Developing Switching Skills Making it Successful

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Developing Switching Skills-Making it Successful

• Tuesday 10th September 2008
• Nisha Kerai Occupational Therapist (ACT)
• Lynne Rogers Occupational Therapist
• (ACT)
• Stephanie Nicholls Occupational Therapist (EC
  Link Worker)

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Contacting ACT

• Helpline 0121 472 0754
• Website http//www.actwmids.nhs.uk/
• Email format Firstname.Secondname_at_sbpct.nhs.uk
• Main phone number 0121 627 8235
• Address ACT, WMRC, 91 Oak Tree Lane, Selly Oak,
  Birmingham. B29 6JA

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Timetable

• 9.00 Registration and Coffee
• 9.30 Introduction
• 9.45 Switch Ranges and Types
• 10.45 Tea/coffee
• 11.00 Assessing for Switch Access
• 12.15 Lunch
• 12.45 Mounting and Plugging in Switches
• 1.45 Tea/coffee
• 2.00 Scanning
• 3.00 Ideas and Resources
• 3.30 Close

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Introducing ACT

• Regional NHS Tertiary Assistive Technology
  Service all ages and conditions
• Mission statement
• To empower people with disabilities, using
  techniques and technologies which optimize
  potential for communication and control.
• Staff OT, SLT, Clinical Scientists, Workshop
  team, Administrators about 30 people.
• Other teams in UK are similar but each is unique

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The West Midlands AAC Care Pathway

• Brief history
• About the training packages
• The documentation and how it can be used.
• Sourcing the documentation

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The West Midlands AAC Care Pathway
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The West Midlands AAC Care Pathway
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Learning outcomes

• Following the course participants will
• Be aware of the range of switches on the market
  and their different characteristics
• Feel confident in assessing and providing simple
  switch access solutions
• Be able to use and position switches in
  innovative ways
• Understand the risk implications of switch access
• Have a knowledge of the potential of switch
  access and more complex systems

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Introductions

• Your role / experiences of switching?
• Why you are on the course?
• A question for us to answer during the day

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Switch Ranges and Types

• Different Switch Types
• Properties of Switches

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Switch Properties

• Identify switches around the room
• Describe 2 properties of the switches and
  describe how they may be used.
• Presenter demonstration

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Contact Switches

• Pressure required to operate
• Positive feedback
• Travel distance
• E.g. Jelly Bean, Specs Switch, Buddy button
• Adjustable pressure

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Low Pressure Switches

• Touch or low pressure required to operate
• Little physical feedback
• Zero Travel distance
• Skin conductants

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Suck Blow switches

• Mouth operated
• Intrusive
• Mounting?
• Cleaning blockages

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Leaf Switch

• Cope with spasms
• Two way deflection

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Chin Switch(es)

• Head Movement (!)
• Easy mounting
• Consistent positioning
• Can get multiple neck switches

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Eye Blink Switches

• Switch with a blink
• Glasses/head band mounting
• Future Eye Gaze

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Pneumatic Switches

• Operated by air-pressure
• Squeeze / Push

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Remote Switches

• Wireless
• IR beam
• Proximity switch
• Mounting Options

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Bespoke Switches

• Slide Switch
• Recessed Switches

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Video - Jessica
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Other Switches

• Touch switches
• Head Switches (Turk)
• Sound switches / Voice activated
• String switch
• Muscle switches (Piezo EMG)
• Vibration switch
• Tilt switch
• Thermal sensing

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Coffee/Tea Break

• A chance to look at kit / chat

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Assessing for switch access
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Switch Access

• Switching Considerations
• Size
• Position
• Type
• Cognitive issues
• E.g. switch feedback
• Physical issues
• E.g. type of movement
• Environmental issues
• E.g. amount of setup?

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Assessment for Switch Access

• Activity
• Role Play

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Assessments - Physical Aspects

• Posture and positioning
• Active movement/ ability to move
• Tone
• Reflexes
• Abnormal Movement
• Tremor
• Repeatability
• Sensory loss

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Assessments

• Cognitive Aspects
• Memory
• Attention
• Problem solving
• Sequencing
• Initiation
• Impact on scanning / timing
• Personal psychological / motivation

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Assessments

• Environmental Aspects
• Position of client
• Position of equipment
• Complexity of the equipment
• Ability of environment to support Environmental
  Control
• Risk Factors

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Switch Access Switch Ranges and Types

• Other things to do with switch inputs

• Latch
• Delay
• Invert
• Debounce
• PIC box
• Doubler / Splitter

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Assessing for Switch Access

• No right or wrong way necessarily
• Matching the switch to the movement and the
  client
• Risk factors what switch is most reliable,
  are there long term issues?
• Monitoring and review best at a local level,
  who is empowered?

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Video

• Brenda

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Lunch
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Mounting

• Factors to consider with mounting
• risk
• stability
• repeatability
• degeneration/improvement
• effectiveness
• environment, set up etc..

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Video attitudes and strategies
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Explore other solutions

• Velcro
• Dycem
• Flexible arm
• Floor stand
• Double sided sticky tape
• Maxess
• Foam
• Then consider when to refer to ACT or other
  agencies

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Video Attitudes and Strategies
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Connecting Switches

• Computers Joy Cable / Box (software)
• AAC devices-
• low tech - using bleep box with partner assisted
  scanning
• VOCAs - Big Mack / Dynamic Screen
• Mains Controllers
• Environmental Control
• Switch adapted toys

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Introducing switches

• Single switch
• Cause effect
• Moving onto two switches
• Consistent use of instruction
• Repeating with different people / environments

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Developing scanning skills - 1

• Have identified person may benefit from having
  access to a switch increased control over their
  environment.
• Can not introduce with high tech until we have
  addressed a number of issues
• Concepts of switching / scanning is complex and
  must be introduced in a structured way
• Use team to carry out assessment and develop
  switching
• Established / identified person has skills
  (cognitive and physical) and motivation / reason
  / opportunity

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Developing scanning skills - 2

• Identified single switch site (team)
• Give person a single switch in appropriate
  position to explore cause and effect errorless
  / motivating.
• Model use
• The person has a single switch that they are
  happy using, is switch press purposeful /
  reliable / meaningful.

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Developing scanning skills - 3

• Timing Is it possible that the person learns to
  press the switch at a particular time (switch it
  games to teach
• If timing is an issue two switches may be
  needed
• Need to consider which scanning method will suit
  individual - how many switches are needed to
  access this scanning method (will explore in more
  detail later).
• Do we need to introduce a second switch
• Can a second switch site be identified

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Developing scanning skills - 4

• Develop scanning initially with low tech system
  to establish concept
• Timing not an issue
• People are more forgiving / can check selection
  was correct
• Use a bleep box / singles message device to make
  selection
• Alphabet chart / Aided Language Display (ALD)
• Step by Step
• Multi message static display VOCA (Tech 8 / 32)
• EC / games sometimes more effective than AAC to
  develop scanning skills (will discuss in resource
  section later) Some EC harder to scan than
  others e.g. Freeway v SRS Lite
• Dynamic screen device

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Case study - Jack

• Slide switch Tech 32

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Scanning methods

• Linear or simple scan. Can hold to advance the
  scan, or tap to advance or automatically scan and
  be pressed to select.
• Row/ Column scan or Column/row scan can be done
  with 2 or 1 switch
• Block or progressive segmenting scan scanning
  quartering or halving the selection

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Scanning Practical including coffee/tea break

• Look out for the following as you try out the
  systems
• Number of switches?
• Switch patterns what is highlighted to show the
  scan movement?
• How the scan makes you feel as you use it (angry/
  frustrated/ easy)?
• How quick was it for you to make a choice
• Was timing a consideration?
• Other peoples reactions?
• Are there any people you work with that would
  suit these different methods?

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Other considerations

• Integration - hold down switch
• Number of switches can increase the speed of
  selection
• Scan time
• Initial scan time
• Auto repeat often set to two
• Auditory / visual prompts

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Video communication matters
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Resources

• Switch toy library http//www.stepscharity.org/ind
  ex.php

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Scope Website - Supporting AAC through Education
(SCOPE)

• Chapter 5 Accessing Equipment..http//www.scope.o
  rg.uk/
• Info on switching scanning and other adaptation
  to make accessing technology easier.
• Module 6 Section 16 17 details of software
  and suppliers contact details
• Module 9 (PMLD) Access progression for switch use
• Module 12 Contacts, Web resources and
  discussion groups

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• Priory woods http//www.priorywoods.middlesbrough.
  sch.uk/resources/restop.htm
• Cbeebies http//www.bbc.co.uk/cbeebies/

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• QED / Inclusive Technology
• Switch It Games
• Cause Effect / Timing / Choosing with Switches
  (colour coded)

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Keytools - http//www.keytools.co.uk/home.php
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Power Point
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My Family
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This is my dog Barnie
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I love going for walk and listening to the birds.
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Future Courses

• Developing Switching Skills, Making It Successful
  - Tuesday 10th September
• Using Symbol Based Voice Output Communication
  Aids - Wednesday 17th Sept
• Text to Speech - Wednesday 15th October
• Alternative Access to Computers - Friday 21st
  November
• Meeting the Changing Communication Needs of
  People with Acquired Conditions - Thursday 11th
  December

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• Questions
• Discussion / Cases
• Have we covered course objectives
• Link worker courses
• Further opportunity to look at equipment