 I am absolutely thrilled to introduce Linda Burkhart, who has been a leader in our field for a little while. Well, I can't remember exactly what year it was and the first time I saw Linda close in the gap. It was in the 80s and then again in the 90s and I remember going, somebody was talking about my kids and I have been a stalker and a follower and an absolute fan of Linda's work forever. She talks about our most vulnerable and our most complex children and that's where her heart is, that's where her expertise is and you certainly will be in for a treat. We all will be today. I've seen Linda present, I don't know, lots of times, never once have I come away with not learning something new or be reminded of something important. So with that, Linda, take it away. Thank you very much, Kathy. Thanks so much. Well, for those of you who don't know I'm a classroom teacher or at least I was at one point in my career, started out as a special educator in Prince George's County, Maryland in the US and I got dragged out of the classroom about 15 years later to the Center for Technology and Education, which is a joint project between Johns Hopkins and our Maryland State Department of Education and in that role I was an AAC specialist throughout the state of Maryland and somewhere as I first got started, when I was still teaching I started doing some trainings and workshops so I've been doing those for quite a number of years so if you add it all up it's around 45 or so. So when I started Switch Access, these were my kids that I had in my classroom and my favorite kids and there were no switches. I had read an article in a journal that said they were working on biofeedback and they had this huge helmet you could put on the kid's head and when you pick head up the TV would turn on and I thought oh that sounds really cool and so I wrote to them and I asked them hey can I get this helmet and they said sure just send us $650 well my budget for the year was $25 so it was way out of my reach but what I ended up doing was wandering around the electronics parts stores and saying you know what's that what's that sometimes they do but eventually I put that together with my background in electronics which I got in third grade when the teacher gave me a battery a light bulb and two wires I got the light bulb to light up and basically that's my background and what I was doing but I was decided to make switches and I made switches in the beginning specific for each child like child to help pick up their head or turn their head or sit up straight or move what part of their body and somewhere along the way wrote an early book on this on how to make the switches and then started teaching people around the country how to make them but now you don't have to do that because you can buy these wonderful switches already made for us and ready to go but that kind of gives you a little bit about where I'm coming from the thing is even in the beginning when I started doing trainings I noticed this big difference or just a big problem in my mind because people see switches and they say okay we hook the switch into a toy and we turn on the toy and that was about it until well now they're ready for an AAC system so now we're going to plug the switch into the AAC system and they're going to do automatic scanning and I just saw this huge huge gap in between so this presentation is going to be covering some of my thought process and learning over all those years trying to figure out how do you go from causing the effect up to scanning and some of the teaching principles that go along with that okay um just as a slide disclosure I do have a small home business where I sell some of my software and books and I'm a private consultant I still see kids if I didn't still see kids I don't think I could get out here and talk to you okay so which kids are we talking about who might use these switches um and I'm talking about access to an AAC system or access to education for learning so many of the children that I work with have complex communication needs so they need the AAC system as well as access to learning they may have physical challenges that are significant to the degree that they can't really use direct selection or if they have physical challenges but that might be able to point many of them have additional visual challenges such as cortical visual impairment which means that you couldn't put many pictures on their display and it would limit their vocabulary so they're going to need to be able to use switches to access a more robust language system and then there's some kids who are using a multiple access system sometimes in a great position in the right situation they can use some direct access sometimes they'll use eye gaze and then because of physical position fatigue um environmental factors or strategic competencies or even their preferences they might decide to use switches for part of the day or for certain situations so we're talking about individuals who might use them part-time as well as those who would be um dependent on using them to access all of their communication and learning okay um starting out with there's more to using switches than getting the kid to hit the switch that's my worst um phrase that I hear and hit the switch no um we need to do a little bit more than that so what are we thinking about first of all historically in the field of AAC and switch access field of assistive technology we've been going on a switch hunt we're going to catch a good one now we're going to find a good spot so we'll take a switch and you know does it go best up here you know do we move it back a little bit is it better on the other side did they do it with their hand their knee or whatever um and I've seen this for years and years and years and people are still looking for switch sites um 17 years later and I would suggest from my experience at this point let's stop the switch hunt um we um do need to think about what switch we're using and we need to think about the site but the myth that I think that I have realized is that people think there is a perfect switch site that we have to find and I don't think there is one I think the reality is is we have to find some good possible switch placements and then provide opportunities for the child to learn how to use them these individuals have severe physical challenges they don't move easily and they haven't developed much automaticity of their movements of their movements to start with so they need to learn to use a switch and so it's not about finding the right the perfect switch site it's about finding the perfect switch sites and I use that because nobody can handle can live just with one single site that they use their switch with um and I used to think this was you know I didn't know that this was the case and I thought we just find the perfect place that they're always going to use and then the kids grow up sorry then the kids grow up and um they become they use their switches they use them for communication they use them for education to write to do all of their um online interaction and what happens is they develop repetitive motion disease disorders from using that same movement over and over and over and they end up with lots of pain deformities and orthopedic problems because they're only using one site so even if an individual is going to be an automatic scanner I would make sure in the beginning to teach them multiple places on their bodies now some might be more efficient than others but it gives them opportunities to rest certain areas when they have fatigue and be able to have options also when there's more than one switch site you can think about two switches another thing is that no one starts with automaticity of movement if we're looking for an automatic switch access um we have to think about motor skills are actually learned we all learn um when a baby's born they are not able to move their bodies the way they want if you throw a ball at them it just takes them in the face right but if I threw a ball at you can't over online but if I threw a ball you catch it because you have that automatic reaction of having done that many many times over your lifetime okay another couple of things that I want you to think about is learning is really impacted by two things that Anatvanyel talks about one is the ability to perceive differences our brain cannot learn anything if everything is the same if we don't understand the difference between what a letter looks like from another letter if we can't see the differences if we can't know in our body if we move in a standard pattern where our whole body moves together and we can't perceive a difference from our arms moving and our head moving then we aren't going to be able to isolate a movement to move so it's visual hearing if we can't hear the sounds of our language and differentiate speech sounds we're going to have trouble taking information in that mode so we have to look for the modes that the information can get in and how that individual can perceive differences is one of our really important things to keep in mind another thing that impacts learning hugely is the need for these children to make sense out of the nonsense the visual world their auditory world their physical world doesn't make sense to them in the beginning when they're born it's only over time as they learn that they begin to make more sense out of their experiences okay when you do something fast you can only use motor skills that you've already developed to automaticity what do I mean by that so let's say pick something like tooth brushing that you do every day I hope you do and think about what are you thinking about when you're brushing your teeth thinking about your teeth probably not you're thinking about oh I gotta do this later today or I got where the kid's doing and what's my husband you know spouse doing with all this you're thinking about anything but teeth and when that's the case um you're gonna get your teeth brushed yeah the thing is you won't get better at brushing your teeth you will be able to brush them and you'll keep being able to do that but you won't be able to get better now let's say you go to the dentist and the dentist says uh oh you've been uh avoiding that bottom left a bit you have a lot of plaque build up on the bottom left now when you're brushing your teeth what are you thinking about the bottom left right now you can get better at brushing your teeth learning take some attention and slowing down in order to be able to learn and process information you can't improve or refine your motor patterns without slowing down and attending to what you're doing so for our children who are stuck in whole body motor patterns or patterns where a lot of their body moves together at the same time through through primitive reflexes or their tone it means that every time they activate the switch or move within that pattern they'll get that pattern set more in their brain but they won't improve the pattern just by repeating it okay when a child's only option is to use that current automatic motor pattern um the pattern will get won't get better in quality um simply through repeated juice as I just said and you need to attend to it we need to provide the supports for you to learn how to use your body in a way where we can begin in a healthy position orthopedically for your long term orthopedic integrity and then teach you how to move in somewhat of a healthy way so that you're not limited by some of those automatic patterns that you may be experiencing okay so using two switches without timing is frequently easier and leads to development of more controlled refined movements than using one switch with timing demands what do I mean by that when we have two when we have a single switch and we're doing something like an automatic scanning and we activate the switch and it starts to scan we have to wait wait wait and then we have to quickly move to activate the switch we may miss it but we do a lot of waiting and then quick or fast activation and when we're doing that it means we have to use an automatic movement because it's not slow enough or controlled enough to get better so we're not going to get better at that particular movement or get a better movement that is more healthy for us if we just continue repeating if you use two switches and one moves the item but nothing happens until you move it again move it again move move move it again and then decide to select it now what you've done is you slowed it down and given me the option to focus and think about what I'm doing more so it allows me to have the potential of gaining some better motor control when I'm using those two switches in the learning process okay so teaching switch access before you're able to use switches for learning or communication the individual has to develop automaticity of switch use if you don't have that automaticity like brushing your teeth with the switch news then you're going to be thinking about activating the switch which means there's less room in your working memory to think about whatever tasks you're doing whether it's communicating or writing or doing an assignment or doing an assignment if you're focusing on the switch then you aren't going to have the full working memory to work with so we need to get kids to a point of automaticity before we use switches to test kids or before we use two switches to expect them to be able to show us what they know and what they understand and how well they can use language or interaction um so learning to use that switch is a process and so we're going to talk a little bit about that process um automaticity when I'm talking about automaticity it's a level of skill where you no longer have to consciously think about performing that skill but when you learn how to drive you are really paying attention and you thought about I'm coming to a corner I better look at my rear view mirror I gotta put the blinker on you know you thought about all those things yeah you don't think about it at all you're pulling up the corner you automatically look in the mirror you put on the blinker you um talk on your telephone hopefully not on the on the hands and change the radio whatever you need to do you can do it automatically um so skills take time but once you gain automaticity you don't have to think about it and then you can think about something else about where you're going okay um so I think our kids are facing a juggling act they're trying to use motor skills vision skills auditory skills cognitive skills everything all at once when maybe none of them have developed to that level of automaticity yet and so they are trying to juggle what it's actually how much can fit in my working memory at a time so am I focused on the motor piece or the language piece or which piece is taking my working memory so we always have to remember when we're working with these kids to balance the cognitive and the motor load if the cognitive loads high we better reduce motor load if motor load is high we need to reduce the cognitive load so we need to always think about those two components I think basically juggling explains um the inconsistency of performance do you have kids that are inconsistent that's like very many of the kids I work with they're inconsistent like you did it you saw it right and then then we have these goals that say you need to repeat it eight out of ten times on five occasions or something ridiculous like that and he can't because the time that you saw everything with the plates in the air was like his olympic performance you saw it actually come together and an olympic athlete can perform amazing things but just when they win their world record or whatever it doesn't mean that five minutes later they can do it again or even the next day many times they work up at it so believe what you see when you catch a kid juggling everything it's good insight into their understanding and abilities and then work on the individual pieces so that they can be more automatic so that they can be able to juggle more frequently over time we talk about this through the concept of parallel learning Carol Goosens was one of the first that talked about parallel learning and we're thinking about parallel learning for the goal of getting to the development of autonomous independent communication as well as autonomous access to education but let's just look at communication here for a minute in terms of how we work to get to that individual's level of being able to be autonomous and independent for by parallel learning we mean everybody on the team is working in the same direction so you got to sit down as a team and figure it out which can be challenging because these kids mostly have tons of team members but it's important to think about what the physical therapist is thinking about and what the occupational therapist is thinking and the speech language pathologist and the teacher and the vision specialist and the hearing specialist and all the different the parents family members and the individual themselves what are our goals if our goals are going all different directions then we're not going to end up at a place where this child is going to be an independent autonomous user of communication or learning this has to be planned out so we have to think long term down the road where we're going so we can be more parallel in our thought process okay we have to focus on one component of a skill within each activity or part of an activity like this part of activity i'm going to make the motor hard but the cognitive is similar or we're going to take the cognitive load off and work on you know the motor we're going to teach the switch access not to be able to do all this hard stuff at once but we'll teach switch access as a separate but parallel skill to the language and academic learning we're going to be doing all of it it's not like we teach switches then we introduce language then we introduce academics we have to be doing it all in parallel so that they can eventually end up with a skill the children can use okay so in terms of language we may use a non-electronic partner assisted scanning communication book something that allows the child to be able to communicate with something like partner assisted scanning where you either show the child a few pictures at a time and they indicate with a no or a yes and be able to communicate in a robust system or even something still robust but at a simpler simpler kind of level so in this case the motor load is reduced because a child's no could look like this or could look like or could look like that or could look like that or like that and as a human partner you can realize that that's a no and so the child does not have to have as refined a motor skill if they're using a switch for no in order to be able to get that switch they have to have a very refined movement if they're too low if they don't go far enough they have to be more accurate if they're motor skills so sometimes we start children with severe physical challenges using a non-electronic communication system that is at a robust language level and we may have to reduce how much vision they use in order to give them enough language but we're reducing the motor skill and the vision if vision is a challenge when you think about electronics we also could do non-electronic forms of electronic of academic modifications so for example instead of typing or using switches to access an alphabet we use a partner assisted alternative pencil so the child says you say a b c d e say no turn to the next tab f g h i j they say yeah you go one at a time f no g yeah g and that takes you to the controls oops no write it again no another letter no space etc so you can see that they might do that with simpler motor skills and focus on learning to write with the alphabet for comprehension i might use an a b c b board for comprehension answers and what i do here is we certainly set the purpose for listening first or reading or whatever and the child then has perhaps a multiple choice answer and we give them each answer one at a time using the a b c d then we come back yes question we give the answer a if they say yeah we put it over here if they say we give them b if they say no we leave it there see they say no we leave it there see they say yeah we put it over here and the last one is i don't know we're not sure that way now we've narrowed it down and we go back and read the question again and give the two answers you see how this simplifies their ability to answer instead of just um tell them here's the question and answer you've got one shot at it a b c d which is what most technology does it gives you one shot at the answer and then it either tells you you're wrong or it limits the choices and works its way down but this way just like you take a multiple choice test you read through your your options and you narrow it down to the ones that couldn't be or the ones that might be and then you go back and redo it so we can do modifications like this that don't require the child to have to leave take the test or do the comprehension on the high tech while they're learning switch access same thing is the reduced amount of work that they'll be able to do that the whole class may be doing a whole sheet but the teacher might circle the ones that that particular child would be responsible for okay so in parallel also then we're going to be developing that motor control and to start with motor control you have to look at active positioning so the child has to be actively engaged in positioning holding themselves against gravity so that they can perceive differences when their body starts to move you might use something like a um a grass bar so that they have better opportunities this is just a suction cup that you pick up um glass plates with and some PVC pipe and the child can stabilize themselves and then um when they are leaning forward and stabilizing themselves on their hands they have a better chance to isolate um their head movements and perceive differences of their head movements so thinking about that and when you're doing those kinds of things you may have to reduce the cognitive load or the language load or the vision load at that moment where you're really trying to get that active engagement and learning about the active engagement for too long we've had an assistive technology field tried to find the right position and kind of strap the kid and put them in the right position and hope that works and what I have learned over the years is it's not enough to for us to position them they've got to be actively engaged in the position too they need to help hold themselves against gravity because by having a relationship with gravity then they're going to be able to isolate a body part much more easily than if they're just um kind of stuck in whatever straps and their weight bearing on whatever body part we've kind of put them um into so it's not a matter of just getting him in the right position but also teaching them what's a good position and how they can participate in that movement um and then we do introduce switches we would introduce switches though through play so we can reduce the cognitive load and we would allow the child to experience opportunities with problem solving without a high cognitive load without a high language load without a high vision load if needed so what um we're doing is letting them experience that bubbling plate of the of the switch access until they get more automaticity so we don't typically give the child a full robust language system on the high tech device why not because we already have a full high tech uh full light tech or non-electronic wherever I stuck it a full non-electronic system that we might be using with them and it can look a variety of different ways doesn't have to be um for vision challenges kids we can see as well but they have access to their language system but not at the moment they're learning to use the switch and so those are the things I'm thinking about same thing with vision if the child happens to have this cortical visual impairment we need to really think about teaching this child to use their vision and we'll need to look at the CI range by Dr. Christine Roman-Lancy to make appropriate adaptations to materials and environments we have to think about when we're doing vision we better reduce the motor cognitive and language demands on that child perhaps at that moment um and it kind of teaches us that we may not be able to work on vision during some of those other priorities so when we're doing communication or academics we may have to work on those and work on vision in parallel not saying one's better than the other but working on all of them in parallel okay and down the road what our goal is for them to be able to combine their motor skills their language their academic their vision to operate a communication device or whatever technology they might be using to um uh for education for learning so that's our goal and that's where we're going only works if we're in parallel okay um so let's think we're going to teach your motor tasks what does the research say about learning a motor task just a couple of general things that the um research tells us is to learn a motor task initiation from intent must come from within the child the child has to move themselves or want to move or have the intent to move to learn a movement pattern um and one of the important pieces is problem solving that they need to learn how the what is what is the movement as much as what isn't the movement there has to be problem solving I'm just going to get it right the first time and repeat it over and over and over variation is important here um think about a kid learning to walk that's a motor skill and how many times do they fall in their bum like lots of times before they walk because not walking is just as important as walking what is not the balance is just as important what is the balance having that ability to problem solve and find that um range is really important for learning a motor task um practice with repetition is important but the repetition needs to have a purpose they took some kids with cerebral palsy and they um gave them they took they gave them two tasks one they were reaching for a dowel when a therapist was holding up a dowel and they recorded the quality efficiency of and efficiency of their movements and then the second setting was that they did the same kids reaching first the same reaching movement but instead of a dowel they were doing it in as part of a game okay and then they looked at the quality efficiency of their movement pattern same movement the quality and efficient pattern pattern was better when they were playing the game okay but when the individual has a purpose you increase quality efficiency of movement the other thing the reassurance tells us it takes thousands of repetitions to to uh learn a motor task and not just any old repetitions but um with variation that's part of the problem solving so we have to do think about learning a switch a switch here a switch there a couple of times here and there who isn't going to do it this child is going to need thousands of repetitions and um with intent and purpose and variation in order to be able to learn motor skills even the rats that show us that um if a rat can move themselves versus somebody else deciding when they're going to move um then um the rats the larger thicker cortex is more growth hormone more um ability to do and learn so this and I don't want to equate rats with people but this kind of to me illustrates too how hand over hand or putting the kid through the movement is not effective in learning the motor task because the intent is not starting with the child and the child's not getting the motor feedback so developing that level of automaticity is going to take only repetitions thousands with intent purpose and variation and that's really important to remember and when we're using switches that's what we're going to be coming back to and thinking of okay now motivation provides a lot of intent it's got to be worth it to these these kids have a really hard time moving their bodies so certainly we have to think about what will be something that will provide a purpose or an intent for them um in order to be able to learn a switch not just to go through the motions or do the exercises okay and then natural context provides purpose and variation so you think about a natural context and it's never the same every single time so you get variation naturally and it always has a purpose in natural context there's reasons for doing things so the more we can teach switch access within natural context the better okay another thing that I've learned about is that empty praise is not helpful I go into some classrooms sometimes and I see people have gotten a switch set up and they grab a switch here and they um they have it they tell the kid come on you can hit the switch you can hit the switch and the kid just sits there and so what they do is they take the kid's hand and hit the switch hand over hand and um then they go yay you did it the kid's like no I didn't you know kids know they didn't do it so when we praise them for that they get confused they can't perceive differences see what you did versus what they did so instead of just praising randomly wait till the kid actually does something and acknowledges in their own mind I did it then celebrate with them enjoy and praise at that point um help them be able to see the difference the other thing is who likes to be told what to do not most people but what do we do to kids all day long we tell them what to do right okay um so I would suggest limit telling them what to do instead of here's your switch it's over here put your hand over here good you know telling them what to do think about telling them what they did instead of what to do oh you got the you um made the you build up the blocks or are you um you uh made the the pig knock them down or whatever tell them what they did versus what they need to do and this is called strategic feedback instead of prompting a big component of strategic feedback setting them up so they can problem solve explore and do it and then give them feedback and some of that feedback comes from us some of that feedback from how well we've set up the technology and the switches and everything that um the switches are connected to as well okay feedback is critical for motor learning as well um we need appropriate and perceived feedback we don't have a good sense of where our body is in space we don't necessarily get good sense of where that hand is we're not getting good feedback from that and so um we need to make sure that they get good feedback whether it's appropriate accepted feedback visual feedback auditory feedback cognitive feedback whatever a linguistic feedback doing language kinds of things um what we need to do is develop neurological loops that start from the child's intent got an idea i want to move i move i get feedback it goes back in and makes that loop stronger we make our neurological loops stronger by doing them that way so we want to be strategic and clear with our feedback sometimes it means we need to be quiet um and just let the child problem solve and get the feedback from what the switches are connected to so it's a matter of figuring it out for for each child but the idea is to give them the feedback that will help them process what they did okay another thing is i want to caution is don't build an external prompt into the motor loop sometimes people um tell the kid put your switch and then the kids begin to wait okay is it time for me to hit the switch now or is it time for me to say something this happens with aac like i'm waiting for you to ask me a question or waiting for you to prompt me versus i use it so remembering that the prompt is not what we want to do the strategic feedback is more effective for getting autonomous strategic okay and then another way to um reduce our prompting is model um and modeling by taking a turn not doing the exact same thing they're doing but if um they're using switches you use switches you put it by the body part that they're using and do part of an activity that's similar to what they're doing and so they can see you and peers do that sort of thing as well okay all right so let's getting back to the actual body and get started how you teach this motor skill i don't have time of course to go into all of the physical position types of considerations that's what you work with your OTs and your physical therapists um for with and i'm just going to put a few pointers out there that active weight bearing on their pelvis so that they can have a relationship with gravity somewhat more forward it's typically but not all children if they can to get some weight bearing forward on their arms um wrote um learning to shift weight if they're going to activate a switch they're also going to have to shift weight to get off of it or if they go to one side to get off of it they're going to have to shift weight to go to the other so shift weight or rotate they can learn slight ones if they have a good relationship with gravity and you have a good way to teach them how to do that um talked about the grasp are all ready ready but it helps them to give that active line helping hold my body as well and also just a pointer that um control for these individuals often begins at the head we develop oftenly cephalodiccadals so um we typically uh we'll find more success by starting with switches at the head than we do with at the hand depending of course on that individual and the severity of their physical challenges because of the severity of some of the physical challenges one of the things i'd like to mention also is the use of a proximity switch or a sensor switch these can respond to very subtle movements without any extra force being applied um there's a variety of different ones that are on the market there's the candy corn this one actually has a a beep first i turn it on proximity switches need a battery so they have to be turned on you can see how it lights up and i think you can hear can you hear that that it's turning on it makes this beep in the beginning you might think oh that's cool it's good feedback it's cool for a very short time but after a while that beep i wish i could turn it off because if i keep that feedback here then my only feedback is this part i'm not getting the feedback focus or my attention on the activity i'm doing so i need to shift my attention to the to the feedback from the actual thing that it's plugged into versus just the switch itself um they make a larger one where you can turn off the um sound but the little one you can't do that so um i don't know what the big one's up next to its head but the little one again so for learning it's a great idea and it's a economical choice and another one would be that one's from ablenet this one's the honeybee from uh adaptation and this one works with line of sight there's this little red box here so you have to um so in the right that line of sight and it can do one inch three inches six inches so it has some options where you don't actually have to touch it the advantage of a proximity switch is that you can move towards it but not have to apply force with a mechanical switch that's about this candy problem with a mechanical switch you move towards it then you also have to apply force when you add that additional force you're more likely to trigger whole body movement patterns from the individual and make it harder for them to perceive differences because they're pushing harder than they would just moving towards it so you can start with much smaller movements and teach an individual to move just a little so individuals who don't move much at all can be successful with a proximity switch without much movement at all okay they um then you can move it out so that they can begin to learn a broader movement so that they can be able to do um more effective types of access right um and the adapted switch labs version and this one connected to little fashion tapering this one um this one oh it was in between songs so when we're on it we're on off we're off these don't work on line of sight these actually sense your closeness so these can be embedded in a headrest they can be put under a tray like a wheelchair tray and you can get your hand over the tray and still activate them and so these also have a little screw to adjust the amount of sensitivity there so those are from the back just some different ones that you might think about in terms of looking for a proximity switch so that we can help the child perceive differences in movements by not adding that extra force or speed that the child sometimes they and have to work up some speed to get that force and that also limits their success okay just to show you a student who's using this this is alex alex is doing an activity where he's got two proximity switches and he's going between them if he has mechanical switches he has a lot of extra motor overflow his body gets if he gets stuck in particular positions um you'll see a little bit of overflow in this video but not nearly the amount that he would have with a um uh mechanical switch okay so here he is and what he's looking at is an ipad but he's not working on an app that's switch connected to the ipad he's actually working on a software on the computer because we have much more robust software on the computer for switches so the switches are connected to the computer and i'm using splashtop to mirror it on the um ipad but for i'll show you that in a minute but let me just show you his movement parents so he's so his choices aren't as left fine dialogue what's this a choice fine Lucy Lucy oh you might lose fine Lucy all right okay so you get the idea there so what i was using was um splashtop you can also use team viewer it mirrors a computer screen on your ipad and allows you to move it in closer so that the child might have vision challenges in addition to meeting switch access you can put it in an area where they have a better chance of seeing it and reducing some of that background clutter okay um okay so okay moving into my stepping stone process so all of these principles kind of build to how do i get started with using switches um and i created a stepping stones analogy because i think about um it's not rigid when you're crossing a creek you're on a couple of different stones and you can go forward or backward it's not like a ladder where you're going up step by step so a lot of times kids are on multiple steps i might start them on a lower step to get them going excited where's here's the switch right and then challenge them keep them interested by moving up a little bit and then as the activity um gets really challenging and they are starting to fatigue i might reduce it a little bit so that the child can be successful to end the activity so it's not a rigid process but it's how it's evolved out of that frustration i talked about at the beginning of people starting with cause and effect and going to automatic scanning how do we get there this is the process okay so stepping stone one is single switch cause and effect we all do that right um something that um people use um a lot and when i go around to schools i see it on ips a lot i find that sometimes it's been on ips for 10 years or longer um and people are still working on it and um it's the it's interesting because cognitively it doesn't take much to learn cause and effect um um what um do you know how young and child might be um to be able to be understanding what cause and effect is yes it's they've shown some research now that a fetus can do cause and effect okay so when people say he's too low well i don't know it's a cognitive issue um so the problem with cause and effect is you can't cause and effect is learned through experience and so our job is not to teach cause and effect it's to set up a situation where the child can learn cause and effect through experience okay and that's the challenging part for us to be able to figure out okay how do i set this up for them to experience it but once you set it up correctly then what you find is children learn it fairly quickly sometimes i stay on the step 10 minutes um and not 10 years but setting it up finding what the child might be motivated interested in finding the body part movement that they could accidentally use is important the concept is we're trying to get the child to associate an intent and a movement with something that happens so they can repeat it so um one of the things is that we need to find an accidental switch activation i think it's too much to teach a new movement pattern and cognitive concept of cause and effect at the same time now if it already has cause and effect you can go to the teaching movement pattern but if the child doesn't have cause and effect in a way that they've been able to demonstrate it to us yet then we need to um think about we need to work on the fact that they can understand that moving some part of their body can cause something to happen so we need to take a movement that they already can do if possible okay so we may for a very short time use an abnormal pattern at this point so if a child has an atnr we may put the switch um there only if the child's atnr is one that is not fixed that they can come in and out of because they have to be able to repeat that movement or if they use a movement pattern and this is why we're doing it only very briefly because we certainly don't want to reinforce those motor patterns but we might use it just to get the cognitive connection oh i'm doing it and then we can shape and teach a more healthy um useful motor pattern because they know they can do it they're going to work to be able to learn that skill okay so um for example for the kid has a floppy head you might put the switch under their head um if um this is skylar skylar has dread syndrome and she tends to rock a lot so where do you think i put the switch right in front of her so that she's going to rock into it okay so let me show you this video um this is her first time um experiencing switch this fight and so he was a long time ago much younger there okay here we go she got it you think she has causing of it she certainly got it very that uh no does that mean she has control over that movement no she still has to learn better motor control but we know that she's got the cognitive understanding that i can do something now what's the next thing that's going to happen after a child explores discovers that they can do something they will not do it nine times out of ten as soon as the child figures out they can do the switch they will not they're trying to figure out what happens is somebody going to do it for me is somebody going to help me with this or um you know or did i really do it it wasn't me did i can they want to proceed the differences they want to know did they do it do they have that control to do it again and you'll see real clearly in this video is one reason why i love it is that she stops it on purpose now she doesn't know how to get to the movement back to find it again and it takes her a while to be able to find that movement again um to explore enough to find it but the idea is not that she's going to use this movement for switch access down the road but that she's got that concept that she can learn to persist to go after a movement to find it she'll eventually get her arm kind of um she's getting interrupted with her stereotypes but she'll eventually get her arm and body into it together and she'll lean into it okay so you see what i'm talking about starting with an accidental um switch activation the other thing you saw there was i was using momentary or direct um uh switch access by that i mean when it's on it's on it's off it's off and that's the kind of access i was showing with the proximity switches where when it's like the tape recorder which is one of you know the old-fashioned tape recorders um when you're on it it's playing when you're off it stops immediately this is really important because then the child gets very clear feedback if they hit it and it happens to stay on for a couple of minutes finding that movement of where they were when they got it on is going to be harder but moving on it and off of it now i only use this for a very short time because i'm not trying to torture the kid the child is need to hold it on to hear their music um when it's a recreational leisure i'll use a latch timer or a timer of some sort so that when they activated it stays on for a period of time but in the learning part if we do that it doesn't give them as clear a feedback and they're not as likely to be able to perceive differences okay um so um there's there's some software that's available for um direct access and one of the ones that i've been working on in mind express and disclosure at the beginning that i do have some products mind express is the software that i'm using to kind of replace some of the things i used to do on classroom suite program that i loved and is no longer available um but anyway on some of those the child can you can upload your own video and or use the videos in there and the child activates it's on off it's off so gives them that opportunity even if you use it for a couple of minutes at the beginning of an activity to say here's your switch today or here's going to try it in me spot so that they get that and then they move on through the other step itself so when you're looking for software and technology that works for cause and effect it has to have an immediate response to the effect needs to be momentary or direct or at least just a short time okay um and it can't play for two minutes so lots of the things out there that are labeled cause and effect aren't really cause and effect they're more recreation and leisure okay one of the other ones that does cause and effect is the good old um rad sounds from rj cooper um judy lin's software has the boombox that you can put your own songs in that as well and that has a director momentary as well okay and then um for short activations we can do tar hill gameplay and that allows us to set like a few seconds and it stops and then the child will activate their switch again so for example um for time i'll just use the space bar to show you um here we're in um a song when i activate it it plays for a short time and then you can shake it shake it like i'm supposed to be because i got that boom you get the idea it's gonna play one more time okay all right so you can download videos there the ways i like to download videos currently for on a computer this is the website i use um it seems like these websites come and go um i used to use video grabby there was a whole bunch of other ones just keep up with the new ones that come out um but this will allow you to download a video for free from youtube or whatever um again being um conscious of copyright and that sort of thing for educational purposes if you're downloading on an ipad use the icab app um and then there's another free program if you want to turn a video into a gift okay i was stepping stone one we're on stepping stone two close all right um let me go a little bit further so stepping stone two is a single switch multiple locations for multiple functions in other words now i know i can turn on a switch but why should i and how do i get better at that and what could i move to do that with so it's helping that child um practice that intent to get something to happen and begin to learn different movements that they can um use effectively okay i'll just show you analia here analia's using a single switch and i'm providing strategic feedback not telling her get your switch get your switch but telling her when she does she's watching a um a hiding of her dad hiding behind a a box and he comes out and dances and so i say there's daddy uh oh he hit again oh now it's tommy tommy's height favorite feedback it doesn't work when you go down there she goes yeah there you go so you can see how i'm not trying to coach her all the way through it i'm giving her feedback okay i give her feedback for what she's doing and there was a long pause in there how many of you would want to help or um in between there um it's a human nature to want to do that but it's important not to because that helps them get that motor loop okay and kathy is giving me the um the uh time sign so i guess um this is to be continued um next time next wednesday yeah next wednesday at um 3 30 a same time same channel there's a couple of questions which is the other thing that i wanted to do um so um before i get to the questions i just okay again you did it to me every time you do it to me um the myth of the perfect switch site and parallel learning i know that i always need to be reminded i always always always need to be reminded and then i love your quote a good relationship with gravity love it love it so um okay so of course and alway's people are asking about those books that you showed at the beginning which were your the the pod books and the oh the pod books yeah and how can we get some so uh you can either talk to that now and or if you want to talk to that at the end of the next one i'm kind of well those those are pod communication books and there are pod trainings um for the us and canada i think they're all the trainings that are available are listed on the website podusa.com yeah and so that would give them access there right and and and also i'll just let you know that it march 8th and 9th in calgary uh yeah there's a two-day pod training and you need to do a two-day pod training before you can go to the full-blown five-day which i'm finally going to um at the end of june in portland um so it is it you do need to learn a little bit well you need to learn more before you just get those books sent out to you um they were also wondering about the lovely alternative alphabet book that you did and i have to say too i've seen lots of um alphabet flip tarts that were not as lovely as and and as rich and as deep as what you showed us so yeah i think i'm going to have to make this one available on my website i'm going to work on it i if i do it in boardmaker format i can use the boardmaker symbols that i have in the back if i did it in a pdf i'd have to take them out i guess so i'm trying to decide what format to put them up on but i'll do that at some point on my website hopefully sooner than later okay yeah it's it's just really um the best uh obviously i'm not alone in thinking oh that's the best i've seen so it just doesn't surprise me that it's you i have the lower case too i use both okay beautiful beautiful um and then i'm just looking through um people wanted to know about your proximity switch and does the companies do the companies that sell them provide training my answer was sort of but not like you're getting here today so do you want to speak to that um probably the one that would does the most training is the adaptive switch labs because they actually make it for wheelchairs okay so they they actually you can do it you can get the version that works through the wheelchair or you can get the version that works through um just the computer or both i mean there's the educational um versions that are more switch adapted for using a switch interface directly um without the power chair and then there's others that kind of combine all those things together so adaptive switch labs probably does the most amount of training there um some of the other companies do have training do have trainings i think there's not a lot to learn on it um to learn how to use the honey bee there's a quick video right on their website at the first page or right by there it tells you troubleshooting that kind of thing but basically use it the way you use any other switch um and so what i'm trying to teach in this webinar is some of the things to think about regardless of what switch you're using right so teaching about how to use the switch and teaching about the broader things that you're talking about are very different things and so yeah the companies will show you about their switches but i mean we're just so lucky today and next wednesday stay tuned folks to have linda talk us through um her process and i also am really grateful for some of the things that you did at front end today to bring us um this the foundational thinking around this so not just about the switch and i have to do all that other part first right on all right um i'm going to just pause her minute and see if there's anyone else that has any other questions for you on today day one and i'm i'm sorry to cut you off i i actually let you just kept on going for hours but i do want to honor your time and other people's time and to remind everyone she's coming back part two so are there any other things before we go this evening that people want to um ask you can turn your mic on i won't mute you or um if you want to throw something into the chat okay i'm hearing crickets so um and so um people thank you yeah thank you thank you well um yeah so i will i will underscore that as always and ever every time i hear you talk i um i learned so much and this was no and and i'm reminded of what you taught me a long time ago that i probably forgot so anyway thank you linda uh we look forward to part two and um and also i just need to take a little moment to say linda worked really hard so that we could get this recorded to post she found some families in these videos that and went back and asked the families if they would be able to share them with us and so um you really went above and beyond so i totally appreciate that and thank you i think seeing the kids and the pictures are really important too they really are it just shows everything so all right and very generous to share them with me lovely so if you if you send them a big thank you from the whole province of alberta we would like it awesome thank you linda we look forward to part two and um yeah as other people say alberta thanks you exactly so we'll see you all next week um keep doing wonderful things with kids and uh more of this great stuff to come good night all thanks so much kathy for having me