barriers to the use of assistive technology for children with multiple disabilities

Barriers to the use of assistivetechnology for children withmultiple disabilities

JODIE COPLEY Division of Occupational Therapy, University ofQueensland, St. Lucia, Australia

JENNY ZIVIANI Division of Occupational Therapy, University ofQueensland, St. Lucia, Australia

ABSTRACT: Assistive technology has aided children with multiple disabilities toimprove access and participation in their school and home environments. Effectiveeducational outcomes from assistive technology use are dependent upon a co-ordinated assessment and implementation process. The literature on assistivetechnology with children was reviewed in order to identify current barriers to itseffective integration within schools. These barriers were found to include lack ofappropriate staff training and support, negative staff attitudes, inadequate assessmentand planning processes, insufficient funding, difficulties procuring and managingequipment, and time constraints. A team model for assistive technology assessmentand planning is proposed to optimize the educational goal achievement of childrenwith multiple disabilities. Such a model can help target the allocation of occupationaltherapy resources in schools to best promote educational and broader functionaloutcomes from assistive technology use.

Key words: assistive technology, children with multiple disabilities, school-based occupational therapy

Children with multiple disabilities often face barriers to accessing and partici-pating in self-care, play, leisure and education (Cavet, 1995). Assistivetechnology (AT) has been employed as one strategy, particularly in educa-tional settings, to enable these children to participate more fully in variousactivities (Inge and Shepherd, 1995; Derer et al., 1996; Hutinger et al., 1996;Margolis and Goodman, 1999). Assistive technology includes both low-techdevices (adapted equipment such as spoons with built-up handles) and high-tech devices such as microswitches, electronic communication devices,powered mobility and environmental controls (Parette, 1997). This paper isconcerned particularly with high-tech devices.

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There is evidence that AT can have significant beneficial effects forchildren with multiple disabilities (Hutinger et al., 1996; Sullivan and Lewis,2000). There is also a strong indication, however, that AT is currently imple-mented within educational environments in a less than optimal manner(Derer et al., 1996; Scott, 1997). The purpose of this paper is to review theliterature to identify the potential barriers to AT assessment and implemen-tation for children with multiple disabilities. To this end, ERIC, CINAHL andMedline databases were searched using the keywords of AT, children andmultiple disabilities. The results of this search are used to identify existingbarriers to the utilization of AT. This is the first step in designing processes thatwill facilitate positive and sustainable AT outcomes for these children in theireducational contexts.

Benefits of assistive technology use

Studies addressing the outcomes of AT use have provided evidence of benefitsbeyond simply allowing users to perform tasks or functions that they wouldotherwise be unable to accomplish. Perhaps one of the chief benefits of AT usethat is highly relevant for children with multiple disabilities is as a means ofenabling mastery or control over their environment, including enhancedexploratory play and independence in activities of daily living (Reed andKanny, 1993; Hutinger et al., 1996; Cowan and Turner-Smith, 1999; Sullivanand Lewis, 2000). Two comprehensive studies of AT applications in schools(Derer et al., 1996; Hutinger et al., 1996) found that facilitation of indepen-dence (including development of autonomy and self-determination) wasamong the most frequently cited benefits identified by parents and teachers. Acommonly reported benefit contributing to self-determination is the ability tomake choices and direct one’s own care with the use of augmented or alter-native communication (Todis and Walker, 1993; Hutinger et al., 1996). Otheroutcomes include enhanced social interactions (Mistrett et al., 1994; Derer etal., 1996; Angelo, 2000), and increased motivation and self-esteem (Reed andKanny, 1993; Swinth and Case-Smith, 1993).

A further area that has been demonstrated to improve with the use of AT isskill acquisition and enhancement, such as handwriting, motor skills, reading,visual attention and perception, and maths skills (Reed and Kanny, 1993;Derer et al., 1996; Hutinger et al., 1996). Reported cognitive benefitsassociated with AT use include understanding of the cause–effect relationship,increased attention span, and problem solving ability (Reed and Kanny, 1993;Todis and Walker, 1993; Hutinger et al., 1996). Teachers have furtherrecounted improvements in general academic behaviour such as work habitsand productivity (Derer et al., 1996).

Observing the overall benefits associated with the use of AT by childrenwith multiple disabilities, parents and teachers have recognized the capacity ofAT to offer children new opportunities, reveal their potential and provide

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them with the tools to realize that potential (Derer et al., 1996; Hutinger etal., 1996). Increased awareness of children’s capabilities has, in turn, led toparents and teachers raising their expectations of these children (Anderson,1995; Hutinger et al., 1996). Yet, despite the potential benefits of AT there aredocumented shortcomings in its current application with students withmultiple disabilities.

Problems in the effective application of assistive technology

Studies of AT utilization have suggested infrequent use of prescribed devices inhome, vocational and community settings (Allaire et al., 1991; Derer et al.,1996), poor rates of use by teachers and other professionals who work withchildren with multiple disabilities (Parker et al., 1990), and concernsregarding the way in which AT programmes are being implemented at schooland at home (Hutinger et al., 1994, 1996; Scott, 1997). Reasons given forabandonment of devices have been expressed in broad terms, such as thedevice being ‘unsuitable’ for the child (Carey and Sale, 1994). Studies thathave followed AT usage longitudinally by children with severe and multipledisabilities suggest that it is difficult to identify any one factor that limitseffective AT application. Rather, it is likely that problems arise from an inter-action of factors associated with the people, services, systems and processesthat currently guide AT practice (Todis and Walker, 1993; Carey and Sale,1994; Hutinger et al., 1994, 1996; Derer et al., 1996; McGregor and Pachuski,1996). The problematic issues reported in the literature fall into seven broadcategories and are discussed below.

Staff training and attitudes

Much of the literature dealing with AT programmes for students with multipledisabilities emphasizes the central role of teachers in the day-to-day imple-mentation of technology plans. Lack of suitable training for school personnel,however, constitutes a major barrier to effective AT implementation (Parker etal., 1990; Hutinger et al., 1994; McGregor and Pachuski, 1996; Parette, 1997).

In a survey of 405 teachers, only 19% believed that they had adequate ATtraining (Derer et al., 1996). Devices were often prescribed and providedwithout the necessary training and support services being offered (McGregorand Pachuski, 1996; Parette, 1997). Inadequate follow-up support and on-siteassistance from consultants and suppliers has also been reported (Parker et al.,1990), leading to a lack of familiarity with the equipment (Carey and Sale,1994), incomplete awareness of applications that may assist students(Hutinger et al., 1994), and an inability to troubleshoot when the device doesnot function as expected (Carey and Sale, 1994). Even teachers who havepursued formal training in the area do not believe that this type of trainingprovides them with the skills to use the technology effectively with their

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students on an ongoing, day-to-day basis (Todis and Walker, 1993; Hutinger etal., 1994). Rather than a single training session (e.g. inservice, workshop)school staff often communicate a preference for on-site, practical support thatis available when required (Todis and Walker, 1993; Carey and Sale, 1994;Hutinger et al., 1994).

The training that is available to school personnel has also been criticizedfor covering the technical aspects of device use but neglecting the purpose andgoals of AT programmes (Todis and Walker, 1993; Margolis and Goodman,1999). The results of a two-year study investigating the implementation of ATwith students with multiple disabilities in their school settings support thiscriticism. Teachers in the study used AT to train isolated academic skills,rather than integrating the technology into daily classroom activity. A furtherbarrier was met when students changed from a more skilled teacher to one withless technology awareness. When this occurred their learning was essentiallyput ‘on hold’ until the new teacher could gain the necessary skills (Hutinger etal., 1994).

In addition to teachers, occupational therapists have a critical role in theassessment of AT needs and the implementation of device use, particularly indetermining ways for the child to interface effectively with the technology(Kanny et al., 1991; Smith, 1992a, 1992b; Reed and Kanny, 1993; Shuster,1993; Cowan and Turner-Smith, 1999). However, in an examination ofoccupational therapy training programmes in the early 1990s, minimal coursecontent related to AT was identified, suggesting that occupational therapygraduates may be ill-prepared to fulfil their roles in technology teams (Kannyet al., 1991; Smith, 1992a). Further research by Reed and Kanny (1993)confirmed this assumption, with school-based occupational therapists found touse AT with only a small percentage of their caseload. A principal reason citedfor low rates of use was insufficient expertise to allow investigation and appli-cation of different devices. While the undergraduate training and continuingeducation available may have increased since these studies were conducted, sotoo has the proliferation of AT devices available. It is unlikely that formalizedtraining alone can keep up with the training needs of therapists faced withever-increasing AT choices.

In addition to issues such as inadequate training, the literature providesexamples where student outcomes from AT use are further limited as a conse-quence of teacher resistance or rejection of AT (Derer et al., 1996). Carey andSale (1994) suggested that many reasons advanced by teachers forabandonment could have been addressed by staff if they had chosen to do so.For instance, some teachers perceived that students’ use of communicationdevices interrupted the class and that it was too difficult to manage thisbehaviour, even though classroom interruptions by verbal students wascommonly managed using routine disciplinary measures. The authorsproposed that the challenges of AT use created reluctance among staff tocommit to AT programmes.


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Hutinger et al.’s (1996) two-year study chronicled several situations inwhich a student’s progress either plateaued or regressed, depending on theteacher’s attitude towards AT. For example, one student could no longer usehis communication device after changing classes because the new teacher feltthat it would take too much of her time to learn to programme it. Hutinger etal. (1996) suggested that some teachers had no desire to learn to use AT or didnot accept that technology could assist their students.

It is possible that staff attitudes are, in part, a response to the systems andprocesses that are used to introduce the AT to them. In particular, it appearslikely that lack of commitment to AT use is compounded when staff membersare not integral to the assessment process and involved in decision-making(Todis and Walker, 1993). It could also be that limited administrative supportfor teacher training allows reluctant staff members to avoid confronting thechallenge of learning about AT applications (Hutinger et al., 1996).

Assessment issues

Assessment of an individual’s AT needs and subsequent identification of appro-priate equipment has been called by some researchers a process of ‘trial anderror’ (Enders and Hall, 1990). It has been suggested that there are few guide-lines available regarding the components of a competent AT assessment(Margolis and Goodman, 1999). The literature suggests that the deficiencies ofAT assessment centre on two major factors: less than comprehensive assessmentof individual needs and lack of team involvement in the assessment process.

Vital aspects of the individual child’s abilities and needs may not receivedue attention at the assessment stage. Service providers inexperienced in theassessment process are often primarily focused on obtaining a piece ofequipment for the student’s use. Ascertaining the method by which thestudent can effectively access the device is sometimes considered as an after-thought, thereby increasing the chances of device abandonment (Todis andWalker, 1993; Cowan and Turner-Smith, 1999).

Criticism has been levelled at assessment that fails to investigate theimpact of AT use within students’ daily physical and social environments.Factors such as where the technology will be placed, how it will integratewith other devices used by the student and environmental modificationsrequired are often overlooked (Todis and Walker, 1993; Todis, 2001). Thiscan be exacerbated when assessment occurs off-site rather than within theeducational environment. Behrmann and Schepis (1994) compared threeapproaches to determining students’ AT needs when performing vocationaltasks. The two approaches that involved situational assessment in thestudents’ natural environments, either in person or via videotapes, resultedin specific, functional AT recommendations. In contrast, the multidisci-plinary approach that involved professionals conducting separate,standardized assessments in a rehabilitation facility tended to result in


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general recommendations and the need for further evaluation. These resultssuggest that considering technology needs within a functional context is avital component of assessment.

One shortcoming of AT assessment that has received attention in the liter-ature is that of inadequate team involvement in the assessment process. Todisand Walker (1993) found that staff members who are not included in theassessment process tended not to use the technology with the student asintended. It is therefore not surprising that occupational therapists reportedpoor teacher follow up of AT recommendations made primarily by the therapist(Reed and Kanny, 1993). Hutinger et al. (1996) similarly reported that lack ofcommunication among school staff members contributed to limited integrationof the technology into the student’s educational programme.

Of equal concern is the lack of collaboration between the school and thehome (Angelo et al., 1995). Despite family participation in services beingmandated by legislation in the US, research has indicated that family factorsare the least considered by teams when determining a child’s AT needs. Lack ofconsideration of the child’s own preferences is also apparent (Parette andHourcade, 1997). Researchers have noted that failing to fully include thestudent and family in assessment and decision-making processes results in ATprogrammes which do not reflect family values and, hence, are not embracedby the family. Failing to incorporate user opinion and broader psychosocialfactors into the assessment process is also associated with technologyabandonment (Phillips and Zhao, 1993). Lund and Nygard (2003) found thatthe extent to which people used their assistive devices depended upon thecontribution the device made to their occupational self-image. For parents ofchildren with multiple disabilities, this may translate to whether the device fitsthe image they have, or wish others to have, of their child. At worst, lack offamily input can lead to inappropriate prescription of technology, whichdramatically increases family stress levels and impacts negatively on thestudent (Parette and Hourcade, 1997).

Planning issues

Beyond the process of assessing AT needs and acquiring the necessaryequipment, careful planning of the way in which students will use AT toaddress their goals is critical. Studies that have tracked AT use by studentswith severe and multiple disabilities in their educational settings consistentlyreveal a lack of planning for successful implementation. Often, specificrealistic outcomes for the student’s technology use have not been determined(Fuhrer et al., 2003). Frequently, no structured programme is put in place toallow the student regular, systematic use of technology in the classroom (Careyand Sale, 1994).

This lack of integration is further evidenced by the limited mention of ATdevices in students’ individual education programme (IEP) goals. An IEP is a

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summary of a student’s educational goals and the way in which the educationalteam proposes to achieve these goals. Even where IEP documents include ATuse, there is seldom sufficient detail regarding how the technology should beapplied to help achieve wider educational goals (Carey and Sale, 1994). Todisand Walker (1993) argued that if school staff were not aware of the purpose ofthe AT, training students to use devices became the long-term focus ratherthan a practical application to build on students’ academic and social skills.Endless training in device use occurs at the expense of goal achievement(Todis, 2001). In Hutinger et al.’s (1996) study, no teachers nominated recip-rocal communication as an objective for students’ technology use, even thoughthe majority of students involved in the study were non-verbal.

Problems with insufficient planning have an ongoing influence on students’long-term service provision. Lack of follow up, review or re-evaluation afterAT recommendations have occurred or technology plans have commenced iscommonly reported and is associated with low rates of use (Scherer andMcKee, 1990; Reed and Kanny, 1993; Cowan and Turner-Smith, 1999). In astudy of 14 children over a two-year period, ongoing reassessment of AT needsdid not occur unless initiated by an agency external to the school (Hutinger etal., 1996). This suggests that long-term planning and review of students’ ATneeds is not an inherent feature of many school programmes and this omissionlimits the effectiveness of technology programmes that are implemented.

Funding issues

The high costs of AT devices and the lack of funds available to meet thesecosts were the most frequently mentioned barriers to AT use reported byteachers in Derer et al.’s (1996) study. Schools typically report access to fewerfinancial resources than they require to meet the technology needs of theirstudents (Hutinger et al., 1994). Governments and private insurancecompanies vary considerably in terms of the type of equipment they will fund(Todis and Walker, 1993; Cowan and Turner-Smith, 1999).

The cost of equipment maintenance is often not accounted for when AT ispurchased (Cowan and Turner-Smith, 1999), even though additional costs areroutinely incurred for evaluation, training in equipment use, repair ofequipment, maintenance, replacement and customization (Noha, 1992).Funding to expand or upgrade hardware and software as the child grows andchanges must also be considered (Swinth and Case-Smith, 1993). These‘hidden’ costs place a heavy burden on service providers to make decisionsabout appropriate technology systems prior to purchase (Swinth and Case-Smith, 1993). This task is made more difficult because the high cost of devicesmeans that providers have less than ideal exposure to different devices andmust therefore make these decisions on the basis of limited information(Higginbotham, 1993). To address these issues, equipment loan services havebecome available in some locations to allow trial of equipment at minimal cost

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prior to purchase. Two examples of this service are the Centralized EquipmentPool in Ontario, Canada and the trial equipment available from Regency ParkRehabilitation Engineering in South Australia (Hobbs, 2003).

Equipment issues

Problems reported in the literature in relation to AT equipment reflect diffi-culties accessing the equipment, criticism of the design and features of specificequipment, and problems in the use and maintenance of equipment. Difficultylocating and obtaining equipment is, like funding, considered a commonbarrier to achieving the promised benefits of AT for students (Derer et al.,1996). The assessment process is hampered by a lack of equipment for loan(McGregor and Pachuski, 1996) which may, in turn, discourage professionalsfrom recommending devices for purchase (Reed and Kanny, 1993). Onceequipment is ordered, a long wait may ensue before it arrives and is ready forstudent use (Carey and Sale, 1994; Cowan and Turner-Smith, 1999; Margolisand Goodman, 1999). In many schools, it is common practice for equipmentto be shared between classrooms, which reduces its availability to individualchildren (Carey and Sale, 1994). The way in which individual schools storeand manage equipment further determines accessibility of devices for sponta-neous and functional use (e.g. ready access to allow communication with peersor teachers when desired) (Hutinger et al., 1996).

The design of an AT device may be a powerful determinant of its ongoinguse by families and service providers. Lack of portability of equipment is aproblematic factor frequently mentioned by consumers, carers and staff, as isthe inflexibility of equipment that can only be used in a few settings (Schererand McKee, 1990; McGregor and Pachuski, 1996; Priest and May, 2001).Further frustrations result from problems achieving compatibility amonghardware and software (Beaver and Mann, 1994), limited adaptability ofsoftware for differing needs (Reed and Kanny, 1993; Todis, 2001), andequipment that is complex or operates at an unsuitable speed for the user(Scherer and McKee, 1990; Todis, 2001).

Difficulties with repair and maintenance of equipment are a constantsource of frustration to users and service providers alike. When equipmentbreaks down, teachers report that students may be without their AT formonths while it is returned to the manufacturer or supplier for repairs (Careyand Sale, 1994; Hutinger et al., 1996). This situation is compounded by thenotable lack of in-school procedures and systems to register equipment faultsand organize repairs (Hutinger et al., 1996). In a sample of 28 technology co-ordinators, less than half reported that they considered factors such as ease ofequipment maintenance and repair to a great extent during AT assessment(Parette and Hourcade, 1997). Even day-to-day maintenance of deviceswhich require a constant power source can be disruptive and time-consumingfor teaching staff. Carey and Sale (1994) found examples of communication

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devices that had been taken out of use and stored in a cupboard whenbatteries had run out.

Time constraints

Given the difficulties already discussed with respect to obtaining andmaintaining equipment and training in its use, it follows that time is at apremium for teachers and therapists who use AT with their students. The timerequired to obtain equipment, programme and install it, and train themselvesand then students to apply the technology represents a significant barrier toteachers attempting to use AT to its full potential (Carey and Sale, 1994; Dereret al., 1996; McGregor and Pachuski, 1996). Further time is expended in movingequipment from one setting to another and determining the cause of equipmentmalfunctions (Carey and Sale, 1994). The unfortunate outcome is that someteachers cease to use devices because they perceive that these aspects oftechnology use do not fit into tight classroom schedules (Hutinger et al., 1994).

Overcoming barriers

Recognition of the problems encountered in the effective application of AT inschools has resulted in some practitioners developing and undertaking trials ofsystems and approaches to allow better delivery of AT services to meetindividual needs. In addition, many researchers have proposed recommenda-tions to circumvent the AT pitfalls identified in the literature. Apart fromchanges to funding mechanisms and equipment access and management, therange of solutions advanced can be grouped into two broad areas: training andsupport, and assessment and implementation of technology plans.

Training and support

Surveys of teachers and therapists, together with studies that have closelyexamined AT use in schools, have produced recommendations for training andsupport of families and service providers that cover a variety of needs (Todis andWalker, 1993; Carey and Sale, 1994; McGregor and Pachuski, 1996; Paretteand Hourcade, 1997). A multi-faceted approach to training and support isdeemed necessary (Derer et al., 1996), particularly in view of the range ofknowledge and skills required. Knowledge with respect to disability, hardwareand software, adaptive devices, systems for procuring equipment, design andconstruction of individualized equipment adaptations, and the settings in whichthe technology will be used is fundamental (Beaver and Mann, 1994). Compe-tence in the application of this knowledge would therefore be a requirement ofoccupational therapists working in the field (Smith, 1992b).

The occupational therapist is just one member of the team involved insupporting AT. Strategies have been proposed to increase access to information

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about AT for all members of the team and include resources such as databases,newsletters, product reviews and evaluations of different devices (Noha, 1992;Higginbotham, 1993; Derer et al., 1996). Other suggestions that have recentlybeen undergoing trials have involved establishing a toll-free telephonehotline, a peer support information network and local information andresource centres (Noha, 1992; Derer et al., 1996; Cowan and Turner-Smith,1999; Doty and Gray, 1999; Margolis and Goodman, 1999). While thesemeasures are considered useful, print resources have been rated of least impor-tance to teachers (McGregor and Pachuski, 1996), who have cited moredirect, organized training as preferable (Derer et al., 1996; McGregor andPachuski, 1996).

Improvements to formal training programmes for service providers havefurther been proposed, including more specific AT course content for under-graduate and postgraduate occupational therapists and special educators(Kanny et al., 1991; Cramer, 1992; Smith, 1992a, 1992b), instructional unitsfor teachers (Noha, 1992) and an accreditation or certification system fortherapy teams (Smith, 1992a). One difficulty encountered in the quest forimprovement of undergraduate training for special educators is the lack ofconsensus regarding the competencies necessary and the way in which theseshould be taught (Cramer, 1992; Lahm and Nickels, 1999).

Less formal continuing education options such as focused group trainingsessions and workshops are also sought (Parker et al., 1990; Reed and Kanny,1993; Derer et al., 1996). Administrative support for these sessions, e.g.teacher release systems to allow attendance, is important to lessen the timedemands for staff and encourage less confident teachers to participate (Derer etal., 1996; Hutinger et al., 1996).

Despite increasing attention to the training options available to serviceproviders, it appears that organized training is not the complete answer to ATproblems. A critical examination of AT use by teachers and occupationaltherapists reveals that a high level of formal training and/or continuingeducation does not necessarily correlate with better technology applications(Reed and Kanny, 1993; Hutinger et al., 1996; McGregor and Pachuski, 1996).Highly trained teachers identify the need for more extensive training andongoing support (Hutinger et al., 1996). Research suggests that this needextends to families and the students themselves, who rely on the skills ofprofessionals (Phillips and Zhao, 1993; Todis and Walker, 1993; Carey andSale, 1994; Parette and Hourcade, 1997; Margolis and Goodman, 1999).

One-to-one consultation by a technology expert is often cited as a way ofensuring ongoing support. Consultants can either be on-site or conduct regularvisits, and it has been deemed important that they are available fortroubleshooting when the need arises (Parker et al., 1990; Reed and Kanny,1993; Derer et al., 1996; Hutinger et al., 1996; McGregor and Pachuski, 1996;Scott, 1997). On the basis of experience with local technology resourcepersons, service providers stress that the value of consultants hinges on their


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readiness to provide support, their expert technical skills and their knowledgeof the student (Carey and Sale, 1994; Hutinger et al., 1996).

Of equal importance is the type of support provided and the way in whichthis is delivered. Technology specialists often train one or two members of astudent’s educational team, as the time required to train large numbers of staffin specific applications becomes prohibitive in the context of the specialist’slarge caseload throughout the school or among different schools. The highattrition rate of teacher aides in particular means that there is a frequent needfor training of new staff (Todis and Walker, 1993; OVEC, 2000).

In recognition of the need for integrating AT knowledge and skills within ateam (Smith, 1992a), a different model of consultation, which features atechnology team that is external to schools has undergone trials. It has beenreported that such teams are successful because they have technical expertiseand are able to focus purely on AT issues without needing to fulfil the otherresponsibilities of a typical educational team (Carey and Sale, 1994).However, the advantage of this model dissipates when team members leave.Even though technology expertise is spread among the team rather thanconcentrated in a single technology expert, this model still relies on the skillsof a small number of people (Cowen, 1994). Some authors have thereforeconcluded that the availability of technology experts does not replace theneed for all staff to have some level of knowledge and skills, a need that hasbeen clearly demonstrated when students change schools (Cowen, 1994;Hutinger et al., 1996).

Technology projects recently piloted in the US have incorporated featuresincluding training teams within school districts in AT implementation, as wellas providing ongoing support, technical assistance and regular follow-up (Dotyand Gray, 1999; Nochajski et al., 1999; OVEC, 2000). The ReachingIndividuals with Disabilities Early (RIDE) Project was conducted over a five-year period. It involved using a series of training modules to provide localeducational teams with the knowledge and skills to effectively address theirstudents’ AT needs. In addition, technical support was provided to teachers,parents and children on demand within the school setting. Results indicatethat the total length of time spent using AT per day increased significantly forchildren whose teams participated in the project (OVEC, 2000).

Assessment and implementation of technology plans

The literature supports the need for more effective ways of determiningstudents’ needs, matching these with appropriate AT, and allowing morecareful selection of equipment that is guided by forward planning of thestudent’s future needs (Parker et al., 1990; Higginbotham, 1993; Carey andSale, 1994; Derer et al., 1996). To achieve this, educational teams needsupport to gather assessment data over an extended period of time (Carey andSale, 1994), including observation of technology use in the settings in which it


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will be utilized (Behrmann and Schepis, 1994; Margolis and Goodman, 1999).Support is required to ensure that all team members have the opportunity tocontribute to assessment (Todis and Walker, 1993; Nochajski et al., 1999;Fuhrer et al., 2003), and that perceptions of the student and family are investi-gated (Luborsky, 1993; Parette and Hourcade, 1997; Priest and May, 2001).The classroom environment, together with time and other resources availableto teachers, must be considered at the assessment stage so that the technologyplan can be responsive to these issues (McGregor and Pachuski, 1996). Teammembers need assistance to identify the purpose and objectives of AT use andto incorporate these into specific IEP goals (Todis and Walker, 1993; Careyand Sale, 1994; Doty and Gray, 1999). Cramer (1992) confirmed that whilespecial educators are trained to write measurable behavioural objectives, theymay not receive instruction in how to incorporate AT into these objectives.Fuhrer et al. (2003) propose that conceptualizing the expected outcomes fromuse of a particular device is critical in determining whether individual users’needs have been met.

To promote the effective use of technology, a detailed AT plan may behelpful. This plan could help to ensure that the student, teachers, parents, andpeers are aware of the plan and their role in its implementation (Margolis andGoodman, 1999). Educational teams must then be assisted to modify theschool programme to accommodate AT use (Cramer, 1992; Carey and Sale,1994). This may involve setting timelines for systematically training thestudent in how to use the device appropriately, followed by regular practice(Carey and Sale, 1994). It is vital that AT use is incorporated into dailyroutines to support academic, social and personal goals (Cramer, 1992; Todisand Walker, 1993; Hutinger et al., 1996). Throughout implementation,specialist support should be requested as needed (Doty and Gray, 1999).Finally, the team should also be guided to re-evaluate frequently the goals andtechnology plan (Todis and Walker, 1993; Margolis and Goodman, 1999).

As the primary service providers, the educational team possesses much ofthe critical assessment information described above and is ultimately respon-sible for technology implementation. It follows that the team must befacilitated to drive the assessment and planning process (Behrmann andSchepis, 1994; Margolis and Goodman, 1999). Effective team functioning isseen as vital to achieve this task. It is likely, then, that educational teamsrequire additional support and guidance to use an effective team process in theassessment, planning and implementation of students’ AT use.

It would appear that an appropriate model for AT assessment and planningshould involve a team assessment process that is conducted by the educationalteam and supported by a technology consultant. The consultant could facil-itate team functioning (Shuster, 1993; Beaver and Mann, 1994; Hutinger etal., 1996), guide the assessment and goal setting process, co-ordinate familyinput and assist team members to create and implement a detailed AT plan.Expert technical support could be accessible to provide information about AT


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devices, assist in procuring equipment for trial, and to provide on-the-spottraining and troubleshooting (Shuster, 1993; Margolis and Goodman, 1999).Effective evaluation of such a model will help determine how educational andtherapy resources can be directed so that AT use can facilitate better educa-tional outcomes for children with multiple disabilities.

In summary, the literature reviewed identified a number of issues as impactingon the current use of AT with children with multiple disabilities. Broadly, theseissues relate to resources available to educational staff and the processes used toevaluate AT needs and implement plans. The way forward is the integration ofteam-based assessment and implementation, with clear identification ofindividual goals and provision of relevant supports and resources.

References

Allaire JH, Gressard RP, Blackman JA, Hostler SL (1991). Children with severe speech impair-ments: Caregiver survey of AAC use. Augmentative and Alternative Communication7(December): 248–55.

Anderson N (1995). Inclusive education: Using technology to provide higher level cognitivechallenges. Australian Disability Review 2: 34–9.

Angelo DH (2000). Impact of augmentative and alternative communication devices onfamilies. Augmentative and Alternative Communication 16(March): 37–47.

Angelo DH, Jones SD, Kokoska SM (1995). Family perspective on augmentative and alter-native communication: Families of young children. Augmentative and AlternativeCommunication 11(September): 193–201.

Beaver KA, Mann WC (1994). Provider skills for delivering computer access services: Anassistive technology team approach. Technology and Disability 3(2): 109–16.

Behrmann MM, Schepis MM (1994). Assistive technology assessment: A multiple case studyreview of three approaches with students with physical disabilities during transition fromschool to work. Journal of Vocational Rehabilitation 4(3): 202–10.

Carey DM, Sale P (1994). Practical considerations in the use of technology to facilitate theinclusion of students with severe disabilities. Technology and Disability 3(2): 77–86.

Cavet J (1995). Sources of information about the leisure of people with profound and multipledisabilities. In J Hogg (Ed.) Making Leisure Provision for People with Profound Learningand Multiple Disabilities. London: Chapman and Hall, pp. 3–26.

Cowen J (1994). Providing assistive technology as an occupational therapist in the schoolsetting. Technology. Special Interest Section Newsletter 4(4): 2–3.

Cowan DM, Turner-Smith AR (1999). The user’s perspective on the provision of electronicassistive technology: Equipped for life? British Journal of Occupational Therapy 62(1): 2–6.

Cramer SF (1992). Assistive technology training for special educators. Technology andDisability 1(3): 1–5.

Derer K, Polsgrove L, Rieth H (1996). A survey of assistive technology applications in schoolsand recommendations for practice. Journal of Special Education Technology XIII(2):62–80.

Doty A, Gray S (1999). Assistive technology in Oklahoma Public Schools: A Service DeliveryModel for Rural Schools. Paper presented at the Rural Special Education for the NewMillennium. Conference Proceedings of the American Council on Rural Special Education(ACRES), Albuquerque, New Mexico.

Enders A, Hall H (eds.) (1990). Assistive Technology Sourcebook. Washington: RESNA Press.Fuhrer MJ, Jutai JW, Scherer MJ, Deruyter F (2003). A framework for the conceptual modelling

of assistive technology device outcomes. Disability and Rehabilitation 25(22): 1243–51.


OTI 11 (4) 11/12/04 10:18 AM Page 241

Higginbotham DJ (1993). Assessing augmentative and alternative communication technology.Technology and Disability 2(3): 42–56.

Hobbs DA (2003). The Winston Churchill Memorial Trust of Australia. Regency Park Rehabil-itation Engineering, Crippled Children’s Association of South Australia.

Holder-Brown L, Parette HP (1992). Children with disabilities who use assistive technology:Ethical considerations. Young Children (September): 73–7.

Hutinger PL, Hall S, Johansen J, Robinson L, Stoneburner R, Wisslead K (1994). State ofPractice: How Assistive Technologies are Used in Educational Programs of Children withMultiple Disabilities. A Final Report for the Project: Effective Use of Technology to MeetEducational Goals of Children with Disabilities (Reports – research/technical 143).Washington, DC: Western Illinois University, Macomb.

Hutinger P, Johanson J, Stoneburner R (1996). Assistive technology applications in educationalprograms of children with multiple disabilities: A case study report on the state of thepractice. Journal of Special Education Technology XIII(1): 16–35.

Inge KJ, Shepherd J (1995). Assistive technology applications and strategies for school systempersonnel. In KF Flippo, KJ Inge, JM Barcus (eds.) AT. A Resource for School, Work andCommunity. Baltimore: Paul H. Brookes, pp. 133–66.

Kanny EM, Anson DK, Smith RO (1991). A survey of technology education in entry-levelcurricula: Quantity, quality, and barriers. Occupational Therapy Journal of Research 11(5):311–19.

Lahm EA, Nickels BL (1999). Assistive technology competencies for special educators.Teaching Exceptional Children (Sept/Oct): 56–63.

Luborsky MR (1993). Sociocultural factors shaping technology usage. Fulfilling the promise.Technology and Disability 2(1): 71–8.

Lund ML, Nygard L (2003). Incorporating or resisting assistive devices: Different approaches toachieving a desired occupational self-image. Occupational Therapy Journal of Research 23(2): 67–75.

Margolis L, Goodman S (1999). AT Services for Students: What are These? Special Edition ofTech Express (ERIC Document Reproduction Service No. ED437800). Washington, DC:United Cerebral Palsy Associations.

McGregor G, Pachuski P (1996). Assistive technology in schools: Are teachers ready, able, andsupported? Journal of Special Education Technology XIII(1): 4–15.

Mistrett SG, Constantino SZ, Pomerantz D (1994). Using computers to increase the socialinteractions of preschoolers with disabilities at community-based sites. Technology andDisability 3(2): 148–57.

Nochajski SM, Oddo C, Beaver K (1999). Technology and transition: Tools for success.Technology and Disability 11: 93–101.

Noha N (1992). Assistive technology: Just how aware are you? CommunicationOutlook(Winter): 16–19.

OVEC (Ohio Valley Educational Cooperative) (2000). Reaching Individuals with DisabilitiesEarly (RIDE) Project: Individuals with Disabilities Act, Non-Directed Model Demon-stration Project. Final Report. (ERIC Document Reproduction Service No. ED443230).Shelbyville, KY: Ohio Valley Educational Cooperative.

Parette H (1997). Assistive technology devices and services. Education and Training in MentalRetardation and Developmental Disabilities 32(4): 267–80.

Parette HP, Hourcade JJ (1997). Family issues and assistive technology needs: A sampling ofstate practices. Journal of Special Education Technology 13(3): 27–42.

Parker S, Buckley W, Truesdell A, Riggio M, Collins M, Boardman B (1990). Barriers to the useof assistive technology with children: A survey. Journal of Visual Impairment and Blindness(December): 532-533.

Phillips B, Zhao H (1993). Predictors of assistive technology abandonment. AssistiveTechnology 5(1): 36–45.


OTI 11 (4) 11/12/04 10:18 AM Page 242

Priest N, May E (2001). Laptop computers and children with disabilities: Factors influencingsuccess. Australian Occupational Therapy Journal 48(1): 11–24.

Reed BG, Kanny EM (1993). The use of computers in school system practice by occupationaltherapists. Physical and Occupational Therapy in Pediatrics 13(4): 37–55.

Scherer M, McKee B (1990). The assistive technology device predisposition assessment.Communication Outlook 12(1): 23–7.

Scott SB (1997). Comparison of service delivery models influencing teachers’ use of assistivetechnology for students with severe disabilities. Occupational Therapy in Health Care11(1): 61–74.

Shuster NE (1993). Addressing assistive technology needs in special education. AmericanJournal of Occupational Therapy 47(11): 993–7.

Smith RO (1992a). Technological approaches to performance enhancement. In C Christiansen(ed.) Occupational Therapy: Overcoming human performance deficits. Thorofare, NJ:Slack, pp. 747–85.

Smith RO (1992b). Technology education from an occupational therapy view. Technology andDisability 1(3): 22–30.

Sullivan M, Lewis M (2000). Assistive technology for the very young: Creating responsiveenvironments. Infants and Young Children 12(4): 34–52.

Swinth Y, Case-Smith J (1993). Assistive technology in early intervention: Theory andpractice. In J Case-Smith (ed.) Occupational Therapy and Early Intervention. Boston:Butterworth Heinemann, pp. 342–68.

Todis B (2001). It can’t hurt. Implementing AAC technology in the classroom for students withsevere and multiple disabilities. In JC Woodward (ed.) Technology, Curriculum and Profes-sional Development. Adapting Schools to Meet the Needs of Students with Disabilities.Thousand Oaks, California: Corwin Press, pp. 27–46.

Todis B, Walker HM (1993). User perspectives on assistive technology in educational settings.Focus on Exceptional Children 26(3): 1–16.

Address correspondence to Jodie Copley, Division of Occupational Therapy, The University ofQueensland, St. Lucia, 4072, Australia. Tel: 61 7-3365 3011, Fax: 61 7-3365 1622. E-mail:[email protected]


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barriers to the use of assistive technology for children with multiple disabilities

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