Access to Literacy - February / March 2024, Closing The Ga…

2024 Feb/March Closing The Gap Resource Directory Solutions - Access to Literacy Using Universal Design for Learning and Assistive Technology through the Lifespan By Tammy Bruegger

UDL and accessibility

Access to Literacy Using Universal Design for Learning and Assistive Technology through the Lifespan

Picture this scene: “Mary, a woman in her 60’s is driving her car to her doctor’s office. She pulls into the parking lot and parks her car. In the parking space she gets too close to the car in front of her and her car emits a beeping sound which gets progressively louder. She hears it and looks into the camera on the screen in front of her and sees the other car and stops. Then she gets out of the car and walks into the building, choosing to use the terra cotta colored curb cut with bumps (truncated domes to walk onto the sidewalk since the sidewalk is slippery from the recent rain. She then walks on the relatively flat, textured sidewalk into the building. As she gets close to the doors they automatically open. She walks to the elevator and pushes the button and as the doors open she enters the elevator. Inside the elevator she pushes the button for the 3rd floor noticing the Braille labeling on the button pad as the button lights up. In a few seconds she arrives at the 3rd floor, the elevator emits a ringing sound. Then she walks out of the elevator to the doctor’s office on her left side. Mary walks into the office and moves over from a lower counter where the receptionist is sitting to the counter that is waist high. The receptionist greets her, “Good Morning Mary!” as Mary hands the receptionist her insurance card to be scanned and entered into the computer…” The modifications to the built environment that Mary encountered are things we all take for granted, but are changes that have occurred over time due to universal design. Universal design is the design of products, buildings, or environments so they are usable for all people regardless of their physical, cogni-

tive, or communicative abilities. Without these adaptations there remain barriers to access to the built world by everyone. UNIVERSAL DESIGN FOR LEARNING An extension of universal design is universal design for learning. Universal design for learning (UDL) involves access to learning for all people no matter their diversity of abilities. UDL includes these three principles: • Multiple Means of Representation: the “What” of learning which emphasizes providing information in multiple formats. • Multiple Means of Action and Expression: the “How” of learning addresses the needs and abilities of the learner providing tools and options that support the learner. • Multiple Means of Engagement: the “Why” of learning including what stimulates, interests, and motivates learning (CAST, 2018). The “What” is how a person obtain information such as verbal, print, auditory/TTS etc. The “How” is the expression of information knowledge such as voice, switches or communica- tion apps or devices. The “Why” is more individual to the learner such as topics of interest ie; super heroes, trains, shopping that connect their interest with the learning to increase motivation. UDL influences the accessibility of knowledge transfer through presentation, instructional design and teaching techniques that support understanding and the ability to use

TAMMY BRUEGGER is a is an Assistant Professor in Occupational Therapy at Rockhurst University in Kansas City, Missouri. For over 25 years she has worked as an Assistive Technology Practitioner and Occupational Therapist at The Children’s Center for the Visually Impaired. She is a RESNA certified assistive technology practitioner, OT and special educator who has worked for over 40 years in a variety of settings with children and adults who have visual impairment and other neurological conditions. She has presented on and is conducting research with individuals with cortical/cerebral visual impairment, coping and resilience, sensory processing and participation of children with visual impairment. She has also researched and presented on literacy and learning/teaching practices using simulation, mindfulness and art. Tammy has authored a chapter in the book, “Best Practices for Occupational Therapy in Early Childhood” on children with visual impairments.

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information (Rose, Hasselbring, Stahl & Zabala, 2005). This may occur within a classroom or settings within the commu- nity where an individual or group of people may have difficulty understanding and using information. For example, in a class- room the students may be reading a book during a literacy activity and then answering questions about the book. Some children are using a typical book and others may use a digital book on a tablet using text to speech to “read” the book using an adaptive switch to turn the pages of the digital book. Another example is an older adult may read a standard newspaper in the morning, but their spouse may view the newspaper on their Smartphone with a magnifier app. due to their low vision. As these two individuals demonstrate, the guiding principles of the UDL framework suggest how literacy resources may be modified to accommodate a variety of learning needs. UDL, LEARNING AND LITERACY UDL may involve a wide variety of methods used to access information and to express and apply knowledge. This knowl- edge and application of knowledge is the process and outcome of learning. Learning is accessed through literacy activities and may also result in increased literacy as an outcome of the activity in a interdependent interaction between the activity, context and the person. Literacy connects the person to a continuum of learning which enables people to achieve their goals, to develop their knowledge and potential, and to partici- pate fully in their community and wider society (Unesco, 2023). The United Nations defines literacy as “the ability to identify, understand, interpret, create, communicate and compute, using printed and written materials associated with varying contexts” (UNESCO, 2008). However, other definitions expand literacy to include freedom of expression, to seek, receive and impart information and ideas in any form ie; oral, written, print or other media (Keefe, E. B., & Copeland, S. R., 2011). The defi- nition of literacy utilized impacts how one views literacy and may have different perspectives based on the person’s view of literacy. In addition, there are many kinds of literacy to consider including foundational literacy, functional literacy, and digital literacy to name a few. Foundational literacy involves the basic skills for reading, writing and communication needed to support all learning. Foundational literacy assists with and is connected to day to day functional activities resulting in func- tional literacy. Functional literacy is literacy needed to func- tion in daily life activities such as communicating with others to express a person’s wants and needs, and to make choices. It is further defined as the ability to interpret common written materials needed to effectively carry out basic daily life skills and participate in meaningful occupations and social roles (Grajo & Gutman, 2019). It involves ways of gaining information or knowledge in everyday life and conveying what the person knows such as reading instructions for a recipe to cook a meal,

making appointments to get a driver’s license, and even filling out an application to get a job or managing a bank account or budget. Grajo and Gutman (2019) propose 3 parts of functional literacy (a) literacy as a form of occupational justice promotion; (b) literacy as an approach to health facilitation, well-being, and adaptive capacity; and (c) literacy as a means to strengthen social connectedness. Definitions of literacy vary by discipline and perspective and further varies how one may interpret literacy in broader contexts. In schools or community education programs for adults typically the teacher is responsible for foundational literacy. As a person needs more assistance for the day to day functional literacy it may involve other professionals. One professional that may be involved is an occupational therapist. Although OT practitioners are not the primary professionals responsible for teaching individuals to read and write, it is within the OT scope of practice to assist clients to access literacy resources to improve occupational participation, especially for these func- tional literacy activities (Grajo and Gutman, 2019). This “access” may involve collaboration with the teacher and other team members in the school, hospital, or other community setting. As the need for adaptations become less mainstream it may require the use of assistive technology. Assistive technologies are defined as any device or service that is specifically designed to reduce barriers for people with disabilities (Rose, Harbour, Johnston, Daley, and Abarbanell, 2006). Universal design for learning (UDL) and assistive technology (AT) enable a person to expand their participation in occupations and daily life activi- ties by providing access to literacy throughout the lifespan. For instance, a person who learns to use their Smartphone to set up a doctor’s appointment or reservation at a restaurant or even make an appointment at the driver’s license center is able to expand their participation in daily activities in the area of health, social connection, and transportation. UDL and AT have become widely integrated tools that work collaboratively to improve access to different types of literacy. UDL, ASSISTIVE TECHNOLOGY AND LITERACY When considering using assistive technology it is important to consider theories and frameworks to organize our thoughts and process. As an occupational therapist this includes OT theory and frameworks, such as found in the Occupational Practice Framework 4th Edition (OTPF-4) and for assistive tech- nology practitioners it is AT theory such as the Human Activity Assistive Technology model (HAAT). The HAAT model empha- sizes matching the person to the technology by evaluating the dynamic interaction between the user, the activity, and the AT within the specific environment (context) of use. The usability of AT is determined by the interaction between these compo- nents, the degree to which a user can use AT to reach their goals effectively (completeness), efficiently (time and effort used),

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and satisfactorily when using AT in a specific context (Borg- estig, M., Sandqvist, J., Ahlsten, G., Falkmer, T., & Hemmingsson, H., 2017). AT and UDL can be thought of as a continuum with definite distinctions on each end of the continuum but more reflective and integrated in the middle and often interdepen- dent for effective solutions (Rose et al., 2005). Both enhance an individual and a populations’ ability to participate within society by optimizing their function and independence (Smith, 2017).

or customized, that is used to increase, maintain, or improve the functional capabilities of a person with a disability”(Goodrich, B. & Garza, E., 2015.). More recently, IDEA defines assistive technology services including the evaluation, acquisition, and training to use AT as part of the included services (IDEA, 2023). The focus is more on the person rather than the technology or device. Newer technologies incorporate UDL or acces- sibility within the design. Many computers, digital tablets, Smartphones, software, or digital applications are developed with accessibility features making them flexible and usable for everyone (Mole, 2013, Dalton, 2017). These include accessible education material (AEM). Accessible educational materials (AEM) are materials and technology usable for learning across the widest range of individual variability, regardless of format or features (CAST, 2019). Whether a document or technology is designed from the start to be accessible for all learners or is made accessible for learners with disabilities, it is considered AEM (CAST, 2019). Universal Design and AEM follow the princi- ples of equitable and flexible use, are simple and intuitive, have perceptible information, low tolerance for error or physical effort, and have appropriate size, space, and use (CAST, 2019).. UDL, AEM and AT viewed as a continuum of services benefits more people using each of these options at the appropriate time, task, and context. OCCUPATIONAL THERAPY’S ROLE IN ACCESS TO LITERACY In the schools and in other community settings, there is a team comprised of a variety of professionals along with the teacher who provide services and can consider UDL and assistive technology. Occupational therapy is often one of the related service providers for children with disabilities. OTs are not only members of a team in the schools but is involved frequently with children and adults in outpatient or inpatient rehabilitation facilities, mental health centers and community based settings. Part of OT’s role is to “coach” or train individ- uals in the use of assistive technology after determining access mode considering physical, cognitive, visual, and other abili- ties to increase participation and success in school and in daily occupations (Reed, P & Bowser, G., 2012). Occupational Thera- pists often assist with and make modifications to typical school curriculum and daily activities, provide solutions for students and clients to participate in the classroom or other settings to increase participation. These areas may include: seating and positioning, physical access, activities of daily living (ADL’s), instrumental activities of daily living /(iADL’s), reading/writing adaptations, executive functioning, functional cognition and communication, visual and hearing adaptations, functional mobility and social-emotional functioning (Goodrich, B. & Garza, E., 2015; Reed P. & Bowser, B., 2012; Stauter, D. W., Prehn, J., Peters, M., Jeffries, L. M., Sylvester, L., Wang, H., & Dionne,

SOCIAL JUSTICE AND ACCESS TO TECHNOLOGY AND ASSISTIVE TECHNOLOGY The OTPF–4 serves as a guide for evaluation and interven- tion of contexts, performance patterns, performance skills and client factors involved in literacy and occupational engage- ment. However evaluation must also include an assessment of whether technology is physically available to the individual. Access to literacy not only involves the use of AT, UDL and other strategies, but at a more basic level, the social justice and equity involved in access and availability of the technology and the Internet (Hitlin, P., 2018; Herold, B., 2020). According to the Pew Research Center (2019) 90% of adults of all ages use the Internet, but only 27% of adults over 65 years of age use the Internet. Surprisingly, 100% of adults in the 18-29 year old age group report using the Internet or other types of technology daily. Access to the Internet is an issue for 6 out of 10 rural Americans with 43% of adults not having broadband access due to socio- economic reasons (Anderson, M., Perrin, A.,Jiang, J., & Kumar, M., 2019). Along with this disparity between young adults and older individuals related to the use of technology, many older adults report requiring assistance to set up and learn to use technology (Choi, N. G., & DiNitto, D. M., 2013). In children and younger adults’ technology has become so ingrained in day to day life that it is difficult to participate in daily occupations without technology (Pew, 2018). However, inaccessibility may be due to marginalization in society, culturally or socioeco- nomically. Inaccessibility and poor literacy skills may limit an individual’s occupational options fostering a cycle of socioeco- nomic and educational deprivation and occupational injustice (Durocher, Gibson, & Rappolt, 2013; Townsend, 2012) In the educational setting, inaccessibility to technology may be due to the cost associated with specialized devices and training to use the devices. The Individual Education Act defines AT as “any device, piece of equipment, or product system, whether acquired commercially off the shelf, modified,

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C. 2019) UDL is often the first area of intervention in the continuum to be considered when looking at the occupational performance areas listed above. Occupational therapy and other team members are able to aid using UDL and AT options through direct service, coaching, consultation, and advocacy. Using the Occupational Practice Framework 4th edition and the HAAT framework as guiding structures it is possible to optimize interventions with individuals throughout all areas of occupa- tion, no matter the need, context, diagnosis, or age. EXAMPLES OF UDL AND AT A first grade student with cerebral palsy has difficulty participating in classroom reading and writing tasks because of limited motor control in her arms. The occupational therapist works with the teacher, and they introduce many high- and low- tech options, including a computer and digital tablet with word prediction/abbreviations to increase her writing efficiency and legibility; an adaptive desk with supports for her arms so she can access a large print keyboard; testing using the computer or tablet and accessible testing. She reads using a digital tablet with access to online digital book applications, and she uses a dedicated speech generating device for communication (intro- duced by the speech pathologist). These supports allow her to access literacy in the classroom, participate in classroom discus- sions and communicate with classmates and teachers. An 81-year-old man with vision loss resulting in low vision lives at home. An occupational therapist helps identify and implement a variety of supports to increase his function in the home for iADL’s, including a Smartphone with a camera to photograph and enlarge labels and recipes; speech to text on the tablet to help him search for recipes online; high-contrast dials with tactile dots for the oven and stove; and large-print cookbooks and measuring tools. These interventions allowed him to remain independent and safe in his home without addi- tional assistance (AOTA, 2015). These supports also allow him to access literacy activities such as searching for and reading recipes on his tablet, using his Smartphone to enlarge labels so that he can read the labels and reading the markings on measuring cups while cooking. Today there are many options from built in accessibility features in devices, apps, chrome extensions and other more specialized assistive technology. Using a continuum of options from universal design for learning and low tech/high tech assis- tive technology it is possible for everyone to have access to literacy opportunities and participation.

The table below shows a few options and other information can be found through the Closing the Gap Resource Directory, Microsoft and Apple accessibility.

Table of Literacy Modes, Devices and Software/applications (not inclusive)

Code: Switch Access: SA, Voice Access: VA, Gaze Access: GA, Auditory Output: AO, Text to speech: TTS, Speech to text: STT

Area of Literacy Access/Access Type

Assistive Tech- nology Devices

Function of AT

Universal Design for Learning

Reading

Braille books JAWS Screen Reader Other Screen

To read to gain knowl-

Immersive Reader Built in Accessibility Options on Commer- cially Available Devices Starfall app., or website ABCmouse app. Literacy app: Inclusive Tech. Choose it Maker 3 software and Choose it Maker app.: Inclusive Tech. Chrome: Read and Write, Read Aloud Other Reading Apps: Easy Reader Read and Write, Readability, Kindle, Tar Heel Game Play Tar Heel Reader Pictello Magnifier Apps Built in Accessibility options: text to speech, speech to text, high contrast, magnification, switch activation, iPad “Recipes” Use of external keyboard, onscreen keyboard, speech to text, word prediction, short cuts/abbrevia- tions. Chrome: Read and Write for Chrome Cowriter Speech to Text/ Recording software/ apps: Audionote, Notability

edge and for leisure activity. 2. augment or substi- tute

Readers/Magnifi- cation Software CCTV’s Magnifiers/Digital Magnifiers

Writing

2. Adaptive keyboards: Big Keys, Large print Logic Keyboard: KeyCaps IntellikeysBig Keys Keyboard Refreshable Braille Displays Smartbrailler Mountbatten Learning System Clicker apps

To write indepen- dently with varied access.

Notetaking

Onenote Evernote Glean

voice recorder (Built in to OS or Android), Google Keep

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Math

Talking Calculator Large Print Calculator Picture in a Flash: used to make tactile diagrams/ pictures for visu- ally impaired Code Jumper” coding device for the visually impaired Picture or Object Symbol Sched- ules, Picture or Object Symbol Step by Step Directions for ADL/iADLs Orbi Feeder Adaptive Dressing Aids ie; reachers, dressing stick, buttonhook, large handles utensils etc. Variety of dedicated speech generating devices and low tech voice output buttons (provide low tech and high tech options) Low Tech Picture or Object/Tactile Symbol Commu- nication Boards

To complete computa- tion To complete science

Numeracy app: Inclu- sive Technology Digital calculator on Smartphone Science app: Inclusive Tech.

Keyboarding

To access writing

Websites:TypingClub EduTyping Typing.com TypingPal Taptyping Accessible Apps: Typio TapTyper Keyboard Fun

Science

TypeAWord SpellA Word ScanAWord Talking Typer

Switch access: Learning/ literacy

Variety of adap- tive switches with sound, touch, press, proximity, EMG/twitch access Computer or BlueTooth Switch Interfaces

To access with your switches.

OS built in switch access Helpkidzlearn Pictello: book app. Tar Heel Gameplay Tar Heel Reader: add Recipe in switch access in Ipad to turn pages/ read book OS voice to text/Suri Alexa Built in accessibility: iPad Pro, iPhone 11 Jabberwocky app for text to speech access using head movement OS adaptive touch access/gestures Open Captioning (Beta on OS). Allows captioning with conversations. Closed Captioning on digital/video media

Functional ADL/IADL’s/ Executive Function

Apps with recipes, grocery lists or ordering groceries. Grocery shopping app Choicemaker App

Voice access/ Speech to Text Face Tracking

Dragon Dictate Voice access

AAC

To communi- cate

Touchchat SnapChat Cough Drop SoundingBoard Go Talk Now

Touch

Auditory Processing/ Hearing

Assistive listening devices: FM Systems, Hearing Loop Systems, Infrared Systems

REFERENCES: American Occupational Therapy Association. (in press). Occu- pational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74 (Supplement 2). Advance online publication. ACOTE (2018). Accreditation Council for Occupational Therapy Education (ACOTE®)Standards and Interpretive Guide. https://acoteonline.org/accreditation-explained/standards/ Anderson, M., Perrin, A.,Jiang, J., & Kumar, M. (2019). The Pew Center. https://www.pewresearch.org/fact- tank/2019/04/22/some-americans-dont-use-the-internet- who-are-they/ Borgestig, M., Sandqvist, J., Ahlsten, G., Falkmer, T., & Hemmingsson, H. (2017) Gaze-based assistive tech- nology in daily activities in children with severe physical impairments–An intervention study, Devel- opmental Neurorehabilitation, 20:3, 129-141, DOI: 10.3109/17518423.2015.1132281 CAST (2019). Accessible Education Material. National Center on accessible educa- tional Materials. http://aem.cast.org/

Health/Health Literacy

To maintain health and wellness.

Apps (endless options) Calm: mindfulness MyFitness Pal Headspace Sleep Cycle My Life Check: AHA

Apple Health Waterlogged Nutritionix Fooducate

Eye gaze access Eye gaze Camera (Tobii, Gazepoint, iMotion etc)

To access Hawk Eye eye gaze app Microsoft Eye Gaze using built in webcam

Skyle case: with eye gaze. offers a choice of AAC apps, access to social media, email, and envi- ronmental control (using the Environ app to control Pretorian smart home devices AAC Devices with built in eye gaze.

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Two sides of the same coin. Handbook of special education technology research and practice, 507-518/

Choi, N. G., & DiNitto, D. M. (2013). The digital divide among low-income homebound olderadults: Internet use pat- terns, eHealth literacy, and attitudes toward computer/ Internet use. Journal of Medical Internet Research, 15(5), e93. DOI: 10.2196/jmir.2645 Copeland, S. R., & Keefe, E. B. (2019). Literacy Instruction for All Students Within General Education Settings. Research and Practice for Persons with Severe Disabilities, 44(3), 143–146. https://doi.org/10.1177/1540796919866011 Dalton, E. M. (2017). Beyond Universal Design for Learning: Guiding Principles to Reduce Barriers to Digital & Media Literacy Competence. Journal of Media Literacy Education , 9(2), 17-29. https://doi.org/10.23860/JMLE-2019-09-02-02 Durocher, E., Gibson, B. E., & Rappolt, S. (2013). Occupational justice: A conceptual review. Journal of Occupational Sci- ence , 21(4), 418-430. https://doi.org/10.1080/14427591.20 13.775692 Grajo, L. C., & Gutman, S. A. (2019). The Role of Occupational Therapy in Functional Literacy. The Open Journal of Oc- cupational Therapy, 7(1). https://doi.org/10.15453/2168- 6408.1511 Goodrich, B. & Garza, E. (2015). The Role of Occupational Therapy in Providing Assistive Technology Devices and Services. American Occupational Therapy Association. Herold, B. (2020), The Disparities in Remote Learning Under Coronavirus (in Charts). Education Week. https://www. edweek.org/ew/articles/2020/04/10/the-disparities-in- remote-learning-undercoronavirus.html Hitlin, P. (2018). Internet, social media use and device owner- ship in U.S. have plateaued after years of growth. Retrieved from https://www.pewresearch.org/fact-tank/2018/09/28/ internet-social-media-use-and-device-ownership-in-u-s- have-plateaued-after-years-of-growth/ Mole, H. (2013). A US model for inclusion of disabled students in higher education settings: the social model of disability and Universal Design. Widening participation and lifelong learning, 14(3), 62-86. (6) Rose, David & Harbour, Wendy & Johnston, C. & Daley, Saman- tha & Abarbanell, Linda. (2006). Universal design for learn- ing in postsecondary education: Reflections on principles and their application. Journal of Postsecondary Education and Disability. 19. 135-151.

Reed P. & Bowser, B. (2012) Consultation, Collaboration, and Coaching: Essential Techniques for Integrating Assistive Technology Use in Schools and Early Intervention Pro- grams, Journal of Occupational Therapy, Schools, & Early In- tervention, 5:1, 15-30, DOI: 10.1080/19411243.2012.675757 Smith R.O.(2017) Technology and occupation: Past, present, and the next 100 years of theory and practice. American Journal of Occupational Therapy. 71(6), 7106150010p1- 7106150010p15. Stauter, D. W., Prehn, J., Peters, M., Jeffries, L. M., Sylvester, L., Wang, H., & Dionne, C.(2019). Assistive Technology for Literacy in Students With Physical Disabilities: ASystem- atic Review. Journal of Special Education Technology, 34(4), 284–292. https://doi.org/10.1177/0162643419868259 Townsend, E. A. (2012). Boundaries and bridges to adult men- tal health: Critical occupational and capabilities perspec- tives of justice. Journal of Occupational Science, 19(1), 8-24. UNESCO (2008). The global literacy challenge. Paris: The United Nations Educational Scientific and Cultural Organi- zation.

Rose, D. H., Hasselbring, T. S., Stahl, S., & Zabala, J. (2005). Assistive technology and universal design for learning:

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