Pushing the Birds out of the Nest

Posted on September 23, 2015September 23, 2015 by Eleanor Cawley

These opinions are my own based on my personal school-based experiences and recent postings from other therapists on social media

When is it time to discharge?

This is always one of the biggest questions when it comes down to CSE Meetings and whether or not to recommend services for students next year. Of course, in a school-based setting, the big ‘money makers’ are handwriting and now keyboarding. Before making that decision, I think that it is important to look at the student’s level of function in a particular environment. I feel that when we report progress a rubric is very important but so is the environment or context in which the skill is performed. When I look at either handwriting or keyboarding I look at the following:

Can the student perform the task automatically with my assistance in a therapy room?
Can the student perform the task automatically in the therapy room without my assistance?
Can the student perform the task automatically in a classroom with my assistance?
Can the student perform the task automatically in a classroom without my assistance?

This is an important factor that is left out of documentation on goal progress. Anyone that knows about me, knows that I love to use rubrics. I love documentation to be clear and concise, understood without my being there to explain. So I often base my documentation on the level of self-sufficiency-does the student have the power to perform the task over a wide range of activities and settings. In other words, is the handwriting or keyboarding at the level of being automatic? The DeCoste Writing Protocol is an evidence-based tool with some very good research supporting its development. Based on this research, both handwriting and keyboarding should be at the level of automaticity. If these skills are not automatic, then the focus in on the motor components of the task and therefore the student cannot meet the cognitive demands of the writing task. Basically, we will not know what the student has absorbed because he or she cannot get it on paper.

I remember hearing somewhere that in order to do your best on a test, you should take the test in the same location that the teaching or learning took place. Could that mean that a student may hand write better if he or she is in the room where they actually learned the skill? It is certainly an interesting point and possibly one for a good research study. Our goal is to have the student generalize the skills to all handwriting or keyboarding tasks-to become proficient. The Written Language Production Standards provides us with what is expected of a student with regard to handwriting and keyboarding at a particular grade level. Does your student meet those standards? Do you think that your student is capable of meeting those standards? Why or why not? Is the student capable of meeting those standards in a variety of settings without your support? Why or why not? I feel that I am not doing my job well, if I can’t answer these questions, my student is not performing as expected within the classroom and I have not offered alternatives.

There is also something else to consider and that is the student’s expectations and preferences. Is this student so overwhelmed with handwriting or keyboarding that they have just given up? I use The Student Interview to explore the student’s preferences and understanding of their own skills, i.e., what the student thinks they can do to what the parent thinks they can to and compare that to what I and the teacher see them do. The level of anxiety and frustration that a student experiences with not being able to express themselves on paper should be considered.

So while I would always like to think that OT RULES and I have all the answers, I don’t. What I do know is this, keep the student involved with determining goal progress, assess the skill across settings and keep the student in mind when determining where to go next, if anywhere. If you think that you can discharge a student when they can type 10 words a minute and they are in the 4th grade or above, think again. That student is not ready to handle the keyboard in the classroom.

Eleanor Cawley, M.S., OT

So Why Should Occupational Therapists Bother to Write Rubrics?

Posted on August 17, 2014August 24, 2016 by Eleanor Cawley

Mostly, therapists read my posts on social media and then move on. Some comment positively and others, not at all. But then there are those times when there is that one person who challenges you. I must say, that one person tends to get my fight on! I feel that I have to prove my work all over again. But I really love the debate. To those of you who feel that rubrics are not necessary, that’s okay. However, I feel they are.
Rubrics have been around for a very long time. During my research for my book, “Using Rubrics to Monitor Outcomes in Occupational Therapy“I found that rubrics actually began not in the educational field but in the medical field, decades ago. I feel that rubrics were lost in the shuffle in part due to the changes in the provider/client relationship, moving from power over to power with and ultimately to power through our clients. Now that we are searching for ways to become more ‘client-centered’ as a profession, I feel that transparent, understandable documentation is the key.

It has always been our premise, as occupational therapists, to have our clients engaged in purposeful activity. With the increasing intrusion of third-party payment systems into what we do with our clients and the struggle to become ‘client-centered’ having a method of recording progress becomes increasingly important. Yes, of course, we need to get paid for our work but we also have an obligation to our clients, any one receiving our services.

We all have those people, who question what we do. I am sure that each and every one of us has had this experience. Sometimes we can explain what is going on, through statements based on clinical knowledge, but then there are other times that we need real data. Some challengers will accept the “+” or “-” system of data collection [“+” yes the client was able to perform the task or “-” no the client was not able to perform the task] while

others want more information.

So rubrics offer us a method of documenting some of our thought processing with regard to critical thinking, clinical reasoning and judgment. Sharing rubrics with clients and caregivers provides them with a tool to engage them in the treatment process in a way that is greater than just sharing goals. By encouraging clients to monitor their own progress they become more vested, more engaged and more accountable to themselves and to us, their service providers, ultimately leading to greater gains.

Rubrics may be initially time-consuming to learn and to write, just like any other skill, the experienced therapist will soon be developing rubrics a lightening speed and have at their disposal a wealth of data and documentation supporting our services. In my humble opinion, if a therapist chooses to use or not to use rubrics, it is okay, it’s their decision. I choose to use rubrics, engage my clients in progress monitoring, and have data specifically highlighting the client’s progress. In my opinion, how can I expect my clients to make the best progress if I do not share my expectations with them. I feel that I empower my clients through the use of rubrics, because I want to, not because I have to.

Eleanor Cawley, M.S., OT

Revisiting The Student Interview

Posted on August 6, 2014August 24, 2016 by Eleanor Cawley

I have worked with middle and high school students most often. At this age, a student’s frustrations increase proportionally to the workload. They are aware of what works and what does not work for them. When frustrations run so high and parents begin to panic, it is at this time other professionals, advocate and lawyers, become involved.

The Student Interview was developed because of a number of school-based cases that I had been involved in were quite intense. Every small detail of the case was explored in depth. I felt that it was imperative that the student have a voice and that I had a document that asked all the right questions. While it is very sad to see the state of the educational system, as it is right now, I feel that the educational system is in transition. There are always ups and downs when experiencing a transition.

Over the last few years, I have used this interview with many students. Since this is a form to complete, it is good experience for a student in the transition process. There is a variety of questions, relevant to the student’s educational, vocational and self-care needs. Some questions require a yes or no response, while others are open-ended and call for more detail. The Student Interview serves its intended purpose quite nicely. Since using The Student Interview, I have not had that “uh oh” moment when something comes up that I should be aware of. At least nothing that I have not at least asked and have a response to.

I really love a student’s surprise when he or she is asked to complete the satisfaction survey. This is often the very first time a student is asked for his or her opinion on services. I, now, provide each student with this interview. I find it an invaluable tool not only as written documentation but also as a basis for a deeper conversation regarding a student’s skills, and their perceptions of themselves.

Occupational Therapy

To all the Lefties Out There! Yes, Our President is a Lefty!

Posted on August 20, 2013 by Eleanor Cawley

Check out the President's position. His paper is set up for a right-handed writer. — Check out the President’s position. His paper is set up for a right-handed writer.

Recently we celebrated Left-Handers Day. There were a number of articles written about those who write with their left hand. Some articles talked about the psychological differences between lefties and righties. Other articles discussed the statistics of lefties vs. righties. BUT what about the functional aspects of handwriting for lefties? This is really a world made for righties! Just look at notebooks and binders. The rings of a binder and the spiral of a notebook are all on the left side of the book. The left handed writer must learn to navigate around and through these obstacles. Do you see how this young woman is attempting to write in a binder awkwardly navigating her hand through the rings of the binder?

There are a few ways to solve this problem without having to torture your students:

Flip the binder around so that the rings are on the right side (upside down to a righty). You will be writing on the backside of the righty page (front side for a lefty).
OR Take a page or two out of the binder to write on then replace them when you are done. Some times it helps the quality of the handwriting by having a page or two under the one that you are writing on.
OR Use a loose-leaf pad for notes and (easier to carry than a binder) then place the notes in the binder at the end of the day.

If you must use a notebook, you can use the following tips:

Start at the back of the notebook instead of the front. Particularly if you use one of those wire spiral bound notebooks.
Use a notebook that has the spiral at the top instead of down the side.

Stay organized. Keep your binder neat and tidy so that you can use it as a slant board. A slant board will help extend that wrist a bit. By extending that wrist, you can prevent smudges and fatigue from that lefty flexed wrist.

Lastly, if you are a lefty, elevate the corner of that paper. This may also help you extend that wrist a bit.

Happy Belated Left-Hander’s Day!

Happy Left-Handers Day! Facts and Trivia About Being A Lefty – International Business Times (ibtimes.com)
Facts about left-handers (readingeagle.com)
Celebrate Left-Handers Day with these photos of famous southpaws (rollingout.com)
International Left-Handers Day: What Are The Benefits Of Being Left-Handed? (medicaldaily.com)
Are Lefties More Likely to Become Champions and Leaders? (psychologytoday.com)

Eleanor Cawley, M.S., OT

The Can of Worms is Open!-Building Blocks Missing

Posted on August 10, 2013August 10, 2013 by Eleanor Cawley

I am, in many ways, so grateful for this past year. I have gone from a caterpillar to a butterfly, so to speak. I have been so grateful for having the opportunity to collaborate with occupational therapists from all over the world and learn so much. I am excited about the possibilities for learning from social media and currently sad to see the state it is in.

I was communicating with Katherine [Handwriting with Katherine] and we were discussing my last blog, ‘Does Backpack Safety Awareness go far Enough?’ I really just expressed a lot of my own opinions, but isn’t that one of the privileges of having a blog? In my opinion, one of the major issues, understanding the importance of developing all the blocks before constructing the building. One of my pet projects, as if you didn’t know, is taking notes. There is often a recommendation for assistive technology when what is really needed is more building blocks. As occupational therapists know, good handwriting is built on quite a number of those building blocks; posture, visual perceptual/motor skills, functional pencil grip, enough muscle strength and endurance to maintain the writing task for as long as is needed, integration of primitive reflexes, etc. All of these skills are building blocks that lead to good handwriting, and there are many more.

I am often amazed at how a student could come to me in the 7th grade with poor handwriting skills but missing vital building blocks. The response often is to get him to take notes on the computer. The first thing that comes to my mind is, “Well if he can’t take handwritten notes, what makes you think he can miraculously take notes on a keyboard?” Posture, visual tracking, listening, responding to prompts, formatting the page, keyboarding, etc are all part of taking notes. I am thinking of one student in particular, 12 years old, in OT since early intervention, who still did not have legible handwriting. I observed this student in class and in the therapy room [or should I say therapy closet]. I was shocked beyond belief! What I saw was the residual Asymmetric Tonic Neck Reflex [ATNR] in all its glory. Of course, I could report my findings, but not make a recommendation to visit a neurologist [district policy]. Any way, this student exhibited classic signs of a residual ATNR. He was right handed, but left foot and eye dominant. He tested positive for an ATNR in quadruped. When hand writing, he sat on his left leg with his left arm flexed with his head tilted tilted slightly downward and turned to the right. Basically, reading with his left eye. Using a thumb wrap pencil grasp, he was able to write, but as he moved away from midline, he had difficulty retaining his grip on the pencil. His grip was so tight, I could not pull the pencil from his hand without having him topple over. He was so involved in maintaining control of his body that he failed to learn the listening skills, visual tracking skills, and all the other skills needed for effective note-taking.

Teachers have been complaining for years about his handwriting. He was able to type with both elbows tight against his body but unable to type and read from copy placed to either side as any slight head turn would trigger the ATNR. Any visual tracking to left or right of midline triggered the response. Was he aware of what was happening to him? Did anyone teach him different strategies? One of the first things that I did with him was to encourage him to write with the paper placed in landscape rather than portrait. This way he was always writing at midline. He was asked to sit further back in the classroom so that he did not have to turn his head to see the board. He was asked to work this way as we continued to work on integrating the ATNR. Here is a link to Lisa Fass, OTR/L and her videos on using Yoga to integrate the ATNR [Yoga Poses for Primitive Reflex Integration]. This student has made some progress in improving his handwriting and in integrating the ATNR.

Every baby is born with primitive reflexes which are often integrated in the first few months of life. I chose this picture of the ATNR because it shows both the upper and lower extremity responses to head turning. As you can see, the arm and the leg on the side to which the head is turned are outstretched. The opposite arm and leg are bent-a sword fighting position. Some babies, when pushing down on the foot of bent leg and reaching with the arm on the same side, it can help the baby learn to roll from supine [on his or her back] to prone [on his or her tummy]. Again, this is why tummy time is so important to development. Lisa’s video of integrating the ATNR is working in prone [tummy time].

Some therapist’s feel that once a child gets past the age of nine and the age of rapid changes in neuroplasticity, no amount of therapy will address integration of primitive reflexes. So maybe the jury is still out on this one. What I do know is this: therapists working is school districts need more than a closet to address many of the needs of their students; good mats and equipment should be provided by the school district; therapists need to be able to spot all the signs for deficits in handwriting; therapists need to be able to make recommendations “from one parent to another” or “personally, I would…” I am not sure how this went on for so long. But it did and now this student is stuck in limbo with poor handwriting, just learning about why his handwriting is so poor and what he can do for himself.

Eleanor Cawley, M.S., OT

-Daily Task Worksheets

Posted on August 4, 2013August 4, 2013 by Eleanor Cawley

When working in schools, there is a constant need to collect and analyze data. In doing so, I also feel the need to constantly evaluate my students’ skills in other areas as well. I always try to assess or reassess skill(s) during each session. I began creating Daily Task Worksheets. I typically work with an older population [middle and high school] so that vocational skills also enter into the therapy session. My thought was to get my students used to using and finishing a checklist in a timely fashion. I now keep my forms in Microsoft OneNote so that my students’ work was organized and they can use technology while completing a number of tasks assigned on any given day. Students were assigned to one of my computers [they all had names] and asked to open their own notebook. Since many of my students are seen in groups at this age, it is important to create an individualized plan for each student that encompasses their goals and promotes a sense of independence. My students love working on daily task worksheets.

My students were able to complete tasks independently or with very little assistance. At the same time, I would be assessing activities of daily living [tie your left shoe], left-right discrimination, handwriting, following written directions, and any other number of skills. Since each of the worksheets were created for individual students, I could easily include activities that would measure goal progress and, of course, explore daily progress on anything related to those darn standardized assessments. If the worksheet is completed on a tablet, a stylus is offered to the student for handwriting. Sometimes that portion of the worksheet was printed so that the student could complete it on paper. I always worked on a student’s signature, whether or not is was a goal and had them sign in daily [this just supported my billing]. It was the very first part of the therapy session. Students were required to keep an agenda for school, so I used that agenda to further increase their independence by applying a label for OT, which they applied to the correct date and added a period #. I found that students with transition issues were able to get so much more work accomplished than when they did not have a worksheet.

Eleanor Cawley, M.S., OT

-Taking Notes from an Occupational Therapist’s Perspective

Posted on July 14, 2013August 4, 2013 by Eleanor Cawley

http://1stopbrainshop.com/study-skills/making-notes-on-books-or-handouts/951/

Taking notes is a very complex skill rooted in abilities developed in infancy. While sitting in a classroom, a student is expected to have appropriate cognitive and motor responses to the teacher providing the lecture. That is easier said than done!

As an infant, we are supposed to alert to a sound, respond to that sound with head turning in that direction, differentiate pleasant sounds from unpleasant sound and learn to express pleasure or displeasure. Visually, we are expected to respond in a similar way: alert to a visual stimulus, respond by following that stimulus by turning our head to follow it, differentiate pleasurable from displeasing. Infants are expected to demonstrate a motor response to the stimulus, i.e., eye opening, finger splaying, and activation of limbs.

Just as an infant is expected to display a motor response to stimuli, a student is also expected to respond motorically to stimuli provided by the teacher. Students learn to respond to certain cues, i.e., “This is important,” “Conversely,” repetition of the information, etc. It is very difficult for student to respond if he or she lacks the prerequisite skills. Alternatives for taking notes should be offered to the student. The least invasive is to have the student copy notes from the board (far point). Some students have difficulty with visual skills such as pursuits and saccades (visual tracking and changing fixation from one target to another) making this difficult. First a slant board (often a binder) can be used to address this issue. If that doesn’t work then maybe copying from near point will work.

The next more invasive intervention might be providing the student with some form of prepared notes, i.e., Cloze Notes. Cloze notes are fill-in the blank notes. Students are only required to add one or two words to a statement rather than copy the entire statement. The next level might be providing the student with a copy of teacher generated notes prior to the class for the student to highlight during class. The next level might be having the student attempt whatever he or she is able then giving a copy of notes to the student, usually a copy from another student who takes very good notes.

Another strategy is to use on-line notes for a site like www.studyblue.com. You may be lucky enough to find course notes similar to class notes with flash cards. Kno.com is a site where you can buy electronic textbooks (usually at a reduced cost), this site also provides lecture (from the book), study materials and social networking for studying. Kno.com is iPad friendly. Along with programs like Evernote with Penultimate, this maybe all the student needs to be in class. A student could photograph handouts and never have to carry another piece of paper. Assignments could be entered into Everstudent (a digital assignment book/agenda).

One of the last options would be to type notes on a laptop or a computer. If the student lacks the prerequisite skills for note taking, they cannot be expected to be successful if you give them something to type on even though they can type at a good speed with good accuracy. A sixth grader is expected to type at a speed of 25-30 words per minute with 93% accuracy. If a student has only handwriting concerns, is able to meet all the prerequisite skills for note taking, can type 25-30 words per minute with 93% accuracy then maybe the option for using a keyboard or laptop is the answer.

Eleanor Cawley, M.S., OT

-Dictation is a Necessary Note-Taking Skill

Posted on July 10, 2013August 4, 2013 by Eleanor Cawley

What? Dictation you say???

Yes absolutely, being able to take dictation is an important part of taking notes. After all, isn’t the teacher talking about subject matter, while moving about the classroom? Isn’t the student supposed to be writing some of the things that the teacher is saying [not all, but some].

Learning to take dictation is simple. You should start in kindergarten and 1st grade. Yes, this young. Remember, taking dictation is a motor response to an auditory cue. When a child is young, learning to take dictation should be fun. A scavenger hunt in the classroom, the house or in the backyard is a perfect way to begin. First, dictate letters [no more than 5], have the child write the letters that you dictate and then have the child locate an item that begin with each letter. Make sure that you are using the letters and words that have been practiced in class to reinforce what has already been learned. Also, turn the tables and have the child give you 5 letters [words] and you must also find items. You may also make the sound of a letter and ask the child to write the letter that he or she thinks it is. While some say that this is too early to learn dictation, it is not. As long as you are using the same material learned in class and make a game out of it, you will be fine. ALWAYS follow the child’s lead. Never push a child to go faster. The object of this exercise is for the child to write what he or she hears and not speed. I would also include using a keyboard to type the letters. First we want to create letter recognition and then familiarity with the keyboard. As the child becomes more skilled in keyboarding, allow the child to choose the fonts and colors that he or she likes. Again, this must be a fun activity. If it is not fun then you are not reinforcing the excitement of learning. Learning is not always fun and some students struggle immensely. When working with a parent or therapist, learning should reinforce school skills and be fun. We do not want the child to lose interest and shut down.

As a child grows and develops additional skills, vocabulary words can be used for dictation. Not only does this increase the amount of handwriting and keyboarding practice that a child gets, it also helps to learn study skills. If your child is having difficulty with spelling, you can get a parent account on http://www.spellingcity.com to practice spelling and vocabulary with computer games. They have an iPad app, if you choose.

Increasing the complexity of the task, I would start with sentences in the 3rd grade. Sentences should be very short and be related to the vocabulary being learned in school. You can make a sort of Mad Libs and have the child insert silly words into the dictation. Again, follow the child’s lead and give him or her the time to write what you have said. The goal, again, is for the child to reinforce what is learned in class and to be able to write what is heard. By 4th grade, I would take a very short paragraph from the material that is used in the class and dictate from that. I would also have the child dictate to me. Again, it needs to be fun, a game. I might also have the child correct my handwriting, to help them be more observant in making corrections on their own. Even if you are perfect, make some mistakes that your child has already learned for editing their own work. If you are at a loss for material, many of the local newspapers are written on a 3rd grade level. Pick an interesting human interest or sports story and dictate a very short excerpt.

By the time a child reaches middle and high school, I work on dictating and entire paragraph from the newspaper, often something related to a DBQ [Document Based Questionnaire] that they are working on in class. I have them either type or write the material and begin to improve speed. Up until this point, accuracy has been the focus of the dictation and not speed. I would also practice using the prompt words for note-taking and have the child take down the important points [based on my prompts]. As a therapist, I would be sharing what I would be doing in a session, with the classroom teachers so that they can see the value of the therapy and also follow through. As a parent, if you have any concerns with handwriting, spelling, listening skills, etc., please discuss these with your child’s teacher or therapist.

Assistive Technology

-Using OneNote to take Notes in Secondary Schools and College

Posted on July 7, 2013August 4, 2013 by Eleanor Cawley

Another of my favorite therapy areas is teaching students how to take notes. Taking notes is not easy. Students must be able to respond to auditory cues with a pen/pencil or a keyboard. Some students feel the need to take down every word, while others can take down the highlights. Since I am an occupational therapist, my job is to teach students how to respond to environmental cues with movement. So I would like to talk about taking notes in my favorite note-taking program, OneNote.

There are a number of reasons to set up note – taking templates or forms in OneNote. For example, this T-Chart can be used for a number of different classes and discussions within a class. Prompts that may indicate that a T-Chart should be used are: Compare/Contrast; Conversely; Vocabulary Words/Definitions; Pros/Cons, etc. This note-taking template can also be used for pre-algebra/algebra or anywhere where there is a rule and a sample. The Cornell style of note-taking also uses a asymmetrical T-Chart for cues and notes.

Simple T-Chart created from a table and saved as a template

Much of the job is already done for the student. The page is already formatted for the student. I find that formatting is often part of the delay and disorganization in taking notes. If you click on the date, a little calendar appears and the date can be easily changed (calendar will indicate the correct date). The same can be done for the time. Rows can easily be added to the table by clicking on the appropriate icon in the ribbon at the top of the screen or by right-click and then click on Table. The color of the page and print can also be changed to address any visual concerns.

The real trick is learning the verbal prompts so that the appropriate form can be identified and opened. The great part of this system is that this is an auto-save program! If the student closes the program before saving, the work will still be there. Another factor to consider is keyboarding speed and accuracy. Figure out if the student can take dictation on the keyboard accurately before recommending this method to any student.

Eleanor Cawley, M.S., OT, Occupational Therapy

Working on a New Book

Posted on June 9, 2013June 12, 2013 by Eleanor Cawley

I am currently working on a new book called “Mom, Do I Have to Take Notes?” This will be a humorous look at note-taking skills for students in grades 4 through college.

You are not required to complete the contact information to answer this poll. The purpose of the contact form is for you to acquire additional information, if you chose.

Assistive Technology, Eleanor Cawley, M.S., OT, Occupational Therapy

How Important is the Content of a Referral When Evaluating for Occupational Therapy?

Posted on June 6, 2013June 7, 2013 by Eleanor Cawley

When conducting an evaluation, in my case either an occupational therapy or assistive technology evaluation, is the quality of the referral important? In my opinion, absolutely!

Occupational therapy [and assistive technology] cover a huge array of skills in an infinite number of areas. When conducting a school-based evaluation, it is prudent to know what the student’s difficulties are. For example, if a student is unable to take notes, I would explore a variety of skills in detail [visual tracking, handwriting, orientation to sound, etc.]. I would need to know that the student is having difficulty in this area and this is an area that the school would like to address. I would also need to know what the student thinks: Is writing notes the problem or is something else. Students need to provide feedback during an evaluation. Their feedback provides insight to strengths and limitations that professionals might not see.

If I were evaluating a senior citizen, I would need to know what current and future living situations are being discussed and what the expectations of the patient and possibly the family might be. For example, does the patient and or the family expect that this patient will cook or shop independently? Although I would surely conduct a global assessment of this patient’s skills, I would definitely expand and focus on the skills that the patient is expected to be able to do. In the case of cooking and shopping, my evaluation would focus on handling utensils, navigating the kitchen, energy conservation and safety, including fall prevention, both in the kitchen and out in the community, the patient’s ability to follow written and verbal directions, generating a shopping list, etc.

The referral asks the questions that the patient and his or her family need answers to. Having a referral focuses the evaluation on the client, the student, the patient. It shows the person being evaluated that his or her needs are important and valued. This helps develop a rapport with the client that can support the therapeutic process so that the client has a vested interest in participating in therapy.

So, in addition to the diagnosis, the client needs to learn what an occupational therapist does and what he or she can assist with prior to the evaluation. My next blog will cover “Just What Does and Occupational Therapist do?”

Assistive Technology, Eleanor Cawley, M.S., OT, New Beginings, Occupational Therapy

When Is It The Time To Recommend Assistive Technology For Note-Taking?

Posted on May 23, 2013June 9, 2013 by Eleanor Cawley

I must state, before anyone reads this, that I am a HUGE fan of using assistive technology.

I recently read a comment about a piece of technology not being “cool.” I realize that there are students who will never feel “cool” when using assistive technology. I also feel that students must be taught touch typing and the basics of functional programing before being asked to take notes using assistive technology. It always boggles my mind when some recommends a piece of assistive technology, such as an Alpha Smart, without ever considering if it will really work for the student. Many students consider an Alpha Smart to be ‘uncool’ for the following reasons:

Looking different from peers
Not knowing how to use the device
Still not being able to keep up
Fumbling with the technology in front of others

In my humble opinion, students need time to learn how to use such a piece of equipment or a program. One of the reasons that a student might need the technology is due to an inability to handwrite legibly. Another might be difficulty organizing thoughts and motor movements. Assistive technology needs to be worked on privately with the student or in a very small group with other students using similar technology. Every aspect of using that device and the skill that it is supposed to support needs to be worked on prior to giving this device/technology to the student to use in the real world. For example, when providing an alternative keyboard to a student to use to take notes the following needs to be explored:

Can the student take notes without the device even though his or her handwriting may be illegible to others?
Does the student know the verbal cues that would trigger him or her to start taking notes?
Is the student capable of taking dictation either written or using a keyboard?
Can the student use those verbal cues to format notes? If a student hears the terms “Pros and Cons” or the word “conversely” does the student know that this may be a great time to use a T-Chart style of notes?
Can the student attend to the instructor long enough to follow the lecture?
Is the student familiar enough with the keyboard to type at least 30 words per minute over the length of the class for note taking?
Can the student use punctuation to help the notes make sense with any degree of success?
Is the student comfortable enough with keyboarding in a room full of other students, who are not using a keyboard, to be successful?

Obviously, I could ramble on and on. We need to think, “When is an alternative device or program better than the low-tech copy of notes provided to the student? The technology that we supply is only as good as the support that we give to the student. If we jump to provide assistive technology to a student without looking at the student’s overall ability to succeed without the device, then are we sabotaging the student to dump the device or program and throw in the towel?

I feel that note-taking should be a skill taught in every school, to every student. A task analysis of note-taking skills needs to be completed and the student assessed using that analysis before providing a device. The organization of the page should come before the thought of using an assistive technology device or program. The language that we use in the classroom should trigger a particular format of notes.

There is so much learning that needs to be done by each and every student. Students are getting frustrated and need to have a place, a structure to go back to. At that point, once the structure has been taught and reinforced and the student is not yet successful, then and only then should a device or program be considered for taking notes.

I know that every teacher that I come in contact with is working day and night to help all the students learn everything they need to. I know that many provide notes, study guides and review materials to students, hoping that somewhere, sometime, something will work at some point. I think that those of us working with students need the structure, the organizational hierarchy, to assess a student’s abilities just like our students need to learn.

Assistive Technology, Eleanor Cawley, M.S., OT, New Beginings, Occupational Therapy

Note-Taking from an Occupational Therapist’s Perspective

Posted on May 23, 2013May 23, 2013 by Eleanor Cawley

Assistive Technology, Eleanor Cawley, M.S., OT, New Beginings

Assistive Technology Assessment

Posted on May 22, 2013August 4, 2021 by Eleanor Cawley

Thinking in Terms of Developing Skill Sets Rather Than Compensating for a Disability

There are many types of assistive technology evaluations including: mobility, seating/positioning, communication, computer access, switch-access, and aids for daily living, work-site modification, home modification, and recreational assessments. While assistive technology should be considered in the typical ways; it should also be considered in other ways, i.e., development of skill sets.

From the use of smart phones to navigating the community, developing visual picture schedules to support a cooking or grooming task to the use of laptops and desk top computers for literacy programming, assistive technology supports the development of skills or skill sets. [Assistive] Technology is here to stay.

Students who are unable to develop skills similar to their peers may very well be more capable with the use of technology. The Cloud, iPads, iPhones and tablets make taking notes and organizing those notes much easier [with training] increasing a student’s ability to be independent. Using literacy programming may actually provide a student a voice where he or she did not have one before. Using technology successfully has the potential to help a student develop confidence and self-esteem.

What makes the addition of developing a skill set different from the typical assistive technology evaluation? First the referral is targeted toward a specific reason for that referral. All of the same criteria for that typical evaluation are assessed. The same programming and devices are explored as is the student’s responses. Each teacher working with this student is provided with a questionnaire and interviewed based on those responses. This then gives the evaluator a picture of the student and the skills required to meet the demands in each core class. A clearer picture of the student’s abilities to achieve the desired skill set is then established.

Based on the demands of that particular skill set, the student is observed discreetly in a core class. For example, if the desired skill set is to take notes, the following skills will be explored and data collected: responses to sight and sound, orientation to the teacher, motor response to cue words, quality of the notes taken (content, legibility and organization), etc. Based on the data collected, recommendations are then made to help the student reach the goal of the desired skill set. This may be almost a full day of assessment for a particular student.

Once recommendations have been made, and the report has been submitted to the district, the real work begins. It is important for the evaluator to be in contact with the district’s technology team. Together with the technology team, a device can be prepared to meet the student’s needs in each of his or her classes. In the case of note taking, it may mean that a device must be in sync with the Smart Board in class so that the student can save the lecture notes. Different programs, based on teacher preference, may also need to be learned by the student to ensure that the notes are recorded.

So after a full day of evaluation, and further consult with the technology department, it is prudent to set up additional consult sessions to train the student and the staff in the use of the device, develop future goals and assess whether or not this plan of action will be successful for the student. In order for assistive technology to meet the needs of the student, it must be constantly assessed and re-assessed, with additional support to the student.

In a different scenario, a student may be recommended for an assistive technology evaluation to address poor handwriting skills. In addition to the typical assistive technology evaluation where the student’s keyboarding ability is assessed, he or she may need additional support in keyboarding using a touch typing method to improve speed and accuracy. Often a student with poor handwriting skills has been provided with a computer as needed but he or she has not learned the correct method of keyboarding. This leads to greater frustration and disenchantment, with any device provided, due to a higher error rate.

A traditional assistive technology evaluation may be requested if the student has reading difficulties, for example, Dyslexia. Options for assistive technology include text to speech programming-having text from a computer read to the student in a computer voice. Once the student has been approved for assistive technology, depending on the programming chosen by the district, the voice in the test to speech program can be somewhat pleasing or definitely irritating. It is difficult to train a student to to modify and use this type of programming during the initial evaluation. Digital book sharing services require that the student have an account. This account needs to have a completed application, parent consent and a sign-off by a professional to indicate a visual print disability. It can take a day or two for the company to approve the application. Upon approval, a Welcome e-mail is sent to access the account. Often, an additional program needs to be downloaded before the student or parent can download books to read.

There is a significant delay in the student accessing and using this programming. If the teacher has not had access to digital book sharing prior to this student, he or she also needs to learn how to use the programming. So in addition to the evaluation and initial training, follow up and ongoing training is necessary. This training can be done by the evaluator or district personnel knowledgeable in this area.

In general, assistive technology can only be considered successful if the student is using it to function within his school and home environments and is able to perform the activities with an increased level of independence. This brings attention to another issue that arises with the use of assistive technology, which is caregiver training. Frequently, in this training loop, the parent [or caregiver] is left out. It is important to have the parent participate in at least one training session, once the technology, approved by the district, is in place.

It is ny goal to ensure that every student receiving assistive technology, either through the district or through private funding, receive the training that he or she needs to gain independence. Once again, if the student is not comfortable with the technology or does not fully understand how to use it, the technology is wasted as is the money spent or the evaluation, purchase and training. We must also be very careful in not allowing the assistive technology provided being considered another failure. This can further undermine a student’s self-confidence and self-esteem.

When is it time to discharge?

Share this:

Share this:

Share this:

Related articles

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this: