Summary
Age: 3
Gender: Female
School Placement History: Special
Education Preschool
Education Classification:
Other Health Impaired
Type of Technology: Access
for written communication
Intervention Referral
Andrea is a three-year old girl with a
diagnosis of arthrogyposis and sub-glottal stenosis. Arthrogryposis
is a chronic non-progressive disorder, in which multiple joints remain
immobile because of weak or absent limb muscles. Sub-glottal stenosis
is a narrowing of the trachea. Andrea has a trach and is unable to
vocalize, but she can mouth words and is generally understood by those
around her. Doctors hope that she will be able to have the trach
removed as she gets older and her airway gets larger. She was referred
for a literacy access evaluation. She has little volitional movement
of her arms and uses her feet for access to all of her activities of daily
living. She is able to use markers to write with her feet, but that
access is still difficult for her. She is a very bright little girl
and beginning to develop literacy skills. Andrea is presently able
to control a regular mouse fairly precisely with both feet. However,
she may have to have some leg joint surgeries in the future which would
hinder her ability to write. Her mother and teachers wanted her to
have access to writing so that she can continue to develop literacy skills.
Her access preference is her feet.
Previous Intervention
Prior to this evaluation, Andrea had no written
language intervention.
Assessment Summary
Literacy Needs:
Writing Needs Checklist
Andrea needs to be able to create written
material.
Summary of Technology Assessment:
An assessment of access options was done using Speaking Dynamically Pro
by Mayer-Johnson. Speaking Dynamically Pro was used because it allows
for several different access modes while in the same set-up. The
first equipment that was assessed was the Head Mouse from Origin Instruments.
The Head Mouse is a wireless optical sensor, which tracks a tiny disposable
target that is placed on the user’s forehead. The device translates
the movements of a user’s head into directly proportional movements of
the computer mouse pointer. Speaking Dynamically Pro was set on Direct
Point with a 1.2 seconds delay option. This means that Andrea had
to hold the pointer on the target for 1.2 seconds and then it would automatically
activate. After a short explanation of the task Andrea was able to
access target on all portions of the screen. She was able to recalibrate
the mouse by dropping her head when it would get stuck. The other
equipment that was assessed was a Joystick Plus by Penny & Giles.
Andrea is going to have a wheelchair assessment and a joystick is the probable
access for driving. The team felt that it might be easier for Andrea
if she had the same access for both activities. Andrea was able to
access the joystick and use her big toe for a mouse click. It was
not difficult for her although she had to be positioned at the same level
as the computer to reach the joystick with her feet. This meant that
the screen of the computer had to be raised so that she didn’t strain her
neck. The occupational therapist felt that this might become an issue
as Andrea grows. It would also keep her from being able to access
a variety of computers in her environment without major adjustments.
Andrea stated that she preferred to use
the Head Mouse. It was less fatiguing and easier for her to use.
Summary of Intervention
Andrea is attending a preschool class.
The speech pathologist and occupational therapist are taking her out for
15 to 30 minutes a day to practice on the Head Mouse.
Outcome Updates
July 2001 ? Andrea is able to use the Head
Mouse successfully. Further assessment needs to be done to determine
whether or not she has the ability to use a switch for a click without
moving her head and hence moving the mouse. This is important because
it would allow Andrea to access any program on the computer with the Head
Mouse. If she does not have this ability a program that will allow
a “dwell” activation universally would have to be used. This assessment
will be done at the beginning of the school year.
Comments
Permission to share this information
is on file at Munroe-Meyer Institute of Genetics and Rehabilitation, Scottish
Rite Computer Supported Literacy Program.
Technology Intervention
Head Mouse Origin Instruments
Joystick Plus Penny & Giles
Speaking Dynamically Pro Mayer-Johnson
Co.
A. Writing Needs Checklist
Conventions: Handwriting and Mechanics
L Is handwriting easy or laborious?
N Is his or her handwriting legible?
N Does he or she have keyboarding experience?
? Does he or she prefer handwriting or
word processing?
? How much handwritten text can he or
she produce in 15 minutes?
Y Does he or she express when physical
limits have been reached?
N Can he or she produce the appropriate
size of text for tasks?
N Does he or she use appropriate spacing
between words?
N Does he or she have appropriate margins?
N Does he or she use appropriate punctuation
and capitalization?
Spelling
PP What is his or her underlying spelling
pattern (deviant, prephonetic, phonetic, transitional, or standard speller)?
N Is he or she a consistent first-letter
speller?
N Can he or she recognize a word spelled
incorrectly?
N Does the student think he or she can
catch his or her spelling errors?
Form and Syntactic Maturity
Y Does he or she have difficulty with the
word order in sentences?
Y Does he or she have difficulty with
grammatical features (e.g., pronouns, verb tense, present progressive)?
N Is he or she using complex sentence
structures?
N Does he or she use complete sentences
(e.g., sentences with no main clauses)?
N Do his or her sentences have agreement
within and across other sentences?
Content and Vocabulary
N Does he or she have difficulty finding the
right word to express meaning?
N Does he or she have a weak vocabulary?
Consider both everyday, favored words and specialty, sophisticated words.
Y Does he or she understand a variety
of word meanings?
N Does he or she avoid words because of
spelling difficulties?
Fluency
N Is he or she able to easily generate writing
ideas?
N Is he or she able to generate original
ideas?
? What is the average length of text he
or she is able to produce?
Organization
N Does he or she plan before writing?
N Is he or she able to represent his or
her thoughts in writing?
N Is he or she able to produce a cohesive
writing product? Is there a clear shape, sequence, or direction?
N Are there differences in his or her
written output when he or she is using a prewriting organizer?
N Does he or she use an organizational
structure that is appropriate to the task?
N Does he or she produce a variety of
types or writing products?
N Does he or she have a sense of audience
when writing?
Editing
Y Is he or she willing to edit?
N Is he or she able to revise during the
writing process?
N Does he or she revise after the first
draft?
Y Is he or she a one-shot writer (does
no revising)?
N When the student’s text is read aloud,
can he or she detect writing errors?
Visual and Auditory Discrimination Skills
N Is he or she able to auditorily discriminate
between words?
N Is he or she sensitive to sound (classroom
noise or synthetic speech?
N Would he or she be able to utilize on-line
correction?
? How many features would he or she be
able to utilize when writing without inhibiting the writing process?
N Is the student distracted by “extra”
visual stimuli?
Attitudes and Beliefs
Y How motivated is he or she to write?
Y Does he or she enjoy writing?
Y Does the student like to have others
read his or her written work?
Y Does the student believe that people
understand what he or she is saying when writing?
N Does the student believe that his or
her papers look good (handwritten or word processed)?
N Does the student think he or she is
a good writer?
N Does the student think he or she is
a good speller?
Y Does he or she persist when confronted
with a difficult task?
Y Is he or she a risk taker?
Approach and Strategy Use
? What strategies or problem-solving skills
does he or she use when approaching a writing task?
N Is he or she able to write independently
(without assistance)?
N Does he or she demonstrate any avoidance
behaviors or strategies when writing?
N Does he or she become frustrated when
writing?
Illustrations
Y Does the student need to produce writing
products paired with illustrations?
Y Does the student have motoric difficulty
when illustrating?
Y Would an illustration program be motivating
or provide the student with writing topics?
Writing Needs Summary
1. What penalizes student most in school (e.g.,
classroom goals, grading) as far as producing adequate writing products?
Not applicable
2. Which of the above needs most negatively
impacts his or her writing process? That is, which need requires
the most cognitive and/or physical effort? Motor ability to write
with pencil or keyboard
3. Ask the student what is most difficult
about writing. What is most enjoyable about writing? Motor act is
most difficult
4. Ask parents or teacher what student
finds most difficult about writing. What does he or she enjoy about
writing?
5. Does the student’s writing needs match
the concerns of the student, parent, and teacher? Yes
B. Writing Requirements Checklist
School Writing
Fiction/narratives
Descriptions
Expositions
Journals
X Creative writing
Create books
Plays and skits
Riddles
Rhymes
Worksheets
Reports
Note taking
Summarizing
Outlining
Poetry and songs
X Spelling practice activities
Essay exams
Personal Communications
Notes
Letters
Lists
Journals/diary
Personal feelings
Personal experiences
Writing Requirements Summary
1. What types of writing products is the student
currently completing at home and at school? Practicing letters and
small words, mousing to access academic programs
2. What types of writing activities would
you like this student to be able to do in the future? Age appropriate
writing activities
3. How many writing tasks does he or she
complete per class/day/week? None at present
4. What is the typical length required
for each writing task? Short, single word
5. How much time is student given for
each writing task?
6. How many hours or days is student given
to complete each type assignment?
7. Does the time given match the time
needed? Time is adjusted to meet need
8. Does student need more time than is
typically given to complete written tasks? yes
A. Features of Computer-Supported Writing
Keyboarding Assistance
X Access
X Speed
X Accuracy
Talking Word Processors
X Optional/required speech output
Level of speech output
X Individual letters
Sentences
Paragraph
Selected (highlighted text)
Entire documents
Highlights units spoken
Speaking rate adjustment
Loudness adjustment
X Headphone/external speaker option
Pronunciation editing
Types of Spelling and Vocabulary Support
Spell Checking
At conclusion of document
Simultaneously
Error detection (with suggestions)
Entering corrected words into document
Automatic spacing and capitalization
Copy model
Type from memory
Automatic insertion
Forms of Organizational Assistance
Topic suggestions
Writing style suggestions
Completeness and accuracy queries
Cohesion assistance
Grammar Assistance
Error detection
Grammar correction
Grammar tutoring
Illustration Assistance
X Picture/art work
X Drawing tools/coloration
Computer Features Summary
1. Would the student benefit from auditory
feedback on individual letters, words, sentences, entire documents?
Yes, to assist with visual motor deficits and monitoring
2. Would computer feedback be most helpful
during the writing process or following completion of student’s writing?
Both
3. Are the student’s spelling skills good
enough that the spell checker generates the appropriate choices?
No
4. Would the student prefer on-line (immediate)
or end-of-document spelling error feedback? Would he or she benefit
from spelling suggestions? Would he or she benefit from print or
auditory feedback?
5. Would the student benefit from prompts
cueing particular organizational structures? no
6. How severe are the student’s grammatical
needs? What level of feedback can he or she handle? Not applicable
at this time
7. Does the student need to improve his
or her keyboarding skills? Yes, but motor ability may impede functional
keyboarding
8. Does the student need to produce writing
products paired with illustrations? Does the student have motoric
difficulty when illustrating? Would an illustrations program be motivating
or provide the student with writing topics? yes
Reference: Sturm, J. (1997). Decision
making for software selection. Intervention in School and Clinic, 32 (3).
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