OBJECTIVES

1. Define assistive devices in terms of IDEA and the Technology-Related Assistance For Individuals With Disabilities Act (Tech Act) of 1988, Public Law 100-407.
2. List six types of devices to aid those with disabilities, including magnification, voice input, alternative input, augmented communication, word processing aids, and environmental control.
3. Describe evaluation processes and their relationship to transportation, transportation, sensory and communication, wheelchair and other ambulating aids, education, recreation, personal care, prosthetic and orthotic needs, post-secondary education, training, employment and career development.
4. List options available as alternatives to input: assisted keyboard method, expanded Keyboard, Morse code methods, scanning methods, normal input, and ASCII.
5. List federal sources of interest to educators in serving the assistive and argumentation needs of students with disabilities.

The Individuals with Disabilities Education Act (IDEA) provides for such related services or supportive services as necessary for students to benefit from their education programs. Assistive technology devices and the services necessary to help a student select, acquire, or use assistive technology devices may be required as part of the child's special education or related services, and these may include independent living skills and vocational education (20 U.S.C. Sec. 1401(a)(26); 34 C.F.R. Sec. 300.308).

Assistive technology refers to any devices or services necessary to be educated in the least restrictive environment (34 C.F.R. 300.308). Assistive technology is defined in the Technology-Related Assistance For Individuals With Disabilities Act (Tech Act) of 1988, also known as Public Law 100-407, August 19, 1988, which was incorporated in the 1990 IDEA amendments, as follows:

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 children with disabilities" (20 U.S.C. 1401(a)(25)).

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. The term includes:

• The evaluation of the needs of a child with a disability, including a functional evaluation of the child in the child's customary environment;
• Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by children 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;
• Training or technical assistance for a child with disabilities or, where appropriate, the family of a child with disabilities;
• Training or technical assistance for professionals (including individuals providing education or rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of individuals with disabilities" (20 U.S.C. 1401(a)(26)).

In the development of an IEP, personnel assessing the student should include a review of the need for assistive technology devices and services as part of the student's special education, related services, and/or supplementary aids and services. This can involve both high and low-tech devices. If a child needs a large pencil, for example, this can be included in the IEP and regarded as an assistive device. As in other circumstances surrounding special education, the assessment must determine that an assistive technology device and/or service is needed in order for the student to receive a free and appropriate public education. Assistive technology can be included in the IEP in the following ways:

1. As part of the student's special education, related services, or supplementary aids and services.
2. As a goal statement when assistive technology is needed to develop technology skills to reach other goals and instruction may be needed.
3. As part of a goal statement when assistive technology is needed to carry out specific goal(s).

Special switches can be customized by teachers and parents for assistive device, which can be used to input information into computers and to control devices that affect communication, personal care, safety, environmental control, mobility, and others. Many who are unable to communicate through normal speech are able to conduct relatively normal lives with such assistance. Those who cannot communicate with their voice, for physical and/or cognitive reasons, can substitute computerized speech. Those who need to control their home environments can operate electrical appliances and the room temperature. Mobility is a significant problem for many students. Wheelchairs and other aids to mobility are becoming more sophisticated. Directional guidance systems with auditory cues can assist a person to travel from one location to another.

Most schools should provide some orientation programs for teachers to become familiar with these devices. Ideally, the district or state should have a center for the evaluation of disabled children and adults, for continued research with such devices and a place for parents, teachers, and professionals to learn how to care for and maintain sophisticated adaptive equipment. In any event, schools are obliged to pay for related services, which includes assistive devices and the training needed to use them effectively.

While most educators and the general public are aware that The Americans with Disabilities Act (ADA), approved by Congress in 1990, requires services such as interpreters and readers, elevators, wheelchair ramps, and curb cuts on streets, it is less well known that this also applies to computer access. Students need to use computers for the same reason as others, but for many students it is necessary to make certain kinds of modifications to make them useful.

Each person is unique and has to be examined individually to determine the best adaptive and assistive devices to provide for educational and social needs. Technology can assist those with disabilities in several ways:

• Computers and electronic devices can provide accommodations for the needs of students, making them more capable of competing with their nondisabled peers.
• Technology can enable students to lead more normal lives by increasing their mobility and communication capabilities.
• Technology provides opportunities for employment, through assistance to compensate for a disability or as tools for productive work.

When evaluation of the student is made for assistive technologies, there are several areas that should be considered.
 

Transportation--Transportation needs are covered under the law. A careful evaluation should be made to determine if there are any special devices necessary for transporting the student to and from school, such as lifts and other equipment on a bus.  Sensory and communication--Based on medical and other evaluations, determinations should be made about the need for any kind of sensory or communication aids that can enhance education, understanding, communication, and development.  Wheelchair and other ambulating aids--Some students will require assistance with appropriate kinds of ambulatory devices.  Education--While the same assistive devices may benefit the student in education that also aid in personal sensory or communication assistance, there may be additional devices required in the classroom or the home to make education more attainable.  Recreation--A thorough evaluation of any exercise, recreation, and sports needs should lead to consideration of assistive devices and adaptations to promote physical exercise and activity.  Personal care--Special equipment may be needed for feeding, toileting, and grooming.  Prosthetic and orthotic needs--Consideration must take into account any necessary evaluations of prosthetic and orthotic devices.  Post-secondary education, training, employment and career development--Although vocational rehabilitation and other service agencies may be involved, transition planning should account for any necessary special devices and tools to provide transition to post-secondary programming.

At each juncture, a basic question should be asked: Is a technological solution required? In some cases the answer is obvious, but many times the are better "low tech" solutions. The appropriate use of technology is the guiding principle.

For children and adults with motor control problems or paralysis, special keyboards can be customized to permit numerous ways to control a computer. Using touch-sensitive areas a great many uses of the computer can be adapted, including environmental control, speech, and standard computer uses. This may be a highly individualized adaptation because some people may have to use a head stylus, others may have the use of one hand or only certain fingers, and some may have motor problems that interfere with the use of a standard keyboard, such as spasticity. For persons limited to the use of one hand, a Footmouse can control the computer. These are the major alternatives to input:
 

Students with visual deficits are quite easily and successfully integrated into regular classrooms. Most of them will requires special kinds of aids, many of which are low-tech in nature. Some of the high-tech devices are described below in this chapter. Many students will have glasses and these should be clean, available, and changed frequently. Simple magnifying glasses, which may often need to be prescription, can be very helpful. There are several types, such as hand-held, fixed- focus, and focusable. Microscopic and telescopic aids can benefit by being attached directly to eyeglasses. In addition, good lighting is always important. Reading lamps and visors to reduce glare may be needed in particular locations in the room. Bookstands, special paper with darker lines, fiber-tip pens, and acetate overlays (to make print more readable) are essential. Large print and Braille textbooks may be required for some students, and tape recorders can be useful for substitution in note taking.

For students with more severe visual problems, Braillewriters, slate and stylus, raised-line drawing boards, an abacus, templates, raised-line paper, a talking calculator and other relatively uncomplicated devices can be essential. However, in these examples the involvement of a specialist will usually be necessary in order to assess and recommend equipment.

For all students with limited vision, there is a safety consideration. The physical arrangement of the room cannot be rearranged without risk of accident. Students will not be able to find materials, unless they are always in the same location, and furniture moved about the room can cause students to trip or bump into things. Open and closed doors present a hazard, as do swinging doors.

Students with auditory deficits need more extensive accommodations. There are many electronic devices and an increasing array of high-tech aids, but many low-tech aids are just as important. For many students, hearing aids are sufficient for accommodation. There are two categories, personal (wearable) and group aids. Although mentioned elsewhere as a good strategy, group aids such as FM Soundfield amplification is not common. Personal aids are worn on either the body or at ear level. The aid has a microphone, battery, and amplifier attached to the clothing or worn in a harness and a thin wire connected to an earmold. Ear-level aids are either attached to glasses, worn over the ear, or worn in the outer ear. There are many advantages and disadvantages to each kind.

Assistance by the teacher entails supervision of maintenance and help if the aid malfunctions. The school should probably keep the following items: drying agent for removing moisture, pipe cleaners, battery test, hearing-aid stethoscope, pencil-style typewriter eraser, spare batteries, extra cord, extra receiver (Bess & McConnel, 1981).

Classroom accommodations for students with hearing impairments should include preferential seating, a variety of visual aids, note taking, and interpreters, if necessary.

The National Library Service for the Blind and Physically Handicapped has a network of cooperating regional libraries throughout the United States, Puerto Rico, and the Virgin Islands that produce and distribute books, magazines, bibliographies, directories, and reference circulars. These are made available in Braille and recorded form, along with the necessary playback equipment. Eligible persons are U.S. citizens who cannot read standard printed matter, some with physical disabilities, and those with learning disabilities. Certification as to the nature of the disability is all that is needed to apply for services.

A variety of voice/speech synthesizers are available that permit intelligible speech produced by computers and other output devices. By pushing particular icons or typing a keyboard, the person with a communication disorder may engage in conversation. Telecommunications link those with disabilities to others throughout the world for communication, learning, and hobbies.

Assistive and augmentation technology can be classified generally under the categories of mobility and communication. Experiencing a sense of control over the environment and the ability to interact and control it are essential to self-esteem and well being. Lack of control, because of some neuromuscular or orthopedic impairment, can create a sense of helplessness. Technological interventions can provide children and adults with control. Communications can be greatly augmented.

The primary input method and mode of communication between students and computers is through a keyboard. Therefore, it is very important to determine if students can input information via the conventional keyboard. Alternatives to the conventional keyboard include membrane keyboards, keyguards, and switch controls.

Membrane Keyboards. The most popular computers in public schools toady are the Macintosh and the DOS/Windows PC. All of these come with detachable keyboards that connect to the computer by an expandable cable. This allows students the option of moving the keyboard into positions more suitable for work. For students unable to operate the conventional computer keyboard, the membrane keyboard is a good alternative. These keyboards allow students the opportunities to work on the computer and interact with their peers. Most membrane keyboards are lightweight, flat, and can easily be moved into a comfortable position. These keyboards contain touch sensitive sectors that can easily be programmed as keys or with messages. Most membrane keyboards can be used in combination with other devices.

Speech Synthesizers. Speech synthesizers, when combined with the correct software, will vocalize words as they are typed on the computer. Most software programs for DOS/Windows and Macintosh computers can incorporate speech functions. With such devices, the people can: express themselves more creatively, discover how things work, have environmental control, and use sophisticated strategies to solve complex problems, and develop social interactions with others

Hearing Aids. Ordinarily a classroom teacher will not have much difficult dealing with hearing aids. Students learn to use them and require little assistance, but it is important for teachers to discuss the classroom environment with the student and with the audiologist. Proper placement, attention to background noise, and noticing that the student may turn off or turn down the device at critical times is essential.

Alternative Mouse Systems. This enables students an alternative to the conventional mouse. Examples include NoMouse for Windows, software that imitates a mouse with cursor keys from Abacus; Jouse, a Joystick for head/mouth from Aroga Technologies Ltd.; Mouseman Cordless; and HeadMouse for PC's or Macs wherein movements of the head control the computer, from Origin Instrument Corporation.

Alternative Keyboard Systems. Alternative keyboard systems replace conventional keyboards on computers, and they range from keyguards to prevent two keys from being pressed simultaneously, to mini keyboards or pressure sensitive pads. The computer interprets the inputs as it would with a conventional keyboard. Examples include AccessDOS by IBM,  SofType(Pro, Elite for Windows 3.x), Intellikeys for PC's or Macintosh computers, and ScreenDoors for the Macintosh.

FM Soundfield.  Mentioned in other chapters, the FM Soundfield would be a good device for boosting the audio of the teacher's voice to all students in a classroom. This has advantages for all students, especially those with disabilities.

Screen/Text Magnification. Some students with visual impairments can benefit from software and hardware that increases the size of computer screen print. Screen magnification software enlarges images on a computer screen by choosing selected factors. The magnification programs run simultaneously with the computer's operating system and applications and magnify a portion. Examples are Screen Magnifier/2  from IBM, ZoomText 5  from PC Squared, and Super Vista from TeleSensory.

Braille Devices. There are numerous Braille devices including computers, writers, printers, note-taking devices, translators and others. For the most part, teachers will not have to be concerned about caring for these devices.

Word Prediction. Word prediction software programs function in a similar manner to spelling checkers, except that as a word is typed the program continually checks against a dictionary and presents options on screen in a window. If the proper word is there, it can be selected and typing can begin on the next word with the same procedure. While this program can be useful to all students, it is very useful for students with poor fine motor skills or other motor problems. With just a few keystrokes an entire word can be selected and inserted into the document, saving time for slow or inefficient typists.

Voice Recognition System. This technology allows a student to use his or her voice as an input device to a computer instead of typing or to control the computer. Each sound is interpreted by the computer and printed on the screen. The best known example of this technology is DragonDictate from Dragon Systems.

Speech Synthesizers. An electronic device for a communication aid that generates synthesized speech. Words and phrases can be typed in and may be saved under a specific key location or as a sequence of function keys. Often it is a flat membrane keyboard that can be configured to contain many keys and key size can be altered. Some are specific to particular kinds of computers, but others are designed to attach to any computer with a cable. The computer saves vocabulary and the student can create sentences by pressing the keys. Some systems have "hot" keys to access frequently used words, grabber keys which immediately interrupt any mode, and grammatical keys. An examples is Artic SynPhonix by Artic Technologies.

Speech Viewers. Students with speech, language, and learning disabilities can improve the speech and language skills with the SpeechViewer.   SpeechViewer synchronizes audio playback with interactive graphic displays to give better feedback about speech sounds.

Talking Calculators. As the name implies, there are calculators that read out inputs. Developed for the blind, they can be helpful to anyone.

Canes, Braces, and Crutches. Many students with disabilities may use canes, braces, and crutches, either temporarily or permanently. As a rule, these devices cause few problems in the school, and the teacher is not required to have special knowledge about caring for them. Canes and braces must be changed frequently as children grow.

The most common types of braces used with children are corrective, control, and support. Corrective braces prevent or correct deformities during growth periods, as in the case of scoliosis. Control braces prevent involuntary movements. Support braces enable students to stand and walk.

Wheelchairs. Manual, power, and tilt-in-space wheelchairs are available to meet the needs of a wide variety of problems presented by disabilities. Chairs can be incorporated around built-in technology to include communications devices. Teachers may require training in dealing with handling of manual chairs, especially negotiating curbs and other obstacles.

Although wheelchairs can be highly imbedded with electronics for some students, the primary function of a wheelchair is to increase mobility. A wheelchair enables a student to assume responsibility for daily chores, encourages and permits access to recreational, vocational, and academic programs, and reduces the psychological effects of being immobile (Mullins, 1979).

The most common wheelchair has four wheels, a seat, a backrest, and footrests. For students with weak muscles or upper-extremity involvement, motorized chairs are available. There are ordinarily not used unless absolutely necessary because manual propulsion increases physical activity and builds strength and endurance.

The "Tech Act" Program (NIDRR)

National Science Foundation Programs

The National Science Foundation sponsors a number of programs focused on people with disabilities. Rehabilitation Engineering Research Centers Program (NIDRR) Funded by the National Institute on Disability and Rehabilitation Research (NIDRR) of the U.S. Department of Education and NIDRR, these programs focus on research and development of new Assistive Technologies as well as information dissemination and educational activities.

RERC Adaptive Computers and Information Systems

Trace Center/University of Wisconsin
Waisman Center, S-151
1500 Highland Avenue
Madison, WI 53705
Gregg C. Vanderheiden
Principal Investigator: Gregg C. Vanderheiden, PhD
Phone: 608/262-6966 (V); 608/263-5408 (TT)
Fax: 608/262-8848

Objectives: To make all electronic products and systems more accessible to individuals with the full range of type, degree, and combination of disability.

RERC on Applications of Technology to the Rehabilitation of Children with Orthopedic Disabilities

Los Amigos Medical Center
Los Amigos Research and Education Institute, Inc.
7503 Bonita Street, Bonita Hall CA 90242
Principal Investigator: Donald McNeal, PhD
Frank DeRuyter, PhD
Phone: 310/940-7994
Fax: 310/803-6117

Objectives: To advance state-of-the-art applications of technology for the rehabilitation of children with orthopedic disabilities.

RERC on Augmentative and Alternative Communication

University of Delaware
A. I. duPont Institute
1600 Rockland Road
P.O. Box 269
Wilmington, DE 19899
Richard A. Foulds
Principal Investigator: Richard A. Foulds, PhD
Patrick Demasco, MS
Phone: 302/651-6830 (V); 302/651-6834 (TT)
Fax: 302/651-6895

Objectives: To provide a balanced approach of advanced research technology development and information dissemination which will: define the foundations of the AAC (augmentative and alternative communication) devices of the next decade; increase the objective knowledge on the efficacy of AAC devices and techniques; develop innovative, common sense solutions to communication problems; promote rapid transfer of research into commercially available devices; provide information and training so that individuals with disabilities and those who serve them become better educated consumers; support individuals with disabilities, advocates, and public and private agencies in changing public policy regarding the provision of AAC devices and: services; encourage clinical programs that provide excellent service and respect the consumer; and promote the empowerment of individuals with disabilities.

RERC on Hearing Enhancement and Assistive Devices

The Lexington Center, Inc.
Research Division
30th Avenue and 75th Street
Jackson Heights, NY 11370
Harry Levitt
Principal Investigator: Harry Levitt
Phone: 718/899-8800, ext. 230, 239, or 313 (V/TT)
Fax: 718/899-3433

Objectives: To conduct research programs that promote technological solutions to problems confronting people who are deaf or hard of hearing.

RERC on Modifications to Worksites and Educational Settings

Cerebral Palsy Research Foundation of Kansas
2021 North Old Manor
Box 8217
Wichita, KS 67208-0217
John H. Leslie, Jr.
Principal Investigator: John H. Leslie, Jr., PhD
Phone: 316/688-1888 (V/TT)
Fax: 316/688-5687

Objectives: To promote the use of technology to enhance the autonomy of people with severe disabilities.

RERC on Prosthetics and Orthotics

Northwestern University
Rehabilitation Institute of Chicago
345 East Superior Street, Room 1441
Chicago, IL 60611
repoc@nwu.edu (center); Dudley S. Childress (director)
Principal Investigator: Dudley S. Childress, PhD Phone: 312/908-8560
Fax: 312/908-6526 (Also V/TT)

Objectives: To develop a more scientific and technical base for prosthetic/orthotic advancement.
RERC on Technology for Blindness and Visual Impairments

Smith-Kettlewell Eye Research Institute
Rehabilitation Engineering Research Center
2232 Webster Street
San Francisco, CA 94115
Arthur Jampolsky, MD
Principal Investigator: Arthur Jampolsky, MD
Phone: 415/561-1630 (V)
Fax: 415/561-1610

Objectives: To develop and evaluate new technology for people who are blind, have visual impairments, and people who have multiple disabilities.

RERC on Technology to Improve Wheelchair Mobility

University of Pittsburgh
Rehabilitation Technology Program (RTP)
915 William Pitt Way
Pittsburgh, PA 15238
Douglas A. Hobson, PhD
Principal Investigator: Douglas A. Hobson, PhD Clifford Brubaker, PhD
Phone: 412/826-3138 (V); 412/826-3197 (TT)
Fax: 412/826-3143

Objectives: To elevate the state-of-the-art technology and knowledge relevant to wheelchair mobility, seating, and transportation to the highest possible level; and to disseminate and transfer this state-of-the-art knowledge and technology to a state of practice that results in optimum utilization of this technology and knowledge by persons with disabilities.

Regardless of the nature of the device, such as a computer-aided system, hearing aid, or prosthesis, the student will have to experience a period of experimentation to get used to the device. The school may be asked to participate in monitoring the student's progress, including removal of devices for short periods of time during the day. In many cases, students must buildup their stamina in dealing with certain kinds of equipment. They will require training, as will their families.

Another consideration is transportation. While the teacher may not have much to do with the selection and supervision of transportation, the teacher should know how long it takes a student to get to school, get to the classroom, and to move from one place in the building to another. Thus, a child may need to leave a little early and may sometimes be late.

The teacher will be more involved with mobility in the building. It should be recognized that some students will be slow getting around, but it must be remembered that this requires extraordinary effort and energy. Thus, students may need to rest occasionally and take snacks. They will have problems with associated activities others take for granted, such as carrying books while moving.

Within the classroom, cafeteria, and media center, seating and body support will be a concern. For some students there may be the need to follow a routine of pressure management, adjusting the body from time to time to avoid sores. There is also the need to be alert to potential problems caused by the need for extra support or leverage. Some students may attempt to brace themselves or pull on objects that are normally ignored by other students. For example, pulling on a cart, which may have a television monitor, can cause the cart to topple and injure students. Some students will also need to have stability and support for different parts of the body such as upper extremities, lower extremities, and the head.

As anyone who has ever used an electronic device is aware, they sometimes breakdown. At some point, students who rely on special devices--wheelchairs, computers, hearing aids--will have problems. This is a temporary problem that should cause no particular concern. It may be a matter of having backup batteries, but sometimes repairs are needed that will require a day or so. In any event, if a power chair breaks down, someone can usually push it. In fact, appropriate use of technology usually includes an analysis to first see if tasks can be accomplished without assistance. To the maximum extent possible, the teacher and the student should rely on "human power" for most things. While it may be possible to get from Denver to New York on the space shuttle, it would be much easier and cheaper to take a commercial flight. It may be more desirable and useful to use other people to assist with many tasks instead of a device.