Unit-1

Syllabus: Definition and historical overview of assistive technology, multidisciplinary

nature of service provision, introduction to adaptations framework, selecting specific
characteristics, evaluation of effectiveness of adaptations.

1.1.1. DEFINITION – ASSISTIVE TECHNOLOGY (AT)

Assistive Technology is defined as “the application of practical or industrial arts that help
people with disabilities.”
AT is a concept or a perspective that leads to make practical decisions about specific devices,
services, and adaptations that can be used by people with disabilities, their advocates, and
their family members to make independence possible.
“For people without disabilities, technology makes things easier; for people with disabilities,
technology makes things possible.”
Assistive Technology Device

An assistive technology device refers to “any item, piece of equipment, or product system,
whether acquired commercially off the shelf, modified, or customized, that is used to
increase, maintain or improve the functional capabilities of a child/person with a
disability”. It includes any item or system, from electronic wheelchairs for people with
mobility impairments to remedial reading software programs for children with dyslexia.
There are three components of the AT device definition: What it is, how it is made, and its
use.
The what refers to the unit itself, which can be an item (a Hoover cane to help a person who
is blind move about), a piece of equipment (a corner chair that supports a child’s torso in
extension, which helps the shoulders and arms to move freely), or a product system (a
computer with speech recognition software and a microphone attachment that allows a person
to speak into the computer and have the spoken words translated to text in a word processing
program).
The how refers to whether the device is purchased as an “as-is” item in a store (a motorized
wheelchair from a mobility vendor), modified (the same chair, but with “special features,”
such as balloon tires for beach access), or customized (the same type of chair but one that is
created especially for a person with very specific needs).
The use deals with the purpose of the device as it pertains to the user. The device has to be
able to be used either to enhance a person’s functioning or to maintain functioning at its
current level, that is, to prevent a condition from worsening. This means that the device
allows a person with a disability either to do something that he or she could not do without
the device or to keep doing what is currently being done.
AT devices are grouped into seven categories.
i. Positioning refers to finding the best posture for a person to be in for a particular
function. This function might entail moving about from one place to another,
sitting during conversation, eating, sleeping, and so on. Physical and occupational
therapists are key professional contacts who deal with positioning issues.
ii. Mobility refers to the act of movement. Humans are active creatures, and
mobility allows doing everything from flipping the pages of a book to boarding
an airplane. Thus, AT devices that facilitates mobility help people move about in
various environments. Mobility devices include wheelchairs, children’s scooter
boards, vehicular modifications, white canes, electronic direction finding/
mobility aids, and other adaptations and devices. Rehabilitation engineers,
physical therapists, orientation and mobility specialists, and engineers are vital
team members when mobility issues are discussed.
iii. Augmentative and alternative communication (AAC) devices help people to
communicate with each other, even if they have speech difficulties.
iv. Computer access devices are those that allow people to use the computer, even if
their disability inhibits typical access. For example, instead of using a
conventional keyboard to input information into a computer, people with physical
impairments can use beams of light to activate or simulate a terminal. Or they can
speak into a microphone and tell the computer what functions to employ. People
who are blind require alternative output methodologies for computer use, and text
to speech offers a critical access feature. Educators and rehabilitation specialists
typically are called on to assist in this area.
v. Adaptive toys and games is an area of assistive technology that provides
children with disabilities the opportunity to play with toys, games, and one
another, thus allowing children to develop cognitive skills associated with these
activities.
vi. Aids to daily living refers to the use of devices and approaches that allow a
person to manipulate the environment to allow for daily living, working,
schooling, playing, etc. For instance, most people use remote control units to
change channels on their television sets without having to get up from the couch.
People with disabilities can do the same thing and also can use the same units to
turn lights on and off, respond to a ring of the doorbell, adjust their beds, and
carry on a number of other activities in the home, school, or workplace.
vii. Instructional aids help educate a person in school or during employment
training. Instructional aids also can be used during functional living skills training
in an adult’s new home. Whatever the application, this broad category involves
devices and adaptations that help facilitate learning in one way or another.
Instructional aids include technology that is used to compensate for a person’s
functional limitations (e.g., screen reader programs that allow for information
access) or technology that is used for remediation purposes (e.g., math or reading
instructional programs).
Assistive Technology Service
The term ‘assistive technology service’ means any service that directly assists a child with a
disability in the selection, acquisition, or use of an assistive technology device. Such term
includes —
 the evaluation of the needs of such child, including a functional evaluation of the
child in the child’s customary environment;
 purchasing, leasing, or otherwise providing for the acquisition of assistive technology
devices by such child;
 selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing,
or replacing assistive technology devices;
 coordinating and using other therapies, interventions, or services with assistive
technology devices, such as those associated with existing education and
rehabilitation plans and programs;
 training or technical assistance for such child, or the family of such child; and
 training or technical assistance for professionals (including individuals providing
education and rehabilitation services), employers, or other individuals who provide
services to, employ, or involved in the major life functions of such child.

Instructional Technology

Instructional technology refers to any technology that is used as part of the education of an
individual. The term includes presentation hardware and software used by teachers and
students, including overhead transparencies and projectors; multimedia software and tools;
Internet technology for watching real-time activities. The term also includes instructional
software that is used to remediate academic weaknesses.
Phil has no reading difficulties and uses the instructional software to improve his skills.
Maria has dyslexia and uses the instructional software and hardware (a computer) to
“increase her functional (reading) capabilities.” For Phil, the technology is helpful; for Maria,
the software is assistive, that is, an AT device.
Instructional technology also can include such techniques as anchoring instruction, when the
technique involves the use of CD-ROMs, video, or some other technology. This and other
instructional approaches and devices provide the educator with innovative ways to instruct,
whether that instruction occurs in a classroom, a workplace, at home, or elsewhere.

Adaptations

Adaptations are alterations that are made so that a person who does not possess the requisite
abilities needed for task completion can accomplish a task. In this way, adaptations are access
vehicles that facilitate participation and inclusion in everyday activities. Not every adaptation
requires AT devices. Yet, a mind-set for making adaptations is necessary for anyone who
interacts with people who have disabilities. Otherwise, people with disabilities are destined to
be excluded from activities in which they could participate.
It is also important to understand that adaptations can be either remedial or compensatory.
The example of the instructional program being used by Maria and Phil to improve their
reading skills would be considered a remedial adaptation. But if Maria uses a screen reader
program to access her e-mail by bypassing her area of weakness (i.e., reading), then the
adaptation would be compensatory. Many of the devices and approaches discussed will be
compensatory in scope, but it should not be assumed that remediation and compensation are
mutually exclusive concepts. For instance, one never gives up trying to teach a non-reader
how to read, so AT devices can be used for remediation purposes throughout the lifespan. But
it is also important that a person have access to print, so the use of a compensatory strategy
concurrently with remedial efforts is reasonable.

1.1.2. HISTORICAL OVERVIEW OF ASSISTIVE TECHNOLOGY

Foundation Period: Pre-1900s

One of the earliest incidences of acquired learning disabilities can be traced to A.D. 33, when
Mecurial reported the case of a man losing his memory for letters after being hit on the head
with an axe during a skirmish.
The first recorded spinal surgery occurred around A.D. 600, providing evidence that
individuals existed with acquired physical conditions required postsurgical adaptations for
remaining functional limitations (special feeding utensils and techniques or specially
designed wheeled mobility mechanisms).
Further examination of historical accounts shows autopsies being performed on deceased
veterans in the 1600s and 1700s to examine causal factors for physical and mental conditions.
There are evidences of seafarers with wooden legs and hooks continuing to go to sea long
after injuries caused the loss of their extremities.
At the end of the 18th century, special education began with Dr. Jean-Marc-Gaspard Itard’s
efforts to teach Victor, nicknamed “The Wild Boy of Aveyron” because of his early years
spent in seclusion in the woods of France.
In 1817, Thomas Hopkins Gallaudet opened his school for students who were deaf. The name
of the school is the American Asylum for Education of the Deaf and Dumb (the American
School for the Deaf).
Twelve years later, Louis Braille introduced an adaptation of Barbier’s “Ecriture Nocturne”
(night writing, originally developed for the French military) embossed code so that people
who were blind could decode the printed word. In 1834, he perfected the literary code that
bears his name.
Dr. J. G. Blomer established an institute for people with physical disabilities where he
maintained a workroom for devising apparatus, bandages, and artificial limbs (early AT
devices).
Samuel Gridley Howe started the New England Asylum for the Blind (Perkins School for the
Blind) in 1832, providing educational services that utilized a variety of techniques specially
tailored to the students’ visual needs.
In 1836, Taylor devised what was thought to be the first tangible math apparatus that could
be used by individuals who were blind.
The American Annals of the Deaf was first published in 1847, followed a year later by the
opening of the first residential institution for people with mental retardation (the Perkins
Institution in Boston).
In 1855, Kentucky set up a printing house for people who were blind, which later
incorporated as the American Printing House for the Blind.
In 1860, the Gallaudet Guide and Deaf Mute’s Companion became the first publication
written especially for people with disabilities. Four years later, in 1864, Gallaudet University
was founded as the National Deaf Mute College.
In 1869, a patent was filed for the basic design for the manual wheelchair in use to this day.
The wheelchair had been introduced in the United States during the Civil War, when wooden
chairs and wooden wheels provided mobility for soldiers whose legs had been amputated.
In 1877, Thomas Edison invented the phonograph, a significant event for those who would
later benefit from learning through listening to material on recordings.
Two years later, Public Law 45-186 provided a subsidy to provide books in Braille; the same
law also funded the American Printing House for the Blind.
Then, in 1884, the Home of the Merciful Savior opened its doors in Philadelphia to children
with physical disabilities. Finally, in 1892, Frank Hall invented the Braille typewriter.
Establishment Period: 1900–1972

The 72-year period from 1900 through 1972 is labelled as the Establishment Period because
these years established the disability disciplines as specific entities, and the policies, laws,
and litigation that emerged during this time ushered in an era of unprecedented gains for
people with disabilities, their families, and their advocates. Throughout this period,
educational, scientific, and psychological advances were made concerning the causes,
preventions, and ramifications of disabilities. People’s viewpoints concerning disabilities and
the capabilities of people with disabilities changed dramatically. Devices and techniques were
devised to help people with disabilities utilize their strengths to compensate for their
limitations. In addition, legal and procedural barriers that discriminated against people seen
as “different” were addressed. Finally, organizations such as the currently named Council for
Exceptional Children, American Speech-Language-Hearing Association, American
Association on Intellectual and Developmental Disabilities, Easter Seals, United Cerebral
Palsy, the ARC, and the Learning Disabilities Association of America, to name but a few,
were formed to advocate for people with disabilities and the professionals and families
associated with the disability movement.
After World War I, the U.S. Congress recognized the results of battle-caused disabilities
when it passed the Soldier Rehabilitation Act (Smith-Sears Veterans Rehabilitation Act) in
1918. This significant legislation was intended to help veterans with disabilities resume life,
post-disability, and included the first vocational rehabilitation provision.

Two years later, the Smith-Fess Civilian Vocational Rehabilitation Act was passed, extending
vocational rehabilitation services to nonveterans whose challenges were similar to those of
their military counterparts. Funds were provided for vocational guidance, training, job
adjustment, prostheses, and placement services. Clearly, recognition of functional capabilities
and people’s assets became the rule rather than the exception; rehabilitation professionals
focused on using techniques and devices to help people compensate for their functional
limitations. Not surprisingly, this new focus brought about a new emphasis on compensatory
strategies and equipment that would change the face of disabilities forever.

In 1920 Barr, Stroud, and Fournier d’Albe patented the first reading machine, the Optophone,
for use by people who were blind. Three years later, Barr and colleagues expanded their
apparatus facilities to deal with the increased demands for their services.

By the end of the decade, guide dogs had been introduced to America, providing mobility
independence potential to people who were blind. Breakthroughs in blindness continued,
including the National Institute for the Blind’s introduction of a high-speed rotary press for
embossed type and the Library of Congress’s 1931 decision to distribute Braille reading
materials under its auspices. The next year, long-standing debate as to the “preferred” Braille
style partially was settled when British and American committees adopted Standard English
Braille as uniform type.

In 1933, the American Printing House for the Blind adopted Standard English Braille Grade 2
for junior and senior high school textbooks. A few years later, the first talking books on long
playing records were produced and disseminated. By 1936, the American Printing House for
the Blind had produced and disseminated its first recorded materials.

In 1932, an engineer named Harry Jennings ushered in a new era in mobility enhancements
when he built the first folding, tubular steel wheelchair.

The passage of the Social Security Act in 1935 provided grants to states for assisting (a)
individuals who were blind and (b) children with disabilities. The decade of the 1930s also
produced the Coyne Voice Pitch Indicator, which allowed people’s speech patterns to appear
as visual images. The year 1937 brought a patent for the X-frame folding wheelchair by
Herbert A. Everest and Harry C. Jennings. In 1939, Lowenfeld began his six-year exploration
of the educational role of talking books, which resulted in the demonstrated value of these
tools in the teaching-learning process. Also in 1939, Homer Dudley presented the VODER,
which produced electrically generated synthesized speech sounds at the World Fair.

The Barden-LaFollette Act, also known as the Rehabilitation Act of 1943, introduced training
funds for physicians, nurses, rehabilitation counselors, physical therapists, occupational
therapists, social workers, psychologists, and other rehabilitation specialists.

The year 1947 brought about the introduction of the Hoover cane, which was developed as
part of a comprehensive approach to orientation and mobility training that was known as the
“touch cane technique” and was designed in part to assist veterans who became blind during
World War II. Annie T. McDonald established the organization to help veterans who had lost
their sight during the war obtain an education under the G.I. Bill of Rights.
In the latter part of 1940, Sir Ludwig Guttman, a German-born neurologist, first came up with
the idea of creating a separate Olympic competition for World War II veterans with spinal
fractures. His efforts led to the Paralympic Games, which were first held in 1960 in Rome.

Computerized Braille was first demonstrated in 1955, and the following year the American
Printing House for the Blind first made materials available for day school students. By 1957,
the Visotonor - transformed musical sounds to letters, and Visotactor- a reading machine that
produced vibrations that could be felt by the fingers in order to facilitate decoding were
available.

The 1960s saw legislation intended for students who were bilingual (the Bilingual Education
Act of 1968) and who had learning disabilities (the Children with Specific Learning
Disabilities Act of 1969).

The lasercane, which emitted beams of light to detect objects deterring unobstructed
movement, was invented in 1966 and helped people receive advance notice of obstacles and
detect items that were not detected by a traditional white cane (e.g., things that would hit
above the elbow). In 1971, the Optacon was marketed as another tool to allow people who
were blind to read text. In that same year, the first Braille Vision Books were produced,
which contained one page for Braille next to a page of print.

Empowerment Period: 1973 to Present

The year 1973 was selected because that was the year the Rehabilitation Act was revised to
include Section 504, which for the first time made it formal United States policy that
discrimination against people with disabilities would not be tolerated.

With regard to assistive technology, Title II of Section 504 referred to auxiliary aids, which
must be provided when necessary to ensure that a person with a disability has an equal
opportunity to benefit from programs and services provided by a public entity. The law
further states that auxiliary aids need not produce the identical result or level of achievement
for people with and without disabilities. Rather, such aids simply provide a level playing field
in which all people have the same opportunity to succeed. The U.S. Department of
Education’s Office for Civil Rights (OCR) is the enforcement agency for Section 504 and
responds to students and others who question their university’s or college’s adherence to the
auxiliary aid provision.

The year 1974 introduced the development of the closed-circuit television (CCTV) for the
electronic magnification of print, and the first compact Braille electronic calculator was
developed. In the following year, an early version of the speech synthesizer was developed
and the first talking calculator with audio and visual output was introduced.

In 1975, special education law was enacted with the passage of PL 94-142, later named the
Education for All Handicapped Children Act (EHA). Education for students with disabilities
was now protected in public schools and at publicly supported institutions of higher learning.
A period of extraordinary AT development to support educational activities and post-
educational employment and living was about to begin.
In 1976, the Kurzweil Reading Machine gave people who were blind the opportunity to
access text, but it was so costly that few could afford the technology at the time. During the
four years between 1976 and 1979, the Optacon Dissemination project saw that device used
with increasing frequency. Grants became available to provide adaptive equipment to
classrooms and concurrent training to classroom teachers.

Also in 1976, Pialoux, Chouard and McLeod published a paper in the journal Acta Oto-
Laryngologica reporting that they had implanted eight-channel cochlear implants in seven
patients, and that the recipients had understood about 50% of ordinary words without lip-
reading. This was the first such audiological data to be reported in the literature.

VersaBraille was introduced in 1978, followed by the View Scan. The first Braille embosser
connected to a microcomputer was introduced in the late 1970s, increasing dramatically the
availability of Braille text to children and adults. At the same time, IBM operated its special
needs unit, which led the way in developing and adapting technology for people with
disabilities.

The Education for All Handicapped Children Act (EHA) was passed in 1975 and
implemented in 1978. For the first time, a federal law mandated that all children with
disabilities would receive a free, appropriate public education.

EHA was modified in 1985 and made its first provisions for AT. The reauthorization of the
law in 1997 went so far as to mandate the consideration of assistive technology for all
students with disabilities.

The passage of the Americans with Disabilities Act (ADA) in 1990 continued the string of
legislation passed on behalf of people with disabilities by extending the principles of Section
504 to all sectors of the United States, public and private.

One important component of the ADA was the institution of curb cuts so that all public
locations would be accessible to all people. Although curb cuts had been in place in previous
years, for the first time they had to be placed in spots where wheelchair users could move
along sidewalks without endangering themselves. Thus, a common barrier for wheelchair
users was required by law to be removed. Curb cuts not only helped wheelchair users move
about their environment with fewer obstacles, they also proved useful for people with baby
carriages, luggage, carts, and any other items with wheels.

Another law is the Technology-Related Assistance for Individuals with Disabilities Act of
1988 (commonly called the Tech Act) and its reauthorizations of 1992 and 1998. The overall
purpose of the Tech Act was to provide financial assistance to states to help them develop
consumer-responsive, cross-age, and cross-disability programs of technology-related
assistance (Rehabilitation Engineering and Assistive Technology Society of North America
[RESNA], 1992). Although assistive technology has been viewed historically as beneficial to
individuals with physical and sensory impairments, over time there has been an increased
focus on technology for people with all types of disabilities.
In 1997 Dragon Systems published Dragon NaturallySpeaking, Personal Edition, V1.0, the
first continuous-speech, general-purpose, large-vocabulary speech recognition system. Recent
developments in speech synthesis, graphics magnification, Braille printers, augmentative
communication devices, wheelchair production, hearing magnification, environmental control
units, AAC devices, and so forth have increased the proficiency of the technology and, for the
most part, driven costs down to an affordable level for most consumers.

Innovations for all technology users, such as wireless Internet, e-text, and cell phones,
provide almost limitless information accessibility for people with disabilities. CD-ROMS and
e-books help make widespread access to text that students with disabilities (and those who
read for enjoyment) only dreamed of 10 years ago. Perhaps universal design (see Chapter 2)
for classrooms, homes, and businesses has yet to become pervasive, but its applications have
proven to be successful in the past 10 years or so, and it is only a matter of time before these
applications are commonplace. Colleges and universities throughout the United States are
reconfiguring old buildings to allow access for all students, and schools are providing AT
devices and services to their students with disabilities in unprecedented numbers.

Accessibility is now also extended to print materials in public schools. State education
agencies (SEAs) and local education agencies (LEAs) are required to ensure that textbooks
and related core instructional materials are provided to students with print disabilities in
specialized formats in a timely manner (Section 300.172, Final Regulations of IDEA 2004).
Print disabilities include visual impairments, physical limitations, and organic dysfunction,
including students who cannot see print, turn pages in books, and/or read print (e.g., students
with reading disabilities/ dyslexia).
1.1.3. MULTIDISCIPLINARY NATURE OF ASSISTIVE TECHNOLOGY
SERVICE PROVISION
It is the nature of assistive technology to be multidisciplinary in that professionals involved in
AT come from education, medicine, speech-language pathology, occupational therapy,
physical therapy, social work, rehabilitation counseling, and engineering, among other fields.
Terms such as AT are synonymous with adaptive technology, adaptive aids, auxiliary aids,
rehabilitation technology, prostheses, and other such terms that make the field somewhat
confusing at times. In addition, there has traditionally been a knowledge gap among
professionals; between professionals and consumers; and among professionals, consumers,
and vendors. For example, a consumer or family member may hear of an AT device that
seems the perfect answer to the person’s difficulties. In some instances, professionals may
never have heard of the device, or perhaps the reality of the device is not what the consumer
or family member had perceived. And vendors may be quick to point out the virtues of a
device without mentioning potential drawbacks. Added to this may be the “this is what we
have, so take it or leave it” mentality, which results from having a library of devices from
which people are expected to choose. The reality of AT is that it is a constantly evolving
field, with new devices being created and improvements made in existing devices seemingly
on a daily basis. A quick tour of the Exhibits Hall at Closing the Gap or CSUN leaves the
attendees with their heads spinning from the myriad of devices, all with advantages and
potential problems.
Without doubt, knowledgeable leadership and participation in the AT evaluation and
implementation processes is critical to successful AT use. Further, interdisciplinary
knowledge (i.e., knowledge of how all professionals contribute to the process by bringing
specific skills to the table and shared knowledge about devices and services among
professionals) promotes dialogue and eventual integration of the devices into the consumer’s
daily life. Augmentative communication is not strictly the responsibility of speech-language
pathologists, nor are positioning and mobility issues restricted to physical and occupational
therapists. In the same way, if only educators or rehabilitation specialists know computer
access issues, the picture is destined to be incomplete.
That said, there is a growing awareness that professionals need to work together and cross
disciplinary boundaries for the good of the user. The degree to which that awareness
translates to actual practice will dramatically affect the ability to acquire and use AT devices
and services in a timely fashion.

1.2.1. ASSISTIVE TECHNOLOGY ADAPTATIONS

Adaptations become “assistive technology” when they conform to the definition of such
technology and help individuals “improve functional capabilities.” Thus, if a person with a
disability uses a device, it becomes assistive when it is “used to increase, maintain or improve
the functional capabilities of individuals with disabilities. AT, in some instances, is simply
technology that becomes assistive when its use satisfies the criteria found in the AT
definition. For example, a calculator is “helpful” technology to many people but can be
considered AT when used to perform basic calculations by an individual with a mathematics
disability. Similarly, a doctor might dictate her findings about a patient into a handheld
recording device. For someone with traumatic brain injury or a learning disability who needs
assistance to remember items and appointments, a personal handheld device may be crucial in
helping the individual with daily living skills; thus, the device becomes a type of assistive
technology. Finally, a person might enjoy listening to a favorite novel on a CD, whereas, for
a person with a print disability (blindness, visual impairment, physical limitations, organic
dysfunction such as a learning disability in reading/dyslexia), an electronic novel might be
the best way to access the book and thus becomes assistive technology for that individual. AT
adaptations can also be thought of in terms of their features, thus ranging from simple to
complex.
Simple-to-Complex Adaptation Features
AT adaptations range on a continuum from simple to complex depending on features such as
types of AT (e.g., technological: hardware platform specifications, electronic capabilities; and
nontechnological: enlarged print, writing template, adaptive eating utensil); ease of
implementation; maintenance demands; environmental needs; and user, family, and
teacher/caregiver training requirements.
For example, a calculator with large keys might be considered a relatively simple adaptation
because the technology components are quite simple, it is fairly simple to use, maintenance
costs are restricted primarily to battery replacement, it can be used and stored in a small
space, and only limited training is necessary. On the other hand, an augmentative
communication piece of software, such as Speaking Dynamically Pro (software that speaks
what is displayed on the screen), would be an example of a complex AT adaptation.
This software requires training for the user, family, and teacher on the technological features
such as graphics, buttons, digitized speech, scanning and printing capabilities, word
processing abilities, and various access method capabilities. Although these are excellent
features in terms of providing communication options for the user, the software is complex to
use, at least initially, would require an upgrade as needed, and must be compatible with
available computer platforms.
Types of AT Adaptations
AT adaptations vary considerably depending on the no-, lower-, or higher-tech nature of the
device or software. “No-tech” adaptations can be quite simple and appropriate for the user. A
universal cuff to help the user hold something (crayon or cup); a grab bar in a bathtub to
provide an individual with a physical disability much-needed support; a toothbrush with a
built-up handle to help the person with fine motor problems hold the device; a key guard to
limit random, erroneous keystrokes often caused by limited fine motor coordination; and
enlarged print for someone with a print disability are examples of no-tech adaptations.
Lower-tech adaptations might include page turners for books to enable a person with limited
use of upper extremities to have access to print, a talking watch to help an individual who has
a visual impairment tell time, a simple voice output device to aid communication, and a
signaling device to alert someone with a hearing impairment that the doorbell is ringing.
Finally, a powered wheelchair for an individual with a mobility impairment, a voice output
device with speech synthesis to facilitate communication, and an interface and switch to turn
electrical appliances on and off as part of environmental control are examples of higher-tech
adaptations.
Ease of Use
The use of the AT adaptation should be evaluated carefully by professionals, family
members, and users by examining several factors.
First, it should be noted how easy it is for the AT adaptation to be used and whether further
training is required. For example, an electronic device may overwhelm the family and user,
thus limiting the possibility that the device will be used. More training may be required for
successful implementation.
Second, users should note their ability to keep pace with their peers or colleagues to complete
the tasks of the setting demands (e.g., taking notes in class). Practice using various types of
AT adaptations (technological in particular) may be needed to maximize their effectiveness.
Finally, user fatigue should be monitored to determine if the use of the adaptation proves
tiring and thus hinders productivity. Observations of the user in action may also result in
optimized patterns of technology use or the development of new techniques that prove more
effective.
Maintenance Demands
The performance (i.e., reliability and durability) of technological adaptations should be
monitored carefully. If the performance of the adaptation necessitates frequent repairs, and
thus interferes with the user’s success, then the AT adaptation may need to be reconsidered.
Devices that are frequently broken or that need parts, which take time to order and receive,
are quickly abandoned; thus, the potential of AT is lost needlessly. The availability of
technical support is critical. Users and service providers must have access to support by
technology experts when problems are encountered with the AT.
Environmental Needs
Environments must be examined to ensure that individuals can use the AT adaptation as
needed. Any AT adaptation that involves hardware and software should be examined to
determine specific environmental needs. Some devices will necessitate environmental
accommodations. Devices that produce sound, such as talking calculators, speech
synthesizers, and tape recorders, may need to be used in a location that does not distract
others; headphones are an alternative to segregation. The location of electrical outlets will
dictate where devices that require electricity can be set up; other devices may require
batteries—battery-operated versions are often preferable when mobile environments are part
of the setting. Physical space may need to be analyzed if it impedes cross-environmental use.
For example, if an individual uses a wheelchair, then access to all environments (e.g.,
classroom, corridors, and doorways) must be ensured. Finally, professionals, family
members, and users should note the versatility of AT devices across environments, such as
classroom to dorm room/home, home to community, and class to class, to ensure that devices
can be easily used or adapted to be used across environments (e.g., transporting the device,
ability to use device across setting demands).
Training for Assistive Technology
Training, which is considered to be an AT service, is critical to ensure that AT adaptations
are used and maintained rather than abandoned. Training in the use of specific AT
adaptations is one of the top-ranked issues for the successful implementation of the devices.
The limited use of AT adaptations happened because classroom teachers had difficulty
coming up with solutions to problems with technology devices that were not working
properly and found that devices were left unused and students were left without the support
they needed.
The need for training applies to any individual who works with the user, such as classroom
teachers, instructional assistants, specialized professionals (e.g., speech/language therapists),
family members, and the user. Because teachers are usually the first people with whom
families discuss school issues, teachers should have a good working knowledge of AT
adaptations. Professional development workshops can provide both low- and high-intensity
training, coupled with follow-up support that focuses on practical application and
troubleshooting implementation problems.
1.2.2. SELECTING AND EVALUATING THE USE OF AT ADAPTATIONS
There are different perspectives about how to select and evaluate the use of AT adaptations.
Commonly used are the SETT Framework and the Adaptations Framework.
1. SETT Framework
Professionals can benefit from having a framework for considering, selecting, and evaluating
adaptations, including AT, which was developed by Joy Zabala.
SETT is an acronym for Student, Environments, Tasks, and Tools. The SETT Framework
provides a structure for collaborative groups to work together and think well about the
assistive technology devices and services that are needed to provide a student with disabilities
access to educational opportunities. When using the SETT Framework, each person shares
individual knowledge in order to build the team’s collective knowledge of the student, the
environments in which the student is expected to function, and the tasks that the student
needs to be able to do to be an active learner in those environments. When the team’s
knowledge about the student, environments, and tasks has been built and analyzed, they are
able to consider what system of assistive technology tools (devices and services) is necessary
for the student, in identified environments, to do expected tasks.
According to Zabala, the development of the SETT Framework was needs based. When AT
first emerged, there was great hope that the “right” tools would help most students with
disabilities make major strides in their educational programs and their lives. From the start, a
great effort was made to match the needs of the individual to the features of devices, and
many seemingly “right” tools were put in place. However, underutilization and abandonment
of AT devices were occurring at an unacceptably high rate. Thus, many individuals were not
benefiting much from the early promise of AT. It became increasingly clear that tools
“worked” better when they (devices and services) were based on matches. The matches
would consider not only the individual and the tools, but also the factors related to the
environments in which the tools were expected to be used and the tasks that those
environments required and/or that were very important to the individual.
As pointed out by Zabala, an important feature of the SETT Framework is that it supports
collaborative work by helping team members understand that each person on the team brings
critical expert knowledge in some area to the work of the group. When using the SETT
Framework, each person shares his or her individual knowledge of the student, the
environments, and/or the tasks in order to build the team’s collective knowledge. Team
members can then use their collective knowledge to consider whether assistive technology
tools (devices and services) are required by the student. If they are, team members can
develop a system of tools that is student centered, environmentally useful, and task focused.
In other words, they can provide tools that can be used by the student to do expected tasks in
a way that is compatible with the student’s customary environments. It also helps all
members of the team know when, how, and for what purpose assistive technology is
integrated into the student’s educational program.
Finally, Zabala emphasizes that families play a critical role in all planning of the educational
program of students with disabilities, including being a part of assistive technology decision
making and implementation. The SETT Framework encourages and honors the role of
families because it requires the family’s perspective and expertise, particularly in the area of
the Student, but also in the Environments and the Tasks.
2. Adaptations Framework
The Adaptations Framework can be used to help professionals, families, and users decide on
the type of adaptations that would be most beneficial to enable an individual to become more
independent and achieve success with tasks in any environment. Decision makers may use
the Adaptations Framework to determine that (1) the individual requires an AT adaptation to
meet specific needs; (2) the individual requires a different type of AT adaptation than what is
presently being used; (3) the individual does not need an AT adaptation to meet his or her
needs at this time; or (4) further information is required and additional evaluation is
necessary, which may include an AT evaluation.
The Adaptations Framework consists of setting-specific demands, person-specific
characteristics, AT adaptation options, and evaluation.
a. Setting-Specific Demands
People encounter many settings as they go about their daily business. Classrooms, offices,
movie theatres, sports venues, restaurants, public facilities, and grocery stores are all
examples of different settings or environments. These settings present specific demands that
people must be able to address to be successful in those settings. Setting demands include (a)
tasks people must do and (b) the requisite abilities or skills people need to perform the tasks
successfully.
In an activity of daily living setting, for example, in the grocery store (the setting),
individuals must be able to select food items (task). To do so, they must be able to read a
grocery list or remember what is needed, locate the items in the store, carry them in some
fashion, purchase them, and get the items home (requisite abilities).
In an academic setting, setting demands are particularly difficult for many students with
disabilities. Setting demands include the curriculum that is taught, how information is
delivered to and received by students, and how students demonstrate their understanding of
the curriculum. The teacher may expect students to come to class on time, listen to lecture,
take notes, read text, and write a report (tasks). To perform these tasks, students must be able
to tell time; possess the ability to hear; understand the critical features of the lecture for note-
taking purposes; be able to decode and comprehend text; and know how to identify, organize,
and produce ideas in written form (requisite abilities for the tasks), respectively.
Tasks
People encounter numerous tasks related to settings on a daily basis whether they are
functioning at home, at work, or in the classroom; negotiating public transportation or public
facilities; engaging in activities of daily living; or taking part in leisure activities. Individuals
with disabilities encounter an array of issues related to the tasks that we all perform every day
and for which AT adaptations are often helpful solutions.
In the public school setting, students are expected to comprehend textbook material; solve
complex mathematical equations; develop a listening, speaking, and reading vocabulary in a
foreign language; demonstrate writing proficiency skills; and use note-taking skills. For
students with learning disabilities or sensory impairments, these tasks are daunting without
adaptations that allow access to these setting-specific demands.
Similarly, in a movie theatre setting, people need to be able to hear the dialogue. In the home
environmental setting, in order to be able to live independently, people need to be able to use
bathroom facilities and environmental control features, engage in leisure activities (e.g.,
watching television, listening to the radio, using a computer), and have safety features (e.g.,
smoke detectors, fire extinguishers, telecommunications) available.
In the work setting, in order to do their jobs, people need to use telecommunications,
environmental features (e.g., desk, chair, and reference materials), restroom facilities, and so
forth. Consider an individual who uses a wheelchair for mobility and works on the second
floor of an office building (the setting). If the elevator is not operating or if there is an
evacuation of the building (no elevator access), what are the options? Thus, each task (e.g.,
evacuating from a building, getting to one’s office) represents a challenge if the task clashes
with a person’s disability-related limitations. Such “functional dissonance” mandates that
adaptations be made so that people can accomplish those tasks successfully.
Requisite Abilities
Requisite abilities are skills that must be demonstrated to accomplish the tasks of the setting
demands. The task of “reading the textbook” requires the requisite abilities of seeing print,
decoding, comprehending text (including vocabulary), reading fluently. The task of
communicating with a friend, colleague, or customer requires the requisite abilities of
thinking about the message, articulating the words to send the message, having a mechanism
for sending the message (e.g., cell phone, voice, sign language, computer-visual or verbal),
and having a means for receiving feedback about the message. Many people possess the
requisite abilities for these tasks; however, some individuals with disabilities lack the skills
that are necessary for performing specific tasks unless AT adaptations are implemented.
b. Person-Specific Characteristics
As a part of the Adaptations Framework, decision makers examine and assess person-specific
characteristics, the person’s functional capabilities and limitations, as they relate to the
setting’s tasks and specifically to the requisite abilities. Decision makers should consider AT
adaptations that will enable the individual to perform the task.
Functional Capabilities
Functional capabilities or strengths refer to cognitive (reading, writing, reasoning, thinking,
processing information), sensory (visual, auditory), language (listening, speaking), and motor
capabilities that individuals use to perform tasks and the associate requisite abilities.
Determination of an individual’s functional capabilities in relation to setting demands is
important for selecting appropriate adaptations. A student who has a reading disability yet has
good listening skills may benefit from electronic textbooks with a comprehension check to
access the reading material for class.
Functional Limitations
Functional limitations are disability-related characteristics that could impair an individual’s
ability to perform the setting demands (tasks). Functional limitations include difficulties with
cognitive or academic skills, sensory abilities, language, and motor skills as they relate
specifically to the tasks and requisite abilities in the settings. A person who has a
mathematical disability (e.g., dyscalculia) may exhibit difficulty with computational or word
problem-solving skills, tasks of the setting, and the associated requisite abilities (e.g.,
recalling arithmetic facts, computing problems, interpreting the information presented in a
word problem). Functional limitations typically are documented in a psycho-educational
assessment including an AT evaluation.
Decision makers must determine how a person’s functional limitations interfere with the
ability to perform specific tasks and the associated requisite abilities. Following the
identification of the setting-specific demands (tasks and requisite abilities) and the person-
specific characteristics (functional capabilities and limitations) as they relate to the setting,
decision makers can examine and make recommendations for possible AT adaptations.
 c. Selection of AT Adaptations
There are several considerations for identifying AT adaptation solutions. The features of the
AT adaptations must be carefully examined to determine whether a good match is present
with the setting-specific demands and the person-specific characteristics. Also, the attitudes
and acceptance levels of all parties involved in the use of the AT adaptation are critically
important to ensure use rather than abandonment of the AT adaptation. Finally, funding
options and support for families and users is important.
Features
The features of the AT adaptations (types of AT, ease of implementation, maintenance
demands, environmental factors, and training requirements) must be examined to determine
an appropriate match with the setting demands and the person-specific characteristics. When
selecting AT adaptations, decision makers must identify AT adaptations that would enhance
the individual’s success and independence to function across settings. Independence is one of
the most promising and crucial aspects of AT.
Thus, the features of the AT adaptation must be matched appropriately to the individual’s
needs (functional strengths and limitations) and to the tasks and requisite abilities required in
the setting to facilitate independence as much as possible. For example, if the individual
needs to use a computer to type a paper, being able to access the computer (visually,
motorically) would be necessary requisite skills. If the individual has limited fine motor
control but has typical visual acuity, then a keyboard adaptation might be appropriate. A
touch screen or voice recognition software would reduce the need for a keyboard.
When dealing with technology-based AT adaptations, reliability and durability are two
critical issues to be considered for successful implementation. Devices that fail or perform
occasionally and have parts that break easily will quickly be abandoned unless repair is
expedient or “loaners” are readily available. Thus, the selection of AT adaptations hinges on
careful consideration of the setting-specific demands, the person-specific characteristics, and
the features of the devices.
Attitudes and Acceptance
Attitudes and acceptance are often influenced by a person’s comfort level with the AT
adaptation; most people do not feel comfortable initially with new devices. Thus, decision
makers must acknowledge and address the importance of persistence, training, and support to
help users and their families or support systems adjust to the AT adaptations.
The selection of adaptations requires the collaborative decision making of professionals,
families, and users; the attitudes and levels of acceptance by all parties involved can be
influential in the sustained use of the adaptation. Professionals must be involved in the
selection process and encouraged to describe their attitudes about the proposed adaptations.
Acceptance of the selected adaptations by professionals is critical if the adaptations are to be
integrated properly into the environment (e.g., classroom, work).
The implications of technology for people with disabilities and their families are critical.
Including families in selecting AT devices and hearing their viewpoints is crucial. Several
key ideas should be included in the AT decision-making process. Team members must
consider family and cultural viewpoints about disability and how services that are intended to
be helpful may be interpreted. Decision makers must consider family experience and comfort
level with technology, their acceptance of the AT adaptations. Families should be aware of
the expected outcomes of AT adaptations; these outcomes should reflect the needs of the
users and their families in promoting independence. Assistive technology services, such as
training and funding options, must be provided to families and/or caregivers as they work
with the user. Selection of AT adaptations that are not accepted by family members will
contribute to difficulties between home and school and ultimately to the abandonment of the
adaptation by the user.
Finally, decision makers must consider the user’s attitudes and acceptance level of the
adaptation. The user’s opinions about the types of AT adaptation options, attitudes about
using AT adaptations, and interest in trying available options must be considered. Decision
makers should be sensitive to the user’s attitude about whether or not the AT adaptation will
promote his or her independence. Moreover, the motivational level of the user is critical when
selecting AT adaptations. No adaptation will work if the user is against it, because the device
simply will not be used.
Funding
Different funding sources are available from which assistance can be provided once the AT
adaptation is selected. AT adaptations, such as technological devices, have a wide price
range. Decision makers can explore simple and reasonable, low-cost AT adaptations as viable
options to match the needs of the user. AT adaptations do not always have to be high-end to
be effective for an individual; starting out with a low-tech device could work well to help the
individual compensate for a limitation. Locating a funding source can be a problem, but
funding alternatives and supplemental funding sources, such as Medicare, insurance, and
grants, should be explored. State rehabilitation offices are possible sources of AT devices and
assistance in obtaining funding. Also, for public school students, school districts are
responsible for providing AT whether it is done through the district or a community agency.

d. Evaluation of the Effectiveness of AT Adaptations

Various studies show that almost one third of AT devices are abandoned within the first year
of use. Abandonment occurs because users may not be achieving independence, training was
insufficient, or numerous equipment issues (maintenance, reliability) interfere with their
success.
Professionals, family members, and users can evaluate whether the AT adaptations help users
compensate for specific difficulties (reading and writing, computer use, access to
telecommunications) so that they can meet the demands of the settings. Evaluation of the AT
adaptation needs to be ongoing to determine if the adaptation continues to meet the
individual’s needs as he or she grows (e.g., a student in the elementary classes will have
different needs than a student in a postsecondary setting; a younger person will have much
different capacities than a much older person) and as the setting demands change (public
school to workplace setting to leisure activities to retirement).
As individuals learn more skills and mature, and encounter increasingly complex setting
demands, their needs undoubtedly will change. For example, a child with cerebral palsy who
receives physical therapy to develop motor skills will probably benefit from different AT
adaptations than an adult with cerebral palsy who has developed some motor skills and has
adapted to many of his environments. Many disability-related technologies (screen readers)
become dated with the evolution of the mainstream technology, which happens quite rapidly.
This factor may actually be more linked to a need to upgrade than to the individual’s
changing skills, demands, and abilities.
However, as the individual continues to age, his AT needs will continue to change to reflect
the aging process. For school-age children, as their skills increase and as the academic setting
demands become more challenging, AT adaptations at the elementary level (e.g., a pencil
grip) may need to be changed to something more appropriate (e.g., a word processing
program) to better address the setting–person–feature match.
Evaluation is an integral part of the Adaptations Framework. Re-evaluation of any
component of the process may be necessary to determine a more appropriate adaptation to
satisfy setting demands and user needs and to foster success, independence, and accessibility.
Therefore, evaluation of the effectiveness of AT adaptations including AT is crucial.
Table provides an example of the Adaptations Framework in action. In this case, the setting is
the bathroom, where tooth brushing has been identified as a task that an individual needs to
learn how to do. We have to think about the task, the person, and the AT adaptation solutions,
which will help the person complete the task independently and correctly. Only by carefully
evaluating each step of the Adaptations Framework can we begin to ensure a good match
between the person’s needs and the task at hand. Take a moment to review the framework.
 Assignment-cum-Tutorial Questions
Objective:

Descriptive: