Case Studies

The purpose of this section is to illustrate examples of the variety of assistive technology and diverse needs that can be met using AT. The case studies amplify and illuminate different scenarios in which AT can be used to access, participate in, and make progress in education.

Student with Muscular Dystrophy

A.L. is in seventh grade at a local middle school. He is diagnosed with muscular dystrophy. He has a 504 Plan at school that lists a variety of accommodations and modifications. He becomes very fatigued in the afternoon, and it was requested that his academic classes be held in the morning. He uses a variety of materials, including a portable word processor with word prediction for some writing during his classes, voice recognition for more lengthy writing assignments, various types of pens and markers that are easier for him to hold, a portable voice amplifier for when he has difficulty projecting his voice, a call button for getting people’s attention, a page turner, access to electronic text, and other tools. In addition, A.L. has adapted seating materials, including an electric wheelchair.

A.L. receives the services of a one-to-one paraprofessional, though the focus of the team was on what tools he could use to increase his independence. Based on how he feels, the student decides what specific tools he would like to use for the different tasks. Due to fatigue and his differing voice qualities, A.L. has three different voice files with his voice recognition, for the morning, afternoon, and evening. He was trained in using voice recognition for a year before he was expected to use it for assignments, and the team started training in dictating skills when he was in elementary school, anticipating the long-term need for voice recognition. At home, A.L. uses a variety of mid-tech tools when he is in bed and requires assistance. His parents have placed a battery-operated doorbell by his hand when he sleeps, and the receiver is in their room, so if he needs help he needs only to push the button and the bell rings in his parents’ room. The family is investigating additional materials, including a hospital bed and electronic lift system.

Student with Learning Disabilities 1

A.P. is in middle school and has always had difficulty with his handwriting and spelling. He has successfully used word prediction since second grade, but word prediction alone might not be enough for him when his writing demands increase in high school. He is comfortable and familiar with dictating his responses to various scribes after preplanning what he is going to write, so A.P. and the team wanted to explore voice recognition. Prior to actually using it, he had been practicing dictating with his scribes by saying text exactly as it would appear in a document, including what punctuation was needed, when a new paragraph was needed, and visually monitoring what was written to edit the text on an ongoing basis. A.P. used the voice recognition built into the operating system of his computer with a microphone that had been suggested by another voice recognition user.

A.P. was successful in learning how to use voice recognition and used it for a variety of more enjoyable writing tasks, such as sending e-mails to family and friends, before he was asked to use it for any class assignments. A.P. generally had good recognition of his spelling errors and was able to correct most of his errors using the spell-check of his word processor, though he continued to use word prediction for some more difficult words. He used the read-back feature of his operating system to further proof his work, as it was easier for him to hear errors than see them in his writings. A.P. and the team decided to investigate the features of the built-in voice recognition of his operating system versus the features of various purchased voice recognition programs. In seventh grade, A.P. focused on becoming very familiar with the voice recognition feature of the built-in program of the operating system on his computer. By eighth grade, focus was on using it for the majority of his longer writing assignments as well as on training others how to use the program.

Student with Learning Disabilities 2

B.D. was 15 years old in ninth grade. She was very motivated to learn and aware of the extent of her learning disabilities. Her test results revealed that her oral reading and spelling were between a first- and second-grade level, while her auditory comprehension was at a 12.6 grade level.

B.D. has had access to a laptop, which has not increased her writing skills as the word processing program did not provide her with the level of support she required. B.D. tried a variety of strategies and decided what tools best met her needs. She was able to immediately recognize the benefit of many of the tools and could use the various tools available over the Internet.

As the laptop was dedicated to her use, the team decided on software that incorporated built-in word prediction, a text reader, and a scanning component, so that various textbooks could be scanned into the computer. B.D. used a combination of materials for writing. For preplanning her writings, she used computer or Web-based graphic organizers, which she would display in an outline format while writing. She would then write her information using word prediction. B.D. also began using voice recognition and found that it was helpful for longer writing assignments, especially once she did her preplanning. She used word prediction with her graphic organizers and could have that information read to her using the built-in speech in an operating system or in the software itself. For writing notes in class, she used one of the pens that allow auditory information to be recorded. She would record key points of the lectures as she added information to the teacher’s notes that had been photocopied onto the special paper that came with the recording pen. The student was given access to a variety of e-text resources and signed up for Bookshare as well as Learning Ally. The goal for B.D. was to learn to set up and use all of her tools for academic success by the time she graduated from high school so she could be independent in college.

Student with Cerebral Palsy with Intellectual Disability and No Augmentative and Alternative Communication

C.A. is in first grade and is having difficulty with reading and writing. She has some difficulty with articulation and often runs out of breath while speaking. She is diagnosed with cerebral palsy, visual impairments, and cognitive impairments. C.A. uses a wheelchair and a walker at school.

C.A. has emerging phonemic awareness for the first sound in words starting with consonants. She understands the sound-symbol relationship for all consonants and has emerging knowledge for vowels. She is able to read only two sight words, “I” and “you.” C.A. demonstrates increased reading skills when provided with picture cues for stories as well as when reading books with repetitive lines or when one or two words vary in sentences. She is able to access a standard keyboard, though she types more than one repetition of her letters as well as incorrect letters because she activates keys with the heel of her hand. She is able to produce sentences using a word bank paired with pictures with 10 to 14 words in the bank, with the words color-coded by parts of speech and set up in a subject-verb-object format, when provided with auditory feedback. She showed emerging skills with word prediction, with “predict ahead” turned on and when provided with help to sound out the letters in words.

As C.A. has impulsivity issues, she did best when a process for using the computer was reviewed with her. She used visuals of words paired with pictures posted by the computer as well as color-coding for the words in her word/picture bank. She was able to use a standard mouse with an enlarged cursor, and a screen with a white background and a larger-sized text. She was able to find and locate letters on the standard keyboard using a keyguard to increase her accuracy and when the “key repeat” was turned on in the system preferences. C.A. benefited from the use of a portable amplifier in the classroom when speaking in groups to increase her loudness level, as well as from providing the topic when people had difficulty understanding her. She also benefited from supported seating positions whenever doing fine motor tasks, including a wheelchair tray and adapted chairs and tables at the correct height.

Student with Autism Spectrum Disorder (ASD)

D.J. is in ninth grade and is diagnosed with ASD. He has difficulty with reading and writing and had trouble organizing his thoughts for writing. He did best when using a computer-based graphic organizer using teacher-created templates delineating the amount of information he needed to include in each category as well as assistance in establishing the main categories. D.J. benefited from using the created outline when writing his assignments. He was distracted when using word prediction and could correct his spelling errors using the standard spell-checker built into his word processor.

D.J.’s typing was slow. He was able to dictate his thoughts to an adult and with training was able to benefit from the use of voice recognition. He benefited from the use of a text reader to proof his work.

D.J. also had difficulty in social situations and was receiving counseling at school. As part of this counseling, the team was using video self-monitoring as well as role-playing activities. Both of these strategies assisted the student in improving his social skills as well as his self-advocacy skills. D.J. benefited from the use of visuals, generally word-based, especially for new activities and routines.

Preschooler with Cerebral Palsy

J.T. is a friendly 3-year-old student with cerebral palsy. He enjoys participating in all play activities, particularly music. When he sees his other siblings playing with musical instruments, he attempts to go toward them by bunny hopping. He interacts with his family members and preschool service providers by smiling, laughing, and pointing to objects. He occasionally points to a picture that is in his vicinity. J.T. vocalizes and uses a few intelligible words to communicate.

J.T. tries to join in when his siblings are singing but feels frustrated when he cannot. He also attempts to choose a song that he wants his mother to sing but can do so only when given a choice between two songs, and this often frustrates him. His family members try to help him communicate and be a part of the family activities, but they have to depend a lot on guessing what he prefers. The mother has started to use some pictures with him, and his responses are quick and do not show any frustration.

J.T. loves to do things independently and gets very frustrated when he is unable to express himself. After evaluation and trials of a few devices, the early intervention team decided that a transient screen device was appropriate for J.T. as it would not only assist him in participating in music activities but also would have an impact on his overall communication skills.

Elementary Student with Down Syndrome and Intellectual Disabilities

S.H. is a friendly 9-year-old student in grade 3 with Down syndrome. She likes to participate in most classroom activities. She communicates with her teachers and classmates using gestures, body language and vocalizations. There have been several occasions when S.H. has pointed to objects, pictures, and even some words to communicate with her peers and classmates. One of her favorite activities is looking at and reading books. She likes to point to pictures and words in books and pretends to read them to classmates.

During the read-aloud activity, all students sit in small groups of 3 or 4 students after one of them has selected a book with short stories. The student who has selected the book reads it aloud to the peers in the group and then asks questions. Every participant in the group gets a chance to ask questions. The questions are answered by the other students in the group. All students in the class get a chance to select a book and be the lead in the story group session. During group read- out, S.H. sits with her paraprofessional, who selects a “simple” book for her and reads it to her. She then asks her questions (mainly what and who) that she knows S.H. can answer by pointing to the pictures in the book that is being read. Her teacher and paraprofessional have noticed that S.H. has recently wanted to sit with a group of students and be part of the group rather than sit and read with an adult.

S.H.’s parents purchased a mid-tech fixed display communication device with different levels and wanted the school to use it for S.H., especially during the read-aloud activity. The multidisciplinary team working with S.H. learned to program the device, and the paraprofessional was given the responsibility of programming it every day. The device was programmed with vocabulary so S.H. could participate in a variety of situations and classes.

Middle School Student Using Augmentative and Alternative Communication

J.C. is a seventh grader at Hill Valley Middle School. J.C. enjoys being part of the classroom and being alongside peers. She walks with an awkward gait and often has seizures. J.C. is fully integrated in all grade activities and participates in all classroom activities. J.C. also has significant cognitive impairments. In all of her classrooms, including her home room, J.C. has picture schedules and pictures or photographs associated with the activity or current topic. J.C. also has a digitized communication device with eight messages. To ensure participation within the school routine throughout the day, the multidisciplinary team at the Hill Valley Middle School worked closely preparing appropriate materials. For example, when arriving for her science class, J.C. greets the teacher using her speech generating device. When the teacher reviews last week’s quiz and asks questions, J.C. responds using her speech-generating device and the communication display. When the teacher introduces the lesson on photosynthesis, J.C. listens and follows the adapted book with photographs that has been made for her.

J.C. uses her speech-generating device to draw attention to herself and her picture communication board. After the lesson is over, J.C. walks to the door with a peer and looks at the picture schedule that is hanging there to help her to determine her next class. For all of J.C.’s classes, the general education teacher, the special education teacher, and the speech and language pathologist have planned together as a team to ensure that J.C. has the communication system with the appropriate vocabulary and accommodations to enable her to participate in a rich educational experience.

Student with Visual impairment and Transition Plan

T.R. is a high school student and an outgoing, friendly young man who loves to engage in conversation with familiar and unfamiliar people and participate actively. He enjoys his independence despite a significant visual impairment. T.R. is working with a transition team who explored with him his desire to work in a food service job after exiting high school. T.R. and his family visited numerous adult service agencies, and after reviewing their options, chose an agency in his home town that had a baking program. The transition team, along with the adult service agency, collaborated with BESB (Bureau of Education and Services for the Blind) to find AT options that would enable him to function as independently as possible. In addition, T.R. and his family needed to arrange transportation services to the adult service agency. T.R. used a cane along with personal assistants for mobility.

T.R. used audio books for leisure as well as for work. TR also had a computer with specialized software that assisted him in reading. To facilitate his skills at work, BESB provided T.R. with adaptive equipment such as sound-making measuring cups and spoons and a tactile bowl to assist in pouring. BESB worked with the adult service agency to ensure that the environment was accessible (e.g., placing items in particular arrangement, tactile coding key areas in the building such as front door, kitchen, bathroom). BESB also provided in-service training to the adult service agency to ensure that T.R.’s transition was as smooth as possible. At the same time, the school funded a transition period to the adult service agency.