Switch It Up in a NY Minute! Teaching Students with Complex…

augmentative & alternative communication (AAC)

Switch It Up in a NY Minute! Teaching Students with Complex Communication Needs to Use Switches GRETCHEN HANSER , MS, OTR/L, PhD has worked in the field of assistive technology and literacy for students with significant disabilities for over 25 years. She is an educator and an occupational therapist. Her primary focus has been on augmentative and alternative communication and literacy for students with the most significant disabilities. She has worked in a variety of educational settings developing model classrooms, developing school based assistive technology centers, providing teacher and related service provider trainings, participating in assistive technology assessment teams and working directly with students and staff in the class - room. Gretchen has taught university classes and presents nationally and internationally on these subjects. She is currently the Director of Assistive Technology and Literacy Instruction at the International Academy of Hope in NYC. JENNIFER HENSLEY ,MS, OTR/L has worked as a school-based occupational therapist for nine years, supporting students with multiple disabilities with a focus on engagement in meaningful occupations using assistive technology. She specializes in providing seating and positioning supports to enhance students' access methods and muscular skeletal health. Jennifer is committed to fostering self-advocacy skills and empowering individuals to regain autonomy through assistive technologies. Drawing on her background in the arts, she creates innovative, access-based solutions and enjoys tackling environmental challenges that can prevent engagement. Jennifer also guest lectures for occupational therapy university programs and presents at national conferences. She is currently the director of the occupational therapy department at the International Academy of Hope in NYC.

NORA HENRY - BMS, OTR/L, ATP has her Masters of Science in Occupational Therapy from The University of Scranton .She is a Senior Occupational Therapist- International Academy of Hope and is passionate about students' access to meaningful activities continuing into their adult life.

JESSE SIMON - BMS, OTR/L has been a pediatric occupational therapist for over five years. He is pursuing his clinical doctorate at Touro University. Currently, Jesse is integrating his capstone project to introduce to custom-made electronic switches to therapists, and providing alternative switch access solutions for children with brain injury. He is an Occupational Therapist at the International Academy of Hope in NYC.

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INTRODUCTION Students with Complex Communication Needs (CCN), significant physical disabilities, and Cortical Vision Impairment (CVI) have profound challenges with communication, mobility and physically accomplishing basic school tasks. Throughout the day, they may be “observers from the bleachers”, having little opportunities for true, independent participation and access to activities. Figuring out how to reverse this and put students in the driver’s seat might appear complex at first, but it is a very do-able process once you breakdown the components! When it comes to learning, finding what is meaningful for these students is key to unlocking their potential. Yet, despite our best efforts, we sometimes find ourselves facing roadblocks. We have all most likely experienced this. Is your student showing disinterest in using switches? Does your student bang and throw switches? Are you struggling to teach them the essential skills of scanning on an augmentative and alternative communication (AAC) device? Perhaps you've been stuck in a rut, using the same tired switch games year after year, feeling like creativity has hit a dead end. If any of this sounds familiar, fear not! This article is here to offer a fresh perspective with solutions to help you " SWITCH IT UP " and to reignite enthusiasm in your students and your classroom. GUIDING PRINCIPLES Successful teaching of switch access is not just about the activity and the AT, but it’s also about the professionals’ being on the same page with the important beliefs and knowledge. NO COGNITIVE PREREQUISITES: Professionals may believe that students need to have a certain prerequisite set of cognitive skills for using switches. Students may bang, slap and attempt to throw switches. This often leads to professionals thinking that these students “aren’t ready” for switches or that they need to work on cause/effect. These students typically end up getting access to only “cause/effect,” activities devoid of social interactions and real-life context – which is what they really need to build understandings. WATCH OUT FOR A TESTING AGENDA: Professionals may focus on accuracy and timing of switch access in a mechanical trials- based manner. This type of testing agenda where students have to hit switches on demand does not allow students to develop the thought processes and problem-solving skills which are necessary for developing the motor planning skills needed for switch access. Instead, make switch activities authentic and based on real life, motivating interactions. While it is important to track progress, gathering data can be done through naturally occurring activities.

CORTICAL VISION IMPAIRMENT (CVI): Many of our students have CVI. CVI is a complicated, and often unrecognized diagnosis, and each student has different visual abilities and needs. Some students may benefit from switch activities with black backgrounds with simple neon-colored items with slight animation to help engage students’ vision. Whatever their needs are, don’t let vision be a gatekeeper to engaging in switch activities. Students with CVI may have difficulty looking and listening simultaneously-especially in busy, loud classrooms. Bottom line is...don’t force students to use their vision for activities. If it is already hard to use a switch, decrease the visual demands. Choose activities that have auditory and tactual components so that vision is not necessary. Talk to your Teacher of the Visually Impaired (TVI) for guidance about students’ vision needs, as well as the visual presentation and positioning of switch activities. FIND THE RIGHT ACCESS METHOD: Students with significant physical issues often end up with the wrong access method to access AAC device and basic school tasks. Many students struggle to use an AAC device with their hands or eye gaze and can point to just a few individual messages. Frequently, those students would have access to far more vocabulary if they could use switches for scan through the messages. Another common scenario is when students are struggling to use 1 switch with high reaction time demands when they should be learning to use 2 switches! Professionals need to use the access framework to determine the access method that gives the students access to as much vocabulary as possible-with room to grow. BALANCE THE PHYSICAL & LANGUAGE DEMANDS: When struggling switch users are faced with learning to use switches with AAC devices and during academics, they often fail because, the cognitive/language demands AND the physical demands – simultaneously - are far too high resulting in student shut down. Struggling switch users will have far more success when these skills are broken apart. “Learning motor skills requires conscious effort and, therefore, occupies the individual’s working memory until it reaches a level of automaticity. The brain’s working memory can only focus on a limited amount of information at one time. Anything that is not automatic occupies working memory, which limits available working memory for learning new tasks. It is now widely accepted that individuals can learn skills in parallel," (Burkhart, 2018). Focus on building the physical skills for switches during fun, failure free motor activities with minimal language demands. During lessons with heavy language demands, such as using AAC devices/academics, minimize the physical demands so that students can devote their energy and focus to the content. A possible solution in these situations is partner assisted scanning (PAS). PAS can be an invaluable strategy for giving struggling scanners access to AAC. During PAS, the communication partner verbally and/or auditorily lists out choices for the student. When the student sees and/or hears what they want,

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planning. This concept is no different than the opportunities that children without disabilities get when learning to use new tools.

the student signals the partner using whatever physical method is the easiest. You might setup switches connected to a voice output communication aid (VOCA) with messages such as“that’s the one” or “no, not that one.” However, if the student is having trouble with switches, it’s best to have the student use unaided communication strategies, such as gestures and/or facial expressions. Keep in mind, when teaching language, you want to focus on communication—not accurate switch use. With the motor demands at a minimum, professionals can even use PAS to teach students the vocabulary and layout on SGDs. This allows students to develop a mental map of their vocabulary to make it easier to layer on physical switch access component. The other bonus to PAS is that it can also be done auditorily using partner assisted AUDITORY scanning (PAAS). This is an ideal method for students with vision issues as it requires no vision. See Linda Burkhart’s work for a wealth of resources on students with complex needs and PAS and PAAS: https://lindaburkhart.com/ PLAN SWITCH OPPORTUNITIES THROUGHOUT THE DAY: One hour of switch work a day isn’t going to be enough to help our students develop the physical skills for switch access. Our students have extremely challenged motor skills and will need time to develop the movement and the fluency for using switches. According to the Fitts and Posner stages of motor learning, it takes ongoing repetitions to learn a motor pattern with automaticity where the student can do the movement without thinking about it. Therapists determined that once movements performed by children with cerebral palsy were automatic, it became easier for them to process the cognitive and language components behind switch use (Beauchamp et al., 2018). According to Burkhart (2004), new neurological connections that lead to learning these movements to the level of automaticity require thousands of repetitions that include purpose and variation. MODEL, MODEL, MODEL: Part of developing motor planning is knowing what the activity is and what the outcome looks like. The adults need to model switch use. Once the adult models, there should be no requirement that the student copies the movement. Adults need to model and move on to show the student how the activity works. GROWTH OCCURS OVERTIME: Take into mind that our students may not initially be proficient with using switches - this takes time and teaching! Some students might take a couple years to become a reasonable scanner. For these students, it is not necessarily about immediate, accurate, independent switch use to access AAC. It’s about students learning to communicate with robust vocabulary on an AAC system, regardless of the access method. LET STUDENTS MAKE MISTAKES: Given our students’ limited experiences with switches, it is important to give them ample opportunities to experiment and make mistakes in order to build problem solving skills which ultimately contributes to motor

THE POWER OF PERSONALLY MEANINGFUL : Start out with things that students care about. This type of intrinsic motivation drives attention and engagement which leads to the development of motor planning. Learning to use a switch may be hard, and even abstract for many students. The best way to teach this abstract concept is to layer it on top of something students already know. FOSTERING ENGAGEMENT: Be careful about parking students at the computer on their own with switches - unless the student really wants that. For students who need more feedback, success of learning rests on the social interaction in real life contexts. Involve peers! When planned correctly, switch activities should be fun, interactive and a great way to foster relationships! FOCUS ON SOCIAL INTERACTIONS & ATTRIBUTING MEANING: This is something we do naturally for young children when they do something random and make errors. It is natural that young children would make errors because they don’t know enough about what they are doing. Adults respond to children’s random attempts and errors to teach them what it means. Adults tell the child what they saw and then they make a connection between the child’s behavior and the something real in the activity. It’s important to do the same thing with our students using switches who are learning so many new skills! For example, a student briefly looks at the computer with a game and then look down at switch and starts to bang it. Adult response: “I saw you look at the computer screen. Oh look-there is a game there! I wonder if that is what you were thinking about! Look- we can press the switch to play it! Let’s do it together.” Over time, attributing meaning to students’ random behaviors builds their conceptual knowledge and awareness about their actions. USE A FRAMEWORK AS A GENERAL GUIDE: It’s important to not have switch activities be drill based and mastery based. Students need to be exposed to lots of different types of activities. Our students need systematic teaching which starts with a purposeful activity, knowing the type of motor demands and language demands of the task and how it needs to be graded for the student. The Stepping Stones Framework to 2 Switch Scanning (Burkhart, 2018) is an invaluable resource for students who will eventually be doing switch scanning to access AAC. It breaks down the cognitive and motor concepts of learning to use switches with suggestions for activities based on the students’ needs. To see Linda’s presentation, go to ableU (from Ablenet) www.youtube.com/@ableu InclusiveTLC has an extensive Switch Progression Roadmap which can be downloaded from their website. It is a guide that describes the different physical skills needed for switch access, along with a wide range of appropriate activities and the needed AT.

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THE TOOLS

INFUSE EMERGENT LITERACY : Many of our students have had very limited opportunities, if any, to engage with writing and exploring books as they can’t physically hold them. Many of them are “emergent” readers and writers and need to have the early literacy opportunities similar to young children before they start school. We know those early emergent experiences pave the way for conventional literacy when children enter school and learn to formally read and write. Emergent literacy is meant to be the play of young children- we can do the same thing with our students, but with switches to experiment with books and writing with alternative pencils! The beauty of emergent literacy is that it’s about exploration which fits the needs of our students who are exploring using switches! No correct answer or accuracy is needed! At iHope, we have found that all of the above beliefs are the foundation for teaching switch use. Now, let’s turn to tools and activities for getting your students going! From play and art to games, toys, cooking, books, apps, alternative pencils, practical jokes, and DIY tips, we'll explore creative avenues to engage students and enhance their AAC learning experience.

ACCESS TOOLS There are SO many different types of switches, either commercially available and DIY. They are all different in regard to size, shape, color, strength requirements, travel, sensitivity, auditory feedback, tactile feedback, visual feedback and durability. The key point is that all of our students have different physical abilities and sensory needs. Students need to be carefully assessed for the types of movements they can make, along with their strength, sensory needs, timing, endurance and personal preferences. Once these things are considered, the appropriate switch should be selected to match the students’ needs. This can be done informally through professionals’ observations. This is not a one size fits all approach! SWITCH MOUNTS In many cases, students will need a mount to position the switch in the spot where the student can move. For example, if a student can turn their head, a mount would be used to position the switch next to their head where it is easiest for them to activate. There are many different types of mounts and finding the right one makes all of the difference.

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OTHER “MUST HAVE” ACCESS TOOLS Timer Boxes : Some activities require quick switch hits and releases, like reading books. Other activities require students to hold down the switch for an extended period of time, like when cutting out a picture using switch adapted scissors. If holding a switch down is challenging for a student, a switch latch & timer box allows you to set a designated amount of time the tool will stay on with just one switch hit. These can be found www. adaptivation.com. Battery Interrupters: There are many wonderful vendors that sell toys which are already switch adapted, such as Adaptive Tech Solutions, Inclusive TLC, Adapted Creations on Etsy and Enabling Devices. However, you can also buy a battery-operated toy and switch adapt it yourself! You can do this with a “battery interrupter.” You can buy a battery interrupter online or get one from a local Makers’ group. There are also DIY directions online.

physical participation, they are not the sole determining factor of effectiveness. Ultimately, what holds the most significance is the meaningfulness of the activities and the social interaction. You don’t need to have a lot of fancy AT to get started...and it doesn’t all need to be on the computer! At iHope, our program has a basic set of AT tools, but we use them for MANY different purposes. We are going share our favorite classroom tools, from walking toys, computer and iPad switch interfaces, alternative pencils, PowerLink, to switch adapted scissors, pour cups, ball throwers and other toys. Once you start seeing these ideas– you'll come up with many more of your own! CONCLUSION: We hope this article inspires your team to 'Switch it Up'. Taking the time to understand your students’unique needs, motivations and interests can spark countless ideas for accessible activities. The enthusiasm for discovering new ways to engage students becomes infectious among team members, fostering growth for both students and those who support them!

AT for the Activities While switches and other technologies allow open doors to

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REFERENCES Burkhart, L. J. (2004). Two switches to success: Access for children with severe physical and/or multiple challenges. Eldersburg, MD: Author. Burkhart, L. (2018). Stepping stones to switch access. Perspectives of the ASHA Special Interest Groups, 3(12), 33–44. https://doi. org/10.1044/persp3.sig12.33 Beauchamp, F., Bourke-Taylor, H., & Brown, T. (2018). Therapists’ perspectives: Supporting children to use switches and technology for accessing their environment, leisure, and Communication. Journal of Occupational Therapy, Schools, & Early Intervention, 11(2), 133–147. https://doi.org/10.1080/194 11243.2018.1432443

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