Mark wants to know how using a robot arm helps you to learn.

How do I help?

1. Wear something which will send sensations to your hands and fingers

2. Move a robot arm using eye-gaze

Symbolised PIS and PAF v1.8 (After ethics submission).docx

You can stop taking part at any time.

If you are unhappy, talk to Simon Brown, Kate Baldwin, Angus Collins or Aaron Gregory (Safeguarding team)

What next?

Mark wants to use your results to help other children. Your name will not be used.

__________________________________________________________________________________________________

Can you help?

…………….………………………………..................................................................................

Name and Signature of participant (or VEC staff member/parent/carer/guardian/ where appropriate)

Witness’ name.......................................... Title...................................... Signed .................................. Date..............................

Participant’s name: ……………………………………………………………………..

Consent taken by: ……………………………………………………………………….

Location: ……………………………………………………………………………….

Signature: ……………………………………………………………………………….

Position: …………………………………………………………………………………

Date: …………………………………………………………………………………….

Others present: ………………………………………………………………………….

Consent verified by: …………………………………………………………………….

Verification method: e.g. Yes/No questions, eye-pointing, VOCA, other:

……………………………………………………………………………………………..

This combined PIS and PAF uses Mayer Johnson’s BoardMaker PCS symbols

This combined PIS and PAF is based upon one created by Nicola Mearing (Speech & Language Therapist – Victoria Education Centre) – used with kind permission

Robotic arm image: http://www.lynxmotion.com/images/hi-res/al5d2.jpg and photograph courtesy of Helen Oakley: http://www.smartboxat.com/2012/09/helen-oakley-tobii-eye-gaze/

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