Scenario 6 - Organizing seating and equipment for an individual pupil

Michael is fifteen years old and has cerebral palsy. He attends a special unit for pupils with severe and complex disabilities, located in a secondary school. Michael has severe physical involvement, communication difficulties, and is visually impaired. He cannot maintain sitting balance and requires seating to support his pelvis and trunk. He also uses a standing frame for part of the day. The seat and standing frame were both specified by the visiting occupational and physiotherapists; positioning is reviewed regularly. The therapists also recommended a timetable for the periods when Michael is in his CAPS II seat, frame, and lying unsupported on a floor mat; this was devised to fit in with the unit activities throughout the day.

Michael has had little experience of ICT, but recently a specialist ICT / AAC Centre was engaged to visit and make recommendations for use of ICT. The main suggestions were:

• more opportunities for choice making through verbal scanning
• purchase of two modern computer workstations for the unit (to replace an Acorn and a BBC machine)
• adjustable-height trolleys, so that the computers can be raised and lowered to be accessible when the pupils are seated and also in standing frames
• simple switch-operated technology such as single message communication aids, and toys, to introduce and develop basic switch control, communication skills, and independence
• more opportunities for choice making through verbal scanning
• investigation of a Smart Wheelchair, for shared use by several children within the unit
• ‘early learning’ switch software, such as the SwitchIt! series from Inclusive Technology
• that Michael operates this equipment with a single switch, located to the left side of his head

In this sort of situation it is important to get advice from an occupational therapist, bioengineer, or other specialist, not only to help with assessing the best position for the switch, but also to help with mounting it in that position.

The photograph shows a Jelly Bean switch, positioned using a Universal Switch Mount. These were used during the assessment; the Magic Arm is good for experimenting with switch positions as it can be clamped to most seats and chairs, and moved around quickly. However, it is fairly bulky and can be easily knocked out of position accidentally. A better system for day-to-day use would be a bespoke mounting made from individual clamps, poles and connections, such as those available from the QED Mobilia, Daessy Stem, or Leckey ranges. These can be attached to the head rest, and easily detached or swung away when not in use. In most cases you would be advised to contact an occupational therapist or other specialist to help order the correct parts and fit them properly.

The following units provide more information about these resources and how they may be used:
Unit 3 – Language and communication
Unit 5 – ICT resources for pupils with multiple disabilities
Unit 8 – The development of switching skills

Key skills and equipment

The key skills for the above example are the ability to:

• liaise effectively with occupational, speech and language and physiotherapists, and bioengineers
• set up and operate switch controlled devices and software
• integrate use of these ICT resources into the curriculum

• special seating and positioning equipment
• adjustable height trolley
• a head switch, with appropriate mounting system
• switch operated devices and software

Accessibility features of computers

Windows and Macintosh computers have built-in facilities for people who have difficulty using the standard keyboard and mouse. Sometimes, making simple adjustments to the keyboard and mouse is all that is needed to improve a pupil’s access to the keyboard and mouse: for example, slowing down the key repeat or mouse speed. It is always worth looking at the basic positioning and built-in settings before reaching for specialized and possibly complex and expensive alternatives.

Keyboard adjustments

Adjusting the keyboard response settings in the computer can help pupils who have motor problems or who type using a finger, head-pointer, or mouth stick. The various types of settings are described below, while the appendices show how they are adjusted for Windows and Macintosh computers.

Try these options out on your computer, or log on to the interactive tutorial programs on the CALL Centre Web site: callcentre.education.ed.ac.uk/sat_interactive/home.htm

The keyboard settings will need to be carefully adjusted to suit individual users – this usually requires some trial and error. The physical condition, such as muscle tone and motor coordination, of some pupils may change from day-to-day or over a longer period of time, so it is important to monitor the pupil’s use of the keyboard on regular basis and make adjustments to the filter and other settings accordingly.

• Input Acceptance Filter (‘SlowKeys’)
  The Input Acceptance Filter slows down the response of the keyboard so that the user has to keep the key pressed down for a set time, called the input acceptance time, before it is accepted. If the pupil tends to ‘knock’ other keys when typing, increase the input acceptance time until the unintentional key presses are filtered out.
• Tremor Filter (‘FilterKeys’)
  The Tremor or Post Acceptance Filter should be used if the pupil tremors when trying to release a key, causing the key to be pressed a few more times. This filter slows down the response of the keyboard after a key has been released by ignoring further key presses for a certain time, called the post acceptance delay.
• Repeat Filters (‘RepeatKeys’)
  Some pupils have difficulty releasing a key after pressing, and get several unwanted letters appearing on screen. Prevent this by increasing the repeat delay or turn the repeat off completely. When a key is held down, it will start repeating once the repeat delay has finished. The interval between successive repeats is determined by the repeat time
• Sticky Keys
  Pupils who type using a single finger, mouth stick or head-pointer are not be able to hold down the modifier keys (Shift, Alt, Ctrl) in order to produce shifted characters and commands. The Sticky Keys feature overcomes this problem by allowing the user to tap once on one or more modifier keys to have them latched (held down) for one key press. For example, a capital ‘S’ can be typed by tapping Shift to latch it, and then pressing ‘s’; the ‘Shift’ key is automatically unlatched after typing the letter.
• Auditory Feedback (‘Key Beeps’)
  When a learner is concentrating on hitting the correct key on the keyboard, it can be helpful to have feedback that the key has been pressed successfully. Windows and Macintosh computers can both issue a range of different sounds to indicate when keys are pressed, or Shift or other modifier keys are locked down. Users with visual impairment who are not able to see the status indicator light for the Caps lock or modifier keys may benefit from ToggleKeys which gives sounds when these keys are locked down and released.
• Visual feedback (‘ShowSounds’)
  Users with hearing impairment may benefit from visual feedback of keyboard events; for example, if the program beeps, the ShowSounds facility might flash the border round the window, or display a text message.

To adjust these settings on a Windows computer, you need to look in the Keyboard, Mouse and Accessibility Options Control Panels. These can be found from Settings in the Start menu. See Appendix 3.

Macintosh users should look in the Control Panels in the Apple menu at the top left of the screen. Here, the adjustments are made using the Keyboard, Mouse and Easy Access Control Panels. See Appendix 4.

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