Harnessing Assistive Technology Education: Innovative Appro…

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Harnessing Assistive Technology Education: Innovative Approaches for Preparing Occupational Therapy Students

Summary : The breadth of assistive technology (AT) options makes it challenging to effectively teach implementation of AT in entry level education. This article explores the benefits of using a near-peer teaching model in an assistive technologies class in an entry level occupational therapy doctoral program.

INTRODUCTION Assistive technology (AT) is used by occupational therapy practitioners across practice settings to help clients with a variety of diagnosis (Dishman, 2021). The 2023 Accreditation Standards for Occupational Therapy Education (ACOTE) state that occupational therapy (OT) and occupational therapy assistant (OTA) students must be able to implement AT "to reflect the changing needs of the client, sociocultural context, and technological advances" (B.3.8). However, preservice training for OT and OTA students varies across curriculums, and many practicing therapy professionals report feeling unprepared to use AT with their clients (Dishman, 2021). In addition, AT broadly spans across many different categories including augmentative and alternative communication, AT for cognition, smart home technology, computer and gaming access, seating and mobility, and technology for learning disabilities. This breadth

of AT options makes it challenging for faculty and entry level programs to consistently introduce students to everything available. One potential solution to this education challenge is near peer teaching (NPT). This article will discuss the unique way that the occupational therapy department at Virginia Commonwealth University has harnessed NPT to facilitate confidence and learning outcomes in entry level training around assistive technology. THE ROLE OF ASSISTIVE TECHNOLOGY IN OCCUPATIONAL THERAPY PRACTICE Assistive technology, as defined by the Assistive Technology Act of 2004, is “any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities”(29 U.S.C. Sec 2202(2)). Furthermore,

LAUREN ANDELIN, OTD, OTR/L, BCP, Lauren Andelin, OTD, OTR/L, BCP is a pediatric occupational thera- pist with 15 years of clinical experience. Dr. Andelin is an assistant professor in the Department of Occupational Therapy at Virginia Commonwealth University. She also serves as the chairperson for AOTA's Sensory Integration and Processing Special Interest Section and has specialty training in sensory integration and assistive technology.

ISAIAH WILLS , OTD, OTR/L, Isaiah Wills is an occupational therapist who graduated from Virginia Common- wealth University in 2024. Since graduation, Dr. Wills has worked with Live Life Therapy Solutions, Inc. and the Technology for Home grant in Minnesota. LiveLife Therapy Solutions, Inc. provides a wide range of assistive technology services related to environmental controls, AAC, safety, mobility, and home modification needs. Isaiah works with a group of occupational and speech therapists who specialize in adaptive video gaming and computer access.

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assistive technology service is defined as “any services that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.” As related service providers, occupational therapy practitioners should be key members of the teams that assist individuals with disabilities in AT services delivery. Occupational therapy, as defined in the occupational therapy practice framework: Domain and Process–Fourth Edition (2020), is the “therapeutic use of everyday life occupations with persons, groups, or populations for the purpose of enhancing or enabling participation.” The American Occupational Therapy Association’s Position Statement regarding AT devices and services in occupational therapy practice (2024) clearly states the relevance of AT across every aspect of service delivery for OTPs in a variety of practice settings, age groups, and disability profiles. While AT services were once considered a specialized area of practice for OTPs, the influx of commercially available assistive technology as well as the integral role of technology across all aspects of occupational participation, makes it essential for all OT practitioners to have foundational skills related to AT across the OT process (AOTA, 2024). While “assistive technology” can be used to encompass the general areas of devices, services, and systems, the AOTA Position Statement (2024) categorizes AT devices into general functional categories including personal mobility, community mobility, communication technologies, computer and mobile technologies, robotics, technologies for the home, and activities of daily living and self care. CHALLENGES IN AT EDUCATION The 2023 Accreditation Council for Occupational Therapy Education guidelines contain two curriculum standards directly referring to education around AT. In general, OTP students must implement AT "to reflect the changing needs of the client, sociocultural context, and technological advances" (B.3.8). In addition, ACOTE specifies that OT and OTA students must “apply the principles of assessment” and “describe the collaboration process with OT” respectively “to identify appropriate features of assistive technologies and durable medical equipment to support the client’s participation”. OT students must demonstrate the ability to “design, fabricate, apply, fit, and train in assistive technologies and devices used to enhance occupational performance”(B.3.15). Since AT encompasses such a wide breadth of categories and services and the language supporting its integration in occupational therapy education is general, it is not possible for each program to have the same activities and learning objectives for specific types of AT. Therefore, while each program must demonstrate learning activities to achieve these minimum standards, the depth of material and access to AT is variable across accredited OT and OTA programs. In addition, advanced training in AT varies across OTP faculty, further limiting the generalizability of curricular materials.

While some occupational therapy programs dedicate whole courses to the implementation of assistive technology across practice settings and among a variety of clients, other programs include less than a full day of content directly relating to assistive technology. Furthermore, research demonstrates (Penman et al, 2024) the value of hands-on learning and exposure to the different types of equipment and AT that clinicians might encounter in practice, but financial resources and variability in equipment cause further variability in the experience of students in their pre-services training to AT. As new OT and OTA graduates enter the field of occupational therapy, their individual fieldwork experiences and programmatic exposure to AT typically dictate their interest in pursuing further advanced training in AT, perpetuating the cycle of limited exposure. NEAR-PEER TEACHING Near-peer teaching (NPT), generally understood to be a method of peer teaching where the student in the teaching role is at least one year ahead in the same academic program than the students in the student role, can be an effective method to enhance learning outcomes for both the student teacher and the peer (Pinter, et al, 2021). NPT, a subset of peer-assisted learning and sometimes referred to as near-peer mentoring, near-peer tutoring, or cross-peer assisted learning, often occurs in small groups where the more experienced peer models and reinforces learning of their less experienced peers, thereby both teaching peers and learning through teaching (Penman et. al, 2024). The idea behind NPT is that both the near peers and the near learners are cognitively and socially congruent. The more advanced near-peers can explain difficult topics and/or how they learned a more complex technical skills or concept to less academically advanced peers with shared student roles, problems and demands (Loda et. al, 2019). Students learning from near-peers have reported lower pressure when learning from near-peers, leading to more willingness to take risks in their learning. In addition, the near peer teachers gain confidence and teamwork skills to help them in their future practitioner roles (Markowski et. al, 2021). HARNESSING NEAR-PEER TEACHING IN ASSISTIVE TECHNOLOGY EDUCATION FOR OCCUPATIONAL THERAPY STUDENTS During their final semester of academic programming, entry level occupational therapy doctoral (OTD) students are required to complete a doctoral capstone experience (DCE). The DCE consists of a 14 week full-time experience and final project, demonstrating the synthesis and application of knowledge gained during in- depth exposure to one or more focused areas. The OTD program at Virginia Commonwealth University (VCU) structures capstones around three central tracks (Education, Community, and Research), encompassing the eight knowledge areas identified by the Accreditation Council for Occupational Therapy Education (ACOTE,

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2023). In VCU OT’s Education track, students have opportunities to explore academia, gain and apply skills related to the scholarship of teaching and learning, and utilize NPT to the mutual benefit of faculty and students. In the VCU OTD curriculum, we have a three-part activities series, culminating in a 3 credit (1 lecture and 2 lab) course dedicated to using assistive technologies in OT practice. During their final didactic semester in the program, students enroll in the AT course which covers an expansive range of assistive technologies and spans across ages, diagnoses, and practice settings. Throughout the 15 week course, learning activities are scaffolded to allow students an opportunity to experience the AT continuum and service delivery model in a comfortable and engaging environment that encourages hands-on exploration and problem solving. During their first module, students learn about different frameworks to guide their professional reasoning. While students are exposed to several different models, the course primarily teaches students to use the Human Activities Assistive Technology (HAAT) and Student Environment Task Technology (SETT) frameworks to reason through their AT solutions.

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Images 1 and 2: Students creating visual representations of their clinical reasoning for AT solutions using the HATT or SETT frameworks.

Images 3-5: Visual representations of student’s clinical reasoning using the occupational therapy process (OTPF-4) and chosen AT theory to support their reasoning.

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Images 6-12: Students engaging in a case study “fair”, learning from peers about different cases and AT solutions recommended for the different scenarios.

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In subsequent weeks, students are systematically introduced to various types of AT through lectures, hands-on learning, team based problem solving, and innovative lab activities (e.g., escape rooms ( Images 13-17; videos Smart Home 1-4), team based lab activities (Images 18-19), mini design challenges (images 20-26), and practical exams involving case studies and demonstrations of solutions in real time.

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Images 13 through 17: Students participating in escape room lab activity (Image 13) to learn about smart home technology in the smart apartment in VCU’s College of Health Professions Building.

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Video Smart Home 1-4 Students participating in escape room lab activity to reason through a client scenario to determine assistive technology solutions using data driven decision making for precision therapy (Schaaf et. al 2015)

YouTube Video - Video Smart Home 4 https://www.youtube.com/shorts/EbEUNwuR4y4

YouTube Video - Video Smart Home 1 https://www.youtube.com/shorts/f79eJCkmnRc

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YouTube Video - Video Smart Home 2 https://www.youtube.com/shorts/UpbUp1D9Z2Y

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Images 18-19: Students participating in team based lab to learn about setting up smart plugs and home routines using Amazon Alexa.

YouTube Video - Video Smart Home 3 https://www.youtube.com/shorts/8wNqB7Zc6Bg

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Image 20: Worksheet describing students’ assignment of making low tech AT inclusive design solutions for clients from different groups or populations.

Images 21-24: Examples of students’ low tech and commercially available inclusive design solutions.

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Image 25: Worksheet instructions for Universal Design Low Tech Design Challenge.

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and clinical reasoning needed to support clients in the evaluation and implementation of AT in their future practice. Each year, a new capstone student becomes the near peer teacher, immersing themselves into the design and implementation of the course with close mentorship from the faculty member (first author) teaching the course. In addition, the student typically has a special topic of interest that enhances the course content as technology evolves. Last year’s student, Isaiah Wills (second author) developed a comprehensive adaptive gaming module. First students learned about basic gaming systems and different assistive technology to support gamers of all abilities (images 27-28), and then students participated in a multi-station lab activity in teams to get hands-on experience with adaptive gaming (Videos AG 1-3). When Isaiah presented his adaptive gaming materials during one of the final weeks of the semester, students were prepared to layer onto their other knowledge. At this point, students had already worked with different access methods (e.g., head, eyes, hands, feet) and switch controls (e.g., one switch and two switch scanning, various types of switches) across a variety of platforms (e.g., tablets, desktop computers, mobile devices), so learning about how to incorporate this into the occupation of video gaming was an appropriate challenge. QR code 1(https://bit.ly/AdGaming) provides examples of Isaiah’s materials and resources for others hoping to build on his work.

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Generally, the first half of the semester is dedicated to enhancing students’ comfortability in creating solutions for home and community design as well as AT for mobility, including manual and power wheelchairs and alternative drive controls. The second half of the semester focuses on accessibility for computers and tablets, switch control, AAC, AT for leisure, and AT for cognition. While each week of class focuses on new content and/or new types of technologies, students are expected to build on previous knowledge to begin designing more complex and integrated solutions for their case studies as the class progresses. For their final practical exam, students are split into teams of two or three and asked to develop a comprehensive AT solution for a client with complex needs in areas that may include sensory, motor, and/or cognition. Through this practical exam, students are encouraged to creatively integrate all of the tools they have learned about over the semester, allowing them to practice the type of clinical reasoning that is expected in real world practice. In addition to supporting lab development and updating the ever changing array of resources available for assistive technology, the near peer teacher collaborates with the faculty for the course to host a series of open lab opportunities for students to trial solutions and talk through clinical reasoning and ideas prior to the practical exam. Students report feeling more confident in experimenting with AT solutions through these experiences and student feedback for the near peer support is consistently positive. In the most recent cohort, students said, “[The NPT] was instrumental in advancing my understanding of AT, from the lab activities and open labs to [their] one-on-one conversations,” and “Even on the off chance where [the NPT] was also confused–usually due to technical difficulties–, [the NPT] problem solved with us to help us figure it out.” CONCLUSION The use of NPT to support the assistive technologies course in the VCU curriculum has been instrumental over the past five years, allowing our program to provide students with the skills Image 26: Example Low Tech Solutions for Spaces to increase accessibility of spaces.

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Image 30: Student using tobiidynavoxx PCI with surface tablet to play candycrush using eye gaze.

Images 27-28: NPT capstone student, Isaiah Wills (second author) presenting information about adaptive gaming prior to hands on lab activities that he developed for this module as part of his capstone project.

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Image 31: Isaiah Wills (second author and 2024 capstone student teaching faculty member, Lauren Andelin (first author) to play a common video game using commercial controller.

Image 29: Student using xbox adaptive controller to play Rocket League with different switches.

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As we continue to embrace the use of artificial intelligence (AI), particularly chatbots and other cognitive supports, this year’s capstone student plans to develop materials for the course with a particular focus on AI. It is exciting to consider how the use of near peer teaching can continue to support occupational therapy students’confidence in using AT with their future clients. SPECIAL THANKS The Herbert and Charlotte Meyer Assistive Technologies Laboratory & Quiet Room in the VCU College of Health Professions, was made possible by Dr. John H. and Mrs. Carlyn Meyer Dalness, in memory of her parents. The lab space features advanced technology which provides occupational therapy students with further training as they prepare to serve patients in clinical settings after completion of their studies. https://chp. vcu.edu/about/featured-news/articles/a-look-at-the-assistive- technologies-laboratory.html REFERENCES Accreditation Council for Occupational Therapy Education (2023). 2023 Accreditation Council for Occupational Therapy Education Standards and Interpretive Guide. https://acoteonline.org/accreditation-explained/ standards/

YouTube Video - Video AG 1: Students use XBox adaptive controller and different switches to play Rocket League. https://www.youtube.com/watch?v=sVD85iEJ2CM

YouTube Video - Video AG 2: Students using Ablenet Hitch 2 switch interface with different switches to play battleship on imac computer. https://www.youtube.com/watch?v=HyJ9-SG9L-I

Assistive Technology Act of 2004, 29 U.S.C. § 2202(2) et seq. (2004).

Assistive technology devices and services in occupational therapy practice. The American Journal of Occupational Therapy , 2024, Vol. 78(Supplement 1), 7810410130. https://doi.org/10.5014/ajot.2024.78S106 Dishman, K., Duckart, J., & Hardman, L.J. (2021). Perceptions of assistive technology education from occupational therapists certified as assistive technology professionals. American Journal of Occupational Therapy. 75(2). doi: 10.5014/ajot.2021.041541. PMID: 33657353.

YouTube Video - Video AG 3: Student using tobidynavox PCI with surface tablet to play candy crush using eye gaze access. https://www.youtube.com/watch?v=PZTIg5h1qVY

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Loda, T., Erschens, R., Loenneker, H., Keifenheim, K.E., Nikendei, C., Junne F., Zipfel, S., & Herrmann-Werner, A. (2019). Cognitive and social congruence in peer-assisted learning – a scoping review. PLoS ONE 14(9): e0222224. https://doi.org/10.1371/journal.pone.0222224 Markowski, M., Bower, H., Essay, R., & Yearley, C. (2021). Peer learning and collaborative placement models in health care: a systematic review and qualitative synthesis of the literature. Journal of Clinical Nursing , 30(11-12), https://doi.org/10.1111/jocn.15661 Penman, M., Tai, J., Evans, G., Brentnall, J., & Judd, B. (2024). Designing near-peer mentoring for work integrated learning outcomes: a systematic review. BMC Med Education 24(937). https://doi.org/10.1186/s12909-024-05900-6 Pintér, Z., Kardos, D., Varga, P., Kopjar, E., Kovacs, A., Than, P., Szilard, R., Czopf, L., Zsuzsanna, F., & Schleg, A.T. (2021). Effectivity of near-peer teaching in training of basic surgical skills – a randomizedcontrolledtrial.BMCMedicalEducation,21(156). https://doi.org/10.1186/s12909-021-02590-2 Schaaf, R. C., & Mailloux, Z. (2015). Clinician’s guide for implementing Ayres Sensory Integration: Promoting participation for children with autism. AOTA Press Zsuzsanna, F., & Schleg, A.T. (2021). Effectivity of near-peer teaching in training of basic surgical skills – a randomized controlled trial. BMC Medical Education, 21(156). https://doi.org/10.1186/s12909-021-02590-2

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