Jane Hankins, Melody Rodriguez, Teresa Sandoval, Haleigh Salvage, Esther Garcia de la Cadena, Deanna Fierro, Crystal Smith, John Thomas, Marie Orechoff, Olivia Hart, Melissa McGehee, Carolina Hernandez, Laura Celic, Julia Ochoa, Alicia Steph, Victoria Castellon, Melissa Wolny
The iPad has been a boon to special education, but physical and intellectual challenges can result in barriers to access for many of the students who could benefit from it most. Despite the adaptive features, it frequently becomes another frustrating activity that these students give up on as yet one more thing they “can’t do”. KID GLOVZ can transform it from chore back to child’s play by providing quick success and fostering confidence in the process.
Our client was “Emily”, a fourth grade student in a special day class for students with moderate-to-severe disabilities. Emily is intellectually disabled, has a severe-to-profound conductive hearing loss, cerebral palsy affecting her fine motor skills, and sensory stimulation issues. Emily had previously worn a BAHA (bone anchored hearing aid) for her conductive hearing loss, but because of her sensory stimulation issues, she would constantly flick it off. This resulted in damage to the device which was costly and time-consuming to repair, and ultimately Emily’s parents decided to discontinue using the BAHA for the present time.
At the age of 11, Emily has no spoken language skills. Her one-to-one aide uses sign language with her throughout the day and she demonstrates some understanding of it, but Emily is only able to approximate 6 signs herself. Emily had a picture schedule in her classroom but, because she really likes to eat, she only ever grabbed the picture for lunch, no matter what activity was happening. One day we took some voice-output buttons and recorded the different items that were in her lunch. “I want a cookie,” or “I want some soup,” and so on. We placed the button in front of the item, and when Emily pushed it, she got to eat some. It was the first time we realized that Emily was actually making choices that had meaning for her. And even though she could not hear the voice from the buttons, the other teachers and aides in the room started to treat her differently. We recorded this and showed it to her mother. It was then that mom became determined that Emily should learn to use some type of voice output AAC device. She was even willing to pay for an iPad and an AAC program herself, she just wanted our help. There was just one big problem. Emily did not have the dexterity to use an iPad.
We had started noticing a pattern while using the iPad in therapy with students like Emily who had moderate-to-severe disabilities. Many of these students would just slap at the screen. Modeling a finger-point gesture and giving verbal instructions didn’t seem to help. These students were able to make the correct hand shape when someone physically manipulated their hand, but they would revert right back to the open hand slapping as soon as the manual assistance was withdrawn. Repeated attempts at correction resulted in student frustration and a desire to terminate the activity.
For most students, learning the gestures to use the iPad evolves naturally from observation and imitation. Some students need additional assistance.
We needed was something that could:
- bridge the gap while these students learned these skills at a slower pace
- act similar to training wheels for riding a bike
- facilitate the development of fine motor skills
- give these students a quick experience of success
DESIGN & DEVELOPMENT
After hours of observing several students, we saw that one of the main problems was that students would rest their hands on the screen as they attempted to make the gestures and the capacitive screen would not respond. We needed to create some barrier between the child’s hand and the screen so that only the fingers we wanted to touch the screen could make contact.
At the 2014 RESNA Conference in Indianapolis, Katie Duff & Patti Bahr gave directions for making a custom-fit Gentle Assist Pointing Mitten made of neoprene which provides a cut out for the index finger and creates a barrier between the rest of the hand and the capacitive touch screen. The end result however, resembles a medical device a little too much for our students. Therese Willkomm, Ph.D., also has a similar version made from a Fed Ex envelope. Both of these only offer solutions for index finger isolation, and neither of them are very child-friendly.
We wanted something that would look familiar to the children and more like a play object than a medical or therapy device, something that would not single out the user, and—because there is some controversy about the amount of time children should spend on computers—something that could be utilized away from the iPad. It also had to satisfy our criteria of providing a barrier between the capacitive screen and the undesired portion of the child’s hand, while allowing access to the desired portion, at the same time fostering the correct hand formation. The solution we finally arrived at was sock puppets. We looked at the gestures we felt were most important, and came up with a basic set of three puppets: an elephant, a bird, and an octopus.
Elephant—Index finger isolation for tap, drag, & flick
Bird—Thumb & index finger pinch & spread
Octopus—Five finger grasp & splay
Elephant 3 socks, thread, 2 buttons $ .93
Octopus 1 glove, 1 sock, thread, 4 buttons $1.47
Bird 1 sock, thread, 4 buttons, marabou $ .97
Cost per set = $ 3.37
We first tried Emily with the elephant puppet but since it was the most restrictive, she was very resistant to having it placed on her hand. We decided instead to start out with the least restrictive octopus puppet, which had a normal hand shape, utilizing a glove with the fingertips removed. She was intrigued enough by the puppet that her resistance was minimal. The results were immediate. Previously Emily had only been using full hand slapping on the iPad screen. Now, because the glove was preventing sensory feedback from the rest of her hand, she was using just her fingertips on the screen. We quickly turned on a finger painting app and for the first time, Emily engaged with a cause and effect app for almost three minutes.
Emily worked with the puppets for three weeks in class. At that time her iPad skills were reassessed without the use of the puppets. Emily was able to successfully tap a 3 inch target using just her index finger to “pop” a bubble in 1 out of 3 attempts, over 5 consecutive trials. According to her occupational therapist, her accuracy and intentionality have continued to improve.
DISCUSSION & CONCLUSIONS
Since there are no studies done on the long term effects of iPad use on young children, we kept our sessions to under 30 minutes per day, however there were times we wanted to continue using the puppets to practice the fine motor skills, so we came up with the following activities:
Octopus Drop—We were informed by the first grade girls in one of our classes that octopi love gold and jewelry, so we created a game to scoop up plastic gems, coins, and beads with the octopus glove and carry it to the other side of the room and drop it into the treasure chest. The team with the most jewels in the chest wins.
Scrambled Eggs—Colored jelly beans are tossed in a bowl and the bird puppet sorts them by color into an egg carton.
Elephant Soccer—The elephant’s trunk was used to “kick” the ball. Since it was around the time of FIFA 2014, this was a very motivating game for all the kids in the class and ended up helping tremendously getting the students to hold their wrists up. The students even asked if they could use the left over socks to make team shirts for their elephant puppets.
The iPad was released in April of 2010, and since that time it has dominated the educational market, a market it essentially created. Multiple occupational therapy products exist for handwriting and keyboarding issues, but there does not seem to be anything on the market as yet for what appears to be an emerging area of need.
Special thanks to Dr. Maura Martindale, Department Chair, Special Education and Deaf and Hard of Hearing, California Lutheran University, the XXXX Elementary Elephant Soccer League, and Team Doodle Bug.