Astech Articles

April 2005             Solving Mouse Training Problems

August 2004          Creating a Long Term Vision and Keeping the End in Mind  

February 2004       Case Study of an Astech Software Single Switch User

by Lorraine Grundy Occupational Therapist Astech Rehabilitation Services

The ability to use a mouse on a computer, through whatever method, is very empowering to children. They are able to access a greater range of mainstream children’s educational and leisure software.

Finding simple software that effectively teaches mouse skills to special needs children however, can be very difficult. ‘The Astech Approach’ includes Mouse Skills Training software that teaches mouse skills to children in a fun, interesting and effective way. Look the Mouse Training page of this website for more information.

Finding appropriate software is not the only problem encountered by some children. Difficulties seeing the mouse cursor and physically accessing the mouse can mean functional use is impossible. In this article a number of solutions to common problems are identified.

Problem 1

Not being able to see the mouse cursor

Alter Size of Cursor

Windows

1. Go to START  > Settings (Windows 98) > Control Pan (Windows XP) > Mouse
2. Select the Pointers Tab > Select the Scheme drag down menu
3. You can then change the mouse scheme from e.g. the white pointer to a black one.

Installing Large Mouse Cursors
You can install free enlarged cursors from www.ace-centre.org.uk/acemain.asp. Click on large cursors.The website and accompanying ‘read me’ explains how these are installed.

Problem 2

Accessing the mouse buttons

Windows XP
1. Go to START > Control Panel > Mouse
2. Select the Buttons Tab > Check the “switch primary button configuration box” to swap from the default right handed set up to left handed.

Windows 98
1. Go to START > Settings (Windows 98) > Mouse
2. Select the Pointers Tab > Select the Scheme drag down menu

Mouse Guards

You can make mouse guards that cover the right button or if necessary both buttons when teaching just the rollover concept. If you do decide to cover both buttons, you can easily adapt the guard to make the left button accessible at a later time.

At Astech, we make them ourselves out of hand splinting thermoplastic material but I
have in the past purchased some metal ones. You do have to have them made up for each individual mouse.

Problem 3

Being unable to hold the mouse in position when clicking the mouse

For children with a physical disability it can be difficult to maintain
the mouse in position and then co-ordinate a finger to click the mouse.

Slowing the mouse movement
One thing to try first is to slow the mouse down so it doesn’t travel so
far when the mouse is moved. A small tremor may be accommodated.

Windows
1. Go to START > Settings (Windows 98) > Control Panel (Windows XP) > Mouse
2. Select the Pointer Options > Change the position of the slider in the motion section.

Mac
1. Go to APPLE MENU > Control Panels > Mouse
2. Slide the Mouse Tracking pointer to Very Slow or Slow.

Switch adapted mouse
You can modify a standard mouse to have a socket in the side to connect a single switch
(e.g. a jellybean or buddy button switch). This switch then acts as the mouse click.
The child can move the mouse into position then remove their hand from the mouse and
press the switch. Having a cable running from the mouse may be a distraction for some children.

Use a Track Ball with mouse buttons on the side
When neither of the above work then a trackball or the solutions in the next section may be appropriate. There are many different trackballs available with different shapes and mouse button configurations. It is basically a large ball that is sitting in a cradle and as you roll it around it moves the cursor. There are always two external buttons but some have more than this. Some allow you to program the mouse buttons to carry out functions such as click, double click or drag e.g. Traxsys Trackball or check out local computer retailers.

Problem 4

Being unable to access a standard mouse or trackball mouse

N.Z. SUPPLIERS

Here is a list of companies that supply the technology identified in this article.

Astech Software is the answer

extract from Gerry Kennedy’s Review of Songs and Stories Mouse Skills No.1
- Level 1

Click Here
for a printable
PDF of the
entire review

Go to the Mouse Skills page for more information about Astech's mouse training software.

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FEBRUARY 2004 ARTICLE

CASE STUDY
OF AN ASTECH SOFTWARE SINGLE SWITCH USER

By Lorraine Grundy
Occupational Therapist - Astech Specialist Rehabilitation Services

I’d like to present a case study to demonstrate how the Astech Switch Training Software is used and the skills it teaches and why.

TOM    

Tom (not real name) is 7 years old and has Cerebral Palsy.
He has a profound vision loss and no ability to verbally communicate.

These are the skills that Tom first presented with:

• He had definite preferences – he loved music with several favourites.
• Enjoyed funny sounds, laughter and adult attention.
• He has a great sense of humour.
• He had received therapy that included accessing a single switch and he understood the concept of cause and effect in relation to switch access,
  ie: - he knew that if he activated the switch he would get a response.
• Tom enjoyed interacting with others and he did this through smiling and laughing.
• Tom did not have a definite yes and no response. He would smile if he liked something and screw up his face if he didn’t want something – but did not use these responses in reply to yes/no questions.
• Tom had little functional use of his hands. He had severe wrist flexion contractions and moved his arms in a gross way, fully extending (straightening) or flexing (bending) his elbow. He was unable to lift his arms at all.
• Tom used his hands to access a jellybean switch using a forward movement of his arm (extension). The movement was difficult to control.

So in summary Tom enjoyed interacting with others and had definite activities preferences, but he had no way of making others understand what he wanted to do or how he was feeling.

Switch Position
We first changed the position of the switch. It was difficult for Tom to access it with his hand. Access was unreliable and it took a huge amount of effort from Tom. We trialed other positions, such as knee and head movements and found that accessing the switch with the left side of his head to be the most successful for Tom.He quickly learnt to move his head to the left to access a small switch and this movement was controlled, quick and required little effort.

Use of the Switch
When we used the Power Link to activate a tape recorder, Tom knew that he needed to press the switch to hear the music. It was the same with a Step by Step device or cause and effect computer software. The problem was that Tom did not understand that he didn’t have to keep pressing the switch to get the response he enjoyed. The other problem was the action of hitting his head on the switch was quite an enjoyable one for Tom and he would continually activate the switch for this response as well.

At this time we needed to teach him to press the switch when given a particular cue and so we began using the Astech Software Training Approach.

USING ASTECH SOFTWARE

'Press' Software
We initially used 'Press' versions of the 'Songs and Stories' and 'Fun and Adventures' CD-ROMs. The 'press' versions have definite visual and verbal cues to ‘press the switch’, the verbal cue being the most important for Tom. When Tom pressed the switch on cue, the song or story would start. After a while it would stop and then he would be cued again when it was time to press the switch and so it would continue. This software taught Tom that there was a definite time to press the switch and he learnt to move his head onto the switch very quickly when this cue appeared. There was however the continuing problem of him activating the switch when he did not need to i.e. when the song or story was being played. If Tom did not learn when to wait he was not going to progress to the functional skills necessary for communication or choice making. So we then moved to the

'Press Wait' Software
This taught Tom to be more selective in activating the switch. When the song or story stopped it may not be the ‘press the switch’ cue presented but the ‘wait’ cue. If he didn’t wait for a certain period of time the song or story would not progress, when he did wait the “press the switch” cue appeared and he could continue.

• We first showed Tom what he had to do. If he pressed the switch it just said ‘wait’. If he waited for a while the familiar cue of ‘press the switch’ would appear and ‘hey presto’ it continued.
• Initially Tom just kept pressing the switch on the wait cue – he didn’t understand. But we persevered. We helped him to wait after he pressed it a few times. We gave him lots of practice but he continued to press when he should have waited.
• One day I left him to it – he must have pressed the switch 20-25 times and he got nowhere.
• After a while he put his head in the middle away from the switch, heaved a great ‘sigh’ and in this time the ‘press the switch’ cue appeared. The look of recognition on his face was wonderful.
• HE needed to initiate this waiting a few more times before he understood the concept.

The other thing that occurred, along with the understanding of the “wait” concept, was that Tom decreased the amount of times he activated the switch when the song or story was playing. So he began to understand that it was unnecessary to activate the switch at this time.

Tom has now progressed to making choices when a number of items are presented to him, either by using his voice or by pressing a switch to choose. There has been continued training involved in teaching these skills which I will explain in the next newsletter. But Tom proves to me that if we can get over the hurdle of the child understanding that there is a time to press the switch and a time to wait, then we can then go on to teaching them how to press the switch at a particular time to make choices.

The beauty of the Astech Switch Training Software is that the responses the child gets from activating the switch is fun. It has great sound effects, graphics,animation, songs and stories that creates lots of smiles and laughter and keeps the child’s interest. Tom took some time to learn the ‘Press’ and ‘Press Wait’ skills and this software, along with some of Astech's customised software kept his interest so that he wanted to keep practicing.

Creating a Long Term Vision
and Keeping the End in Mind

by Lorraine Grundy - Director of Occupational Therapy
Astech Specialist Rehabilitation Services

'The Astech Approach' is a system that teaches children how to access assistive technology in order for them to use this technology in a functional way e.g. to communicate and/or to control their environment.

For many children who have complex needs (physical, sensory and cognitive impairments) it is often difficult to imagine they could learn to use technology in this way.

Our extensive experience in working with children with complex needs has proven that these are realistic and attainable goals if you carry out the following:

•   Identify a long term vision with an appropriate long term goal.
•   Identify the progression of skills necessary to achieve this goal.
•   Believe the child can attain these skills.
•   Make a commitment to teach the skills necessary.

It is essential to understand that it may take some time to achieve the long term goal, maybe several years, but the benefit for the child and their family is immeasurable.

Vision and Belief

The child’s achievements are only limited by our vision and commitment. Children with complex needs are not going to learn functional communication skills on their own as their challenges are too great, so it is up to us to teach them. Everyone involved needs to have an expectation that the child will gain these skills.

Reaching the long term goal will take some time and those who either live with the child and/or work with them week after week, need to know the long term vision and goals and what the benefits to the child are. If everyone understands where it is the child is expected to go and sees that it is possible, they will then have a better chance of believing that the goal is attainable.

If you are having trouble envisaging what the child could possibly achieve, I advise that you go and visit children who have achieved skills through the use of technology and talk to others who have taught children with severe and complex needs. I have often taken a child and their family to meet other children who have achieved functional outcomes in communication or environmental control and they have found this to be very valuable.

Progression of Skills

You need to know what skills the child needs to learn in order to reach their long term goal. There is no point in teaching a child skills that do not lead to achieving this goal. It takes so long to teach each individual skill, you do not want to be teaching those that actually conflict with the ones needed.

An example of this is to teach a child to activate the switch on a silence without any visual or auditory cue. Where is this skill needed in a functional switch accessing context?

It is essential to always keep the end in mind and a plan needs to be developed of the skills necessary to learn and how they can be taught. This plan can be changed and will evolve as the child learns skills.

Commitment

Once the long term vision/goal is created and all those involved believe that it is an attainable goal there needs to be a long term commitment by all to achieve this outcome. This commitment should be made by the funders of the services as well as the family, educational and therapy teams. We need to ensure that the implementation plan is kept fun and interesting for the child and those working regularly with them. This plan should include a mix of technology and non technology tools to teach the skills required.

It is essential that there is a team of people working towards the long term goal and that everyone applies the same strategies and uses the same language etc . The team must include the family/carers, teacher, teacher aide, occupational therapist, and speech-language therapist. This is not just to gain a mix of knowledge and expertise but to ensure that momentum is continued. If one team member leaves there is someone else that can ensure the child continues to work on the appropriate goals.

It is also very important that this plan is carried out at home as well as school. Setting children up with computer software and activities to use switch technology at home can benefit in three ways:

• There is consistency between both environments making it easier for the
  child to understand how they can interact and control things around them.
• It provides the child with the opportunity for more practice especially
  in the weekend and holidays.
• It can provide an opportunity for the child to participate in an activity independently, a rare occurrence for children with complex needs.

CASE STUDY EXAMPLE
Here is an example of a child with complex needs, the long term goal for him
and the progression of skills necessary to reach this goal.

The Child
Imagine a child with a severe physical disability (any age), with no means of communication, very low vision, unknown cognitive abilities. The child has definite preferences, really liking the Wiggles but not the Teletubbies, likes milkshakes but hates juice. They have no definite switch access skills and as yet, no consistent demonstration of activating a switch to achieve a response.

Long Term Vision
To use an auditory scanning low tech or high tech communication system to allow them to communicate what it is they are feeling and want to do. They could also use auditory scanning to control a scanning environmental control unit to control the TV or stereo.

Auditory Scanning
This is an example of auditory scanning:

The child selects from a list of choices provided by auditory cues. e.g. they could choose from feelings, things to do, food or drink.
For Example: - After the drink page is selected, the cue is spoken;
"Your choices are " milk, juice, water and milo."
"You choose - milk….., juice……, water……, milo……… ."
There are a range of different ways the child could select their choice:

• With a switch that is connected to an assistive technology device or computer software that has auditory scanning.
  
• With a switch that is connected to a recordable communication device (Big Mack, chipper, step by step, etc) that has ‘yes’ recorded on it. There is a low tech communication system of symbols or words that the communication partner cues the child through.
  

• Understand that they have the ability to control something whether
  it be through a switch and/or with their voice.
• Physical ability to access the switch.
• Understand that if they press the switch something will happen.
• To know when to press the switch.
• To know that there are times you don't press the switch.
• To develop preferences for activities.
• To know they have a choice.
• To learn that to make a choice ( i.e. to get the one you want ) you have to wait until the oneyou want is either visually highlighted or is auditorally cued

How to Teach These Skills

Frustrated with the available software and the lack of an integrated teaching approach the Astech Team have developed ‘The Astech Approach’ – a training system that progressively teaches the skills needed to access computers and assistive technology. 'The Astech Approach' has a number of interactive software programs that can be used individually or as a set for a total teaching system.

For the above child you would progress through the following Astech Software:

•   Press
•   Press Wait
•   Choice making within current Astech Software
•   Look for the release of new Astech choice making software in late 2004.
     This new product teaches children the skills needed to use scanning setups.

In conclusion, the team at Astech believe passionately that a shared vision and shooting for the stars can unlock the hidden potential within the most disabled child.

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