Presentation on theme: "Occupational Therapy and Assistive Technology: A Vital Link Molly Shannon, OTR/L, ATP North Carolina Assistive Technology Program Charlotte, NC 704-355-2703."— Presentation transcript:
Occupational Therapy and Assistive Technology: A Vital Link Molly Shannon, OTR/L, ATP North Carolina Assistive Technology Program Charlotte, NC
A Beginning… I drew it, the letter A. There it was on the floor before me. I looked up. I saw my mother’s face for a moment, tears on her cheeks. I had done it! It had started, the thing that was to give my mind it’s chance of expressing itself. That one letter, scrawled on the floor with a broken bit of yellow chalk gripped between my toes, was my road to a new world, my key to mental freedom. Christy Brown, 1954 My Left Foot, movie and book
Overview of Presentation Definitions, compare and contrast OT/AT OT Role Categories of AT and examples Resources Case studies Door Prizes
“Molly, Why Did You Stop Being an OT?” WRONG!! I have never stopped being an OT. I am an OT that specializes in AT. AT professionals come from all backgrounds, but OT is a logical choice. Apple and AOTA in New Orleans years ago, “AT and OT: Changing Lives One Day at a Time”
Why Should O.T.s be Using AT? Why not? Hasn’t OT always dealt with adaptive devices? AT is just an extension of this Best practice! OT Practice Framework: ADL, IADL, Education, Work, Play, Leisure, Social Participation….AT touches all of these! Different settings are demanding increased knowledge of AT: schools and rehab Increased media coverage of AT increases knowledge base of consumers and families
Why Aren’t O.T.s Using AT? Lack of experience and/or confidence Too little time for additional training Little access to AT in particular settings No mentors Just don’t get it, no buy in yet or “ah-ha” moment or client Lack of institutional or supervisor support Lack of resource information
Definitions of OT and AT From AOTA website: Skilled treatment that helps individuals with disabilities achieve independence in all facets of their lives. It gives people the “skills for living” necessary for independent and satisfying lives. AT Definition from PL : AT Device: Any item, piece of equipment or product system whether acquired commercially off-the-shelf, modified, or customized that is used to increase or improve functional capabilities of individuals with disabilities. AT Service: Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.
Compare and Contrast AT: goal is to increase function. If a person cannot perform a required activity, then may need AT to accomplish. OT: use functional tasks to increase independence in self-care, work, school, play and leisure. Do they overlap? Yes.
Terminology/Topics to Consider Least restrictive environment No prerequisites to try AT! Continuum of access concept across lifespan. Universal Design. Jargon: medical vs. educational vs. community. For funding issues mainly. No, low, and high tech: based upon cost or degree of difficulty Method vs. material accommodations vs. accommodation technologies (seating, large print, software for vision limitations)
Full: Level 1SameWith peersEqpt for physical Full: Level 2Same with accommodatio ns With peersIncreased time, decreased quantity, etc. Full: Level 3Same with adaptations With peersVaried input/ output on CPU, format shift Moderate: Level 4Same with content shift With peersBooks on reading level, highlighted, decreased grade level Moderate:Level 5Same at times: Develop- mental With peers or separate part of room Ex: coloring map and tracing names of states or name Limited: Level 6FunctionalSeparateFunctional words, sorting,daily tasks Limited: Level 7Separate Ex:IEP,cause &effect w/switches Inclusion LevelsTasksLocationExamples or AT
Settings for OT using AT Educational: all ages Private, charter schools Non-profit settings Hospital or rehab Private OT Home Health, nursing homes or assisted living Specific AT sites: Tech Act, school team, Voc Rehab
OT Role in AT Evaluation Functional range of motion Strength Sensory Cognitive, depending upon team Coordination Reach Hand Strength and finger isolation or other isolated access control Functional skill levels
Typical OT Roles in AT vs. Generalist in AT Assist in seating and positioning and ECU integration possibly Switch access Mounting Writing assistance tools and sottware But as an OT gains more expertise in AT, the roles between service providers blend. For example, I do quite a bit of AAC consultation for low tech.
Assessment Assistance: few formal evals out there Online typing tutor and AT assessment, $6 month for individuals, free 4 wk trial at WATI free AT eval form (37 pages) and other materials online, SETT (Student, Environment, Task, Tools) online form from Joy Zabala and Denham: Zcomp.doc Principles: Zcomp.doc
Categories of AT Computer Access Augmentative communication Activities of Daily Living Environmental Controls Seating, Mobility and Positioning
Low or No Tech: Do Not Dismiss the Importance! Laptrays, adapted desks Typing aids, splints Book holders, 3 ring binders, slant boards Built-up handles, grips, new Crayon TwistUps, etc. Reachers, mouthsticks and head/chinpointers Hand held magnifiers Raised line paper, writing guides Homemade devices! Client or therapist!
Overview of AT Products Not meant to be all encompassing Just representative, novel products Trying to put a name to a product to help with recognition later Sources listed on slides on handouts or for more info, some fav sources so becomes resource list for you
Hierarchy of AT Computer Access Keyboard Mouse Technology Proportional Joystick Switched Joystick 4 switches 3 switches Single switch scanning 2 switches Single switch Least Restrictive Access Most Restrictive Access
Regular Keyboard Use Slip-on Typing Aid, $16 various Keyguards, $140 various Keyboard Labels or Keycaps, ~$20, various large print and Braille, Low Vision Keyboard, $60,
Portable Word Processors: PC6 from Perfect Solutions $290 plus a text to speech component available for $99 Alphasmart 3000 $199 with Co:Writer Applet add $139 or DANA
Alternative Keyboards: small, large, one hand, chorded, Intellikeys Keyboard $395, Mini Keyboard, various, $60, Fentek Kid Keys Keyboards, $169 Half QWERTY keyboard, $595,
Trackballs, Joystick or Mice Examples Kid-Trac or PC Trac/Max trax, $69-79 (Microspeed) various sources and Infogrip, Vertical Mouse, left or right-handed, $72 Roller II Joystick or trackballs, $309 Logitech Trackman, $40, Infogrip HelpiJoy Mouse, $199, Infogrip
Using Your Head: Many Choices Infrared products: ex. Headmouse Extreme, $1000www.enablemart.com HandiEye, $699 Eye gaze systems, ex. Quick Glance, $ www.enablemart.com
Computer Software: Onscreen Keyboard Example: REACH Interface Author (329 to ) net.com, free 30 day trial, WINwww.ahf- net.com
Word Prediction: (example) Co:Writer $325 Great article from LD Online about word prediction,
Sorting Through Word Prediction and Onscreen Keyboards Onscreen Keyboards: physical issues, with or without word prediction, variables Word Prediction: Applet for Alphasmart or software Increases rate of writing as decreases number of keystrokes required, >12 wpm may not be effective unless need spelling/language support too Have to visually monitor screen to be effective Works nicely with onscreen keyboards or if keyboard is mounted upright
Writing Support Software many choices! Kurzweil 3000, $ , new prod for Windows called ClaroRead for $395.www.enablemart.com Read and Write, Enablemart, $695
Software: Talking Word Processors Example, Write:Outloud, $99,
More Writing software… Clicker 5, $199,
Writing Support Software Inspiration or Kidspiration, $55, 30 day free trial from publisher
Voice Recognition: Primarily using Dragon Naturally Speaking Depends upon individual, yet many clients with SCI depend upon VR Students with LD, neurological like MD, some CP Doctors, lawyers, public safety Bottom line: what tasks need to do? May use VR for some and type via other methods for others Where to use in public school settings? What grades? Cognitive load.
Switch Interfaces and Switches Have to have an interface to use switches to operate computer Several sources, including and others for about $100 Switch software commercially available or can do some customization if needed
Hierarchy of Access Sites: Can Have Multiple Sites for Access Hands Head/voice Arms/elbow Legs/knees Feet
Top Tips for Switch Selection: compiled from Dr. Jennifer Angelo source, Univ of Pittsburgh Movement Issues: naturally occurring, volitional, social and communication issues, motivation is key Positioning and Environmental Concerns: team assessment helps, space constrictions, reflexes, mounting, different locales/times different access? Performance Variables: Target size, Force,Timing, Accuracy, Efficiency, Durability, Safety and Fatigue User Input: Interest and acceptance, Fun for younger users, Increases independence, Comfortable, Ease of use, Reliability, Cost issues Professional or Family Support Pointers: Wait!, consider previous attempts, try it yourself!, ease and reliability of set-up by staff/families 20AND%20switch%20selection 20AND%20switch%20selection ‘
Ideas for Feature Matching with Switches: Varies with Clients! Cerebral Palsy: coordination is key Neuromuscular (ALS, MD, SMA): strength, ROM, fatigue Spinal Cord Injuries: high level quads DD/MR: bright, big, sturdy Visual Impairments: Pressure, rocker, wobble switches. Mounting! Spec, light touch, blink, P switch, cup, microlite Sip and puff, tongue, head controlled Big Red, Bass, wobble, auditory Texture switch, auditory feedback
Scanning: Techniques and Patterns The most laborious and mentally straining form of access is auditory scanning so is usually a last resort for access! Visually scanning is easier. Scanning Techniques: Automatic, Step, Directed or Inverse Patterns: Linear, Circular, Group, Customized
Morse Code Issues Great if ham radio or military experience Expressive, not receptive Which devices or software: JOUSE, EZ morse, DARCI, doublecheck Book, Modern Morse Code in Rehab and Education by Thomas King Website of user and links: Book, Denis Anson,OTR: Alternative Computer Access Speed is key, can get up to 30 wpm Codes become automatic so reduces cognitive effort to write and can concentrate on writing Takes many hours to learn, audio learning best Try at very early age; same age as peers learning to write
Voice Recognition Example:Dragon Naturally Speaking, various versions from $ , various sources including Powerful product that has replaced some other methods for some clients Use a great deal with SCI and RSI Can be operated totally hands free if needed Source for resources for voice recognition: m/Writing/speechRecognition.php m/Writing/speechRecognition.php
Augmentative Communication OT plays vital role as part of assessment team Become a generalist with experience! Should be using their devices in OT sessions, not just in Speech or in class Linda Burkhart great resource site Speech to Speech Relay service,state numbers listed at website
10 things I wish my teacher knew about AAC (insert AT or therapist, parents, etc) Callier Center/ ASHA 1. I wish my teacher would joke with me. 2. I wish my teacher would learn how to work my communication device. 3. I wish my teacher would stop shouting at me like I can’t hear. 4. I wish my teacher would remember that I don’t always spell very well. 5. I wish my teacher wouldn’t have a heart attack when my device doesn’t work. 6. I wish my teacher would have more patience with me. 7. I wish my teacher wouldn’t hit my machine when it doesn’t work- that’s my mouth she’s hitting! 8. I wish my teacher would call on me for Share Day. 9. I wish my teacher would give me enough time to say what I’m thinking. 10. I wish I could walk and talk like my sister and brother.
AAC with Environmental Controls Dynavox and Prentke Romich products have had infrared access for years with high end AAC devices. Use for electronics in home or for operating toys for children. No antennae or is radio Controlled device or toy. AMDI Tech Talk ECU, $795
Environmental Control:ECU or EADLs Simple large remotes,$39,various sources, Wal-Mart or Large remote with switch jacks, $119www.adaptivation.comwww.adaptivation.com Jumbo Universal Remote, $189,www.enablemart.comwww.enablemart.com Powerlink 3,$189, More complex with scanning Switch access start at $ from for Relax units and up to 5K- 15K for Quartet Simplicity voice/switch ECU and components,
Popular ADL Products New products: Soap Genie,$40 Autoflip Spatula, $17, Adapted Gardening, Fishing and Hunting: Drink Aide, $39 from Half gallon carton holder, $8,
Various Newer AT products PDAs for augmentative communication and cognitive support Bluetooth cellular phone for hands free answering and calling Smartphones with Bluetooth and GPS and alarms Infrared plumbing: Pros and Cons! Adjustable shelves and stovetops, Approach Cooktop and Countertops, $1564 each
Self Feeders Neater Eater, $ Winsford Feeder, Sammons, $3746 or at $2795!! Steady Spoon, Sammons, $
Low Tech Toys and Learning My Handout Great research summary article about using AT with infants and toddlers: BP.pdf#search='toddlers%20AND%20power%20mobilitywww.asu.edu/clas/tnt/presentations/UsingAssisTechInfTodE BP.pdf#search='toddlers%20AND%20power%20mobility‘ Spice up use of switch toys by being creative, using in units, cooperative activities, encouraging language and motor skills Look wherever you shop for battery operated, current toys can add a battery interrupter to. Cracker Barrel, $1 stores.. Best sources of adapted switch toys remains but try Ebay as well!
The Low Down on Battery Operated Toy Adaptation Battery interrupters, $8-14 from AAA-D battery sizes Make own, directions online. Cold solder is now available Buying toys already adapted is more expensive, but some benefits Adding own interrupters to cheap toys allows to increase interest with current toys, like Curious George or Dora Great holiday workshops to make switch, adapt toys Single Switch Latch Timer, $75, adds control options
More Toy Tidbits… Some call adapters, but adapters are the way to change from a 1/4 inch plug to a 1/8 plug or vice versa Note can buy both from Enabling Devices, just not shown in catalog. Also from Radio Shack and others Many toys have multiple operations and may not be easy to adapt Some battery compartments are too tight to place copper disk in Rasp to notch edge of cable Key! One adapter for one toy! Last much longer, easily used…
Vision AT Examples Magnifiers, handheld, lighted ADL aids:many talking ones now for blood pressure, color and money detection (Voice It All, $250, scientific calculators,hobbies! CCTVs, ex. Quick Look color portable, $745, Maxiaids Software for screen enlargement (Zoomtext) or screen reading (JAWS, $ , Maxiaids) or Braille input/output
Telephones and Cell Phones: Ameriphone RC 200 Handsfree telephone, $400, Picture Phones, $60, Bluetooth technology advances Amplification,Headsets TTY, Relay services,Speech to Speech/Sprint Alltel Disability Access cell phone reference: Engineer who specializes in adapted cell phones for all disabilities, Ray Gonzales,
Mounting Systems: For Switches or AAC: Cost varies with weight can hold, features E-mount $99 or Magic Arm $190 from Articulating Arm from $115.www.rjcooper.com Profiler-Lite $210, Slim Armstrong $191, USMS $200 from Ablenet. MightyMount $125 plus $90 for arm from TASH. MAXESS switch mounting system, $55 from
Early Positioning AT Bumbo Seats, $40, Ladybug corner chairs, $770 Tomato, ~2K, Giraffe standers, ~1500,
Upper Extremity Support Powerboard, $115www.sforh.com Ergorest, $ www.infogrip.com Zonco Mobile Arm Valet, $838 plus for various attachments Morency Rest, $115www.sforh.com
Electronic Page Turning: Worth it? Book holders and mouthsticks easiest! Cheapest as well. Electronic: GEWA (Winsford) and Touch Turner $980 Roberts Book Holder, $19,
Low Tech Book Holders or Page Turning Handout: A-Z of Adapting Books Books on CD or tape, spiral bound for SCI is easier Book holders, nice ones from Bible stores Magnetic Page Turner, $60, BookWorm, $239, switch access and voice output
I Love Cats! Our Field Trip to Big Cat Rescue
Big or small…. I love cats! Link to how to adapt Powerpoint for switch books, various sites pdf pdf
Power Mobility and Driving These are true specialty areas. Karen Kangas, OT, great resource for power mobility, 13 page article about LMN for head access for power mobility inc.com/PDFS/overallhead.pdf#search=' karen%20kangas%20AND%20assistive inc.com/PDFS/overallhead.pdf#search=' karen%20kangas%20AND%20assistive Peggy Barker, P.T. website with sources for AT for power mobility Adaptive Driving, An Introduction Adaptive Driving and Vehicle Modifications, sources tm tm Melanie, from film com com
Service Provision Setting and Examples of Possible AT CP Autism MD/ALS SCI CVA Learning Disabilities Visual Impairments Arthritis Traumatic Brain Injury
Cerebral Palsy and AT Varies with type of CP: spastic, athetoid, etc. Athetoid connect most with AT with my experience AT to support overall independence, community skills, communication, work, leisure
CP: AT to Consider Adapted computer keyboards (mini, king, keyguards, alternate, virtual onscreen) Mouse emulation via trackballs Head based controls AAC Environmental control/EADLs Switch access for cause and effect, toys, leisure Word prediction and talking word processors
Autism and AT Varies greatly with level of autism and overall developmental level AT to support learning and communication, community skills, and leisure. Can assist with classroom behavior plan and goals as a motivator. Can work with perseveration and make it a functional and motivating activity. President Bush hugs Jason McElwain, the autistic basketball manager who drew national cheers by scoring 20 points in four minutes for his high school team.
Autism: AT to Consider Talking word processors Creative structured software for leisure: Ex: KidPix AAC support: devices or software based Possible touch screens initially Electronic books (audiocassettes or CD-ROMs) Ex: Living Books Educational support via special needs software: example Early Learning from Marblesoft
Muscular Dystrophies, ALS and AT Various types: Duchenne’s, Spinal Muscular Atrophy, ALS Age and needs of clients vary of course AT to support maintaining independence in writing, computer access, environmental controls/EADLs, feeding, leisure, communication Funding is possible with ALS/MD Associations at times
Stephen Hawking, A Brief History of Time “For a time after the tracheostomy operation the only way I could communicate was to spell out words letter by letter, by raising my eyebrows when someone pointed to the right letter on a spelling card. It is pretty difficult to carry on a conversation like that, let alone write a scientific paper.”
MD/ALS: AT to Consider Alternate keyboards: mini or Magic Wand AAC devices Switch access Trackballs Word prediction Electronic page turners and feeders Eye gaze systems Environmental Controls
SCI: AT to Consider Head based or sip and puff mouse access via QuadJoy, HeadMouse, SmartNav Dragon Naturally Speaking PC Trac trackball Adapted desks Voice activated telephones and environmental controls/EADLS Alternate keyboards: onscreen or mini Keyboard trays, lapboards, forearm supports Possible eyegaze computer access for highest level of injury
“I should be approached with the best [assistive technology] that is available and find a way to get it [funded]. And if I can’t, I can [downgrade], but I should be able to see what’s available.” - Marilyn’s storyMarilyn’s story
ActivityC1-4C5C6C7Para FeedingNAYYY Dressing:U NAYYY Dressing:LN AAAA BladderNY*AYY BowelNNAYY TransfersNNY*YY Manual WC NY*YYY Power WC YYYXX DrivingNY*YYY SCI Functional Independence Guide Key: N= Not independent, Y= Independent, A= Independent with assistive devices, Y*= May be independent, but not expected, X= Not usually needed
SCI AT Products of Note Quad Desk, $975 plus Various components Quad Reacher,Vee-Zee C5 Reacher,$182,
Psychosocial Aspects of Recovery I’ve often talked about the transition I have to make almost every morning. I have to emerge from the dreams in which I’m completely healthy and able to do anything and adjust to the reality of paralysis. Once that moment passes, I begin my day rationally and hope returns.
Learning Disabilities and AT Underutilized area for AT is with those with learning disabilities Usually can see the most opportunity for improvement AT allows to level the playing field or impact of disability no matter what the age
LD: AT to Consider Handwriting aids Software to support writing such as word prediction or voice recognition Outline or organizer software Organizers (software or PDA) Electronic or handheld spellcheckers Reading support via OCR assistance such as Kurzweil 3000
Visual Impairments and AT Visual impairment vs. blindness Different organizations and professionals can really help us provide best services AT to increase independence in writing, reading, vocational, community and leisure skills Stevie Wonder Unveiled Breakthrough Music Video Using Description Technology For Blind And Low Vision Music Fans om/entertainment/ /NYF html om/entertainment/ /NYF html
VI: AT to Consider Depending upon age and degree of visual loss and Braille or not Talking word processors Screen reading programs Screen enlargements Portable Braille devices Internet access
Arthritis and AT Standard OT methods of energy conservation and activity modifications AT to improve independence in self-care, cooking, writing, computer access, leisure AT to consider: minikeyboards, trackballs, voice recognition, ADL devices, leisure AT products
CVA and AT Obvious left vs. right CVA differences lead to different AT needs AT to increase independence in functional upper extremity skills for communication, writing, reading, feeding, self-care, leisure Big impact with augmentative and written communication, return to work or other life roles. "My stroke changed me into a better person — a person whom I like. We all want happiness. I've learned we achieve happiness when we seek the happiness and well-being of others." from My Stroke of Luck by Kirk Douglass
CVA: AT to Consider AAC devices One handed keyboards Onscreen keyboard ADL devices Writing aids
Traumatic Brain Injury and AT One of most complicated areas of AT provision as there are so many different areas affected: cognitive, motor, visual, sensory, communication and psychological AT to increase sensory stim and cause and effect, motor control for writing, communication, cognitive skills
TBI: AT to Consider Switch access for toys/leisure/ECU/AAC Augmentative communication Computer access via mouse emulation with switches or touch screen, etc Cognitive supports via electronic reminders, software, organizers
Orthopedic and AT Temporary Injuries or Post-Surgery needs for low tech ADL is standard. One handed needs for keyboarding or self care.
Case Study: Kelly, CP, age 11 Home schooled now by mom who is a teacher Using an AAC device to clarify speech Using roller ball joystick and some regular and spec ed software Trying adapted cooking items already Attempting to handwrite and cut, very motivated still Using a book holder and magnetic page turner for a trial now Exploring various software
Case Study: Michael, CP, teen-adult, transitions in life Originally seen in middle school as school district OT, computer access in school goals at that time and aide training and support When began college, called in for AT and accessibility study by Voc Rehab Two years later, CAP Medicaid Waiver case manager has requested help Has tried many types of AT for computer access, but prefers head pointer. Uses laptop, hands-free Ameriphone RC 200 with a headset, ordering an accessible/adapted mobile phone with Bluetooth capability for hands free calling and answering from wheelchair. NC contact: Will have seen in public school setting, college and will help transition into work world and independent living settings in the future.
Case Study: Allen S, CVA, 19 years old Initially thought he was locked-in syndrome Have seen him from ICU through getting him ready for college Areas assisted: augmentative communication trials/ordering/loaner/training, computer access, positioning of keyboard with lapboard, advocate for helping him get going with college application and coordination with other agencies for funding
Case Study: Carla, C6 SCI, 28 y/o Initially saw in rehab for voice recognition software which her family purchased along with a laptop for her Did work site eval for AT Technology using now: Quad Desk, Dragon Naturally Speaking, lapboard, mike/headphone switch kit, slip-on typing aid, mini-keyboard Returned to work with DSS
Case Study: Jo, ALS, 52 years old, former RN Assisting ALS clinic with head based mouse control and some environmental control Very computer literate and participating in an online research project with a doc for ALS Technology using: laptop computer with Head Mouse Extreme, REACH onscreen keyboard, Ameriphone RC 200 Handsfree telephone, Dynamyte AAC device and for environmental control
AT Resources RESNA Technical Assistance Projects, state listing, Alliance for Technology Access Abledata major source of AT info in a databasewww.abledata.com Family Center on Disability and Technology, Wisconsin AT Info, great resources for educational AT, free eval and data formswww.wati.org/ Frticschi’s AT Tool Chart, great wealth of info!,
More great resources… AT Training Online Project, Univ of Buffalo, Let’s Play Project, fantastic AT info for children Boston Schools, Strategies and Tools for Adapting Books, 15 pages, gBks.pdf gBks.pdf JAN, Accommodation Guidelines by Disability, AAC resources Family Center on Technology and Disability
Disability or Age Specific Resources Extra Hands for ALS, great website with AT and other info SCI Pilot, Chicago Lighthouse for the Blind has launched an AT support line. Individuals who are blind, teachers, and others can call (888) for help in resolving issues Brain Injury and use of PDAs resource 20Reviews.html 20Reviews.html LD and AT html html
More….. AT for young children Universal Design College and AT Resource Guide Home Modifications and other AT info PaTAN 13 pg guide “ AT: A Focus on Accommodations for Learning” includes method and material accommodations and accomodation technology ideas for various skill areas including, writing, organization, etc. ons.pdf#search='accommodation%20Technologies ons.pdf#search='accommodation%20Technologies Baltimore Schools 500 books for which Boardmaker communication boards have already been made (have to have current version of BM)
Conferences, Trainings CSUN, March, Los Angeles,California Handouts from previous conferences RESNA, June, cities vary Closing the Gap, October, MN ATIA, January in Orlando
Freebies!!!! Click ‘n Type: free onscreen keyboard, DASHER: unique text entry!, E-triloquist: free PC talking program, ATA: We Can Play series, National Cristina Foundation: donated computers to non- profits, schools or agencies, Learn to Type, free online typing test and tutor, Jim Mullen Foundation, free computers and software for persons with disabilities, List of freeware and shareware on our website
Top Ten Things to Not Say About AT/AAC 1. It’s not my job! 2. I don’t know anything about AAC or AT. 3. He’s just not ready developmentally for it. 4. It’s broken! 5. It costs too much. 6. It takes too much time. 7. He won’t use the device. 8. I am not a computer programmer! 9. Switch toys are so boring. 10. There is not training or support for me!
When we do the best that we can, we never know what miracle is wrought in our life, or in the life of another. Helen Keller Door Prizes!