Written and edited by

Katharin A. Kelker, Ed.D.

Roger Holt, ATP

Published byParents, Let’s Unite for Kids

516 N 32nd StBillings MT 59101-6003

406-255-0540; 406-255-0523 (fax)800-222-7585 (toll free in MT)

plukinfo@pluk.org • http://www.pluk.org

Family Guide to

Assistive

Technology

Published byParents, Let’s Unite for Kids (PLUK)

516 N 32nd StBillings MT 59101-6003

406/255-0540406/255-0523 (fax)

800-222-7585 (in MT)plukinfo@pluk.org

http://www.pluk.org

April 1997

Written and edited byKatharin A. Kelker, Ed.D.

Roger Holt, ATP

Illustrations byKaren Moses

This guide was funded through a subcontract between the Federation and Parents, Let’s Unite for Kids frommonies awarded to the Federation by the Office of Special Education and Rehabilitation Services (OSERS),U.S. Department of Education. Points of view or opinions herein do not necessarily represent the EducationDepartment’s position or policy.

The Department of Education ensures equal employment, equal educational opportunities, and affirmativeaction regardless of race, sex, color, national origin, religion, marital status, age, or disability.

This material is available upon request in alternative formats by calling: 406/255-0540.

Table of ContentsIntroduction .............................................................................................................. 1Defining Assistive Technology ................................................................................. 2

Sara ....................................................................................................................7Making Assistive Technology Decisions .................................................................. 9

Sierra ...............................................................................................................23Funding Assistive Technology................................................................................ 24

Ted .................................................................................................................. 31Gloria ...............................................................................................................32

Making Assistive Technology a Part of Child’s Education .................................... 33Emily ................................................................................................................38Bryan................................................................................................................39Tracy ................................................................................................................40

Advocating for Assistive Technology ..................................................................... 42More Questions and Answers ................................................................................. 44Appendix ................................................................................................................ 50

Glossary ........................................................................................................... 50Documents ....................................................................................................... 53

Schrag Letter on Assistive Technology .................................................................. 53Individuals with Disabilities Education Law Report .............................................. 54Letter Requesting an Assistive Technology Evaluation ......................................... 56Assistive Technology...Issues to Address ............................................................... 56

Examples.......................................................................................................... 57Educational Software Evaluation ........................................................................... 57Software Features ................................................................................................... 59Alternative Input ..................................................................................................... 59Processing Aids ...................................................................................................... 59Alternative Output .................................................................................................. 59Specialized Products ............................................................................................... 59Assistive Technology Evaluation ........................................................................... 60

Resources ......................................................................................................... 62Parent Training and Information Centers ............................................................... 62Alliance for Technology Access Resource Centers ................................................ 65State Tech Act Projects ........................................................................................... 67Software/Hardware Vendors ................................................................................... 70

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A ssistive technology is redefining what ispossible for people with a wide range ofcognitive and physical disabilities. In thehome, classroom, workplace, and community,assistive technology is enabling individuals withdisabilities to be more independent, self-confi-dent, productive, and better integrated into themainstream.

Beginning early in life, technology is makingit possible for children with disabilities to domore for themselves. A child who cannot use herhands can operate a computer with a switch andan on-screen keyboard. A child with speech prob-lems can communicate using a portable electronicdevice that “speaks.” A child who is unable toget in and out of the bathtub can be safely andeasily lifted using a mechanical device. Theseare just a few examples of the wide variety ofequipment, called assistive technology, that isavailable today.

Assistive technology can mean anything fromsimple, homemade devices to highly sophisti-cated environmental control systems. It can beadapted toys, computers, powered mobility, aug-mentative communication devices, specialswitches, and thousands of commercially avail-able or adapted tools to assist an individual withlearning, working, and interacting socially.

As wonderful as assistive technology can be,it is not always easy to acquire. It takes expertiseand persistence to find the correct devices andfigure out ways to pay for them. For example,children with disabilities who are eligible for spe-cial education have a legal right to technology toassist them with learning. Both the Individual-ized Family Service Plan (IFSP) and the Individu-alized Education Program (IEP) which are re-quired by tthe Individuals with Disabilities Edu-cation Act (IDEA) are potentially powerful toolsfor incorporating assistive technology into theeducation of students with disabilities. But

assistive technology does not become part of astudent’s special education plan unless parentsare knowledgeable about technology and knowwhat to do to ensure that assistive technologybecomes an integral part of their child’s program.

This Guide is intended to help parents learnmore about assistive technology and how it canhelp their children. The Guide includes tips forgetting started, ideas about where to look formoney, and suggestions for what to do whenapplying for funding. Places to contact for moreinformation or to find software and equipmentare listed in the Appendix at the end of the Guide.

Finding and paying for the right technologyrequires commitment and energy. Professionalsin education and medicine can help, but parentscannot rely on professionals to do everything thatis necessary to get the equipment. As a parent,you have a much better chance of getting what isneeded if you and your child are involved in se-lecting the technology and planning for its use.This Guide should help you to understand theprocesses for acquiring assistive technology andprovide you with the tools to advocate for yourchild’s special technology needs.

Introduction

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Defining Assistive Technology

A ssistive technology devices are mechani-cal aids which substitute for or enhancethe function of some physical or mentalability that is impaired. Assistive technology canbe anything homemade, purchased off the shelf,modified, or commercially available which isused to help an individual perform some task ofdaily living. The term assistive technology encom-passes a broad range of devices from “low tech”(e.g., pencil grips, splints, paper stabilizers) to“high tech” (e.g., computers, voice synthesizers,braille readers). These devices include the entirerange of supportive tools and equipment fromadapted spoons to wheelchairs and computersystems for environmental control.

The Individuals with Disabilities EducationAct (IDEA), the federal special education law,provides the following legal definition of anassistive technology device: “any item, piece ofequipment, or product system... that is used toincrease, maintain, or improve functional capa-bilities of individuals with disabilities.” UnderIDEA, assistive technology devices can be usedin the educational setting to provide a variety ofaccommodations or adaptations for people withdisabilities.

The IDEA also lists the services a school dis-trict may need to provide in order to ensure thatassistive technology is useful to a student in theschool setting. The law defines assistive technol-ogy service as: “any service that directly assistsan individual with a disability in the selection,acquisition, or use of an assistive technologydevice.” This service includes all of the follow-ing possibilities:

• evaluation of the technology needs of theindividual, including a functional evalua-tion in the individual’s customary environ-ment;

• purchasing, leasing, or otherwise provid-

ing for the acquisition of assistive technol-ogy devices for individuals with disabili-ties;

• selecting, designing, fitting, customizing,adapting, applying, maintaining, repair-ing, or replacing of assistive technologydevices;

• coordinating and using other therapies,interventions, or services with assistivetechnology devices, such as those associ-ated with existing education and rehabili-tation plans and programs;

• assistive technology training or technicalassistance with assistive technology for anindividual with a disability, or, where ap-propriate, the family of an individual withdisabilities;

• training or technical assistance for profes-sionals, employers, or other individualswho provide services to, employ, or other-wise are substantially involved in the ma-jor life functions of individuals with dis-abilities.

The intention of the special education law isthat, if a student with disabilities needs technol-ogy in order to be able to learn, the school dis-trict will (a) evaluate the student’s technologyneeds, (b) acquire the necessary technology, (c)coordinate technology use with other therapiesand interventions, and (d) provide training forthe individual, the individual’s family, and theschool staff in the effective use of the technology.

During the time that students with disabili-ties are in school, they can have the opportunityto learn to use technology at the same time thatthey are learning academic subjects and socialskills. The efficient and effective use of assistivetechnology can be as basic a skill for students withdisabilities as reading, writing, and arithmeticsince the use of technology can go a long way

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toward circumventing the limitations of disabil-ity and providing students with disabilities witha “level playing field” in every area of life ac-complishment.

What is an accommodation?

Accommodations are reasonable modifica-tions that are made to compensate for skills orabilities that an individual lacks. For example, ifa person does not digest spicy foods well, wemight accommodate this individual by adjustinghis or her diet so that the person was eating onlybland foods.

When the word accommodation is used in con-nection with disability issues, it refers to a wayof modifying a task or assignment so that a per-son with a disability can participate in spite ofwhatever challenges the disability may pose. Forexample, when a student who is unable to re-member math facts is allowed to do math prob-lems with a calculator, the use of the calculator isan accommodation which allows the student towork around his or her disability. With an ac-commodation, the student can still perform mathproblems, but the student does so using a differ-ent method.

In the school setting, sometimes it is neces-sary to make accommodations for individualswith disabilities in order to compensate for skillsor abilities that they do not have. For example,for some students with learning disabilities learn-ing to spell words correctly may be a skill theynever acquire or never acquire with a highenough degree of fluency to do them any goodin written expression. To compensate for thisinability to spell, such students may be encour-aged to use alternative methods for spelling likea spell check software program on the computeror a hand-held spelling device.

What is an adaptation? How does adaptationdiffer from accommodation?

Adaptation means developing unique devicesor methods designed specifically to assist persons

with disabilities to perform daily tasks. An ad-aptation is something specially designed whichis not normally used by other people. An accom-modation, on the other hand, is simply a changein routine, method, or approach which may beused by people with or without disabilities. Ex-amples of adaptations include special grips toturn stove knobs or specially designed keyboardsto operate computers.

What are common types of assistive technol-ogy? Does assistive technology just meancomputers?

Assistive technology certainly includes com-puters, but it also refers to a number of other typesof accommodations and adaptations which en-able individuals with disabilities to function moreindependently. Computers are an important typeof assistive technology because they open up somany exciting possibilities for writing, speaking,finding information, or controlling anindividual’s environment. But computers are notthe only avenues to solving problems throughtechnology. There are many low tech (and lowcost) solutions for problems that disabilities pose.Examples of inexpensive, low tech solutions in-clude wrist splints, clip boards for holding pa-pers steady, or velcro tabs to keep positioningpads in place.

The following is a list of common assistivetechnology applications:

Positioning. In the classroom, individualswith physical disabilities may need assistancewith their positions for seating so that they canparticipate effectively in school work. Generally,therapists try to achieve an upright, forward fac-ing position by using padding, structured chairs,straps, supports, or restraints to hold the body ina stable and comfortable manner. Also consid-ered is the student’s position in relation to peersand the teacher. Often, it is necessary to designpositioning systems for a variety of settings sothat the student can participate in multiple ac-tivities at school. Examples of equipment used

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for positioning are side lying frames, walkers,crawling assists, floor sitters, chair inserts, wheel-chairs, straps, trays, standing aids, bean bagchairs, sand bags and so forth.

Access. In order to participate in school tasks,some students require special devices that pro-vide access to computers or environmental con-trols. The first step in providing access is to de-termine which body parts can be used to indi-cate the student’s intentions. Controllable, ana-tomical sites like eye blinks, head or neck move-ments, mouth movements may be used to oper-ate equipment which provides access to the com-puter. Once a controllable, anatomical site hasbeen determined, then decisions can be madeabout input devices, selection techniques (direct,scanning), and acceleration strategies (coding,prediction). Input devices include such thingsas switches, alternative keyboards, mouse,trackball, touch window, speech recognition, andhead pointers. Once computer access has beenestablished, it should be coordinated with othersystems that the student is using including pow-ered mobility, communication or listening de-vices, and environmental control systems.

Access can also refer to physical entrance andexit of buildings or facilities. This kind of assistivetechnology includes modifications to buildings,rooms and other facilities that let people with

physical impairments use ramps and door open-ers to enter, allow people with visual disabilitiesto follow braille directions and move more freelywithin a facility, and people of short stature orpeople who use wheelchairs to reach pay phonesor operate elevators. Accessibility to shoppingcenters, places of business, schools, recreation,transportation is possible because of assistivetechnology modifications.

Environmental Control. Independent useof equipment in the classroom can be achievedfor students with physical disabilities throughvarious types of environmental controls, includ-ing remote control switches and special adapta-tions of on/off switches to make them accessible(e.g. velcro attachments, pointer sticks).

Robotic arms and other environmental con-trol systems turn lights on and off, open doors,operate appliances. Locational and orientationsystems give people with vision impairmentsinformation about where they are, what theground nearby is like, and whether or not thereis a curb close by.

Augmentative Communication. Every stu-dent in school needs some method of communi-cation in order to interact with others and learnfrom social contact. Students who are nonverbalor whose speech is not fluent or understandableenough to communicate effectively may benefit

figure 1: Alternative and Pr ocessing Computer Access Methods

Input• Alternate keyboards• Interface devices• Joysticks• Keyboard modifications• Keyboard additions• Optical pointing devices• Pointing and typing aids• Switches with scanning• Scanners & optical character recognition• Trackballs• Touch screens• Voice recognition

Processing• Abbreviation/expansion and macro programs• Access utilities• Menu management programs• Reading comprehension programs• Writing composition programs• Writing enhancement tools (i.e. grammar checkers)

Output• Braille displays and embossers• Monitor additions• Screen enlargement programs• Screen readers• Speech synthesizers• Talking and large print word processors

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from using some type of communication deviceor devices. Communication devices include suchthings as symbol systems, communication boardsand wallets, programmable switches, electroniccommunication devices, speech synthesizers, re-corded speech devices, communication enhance-ment software, and voiced word processing.

Assistive Listening. Much of the time inschool, students are expected to learn through lis-tening. Students who have hearing impairmentsor auditory processing problems can be at a dis-tinct disadvantage unless they learn to use thehearing they have, or they develop alternativemeans for getting information. Hearing problemsmay be progressive, permanent, or intermittent.Any of these impairments may interfere signifi-cantly with learning to speak, read, and followdirections. Assistive devices to help with hear-ing and auditory processing problems include:hearing aids, personal FM units, sound field FMsystems, Phonic Ear, TDDs, or closed caption TV.

Visual Aids. Vision is also a major learningmode. General methods for assisting with visionproblems include increasing contrast, enlargingstimuli and making use of tactile and auditorymodels. Devices that assist with vision includescreen readers, screen enlargers, magnifiers,large-type books, taped books, Braillers, lightboxes, high contrast materials, thermoformgraphics, synthesizers, and scanners.

Mobility. Individuals whose physical impair-ments limit their mobility may need any of a num-ber of devices to help them get around in theschool building and participate in student activi-ties. Mobility devices include such things as self-propelled walkers, manual or powered wheel-chairs, and powered recreational vehicles likebikes and scooters.

Computer-Based Instruction. Computer-based instruction can make possible independentparticipation in activities related to the curricu-lum. Software can be selected which mirrors theconceptual framework of the regular curriculum,

but offers an alternative way of responding to ex-ercises and learning activities. Software can pro-vide the tools for written expression, spelling, cal-culation, reading, basic reasoning, and higherlevel thinking skills. The computer can also beused to access a wide variety of databases.

Social Interaction and Recreation. Studentswith disabilities want to have fun and interactsocially with their peers. Assistive technologycan help them to participate in all sorts of recre-ational activities which can be interactive withfriends. Some adapted recreational activities in-clude drawing software, computer games, com-puter simulations, painting with a head or mouthwand, interactive laser disks, and adaptedpuzzles.

Self Care. In order to benefit from educa-tion, some students require assistance with selfcare activities like feeding, dressing, and toileting.Assistive devices which assist with self care in-clude such things as robotics, electric feeders,adapted utensils, specially designed toilet seats,and aids for tooth brushing, washing, dressing,and grooming.

What sort of students might use assistivetechnology?

Students who require assistive technology arethose with mental or physical impairments thatinterfere with learning or other life functions. Thetechnology helps the student to overcome or com-pensate for the impairment and be more inde-pendent in participating at school. Students whobenefit from assistive technology may have mildlearning problems like learning disabilities orthey may have physical or cognitive disabilitiesthat range from mild to severe. Assistive tech-nology is not necessary or helpful for every stu-dent in special education, but it is an importantpart of the support system for many studentswith identified disabilities.

Isn’t assistive technology appropriate only forstudents with more severe disabilities?

Assistive technology is simply a set of tools

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that can be used to compensate for some deficitthat a person may have. For individuals with se-vere mental or physical disabilities, the techno-logical solutions can help to solve multiple andcomplex problems. But individuals with less in-volved problems also can benefit from assistivetechnology. For example, individuals with learn-ing disabilities who have difficulty with readingor writing can benefit educationally from usingthe word processing and voiced reading capa-bilities of computers.

Isn’t assistive technology just a crutch? Won’tstudents become too dependent on technol-ogy and not learn to use the skills they have?

Assistive technology should be used as sup-port for access, learning and performing dailytasks. In general, assistive technology is appro-priate when it compensates for disabilities so thatthe individual can function as normally as pos-sible. If assistive technology is necessary for astudent to have access to educational opportuni-ties or to benefit from education, then it is not a“crutch,” but a legitimate support.

Some skills are too laborious or taxing to ac-complish at a rate or with degree of proficiencyto allow for participation in the least restrictiveenvironment. With assistive technology, the stu-dent can participate more fully and more closelyapproximate the levels of achievement and in-teraction of his or her peers.

The use of assistive technology enhancesfunction and increases skills and opportunities.Though a student may be dependent upon a par-ticular device in order to perform skillfully, de-nying the device denies the student an opportu-nity ever to achieve success at the level of his orher potential.

When is using assistive technology appropri-ate?

Assistive technology may be considered ap-propriate when it does any or all of the follow-ing things:

• Enables an individual to perform functions

that can be achieved by no other means

• Enables an individual to approximate nor-mal fluency, rate, or standards—a level ofaccomplishment which could not beachieved by any other means

• Provides access for participation in pro-grams or activities which otherwise wouldbe closed to the individual

• Increases endurance or ability to persevereand complete tasks that otherwise are toolaborious to be attempted on a routine ba-sis

• Enables an individual to concentrate onlearning or employment tasks, rather thanmechanical tasks

• Provides greater access to information

• Supports normal social interactions withpeers and adults

• Supports participation in the least restric-tive educational environment.

SummaryAssistive technology means any device which

helps an individual with an impairment to per-form tasks of daily living. There is a wide rangeof types of devices in assistive technology fromlow tech, homemade aids to computers and so-phisticated electronic equipment. Assistive tech-nology is one of the services which can be pro-vided in a special education program under theIndividuals with Disabilities Education Act(IDEA). The requirements of IDEA say that stu-dents who need assistive technology are entitledto the aids and devices and the assistive technol-ogy services (e.g., evaluation for assistive tech-nology and modification and maintenance ofequipment) that are necessary for the student tobenefit from a free, appropriate public education.

Hints for Parents

It is never too soon to consider using assistive tech-nology. Some infants with physical disabilities, for ex-

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ample, really benefit from early interaction with toysthat operate by switch. Here are suggestions for timesto evaluate a child for assistive technology:

• When disability limits interaction with the envi-ronment and interferes with experiential learn-ing.

Assistive technology can be used to providephysical access to the environment (e.g.,switch toys, floor scooters, touch window)

• When a significant gap exists between receptiveand expressive abilities.

Assistive technology can assist with expres-sion through the use of programmableswitches, electronic communication devices,voiced word processing, braille embossingand so forth.

• When an individual’s performance falls behindthat of his or her peers.

If an individual’s handwriting, for example,is very slow, laborious and difficult to read,use of a word processing device can be sub-stituted for handwriting; thus allowing theindividual to keep up with others in termsof written expression.

• When a physical disability is impeding the edu-cational/vocational potential of an individual.

Assistive technology can provide access tothe workplace, for example, by allowing anindividual who is blind to learn to use ascreen reader and voiced word processingto do clerical tasks that would otherwise beimpossible.

• When a disability is impeding the independenceof an individual.

Sometimes assistive technology can be usedto allow a person with a disability to func-tion more independently. For example, hav-ing a power wheelchair allows an individualto travel independently without the neces-sity of having someone to push the wheel-chair.

SaraSara, who has Down syndrome, is eight

years-old. Her language and speech skills arethree years delayed, but she has age appropriatesocial skills. Sara has spent part of her schoolday in a regular classroom ever since kindergar-ten, but this year her third grade teacher is sug-gesting that Sara really cannot keep up with herclassmates. The teacher thinks that Sara wouldbe better off in a self-contained class with stu-dents who work at her pace. Sara has some finemotor coordination problems, and she has haddifficulty learning to write in cursive. Her oralreading is hampered by her speech difficulties.However, Sara has learned to do addition andsubtraction problems well and has mastered add-ing with carrying and subtraction with borrow-ing. She reads at about a second grade level withreasonably good comprehension. Sara’s parentswould like to see her continue in the regular class-room for as much time as possible, but they rec-ognize that Sara’s writing and speaking problemsare keeping her from doing her best work.

What are Sara’s needs?

What kinds of technology should go in Sara’sIEP?

How would you make a case for puttingassistive technology into her IEP?

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Sara’s SolutionSara’s IEP Team met to discuss her needs and

concluded that she is doing well in a regular class-room setting; she is making adequate progressin academic skills and has learned how to inter-act socially with her peers. It is to be expectedthat Sara will have difficulty keeping up with thepace in a third grade, but as long as she is mak-ing progress toward her individual goals, theregular classroom is a good setting for her. How-ever, some simple accommodations and technol-ogy may help Sara to work faster and more effi-ciently.

At this point Sara may need some assistancewith handwriting and speaking, but the solutionsto her problems in these areas need not be com-plex ones. The team decided that Sara shouldcontinue to practice cursive until she has mas-tered all the letters and can be more facile in us-ing script. However, while she is still learningcursive, she needs other means for respondingin writing. For short written responses, the teamagreed that Sara should be encouraged to usemanuscript printing. When speed is importantor when writing assignments are longer, Sarashould have access to a computer with an adap-tive keyboard (e.g., IntelliKeys). The adaptivekeyboard is helpful for Sara because the “keys”are larger and easier to see. Using the keyboardrequires only a very light touch so Sara finds iteasier to use than a standard computer keyboard.

In terms of oral reading, the team decided tohave Sara practice reading into a tape recorder.Her speech therapist will work with her on slow-ing down her rate of speech and reading withexpression. When Sara has a good tape of heroral reading, she will submit it to her teacher forreview.

Solution SummaryPractice cursiveUse manuscript printing for short assign-

ments

Use computer with adaptive keyboard forlonger assignments

Practice oral reading using a tape recorder

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Making Assistive Technology Decisions

W hen parents learn about assistive tech-nology and the wonderful opportuni-ties it can provide, they want to jumpright in and get the latest in technology for theirchildren. Who wouldn’t want an augmentativecommunication device for a child who cannottalk? What parents wouldn’t want to buy a com-puter if it would help their child learn?

When the world of assistive technology opensup for parents, it can be like entering a great toystore—everything looks so wonderful that itmakes it hard to know what to select. Choosingthe right device to meet an individual’s needsrequires technical knowledge and indepth under-standing of the individual’s functional capabili-ties. Not only is the selection of a device madedifficult by the complexity of the equipment andthe demands of the individual’s impairment,assistive technology devices can be very expen-sive. Making such purchases is a major financialcommitment for most families, one that takes agreat deal of soul searching and sometimes sig-nificant sacrifice.

Families invest more than money in theirchildren’s assistive technology. Practical invest-ments of time and effort and emotional invest-ments of hope and enthusiasm are made withevery assistive technology purchase. Because ofthe high level of financial, personal and emotionalcommitment, family disappointment is greatwhen equipment fails to perform as expected.

Buying and then not using a device becauseof dissatisfaction can be a devastating experiencefor all concerned. That is why it is so importantfor parents to proceed cautiously into the worldof assistive technology and make purchases onlyafter careful evaluation and trials with the newdevice. Following is a summary of some sug-gestions for parents to consider before makingany assistive technology purchase: be realisticabout your child’s capabilities and needs; get a

multidisciplinary evaluation; examine availabletechnology with a critical eye; match the child’sneeds to specific equipment features; do not makea purchase until you have used the device for atrial period; identify next steps; and determinewhat needs to be done for follow-up after pur-chase.

Guidelines for Making Assistive TechnologyDecisions

• Be realistic about your child’s capabilitiesand needs.

Assistive technology can open up excitingnew opportunities for a child, but it is not magic.There are certain basic requirements for any in-dividual to be successful with technology, and itis important to face these requirements squarely.There is nothing more disappointing or discour-aging than purchasing expensive equipment fora child which is beyond his or her capabilities touse.

Prerequisites for Computer Use. Physicalor sensory impairments do not limit access tocomputers, but cognition is a factor in computeroperation. The major prerequisite for using acomputer (with or without adaptations) is thecognitive ability to understand cause and effect.The child must be able to understand that thecomputer operates (e.g., changes, does some-thing) because the child has activated the equip-ment through some volitional movement or ac-tivity (e.g., eyebeam, speaking, puffing into astraw, hitting a switch). Some children enjoyplaying with switches by hitting them randomlybut may not be able to connect their own behav-ior to the response their movement activates. Inorder to be successful in interacting with a com-puter, the user must be able to control some voli-tional activity and to do so consistently. For ex-ample, the child would have to be able to acti-vate the computer in response to a visual, tactile,or auditory prompt.

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Another prerequisite to computer use is theability to make conscious, meaningful choicesbetween alternatives like yes and no. The choicescan be very simple ones, but there has to be evi-dence that the child has made an actual decisionand not merely acted randomly.

If a child does not have the concept of causeand effect or cannot make consistent choices, us-ing a computer is probably not a worthwhile nextstep at this point in the child’s development.Other types of activities may be more appropri-ate, less expensive, and just as rewarding devel-opmentally and personally.

Prerequisites for Augmentative Communi-cation. Augmentative communication devicescan literally give voice to the thoughts of indi-viduals who cannot speak or cannot speak clearly,but—again—these devices are not magic. Elec-tronic communication devices are of no valueunless the user has some communicative intent.That is, for a communication device to be help-ful, the user has to have some basic understand-ing of the communication process and must beintentional in expressing choices, desires, orneeds.

For example, Maggie is a four-year-old whois nonverbal. She communicates her wants andneeds by using eyeblinks as responses to yes orno questions. When Maggie’s dad asks her if shewould like another glass of milk, she indicatesher choice by raising her eyes up vertically foryes or moving her eyes down for no. Maggieclearly knows what she wants to communicate,she has a consistent method for making herwishes known, and she expects that her dad willunderstand her communication and act on it.

Dan, who is also nonverbal, communicatesin a different way. He points to objects and makesgestures to show what he wants or needs. Hisgestures are clear and used consistently so thatfamily members and even people who do notknow Dan well can understand most of the timewhat he is communicating.

Shelley communicates very basic informationabout how she feels by crying when she is un-comfortable or wants attention and by laughingwhen she enjoys something like music, brightlights, or water running. Shelley does not, how-ever, respond to yes or no questions. She doesnot make choices, even when objects are pre-sented to her individually or in pairs. She can-not respond to a question like “Do you want someice cream now?” Or “Would you like the teddybear or the doll?”

Maggie and Dan may benefit from usingsome communication device because they arealready using communication systems meaning-fully and consistently. Shelley, however, mayneed to develop greater ability to communicatemeaningfully before moving on to electroniccommunication.

Communication skills fall along a continuum.At one end of the continuum are very simplecommunications like expressing preferences byindicating yes or no, pointing or gesturing towardobjects, or pointing to pictures. Use of sign is amore complex form of communication becauseit requires that the user understand that the signsare symbols for meaningful communications.When an individual is able to string togethersigns or words into meaningful phrases, this isan additional step toward more complex com-munication. When a person understands syntaxand is aware of typical word order, this is anotherstep forward. Each of these advances along thecommunication continuum represents a step to-ward more complex and sophisticated commu-nication. Whatever assistive communicationdevice is chosen should match or just slightlyexceed the place on the continuum where the in-dividual is functioning. It makes no sense, forexample, to purchase an elaborate electronic com-munication device that requires understandingsymbols and syntax when the individual usingthe device is just at the point of learning how toexpress yes and no preferences.

An electronic device does not teach commu-

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nication; it enhances communication by givingaudible expression to thoughts that already existin the mind of the user. If the thoughts are notthere yet or are not completely formed, they can-not be expressed by the device.

Physical and Sensory Impairments Are NotBarriers. Mastery of a few simple prerequisiteskills is necessary before computers or electroniccommunication devices should be considered,but it is not necessary for a child to master everydevelopmental milestone before entering theworld of assistive technology. Physical or sensoryimpairments can often be circumvented by thetechnology itself, and typical developmentalmilestones can sometimes be bypassed so thatassistive technology can be used. For example,some educators assume that students cannot usecomputers until they have completely masteredkeyboarding skills. This is a false assumption.Many students benefit from using computers,even though they operate the machine using a“hunt and peck” method or only one or two keys.In a similar fashion, students with limited verbalability who have not mastered oral speech ben-efit from using augmentative communicationdevices while they continue to develop oral lan-guage.

Overall, the keys to knowing when to tryassistive technology are (a) being realistic aboutthe child’s cognitive abilities and potential, and(b) being open to trying the level of technology

which meets the child where he or she is.

• Get a multidisciplinary evaluation.

Evaluations for assistive technology are notalways easy to arrange. In many parts of theUnited States, there is no convenient center or“place” to go for an assessment. The availablecenters may be far away in another city or evenanother state. Since assistive technology is a newfield, the systems for disseminating informationand providing assistance are in the process ofevolving. Parents may have to be “assistive tech-nology detectives” in order to put together theinformation needed for a complete AT evalua-tion for their child.

The place to start the evaluation is by consid-ering the functions the child needs to performand cannot because of impairment. The physi-cians, teachers, and therapists currently workingwith the child, as well as family members andfriends who are around the child on a daily ba-sis, can provide very valuable information aboutfunctional problems and potential solutions.

Finding Functional Solutions. The Alliancefor Technology Access (ATA), a national networkof assistive technology centers, has developed aninformal method for using the functional infor-mation available from professionals, family mem-bers and friends as a basis for analyzing assistivetechnology needs. This process, called a Solu-tion Circle, is a means to bring people togetherin an informal session that allows for creative

figure 2: Factors to consider when selecting Assistive T echnology

Cognitive Factors• Diminished Cognitive Abilities• Learning Disabilities• Attention Deficits• Sensory/Perceptual Deficits• Memory Deficits• Abstract Reasoning Deficits• Problem-Solving Deficits

Motor Factors• Voluntary Motor Deficits• Involuntary Motor Deficits• Fixed Posture & Positioning Deficits• Recurring Purposeless Motion• Motor Paralysis• Low Muscle Tone• Rigidity• Spasticity• Tremors

12

thinking and is not inhibited by what is “legal,”“currently available,” or “what has been done be-fore.” The individual with a disability and 4-10family members, professionals, and friends gettogether to brainstorm ideas about the technol-ogy which may help the individual perform func-tions that are hard, or impossible, to do becauseof disability. The Circle usually includes a bal-ance between people who know the person whoneeds the technology and people who have spe-cialized knowledge about technology, education,or work-related issues.

Solution Circle for Tom. To demonstratehow the Solution Circle works, let’s take a lookat how this process was used in the case of Tom,a high school student with a learning disability.For Tom, the print in textbooks is a significantbarrier to learning. Tom is “print disabled”; thatis, he cannot read the printed word with muchcomprehension. Reading is a slow, unproductiveprocess for him, even though he is intelligent andeager to learn. Tom and his parents were hopingthat there might be a way that new technologycould help Tom overcome or work around hisproblem with reading so that he could get moreout of school and perhaps go on to college.

Tom’s Solution Circle included his parents,Betty and Bob; his resource teacher; a friendDarrell; his soccer coach; his 4-H leader; and theowner of a local computer store. This group mettogether to think about how Tom could partici-pate more fully in school and prepare himself forcollege, even though he could not read with com-prehension past the second or third grade level.

Solution Circles generally take 1 to 1 1/2 hoursto complete. The steps include the following:

1. Star Time. The individual for whom theSolution Circle is being held is described in a ho-listic way. The emphasis is on how the individualis functioning at home and in the community.What does he or she like and dislike? What arehis/her goals? Interests? If possible, the indi-vidual with a disability speaks for himself or her-self or a video or pictures may be presented. The

point of this part of the discussion is give a clearpicture of the individual as a whole person.

At Tom’s Solution Circle, he explained hisdream of going to college and becoming an agri-cultural botanist. Tom loves plants; he is inter-ested in breeding new strains of wheat and per-fecting various types of grain crops. Tom’s 4-Hleader agreed that Tom had real gifts in under-standing plant growth and physiology, and thathe already had sophisticated knowledge aboutbotany which would prepare him well for col-lege study.

2. Strengths. With a complete picture of theindividual in mind, the group then makes an ex-haustive list of the individual’s strengths, particu-larly noting any technological accommodationswhich the individual is already using. What doesthe individual do well? What are his or her un-impaired functions? Often this discussion revealsan incredible number of adaptations that the in-dividual has already achieved.

Tom’s Solution Circle discovered that he hadmany strengths, including keen intelligence, per-severance, and thoroughness when approachinga task. Tom already had some effective learningstrategies for remembering material that heheard. He had also learned to use a small taperecorder for keeping track of information pro-vided in class.

3. Obstacles. With the individual’s strengthsin mind, the group then turns its attention to aconsideration of the environment in which theindividual is functioning and the activities inwhich the individual wants to participate butcannot at this time. The group considers whatthe obstacles and barriers might be for the indi-vidual in his or her environment and makes alist of these impediments.

For Tom, reading was a serious obstacle. Hecould not keep up with homework assignmentsbecause it took him so long to read his textbooks.In addition, he had difficulty reading directionson tests and often misread assignments on the

13

COGNITIVE FACTORSCognitive Ability

Documented below average abilityDocumented significant overall delayDoes not appear age appropriateLacks understanding of cause & ef-

fectPaying Attention

Difficulty following prompts or direc-tions

Difficulty with multi-step proceduresDifficulty filtering informationDifficulty staying on task

PerceptionNeeds lengthened response timeRequires multi-sensory inputDifficulty with rapid changeSignificant visual/perceptual problemsSlow visual-motor dexterity

MemoryDifficulty with recallRequires reteaching learned skillsRequires repeated practice

Abstract ReasoningDifficulty analyzing simple proceduresUnable to reproduce a sequenceUnable to analyze or synthesize in-

formationProblem Solving

Unable to use prompts or cues to ac-complish tasks

Unable to modify attempts and try an-other way

MOTOR FACTORSMobility

Needs help to be mobileNeeds motorized help to be indepen-

dentNeeds help boarding transportationUnable to transfer independentlyCannot climb stairsCannot open doors independentlyCannot carry materials in hands or

armsCannot lift weight

Voluntary MotorLimited control of head, trunk, or ex-

tremitiesVisual motor deficitsFixed position and posture

figure 3: ASSISTIVE TECHNOLOGY EVALUATIONIndividual Functional Analysis

Name: Date:

Needs support to sit or standNeeds adaptations in order to use

technologyMotor Paralysis

Changes in muscle tone interfere inmotor movements

Spastic movements result in poor con-trol

Limited movement of head, arms orlegs

Difficulty balancing in sitting positionDifficulty maintaining good posture

Low Muscle ToneLimited use of arms or legsPoor posture controlFatigues quickly

RigidityInhibits arm and leg movementInhibits balance to sitInhibits good posture

SpasticityLimited upper range of motionLimited lower range of motionInterferes with accuracy and consis-

tency of motor movements on oneside

TremorsPresent all the timePresent when doing purposeful upper

extremity taskUnable to compensate for tremors

Extraneous MovementAthetoid (constant)Ataxia (poor coordination in move-

ment)FINE MOTOR

DexterityLimited fine motor controlHas limited hand movement

HandwritingWriting or copying ability is signifi-

cantly below peersSignificant legibility factor--written

work not readableCannot keep up with the pace of writ-

ten workIs frustrated by writingFatigue is a factorTyping appears to be potentially faster

than handwriting

SELF CARENeeds assistance with going to the

bathroomUnable to be toilet trainedNeeds assistance to eatCannot take in food orallyNeeds suctioning routinelyHas degenerative medical conditionIs medically fragileSeizures limit alertnessNeeds to rest frequentlyNeeds assistance to zip coat or tie

shoesCOMMUNICATION

Receptive LanguageReceptive language is significantly

lower than abilityReceptive language is significantly

higher than expressiveExpressive Language

Speech is unintelligibleExpressive language is significantly

lower than abilityMean Length of Utterance (MLU) is 3

words or lessSpontaneous or self initiated language

is significantly limitedDoes not make choices consistentlyDoes not respond appropriately with

yes or noDoes not have communicative intent

SENSORYVision

Requires corrective lensesRequires large print to readRequires mobility trainingHas blind spot

HearingRequires preferential seatingHearing limitations affect the language

thresholdsRequires assistance to receive lan-

guageRequires sign language to receive lan-

guageHas fluctuating hearing lossNeeds visual signals for safety pur-

poses

14

blackboard.

4. The Enemy Within. Physical and cogni-tive impairments may pose difficult obstacles foran individual, but often the feelings that peoplehave about the individual’s disability or aboutassistive technology pose greater problems thanthe disabilities themselves. The Solution Circleprocess recognizes that human fears, concerns,reservations, and prejudices might stand in theway of a person’s success as much as other typesof limitations. Getting these fears and concernsout on the table often helps the group to deal moreconstructively with what is possible and whatneeds to be done.

One of the serious issues in Tom’s situationwas that his resource teacher felt he should con-tinue to try to read for himself instead of using a“crutch” like assistive technology. The teacherthought that if Tom did not have to read all thematerial, he would lose what little reading skillhe had. In some ways, the teacher’s oppositionto considering assistive technology actually poseda greater barrier than the reading problem itself.

5. Solutions. The exciting part of a SolutionCircle occurs when the group takes each obstacleor concern and turns it into a possible solutionthrough the use of technology or some other typeof adaptation. Not all solutions suggested even-tually prove to be feasible, but the point of thediscussion is to produce many possible solutionsso that the individual and his or her family havean array of options from which to choose. Withgood minds puzzling over the problems and aspirit of cooperation and collaboration, seeminglyimpossible barriers can be removed or conquered.The process recognizes the expertise and contri-butions of all participants, including the indi-vidual with disabilities and his or her familymembers. The freewheeling format of the dis-cussion promotes ingenuity and innovation. Allinvolved come away from a Solution Circle ener-gized by the new possibilities.

Tom’s Solution Circle became excited about

the possibility of solving his reading problem byusing computerized texts. The computer storeoperator mentioned he had heard that Record-ings for the Blind (RFB) offered textbooks on disk.Tom’s parents got in touch with Recordings forthe Blind and ordered texts for Tom to try on hiscomputer at school. Soon Tom found that hecould keep up with his classmates and study ex-actly the same material that they were covering.Because Tom had good strategies for memoriz-ing information that he heard, he learned quicklyfrom the texts that were read aloud to him by thecomputer. When given oral tests by his classroomteachers, he was able to recite appropriate an-swers which would have eluded him if he hadhad to read the tests for himself.

Technology has made all the difference forTom; he has every reason to think that he will beable to go to college and pursue his intellectualinterests. His resource teacher is now completelysold on the idea of assistive technology and us-ing computerized books and wants to use thetechnique with other students. More than that,Tom’s teacher also appreciates the process of theSolution Circle which allowed professionals andnonprofessionals to work together to find prac-tical solutions without being too concerned aboutthe formalities of the special education process.The informal nature of the Solution Circle vali-dated the expertise of all the participants andgave everyone a chance to offer suggestions. Thecombination of a new process for planning andnew technology made Tom a winner. This samecombination holds potential for many studentslike Tom who benefit from technologies whicheliminate barriers and open up new possibilitiesfor learning.

From Function to Technology Solution. Ithappened that a participant in Tom’s SolutionCircle hit on a great idea for a solution to his func-tional problem with reading. This was a fortu-nate connection to make. At the suggestions ofhis Solution Circle, Tom began to use computer-ized books which he “reads” by having the com-

15

puter speak the words as he follows along withthe text. For Tom, computerized books proved tobe a successful solution to his reading problembecause they help him to get the information heneeds without struggling with the reading pro-cess.

Not every Solution Circle will be like Tom’sand identify the exact technology that the indi-vidual needs. But if a Solution Circle has workedwell, the end result will be a clear analysis of thefunctions that need to be performed. This func-tional information can then be brought to techni-cians who can make suggestions for possibleassistive technology solutions. There are over 50assistive technology centers in the United Stateswhere knowledgeable individuals can assistpeople with disabilities and their families withmaking a match between functions that need tobe performed and the technology that is availableto perform those tasks. A list of assistive technol-ogy centers is available in the Appendix to thisGuide.

Formal Assessment. Solution Circles are aneffective, informal way to identify functionalneeds that can be met through technology. How-ever, in the school setting, it is also necessary toestablish a student’s needs for technology in amore formal way. Formal evaluations for assistivetechnology must be multi-disciplinary, involvingeducators and therapists who are knowledgeableabout the school curriculum and the particulartypes of impairments that the student being as-sessed may have. For example, for a student withcerebral palsy the assistive technology evaluationmight involve a teacher, a physical therapist, aspeech and language clinician, and an occupa-tional therapist. The teacher would assist thetherapists in determining what skills the studentneeded to learn and how technology might assistthe student in acquiring those skills. Someassistive technology evaluations might require theadditional services of an A-V technician, adap-tive physical education teacher, a rehabilitationcounselor, or speech and language pathologist

with specialized training in augmentative com-munication. In school districts where there is nospecialized expertise in technology and its appli-cations, it may be necessary to contract for evalu-ations with special education cooperatives, medi-cal centers, or centers that focus on technologyassessment.

Individuals conducting an assistive technol-ogy evaluation should:

• Be knowledgeable of the student’sstrengths and weaknesses: medical needs,mobility, fine and gross motor skills, cog-nitive ability, communication abilities, vo-cational potential, self help needs, sensoryabilities, level of academic achievement,and area(s) of disability;

• Have knowledge of and access to an arrayof assistive technology devices;

• Be familiar with the student’s educationalsetting and educational needs;

• Be able to communicate effectively withparents and educators.

Because the assistive technology field is sonew, there are no particular licenses orcredentialing processes to identify a professionalas qualified to do assistive technology evalua-tions. Generally speaking, individuals with pro-fessional licenses as occupational or physicaltherapists, special educators, speech pathologists,or rehabilitative counselors may have the exper-tise to conduct an AT evaluation. When consid-ering an evaluator, it is wise to ask about theevaluator’s specific experience with assistivetechnology. It is also important to recognize thatno one person or discipline will know everythingabout assistive technology; therefore, access toknowledgeable people at the local level andthrough other agencies, programs or services isessential.

Conducting the AT Evaluation. The assistivetechnology evaluation must be tailored to theunique needs of the student. In some cases, theevaluation may be conducted by at team of indi-

16

viduals; in other cases, the evaluation may beconducted by a single individual (e.g., the speechpathologist). Questions to be addressed duringthe assessment should be related to the specifictasks the student needs to be able to perform andwhat, if any, assistive technology would help.The following questions may be considered dur-ing the assessment:

• What tasks does the student need to per-form that he or she cannot perform?

• Is there a low tech device which will ad-dress the student’s needs satisfactorily?

• What types of high tech assistive devicesmay help the student in performing thetask?

• Will assistive technology help the studentto perform the task in the least restrictiveenvironment?

• Is the device being considered suited to thestudent’s educational needs and abilities?

• Will the assistive technology device remainsuitable over time? How long lasting willthis solution potentially be?

The above are only a few of the considerationswhich need to be addressed as part of the evalu-ation process. There is no specific “test” forevaluating the need for assistive technology.Therefore, prior to conducting the evaluation, theindividuals doing the assessment need to have awell planned process in mind.

The formal written assistive technologyevaluation report should address, but not belimited to, the following points:

• Procedures used to evaluate the student;

• Instruments employed in the evaluation,assuring that a range of levels of technolo-gies has been considered;

• Results of evaluations, including bothqualitative and quantitative measures;

• Recommendations for levels of technologyappropriate to the student’s capabilitiesand potentials, and

• Implications for educational program-ming, including discussion of both indi-vidual technology needs and recom-mended environmental and instructionalmodifications.

In the end, an assistive technology evaluationshould provide recommendations for accommo-dations, adaptations, devices, and services basedon the individual’s strengths, needs, and pre-ferred lifestyle. The evaluation should indicate(a) whether devices and services have potentialfor improving function, and (b) what trainingmay be necessary in order to use the technologyequipment safely and effectively.

• Examine available technology with a criti-cal eye.

It is easy to be dazzled by the possibilities innew assistive technology, but it is important forparents to be wise consumers and ask probingquestions about the features and quality of anassistive technology device. The following is alist of questions to consider when evaluating aparticular assistive technology device:

Performance

Does it work efficiently and effectively?

Is it easy to learn to use this device?

Is it compatible with other devices?

Does this device serve only one purposeor is it flexible?

“Elegance”

Does this device represent the simplest,most efficient way to accomplish the task?

Or is this device too elaborate, too com-plicated to be worthwhile?

Ergonomics

Does it fit the individual?

Is it convenient to use in the environment?

Is the equipment portable enough to gowhere the user goes?

Are different devices needed in differentenvironments?

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Reliability

What is the manufacturer’s reputation forreliability?

Does it stand up well to normal use?

Is it durable?

Safety

Is it safe to use?

What is the power source for the device?Is it safe?

Is a margin built in for foreseeable mis-use?

Practicality

Do company sales people seem knowl-edgeable and helpful?

Are the company’s service people knowl-edgeable and helpful?

Does the device have a warranty? Howlong is the device guaranteed to function?

How available are repair services? Atwhat cost?

Can this device be leased?

Is this device available for a trial periodbefore purchase?

Will this device soon be outdated? Issomething better on the horizon?

Will the company update the device?

Does the manufacturer provide trainingin using the device?

Aesthetics

Is this device attractive to the eye?

Does the device fit well into the user’slifestyle?

Normalization

Does the device assist the user with morenormalized living?

Can the user operate the device indepen-dently or with a minimum of assistance?

Or does the device “stick out” too muchand advertise the disability of the user?

Does the equipment minimize differenceor exaggerate difference?

Does the device have the potential to in-crease the quantity and quality of time spentwith nondisabled peers? Or does the de-vice separate the user from others?

Cost effectiveness

Do the benefits the device provides jus-tify the cost?

Are there less expensive devices or mod-els that serve the purpose as well?

Personal acceptance

Is this device the user’s own choice?

Does the potential user like this deviceand want to use it?

Does the potential user view this deviceas life-enhancing?

Would the user have preferred some otherdevice or means to perform the task?

Will using the device always be a choreor can using it become a habit?

There are several ways that consumers canfind answers to their specific questions aboutassistive technology devices. Most vendors willprovide good basic information about the prod-uct. Call the vendor and ask for brochures, prod-uct specifications, price list and any other writ-ten information. This is a place to start. A sec-ond step is to read reviews of the product in trademagazines or Closing the Gap, a widely respectedpublication that reviews new assistive technol-ogy products. If possible, it is very helpful totalk to other consumers who are already usingthe product. Ask them about the pros and consof using the device. Then visit a preview center,if there is one nearby, and try out several typesof devices. Ask for general recommendationsfrom the preview center’s staff. After identify-ing a device that appears to meet the potentialuser’s needs, try the device out for a month tosix weeks to make sure that it performs as adver-tised and fits in well with the user’s lifestyle.

18

During the trial period, it will be possible to iden-tify training needs for the user, family membersand school staff. The trial period will also be atime for the user to test the device in several set-tings to determine its portability and flexibility.

• Match the Individual’s Needs to SpecificEquipment Features.

When considering an assistive technologydevice, it is very important to consider how adevice matches up with the particularindividual’s needs and habits. In some ways, anassistive device becomes an extension of theuser’s mind and body. As such, it is a highly per-sonal item. A device may work as advertised,but still not meet an individual’s needs becausethe individual just does not feel “comfortable” inusing it. For example, Cindy, a fourteen-year-oldwho is totally blind and has mild cerebral palsyaffecting her hands and arms, was being taughtMorse Code as a means to speed up her writing.She had difficulty using a Brailler because her armstrength was so limited so her teacher thoughtMorse Code would be an easier method of writ-ing for Cindy. The only problem was that Cindydid not like using Morse Code. To her, it seemedlike she was having to learn another complicatedlanguage when she already knew braille andliked to use it. Cindy admitted that writing inbraille was slow for her but she was more com-fortable with it. Cindy and her teacher were atan impasse until a friend suggested to Cindy thatshe try writing on a voice-output computer.Cindy loved the computer! With a headset at-tached to the sound system, she could listen care-fully to the computer as it read aloud the lettersand words she was typing on a light touch, tac-tile-marked keyboard. This computer also had afeature of printing out text in either standard printor braille. Cindy was delighted—she could writecopy for herself to read in braille and for hersighted teachers to read in regular print. Thissolution worked because it met Cindy’s learningneeds and responded to her own ideas about her-self. She did not want to use Morse Code because

it was a separate type of communication knownonly to a few. With her computer, voiced soft-ware, and dual printer, she had the best of twoworlds—she could “hear” her writing as shetyped, she could read it over in braille, and hersighted teachers could read her finished prod-uct. This solution helped Cindy to improve hercomposition skills, speed up her writing time,and communicate more easily with sightedpeople.

Cindy was fortunate because her assistivetechnology solution met her needs almost per-fectly. Such a close match is not, however, al-ways possible. Nonetheless, every effort shouldbe made to have the match be as close as it canbe. In general, when assistive technology solu-tions are individualized, simple to use, and re-sponsive to the whole person, they are more likelyto be used by the individual. When the deviceperforms a task well, but does not “fit” the indi-vidual, the technology is likely to be abandonedby the user in favor of something else whichmeets the need more exactly. Too often devicesare purchased because of their technical poten-tial without thought to their relationship to theindividual and his or her lifestyle. These mis-matched devices are the ones that end up lan-guishing in their packing boxes—a sad reminderof time and money spent to no avail.

• Try the Device Before Buying.

It cannot be emphasized enough how vital itis to try out assistive technology devices andequipment before buying. Trying out a devicefor several weeks provides the user with an op-portunity to learn how to use the device and howto adapt to its features while at the same timetesting the device in the various environmentswhere it will be used. For example, Mike triedout a communication device which attachednicely to his wheelchair tray and was compat-ible with his computer that he used for doingschool work. Though the communication deviceworked well and was relatively easy to program,

19

MOTOR/SELF CARE

manual wheelchairpower wheelchairbus liftsupportive classroom

chairstanderwalkerlift for transferspositioning devicecanes or crutchesadapted commodesuctioning devicebraces or supportsother ____________

________________

________________

________________

________________

________________

________________

________________

________________

________________

________________

________________

figure 4: ASSISTIVE TECHNOLOGY EVALUATION

Device or Equipment Features or Functions

Name: Date:

FINE MOTOR

word processorword processor with

predictionvoiced word proces-

sor with predictionadapted keyboardkeyguardalternative key

arrangementvoice activated

computer accessinfrared computer

accessmouse accesstrackballjoystickpower padswitch (e.g., mouth,

lip, chin)touch screenpointersdrag and click desk

accessorysticky keysonscreen keyboardprinter for written

work

adapted feedingutensils

braces or splintsother ____________

________________

________________

COGNITIVE/COMMU-NICATION

communciationboard(s)

communication wallettotal communicationmanual signword processor with

voiceprogrammed voice

outputicon predictionelectronic communi-

cation deviceprogrammable switch

with voice output

no-reading-neces-sary word proces-sor

spell checkergrammar checkeroutlining programother ____________

________________

________________

________________

________________

________________

________________

________________

SENSORY/PERCEP-TUAL

hearing aid(s)

classroom amplifica-tion

boosted signal tonoise ratio (e.g.,headset to keepfocus during wordprocessing)

corrective lensesenlarged printtaped booksvoiced word process-

ingvoiced screen

directionsCCTVother ____________

________________

________________

________________

________________

________________

________________

________________

________________

________________

________________

20

Mike found out quickly that the device was justtoo bulky to be useful for him. When he trav-eled around the school, the communication de-vice blocked his view of the terrain and of peoplepassing by. He found he missed opportunitiesto communicate because he could not see whowas coming his way. Mike also discovered thatthe communication device did not serve him wellin crowds like at pep rallies or basketball games.After a month of working with this communica-tion device, Mike decided it was not for him andselected instead a device that was less compli-cated, smaller, and more portable. The seconddevice was not as sophisticated as the first, but itbetter met his needs for quick communicationwith friends in social settings. If he had not hadthe opportunity to try out both devices for anextended period of time, Mike might not haverealized the value of the second device and mayhave been stuck with a communication devicethat was too large and too sophisticated to matchhis lifestyle.

Similarly, Marilyn benefited from a trial pe-riod with her communication device. She foundout the first week that the particular device shehad chosen would not work for her because itbroke too easily and it was difficult to get re-paired. During the first week that Marilyn hadthe device for trial, her teacher broke one of thebuttons during a programming session. It tooktwo weeks to contact the manufacturer and thenthe device had to be mailed back to the factoryfor repairs. The device was gone for over sixweeks, and the manufacturer would not supplya “loaner” while Marilyn waited for repairs tothe first device. This experience taught Marilynthe importance of having a responsive manufac-turer who is willing to repair devices quickly andto supply substitutes for the user while repairsare being made. Marilyn decided on a differentdevice with similar features and a great helplineto provide assistance with the maintenance of themachine.

The information that can be learned during a

trial period with a device is invaluable to the user.It is discouraging to find out during the trial thata device is not all it is purported to be or that itdoes not work as well as advertised, but it is farbetter to learn before purchase that a device doesnot meet the user’s needs than to learn after pur-chase and be stuck with an expensive, unusablemachine. For the consumer, it is daunting to thinkabout starting over again with the process of se-lecting a device. Nonetheless, it is worthwhileto seek more information and look again. Hav-ing been through a trial, even when the outcomeis not successful, provides the user with greaterclarity about what an appropriate device willhave to be able to do. The second time aroundthe search is likely to go faster and come out witha better result.

• Identify Next Steps.

Once a device has been selected, the con-sumer becomes impatient to have one and beginusing it right away. But at this point, importantwork still needs to be done. Funding the deviceis a major consideration. Sometimes families willpay for the device themselves, but under othercircumstances, the device will be purchased by aschool district, through Medicaid or private in-surance, or through some other means. Parentsneed to become familiar with the various fund-ing options and determine which one will workfor them (See Funding Assistive Technology foradditional information about funding sources).

Also when considering funding, familiesshould think about costs beyond the price of thedevice itself. For example, a computer set-upwith a keyboard, monitor and printer might cost$3,500. This equipment is basically useless un-less other equipment is purchased as well: soft-ware, adaptive devices, paper, manuals, up-grades. Prices for these additions can raise theactual cost of the device by hundreds of dollars.

Devices often require training for the user,family members, and others to ensure effectiveand safe use. How much does training cost? Who

21

will provide it? Repair and maintenance are othercosts usually additional to the price of the equip-ment. Sometimes families will also want to insurethe assistive device so insurance payments be-come part of the overall cost.

Since making an assistive technology pur-chase is such an important personal and finan-cial decision, it is wise to have a realistic budgetin mind that includes all of the equipment andservices that are necessary to make the assistivetechnology work effectively. With this budget inmind, it becomes easier to plan the purchase, seekout funding sources, and make a compelling casefor financial assistance.

• Determine What Follow-up Is Needed.

After the assistive technology device has beenpurchased and put to use, there are additionalfollow-up activities that need to take place. Theoriginal assistive technology evaluation shouldinclude a way to monitor the use of the device.Periodic scheduled reviews the by evaluator, fol-low-up calls to and from the family are some waysto help assure effective, safe use. Families whotravel great distances for evaluation need to becertain that services like maintenance, repair andreplacement of devices are available within a rea-sonable distance from home.

Assistive technology devices are used bestwhen all the people in the life of the individualwith disabilities understand the devices in thesame way. At first, devices may seem to exagger-ate differences between a person and the rest ofthe world. Care should be taken to explain thatassistive equipment is a difference equalizer, nota difference maker. Classmates and friends needto understand that the adapted seating or adaptedkeyboard helps the individual do what other stu-dents do. Adults in a child’s life need to under-stand that devices work to make life easier, bet-ter, and more functional. People need to knowthat ramps help keep individuals with mobilitydisabilities from being separated from peers; thatcommunication technology allows people to

“speak” their thoughts.

Close communication between parents andtheir child’s helpers—teachers, therapists, daycare workers and others—is essential to makesure devices and services are being used safelyand effectively. If the device is working well, butthe child is not being integrated into the class-room or other environments, then there may bea need for additional training for the children andadults who interact with the child.

Besides keeping track of how the device isworking and being used, it is important to ob-serve progress in the areas of technology whichare useful to the individual with the assistivetechnology device. As upgrades of equipmentoccur or more sophisticated models come on themarket, the user may want to consider modify-ing or replacing the equipment that is currentlyin use. Also as the individual becomes moreskilled at using technology, the individual mayoutgrow the current device and need to look formore advanced equipment. It can be assumedwith most high tech items that in three to fiveyears there will be a need for upgrade or replace-ment. The wise consumer begins early to planfor the next step in technology, including savingmoney for a new device and staying alert to thenew options that become available.

What kinds of training are important to occurwhen a child has a new assistive technologydevice?

Because assistive technology of the high techvariety is so new, it is particularly important thattraining be provided to all those who may needit. In the school setting, it is helpful for all edu-cators and administrators to have some aware-ness training so that they have a general idea ofwhat assistive technology is. Areas to be cov-ered in inservice training might include:

• legal issues related to assistive technology

• awareness training concerning how toserve students with assistive technologyneeds

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• information on how assistive technologyrelates to the evaluation process

• how to write IEPs for students who requireuse of assistive technology devices

• the relationship between technology andstudent placement

• the nature of common assistive technologydevices

• resources to contact for information onassistive technology.

Beyond these awareness activities, thosemembers of the school staff who work directlywith a student who uses technology, need to havetraining on the specifics of using the device andhow it is maintained and serviced. Trainingshould include, but not be limited to, the follow-ing:

• review of the student’s educational andassistive technology needs

• review of goals and objectives, supplemen-tary aids and services, and related serviceson the IEP or IFSP

• training on how to use and maintain thedevice

• training on proper transport of the devicewithin the school building and from hometo school

• training on how to program the device, ifneeded

• training on how to use the device effec-tively during instruction

• training in trouble-shooting when the de-vice is not working properly

• information about what to do when thedevice is not functioning or broken

• information about how to coordinateassistive technology with all the activitiesin the student’s day

• training in methods to evaluate the effec-tiveness of assistive technology.

Depending on the type of assistive technol-

ogy used by the student and the student’s needs,it may be advantageous for assistive technologyinformation to be shared with the student’s peers.Such training will help fellow students to gainan understanding of the student’s assistive de-vice, foster acceptance in the social environment,and reduce fears other students may have aboutsocializing with the student who uses technol-ogy. In some cases, parents and the student maywant to be involved in the peer training.

Parents may require training, too, in order forthe device to be used at home for the student tocomplete homework assignments or participatein extended school year services. Once trained,the parents can become a resource to the studentfor proper care and maintenance of the device.

Most importantly, the student himself or her-self, will need training in how to use the deviceas independently as possible. Training for thestudent may be written into the IEP as a separategoal or may be included as a related service thatsupports the student’s special education pro-gram.

SummaryPurchasing a high tech assistive technology

device is a major life decision because of the po-tential impact on the individual and because suchdevices can be costly. When considering anassistive technology device, it is important to dothe following: be realistic about the consumer’scapabilities and needs; get a multidisciplinaryevaluation; examine available technology with acritical eye; match the individual’s needs to spe-cific equipment features; test the device for a trialperiod; identify next steps; and determine whatneeds to be done for follow-up after purchase.Evaluations for assistive technology, both infor-mal and formal, should consider first of all thefunctions that the consumer wishes to performusing technology. When evaluating a particularpiece of equipment, consideration should begiven to the following features: performance, sim-

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plicity of design, ergonomics, reliability, safety,practicality, aesthetics, normalization, cost effec-tiveness, and personal acceptance. Good sourcesof information about assistive devices are manu-facturers publications, trade journals, previewcenters, and consumers who are already using thedevice. Once a device is selected, the consumerwill need to secure funding for the purchase andbe aware of additional costs for related equip-ment, insurance and training.

Hints for Parents

Don’t let the cost of assistive technology deter youfrom considering it for your child. High tech assistivetechnology can be quite costly, but it can also makethe difference for your child in terms of becoming welleducated, employable, and a fully-included member ofthe community. Don’t leave any stone unturned whenlooking for funding sources. Consider any or all ofthe following for funding or assistance:

• Early intervention programs

• Schools

• Transition programs

• Vocational Rehabilitation

• State Programs for Children with SpecialHealth Care Needs

• Medicaid

• Medicare

• State Technology Resources

• Used Equipment

• Leasing

• Equipment Loan Programs

• Disability Organizations

SierraSierra wants to play with dolls like other chil-

dren her age, but she has a muscle disease thathas caused her to lose muscle tone except in onehand. What could be done to allow Sierra to dressand undress her dolls, comb their hair, and bathethem?

Sierra’s SolutionThe assistive technology solution for Sierra

involved her whole family. While vacationingin Mexico, Sierra’s grandmother found her a fash-ion doll that was a bit larger than the typical“Barbie doll.” The larger doll was easier for Si-erra to manipulate. Sierra’s mother sewed sev-eral outfits for the doll using velcro instead ofsnaps or buttons as fasteners.

Sierra’s dad bought doll stands at a toy storeand fastened several stands with clamps toSierra’s wheelchair tray. He also fastened a plas-tic pouch to the tray. Sierra puts the small dollaccessories in the pouch. When Sierra wants todress her doll, she puts the doll in one of thestands. In this way, the doll is held securely andSierra can dress and undress the doll with onehand.

Sierra’s friends also use the doll stands fortheir dolls. With this arrangement, two or threegirls can play together.

Solution SummaryLarger doll

Velcro fasteners

Plastic pouch

Doll stands

Clamps

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Funding Assistive Technology

F unding for assistive technology is availablefrom a variety of public and privatesources. To receive public or private fund-ing, the individual must meet eligibility criteriafor the specific program and provide sufficientdocumentation of the need for assistive technol-ogy.

The following list includes some of the pro-grams which may pay for equipment if the indi-vidual needing the device meets their require-ments. Many of these programs are run by dif-ferent agencies in different states, making themhard to find. In general, the state’s Tech Act of-fice can assist consumers and family members infinding and using these programs (See Appen-dix under Resources).

PUBLIC PROGRAMSEarly Intervention Programs (Individuals withDisabilities Education Act, Part H)

Young children (0-3) and their families mayreceive help through early intervention programsin evaluating what the child needs, in gettingassistive technology, and in learning how to useit. Equipment and services must be included ina written plan, called an Individualized FamilyService Plan (IFSP). To find the program for aparticular state, call National Early ChildhoodTechnical Assistance System (NEC*TAS) at 919-962-2001 or 919-966-4041 (TDD).

Head StartThis child development program provides

comprehensive educational and health servicesfor eligible children ages 3-5. Since 1982, federallaw has required that at least 10 percent of thetotal number of placements must be available tochildren who are disabled and require specialservices. Head Start is a mainstream placementoption for children whose IEP calls for placementwith nondisabled children. The January 1993Head Start regulations specifically require the

consideration of assistive technology services anddevices. For more information, contact NationalHead Start Association, 201 N. Union St., Suite320, Alexandria, VA 22314; 703-739-0875.

Schools (IDEA, Part B)This program mandates a free, appropriate

public education for preschoolers, children andyouth with disabilities. An Individualized Edu-cation Program (IEP) is required for all childrenwith a disability. These children are entitled tospecial education, related services or supplemen-tary aids. If the IEP team determines that assistivetechnology is required for a free, appropriatepublic education, then it must be provided at nocost to the child. The technology must be in-cluded in the child’s Individualized EducationProgram (IEP). Parents have a right to be in-volved and should help to develop the IEP goalswhich may include technology. For help in get-ting assistive technology in the IEP, call the TAPPFocus Center on Assistive Technology at 1-800-222-7585.

State Operated and Supported Schools (Chap-ter I)

This program provides federal assistance tohelp educate children with disabilities who areenrolled in state-operated and state-supportedprograms. Federal funds must be used to payfor services that supplement a child’s basic spe-cial education program, such as construction andthe purchase of equipment. For more informa-tion, contact your State Department of Education.

Section 504 of the Rehabilitation Act of 1973Section 504 provides a civil-rights mandate

that requires accommodations for students whohave disabilities such as orthopedic impairments,but who do not qualify for special education ser-vices. It denies federal funds to any institution,including a school, whose practices or policiesdiscriminate against individuals with disabilities.

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This legislation has resulted in a number of out-comes, including various actions to remove physi-cal barriers to education, which may incorporateassistive technology. For more information, con-tact the nearest regional Office of Civil Rights orthe State Vocational Rehabilitation Agency.

State Programs for Children with SpecialHealth Care Needs

These programs provide and pay for servicesfor eligible children. CSHCN programs varywidely from state to state in the services they of-fer, the number