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Adaptive Technology

Family Guide to Assistive Technology

From the web page http://www.pluk.org/AT1.html

Family Guide to Assistive Technology

Prepared By:
Parents, Let's Unite for Kids (PLUK)
in cooperation with
The Federation for Children with Special Needs

EDITOR: Katharin A. Kelker, Ed.D.
PRODUCTION: Roger Holt, ATP
ILLUSTRATION: Karen Moses
(c) Parents, Let's Unite for Kids 1997

This guide was funded through a subcontract between the Federation and Parents, Let's Unite for Kids from monies 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 Education Department's position or policy. The Department of Education ensures equal employment, equal educational opportunities, and affirmative action regardless of race, sex, color, national origin, religion, marital status, age, or disability. This material is available upon request in alternative formats by calling: 1-800-222-7585 or email: plukmt@wtp.net.

Table of Contents

Introduction

Defining Assistive Technology

Sara

Making Assistive Technology Decisions

Sierra

Funding Assistive Technology

Ted
Gloria

Making Assistive Technology a Part of Child's Education

Emily
Bryan
Tracy

Advocating for Assistive Technology

More Questions and Answers

Appendix

Glossary

Documents

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

Examples

* Educational Software Evaluation
* Software Features
* Alternative Input
* Processing Aids
* Alternative Output
* Specialized Products
* Assistive Technology Evaluation

Resources

* Parent Training and Information Centers
* Alliance for Technology Access Resource Centers
* State Tech Act Projects

Introduction

Assistive technology is redefining what is possible for people
with a wide range of cognitive and physical disabilities. In the
home, classroom, workplace, and community, assistive technology
is enabling individuals with disabilities to be more
independent, self-confident, productive, and better integrated
into the mainstream.

Beginning early in life, technology is making it possible for
children with disabilities to do more for themselves. A child
who cannot use her hands can operate a computer with a switch
and an on-screen keyboard. A child with speech problems can
communicate using a portable electronic device that "speaks." A
child who is unable to get in and out of the bathtub can be
safely and easily lifted using a mechanical device. These are
just a few examples of the wide variety of equipment, called
assistive technology, that is available today.

Assistive technology can mean anything from simple, homemade
devices to highly sophisticated environmental control systems.
It can be adapted toys, computers, powered mobility,
augmentative communication devices, special switches, and
thousands of commercially available or adapted tools to assist
an individual with learning, working, and interacting socially.

As wonderful as assistive technology can be, it is not always
easy to acquire. It takes expertise and persistence to find the
correct devices and figure out ways to pay for them. For
example, children with disabilities who are eligible for special
education have a legal right to technology to assist them with
learning. Both the Individualized Family Service Plan (IFSP) and
the Individualized Education Program (IEP) which are required by
tthe Individuals with Disabilities Education Act (IDEA) are
potentially powerful tools for incorporating assistive
technology into the education of students with disabilities. But
assistive technology does not become part of a student's special
education plan unless parents are knowledgeable about technology
and know what to do to ensure that assistive technology becomes
an integral part of their child's program.

This Guide is intended to help parents learn more about
assistive technology and how it can help their children. The
Guide includes tips for getting started, ideas about where to
look for money, and suggestions for what to do when applying for
funding. Places to contact for more information or to find
software and equipment are listed in the Appendix at the end of
the Guide.

Finding and paying for the right technology requires commitment
and energy. Professionals in education and medicine can help,
but parents cannot rely on professionals to do everything that
is necessary to get the equipment. As a parent, you have a much
better chance of getting what is needed if you and your child
are involved in selecting the technology and planning for its
use. This Guide should help you to understand the processes for
acquiring assistive technology and provide you with the tools to
advocate for your child's special technology needs.

e

Defining Assistive Technology

Assistive technology devices are mechanical aids which
substitute for or enhance the function of some physical or
mental ability that is impaired. Assistive technology can be
anything homemade, purchased off the shelf, modified, or
commercially available which is used to help an individual
perform some task of daily living. The term assistive technology
encompasses 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 entire range of supportive tools and equipment from
adapted spoons to wheelchairs and computer systems for
environmental control.

The Individuals with Disabilities Education Act (IDEA), the
federal special education law, provides the following legal
definition of an assistive technology device: "any item, piece
of equipment, or product system... that is used to increase,
maintain, or improve functional capabilities of individuals with
disabilities." Under IDEA, assistive technology devices can be
used in the educational setting to provide a variety of
accommodations or adaptations for people with disabilities.

The IDEA also lists the services a school district may need to
provide in order to ensure that assistive technology is useful
to a student in the school setting. The law defines assistive
technology service as: "any service that directly assists an
individual with a disability in the selection, acquisition, or
use of an assistive technology device." This service includes
all of the following possibilities:

* evaluation of the technology needs of the individual,
including a functional evaluation in the individual's
customary environment;
* purchasing, leasing, or otherwise providing for the
acquisition of assistive technology devices for individuals
with disabilities;
* selecting, designing, fitting, customizing, adapting,
applying, maintaining, repairing, or replacing of assistive
technology devices;
* coordinating and using other therapies, interventions, or
services with assistive technology devices, such as those
associated with existing education and rehabilitation plans
and programs;
* assistive technology training or technical assistance with
assistive technology for an individual with a disability,
or, where appropriate, the family of an individual with
disabilities;
* training or technical assistance for professionals,
employers, or other individuals who provide services to,
employ, or otherwise are substantially involved in the major
life functions of individuals with disabilities.

The intention of the special education law is that, if a student
with disabilities needs technology in order to be able to learn,
the school district will (a) evaluate the student's technology
needs, (b) acquire the necessary technology, (c) coordinate
technology use with other therapies and interventions, and (d)
provide training for the individual, the individual's family,
and the school staff in the effective use of the technology.

During the time that students with disabilities are in school,
they can have the opportunity to learn to use technology at the
same time that they are learning academic subjects and social
skills. The efficient and effective use of assistive technology
can be as basic a skill for students with disabilities as
reading, writing, and arithmetic since the use of technology can
go a long way toward circumventing the limitations of disability
and providing students with disabilities with a "level playing
field" in every area of life accomplishment.

What is an accommodation?

Accommodations are reasonable modifications that are made to
compensate for skills or abilities that an individual lacks. For
example, if a person does not digest spicy foods well, we might
accommodate this individual by adjusting his or her diet so that
the person was eating only bland foods.

When the word accommodation is used in connection with
disability issues, it refers to a way of modifying a task or
assignment so that a person with a disability can participate in
spite of whatever challenges the disability may pose. For
example, when a student who is unable to remember math facts is
allowed to do math problems with a calculator, the use of the
calculator is an accommodation which allows the student to work
around his or her disability. With an accommodation, the student
can still perform math problems, but the student does so using a
different method.

In the school setting, sometimes it is necessary to make
accommodations for individuals with disabilities in order to
compensate for skills or abilities that they do not have. For
example, for some students with learning disabilities learning
to spell words correctly may be a skill they never acquire or
never acquire with a high enough degree of fluency to do them
any good in written expression. To compensate for this inability
to spell, such students may be encouraged to use alternative
methods for spelling like a spell check software program on the
computer or a hand-held spelling device.

What is an adaptation? How does adaptation differ from
accommodation?

Adaptation means developing unique devices or methods designed
specifically to assist persons with disabilities to perform
daily tasks. An adaptation is something specially designed which
is not normally used by other people. An accommodation, on the
other hand, is simply a change in routine, method, or approach
which may be used by people with or without disabilities.
Examples of adaptations include special grips to turn stove
knobs or specially designed keyboards to operate computers.

What are common types of assistive technology? Does assistive
technology just mean computers?

Assistive technology certainly includes computers, but it also
refers to a number of other types of accommodations and
adaptations which enable individuals with disabilities to
function more independently. Computers are an important type of
assistive technology because they open up so many exciting
possibilities for writing, speaking, finding information, or
controlling an individual's environment. But computers are not
the only avenues to solving problems through technology. There
are many low tech (and low cost) solutions for problems that
disabilities pose. Examples of inexpensive, low tech solutions
include wrist splints, clip boards for holding papers steady, or
velcro tabs to keep positioning pads in place.

The following is a list of common assistive technology
applications:

Positioning. In the classroom, individuals with physical
disabilities may need assistance with their positions for
seating so that they can participate effectively in school work.
Generally, therapists try to achieve an upright, forward facing
position by using padding, structured chairs, straps, supports,
or restraints to hold the body in a stable and comfortable
manner. Also considered is the student's position in relation to
peers and the teacher. Often, it is necessary to design
positioning systems for a variety of settings so that the
student can participate in multiple activities at school.
Examples of equipment used for positioning are side lying
frames, walkers, crawling assists, floor sitters, chair inserts,
wheelchairs, straps, trays, standing aids, bean bag chairs, sand
bags and so forth.

Access. In order to participate in school tasks, some students
require special devices that provide access to computers or
environmental controls. The first step in providing access is to
determine which body parts can be used to indicate the student's
intentions. Controllable, anatomical sites like eye blinks, head
or neck movements, mouth movements may be used to operate
equipment which provides access to the computer. Once a
controllable, anatomical site has been determined, then
decisions can be made about input devices, selection techniques
(direct, scanning), and acceleration strategies (coding,
prediction). Input devices include such things as switches,
alternative keyboards, mouse, trackball, touch window, speech
recognition, and head pointers. Once computer access has been
established, it should be coordinated with other systems that
the student is using including powered mobility, communication
or listening devices, and environmental control systems.

figure 1: Alternative and Processing Computer Access Methods

Input
Processing
Output

* 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

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

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

Access can also refer to physical entrance and exit of buildings
or facilities. This kind of assistive technology includes
modifications to buildings, rooms and other facilities that let
people with physical impairments use ramps and door openers to
enter, allow people with visual disabilities to follow braille
directions and move more freely within a facility, and people of
short stature or people who use wheelchairs to reach pay phones
or operate elevators. Accessibility to shopping centers, places
of business, schools, recreation, transportation is possible
because of assistive technology modifications.

Environmental Control. Independent use of equipment in the
classroom can be achieved for students with physical
disabilities through various types of environmental controls,
including remote control switches and special adaptations of
on/off switches to make them accessible (e.g. velcro
attachments, pointer sticks).

Robotic arms and other environmental control systems turn lights
on and off, open doors, operate appliances. Locational and
orientation systems give people with vision impairments
information about where they are, what the ground nearby is
like, and whether or not there is a curb close by.

Augmentative Communication. Every student in school needs some
method of communication in order to interact with others and
learn from social contact. Students who are nonverbal or whose
speech is not fluent or understandable enough to communicate
effectively may benefit from using some type of communication
device or devices. Communication devices include such things as
symbol systems, communication boards and wallets, programmable
switches, electronic communication devices, speech synthesizers,
recorded speech devices, communication enhancement software, and
voiced word processing.

Assistive Listening. Much of the time in school, students are
expected to learn through listening. Students who have hearing
impairments or auditory processing problems can be at a distinct
disadvantage unless they learn to use the hearing they have, or
they develop alternative means for getting information. Hearing
problems may be progressive, permanent, or intermittent. Any of
these impairments may interfere significantly with learning to
speak, read, and follow directions. Assistive devices to help
with hearing and auditory processing problems include: hearing
aids, personal FM units, sound field FM systems, Phonic Ear,
TDDs, or closed caption TV.

Visual Aids. Vision is also a major learning mode. General
methods for assisting with vision problems include increasing
contrast, enlarging stimuli and making use of tactile and
auditory models. Devices that assist with vision include screen
readers, screen enlargers, magnifiers, large-type books, taped
books, Braillers, light boxes, high contrast materials,
thermoform graphics, synthesizers, and scanners.

Mobility. Individuals whose physical impairments limit their
mobility may need any of a number of devices to help them get
around in the school building and participate in student
activities. Mobility devices include such things as
self-propelled walkers, manual or powered wheelchairs, and
powered recreational vehicles like bikes and scooters.

Computer-Based Instruction. Computer-based instruction can make
possible independent participation in activities related to the
curriculum. Software can be selected which mirrors the
conceptual framework of the regular curriculum, but offers an
alternative way of responding to exercises and learning
activities. Software can provide the tools for written
expression, spelling, calculation, reading, basic reasoning, and
higher level thinking skills. The computer can also be used to
access a wide variety of databases.

Social Interaction and Recreation. Students with disabilities
want to have fun and interact socially with their peers.
Assistive technology can help them to participate in all sorts
of recreational activities which can be interactive with
friends. Some adapted recreational activities include drawing
software, computer games, computer simulations, painting with a
head or mouth wand, interactive laser disks, and adapted puzzles.

Self Care. In order to benefit from education, some students
require assistance with self care activities like feeding,
dressing, and toileting. Assistive devices which assist with
self care include 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 assistive technology?

Students who require assistive technology are those with mental
or physical impairments that interfere with learning or other
life functions. The technology helps the student to overcome or
compensate for the impairment and be more independent in
participating at school. Students who benefit from assistive
technology may have mild learning problems like learning
disabilities or they may have physical or cognitive disabilities
that range from mild to severe. Assistive technology is not
necessary or helpful for every student in special education, but
it is an important part of the support system for many students
with identified disabilities.

Isn't assistive technology appropriate only for students with
more severe disabilities?

Assistive technology is simply a set of tools that can be used
to compensate for some deficit that a person may have. For
individuals with severe mental or physical disabilities, the
technological solutions can help to solve multiple and complex
problems. But individuals with less involved problems also can
benefit from assistive technology. For example, individuals with
learning disabilities who have difficulty with reading or
writing can benefit educationally from using the word processing
and voiced reading capabilities of computers.

Isn't assistive technology just a crutch? Won't students become
too dependent on technology and not learn to use the skills they
have?

Assistive technology should be used as support for access,
learning and performing daily tasks. In general, assistive
technology is appropriate when it compensates for disabilities
so that the individual can function as normally as possible. If
assistive technology is necessary for a student to have access
to educational opportunities or to benefit from education, then
it is not a "crutch," but a legitimate support.

Some skills are too laborious or taxing to accomplish at a rate
or with degree of proficiency to allow for participation in the
least restrictive environment. With assistive technology, the
student can participate more fully and more closely approximate
the levels of achievement and interaction of his or her peers.

The use of assistive technology enhances function and increases
skills and opportunities. Though a student may be dependent upon
a particular device in order to perform skillfully, denying the
device denies the student an opportunity ever to achieve success
at the level of his or her potential.

When is using assistive technology appropriate?

Assistive technology may be considered appropriate when it does
any or all of the following things:

* Enables an individual to perform functions that can be
achieved by no other means
* Enables an individual to approximate normal fluency, rate,
or standards--a level of accomplishment which could not be
achieved by any other means
* Provides access for participation in programs or activities
which otherwise would be closed to the individual
* Increases endurance or ability to persevere and complete
tasks that otherwise are too laborious to be attempted on a
routine basis
* Enables an individual to concentrate on learning or
employment tasks, rather than mechanical tasks
* Provides greater access to information
* Supports normal social interactions with peers and adults
* Supports participation in the least restrictive educational
environment.

Summary

Assistive technology means any device which helps an individual
with an impairment to perform tasks of daily living. There is a
wide range of types of devices in assistive technology from low
tech, homemade aids to computers and sophisticated electronic
equipment. Assistive technology is one of the services which can
be provided in a special education program under the Individuals
with Disabilities Education Act (IDEA). The requirements of IDEA
say that students who need assistive technology are entitled to
the aids and devices and the assistive technology services
(e.g., evaluation for assistive technology and modification and
maintenance of equipment) that are necessary for the student to
benefit from a free, appropriate public education.

Hints for Parents

It is never too soon to consider using assistive technology.
Some infants with physical disabilities, for example, really
benefit from early interaction with toys that operate by switch.
Here are suggestions for times to evaluate a child for assistive
technology:

* When disability limits interaction with the environment and
interferes with experiential learning.

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

* When a significant gap exists between receptive and
expressive abilities.

Assistive technology can assist with expression through the use
of programmable switches, electronic communication devices,
voiced word processing, braille embossing and so forth.

* When an individual's performance falls behind that 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 substituted for handwriting; thus allowing the individual
to keep up with others in terms of written expression.

* When a physical disability is impeding the
educational/vocational potential of an individual.

Assistive technology can provide access to the workplace, for
example, by allowing an individual who is blind to learn to use
a screen reader and voiced word processing to do clerical tasks
that would otherwise be impossible.

* When a disability is impeding the independence of an
individual.

Sometimes assistive technology can be used to allow a person
with a disability to function more independently. For example,
having a power wheelchair allows an individual to travel
independently without the necessity of having someone to push
the wheelchair.

e

Sara

Sara, who has Down syndrome, is eight years-old. Her language
and speech skills are three years delayed, but she has age
appropriate social skills. Sara has spent part of her school day
in a regular classroom ever since kindergarten, but this year
her third grade teacher is suggesting that Sara really cannot
keep up with her classmates. The teacher thinks that Sara would
be better off in a self-contained class with students who work
at her pace. Sara has some fine motor coordination problems, and
she has had difficulty learning to write in cursive. Her oral
reading is hampered by her speech difficulties. However, Sara
has learned to do addition and subtraction problems well and has
mastered adding with carrying and subtraction with borrowing.
She reads at about a second grade level with reasonably good
comprehension. Sara's parents would like to see her continue in
the regular classroom for as much time as possible, but they
recognize that Sara's writing and speaking problems are keeping
her from doing her best work.

What are Sara's needs?

What kinds of technology should go in Sara's IEP?

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

Sara's Solution

Sara's IEP Team met to discuss her needs and concluded that she
is doing well in a regular classroom setting; she is making
adequate progress in academic skills and has learned how to
interact socially with her peers. It is to be expected that Sara
will have difficulty keeping up with the pace in a third grade,
but as long as she is making progress toward her individual
goals, the regular classroom is a good setting for her. However,
some simple accommodations and technology may help Sara to work
faster and more efficiently.

At this point Sara may need some assistance with handwriting and
speaking, but the solutions to her problems in these areas need
not be complex ones. The team decided that Sara should continue
to practice cursive until she has mastered all the letters and
can be more facile in using script. However, while she is still
learning cursive, she needs other means for responding in
writing. For short written responses, the team agreed that Sara
should be encouraged to use manuscript printing. When speed is
important or when writing assignments are longer, Sara should
have access to a computer with an adaptive keyboard (e.g.,
IntelliKeys). The adaptive keyboard is helpful for Sara because
the "keys" are larger and easier to see. Using the keyboard
requires only a very light touch so Sara finds it easier to use
than a standard computer keyboard.

In terms of oral reading, the team decided to have Sara practice
reading into a tape recorder. Her speech therapist will work
with her on slowing down her rate of speech and reading with
expression. When Sara has a good tape of her oral reading, she
will submit it to her teacher for review.

Solution Summary

Practice cursive
Use manuscript printing for short assignments
Use computer with adaptive keyboard for longer
assignments
Practice oral reading using a tape recorder

e

Making Assistive Technology Decisions

When parents learn about assistive technology and the wonderful
opportunities it can provide, they want to jump right in and get
the latest in technology for their children. Who wouldn't want
an augmentative communication device for a child who cannot
talk? What parents wouldn't want to buy a computer if it would
help their child learn?

When the world of assistive technology opens up for parents, it
can be like entering a great toy store--everything looks so
wonderful that it makes it hard to know what to select. Choosing
the right device to meet an individual's needs requires
technical knowledge and indepth understanding of the
individual's functional capabilities. Not only is the selection
of a device made difficult by the complexity of the equipment
and the demands of the individual's impairment, assistive
technology devices can be very expensive. Making such purchases
is a major financial commitment for most families, one that
takes a great deal of soul searching and sometimes significant
sacrifice.

Families invest more than money in their children's assistive
technology. Practical investments of time and effort and
emotional investments of hope and enthusiasm are made with every
assistive technology purchase. Because of the high level of
financial, personal and emotional commitment, family
disappointment is great when equipment fails to perform as
expected.

Buying and then not using a device because of dissatisfaction
can be a devastating experience for all concerned. That is why
it is so important for parents to proceed cautiously into the
world of assistive technology and make purchases only after
careful evaluation and trials with the new device. Following is
a summary of some suggestions for parents to consider before
making any assistive technology purchase: be realistic about
your child's capabilities and needs; get a multidisciplinary
evaluation; examine available technology with a critical eye;
match the child's needs to specific equipment features; do not
make a purchase until you have used the device for a trial
period; identify next steps; and determine what needs to be done
for follow-up after purchase.

Guidelines for Making Assistive Technology Decisions

* Be realistic about your child's capabilities and needs.

Assistive technology can open up exciting new opportunities for
a child, but it is not magic. There are certain basic
requirements for any individual to be successful with
technology, and it is important to face these requirements
squarely. There is nothing more disappointing or discouraging
than purchasing expensive equipment for a child which is beyond
his or her capabilities to use.

Prerequisites for Computer Use. Physical or sensory impairments
do not limit access to computers, but cognition is a factor in
computer operation. The major prerequisite for using a computer
(with or without adaptations) is the cognitive ability to
understand cause and effect. The child must be able to
understand that the computer operates (e.g., changes, does
something) because the child has activated the equipment through
some volitional movement or activity (e.g., eyebeam, speaking,
puffing into a straw, hitting a switch). Some children enjoy
playing with switches by hitting them randomly but may not be
able to connect their own behavior to the response their
movement activates. In order to be successful in interacting
with a computer, the user must be able to control some
volitional activity and to do so consistently. For example, the
child would have to be able to activate the computer in response
to a visual, tactile, or auditory prompt.

Another prerequisite to computer use is the ability to make
conscious, meaningful choices between alternatives like yes and
no. The choices can be very simple ones, but there has to be
evidence that the child has made an actual decision and not
merely acted randomly.

If a child does not have the concept of cause and effect or
cannot make consistent choices, using a computer is probably not
a worthwhile next step at this point in the child's development.
Other types of activities may be more appropriate, less
expensive, and just as rewarding developmentally and personally.

Prerequisites for Augmentative Communication. Augmentative
communication devices can literally give voice to the thoughts
of individuals who cannot speak or cannot speak clearly,
but--again--these devices are not magic. Electronic
communication devices are of no value unless the user has some
communicative intent. That is, for a communication device to be
helpful, the user has to have some basic understanding of the
communication process and must be intentional in expressing
choices, desires, or needs.

For example, Maggie is a four-year-old who is nonverbal. She
communicates her wants and needs by using eyeblinks as responses
to yes or no questions. When Maggie's dad asks her if she would
like another glass of milk, she indicates her choice by raising
her eyes up vertically for yes or moving her eyes down for no.
Maggie clearly knows what she wants to communicate, she has a
consistent method for making her wishes known, and she expects
that her dad will understand her communication and act on it.

Dan, who is also nonverbal, communicates in a different way. He
points to objects and makes gestures to show what he wants or
needs. His gestures are clear and used consistently so that
family members and even people who do not know Dan well can
understand most of the time what he is communicating.

Shelley communicates very basic information about how she feels
by crying when she is uncomfortable or wants attention and by
laughing when she enjoys something like music, bright lights, or
water running. Shelley does not, however, respond to yes or no
questions. She does not make choices, even when objects are
presented to her individually or in pairs. She cannot respond to
a question like "Do you want some ice cream now?" Or "Would you
like the teddy bear or the doll?"

Maggie and Dan may benefit from using some communication device
because they are already using communication systems
meaningfully and consistently. Shelley, however, may need to
develop greater ability to communicate meaningfully before
moving on to electronic communication.

Communication skills fall along a continuum. At one end of the
continuum are very simple communications like expressing
preferences by indicating yes or no, pointing or gesturing
toward objects, or pointing to pictures. Use of sign is a more
complex form of communication because it requires that the user
understand that the signs are symbols for meaningful
communications. When an individual is able to string together
signs or words into meaningful phrases, this is an additional
step toward more complex communication. When a person
understands syntax and is aware of typical word order, this is
another step forward. Each of these advances along the
communication continuum represents a step toward more complex
and sophisticated communication. Whatever assistive
communication device is chosen should match or just slightly
exceed the place on the continuum where the individual is
functioning. It makes no sense, for example, to purchase an
elaborate electronic communication device that requires
understanding symbols and syntax when the individual using the
device is just at the point of learning how to express yes and
no preferences.

An electronic device does not teach communication; it enhances
communication by giving audible expression to thoughts that
already exist in the mind of the user. If the thoughts are not
there yet or are not completely formed, they cannot be expressed
by the device.

Physical and Sensory Impairments Are Not Barriers. Mastery of a
few simple prerequisite skills is necessary before computers or
electronic communication devices should be considered, but it is
not necessary for a child to master every developmental
milestone before entering the world of assistive technology.
Physical or sensory impairments can often be circumvented by the
technology itself, and typical developmental milestones can
sometimes be bypassed so that assistive technology can be used.
For example, some educators assume that students cannot use
computers until they have completely mastered keyboarding
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 verbal ability who have not
mastered oral speech benefit from using augmentative
communication devices while they continue to develop oral
language.

Overall, the keys to knowing when to try assistive technology
are (a) being realistic about the 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.

figure 2: Factors to consider when selecting Assistive Technology

Cognitive Factors
Motor Factors

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

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

* Get a multidisciplinary evaluation.

Evaluations for assistive technology are not always easy to
arrange. In many parts of the United States, there is no
convenient center or "place" to go for an assessment. The
available centers may be far away in another city or even
another state. Since assistive technology is a new field, the
systems for disseminating information and providing assistance
are in the process of evolving. Parents may have to be
"assistive technology detectives" in order to put together the
information needed for a complete AT evaluation for their child.

The place to start the evaluation is by considering the
functions the child needs to perform and cannot because of
impairment. The physicians, teachers, and therapists currently
working with the child, as well as family members and friends
who are around the child on a daily basis, can provide very
valuable information about functional problems and potential
solutions.

Finding Functional Solutions. The Alliance for Technology
Access (ATA), a national network of assistive technology
centers, has developed an informal method for using the
functional information available from professionals, family
members and friends as a basis for analyzing assistive
technology needs. This process, called a Solution Circle, is a
means to bring people together in an informal session that
allows for creative thinking and is not inhibited by what is
"legal," "currently available," or "what has been done before."
The individual with a disability and 4-10 family members,
professionals, and friends get together to brainstorm ideas
about the technology which may help the individual perform
functions that are hard, or impossible, to do because of
disability. The Circle usually includes a balance between people
who know the person who needs the technology and people who have
specialized knowledge about technology, education, or
work-related issues.

Solution Circle for Tom. To demonstrate how the Solution Circle
works, let's take a look at 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 significant barrier to
learning. Tom is "print disabled"; that is, he cannot read the
printed word with much comprehension. Reading is a slow,
unproductive process for him, even though he is intelligent and
eager to learn. Tom and his parents were hoping that there might
be a way that new technology could help Tom overcome or work
around his problem with reading so that he could get more out of
school and perhaps go on to college.

Tom's Solution Circle included his parents, Betty and Bob; his
resource teacher; a friend Darrell; his soccer coach; his 4-H
leader; and the owner of a local computer store. This group met
together to think about how Tom could participate more fully in
school and prepare himself for college, even though he could not
read with comprehension past the second or third grade level.

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

1. Star Time. The individual for whom the Solution Circle is
being held is described in a holistic way. The emphasis is on
how the individual is functioning at home and in the community.
What does he or she like and dislike? What are his/her goals?
Interests? If possible, the individual with a disability speaks
for himself or herself or a video or pictures may be presented.
The point of this part of the discussion is give a clear picture
of the individual as a whole person.

At Tom's Solution Circle, he explained his dream of going to
college and becoming an agricultural botanist. Tom loves plants;
he is interested in breeding new strains of wheat and perfecting
various types of grain crops. Tom's 4-H leader agreed that Tom
had real gifts in understanding plant growth and physiology, and
that he already had sophisticated knowledge about botany which
would prepare him well for college study.

2. Strengths. With a complete picture of the individual in
mind, the group then makes an exhaustive list of the
individual's strengths, particularly noting any technological
accommodations which the individual is already using. What does
the individual do well? What are his or her unimpaired
functions? Often this discussion reveals an incredible number of
adaptations that the individual has already achieved.

Tom's Solution Circle discovered that he had many strengths,
including keen intelligence, perseverance, and thoroughness when
approaching a task. Tom already had some effective learning
strategies for remembering material that he heard. He had also
learned to use a small tape recorder for keeping track of
information provided in class.

3. Obstacles. With the individual's strengths in mind, the
group then turns its attention to a consideration of the
environment in which the individual is functioning and the
activities in which the individual wants to participate but
cannot at this time. The group considers what the obstacles and
barriers might be for the individual in his or her environment
and makes a list of these impediments.

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

4. The Enemy Within. Physical and cognitive impairments may pose
difficult obstacles for an individual, but often the feelings
that people have about the individual's disability or about
assistive technology pose greater problems than the disabilities
themselves. The Solution Circle process recognizes that human
fears, concerns, reservations, and prejudices might stand in the
way of a person's success as much as other types of limitations.
Getting these fears and concerns out on the table often helps
the group to deal more constructively with what is possible and
what needs to be done.

One of the serious issues in Tom's situation was that his
resource teacher felt he should continue to try to read for
himself instead of using a "crutch" like assistive technology.
The teacher thought that if Tom did not have to read all the
material, he would lose what little reading skill he had. In
some ways, the teacher's opposition to considering assistive
technology actually posed a greater barrier than the reading
problem itself.

5. Solutions. The exciting part of a Solution Circle occurs when
the group takes each obstacle or concern and turns it into a
possible solution through the use of technology or some other
type of adaptation. Not all solutions suggested eventually prove
to be feasible, but the point of the discussion is to produce
many possible solutions so that the individual and his or her
family have an array of options from which to choose. With good
minds puzzling over the problems and a spirit of cooperation and
collaboration, seemingly impossible barriers can be removed or
conquered. The process recognizes the expertise and
contributions of all participants, including the individual with
disabilities and his or her family members. The freewheeling
format of the discussion promotes ingenuity and innovation. All
involved come away from a Solution Circle energized by the new
possibilities.

Tom's Solution Circle became excited about the possibility of
solving his reading problem by using computerized texts. The
computer store operator mentioned he had heard that Recordings
for the Blind (RFB) offered textbooks on disk. Tom's parents got
in touch with Recordings for the Blind and ordered texts for Tom
to try on his computer at school. Soon Tom found that he could
keep up with his classmates and study exactly the same material
that they were covering. Because Tom had good strategies for
memorizing information that he heard, he learned quickly from
the texts that were read aloud to him by the computer. When
given oral tests by his classroom teachers, he was able to
recite appropriate answers which would have eluded him if he had
had to read the tests for himself.

Technology has made all the difference for Tom; he has every
reason to think that he will be able to go to college and pursue
his intellectual interests. His resource teacher is now
completely sold on the idea of assistive technology and using
computerized books and wants to use the technique with other
students. More than that, Tom's teacher also appreciates the
process of the Solution Circle which allowed professionals and
nonprofessionals to work together to find practical solutions
without being too concerned about the formalities of the special
education process. The informal nature of the Solution Circle
validated the expertise of all the participants and gave
everyone a chance to offer suggestions. The combination of a new
process for planning and new technology made Tom a winner. This
same combination holds potential for many students like Tom who
benefit from technologies which eliminate barriers and open up
new possibilities for learning.

f igure 3: ASSISTIVE TECHNOLOGY EVALUATION
Individual Functional Analysis

Name:

Date:

COGNITIVE FACTORS

MOTOR FACTORS

Cognitive Ability Documented below average ability
Documented significant overall delay Does not appear
age appropriate Lacks understanding of cause & effect

Paying Attention

Difficulty following prompts or directions Difficulty
with multi-step procedures Difficulty filtering
information Difficulty staying on task

Perception

Needs lengthened response time Requires multi-sensory
input Difficulty with rapid change Significant
visual/perceptual problems Slow visual-motor dexterity

Memory

Difficulty with recall Requires reteaching learned
skills Requires repeated practice

Abstract Reasoning

Difficulty analyzing simple procedures Unable to
reproduce a sequence Unable to analyze or synthesize
information

Problem Solving

Unable to use prompts or cues to accomplish tasks
Unable to modify attempts and try another way
Mobility Needs help to be mobile Needs motorized help
to be independent Needs help boarding transportation
Unable to transfer independently Cannot climb stairs
Cannot open doors independently Cannot carry materials
in hands or arms Cannot lift weight

Voluntary Motor

Limited control of head, trunk, or extremities Visual
motor deficits Fixed position and posture Needs
support to sit or stand Needs adaptations in order to
use technology

Motor Paralysis

Changes in muscle tone interfere in motor movements
Spastic movements result in poor control Limited
movement of head, arms or legs Difficulty balancing in
sitting position Difficulty maintaining good posture

Low Muscle Tone

Limited use of arms or legs Poor posture control
Fatigues quickly

Rigidity

Inhibits arm and leg movement Inhibits balance to sit
Inhibits good posture

Spasticity

Limited upper range of motion Limited lower range of
motion Interferes with accuracy and consistency of
motor movements on one side

Tremors

Present all the time Present when doing purposeful
upper extremity task Unable to compensate for tremors

Extraneous Movement

Athetoid (constant) Ataxia (poor coordination in
movement)

FINE MOTOR

SELF CARE

Dexterity
* Limited fine motor control
* Has limited hand movement

Handwriting

* Writing or copying ability is significantly below peers
* Significant legibility factor--written work not readable
* Cannot keep up with the pace of written work
* Is frustrated by writing
* Fatigue is a factor
* Typing appears to be potentially faster than handwriting

* Needs assistance with going to the bathroom
* Unable to be toilet trained
* Needs assistance to eat
* Cannot take in food orally
* Needs suctioning routinely
* Has degenerative medical condition
* Is medically fragile
* Seizures limit alertness
* Needs to rest frequently
* Needs assistance to zip coat or tie shoes

COMMUNICATION

SENSORY

Receptive Language

* Receptive language is significantly lower than ability
* Receptive language is significantly higher than expressive

Expressive Language

* Speech is unintelligible
* Expressive language is significantly lower than ability
* Mean Length of Utterance (MLU) is 3 words or less
* Spontaneous or self initiated language is significantly
limited
* Does not make choices consistently
* Does not respond appropriately with yes or no
* Does not have communicative intent

Vision

* Requires corrective lenses
* Requires large print to read
* Requires mobility training
* Has blind spot

Hearing

* Requires preferential seating
* Hearing limitations affect the language thresholds
* Requires assistance to receive language
* Requires sign language to receive language
* Has fluctuating hearing loss
* Needs visual signals for safety purposes

From Function to Technology Solution. It happened that a
participant in Tom's Solution Circle hit on a great idea for a
solution to his functional problem with reading. This was a
fortunate connection to make. At the suggestions of his Solution
Circle, Tom began to use computerized books which he "reads" by
having the computer speak the words as he follows along with the
text. For Tom, computerized books proved to be a successful
solution to his reading problem because they help him to get the
information he needs without struggling with the reading process.

Not every Solution Circle will be like Tom's and identify the
exact technology that the individual needs. But if a Solution
Circle has worked well, the end result will be a clear analysis
of the functions that need to be performed. This functional
information can then be brought to technicians who can make
suggestions for possible assistive technology solutions. There
are over 50 assistive technology centers in the United States
where knowledgeable individuals can assist people with
disabilities and their families with making a match between
functions that need to be performed and the technology that is
available to perform those tasks. A list of assistive technology
centers is available in the Appendix to this Guide.

Formal Assessment. Solution Circles are an effective, informal
way to identify functional needs that can be met through
technology. However, in the school setting, it is also necessary
to establish a student's needs for technology in a more formal
way. Formal evaluations for assistive technology must be
multi-disciplinary, involving educators and therapists who are
knowledgeable about the school curriculum and the particular
types of impairments that the student being assessed may have.
For example, for a student with cerebral palsy the assistive
technology evaluation might involve a teacher, a physical
therapist, a speech and language clinician, and an occupational
therapist. The teacher would assist the therapists in
determining what skills the student needed to learn and how
technology might assist the student in acquiring those skills.
Some assistive technology evaluations might require the
additional services of an A-V technician, adaptive physical
education teacher, a rehabilitation counselor, or speech and
language pathologist with specialized training in augmentative
communication. In school districts where there is no specialized
expertise in technology and its applications, it may be
necessary to contract for evaluations with special education
cooperatives, medical centers, or centers that focus on
technology assessment.

Individuals conducting an assistive technology evaluation should:

* Be knowledgeable of the student's strengths and weaknesses:
medical needs, mobility, fine and gross motor skills,
cognitive ability, communication abilities, vocational
potential, self help needs, sensory abilities, level of
academic achievement, and area(s) of disability;
* Have knowledge of and access to an array of assistive
technology devices;
* Be familiar with the student's educational setting and
educational needs;
* Be able to communicate effectively with parents and
educators.

Because the assistive technology field is so new, there are no
particular licenses or credentialing processes to identify a
professional as qualified to do assistive technology
evaluations. Generally speaking, individuals with professional
licenses as occupational or physical therapists, special
educators, speech pathologists, or rehabilitative counselors may
have the expertise to conduct an AT evaluation. When considering
an evaluator, it is wise to ask about the evaluator's specific
experience with assistive technology. It is also important to
recognize that no one person or discipline will know everything
about assistive technology; therefore, access to knowledgeable
people at the local level and through other agencies, programs
or services is essential.

Conducting the AT Evaluation. The assistive technology
evaluation must be tailored to the unique needs of the student.
In some cases, the evaluation may be conducted by at team of
individuals; in other cases, the evaluation may be conducted by
a single individual (e.g., the speech pathologist). Questions to
be addressed during the assessment should be related to the
specific tasks the student needs to be able to perform and what,
if any, assistive technology would help. The following questions
may be considered during the assessment:

* What tasks does the student need to perform that he or she
cannot perform?
* Is there a low tech device which will address the student's
needs satisfactorily?
* What types of high tech assistive devices may help the
student in performing the task?
* Will assistive technology help the student to perform the
task in the least restrictive environment?
* Is the device being considered suited to the student's
educational needs and abilities?
* Will the assistive technology device remain suitable over
time? How long lasting will this solution potentially be?

The above are only a few of the considerations which need to be
addressed as part of the evaluation process. There is no
specific "test" for evaluating the need for assistive
technology. Therefore, prior to conducting the evaluation, the
individuals doing the assessment need to have a well planned
process in mind.

The formal written assistive technology evaluation report should
address, but not be limited to, the following points:

* Procedures used to evaluate the student;
* Instruments employed in the evaluation, assuring that a
range of levels of technologies has been considered;
* Results of evaluations, including both qualitative and
quantitative measures;
* Recommendations for levels of technology appropriate to the
student's capabilities and potentials, and
* Implications for educational programming, including
discussion of both individual technology needs and
recommended environmental and instructional modifications.

In the end, an assistive technology evaluation should provide
recommendations for accommodations, adaptations, devices, and
services based on the individual's strengths, needs, and
preferred lifestyle. The evaluation should indicate (a) whether
devices and services have potential for improving function, and
(b) what training may be necessary in order to use the
technology equipment safely and effectively.

* Examine available technology with a critical eye.

It is easy to be dazzled by the possibilities in new assistive
technology, but it is important for parents to be wise consumers
and ask probing questions about the features and quality of an
assistive technology device. The following is a list of
questions to consider when evaluating a particular 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 purpose or is it flexible?

"Elegance"

Does this device represent the simplest, most efficient way to
accomplish the task? Or is this device too elaborate, too
complicated to be worthwhile?

Ergonomics

Does it fit the individual? Is it convenient to use in the
environment? Is the equipment portable enough to go where the
user goes? Are different devices needed in different
environments?

Reliability

What is the manufacturer's reputation for reliability? 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 misuse?

Practicality

Do company sales people seem knowledgeable and helpful? Are the
company's service people knowledgeable and helpful? Does the
device have a warranty? How long is the device guaranteed to
function? How available are repair services? At what cost? Can
this device be leased? Is this device available for a trial
period before purchase? Will this device soon be outdated? Is
something better on the horizon? Will the company update the
device? Does the manufacturer provide training in using the
device?

Aesthetics

Is this device attractive to the eye? Does the device fit well
into the user's lifestyle?

Normalization

Does the device assist the user with more normalized living? Can
the user operate the device independently or with a minimum of
assistance? Or does the device "stick out" too much and
advertise the disability of the user? Does the equipment
minimize difference or exaggerate difference? Does the device
have the potential to increase the quantity and quality of time
spent with nondisabled peers? Or does the device separate the
user from others?

Cost effectiveness

Do the benefits the device provides justify the cost? Are there
less expensive devices or models that serve the purpose as well?

Personal acceptance

Is this device the user's own choice? Does the potential user
like this device and want to use it? Does the potential user
view this device as life-enhancing? Would the user have
preferred some other device or means to perform the task? Will
using the device always be a chore or can using it become a
habit?

There are several ways that consumers can find answers to their
specific questions about assistive technology devices. Most
vendors will provide good basic information about the product.
Call the vendor and ask for brochures, product specifications,
price list and any other written information. This is a place to
start. A second step is to read reviews of the product in trade
magazines or Closing the Gap, a widely respected publication
that reviews new assistive technology products. If possible, it
is very helpful to talk to other consumers who are already using
the product. Ask them about the pros and cons of using the
device. Then visit a preview center, if there is one nearby, and
try out several types of devices. Ask for general
recommendations from the preview center's staff. After
identifying a device that appears to meet the potential user's
needs, try the device out for a month to six weeks to make sure
that it performs as advertised and fits in well with the user's
lifestyle. During the trial period, it will be possible to
identify training needs for the user, family members and school
staff. The trial period will also be a time for the user to test
the device in several settings to determine its portability and
flexibility.

figure 4: ASSISTIVE TECHNOLOGY EVALUATION
Device or Equipment Features or Functions

Name:

Date:

Motor/Self Care

Fine Motor

* manual wheelchair
* power wheelchair
* bus lift
* supportive classroom chair
* stander
* walker
* lift for transfers
* positioning device
* canes or crutches
* adapted commode
* suctioning device
* braces or supports
* other____________________

* word processor
* word processor with prediction
* voiced word processor with prediction
* adapted keyboard
* keyguard
* alternative key arrangement
* voice activated computer access
* infrared computer access
* mouse access
* trackball
* joystick
* power pad
* switch (e.g., mouth, lip, chin)
* touch screen
* pointers
* drag and click desk accessory
* sticky keys
* onscreen keyboard
* printer for written work
* adapted feeding utensils
* braces or splints
* other____________________

Cognitive/Communication

Sensory/Perceptual

* communciation board(s)
* communication wallet
* total communication
* manual sign
* word processor with voice
* programmed voice output
* icon prediction
* electronic communication device
* programmable switch with voice output
* no-reading-necessary word processor
* spell checker
* grammar checker
* outlining program
* other____________________

* hearing aid(s)
* classroom amplification
* boosted signal to noise ratio (e.g., headset to keep focus
during word processing)
* corrective lenses
* enlarged print
* taped books
* voiced word processing
* voiced screen directions
* CCTV
* other____________________

* Match the Individual's Needs to Specific Equipment Features.

When considering an assistive technology device, it is very
important to consider how a device matches up with the
particular individual's needs and habits. In some ways, an
assistive device becomes an extension of the user's mind and
body. As such, it is a highly personal item. A device may work
as advertised, but still not meet an individual's needs because
the individual just does not feel "comfortable" in using it. For
example, Cindy, a fourteen-year-old who is totally blind and has
mild cerebral palsy affecting her hands and arms, was being
taught Morse Code as a means to speed up her writing. She had
difficulty using a Brailler because her arm strength was so
limited so her teacher thought Morse Code would be an easier
method of writing for Cindy. The only problem was that Cindy did
not like using Morse Code. To her, it seemed like she was having
to learn another complicated language when she already knew
braille and liked to use it. Cindy admitted that writing in
braille was slow for her but she was more comfortable with it.
Cindy and her teacher were at an impasse until a friend
suggested to Cindy that she try writing on a voice-output
computer. Cindy loved the computer! With a headset attached to
the sound system, she could listen carefully to the computer as
it read aloud the letters and words she was typing on a light
touch, tactile-marked keyboard. This computer also had a feature
of printing out text in either standard print or braille. Cindy
was delighted--she could write copy for herself to read in
braille and for her sighted teachers to read in regular print.
This solution worked because it met Cindy's learning needs and
responded to her own ideas about herself. She did not want to
use Morse Code because it was a separate type of communication
known only to a few. With her computer, voiced software, and
dual printer, she had the best of two worlds--she could "hear"
her writing as she typed, she could read it over in braille, and
her sighted teachers could read her finished product. This
solution helped Cindy to improve her composition skills, speed
up her writing time, and communicate more easily with sighted
people.

Cindy was fortunate because her assistive technology solution
met her needs almost perfectly. Such a close match is not,
however, always possible. Nonetheless, every effort should be
made to have the match be as close as it can be. In general,
when assistive technology solutions are individualized, simple
to use, and responsive to the whole person, they are more likely
to be used by the individual. When the device performs a task
well, but does not "fit" the individual, the technology is
likely to be abandoned by the user in favor of something else
which meets the need more exactly. Too often devices are
purchased because of their technical potential without thought
to their relationship to the individual and his or her
lifestyle. These mismatched devices are the ones that end up
languishing in their packing boxes--a sad reminder of time and
money spent to no avail.

* Try the Device Before Buying.

It cannot be emphasized enough how vital it is to try out
assistive technology devices and equipment before buying. Trying
out a device for several weeks provides the user with an
opportunity to learn how to use the device and how to adapt to
its features while at the same time testing the device in the
various environments where it will be used. For example, Mike
tried out a communication device which attached nicely to his
wheelchair tray and was compatible with his computer that he
used for doing school work. Though the communication device
worked well and was relatively easy to program, Mike found out
quickly that the device was just too bulky to be useful for him.
When he traveled around the school, the communication device
blocked his view of the terrain and of people passing by. He
found he missed opportunities to communicate because he could
not see who was coming his way. Mike also discovered that the
communication device did not serve him well in crowds like at
pep rallies or basketball games. After a month of working with
this communication device, Mike decided it was not for him and
selected instead a device that was less complicated, smaller,
and more portable. The second device was not as sophisticated as
the first, but it better met his needs for quick communication
with friends in social settings. If he had not had the
opportunity to try out both devices for an extended period of
time, Mike might not have realized the value of the second
device and may have been stuck with a communication device that
was too large and too sophisticated to match his lifestyle.

Similarly, Marilyn benefited from a trial period with her
communication device. She found out the first week that the
particular device she had chosen would not work for her because
it broke too easily and it was difficult to get repaired. During
the first week that Marilyn had the device for trial, her
teacher broke one of the buttons during a programming session.
It took two weeks to contact the manufacturer and then the
device had to be mailed back to the factory for repairs. The
device was gone for over six weeks, and the manufacturer would
not supply a "loaner" while Marilyn waited for repairs to the
first device. This experience taught Marilyn the importance of
having a responsive manufacturer who is willing to repair
devices quickly and to supply substitutes for the user while
repairs are being made. Marilyn decided on a different device
with similar features and a great helpline to provide assistance
with the maintenance of the machine.

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 that a device is not all it is purported to be
or that it does not work as well as advertised, but it is far
better to learn before purchase that a device does not meet the
user's needs than to learn after purchase and be stuck with an
expensive, unusable machine. For the consumer, it is daunting to
think about starting over again with the process of selecting a
device. Nonetheless, it is worthwhile to seek more information
and look again. Having been through a trial, even when the
outcome is not successful, provides the user with greater
clarity about what an appropriate device will have to be able to
do. The second time around the search is likely to go faster and
come out with a better result.

* Identify Next Steps.

Once a device has been selected, the consumer becomes impatient
to have one and begin using it right away. But at this point,
important work still needs to be done. Funding the device is a
major consideration. Sometimes families will pay for the device
themselves, but under other circumstances, the device will be
purchased by a school district, through Medicaid or private
insurance, or through some other means. Parents need to become
familiar with the various funding options and determine which
one will work for them (See Funding Assistive Technology for
additional information about funding sources).

Also when considering funding, families should think about costs
beyond the price of the device itself. For example, a computer
set-up with a keyboard, monitor and printer might cost $3,500.
This equipment is basically useless unless other equipment is
purchased as well: software, adaptive devices, paper, manuals,
upgrades. Prices for these additions can raise the actual cost
of the device by hundreds of dollars.

Devices often require training for the user, family members, and
others to ensure effective and safe use. How much does training
cost? Who will provide it? Repair and maintenance are other
costs usually additional to the price of the equipment.
Sometimes families will also want to insure the assistive device
so insurance payments become part of the overall cost.

Since making an assistive technology purchase is such an
important personal and financial decision, it is wise to have a
realistic budget in mind that includes all of the equipment and
services that are necessary to make the assistive technology
work effectively. With this budget in mind, it becomes easier to
plan the purchase, seek out funding sources, and make a
compelling case for financial assistance.

* Determine What Follow-up Is Needed.

After the assistive technology device has been purchased and put
to use, there are additional follow-up activities that need to
take place. The original assistive technology evaluation should
include a way to monitor the use of the device. Periodic
scheduled reviews the by evaluator, follow-up calls to and from
the family are some ways to help assure effective, safe use.
Families who travel great distances for evaluation need to be
certain that services like maintenance, repair and replacement
of devices are available within a reasonable distance from home.

Assistive technology devices are used best when all the people
in the life of the individual with disabilities understand the
devices in the same way. At first, devices may seem to
exaggerate differences between a person and the rest of the
world. Care should be taken to explain that assistive equipment
is a difference equalizer, not a difference maker. Classmates
and friends need to understand that the adapted seating or
adapted keyboard helps the individual do what other students do.
Adults in a child's life need to understand that devices work to
make life easier, better, and more functional. People need to
know that ramps help keep individuals with mobility disabilities
from being separated from peers; that communication technology
allows people to "speak" their thoughts.

Close communication between parents and their child's
helpers--teachers, therapists, day care workers and others--is
essential to make sure devices and services are being used
safely and effectively. If the device is working well, but the
child is not being integrated into the classroom or other
environments, then there may be a need for additional training
for the children and adults who interact with the child.

Besides keeping track of how the device is working and being
used, it is important to observe progress in the areas of
technology which are useful to the individual with the assistive
technology device. As upgrades of equipment occur or more
sophisticated models come on the market, the user may want to
consider modifying or replacing the equipment that is currently
in use. Also as the individual becomes more skilled at using
technology, the individual may outgrow the current device and
need to look for more advanced equipment. It can be assumed with
most high tech items that in three to five years there will be a
need for upgrade or replacement. The wise consumer begins early
to plan for the next step in technology, including saving money
for a new device and staying alert to the new options that
become available.

What kinds of training are important to occur when a child has a
new assistive technology device?

Because assistive technology of the high tech variety is so new,
it is particularly important that training be provided to all
those who may need it. In the school setting, it is helpful for
all educators and administrators to have some awareness training
so that they have a general idea of what assistive technology
is. Areas to be covered in inservice training might include:

* legal issues related to assistive technology
* awareness training concerning how to serve students with
assistive technology needs
* information on how assistive technology relates to the
evaluation process
* how to write IEPs for students who require use of assistive
technology devices
* the relationship between technology and student placement
* the nature of common assistive technology devices
* resources to contact for information on assistive
technology.

Beyond these awareness activities, those members of the school
staff who work directly with a student who uses technology, need
to have training on the specifics of using the device and how it
is maintained and serviced. Training should include, but not be
limited to, the following:

* review of the student's educational and assistive technology
needs
* review of goals and objectives, supplementary aids and
services, and related services on the IEP or IFSP
* training on how to use and maintain the device
* training on proper transport of the device within the school
building and from home to school
* training on how to program the device, if needed
* training on how to use the device effectively during
instruction
* training in trouble-shooting when the device is not working
properly
* information about what to do when the device is not
functioning or broken
* information about how to coordinate assistive technology
with all the activities in the student's day
* training in methods to evaluate the effectiveness of
assistive technology.

Depending on the type of assistive technology used by the
student and the student's needs, it may be advantageous for
assistive technology information to be shared with the student's
peers. Such training will help fellow students to gain an
understanding of the student's assistive device, foster
acceptance in the social environment, and reduce fears other
students may have about socializing with the student who uses
technology. In some cases, parents and the student may want to
be involved in the peer training.

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

Most importantly, the student himself or herself, will need
training in how to use the device as independently as possible.
Training for the student may be written into the IEP as a
separate goal or may be included as a related service that
supports the student's special education program.

Summary

Purchasing a high tech assistive technology device is a major
life decision because of the potential impact on the individual
and because such devices can be costly. When considering an
assistive technology device, it is important to do the
following: be realistic about the consumer's capabilities and
needs; get a multidisciplinary evaluation; examine available
technology with a critical eye; match the individual's needs to
specific equipment features; test the device for a trial period;
identify next steps; and determine what needs to be done for
follow-up after purchase. Evaluations for assistive technology,
both informal and formal, should consider first of all the
functions that the consumer wishes to perform using technology.
When evaluating a particular piece of equipment, consideration
should be given to the following features: performance,
simplicity of design, ergonomics, reliability, safety,
practicality, aesthetics, normalization, cost effectiveness, and
personal acceptance. Good sources of information about assistive
devices are manufacturers publications, trade journals, preview
centers, and consumers who are already using the device. Once a
device is selected, the consumer will need to secure funding for
the purchase and be aware of additional costs for related
equipment, insurance and training.

Hints for Parents

Don't let the cost of assistive technology deter you from
considering it for your child. High tech assistive technology
can be quite costly, but it can also make the difference for
your child in terms of becoming well educated, employable, and a
fully-included member of the community. Don't leave any stone
unturned when looking for funding sources. Consider any or all
of the following for funding or assistance:

* Early intervention programs
* Schools
* Transition programs
* Vocational Rehabilitation
* State Programs for Children with Special Health Care Needs
* Medicaid
* Medicare
* State Technology Resources
* Used Equipment
* Leasing
* Equipment Loan Programs
* Disability Organizations

e

Sierra

Sierra wants to play with dolls like other children her age, but
she has a muscle disease that has caused her to lose muscle tone
except in one hand. What could be done to allow Sierra to dress
and undress her dolls, comb their hair, and bathe them?

Sierra's Solution

The assistive technology solution for Sierra involved her whole
family. While vacationing in Mexico, Sierra's grandmother found
her a fashion doll that was a bit larger than the typical
"Barbie doll." The larger doll was easier for Sierra to
manipulate. Sierra's mother sewed several outfits for the doll
using velcro instead of snaps or buttons as fasteners.

Sierra's dad bought doll stands at a toy store and fastened
several stands with clamps to Sierra's wheelchair tray. He also
fastened a plastic pouch to the tray. Sierra puts the small doll
accessories in the pouch. When Sierra wants to dress her doll,
she puts the doll in one of the stands. In this way, the doll is
held securely and Sierra can dress and undress the doll with one
hand.

Sierra's friends also use the doll stands for their dolls. With
this arrangement, two or three girls can play together.

Solution Summary

Larger doll

Velcro fasteners

Plastic pouch

Doll stands

Clamps

e

Funding Assistive Technology

Funding for assistive technology is available from a variety of
public and private sources. To receive public or private
funding, the individual must meet eligibility criteria for the
specific program and provide sufficient documentation of the
need for assistive technology.

The following list includes some of the programs which may pay
for equipment if the individual needing the device meets their
requirements. Many of these programs are run by different
agencies in different states, making them hard to find. In
general, the state's Tech Act office can assist consumers and
family members in finding and using these programs (See Appendix
under Resources).

PUBLIC PROGRAMS

Early Intervention Programs (Individuals with Disabilities
Education Act, Part H)

Young children (0-3) and their families may receive help through
early intervention programs in evaluating what the child needs,
in getting assistive technology, and in learning how to use it.
Equipment and services must be included in a written plan,
called an Individualized Family Service Plan (IFSP). To find the
program for a particular state, call National Early Childhood
Technical Assistance System (NEC*TAS) at 919-962-2001 or
919-966-4041 (TDD).

Head Start

This child development program provides comprehensive
educational and health services for eligible children ages 3-5.
Since 1982, federal law has required that at least 10 percent of
the total number of placements must be available to children who
are disabled and require special services. Head Start is a
mainstream placement option for children whose IEP calls for
placement with nondisabled children. The January 1993 Head Start
regulations specifically require the consideration of assistive
technology services and devices. For more information, contact
National Head Start Association, 201 N. Union St., Suite 320,
Alexandria, VA 22314; 703-739-0875.

Schools (IDEA, Part B)

This program mandates a free, appropriate public education for
preschoolers, children and youth with disabilities. An
Individualized Education Program (IEP) is required for all
children with a disability. These children are entitled to
special education, related services or supplementary aids. If
the IEP team determines that assistive technology is required
for a free, appropriate public education, then it must be
provided at no cost to the child. The technology must be
included in the child's Individualized Education Program (IEP).
Parents have a right to be involved and should help to develop
the IEP goals which may include technology. For help in getting
assistive technology in the IEP, call the TAPP Focus Center on
Assistive Technology at 1-800-222-7585.

State Operated and Supported Schools (Chapter I)

This program provides federal assistance to help educate
children with disabilities who are enrolled in state-operated
and state-supported programs. Federal funds must be used to pay
for services that supplement a child's basic special education
program, such as construction and the purchase of equipment. For
more information, contact your State Department of Education.

Section 504 of the Rehabilitation Act of 1973

Section 504 provides a civil-rights mandate that requires
accommodations for students who have disabilities such as
orthopedic impairments, but who do not qualify for special
education services. It denies federal funds to any institution,
including a school, whose practices or policies discriminate
against individuals with disabilities. This legislation has
resulted in a number of outcomes, including various actions to
remove physical barriers to education, which may incorporate
assistive technology. For more information, contact the nearest
regional Office of Civil Rights or the State Vocational
Rehabilitation Agency.

State Programs for Children with Special Health Care Needs

These programs provide and pay for services for eligible
children. CSHCN programs vary widely from state to state in the
services they offer, the number of children served, and the
requirements for eligibility. Some CSHCN programs do pay for
assistive technology devices when no other funding source is
available and the equipment is necessary for health-related
reasons. Most CSHCN pr