February / March 2024, Closing The Gap Resource Directory S…

Closing The Gap Resource Directory Solutions e-Magazine, 2024 February / March - Volume 42 - Number 6

Closing The Gap Assistive Technology Resources for Children and Adults with Disabilities February / March, 2024 Volume 42 - Number 6 ANNUAL RESOURCE DIRECTORY Solutions

2024 Edi t ion

A guide to the latest assistive technology products for children and adults with disabilities. It is the culmination of an extensive search for the latest software, hardware and other assistive technology products that are on the market today, as well as their producers.

EDITOR’S NOTE: There is no charge for inclusion in the Resource Directory. Listings are based on editorial questionnaires, phone interviews and materials provided by producers. Listings are not advertisements nor is their inclusion in the Directory an endorsement or guarantee by Closing The Gap. Descriptions are edited materials submitted by producers. They are not product reviews. Information provided is as current as possible at publication time.

STAFF

contents volume 42 | number 6

february / march, 2024

Megan Turek ......................................... PRESIDENT Marc Hagen ........................................... VICE PRESIDENT MANAGING EDITOR Becky Hagen.......................................... MEMBERSHIP MANAGER REGISTRATION MANAGER Callie Kriechbaum................................ SALES MANAGER INDIVIDUAL SOLUTIONS MEMBERSHIP Membership Rates 1-yr. $449; 2-yr. $748; Parent $275 GROUP SOLUTIONS MEMBERSHIP Group options available. SUPPLEMENTAL COLLEGE CURRICULUM – ELECTRONIC TEXTBOOK Instructors receive a complimentary one-year membership.

22 AAC Integrated into

Access to Literacy Using Universal Design for Learning and Assistive Technology

Academic Learning NOT a Compliance Tool By Lindsay Markworth and Sarah Singleton

through the Lifespan By Tammy Bruegger

Approaches to Robust Integration of Assistive Technology Content into Professional Occupational Therapy Programs By Annabeth Knight

32 RESOURCE DIRECTORY A guide to nearly 1,500 Assistive Technology Products!

Student Membership 1-yr. $125 Standard

Visit https://www.closingthegap.com/ benefits-of-membership/ for complete details and pricing. PUBLICATION INFORMATION Closing The Gap (ISSN: 0886-1935) is published bi monthly in February, April, June, August, October and December. CONTACT INFORMATION Please address all correspondence to Closing The Gap, P.O. Box 68, Henderson, MN 56044. Telephone 507-248-3294; Fax 507-248-3810. Email <info@closingthegap.com>; Website <www.closingthegap.com>. COPYRIGHT Entire content is copyright 2024 by Closing The Gap, Inc., all rights reserved. Reproduction in whole or in part without written permission is strictly prohibited. EDITOR’S NOTE The information provided by Closing The Gap, Inc. in no way serves as an endorsement or guarantee by Closing The Gap, Inc.

14 An Army of

Squeaky Wheels “The squeakywheel gets the oil.” By Maggie Pickett

33 Producers 47 Hardware Product Matrix 54 Hardware Product Listings 75 Software Product Matrix 85 Software Product Listings 121 Other AT Product Matrix 133 Other AT Product Listings

www.twitter.com/ ATClosingTheGap www.facebook.com/ ATClosingTheGap www.instagram.com/ atclosingthegap

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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leadership, policy, and implementation

Approaches to Robust Integration of Assistive Technology Content into Professional Occupational Therapy Programs

Summary: Though instruction on assistive technology (AT) has been required in professional occupational therapy education pro- grams for decades, overwhelmingly practitioners report feeling underprepared for service provision in this area. This article explores benefits and challenges of various approaches to curriculum design to support practitioner success. It highlights the hybrid approach of the Entry-Level OTD Program at Methodist University that incorporates AT learning activities through- out a variety of courses, in addition to a stand-alone course in AT.

edge and skills is through intentional curriculum design at the professional program level to help prepare new graduates for the clinical service provision of this portion of the occupational therapy scope of practice. Occupational therapy (OT) is one of many professions which addresses assistive technology within its scope of practice. OTPs work to enable participation of individuals or populations through the therapeutic use of everyday occupations, (AOTA, 2010; AOTA, 2015). Intervention approaches intentional modifi- cation and/or adaptation of activities to enhance participation, frequently through the use of assistive technology, (Cook, Pol- gar, & Encarnação, 2020; WFOT, 2019). The Occupational Ther- apy Practice Framework-4 provides guidance about the scope and execution of occupational therapy, (AOTA, 2020). This framework encourages practitioners to both consider AT as part of the client’s environmental context, and to use assistive technology as an intervention, (AOTA, 2020). The profession’s unique contribution to assistive technology service provision

The provision of assistive technology (AT) services is a vital component of everyday practice for the occupational therapy practitioner (OTP) across practice settings. However, research over the past few decades has indicated that overwhelmingly, OTPs feel they are underprepared to provide services in this specialized area of evaluation and intervention, (Gitlow & San- ford, 2003; Kanny & Anson, 1998; Long & Wolverton, 2007; Mc- Daniel & Gitlow, 2021). This is a growing, but not newly emerg- ing challenge. Since the late 1900s, research has indicated that this knowledge and skills gap exists for OTPs providing AT ser- vices in all areas of practice, (Kanny & Anson, 1998). Barriers to competency and confidence in the area of AT service provision includes the rapid growth of technology, few content experts and specialists in the field, and the perception of a lack of clini- cian education required for practice in this area, (Gitlow & San- ford, 2003; McDaniel & Gitlow, 2021; Sarsak et al., 2023). Though continuing education content is available for OTPs in this area of practice, one approach to addressing these gaps in knowl-

ANNABETH KNIGHT OTD, OTR/L, ATP, is an occupational therapist, assistive technology professional, and assistant professor at Methodist University in Fayetteville, North Carolina. She has over 12 years of clinical experience in pediatric occupational therapy across a variety of settings, working primarily with medically complex children who benefit highly from assistive technology service provision. Annabeth earned her post-professional doctorate in Occupational Therapy from Mount Mary University, and her master’s degree in Occupational Therapy from the University of Scranton. In her current role, Annabeth teaches assistive technology coursework in the Methodist University OTD Program. She also mentors student research in the area of assistive technology, and serves as the Doctoral Capstone Coordinator. Since 2014, Annabeth has presented at national and international conferences on various topics in assistive technology service provision.

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involves the integration of a spectrum of assistive technologies into occupation-based evaluation and intervention to meet client-driven functional goals, (AOTA, 2025; WFOT, 2019). In the professional education of OTPs, the American Certification of Occupational Therapy Education (ACOTE) provides AT service provision standards, that offer specific guidelines for the scope of the content that must be covered in OT curriculum at the associates, bachelors, masters, and doctoral level. The standard regarding assistive technologies requires inclusion of learning activities designed to establish knowledge and skills about AT “used to enhance occupational performance and foster partici- pation and well-being”, (ACOTE, 2018, pp. 37; 60). ACOTE does not, however, provide specific guidance on how to integrate this content knowledge into broad program curriculum. Programs are left to determine this on their own; choosing either to integrate AT concepts throughout a variety of courses, to develop a stand-alone course in AT, or a hybrid of the two. Since the practitioner knowledge gap is still pres- ent despite these standards in curriculum in the United States, there is a need to investigate the details of curriculum design when determining how to bridge the gap between the class- room and clinical practice. Additionally, at this time, there has not been a comparative analysis conducted to investigate any difference in outcomes between programs that have a stand- alone AT course, and those that choose to integrate AT con- cepts across multiple courses and education opportunities. Though there is intentionality and potential benefit to either approach to curriculum design, inclusion of a stand-alone course provides the opportunity to address several of the barri- ers to achieving practitioner competency in AT, while also con- sistently tracking student learning outcomes within this area of knowledge and clinical skills. The Doctor of Occupational Therapy Program at Methodist University in Fayetteville, North Carolina is an entry-level pro- gram, which has designed its curriculum to address AT-related education standards through a combination of a stand-along course in AT, and integration of supplemental AT concepts throughout the program curriculum. This hybrid approach empowers students with the underlying theory informing AT service provision by OTPs across their foundational and clini- cal coursework, and introduces concepts and technologies relevant to particular practice areas and client populations as they progress through the didactic curriculum. Additionally, the stand-alone AT course provides a number of benefits to en- hancing learning through targeted instruction by a variety of content-expert instructors, hands-on learning opportunities, on-campus and community collaboration, and opportunities to contribute to research and capstone projects in the area of AT. The stand-alone course, Supporting Occupational Perfor- mance with Technology and Environments , in Methodist Uni-

versity’s OTD Program curriculum utilizes a variety of unique strategies to optimize learning outcomes in the area of AT knowledge and service provision. This begins with focus on mapping broad OT theoretical models onto those that are AT specific, providing students with a foundational understanding of how to apply OT specific concepts and interventions to AT models of practice such at the Human Activity Assistive Tech- nology (HAAT) Model, (Cook, Polgar, & Encarnação, 2020). The dissemination of the course material to students calls on the expertise of multiple parties. The primary course instructor is a licensed OTP, as well as a certified Assistive Technology Pro- fessional (ATP). This resume provides a unique knowledge and clinical skillset that other OT instructors who cover AT topics in their coursework may not have. The course is also supported by a lab assistant; an OTP and adjunct instructor whose primary clinical role involves high levels of specialized AT service pro- vision. In addition to having experienced clinicians teach this course, there is intentional use of guest lecturers throughout this course to provide students with the expertise of additional stakeholders in the AT field. As user experience is such an in- strumental component of on engagement in and reflection on outcomes of AT service provision, students learn directly from disabled AT users as they serve as guest lecturers across the course. Students not only gain knowledge about the ex- periences these individuals have with using AT, but also about systematic barriers they may have faced as a disabled AT user. Additionally, students begin reflection about general user ex- perience (UX) design, which is an emerging, non-traditional area of practice for OTPs. Finally, local AT equipment vendors are utilized as guest lectures to offer their expertise on a par- ticular group of technology such as wheelchairs and mobility aids, augmentative and alternative communication systems, and 3D printers. From these lab experiences, students not only gain exposure to a variety of AT, but also learn the importance The entry-level Doctor of Occupational Therapy Program at Methodist University aims to deliver the most contemporary, high- quality educational experience to train future practitioners that are compassionate and ethical leaders who will engage, enrich, and empower the lives and communities they serve.

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continuing education, and referral for AT services for their fu- ture clients. Students learn about complex manual and power mobility equipment and durable medical equipment (DME) through collaborative lecture and lab activities led by their instructor and a local vendor. This seating specialist also pro- vides pressure mapping equipment for students to trial as they learn about approaches to client positioning and conducting mechanical assessment tool (MAT) evaluations. Vendors of augmentative alternative communication (AAC) products also provide hands-on lab experiences for the students, bringing a variety of high-tech AAC systems on campus for students to tri- al while discussing the feature matching process, and the role of the OT on the AAC team. Finally, inclusion of a stand-alone AT course in this program allows for the design and implementation of assignments and learning activities that provide students with opportunities to gain hands-on experience with AT, interact with interprofes- sional team members off campus, and positively impact the community. Throughout the semester, students engage in a switch adaptation lab, an adapted toy project, and a low-tech AT design competition that brings AT application to life in the classroom. Each of these projects have evolved over the past several years to involve more direct application of AT concepts

of collaboration with area vendors to best serve their future clients. The emphasis here is not on having robust knowledge about particular AT vendors and/or equipment companies, but instead on gaining an understanding that as OTPs they do not have to be an expert on all equipment and can rely on the ex- pertise afforded by local vendors as part of the interdisciplinary team. AT service provision is a complex process that begins with understanding of the feature matching process, as well as ex- posure to and hands on experience interfacing with the AT equipment itself, (AOTA, 2015; Cook, Polgar, & Encarnação, 2020; WFOT, 2019). Budgeting to have a robust library of AT equipment can be a barrier for many OT education programs. Though the program at Methodist University has a variety of AT equipment in-house, hands-on experience is supplemented through a variety of channels. Partnerships with local organiza- tions and vendors are utilized to provide access to AT equip- ment in the classroom, and students learn the importance of collaboration with these players as OTPs along the way. Stu- dents in this program begin the semester with a lab experience led by an AT provider from one of the state’s Assistive Technol- ogy Act Program (ATAP) locations. Here, they not only have the opportunity to explore a variety of AT equipment in person, but also learn about the legislation which supports funding of state ATAPs, and the utility of the program for equipment loans, Second-year Doctor of Occupational Therapy students engage in hands-on learning in their assistive technology course through exposure to specialized communication and alternative access technologies.

Students gain practical skills switch-adapting electronic toys to provide alternative access to play.

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to real cases, increased collaboration with professional experts to provide students with feedback, and intentional design to impact the community. The switch-adaptation lab provides students with an opportunity to learn and apply engineering principles while building a basic switch and battery interrupter. Students then use their equipment to switch-adapt toys and electronics, while discussing relevant case study applications. The adapted toy project challenges students to adapt an exist- ing toy or game to meet the needs of a disabled child in the community. Students collaborate with area OTPs to discuss real clients on their caseload who could benefit from an adapted toy, and design their adaptations based on the unique needs of that child. This activity allows students to not only implement components of the AT evaluation, development, and interven- tion process, but also provides them with the opportunity to engage in professional communication and collaboration with therapists in the field. The low-tech AT design project in this course has evolved significantly over time to expand its real- life application and impact on the community. Once an in-class project involving a quick presentation of design ideas to peers, the project now involves development of a prototype and pre- sentation to a panel of experts for contest judging. The expert panel includes therapists, community members, students, and professors from related departments such as engineering and kinesiology to provide design and usability feedback from their unique perspectives. This project is designed to mirror a student design competition held annually at the state’s oc- cupational therapy association conference. Students are able to submit their work to this competition at the end of the se- mester, providing them additional opportunity for professional presentation, resume building, and AT community impact. As OT education programs at any level engage in continu- ous quality improvement of their curriculum design, it is im- portant for them to consider the feedback of clinicians about their perceived level of preparedness for AT service provision as new graduates. Future directions at Methodist University include continued expansion of community partnerships that promote opportunities for students to gain more hands-on ex- perience with AT users across the lifespan, and to bring growth to community impact of the program through service learn- ing, collaborative research, and capstone projects. Though we know there are benefits of any effort to enhance to AT content in OT curriculum, it has not yet been determined whether one specific approach of integrating more robust AT-content into programs yields the most optimal academic and clinical out- comes. Further outcomes-driven research is indicated in this area to expand our understanding of the dynamic causes of gaps in AT knowledge amongst OTPs, therefore improving the preparedness of our graduates and the overall quality of AT ser- vice provision.

REFERENCES American Council on Occupational Therapy Education. (2018). 2018 Accreditation Council for Occupational Therapy Educa- tion (ACOTE) standards an interpretive guide . https://acoteo- nline.org/accreditation-explained/standards/ American Occupational Therapy Association. (2020). Oc- cupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Ther- apy, 74(Suppl. 2), 7412410010. https://doi.Org/10.5014/ ajot.2020.74S2001 American Occupational Therapy Association. (2015). The role of occupational therapy in providing assistive technology de- vices and services . https://www.aota.org/about-occupation- al-therapy/professionals/RDP/assistive-technology.aspx AT content experts provide resources to students in addition to hands-on lab experiences, empowering them with community connections to utilize during fieldwork experiences and as future clinicians.

Cook, A., Polgar, J., & Encarnação, P. (2020). Assistive technolo-

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gies: Practice & principles. Elsevier.

Gitlow, L. & Sanford, T. (2003). Assistive technology education needs of allied health professionals in a rural state. Journal of Allied Heath , 32, 46-51. Kanny, E. & Anson, D. (1998). Current trends in assistive technology education in entry-level occupational therapy curricula. American Journal of Occupational Therapy , 52 (7), 586-591. Long, L. & Woolverton, M. (2007). Training needs of pediatric occupational therapists in assistive technology. American Journal of Occupational Therapy , 61 (3), 345-353. McDaniel, K. & Gitlow, A. (2021). Perceptions of assistive tech- nology education from occupational therapists certified as assistive technology professionals. American Journal of Occupational Therapy, 75 (2), 7502205110. Sarsak, H., Kamadu, A., Pearlman, J., Goldberg, M., Kandavel, K., & Augustine, N. (2023). A perspective on occupational therapy and assistive technology: Research, contributions, challenges and global initiatives in the World Federation of Occupational Therapists Bulletin. World Federation of Oc- cupational Therapists Bulletin, 79 (2), 118-126. World Federation of Occupational Therapists. (2019). Occupa- tional therapy and assistive technology: A position paper of the World Federation of Occupational Therapists. World Federation of Occupational Therapists Bulletin, 76 (4), 10-13.

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