Author: Linn Wakeford, M.S., OTR/L
This is actually a review of three cases in which simple computer adaptations have enhanced a child's ability to engage in preschool learning and peer interactions in their classroom environment. Although there are particular products named, they are not necessarily recommended, but are representative of the types of peripherals and software that may be useful for particular preschool children.
Elena, Aaron and Mark are all enrolled in preschool classrooms that are part of an inclusive child care program. Elena, a 4-year-old, is diagnosed with cerebral palsy; Aaron, who just turned 4, is diagnosed with autism, and Mark, also a 4 year old, is diagnosed with oral dyspraxia and has difficulty with both gross and fine motor praxis as well. All three receive occupational therapy and speech therapy services, and Elena and Mark also receive physical therapy services. Therapy services are provided on an integrated model, and participation in classroom routines and learning experiences are among the goals of intervention.
Elena has been interested in writing her name for about 6 months or so, both at home and in the company of classmates who are mastering this task. Elena has very good cognitive and language skills, but has difficulty with the motor control necessary for writing. Elena's mother asked for help in teaching Elena to write her name, and Elena's teacher agreed to assist the OT in a regular program to address this issue. The use of an adapted keyboard was discussed, in addition to working on actually writing Elena's first name. The OT borrowed and set up an IntelliKeys keyboard on the classroom computer, and designed a program of 15 minute practice sessions at least 3 times weekly, which would include both using the keyboard and practice writing. Pre-intervention measures were taken which included time required and number of errors on two tasks: tracing her first name and typing her first name on the keyboard. Intervention took place for 4 weeks, and those measures were then re-assessed, in order to make decisions about further intervention. During the course of intervention, several positive outcomes occurred regarding the use of the keyboard. The first was that within two sessions, Elena was able to use the shift key to make the first letter of her name upper case, and then type the rest of her name correctly 2 of every 3 tries. She also knew how to backspace to correct errors, and how to use the enter key to go to the next line. She could type her first name correctly in about 7 seconds, while even after 4 weeks of intervention she traces her name with multiple (>10) errors, and does not form legibly all the letters in her name. Another very positive outcome involved her increased interaction with peers while working at the computer, spelling out their names, and teaching them how to operate the keyboard. This was particularly positive for Elena because, while she does have friends in her class and is a sweet and sociable child, she tends not to initiate with many of her classmates and is more comfortable interacting with adults. Elena has become quite proficient with the IntelliKeys keyboard, and is anxious to begin using it for other activities on the computer as well (she had also previously learned to use a trackball with relatively good proficiency). It will also be a useful and familiar tool for her as she enters a kindergarten classroom next school year. (Note: A basic word processing program that was already on the computer was used for this intervention, but a word processing program with auditory feedback, such as IntelliTalk might have been a nice addition had we had ready access to it.)
Mark is one of Elena's classmates, and so has access to the same computer and peripherals. Mark is a bright child who is very aware of his own difficulty with motor tasks, and he had demonstrated little interest in using the computer because he perceived that even using the trackball attached to it was going to be too difficult for him. He characteristically resisted adult attempts to direct his learning in this area, and so had little experience with the computer. In order to encourage learning to use the trackball in a non-threatening and self-directed way, the OT loaded the software program KidPix on this computer, and showed teachers how to access and use it (it's quite simple). As his classmates explored random drawing and creative activities using this software and trackball, Mark became interested himself, and began to engage in this activity during free choice play times in the classroom. He has learned to use the trackball fairly proficiently, and is beginning to use it to access more structured learning software. After the IntelliKeys keyboard was installed on the computer, Mark also became interested in using this peripheral, particularly after observing his classmates using it. Since Mark will likely have some difficulty learning handwriting, due to his motor planning deficits, the use of a keyboard had already been discussed as an option for him. While the keyboard would not replace basic functional handwriting skills for Mark, it was felt that beginning to be comfortable with this method of written expression would be helpful, and could be integrated easily with intervention related to language, speech and pre-literacy goals. At this point, Mark is able to use the IntelliKeys keyboard to write his first name, and is exploring typing the names of classmates, toy animals, etc. The keys with Mark were to 1) begin with a very simple software program that essentially guaranteed success to hook his motivation, 2) introduce it by means of the peers he most likely would try to imitate, and then 3) provide opportunities for him to decide to move on to more difficult tasks on his own. Adult support was provided as positive feedback, and to help him attend to what his peers were doing, but was not directive in any way.
Aaron is a bright child and in the high functioning end of the spectrum of autism, but has some mild to moderate motor dyspraxia. He had been interested in computer games and learning software both at home and at school, but was unable to master using the mouse to interact with the software independently. He was able to point to what he wanted selected, and so was able to use a touch window for access. However, because Aaron is bright and in the future will be capable of using the computer for a variety of learning and academic tasks, it was felt that limiting him to use of a touch window was not adequate. It was decided to give him the opportunity to learn to use a trackball rather than the mouse, since trackballs are readily available commercially and easily accepted as an access method. It was also felt that Aaron may be more successful moving only his fingers to move the ball, rather than the more extensive movement required to control a standard mouse. The OT installed a trackball with wrist support area on the computer in Aaron's classroom, and discussed teaching methods with Aaron's teachers and parents. Aaron was shown the connection between the movement of the ball and the movement of the cursor on the screen by giving him verbal descriptions as he traced where the cursor went with his finger first. Then he was given the opportunity to move the ball to make the cursor go where he wanted. A familiar routine for Aaron was for him to point to where to arrow should go and the adult (or a classmate) actually moved it there. That familiar routine was used, but with roles reversed for him, so that the adult was pointing to where the arrow should go, and he made it go there. Also, for the first learning session, very familiar software was used, so that Aaron could concentrate on learning to use the trackball rather than on the software activity itself. Within one session, Aaron was able to use the trackball to access learning and game software on his classroom computer. He is now able to access software on his own, and to participate with classmates in taking turns pointing to icons and moving the cursor to play various computer games. This has enhanced his social roles as well as his independence and play skills. His parents were so thrilled with this that they immediately bought a trackball for use on their computer at home!
These three cases are not examples of high-tech, complicated interventions that required a technological genius to devise. They are simple uses of basic technology that worked because the individual characteristics of the child, their environment, the task, and their particular learning needs were matched with technology that was easily integrated into their daily routines. Parents and teachers, as well as other team members, were highly involved in the process, and the result was a team intervention that worked and can now lead to further learning and participation by each of these children.
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