorian APPlicator

During therapy sessions, I use them all.  The combination of all approaches supports intent, initiation, persistence, and communication needs through motivating play. This student must request a turn using a picture exchange to then activate the cause and effect switch based toy/app, indicate more wanted time on the swing, or use of the rice box.  Notice, I haven't attempted to start an alternative and augmentative communication (AAC) app.  S/he is not ready for it yet.  Maybe in the future, maybe not.  

Example 2.

The Student: Student with significant physical mobility challenges. S/he is very bright but has difficult time keeping up with his/her peers during class activities. S/he can type on average at the same speed his peers write; s/he can write single letters and numbers recognizably but large.

The Environment: regular education setting

The Task: S/he needs to be able to complete math, reading, and writing worksheets independently.

The Tools: 
No Tech: scribing, however this involves an adult or peer to do the work, and the student is dysarthric. Reliability of answers should be considered.

Low Tech: Use a Slant board, built up pencil, and strategic positioning (and repositioning) of materials

Mid Tech:Lap top already available in the classroom with shortcut to a word processing application and a printer

High Tech: iPad with a PDF translation app that takes a photo, turns it into a PDF on which the student can type or draw on, access to email and/or printer

The student uses a combination of all four, again. Now that the student has access to the tech, the need for the scribing is lessened.   Sometimes the child wants to write. So with strategic positioning and his built up pencil, s/he can fill in the blank or draw the lines. But when the writing is more than a few letters or numbers, he can complete his work on either the iPad or the computer.  Is it perfect? Is it up to UDL? No, because in theory, the means of his expressing his knowledge wasn't explored before creating the lesson.  But does it work and give him improved access right now?  Yes.  

Example 3.
The Student: Elementary student with decreased strength and endurance to upper extremities and absent lower body sesnsation.  Also wears glasses.  Enjoys reading and music, but has a hard time comprehending and expressing what she knows.  S/he hunts and pecks on the keyboard.
The Environment: The inclusion classroom
The Task: Reading assignments, comprehension
The Tools:
No Tech: Provide modified educational materials like multiple choice questions
Low Tech: Highlighting strips to visually narrow the area the student needs to which s/he needs to attend. Access to read-aloud accommodations on the ePublished version of the reading program
Mid Tech: Access to laptop with a text to speech app/extension (Read and Write for Google, Readability, etc)
High Tech: iPad with PDF translation app to enlarge the print on the screen and limit visual clutter.  If student has a print disability, may qualify for Bookshare account and could use Voice Dream app on the iPad as well.

Combination of all four.

Notice the trend?  There is no end-all, be-all answer to access needs because depending on the strengths, needs, environment, and task, the tools required will be different.  And it is always a work in progress as the demands of the schoolwork change.  The important thing to take out of this is that you need to ask the right WH questions.  Who? Where? What? and How? Because if you don't know the answer, you can consult with your team or request an Assistive Technology Evaluation from your local AT group, in accordance with your district policies and procedures.  If you're not sure, refer!  

If you want to learn more about SETT, UDL, CAST, AIM, or any of the other Assistive Technology acronyms, there are amazing free and at cost webinars available on-line through AbleNet University, CDT Institute, and AOTA .  And don't forget to make friends with your local AT program!  They can be an amazing resource.

Adventures in Assistive Technology: Adapting the Power Wheels

I had been dying to do this project for over a year, since I had first heard about the Go Baby Go through the University of Delaware.  It was an AH HA moment.  I could totally do that. Adapting a powered toy car so my kiddos could have access to play with their peers as well as build other skills such as switch use, or head and trunk strength, or language, upper extremity strength... you name it, I could justify it.  It is my magic, as an OT, ya know to justify ANYTHING!

So a few weeks ago I finally resparked the flame of innovation and started asking for donations of used power toys.  And to my joy, my nieces and nephews donated their John Deer truck because they weren't using it anymore and they wanted to help my kids.  There I was, John Deer in hand. Now to get the rest of the supplies.

Ratcheting PVC cutter
Cuts through pipe like buttah'

Switch. Check.  (ablenet.com)
PVC piping. Check.  (local neighborhood hardware store)
Nuts and Bolts. Check.  (local neighborhood hardware store)
Kill Switch. Check.  (amazon.com)
A husband to help me rewire. Check.

Once my Mr. Fix-It helped to rewire and solder the gas pedal to the switch, I got my Ratcheting PVC cutters out.  These are a necessary tool if you work with PVC.  Worth every penny.  I also got to steal Mr. Fix-Its Dremel tool and new Milwaukee Power Drill to perforate the holes in the piping and the truck to install the support frame.

Finishing touches included good ole pipe insulation,  duct tape to provide a softer support to the bracing, and industrial Velcro for a lap belt and shoulder support.  And voila, Pimp My Ride: John Deer Power Wheels edition was complete.

My son testing it out

When I envisioned the outcome, I primarily had my students with significant physical disabilities in mind, but the benefits of the project spread beyond that group.  Students with autism found it quite intriguing and motivating.  Those that were non-verbal, vocalized and expressed words such as "Cool!" "Go!" "4 by 4" and "Deer".  It gave others a chance for parallel play and structured communicative play by incorporating voice out put switches with phrases like "Do you want to go for a ride with me?" and "GO!"  Driving also encouraged bilateral hand use and intrinsic hand strengthening, as the children have to use push the switch while holding the steering wheel as they drive.  For my more involved students, I steer while they activate the switch.


Though not 100% complete, I still need to set a secondary switch for a right cheek activation site, this project is well on its way to fulfilling its purpose: increasing participation amongst children with multiple disabilities during free time play.  I actually wish that I had considered completing a research study on its effects on social participation.  Maybe next year....

Overall, I would consider this an advanced project due to the nature of adaptation and tools needed.  If I didn't have my husband's support, I don't think it would have made it out of my basement.  Also, there are a significant amount of obstacles.  First, logistics.  The size of the vehicle is big.  It's a two-seater.  And even though we removed the dump bed from the truck, it is still large to store (ask my co workers).  So if you are considering doing a project like this, you need to examine your storage capacity.  You also have to respect administration for your building.  I am lucky to work with educators and facility managers that don't mind my therapeutic antics.  Second, cost.  Though the power wheels was donated, I purchased most of the materials.  PVC is cheap; foam insulation is cheap; switches can be costly.  I completed this for under $50 but I had a lot of materials and tools already.  Third, overall understanding of positioning and access sites.  Position of the body is key to accessing life, including switches.  If a child is not supported appropriately and safely, the participation in motorized play will not be successful.

Sea Choice Universal Kill Switch
Available through amazon.com

So if you are interested in researching a project like this, check out Cole Galloway and his team at the University of Delaware.  I downloaded their instructions, and then modified it to fit my needs.  For example, the kill switch they used is a single throw switch; my Mr. Fix It recommended the coil based like ones used on boats. Since it attaches to me while the children are driving, I don't have to worry about them driving off.  Go Baby Go project developers recently published new directions which are clearer and more organized.  And if you want to help me make another adapted car, you can visit my Donor's Choose site.

Special Thanks to Maddie and Patrick for donating their toy! Without it, my students would not be having nearly as much fun!

April is National Autism Awareness and National OT Month.

This was my guest post on BlueOrange Games' blog.  I just wanted to share it on this as well because much of what I do as an OT is work with amazing children with autism.

It makes sense that these two things are together since Occupational Therapists are often an integral part of the educational and clinical treatment team for a child with Autism.  Now that I have had the pleasure of working with children who are on the spectrum for some time now, I would like to share the top 5 things I have learned from these amazing kids.

5. Just because I am not looking at you, does not I do not see you.

Children with autism often look at people through their peripheral vision. It is difficult to look at a person directly and take the infinite number of muscle combinations AND listen to what they are saying. So if someone with Autism does not look at you in the eyes while talking, please understand you are a visual complex piece of art, and it is sometimes hard for someone to look and listen at the same time.

4. That clock ticking in the background is making my head explode.

Things you and I may be able to force to the background, like the clock ticking, a fan humming, a light flickering, may not be the case for someone with autism.  Many times a person with autism is on high alert to the things in their environment.  Their threshold for tolerating the smells, sounds, sights, tastes, and touches of the environment they are in can send their bodies into flight or fight mode. 

3. Show me, don’t tell me.

Visual supports help many people with and without Autism Spectrum Disorder. I love my checklists; it helps me organize my day. But breaking down tasks and expectations with visuals, either words or pictures, can help ease anxiety and help someone with autism be successful at home, school and work.

2. Give me a minute, will ya?

When I first transitioned to school based therapy from geriatrics, I had the pleasure of attending The Autism Project of Rhode Island’s A Starting Point, which was a multi week learning experience that touched on many aspects of Autism. But one of the most poignant statements was regarding giving time to process auditory requests.  Picture a rotary phone (if you don’t know what a rotary phone is, ask someone at least in their 30s); every time you verbally request something it sets the dial back all the way.  Give time for the dial (aka person) to process it or they will not be make the call.

1.  I am awesome.

There is an amazing person stuck inside that little body, just waiting for someone to make a connection and “get” them.  Sometimes it takes getting them on a swing or blowing some bubbles to get that little smile or laugh.  Then before you know it, that little person is requesting more with signs, gestures, pictures, or words.  Other times, you have to take a sledgehammer to open the door to functional communication just a little crack. But keep working, because there is an awesome little being in there, wanting someone to play with them.

If you want to be edutained….

The MacGuyver of Assistive Technology herself, Dr. Therese Willkomm will be in Rhode Island in March to lead a great workshop.  I have had the pleasure of participating in Therese's workshops twice.  Her unique presentation style and ideas ignite creativity and practicality that will follow you to work and home immediately.  After her workshop, I visited my local Ace Hardware multiple times to get my hands on PVC piping and various other supplies to make a variety of assistive tech supports for my students.  And luckily, my husband has access to lots of companies who supply many of the materials she recommends.  So if you want to be edutained, consider contacting TechAccess to register for this make and take session with materials included!

Assistive Technology Solutions in Minutes – Using Ordinary Items to Create

Extraordinary Solutions – A Hands-On Make and Take Fabrication Workshop

March 28, 2014 8:30 am —3:30 pm

Learn how to make over 50 adaptations to accommodate someone who experiences a disability. This hands-on, interactive fabrication workshop will teach you how to make over 50 adaptations in 5 min. or less. These adaptations include assistive technology mounting solutions for a wheelchair, table, bed, car, crib, and other surfaces; adaptations to an iPAD; creating basic switches; and making solutions using various plastics. Each participant will fabricate: an iLean, BookiLean, SlantiLean, ScaniLean, SitiLean, FlipiLean, MouseiLe-

an, a battery interrupter; momentary switch; a Plate switch; a camera mount; and an adapted stylus. In addition, participants will learn how to heat and bend acrylic and cut PVC pipe.

Materials and Registration $180.00 

Contact TechACCESS to inquire about group discounts    

To register for any of our workshops visit our website: www.techaccess-ri.org 

The mission of TechACCESS of RI is to promote and support the independence and achievement of people with disabilities through the use of technology.

Tech Tip: Using the Clock Timer on your iDevice to Teach "Help"

I'm kinda evil sometimes.  And the other night, I had a 3 am epiphany: Use the Clock Timer to teach the concept of Help.

Many of the students with whom I work are non-verbal and use a picture exchange system to communicate. With any learning experience, repetition is key to learning a new concept.  And help is sometimes a difficult one to teach.  So, you have to set up the opportunity.  With iPads and iPhones pretty prevalent at school and home, this opportunity knocked.  It takes a little finesse, but I tried it with a student with autism with really good results.

First, Create and Set your Passcode, if you haven't already…
Go to General
Then Passcode Lock

Enter an EASY TO REMEMBER passcode and set it to Immediately

Now, can exit out and find your Clock. Go to Timer. Scroll all the way down until you see Stop Playing, and select it.  This will shut off what ever you are doing when the timer goes off instead of playing Waves or Twinkle.

Here is the fun part. Before you hand the iWhatever to the child, set the timer.  I usually just set it for a minute. Then put them into whichever app you chose.

As the child is playing in the app, the timer is going and going.  When the time is done…. it goes to your lock screen. Poof.

I have a picture card of HELP placed near the child and at first had to do some physical prompting.  But eventually, the child will hand me the picture. "Help." When they do, I put in my Passcode.  But before I give it back to them to play,  I quickly set the alarm again.

When the alarm is set for brief amounts of time, there are plenty of opportunities for "Help".  Be sure to keep an eye on the frustration level, you don't want it to get to elevated. This little trick might be a good option for many children who need to learn or generalized the concept of Help.

OT Soap Box: SPD

I bet few of you know that it is Sensory Processing Disorder Awareness Month.  Don't worry, I didn't know until the other day either.  And I'm an OT!  I felt like I should have known.  So to celebrate SPD Month, I wanted to share some insight, websites, and other tidbits about it.


First, how many senses do you have?  I bet you said 5: touch, taste, smell, sight, sound.  Well, if you said that, you are partially correct.  In fact, you have seven, and I bet you forgot Proprioception and Vestibular senses.  Proprioception is the way your body and brain sense how much force is needed, like the ability to judge how to tap your neighbor to say excuse me rather than punching them.  Vestibular sensations allow your body to understand your head's position in space, like if you are tilted, upside-down or right side up.  And when any of these senses are not working properly, then you get .....Sensory Processing Disorder.  When the brain and body cannot quite understand how to interpret and execute functioning in the world around them. 


Research has been going on for years and many have been working diligently, advocating to the American Psychiatric Association to have it added to the DSM (the Diagnostic and Statistical Manual of Mental Disorders now working on 5th version due out 2013).   But they have been met with caution since SPD can look like ADHD, Autism Spectrum disorders, and other illnesses, or be secondary underneath them.  But the SPD Foundation has recently shed positive news saying that possibly Sensory Under Responsiveness and Over responsiveness may be an associated feature under the Autism Spectrum, which may help people get insurance to cover much needed clinical treatment.  I can only hope!  I know too many that get denied and have to pay out of pocket!


But in the meantime, to support a child with an SPD takes a lot of patience, trial and error.  But there are people out there wanting to help.  First, if you suspect you or your child is having a hard time, talk to your pediatrician and possibly get a referral for an OT evaluation.  But be ready to be on a long waiting list.  In the mean time, talk with your child's teacher to see how they are doing in school.  If they appear to be struggling, meet with the educational team and request a screening.  If you've been there already, check out companies like Fun and Function who wanted to make sensory items affordable, as often they are not. And get connected.  Often other parents and therapists can lead you in the right direction of who to see, what to get, as well as be a shoulder of support.  Last, or maybe I should say, Always, keep your head up.  You are your child's best and most loving advocate.  Be open. Be loving. Be patient.


Check these out!
Do You Know Me? by Melissa Zacherl
Sensory World Poster
Sensory Street Parent Tool
Sensory Street Research
Heavy Work Activities 

Road ID, My Family's Peace of Mind

It started when Kyle began running about a year ago. He had little choice but to run in dark.  Durty Feets told me about his Road ID so I looked into the company. Road ID is well known among runners for their basic concept of an identification bracelet for the just-in-cases of the world.  You know, get hit by a car, have an asthma attack, pass out from heat exhaustion, whatever.

At Christmas time, I purchased the Wrist ID Sport (above), the Firefly Supernova in blue (below), Firelfy laces and some Speede and Aireator socks. Like I said he was running at night, I wanted him to make it home. He could have caused a seizure to drivers with the Supernova on blink mode, but he could be seen.  And that's what I wanted.

But now fast forward to current day.  I have been running for a few months, completed one 5K, and had done so using my husband's identification.  Kinda funny since my cell is on his bracelet so that wouldnt do me any good; luckily it has room for 2 contacts.  Finally the other day, I purchased my own Road ID Slim, which is basically a silicone wrist band with the metal identification piece attached.

I've worn it running, and I am also wearing it when I am out with the kids for the same reasons.  My oldest knows our home telephone number, but in case of emergency the Road ID has my two contacts.  God forbid anything happens during a nature walk or a bike ride, at least someone can get in touch with my family.  I am actually considering getting the two boys their own IDs as well.  It is also a good alternative to the medical ID bracelet and because it comes in different colors and styles, children with special needs can wear it without feeling funny, especially if they have the Shoe or the Ankle ID.  And now, Road ID has come out with a pooch friendly Scout ID that doesn't jingle, like the one our dog Maggie uses.

There are tons of reason to check out Road ID, but the main one is for peace of mind, which is why it was created.

OT Soap Box- Autism, yup there's an app for that

When the iPad was first introduced the first thing I said to Kyle was "wow, if they could make an augmentative communication application it would be way cheaper than the Dynavox."  Dammit if I only knew how to make an app. I contacted Apple. I contacted a few other sites to no avail.  I swear within a few days, though, people read my mind and I came across quite a few apps that could make children with autism and other speech and language difficulties be able to "talk" to their family and friends.

Go to the app store on you iPad or iPhone or even iPod and just search autism.  Tons of things will come up. Some free some not.  But it is really amazing the variety of things out there that can help anyone from stroke victims to autism. Not only that, there are apps for schedule makers, first/then boards, timers, as well as items like Proloquo-to-go which are set up similarly to a picture exchange system.

Traditional systems like the Dynavox are still very good, but they are heavy and cumbersome.  I had little ones who were no bigger than my three year old, not really able to use it on a daily basis because it was too damn big and heavy.  They may be sturdier but they are anywhere from $7-10 thousand dollars.  If the family can advocate and get down insurance throats or get special grants, maybe they might get it covered.  But for $499 and up plus the cost of an app, and cover, it all of a sudden makes it that more accessible for the child to have a more accessible world.

OT Soap Box- Daily Pint Size Inspiration

I love my kids. Not just the ones I gave birth to but also the amazing ones with which I work. Many of the children I get to play with on a daily basis are those with exceptional needs, including many with autism. Most of these kids are under 6 years old. They don't speak. But they can make me smile doing some of the simplest things that many of us take for granted with our own "typically" developing kids. 

The first time they exchange a picture to request more swing time...The first time they squish play doh.... The first time they jump on a trampoloine without me having to bounce it with my foot.... The first time they look me straight on the eye and give me a high five.  

These children are just a few of the approximately 1:100 that are diagnosed with autism spectrum disorder. April is Autism Awareness month. So I figured I might step on the OT soapbox for a few blogs to talk about it.  These kids are still just kids trying to make sense of a world that is trying to make sense of them. 

Check out www.BradyRymer.com for kids' music inspired by children at the Celebrate Children School in Wharton, NJ.  Part of the proceeds of the his album "Love me for who I am" will go to Autism Speaks and the Celebrate Children School.