Transcript Adaptive Technology Assessments for

Assistive Technology Assessment
for Individuals with Acquired Brain
Injury and Vision Loss
Presented by
William Hersh, MSLVR, CLVT
Overview
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Visual system dysfunction
What is Access?
A note on Teams
A structured approach to providing AT services
Making the assessment protocol more effective in
addressing the unique needs of those with CVI
• Technology
• Case Study
When structures of the eye don’t
function as they should
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Acuity
Contrast
Field
Accommodation/Focus
Light Dark Adaptation
Color
Stereoscopy/Convergence
Motility
Refractive Errors
Snellen
Amsler Grid
Scotoma
Ocular impairment affects
Visual Skills
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Fixation
Eye Movement (Saccade and pursuit)
Shifting Gaze
Localizing
Scanning
Tracking
Tracing
Fixation
Saccade and Pursuit, Shifting Gaze,
Localizing, Scanning
Tracking
Tracing
Ocular Impairments, missing visual
skills, and CVI affect
Perception
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Discrimination/matching
Closure (letter recognition from partial image)
Figure-Ground
Form constancy (recognition regardless of size or
orientation)
• Visual memory
• Visual motor Function
• Visual emotional function
Discrimination
Closure
Figure Ground
Form Constancy
What am I?
Form Constancy
Is this better?
Closure with inferior Scotoma
IUMRING TO GONGIUSIQNS
Visual Memory
Can be Misleading
IUMRING TO GONGIUSIQNS
More Reading with Scotoma
Access
Holistic Model
• Person with a disability – motivated and amenable to
available access methods (tools & strategies)
• The task and task components have to be inherently
accessible (i.e. to the tools and strategies as they
currently exist) or able to be modified
• Tools and strategies to redress access barriers have
to be available
• The skills and knowledge necessary to effectively use
the tools and strategies must be developed
• Team must be in place and committed
Structured approach to achieving
Access
• Identify task(s)
• Identify barrier(s) – (barriers may be present in any
of the components of the access model).
• Explore the inherent accessibility of task- Universal
Access
• Select AT tools & vision strategies
• Skill with AT tools & strategies are developed/taught
• Help maintain consumer motivation by taking small
achievable steps
• Communicate with the team to foster cohesion and
support for the process
Assessment & Evaluation
Team Players
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Ophthalmologist (no specialization in low vision)
Ophthalmologist (specializing in low vision)
Social Worker/ Case manager
Assistive Technology Specialist
O&M
TVI (K-12)
CVI - Low Vision Therapist, OT, PT, Speech Language
Pathologist (Additional specialists when needed)
• Family and community support …..
More on Teams
• unidisciplinary: developing competence in one’s own
field
• intradisciplinary: believing that you and others in
your field can make contributions to individuals with
disabilities
• Multidisciplinary:
– recognizing the important contributions of other
disciplines to individuals with disabilities
– enunciating a philosophy that comprehensive
services based on individual needs must be made
available to all individuals with disabilities
More on Teams
Cont.
• interdisciplinary: working with other disciplines in
the development of jointly planned programs for
individuals with disabilities
• transdisciplinary: committing oneself to teaching,
learning, and working with others across traditional
disciplinary boundaries to better serve individuals
with disabilities
A Structured Approach
To AT Service Delivery
• Establish connection with the team – at specialist is a
supportive role
• Gather information
– history (Visual, Physical, Cognitive, Social)
– Reports, other assessments
– Etc.
• Discover and set goals
• Break goals down into tasks
A Structured Approach
To AT Service Delivery
Cont.
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Analyze barriers
Choose Tools (usually compensatory)
Provide Training
Follow up (possible re-evaluation – new team
members – sometimes starting from scratch)
Does the protocol change?
Typical measures of eye function (e.g. acuity, field,
contrast, etc.) are not an indicator for how the visual
system functions – it does not tell us how the person
is going to use their vision – so it cannot be used as
the sole basis for selecting technology – especially
for those with CVI.
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Does the protocol change?
Cont.
Color
Latency
Movement
Complexity
Visual Field
Novelty
Reflex Response
Distance Viewing
Light Gazing
Visually Directed Reach
Does the protocol change?
Cont.
• More emphasis on Team and role release
• Breaking down tasks into components may require
additional breakdown into even smaller steps
• Understanding skills hierarchy and analysis of skills
deficits may require more focus
• May Vision Therapy prior to or in conjunction with
provision of AT to address gaps in skills
Does the protocol change?
Cont.
• Decision to use AT as therapeutic tool or as
compensatory tool or both
• Ongoing formative assessment – MCB may drop in
and out of process over a period of months or years
– a RECURSIVE PROCESS
• Remaining available as a resource to the team
• Who should take the leading role? MCB?
• Other considerations?
Technology
• Compensatory (tool) or Rehabilitation (therapeutic) –
in the middle?
• Low Tech? High Tech? Both?
• Interface type?
• Community support & the team?
• Follow up? Follow along?
• The future
Tech Devices
Monocular
Video Magnifier
HH Magnifiers
Spectacle Mounted
Portable VM
Black Light
Dome
OCR
Light with Magnifier
Portable VM
Refreshable
Braille Display
Portable VM
More Tech Devices
Bioptic
Synthesizers
PDA
Software
NOIR Filters
Tablet
Demo
The Future of Technology
Algorithmic Intelligence
• Algorithmically intelligent software
– Tutors
– Formative evaluations
– Self adapting software (don’t we already have this?)
• Algorithmically intelligent environments
– your clothes
– Your home
– Your car
• Algorithmically intelligent ecosystems
– Your town, city, …
The Future
Flexible Interface
Wearable Devices
In Our Clothes
Gestural Interface
The Future
Cont.
Self Driving Car
Natural User Interface
The Future
Cont.
Can’t find it on
the open
market?
Maybe ask a
friend??
$250 !! He
made it in his
garage !
Case Study
iPad Calendar
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Joe Smith
Background – cerebral stroke during surgery resulted
in functional vision loss characteristic of CVI.
Team – Spouse, OT, Speech Path, Ophthalmologist,
other medical specialists, MCB team members – CM,
O&M, Supervisor, AT Specialist.
Desired Task – to be able to access the calendar on
an iPad and to independently schedule and check
appointments.
Task components (specific to accessing the calendar)
Barriers – acuity loss, field loss, visually guided motor
dysfunction
Case Study
iPad Calendar
• Addressing Barrier w/existing technology –
magnification, increased contrast, repositioning
device, teach scanning skills, lighting, seating,
spacing of icons, redisplaying calendar content so
that targets are further apart & seen is less complex,
alternative display, different device, tactual feedback,
etc., pen friend as memory aid.
• Addressing Barrier in the future?
Suggestion Box
• We need to rely more heavily on a team approach
• We should be prepared for the time investment that will
be required to make progress
• We will need to find creative ways to balance resources
with need – for example – role release.
• We need to develop in house expertise and redundancy
• Utilize technologies not usually part of the VI tool kit –
e.g. Jelly Bean Switch, Wire Bead Manipulative, Vision
Stimulation Apps, etc.
• Embrace the high rate of change in technology and find
ways to stay on the leading edge
Works Consulted
Cook, A. M., & Hussey, S. M. (2002). Assistive
Technologies Principles and Practice. St. Louis:
Mosby, Inc.
Joyce, B., & Weil, M. (1986). Models of Teaching.
Englewood Cliffs: Prentice-Hall, Inc.
Lueck, A. H., & Dutton, G. N. (2015). Vision And The
Brain - Understanding Cerebral Visual Impairment in
Children. New York: AFB Press.
Works Consulted
Cont.
Presley, I., & D'Andrea, F. M. (2008). Assistive
Technology for Students Who Are Blind or Visually
Impaired - A Guide to Assessment. New York: AFB
Press.
Scheiman, M. (2002). Understanding and Managing
Vision Deficits - A guide for Occupational
Therapists. Thorofare: SLACK Incorporated.
Images
Images from Google Images and from Vendor
Websites.
Questions?
Contact Information
[email protected]
413.781.7214