CHILD'S NAME: Mary Sample
123 Any Street Hometown, Illinois 60000
AGE: 5 years, 9 months; BD: 10/12/90
DATE OF ASSESSMENT: August 2, 1996
LOCATION OF ASSESSMENT: Western Illinois University, Horrabin Hall, Macomb, IL 61455
STAFF PARTICIPANTS AND POSITIONS:
Linda Robinson, TTAP Outreach Coordinator
Carol Schneider, Child Development Computer Specialist
John and Sharon Sample, Parents
TTAP Training Participants
This computer evaluation was videotaped.
REASON FOR REFERRAL FOR ASSESSMENT:
Initially Macomb Projects was contacted by Mary's mother to inquire about an assessment for Mary. Her family was interested in exploring how technology could help her both at home and at school. Mary has Spastic Quadriplegic Cerebral Palsy and poor vision.
The purpose of this session was to evaluate Mary's ability to use the computer for communication and to access the kindergarten curriculum. Her family is interested in finding out what equipment and software would be best suited for her needs at home and school.
EQUIPMENT AND SOFTWARE USED DURING THE ASSESSMENT:
Mary was evaluated from her wheelchair. The computer was placed on an adjustable table with the monitor positioned at a comfortable eye level for her.
Before the assessment began, Mary demonstrated how she used her Dynavox communication device. She used a Spec Switch at the left side of her head to start and stop a scanning array which gave her auditory cues.
To establish switch type and placement, we started with a simple picture and sound program, "Make It Sound," on a switch-operated software program, Switch Intro. In this program a picture appears on the monitor and a switch press causes the sound to be heard. We decided to begin with Mary showing us how she uses her Spec Switch at the computer. The switch was positioned at the left side of her head, a position she was already using at home for switch use. She turned her head to the left to activate the switch. She seemed to understand how to operate this first program and smiled at the sounds she enjoyed most. She responded with a "yes" to Linda, one of the team members, when asked if she wanted to change the picture in the program.
For the next activity the team decided to assess Mary's ability to use a different type of switch and placement. The Jellybean Switch was placed in a switch holder and positioned on the left arm of her wheelchair. Mary made a good effort to reach and press the switch, but as her hand moved across the switch, it would then fall off of the side of the switch holder. She would then have to work to get her hand back onto the switch. This positioning did not seem to work well for you. The switch was then moved to the right side of the wheelchair for use with her right hand. It was too difficult for Mary to reach and press the switch in this position also.
To provide more versatile switch positioning, we used a Universal Switch Mount anchored onto the left side of Mary's wheelchair. A Jellybean switch was fastened with velcro to the mount which was positioned close to the left side of the monitor. We used the story program, "Forgetful," on the software, Storytime Tales. A switch press turns the page in the story. Mary was able to reach the switch with her left hand fairly consistently, however her head would fall down to look at the switch and would remain down for most of the activity. To encourage her to raise her head more often, we re-positioned the switch a little higher. However she had difficulty reaching the switch in this new position. At this time, Mary's father brought her wheelchair tray into the room so that we could try switch positioning on the tray.
For the next activity the Jellybean switch was placed in the switch holder and positioned toward the left side of Mary's wheelchair tray, so that she could use her left hand to activate the switch. We continued with the same software program and Mary's brother and sister sat on either side of her to listen to the story also. Mary was able to press the switch, however her head remained down throughout most of this activity. She did not attend to the monitor. She only raised her head to answer questions Linda asked her about the story. She seemed tired at this point, therefore we decided to take a short break.
To assess Mary's ability to understand a simple scanning array, we used "Molly's Dirty Duds," another portion of the same software program, Storytime Tales. For this activity the team decided to test Mary's ability to use her left elbow to activate her Spec Switch. The switch was strapped loosely around her elbow so that when she moved her elbow back slightly the switch would activate. The program was set up for scanning with Ke:nx, an adaptive interface for switch or touch tablet use with the Macintosh. Mary was required to listen to the two choices, "Turn the Page" or "Read Again," presented to her in the scanning array which appeared on each page of the story. It was difficult to tell whether Mary was pressing her switch intentionally throughout this activity. She was able to press the switch, but she tended to leave her elbow on the switch often. She seemed confused by the scanning array, since she was familiar with using the program with a simple switch press to turn the page.
To further test her ability to use the Spec Switch at her left elbow, we changed to another program, Pippi, which was set up through Ke:nx to present scanning choices to play musical instruments. Pippi is a story and exploration program based on the Pippi Longstocking story. Again Mary tended to leave her elbow pressed against the switch several times during this activity. Also it was difficult to tell whether the switch presses were accidental or intentional.
At this time the team members wanted to assess one more switch position with Mary. The Spec Switch was positioned with a strap to the bottom of her left foot to test her ability to lift her foot slightly to activate the switch. We used another music program, the "Oranga" portion of Thinkin' Things. This program was also set up with a simple scanning array which scanned musical instruments which Mary could play by pressing her switch. Mary did very well with listening and following directions to lift her foot on and off of her foot rest in order to activate the switch. However she did have difficulty keeping her foot slightly elevated to turn the switch off. Team members discussed the option of using a switch which was always on and having Mary press down on the switch to turn it off. We did not have this type of switch for Mary to use during the assessment. Therefore further exploration of her foot use would need to be done. Throughout this activity, however, Mary kept her head down and only attended to the monitor when her mother held her head up for her.
Key Largo Activity
For the final activity we decided to assess Mary's ability to use the Key Largo, a touch tablet used in combination with Ke:nx for computer input. This device provides a larger activation area than a switch, and it can be customized for communication choices. The Key Largo was used with the "Bobby Bobby" portion of the Storytime Tales program. The overlay which was placed on the Key Largo had three pictures representing the communication choices, "I like this story," "squeaky clean," "yuk, dirty," and a picture of an arrow which turned the page in the story when pressed. Mary had difficulty reaching areas on the overlay and exerting enough pressure to activate the program. She did not attend to the monitor since her head was down throughout most of this activity. The Key Largo does not seem to be a suitable method of input for Mary at this time. At the conclusion of the story we ended the assessment. Mary played on a switch-operated Music Mat on the floor with her brother and sister while the team met to discuss recommendations.
With Mary's need for communication and a way to access the kindergarten curriculum, technology seems to be an appropriate tool to help further development of these skills. Mary demonstrated an enthusiasm for using her Dynavox and an understanding and enjoyment of the computer activities. She showed determination and persistence in using whatever input device was presented to her.
Mary showed reliable movement with her head and her left hand, demonstrating physical ability to activate a switch properly positioned in those locations. At this time touch tablet use with a device such as the Key Largo does not seem suitable for Mary's abilities. She attended most to the monitor when she was using her head to activate the switch, a placement she was already used to. She seemed to enjoy programs which offered a simple auditory stimuli of voices, sounds or musical instruments. This is understandable since she already relies on auditory cues to use her Dynavox.
All of these factors need to be considered for her effective use of technology. Based on a discussion of the observations of team members, the TTAP team make the following recommendations.
1. Input Method: Switch input seems to be the most suitable input method for Mary. Although Mary may be able to use several different types of switches, the Spec Switch works well when positioned properly. This is the switch type which she presently uses with her Dynavox. Her family has other tread-like switches which could also be positioned for head or hand use. We recommend consulting an occupational therapist for the most suitable positioning for the switch.
a. Spec Switch (Ablenet) The Spec Switch can be used with programs which reinforce communication, as well as cognitive skills, such as attending, and problem solving. The switch can be used with auditory cues in software to help Mary gain the necessary skills to use her communication device most effectively. Whatever switch Mary uses, stable positioning of the switch is essential. When using a tread-like switch, a wooden switch holder or a switch mount, should be used for positioning. Directions for making a switch holder and a list of switch resources are included with this report.
b. Ke:nx: In order to use the switch with the Macintosh, Mary will also need the Ke:nx® ($780 from Don Johnston) as an adaptive interface. With this additional equipment adaptations can be made to any software program to help meet her needs. Further information on peripherals is attached.
2. Computer Equipment: Mary would benefit from consistent use of a computer to help with accessing the kindergarten curriculum. Any recent Macintosh Performa model could be used with the recommended input method and software. However, if a new computer system is being considered for Mary, we recommend the following Macintosh system, or one which is comparable, to meet her needs as well as those of her whole family.
a.Macintosh Power PC Computer System, such as the Macintosh Power PC Performa 6300CD 16MB RAM, 1.2GB CPU, 15" color monitor. Other comparable Macintosh systems could be used, however when purchasing a new system, factors such as RAM, hard drive space, CD-ROM drive, monitor, and microphone, must be taken into consideration. See the attached page, "Considerations for Purchasing A New Computer System," for further information. One other important equipment consideration for Mary is the computer's ability to interface with her Dynavox. As she gets older she may want to use her communication device in conjunction with the computer for communication and classwork.
Any Macintosh system which meets these requirements will be adaptable to meet Mary's needs now, as well as in the future. There are many built-in options for persons with special needs, including slower key acceptance, delay in key response time, built-in speech feedback for some programs, and font enlargement. The computer can be used with software to help Mary develop a variety of skills.
Our recommendations are based on the most current computer systems and input devices available for school and home use. However older computer systems with similar functions, adaptive devices, and software may be used to accomplish the same goals. For further information on Apple IIe or IIGS applications and recommendations, please contact Carol Schneider or Linda Robinson. The Macintosh computer is recommended for two main reasons, adaptability for children with special needs, and educational software availability. Although there are other systems, such as IBM, which offer some of the same advantages, Apple and Macintosh still provide a greater variety of educational applications for children. Both IBM and Apple have special education offices which will provide further information on software and adaptations.
Office of Special Education and Rehabilitation
20525 Mariani Avenue MS 43-S
Cupertino, California 95014
408/974-7910 or 408/974-7911 (TDD)
National Support for Persons with Disabilities
Atlanta, Georgia 30301-2150
or D.A.N. (IBM's Disabilities Assistance Network)
b. Apple Color StyleWriter 2500 We also recommend a printer for producing words or graphics. To print color drawings or graphics, the Apple Color StyleWriter 2500 is a suitable model. A color printer is needed for printing computer screens for off-computer activities or communication overlays. Pictures which appear on the monitor can be printed and used in making books or other materials to help reinforce skills.
3. Software: Concerning software for Mary, we recommend working on a progression of switch activities. Switch-operated software can be used to learn and reinforce scanning skills needed for use with her communication device and future academic skills. Many skills, such as attending, visual tracking, problem solving, and communication can be enhanced through software use.
For computer activities, begin with simple programs which offer a variety of options, yet require only beginning switch skills. Good beginning programs for switch use which we recommend at this time include Switch Intro, Toy Store, Workshop, Storytime Tales, and Pippi Longstocking (Don Johnston). Mary should begin with activities which reinforce attending and other cognitive skills, while working toward a progression of switch skills. These programs contain a variety of options to help reinforce these skills. See the attached "Levels of Switch Progression for the Macintosh," for other suggested software to reinforce scanning skills. Other programs which will help enhance a variety of skills include Millie's Math House, Thinkin' Things, Just Grandma and Me, and Ruff's Bone (available from Educational Resources). A variety of activities can be developed around any of the recommended programs. Software resource information is attached.
4. Equipment Placement: We recommend that the monitor be positioned at a comfortable eye level for Mary. Also the computer environment should be designed with the least amount of distractions. The switch should be placed in a stable position.
5. Goals: Since Mary needs to develop scanning skills to use her communication device and the computer appropriately, we recommend that family members, teachers, and therapists work with her on a daily basis on the skill of attending to the monitor while pressing and releasing the switch. We also encourage incorporation of technology use into her therapy goals. Skills needed for appropriate switch use take time to develop. Consistent use of this equipment is recommended in order to develop these skills. In order to fully integrate the computer into Mary's curriculum at school, the role of the teacher and the environment are important. The teacher's role is critical in arranging the environment and planning developmentally appropriate activities for Mary. The computer environment should be designed so materials are accessible, computer activities are developmentally appropriate and interesting, and the computer is positioned at Mary's eye level. Mary would benefit from using the computer during free choice and group activities, as well as during individual therapy time. We recommend the incorporation of communication choices into planned computer activities. See the attached "Storytime" curriculum activity for an example of how technology can be used for a variety of individualized goals.
We recommend the following equipment and software for Mary at this time:
Macintosh Power PC Performa 6300CD 16MB, 1.2GB CPU, 15" color monitor or comparable system
Apple Color StyleWriter 2500
Ke:nx (Don Johnston)
Spec Switch (AbleNet)
Software available through Don Johnston:
Software available through Educational Resources:
Millie's Math House
Just Grandma & Me (CD-ROM)
Ruff's Bone (CD-ROM)
Along with Mary's present use of the Dynavox, computer technology can provide Mary with a tool for increasing communication, and helping to develop a variety of early childhood skills. She will benefit from consistent use of the equipment as a tool. This is an important time in her life for acquiring early concepts and gaining confidence in her communication and cognitive skills. By being given the opportunity to perform at her full potential now through technology, she is also becoming prepared for future use of the computer as a tool for later skills.
FURTHER SUPPORT FROM PROJECT TTAP:
Mary was a delightful child during the evaluation. She was very cooperative and showed a wonderful persistence to be successful. Her present ability and determination to communicate makes her an excellent candidate to succeed through technology. We wish the best for her and her family in the future. We hope that the information in this assessment report will be useful for family and school staff, not only for the present school year, but for years to come. Training and consultation on input devices or software is available through our Project. Please contact our office for a current schedule of workshops. Our Project has also compiled a vast library of resources on technology and will share information as needed.
Report was prepared by:
Linda Robinson, TTAP Outreach Coordinator
Carol Schneider, Child Development Computer Specialist/Trainer
September 3, 1996