2003 Conference Proceedings

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Molly Shannon, OTR/L
Assistive Technology Specialist
North Carolina Assistive Technology Program
Charlotte Institute of Rehabilitation
1100 Blythe Blvd.
Charlotte, NC 28203
Phone: (704)355-2703
Email: mshannon@ncatp.org

Half of the 11,000 spinal cord injuries (SCI) sustained each year in the United States result in quadriplegia or loss of movement in arms and legs while the other 50% result in paraplegia which causes a loss in movement of the legs (1).While the majority of SCI involve adult males between the ages of 16-30, 15% are children under 15 years who are acquiring SCI injuries due to injuries which occur when playing, participating in sports, the result of car accidents, falls or non-accidental trauma (2, 3). A current review of assistive technology (AT) print and Internet resources yields few resources pertaining to educational accommodations or technology interventions for any age student with a SCI. Even within resources for the adult population of persons with SCI, there is scarce information as to educational considerations when attending college. There is even less available for references for children who are trying to re-enter school settings from preschool to high school. As a result, this combination lecture and demonstration seeks to demystify educational staff working with students with SCI regarding the wealth of AT solutions and educational accommodations available.

Even for an experienced special educator or therapist, the mention of a new student with a SCI is cause to pause and reflect. Many educators, while experienced with students with cognitive or physical disabilities such as cerebral palsy, have not encountered a student with a SCI. There is a wealth of medical information that all staff must learn relating to terms such as incomplete versus complete injuries, sensory versus motor levels of function, and various extremely important medical complications and precautions such as autonomic dysreflexia and orthostatic hypotension (4). While occupational and physical therapists may have current or past experience in working with this population, they may have not worked with a person with a SCI in an educational setting or know little about AT solutions.

Surprisingly, when one conducts a literature review of assistive technology publications and books, in the majority of instances, little or no mention is specifically made of persons with spinal cord injuries. When one does see them mentioned it often is a case study on a half page describing use of a vocational assistive technology device or an article about finding a job for a person with SCI (5). Even the well-respected AT resource, ABLEDATA, primarily provides simple lists of broad categories or listing of devices for those with SCI with little actual practical ideas for accommodation or specific AT solutions (6). Other AT resources, such as Denis Anson's excellent book, Alternate Computer Access, take the approach of dealing with classes of AT products whether than discussing specific injuries and possible AT solutions (7). Upon review of spinal cord resources, there were mentions of education, yet it most often referred to education and research into the injuries themselves and prevention and not in the sense of re-entry into an educational setting. Many SCI sources simply listed organizations for support or companies that sold AT products for persons with SCI, and while this is somewhat helpful, it is not detailed enough information for those who are in the dark about what they need to increase their independence(8,9).One hospital did refer to in-house education for it's SCI students and most rehab hospitals do have someone who would serve as an educational liaison between the hospital and the school.

As a result, there is a definite need to discuss ways in which students with a SCI can experience success in an educational setting. A distinction should be made between the use of the terms adaptation and accommodation as these terms often mistakenly are used interchangeably. Adaptation involves the development of devices or methods designed specifically to assist persons with disabilities to perform daily tasks. It is something specifically created which is not normally used by other people. An accommodation is a change or adjustment in routine, method or approach, which may be used for people with or without disabilities. Whenever possible it is desirable to make accommodations that will assist students in compensating for skills they lack before using adaptations (10). Upon review of these distinctions between an accommodation and an adaptation, it is obvious that assistive technology is considered an adaptation and not an accommodation. Accommodations usually do not require technology, yet quite frequently adaptations may especially when discussing AT solutions. As a result, this presentation will highlight easy accommodations that may assist students of all ages with SCI, yet will concentrate more so on AT solutions that should be explored.

An important factor in the education of a student with a SCI is the use of a personal assistant or note-taker (as they are called in a college setting). Depending upon the level and severity of the SCI, a student may or may not require physical assistance in an educational setting, yet this will have been determined prior to their placement in an educational setting. It is also important to note that many persons who sustain SCI may also have some traumatic brain injury as well and, while this should be well-documented, it certainly may have an impact on some of the AT considerations and educational accommodations discussed in this paper (11).

The main accommodations and AT solutions for students with SCI can be placed into three broad categories: text manipulation (reading and writing), computer access, and general curriculum considerations. Accommodations, light tech and more dedicated technology interventions will be presented in each category and will cover students from preschool to college. Handouts will be provided with for the three education categories, product information, resources and many practical ideas for accommodations and resources for students with SCI and the professionals working with them.

Text manipulation will cover a broad range of text including print (reading)and production (writing). The text category will highlight products to help stabilize books for reading, the use of various mouthsticks for turning pages or operating word processors, electronic page turners, optical character recognition, and the use of textbooks or other books in a CD-ROM format. The production of text will go into detail about note-taking, agendas, outlines, text generation, tests, projects, and illustrations and the AT tools, adaptations, and accommodations to accomplish these tasks.

The second educational category is that of computer access which will concentrate on the wide variety of ways to adapt the input of information into the computer and mouse functions. Alternative keyboards and mouse emulators for a variety of spinal cord levels of injury will be discussed. Ways to bypass a mouse click via switches or mouse dwell programs will be demonstrated. The use of on-screen keyboards with or without word prediction and voice recognition software solutions will be explored with specifics regarding logistics and educational considerations of these products.

The final educational category, curriculum considerations, is an all-encompassing one. General curriculum suggestions involving accommodations and AT will be presented in the following areas: class selection/electives, study halls, computer use specifics (such as portable versus desktop, location of computer for use, transportation, etc.), lunch, physical education, clubs, standardized tests, science labs, keyboarding classes, Internet access/options, library use, class to class strategies, transition issues, and personal needs.

While there is a great deal information of available through resource books and the Internet regarding persons with SCI, general educational modifications for students with special needs, and AT in general, there is little dealing with all three areas. This presentation explores the educational needs of students of all ages who have experienced spinal cord injuries in order to increase their success in an educational setting through the use of accommodations and/or assistive technology.

  1. National Injury Prevention Foundation Facts and Tips, 2002.

  2. National Injury Prevention Foundation Facts and Tips, 2002.

  3. Traumatic Brain Injuries and Spinal Cord Injuries in Children: Current Management in Child Neurology, 1999 Chapter 60.

  4. Spinal Cord Injuries of Adults in the Rehab Setting, North Carolina Occupational Therapy Association presentation, September 2002.

  5. It Takes Work to Get a Job: Pushin' On Newsletter. SCI Information Network, Summer 2000.

  6. Informed Consumer Guide to Assistive Technology for People with Spinal Cord Injuries. ABLEDATA, 1996.

  7. Alternative Computer Access, Denis Anson. F.A. Davis Company, Philadelphia, 1997.

  8. It's a Jungle Out There: Navigating the Pitfalls of Adaptive Equipment: New Mobility, July 1998.

  9. Assistive Technologies: National SCI Association. http://www.spinalcord.org

  10. Tools, Tips and Trick for Integrating AAC into the Curriculum: presentation by Elizabeth Rush and Grace Williams, September 2002, North Carolina Augmentative Communication Association presentation.

  11. Spinal Cord Injuries of Adults in the Rehab Setting, North Carolina Occupational Therapy Association presentation, September 2002.

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