Using Outcome Measures To Improve ... - Fox Rehabilitation

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Table 1. Accessibility features: Setting>General>Accessibility Accessibility Option Feature Description VoiceOver “Speaks” items on the screen; can be used for students with poor vision or students with limited literacy skills Zoom Magnifies the screen; can be used for individuals with visual impairments Large Text Enlarges text size in contacts, e-mail, messages, and notes White on Black Provides high contrast to all screens Speak Auto-text Automatically “speaks” auto-corrections and auto-capitalizations edge and skills in activity analysis, contexts, occupational domains, 7 and environment and technology, 8 occupational therapy practitioners can be key members of ITP teams using technology to foster independence in students’ functional ITP goals and objectives. This article will explore one collaborative transition program in which occupational therapy team members are using iPad and iTouch tablets for success in meeting the functional skills of high school students in transition. Apple products were used for this program because they were available for use; however, several other brands and types of touch tablet devices available on the market can offer similar features in meeting students’ needs. USING THE TECHNOLOGy Touch tablets, whether large or small, require a unique set of skills and abilities for access. The role of the occupational therapist includes evaluating performance skills to determine whether a student has the motor, visual motor, visual, motor planning, and sensory skills needed to use a touch tablet device. Accurate finger isolation, for example, is needed to make selections and use the keyboard. If finger isolation is poor, a special stylus designed for touch tablets can be used, such as the Pogo Stylus or the Pogo Sketch from Ten One Designs. Precise visual motor control is also necessary to make accurate selections. If visual motor accuracy is not precise, a larger device (such as an iPad) should be considered over a handheld device (such as the iPod Touch). A critical skill to evaluate is the ability to swipe across the screen both vertically and horizontally. Screen and page navigation depend on the user’s ability to touch– swipe–release in rapid succession. The evaluation should also include determining whether the student has the ability to hold a device in the palm of his or her hand, or if alternatives to stabilize the device such as the Hand-e-holder may be needed. Consideration is also needed for device stands that allow for visual placement that may increase use. The evaluation process should also include assessing visual skills, which are necessary to identify features and applications in order to make choices, and tactile and proprioceptive skills, which may influence the gradation of movement and activating buttons. The occupational therapist may use accessibility options to help circumvent these issues (for more on this, see Table 1). The occupational therapist must also work collaboratively with classroom staff to consider students’ literacy and cognitive skills. Memory, attention, and language abilities will influence students’ use of a touch tablet. Considering these skills early on will be valuable when preparing to implement the touch tablet in functional activities. The occupational therapist must also consider the environment during the evaluation. The following are some important environmental considerations: Does the student have freely accessible Wi-Fi access in his or her home, school, and work environments? Does the school or facility have a Web filter that blocks the content? If either of these situations occurs, then the occupational therapist doing the evaluation and planning the intervention may want to consider a device that offers 3G service, available from a number of manufacturers. This type of service works from a satellite, so an Internet connection is not needed to use the device, though data plans must be purchased. Hidden costs such as monthly service plans and Wi-Fi accessibility need to be considered when recommending the use of these products. THE INTERVENTION PROCESS When implementing large or small touch tablet use with students, collaborating with classroom staff and forming an implementation plan that outlines individual roles, responsibilities, and timelines helps ensure that the intervention team continually receives recommendations about effective strategies and tactics for supporting performance in occupations. Team discussion on how the smartphone or touch tablet can support students’ meaningful participation in occupations is critical. The team can, for example, evaluate the student’s day and determine where such technology can provide support and in what ways (i.e., can this technology facilitate communication, participation in vocational activities, or participation in leisure activities; if so, how?). In looking at all the tasks that the student is participating in during his or her day, the team must prioritize which tasks require intervention (e.g., time management, communication). After the task and outcome are determined, then specific application trials to increase independence can begin. Among other things, sharing knowledge 20 JUNE 20, 2011 • WWW.AOTA.ORG PHOTOGRAPH © GERI LAVROV / GETTY ImAGES
with classroom staff on using applications (apps) in ways other than which they were intended fosters creative ways of using the devices for functional skills. For example, students can use StoryKit, an app for writing stories, to share information about the day’s events with peers and family members or as conversation starters. For a listing of many other apps, see Table 2. When integrating the devices into functional activities, students need instructions on how to set them up and create access apps online. Prior to formal training, a preparatory session to explore the smartphone and tablet allows students to recognize that mistakes can happen and be corrected. During this time, practicing basic device navigation (such as pressing the on/ off and volume buttons or sliding the screen to unlock the device or navigate pages) will build confidence. In addition, student safety when using a device is of critical importance to parents and school officials. Restrictions, established via a password, can be set before giving the device to a student. Occupation-based interventions are introduced by integrating the devices into daily tasks for each student’s ITP. For example, during the calendar portion of morning work, a student can be shown how to access the calendars on whatever smart phone or tablet device he or she is using. Features on the device’s calendar app, such as the alarm, can provide a student with a quick, effective way to better manage his or her time. In using preparatory methods, the clinician can review the specific skills needed to use each feature and/or application, followed by practice with students during meaningful occupations. As student performance is observed, adjustments to the application or the environment can then be made. For example, a student who had a tendency to select items in error by tapping the device with her thumb for stabilization was provided with a protective case by the authors, which decreased errors. Throughout the intervention and re-evaluation process, clinical observation skills should be used to evaluate the tasks, the environments, and student abilities to maintain success in daily occupations. As with all assistive technology, issues of cost, OT PRACTICE • JUNE 20, 2011 Table 2. Partial List of Applications Application Description Occupational Therapy Domain iPrompt** Pictures are used to create Activities of daily living (ADLs), sequences for prompting Instrumental ADLs (IADLs) iInteract** A basic text-communication tool Communication, Social Participation iComm** A basic symbol- and text- Communication, based communication tool Social Participation Brain Pop** Lifelong learning is prompted Education, Leisure through movies Making Change** Teaches how to make change Education Money Counting Money skills or tool to count Education, Financial Calc** money when shopping Management Bread & Milk Creates a grocery shopping IADLs Classic** list and estimated bill MSNBC.com** Current events through videos Work, Social Participation, and stories. Leisure BugMe!— Quick color-coded handwritten ADLs, IADLs, Work, Education, Ink Notepad or typed “Post-it” notes, reminders, Leisure, Social Participation & Alarms** and alarms Vocal Voice A voice-reminder system ADLs, IADLs, Reminder** allows for custom alert settings Social Participation Time Timer** A visual timer allows user to ADLs, IADLs, Work, see how much time is left in a task Education Speak It Text to speech that can be used as a Communication, Education, Text to Speech** communication system Work, Social Participation Facetime iPhone and iPod Touch feature that Social Participation Communication provides the ability to virtually communicate Stories 2 Learn** Personalized stories using photos, Social Participation, text, and audio messages Education, Leisure Story Kit** Creates electronic storybooks using Social Participation, pictures, text, drawing, and audio Leisure, Education, Work, recordings IADLs, ADLs Pictello** Similar to StoryKit, allowing more Social Participation, independence in creating journals Leisure, Education, Work, and stories IADLs, ADLs Penultimate* Allows for notes, sketches, or sharing Education, Leisure, ideas Social Participation Autism News Customizes the top stories from the Education, Leisure, Reader** best health news and information sites Social Participation and delivers them to your device Dragon Voice to text that converts speech Work, Education, Dictation** to text. E-mail or place in any text Social Participation document Dragon Search** Speak your search queries and get Work, Education, instant results Social Participation MemMatches Classic card matching game Leisure iDress for Weather** A picture-based tool to check the ADLs weather and determine what type of clothing is appropriate after checking in the virtual closet Living Safely**+ Home and personal safety lessons ADLs, IADLs Everyday Skills**+ Learning sessions regarding the ADLs, IADLs, Education community, personal skills, Social Participation transition, and transportation Community Acts as a travel companion and will Work, Leisure, Sidekick**+ track the location of an individual and Social Participation send e-mail messages with map links Key: *iPad only, **All Apple operating system (iOS) devices, +Pricing may vary with device 21
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