Assistive Technology (AT)

Introduction

AT is all about navigating equitable access to:

• hygiene
• nutrition
• art and craft
• risk and safety
• sport and recreation
• meetings of the minds
• memory and memories
• activities of daily living
• expression and reception
• information from all sources
• environmental sensation and control
• motion, position, stability, and location…

in other words, to anything and everything that would typically be available to a functionally independent individual.

As a district, Lane ESD AT places emphasis on a student’s access to a challenging educational experience, and each Lane ESD classroom incorporates an extended AT framework.

Districts who are building their AT program capacities would be well advised to participate in the AT Teams Project by the Oregon Technology Access Program (OTAP).

AT Specialist (ATS)

When a student’s needs are observed to exceed those addressed by the classroom’s extended AT framework, the AT specialist performs an evaluation for individual AT services. While there is an AT screening checklist that helps to inform the evaluation, there is no formal referral process for students in Lane ESD classrooms as this service is included in the package. (The process is more formal for districts requesting an AT evaluation for a student who is not being served by a specialist associated with Lane ESD.)

The ATS will select and customize systems for a student to help access their education, and will provide training as needed to the student, family, and educators. Home use is allowed and encouraged if the IEP team records it as being necessary for FAPE, which includes the likes of participating in homework. A checkout process covers home use of ESD-owned systems, with an associated user agreement form for higher-tech equipment.

Individual AT Hardware Options

• More and/or Different switches (sip/puff, vibration/microflex, sound/light sensor, variable pressure, wired/wireless remote controls), interfaces, battery interrupters
• Stability frames (LocLine armature, clamps, arm support, tray modifications coordinated with a wheelchair provider)
• Sensory frames (PVC, switch-access rewards)
• Gaze frames (content designed by the SLP)
• Portable word processor (AlphaSmart Neo2, Fusion, and similar)
• Adaptive input: mouse (track ball, track pad, joystick, mouth stick, head pointer or tracker, or more rarely an eye-gaze tracker); keyboard (e.g., ergonomic, big keys, different layout or colors, keyguard, touchpad); touchscreen
• Calculator (talking, big display or keys, printer)
• Measuring device (tactile/talking clock, ruler)
• Adaptive toy/game (e.g., switch access, handles, rugged materials, bigger pieces, different dice roller, All-Turn-It and overlays)
• Mobile computational equipment (e.g., laptop, iPad)

Individual AT Software Options

• Voice recognition
• Speech-to-Text, Text-to-Speech
• Switch training and Switch-accessible activities (app/application suites on tablets and conventional computers, online subscriptions)
• Academic titles (installed or online)
• Communication software titles

AT Professional (ATP)

An AT Professional (ATP) is certified by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), having met their specific education and work experience eligibility requirements, and passed their ATP examination. The ATS who coordinates Lane ESD’s AT program is an ATP.

AT Service Levels

IEP hours fall into 4 broad annual ranges: low (5 or fewer); mid (6-10); high (11-15); and extra high (16 or more, rarely). Every direct IEP hour (e.g., switch access training, personal fitting, classroom observation) reflects more indirect attention time (e.g., getting commercial tech support, creating AT shop items, placing orders, programming applications, and so on).

AT hours are lower when: a) student needs are already mostly covered by associated specialists (see below) or the extended AT framework; b) just maintenance suffices for a system; c) an AT trial is just starting; d) only introduction and minor training are needed (i.e., quick independence); or e) a service history suggests a low-intrusion approach. When a student needs very little tailored interaction, a formal referral might not be needed.

AT Across Domains

Many kinds of therapists (some from outside of Lane ESD) provide some AT support within their domains without needing a referral for an AT specialist. Their therapy starts with a student’s inherent capabilities (i.e., can the student speak, extend, chew, stand, and so on), and the AT therapist parallels that therapy from the systems side. The two approaches overlap at methods and tools. Ultimately, coordinating that support among all of these therapists is the goal.

Similarly, there aren’t any tools or materials that are specific to AT alone; any other specialist might become familiar with any particular system in the course of their work. That said, the course of an AT generalist’s work is to know about all of those products no matter their typical domains.

Speech-Language Pathologist

An SLP covers low- to mid-tech communication trials and resulting systems (e.g., visual schedules, PAC/PODD systems, and voice-output devices). While the AT specialist might make an eye gaze frame, the SLP would determine the content of the displayed communication material.

Similarly, at the request of the classroom SLP, the AT specialist might supply a touchscreen device with grid-based communication software for displaying a simple set of individual choice boards. When AT supports for communication remain at this simple level (and do not constitute AAC, as described below), it can be useful to distinguish such systems as assistive communication.

Augmentative Alternative Communication Specialist

The AAC specialist handles communication systems at all levels, including high-tech (i.e., computational) comm devices. Any AT that should be supervised by an SLP is AAC.

Autism and Behavior Consultants

Autism and Behavior consultants often provide such behavioral navigation (and sensory associated) items as weighted and constrictive clothing, manipulables for training, visual schedules, transition systems, and fidgets.

Occupational Therapist

OTs rely on such a broad range of physical and cognitive access tools that they often serve as AT specialists in every way other than job title. Typical items would be adaptive hand tools for the motor aspects of writing, art, eating, and dressing (such as pencil grips, scissors, rollers, stampers, therapy putty, slantboards, chewies, grabbers, paper with raised lines, cuffs for markers/brushes, eating utensils, and dressing adaptations).

Physical Therapist

PTs often provide adaptive body tools for: exercise (therapy bands, adaptive sporting equipment, positioners); stability (posture or arm support); mobility (gait trainer, bikes of various sorts); and stimulus (massagers, temperature changers, wedges, cushions, nonslip surfaces). AT overlaps a host of durable medical equipment (e.g., chairs, braces, standers, lifts).

Teacher of the Deaf and Hard-of-Hearing

Typical equipment provided by a TDHH would be: hearing aids, personal or classroom sound systems, signing materials, captioning, and tactile or visual signalers. (Note: A convenience sample of TDHHs were polled as to their preferred acronym, and there was no effective consensus.)

Teacher of the Visually Impaired

A TVI might provide: mobility and navigation equipment; sensory learning kits; or tactile materials and creators including Braille, screen or print magnifiers and contrasters (e.g., lenses, CCTV, large/contrasted books).

AT Generalist

For a given student’s capabilities, there might be many therapists addressing educational access. Each therapist contributes information that feeds the IEP, which amounts to a requirement specification. AT emerges (as a design) from this specification as it becomes coordinated across domains:

• The SLP might design a comm matrix whose contents need to be navigated with some sort of scanning, with a field size that matches the amount of information that the student can differentiate at one time.
• The OT might weigh in on the student’s range of fine-motor direct selection and hand dominance.
• The PT might provide information about range of motion, maybe indicating that the student’s trunk needs a particular kind of posture support for the arm to extend the hand that is making that selection.
• TDHH and TVI might have information about what the student can hear and see that informs the sensory presentation of the information content.
• The Autism and Behavior consultants might have information about tactile sensitivities, or the student’s typical treatment of devices.
• The teacher might add information about the student’s preferred learning style.
• The parents might weigh in on favorite rewards, themes/colors, or any of the above;
• And of course there is a great deal of shared experience across domains in Life Skills, so therapists from one area often end up making suggestions that cross into others.
• The AT specialist can then make informed suggestions about the range of tools available that might satisfy all of those requirements for that student, in that environment, for those particular tasks (or that might be shared among peers).

These specialists are qualified to make isolated AT decisions, and can do so without coordinated consultation, and sometimes that works out just fine. That is especially true when a specific tool is so domain specific, or there is so little overlap with what the other therapists are doing, that no coordination is really necessary.

But a truly coordinated design only emerges with generalist involvement, usually in the person of the AT specialist (by any other name).

Sensory Lifestyles, Sensation, and Desensitizing

Sensory and mobility challenges significantly affect the development of cognition and communication; therefore, we have provided an extension to this tutorial that specifically addresses sensory lifestyles, sensation, and desensitizing.

Technology and Education

Contrary to common portrayals, technology is not a set of objects in the outside world, and AT is much more than basic tool identification. We encourage you to read our advanced tutorial on technology in education.

AT Policies

Please take note of the following two policies:

• Policy: Classroom Computers are Not TVs
• Policy: Classroom iPad Use with Students (The iPad is never a reward.)

AT Glossary

assistive technology device
“The term ‘assistive technology device’ means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability.” (IDEA) Note, however, that the definition goes on to state, “The term does not include a medical device that is surgically implanted, or the replacement of such device.”

assistive technology service
“The term ‘assistive technology service’ means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device.” (IDEA)

difference in degree vs difference in kind
“Difference in degree” (e.g., an amount, level, or extent of an entity) contrasts with “difference in kind” (another type of entity altogether); for example, “a small jellybean” only differs from “a large jellybean” as a matter of degree (i.e., size), while “a jellybean” (of any amount, level, or extent) will be different in kind from “enlightenment.” This matters in Specially Designed Instruction, which must be different in kind from regular instruction; that is to say, simply adding more time for reading instruction does not suffice.

Durable Medical Equipment (DME)
DME is pretty much what it sounds like: equipment designed to serve a long-term medical purpose. The less obvious part is that the equipment only counts as DME if it is appropriate for home use. Schools, then, do not have to provide DME under AT unless the student needs it to increase, maintain, or improve the functional capabilities required to access FAPE, such as described by their IEP goals and objectives. (See: Unified Approach to AT/AAC)

So, normally, schools do not have to provide such personal items as glasses, hearing aids, and so on, unless the IEP makes it clear that those items are needed for the student to access FAPE. Of course, if the district buys the equipment (instead of the family using private insurance or something), then the district owns it; that is to say, the district would own the student’s glasses, hearing aids, and so on. (And the district would get to choose the style.)

However, and crucially, the school can’t deny the student home use of that equipment if the student needs it to have equitable access (compared to their peers) to activities such as homework and so on.

If something like a personal sound system is used for AT (such as to help a behavioral focus of attention) rather than for an actual HI issue, then it is not DME.

Specially Designed Instruction (SDI)
SDI involves: 1) tailoring instructional content, methodology, and/or delivery to suit any individual needs associated with a student’s disability such that 2) the student can access their curriculum to meet educational standards. This is an overly simplified explanation, of course. Andrea Hungerford informs us that: 1) SDI must be designed with a special education teacher; and 2) you can’t just have a greater or lesser amount of regular education (i.e., it’s not just a difference in degree, but rather it has to be a different type of instruction altogether (i.e., it has to be a difference in kind).