Switch Skills 101: Building Foundations for Alternative

Closing The Gap Solutions e-Magazine, Dec 2024 / Janurary 2025 Volume 43, #3 Switch Skills 101: Building Foundations for Alternative Access by Stacy Springer

Switch Skills 101: Building Foundations for Alternative Access ? instruction, literacy & inclusion Summary: Adaptive switches are essential for individuals with disabilities, allowing access to the environment and preventing learned helplessness. Individuals who need alternative access through switches need to develop switch skills in a learning progression. Building foundations for switch skills through play and games are critical for learning motor patterns and progressing to higher level switch scanning skills. Through targeted activities, switches can support individuals in developing foundational skills for academic and communication tasks.

INTRODUCTION Jean Piaget, the influential Swiss child psychologist, famous- ly said, “Play is the work of childhood” (Piaget, 1951). Children with physical disabilities often have fewer opportunities to ex- perience the world and engage in cause-and-effect interactions compared to typically developing children. Adaptive switches provide individuals with disabilities access to various activities and environments that facilitate active participation and pre- vent learned helplessness. Switches enable individuals to ex- plore and learn about their environment, shaping development in areas such as self-efficacy. They help individuals understand that their actions can produce reactions, reinforcing that they are not only active participants but also active agents in shaping the world around them. A switch is a device for making, breaking, or changing the connections of an electrical circuit. It is used to turn on or off a device that has been modified. They can be used to access and engage in activities such as computer access, play and leisure,

environmental control and powered mobility. Switches can also be used to access academic areas, however, in this article we will focus on how to develop emergent switch skills so that the indi- vidual is able to learn motor patterns and functions of switches which builds the foundation to then be able to use switches to access academics and more cognitively demanding activities. While ideally these foundational skills are introduced during childhood, it is never too late to try. The term ‘individual’ is used to be more encompassing and reflective that all individuals can be supported to develop switch skills. SWITCH ACCESS FOR PLAY AND LEISURE SWITCH ADAPTED TOYS There are many commercially available switch adapted play and leisure activities (See image 1). If commercially available switch adapted items are obtained, then you can use a switch to access them directly into the available 1/8” jack. A toy can come

STACY SPRINGER, MS, OTR/L, ATP has over 20 years’ experience as a special educator, occupational therapist, and assistive technology professional. Currently, as the Program Director of the AT&AEM Center at OCALI, Stacy leads initiatives that enhance access to assistive technologies and accessible educational materials across Ohio and beyond. Her career includes leadership in multiple school districts, state-level roles, university instruction, and consultation across five states, along with contributions to international projects and published work on disability adaptations. Stacy collaborates with local and national educational organizations to advance accessibility and inclusion. Her work is also focused on integrating Universal Design for Learning (UDL) and multi-tiered support systems (MTSS) into educational frameworks. Stacy was an inaugural mentor for the Joy Zabala Fellowship in AT&AEM. She is a member of the Quality Indicators of Assistive Technology (QIAT) Leadership team.

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wire when closing the battery door, then a notching tool can be used to file down a small area for the wire to go through near the battery hatch door. Many toys have multiple buttons and therefore they would not be easily switch adapted. These types of toys can be modified by opening the toy and adding in direct switches and ports. Makers Making Change have a step-by-step article on How to Switch Adapt Toys. SWITCH LATCH AND TIMERS (SLAT) A switch latch and timer (SLAT) is recommended as an ad- ditional key tool to support development of switch skills with battery adapted toys (See image 3). A SLAT is a device designed to adjust the activation time of a toy, allowing it to function for a set duration in seconds or minutes using a timer mode or oper- ate continuously in latch mode. When set to the timer option, ei- ther seconds or minutes can be selected to determine how long the toy or activity operates before stopping. The ability to add timed seconds/minute for the toy to play supports development of switch skills in that it does not require the individual to hold or depress the switch for it to play. Momentary/direct activation continues only if the switch is activated. This step should not last long before moving on. While direct causation is a first emergent step in switch skills, most need to be moved quickly on to the next step, which is to activate the switch, an activity plays, then stops to prompt re-activation. Higher level switch skill activation requires activating a switch once then activating again for an additional activation as opposed to maintaining contact. Using

Image 1: Touch switches with switch adapted spotty dog slide toy, alligator and bump and go train.

commercially switch adapted or can be modified with a battery interrupter to be used with a switch. A battery-operated toy that has a simple on/off button can be modified for use with a switch by using a battery interrupter (See image 2). A way to test this is to check if you can turn on a toy simply by switching a button to the "on" position, without needing to hold the button down or press multiple buttons simultaneously to keep it on. If so, then it likely will work with a battery interrupter. A battery interrupter is a copper disk that interrupts or stops the current from one end of the battery to the battery terminal. It then is connected to a mono stereo wire with a 1/8” jack for connecting any switch. You can make your own battery interrupters or purchase them from a variety of places such as Ablenet. When adapting a toy with a battery interrupter if there is not enough room for the

Image 2: Touch switch, battery interrupter, and battery-operated fan.

Image 3: Dual switch latch and timer (SLAT) from Ablenet.

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SINGLE MESSAGE VOICE OUTPUT COMMUNICATION AIDS Single message voice output communication aids (VOCAs) can look like a switch, however, if you are able to record a mes- sage then they are considered communication devices. The BIGmack from Ablenet is widely used and recognized as a single message VOCA. It comes with two switch jacks, one that can provide access to a switch adapted toy and one jack that can connect to a specialty switch to it that would activate the recorded message in the same way pressing the large 5” surface activates the message. The device comes with a variety of col- ored tops that can be interchangeably used. In addition, there are other single message VOCAs that come in various sizes and shapes. SWITCH ACCESS TO CHROMEBOOKS AND IPADS Many computers, laptops, and tablet devices have built in switch accessibility. Chromebooks and iPads are two of the more prevalent devices used in schools, both of which have built in switch accessibility. To access a Chromebook with a switch, a switch interface is needed. A switch interface allows external switches to send keyboard commands to the computer device. There is built-in switch accessibility for the Chromebook as well as the ability to access websites with built-in switch accessibility. Most switch accessible activities or websites will list what keyboard com- mands they use. If the keyboard commands are not listed, you can also try out keyboard commands to see if they are switch accessible. Commonly used keyboard commands for switch use include space bar, return, tab and arrow keys. Switch interfaces are also needed to access an iPad with a switch. iOS devices offer built-in switch accessibility features, along with access to apps that also include integrated switch accessibility. There are both wired and wireless switch interfaces for iPads and other iOS devices. There are pros and cons to hav- ing either wired or wireless switch interfaces. Wired switch inter- faces provide direct access via the charging port. They reduce barriers that often come with Bluetooth pairing since they are physically connected to the device. Since wired switch interfac- es are physically connected, the connecting cords for the switch interface and the switch are more directly in the way or could potentially cause a barrier from being so close to the device. For example, individuals in wheelchairs may need the iOS device mounted to a table or to their wheelchair and the connecting cords could be easily and/or accidentally removed from the de- vice by nearby movements. Some examples of wired switch in- terfaces for the iPad include Tapio USB/iOS switch interface. Wireless switch interfaces allow for the switch interface and the switch to be positioned away from the iPad therefore reduc- ing the possibility for the cord to be accidentally removed. The switch can still be physically connected to the switch interface while the switch interface is connected via Bluetooth to the iPad. Bluetooth switch interfaces can also pose a barrier as there can

latch setting on a SLAT allows for more advanced or varied toy/ activities. When the SLAT is turned to ‘latch’ it will turn on the toy or activity when activated and remain on until it is activated again. This feature can be used with activities such as turning on lights, blenders, etc. It can also be used as an advanced switch skill for individuals who understand switch functions and simply need a way to access the activity. SWITCH ACCESS WITH ENVIRONMENTAL CONTROL UNITS (ECU) For items with electrical plugs, an environmental control unit (ECU) can be used (See image 4) to make the item switch accessi- ble. Items plugged into an ECU need to have an on/off button so when the switch is depressed it will turn on. Examples of items that this would not work with are those that may require two different buttons to be depressed at the same time. Items that have more than one button to be depressed for activation could be accessed via an ECU if a peer or partner activated the button while the individual activated the switch. Also, if the item had a button that needed activation, it is possible to modify the item by affixing foam or a small object to the button with duct tape to keep the button depressed. Some examples and ways to switch adapt activities with ECUs can include blenders, kitchen appliances with on/off capabili- ties, radios, fans, hair dryers to blow paint around or objects (in- sert image), blow up yard decor, floor and table lamps, electric pencil sharpener, electric paper shredder, and an electric stapler. Ablenet has a one-hour webinar, Ablenet Webinar on the Power of the Powerlink Control Unit that provides examples of ways to use an ECU in the classroom and home environments.

Image 4: Powerlink ECU from Ablenet.

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be difficulties with Bluetooth pairing and connection. Some ex- amples of Bluetooth switch interfaces are the Ablenet Blue2 FT and the Pretorian APPlicator. DEVELOPING SWITCH SKILLS There are a variety of options for switch activities both free and paid, web-based, apps, and software. There are fewer op- tions for programs that provide switch skill development that supports individuals through emergent switch skills such as cause & effect to errorless choice making. For individuals requir- ing alternative switch access, building motor patterns for switch skills through games and activities establishes the foundational abilities needed to later use switches for accessing advanced ac- ademic content and communication tools. SEN Switcher is a free download for developing switch skills, and is available for download on Windows operating systems. Activities range from single switch experiential shapes and pat- terns, to timing, to multiple single switch activations, targeted, and finally errorless choice making. On the website there is a short video that explains SEN Switcher. In addition, SEN teach- er provides access to SEN Switcher online without needing to download. SEN teacher states that the original flash version is converted to a modern format on the fly.

tivities. Specifically, the games & activities provide accessible game-based learning that supports access methods including mouse, switch, eye gaze and touch. The Learning progression and outcomes guidebook provides an overview of all the ac- tivities and what skills they target for developing switch skills. HelpKidzLearn uses the switch progression roadmap that out- lines stages of switch skill development from cause & effect to advanced switch skills such as choice making.

In addition, HelpKidzLearn has a ‘My Switch Journey’ free guidebook for tracking and supporting individual students’ switch skill development. This resource is intended for individu- al student customization for progress and data tracking, obser- vations and comments. It also has a breakdown of the various switch skill progression and outlines what activities support each skill (See image 7, next page). Steps Before Step Scanning for Mind Express 5 is a set of ready- made activities and allows the creation of individual student ac- tivities. It is available to purchase for use with Mind Express 5. All activities are based on the ‘Stepping Stones to Switch Access’ by Linda J. Burkhart. Some of the activities were previously avail- able for IntelliTools Classroom Suite. There is no timing in any of the activities purposely to support an individual’s ability to more easily process the motor and cognitive information to form new neurological connections. It is available only on Windows oper- ating systems. Step Scanning: Eight Lessons to Get There app by Judy Lynn is available to purchase on the app store. It is designed to sup- port users from single switch cause & effect to advanced switch skill progression based on Two Switches to Sucess by Linda J. Burkhart. There are various activities grouped into the following lessons: Lesson 1 - Single Switch Cause & Effect (A pre-requisite) Image 6 : Graph from Learning Progression and Outcomes guidebook depicting milestones that include the various types of activities available and learning objectives for switch skill development.

Image 5: Screenshot of SEN Switcher.

Also available from SENict website from Ian Bean, are ad- ditional free activities that are categorized by access method (switch, touch, pointing devices, eye gaze). The activities are all switch accessible and there is a specific category for two switch skills to support choosing and scanning for individuals work- ing beyond cause & effect switch use. All of these activities are only compatible as downloads for PC computer running Win- dows operating systems. On the website there are companion resource documents including switch advice, switch levels and switch roadmap by Inclusive TLC. HelpKidzLearn provides a variety of accessible learning ac-

Lesson 2 - Cause & Effect with Two Switches Lesson 3 - Interaction between Two Switches

Lesson 4 - Step & Select Introduced Lesson 5 - Errorless Step Scanning

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Image 7: Screenshot of My Switch Journey, a quick guide to skill development.

IMPLEMENTATION TIPS AND CONSIDERATIONS When supporting switch use and development of switch skills the focus is always on the goal not the switch. Activation of a switch is not the activity but rather what the switch acti- vates. Any goals written to support switch use should refer to the switch as the tool not the activity. There are various levels or degrees of prompting to consider when supporting individuals with developing switch skills. Scaf- folding layers of prompting should always occur from least re- strictive to more restrictive based on the needs of the individual. Nankee (2016) explains that the same principles of prompt hi- erarchy for teaching individuals how to use communication de- vices can be applied with some adaptations for teaching switch access. After each prompt it is important to pause and wait for the individual to respond. Each individuals’ pause time or wait time is different and adults often do not wait long enough be- fore requesting or repeating the prompt. Below are prompt hierarchy examples adapted from Assis- tive Technology Internet Module, Switch Access – WATI - Part 1 through OCALI authored by Cindy Nankee (2016). • Environment - Present an inviting and motivational activity to the individual with no additional prompting and observe their interest and exploration of the activity. • Gesture - Use a gesture to indicate or attract attention to the activity.

Lesson 6 - Go Get It - Errorless Step Scanning Lesson 7 - Purposeful Step Scanning Lesson 8 - Step Scanning Matching Activity

There are a variety of websites that provide switch access through one to two keyboard commands to support emergent switch users. For example, YouTube uses a spacebar to play and pause. Monarch Reader provides built-in switch access for read- ing books and provides information on their website of various options. Readers can use one, two or three switches to select, read, or rate books. Example keyboard commands include spacebar, right arrow key, mouse click, tab and enter. Tar Heel Gameplay is a collection of free accessible games that can be accessed by switch, touch, or mouse. It provides access for up to three switches. Users can ‘find a gameplay’ or ‘create a gameplay’. A free registration code is needed to create gameplays, and information on how to obtain the registration code is provided on the website. While Tar Heel Gameplay does not provide activities to support all skills with switch skill pro- gression, it does provide both single switch and two switch ac- cess both with premade gameplays as well as the ability to cre- ate your own gameplay. When creating a gameplay, the prompt desired can be customized as well as how often the prompt is displayed and at what minute markers (See image 8 and image 9, next page).

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• Demonstration - Pair verbal prompt with demonstration, "I'm going to turn the music on," and then perform the activity. o Examples: Turn-taking: “My turn” and adult takes a turn. Could add a verbal prompt with then saying: “Your turn” • Motor guidance – Physical support can either support ac- tive learning or passive learning. Assisting an individual in completing a task with hand-over-hand does not typically provide learning value. Often hand-over-hand elicits pas- sive learning. It may be more appropriate and beneficial to support at the elbow or wrist, or at least hand-under-hand. The article When You Need Your Hands to Help ... Facilitation Guidelines for Staff Working With Students With Physical Challenges by Dale Gardner-Fox, M.S., RPT, is an excellent re- source to support this level of prompting. SWITCH TYPES AND PLACEMENT CONSIDERATIONS There are multiple categories of switch types similar to mul- tiple categories of assistive technology. Also, there can also be various ways to label or categorize switches although they all are essentially describing similar features. For more information on switch types, go to Assistive Technology Internet Module, Switch Access – WATI - Part 11 through OCALI authored by Cindy Nankee (2016). Another great resource is the Ablenet Switch Selection Guide, which includes a variety of mechanical, electronic, wired and wireless switches - Ablenet Swith Selection Guide. Often teams will try various types of switches before trialing various switch placements. When beginning to support and ex- plore switch skills with an individual, starting with a jellybean switch, along with experimenting with various switch place- ments, can be effective before trying different switch types. Before determining switch placements and types, it is recom- mended to ensure that the individual is positioned an optimal as possible. “A student’s ability to successfully coordinate the mo- tor and visual skills required for functional switch use is in large part dependent on the manner in which the child is positioned” Goosens and Crain (1992). If an individual is not positioned cor- rectly, then determining access method will be a moot point. The ability to use your upper extremities and hands functionally, the ability to control your trunk and head, the ability to sustain engagement or even have the motivation to engage is all de- pendent on positioning. For switch placement considerations, teams will want to look for consistent, reliable physical movement. Some questions to guide switch placement: • Can the individual repeat the movement with minimal effort? • Can the individual repeat the movement upon request? • Is the activity motivating enough that the individual wants to turn it on with the switch?

Image 8: Example of 2 switch premade activity in Tar Heel Gameplay.

Image 9: Options available when creating a Tar Heel Gameplay.

o Examples: Draw the individual's attention to the switch by indicating where the switch is located with your hand. Demonstrate the switch-activation motion using the same body part that the individual uses to activate the switch. • Verbal prompt - Request the individual to participate in the activity, "Turn the page or play the game." Avoid saying, "hit the switch" as the switch itself is simply the access tool to the activity. o Example: Say something like “Tell me…” or “Show me…” or “Play the…” • Auditory prompt – Draw attention to the switch by tapping. This can be beneficial for individuals with visual impairments and for those using head access where the switch is not in the line of sight. o Example: Lightly tap the switch or the near the switch to make sound to draw attention to it without activating it.

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CUSTOMIZE YOUR SWITCH There are many ways to customize a switch. In addition to trialing various switch placements, considering the angle and location of the switch when using direct access with a hand can also support successful switch activation. Positioning the touch switch at a 45-degree angle can facilitate activation by eliminating the need to press directly on a flat surface. Instead, the individual can activate the switch by moving their hand to- ward it or by performing a side-swipe motion from left to right. This can be done by using a mount or by cutting a pool noodle or a piece of foam. There are low tech mounts and surfaces for purchase such as the Maxess Switch Mounts to vary positions at a 45-degree angle (See image 10). Also, touch switches can be positioned by placing them within a piece of foam so that the surface is nearly flat. The individual then can then rest their arms or hands on the foam and move to the recessed area to activate the switch. There is a photo example of a child using recessed switches on Ablenet’s Switch Access Beyond Cause and Effect: Stepping Stones for Effective Learning – Part 1 by Linda Burkhart and Fio Quinn (2020). Switches can also be positioned at various angles through the use of rigid switch arm mounts or through flexible switch arm mounts like those described in the Closing the Gap front page report, Flexible Mounts Created by Modu- lar Hose for Assistive Technology. This low-cost option allows teams to easily adjust the mount location on the fly. Often some will continue to pursue a ‘perfect’ switch site be- fore beginning to engage in switch related activities. Waiting until then could result in significant delays or it potentially not happening at all, as there is always room for improvement. The goal should be to find some good possible switch placements and then provide opportunities for the individual to learn how to use them. As the individual engages with the switch and a functional purposeful activity, that will then inform and refine the identification of switch sites. Positioning, motor tone, fa-

tigue, and the activity all influence the potential success of switch sites. The best thing to do is jump in, try it, use it and con- tinue to refine while the individual is engaged in switch activi- ties. It is best to ensure that the cognitive load is reduced while they are learning, such as engaging with switch games and not pairing the new motor pattern required for switch use with com- plex communication and language tasks. Parallel Interventions should take place concurrently that in- clude both building switch skills through play and games as well as utilizing low tech and/or mid tech tools for supporting com- munication needs. Examples of building switch skills through play and games include cause and effect online activities through a computer or iPad and switch adapted toys. Examples of supporting communication through low tech and mid tech tools include the use of providing aided language stimulation, partner assisted scanning for low tech communication books or PODD books, use of eye gaze frame and low-tech picture sym- bols and simple voice output communication aids (VOCAs). STARTING WITH PLAY AND GAMES There are many reasons why individuals who need alternative access should start with building switch skills on the computer. The computer (or iPad) will always provide feedback when a in- dividual activates a switch, and that feedback will be consistent. When engaging in switch activities that are reliant upon adults or peers, the feedback can vary and be inconsistent. One adult may provide a more enthusiastic response than another, pro- vide varying amounts of verbal responses or even at times be unable to respond due to contextual factors. Computer-based games and activities also can provide high contrast and visual interest. When an individual is positioned properly in front of the computer, the screen is directly taking up their visual field, and therefore providing high visual interest feedback. It also supports individuals with visual impairments including cortical visual impairment (CVI) as many of the switch-adapted games and activities include accessibility features that support high contrast. In addition to the visual feedback, computer-based games and activities can also provide intense auditory feedback. This can be done through the built-in speakers of the computer, Chromebook, or iPad or headphones can be used to reduce ex- ternal noise and increase auditory support. Starting with prac- ticing switch skills using computer-based play and games are reducing the cognitive load for the individual in order build the foundation for accessing higher level academics and communi- cation. The goal should be to try to move from one switch to two switch scanning when working beyond the level of cause and effect. While a secondary switch site may not be possible for all, those supporting the individual should exhaust all avenues to identify a secondary switch site and determine that is not possi- ble as a team. Two switch step scanning allows more control and active participation for the individual by being able to control

Image 10: Flat switches can be angled by cutting a pool noodle to create a 45-degree angle.

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two switches and their activation at their own pace. When using only one switch, the individual is waiting to time the activation of the switch when scanning. Also, each switch has its own pur- pose. One switch becomes the ‘mover’ or the scanner and the other switch is the ‘select’. There are multiple resources regarding developing switch skills and building two switch skills. Linda Burkhart’s Stepping Stones to Switch Success article outlines how to teach switch ac- cess for individuals who have significant communication, physi- cal and sensory disabilities and are unable to use their hands for direct access. More information on this can be found on Linda Burkhart’s handout section on her website, Two Switches for Success: Access for Children with Severe Physical and/or Multi- ple Challenges (Burkhart 2004) STEPPING STONES TO SWITCH SUCCESS Step 1: Single Switch - Cause and Effect Step 2: Single Switch - Multiple Locations and Multiple Func- tions Step 3: Two Switches - Two Functions

Step 4: Learning to Two Switch Step Scan Step 5: Two Switch Step Scan Errorless Learning Step 6: Two Switch Step Scan for Clear Choices Step 7: Practice for Increasing Accuracy with Two Switch Step Scanning Step 8: Switch Automaticity - Reducing Time for Success Katie Stuhlsatz and Kathy Lalk (2012), converted Linda Bur- khart’s Stepping Stones to Switch Access (Two Switch Step Scan- ning) into a chart that provides implementation ideas and tips with example activities for each stepping stone (See Image 11). Pairing the activity examples on the chart with the software examples previously described provides a solid foundation for developing switch skills for individuals who need alternative ac- cess. By supporting these skills through computer-based games, switch adapted play activities, and communication tools, while reducing cognitive load and building on each step, individuals will be better equipped to handle increasingly complex aca- demic, communication, and language demands in the future.

Image 11: Screenshot of Step 5: Two Switch Step Scan: Errorless Learning.

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ADDITIONAL RESOURCES • Ablenet YouTube Video Series (each video below is about 1 hour – 1.5 hours) o Switch Access Beyond Cause and Effect: Stepping Stones for Effective Learning – Part 1 o Switch Access Beyond Cause and Effect: Stepping Stones for Effective Learning – Part 2 o Switch Access Beyond Cause and Effect: Stepping Stones for Effective Learning – Part 3 • OCALI Assistive Technology Internet Modules (ATIM) o Students With Complex Needs - WATI - Part I o Students With Complex Needs - WATI - Part II REFERENCES Gardner-Fox, D. (2013). When you need your hands to help ... Facilitation guidelines for staff working with students with physical challenges. Retrieved from https://atinternetmodules. org/m/820/5290 Goossens, C., & Crain, S. S. (1992). Utilizing switch interfaces with children who are severely physically challenged: An emphasis on communication strategies (1st ed.). Pro-Ed. Nankee, C. (2016). Using the WATI Assistive Technology Assess- ment Process: Switch Access - Part I: Online training module. In Ohio Center for Autism and Low Incidence (OCALI), Assistive Technology Internet Modules, www.atinternetmodules.org. Co- lumbus, OH: OCALI. Nankee, C. (2016). Using the WATI AT Assessment Process: Switch Access - Part II: Online training module. In Ohio Center for Au- tism and Low Incidence (OCALI), Assistive Technology Internet Modules, www.atinternetmodules.org. Columbus, OH: OCALI. Perspectives of the ASHA Special Interest Groups SIG 12, Vol. 3(Part 1), 2018, Copyright © 2018 American Speech-Lan- guage-Hearing Association

Switch Access Beyond Cause and Effect: Stepping Stones for Effective Learning - Part 1 https://www.youtube.com/watch?v=LmpjiPA_BZg

Switch Access Beyond Cause and Effect: Stepping Stones for Effective Learning - Part 2 https://www.youtube.com/watch?v=c0lwOpP3EqE

Piaget, J. (1951). Play, dreams, and imitation in childhood . W. W. Norton & Company.

Switch Access Beyond Cause and Effect: Stepping Stones for Effective Learning - Part 3 https://www.youtube.com/watch?v=xFuOyvgIXS4

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