If you are a school-based OT or on a team along with school based occupational therapy professionals, you’ve probably heard this conversation before. We’re talking about what to do to support students that have tried everything when it comes to handwriting interventions. At a certain point, after we’ve exhausted all attempts with handwriting modifications and accommodations and the student STILL can not functionally and efficiently write in a legible manner, we need to move to technology as a mode of communication.
This topic comes up a lot! First and foremost, therapists aim to teach skills using least restrictive or adaptive methods. We only add tools, adaptations, or modifications when traditional methods of writing do not work.
Moving from Handwriting to Technology as a Modification
After 25+ years as a school based OT, I’ve seen a lot of students that have “tried it all” when it comes to handwriting. At the end of the day, function is priority. We need the students to participate in their learning environment. There have been many cases where the OT recommendation is to move to assistive technology as a form of communication.
There are times when our adaptations and modifications do not work to create written work. At this point, we can explore some assistive technology to use when handwriting is not an option.
In this post we will explore what tools, programs and assistive technology to try when handwriting interventions have been exhausted.
This can be a huge transition for some students but also one that is exactly the type of support that helps them efficiently and effectively learn in the classroom setting.
Taking pen to paper is a form of written expression that has been around for thousands of years. The first language is believed to have been in 3200 BC in Mesopotamia. People made impressions in clay tablets to communicate, using a stylus. Fast forward to modern day, and we are still using some sort of stylus or tool to communicate.
Not everyone is fortunate enough to be able to communicate via handwriting. Whether they have a physical or cognitive disability, something is preventing them from being able to effectively use handwriting. This is when we start to explore assistive technology to use when handwriting is not an option.
It’s part of the occupational therapy scope of practice for school based OT in many cases because getting the student set up with effective technology helps them participate in the school day. We can then move to a consultative basis.
How to Use Oral Communication as Assistive technology
Fortunately, there are many other ways to communicate when handwriting is not an option. More and more assistive technology is being invented to aide in augmentative communication. Check out this post on Types of Communication.
When looking at spoken language, there are many ways to express ourselves other than verbal words:
- Verbal communication can be used to dictate words and thoughts
- Nonverbal communication may include gestures, body language, eye gaze, proximity, or appearance
- Sign language is another form of nonverbal communication
- Non-verbal communication in a digital world is becoming more important than ever. Electronic devices combine written communication, pictures, and symbols. There are several types of assistive technology devices that are used for non-verbal communication. These range from low tech output such as a read aloud book or choice board, to a dynamic machine with layers of words and phrases. These can be accessed by tapping on the screen/board, or through eye gaze technology.
- Remember that OT has a role in using AAC in therapy and in the functional settings.
ACC (augmentative and alternative communication) devices in therapy can be simple or complex. They might include cut out pictures or symbols that are laminated and velcro’d to a strip. Or they might include higher technology.
There is no-tech AAC which is using hands or gestures in sign language or by indicating or gesturing needs and wants. In these instances, OT might not be involved as much in the communication aspect, other than knowing how the student communicates so we can support them in our OT sessions (if occurring).
Then there is low-tech AAC which would include a picture exchange board (PECS). When this is the case, OT could very well be utilized. I’ve worked with students who are new to PECS and who are very familiar with the system. I’ve supported students who have changing tone and need adaptations to use their PECS board, both a non-digital style with just laminated cards, and a speech-generating tablet type of device.
Then, there is a level above that. You might also see speech generating devices. These can include pictures, keyboards, word prediction, etc.
For all of these levels of AAC, we as OT professionals might help the student with visual scanning, visual tracking, visual attention, focusing skills, and other visual motor skills. We could also work on the physical components: finger isolation, tone, wrist extension and stability so they can point to and touch the picture, touch pressure, graded resistance so they can pull their hand or finger away from the picture after pressing it, and so many other aspects of using the device.
How to Use Written Communication as Assistive technology
You’ve probably seen this situation before: A student comes onto the OT caseload as a kindergartener. They struggle with letter formation, line use, letter size, and spacing. Then in first and second grade, they continue to struggle with these areas. They may make some small improvements, but requirements increase, paper line size decreases, and handwriting speed expectations increase. Then in second or third grade, cursive is introduced. There are now more motor plans in mind. The challenges with writing requirements, length of written work, speed, etc. continue in fourth and fifth grade. Then middle school arrives. Suddenly, we have this student that has tried everything in the therapy toolbox and they still struggle with illegible work. What do we do now?
This situation happens more often than you might think. There’s the carryover piece, which is a HUGE part of legible writing success. We need these kiddos to practice the skills they are learning in an OT session at home.
So when we have this situation, the occupational therapy provider on the IEP team might suggest that for functional participation sake, it’s time to move onto technology as a means of written communication.
Now, that doesn’t mean that this student will no longer use a pencil or pen, ever again. That’s not the case at all! What we usually mean is that for classwork, we’ll suggest supports like Word documents or Google docs over writing a paragraph on paper. We might screenshot a worksheet onto a tablet and use a stylus to write on the digital version of the worksheet. (There are apps for that!)
When traditional forms of writing have been exhausted, assistive technology can be used. This can range from low to high tech options:
- A name stamp (Amazon affiliate link)- This simple self-inking stamp can generate a name or other pieces of information, if your learner is able to push down on the stamp. Just being able to sign one’s name opens doors for communication.
- Dictation- This is one of the easiest ways to facilitate functional communication. Many tests and other assignments can be dictated orally to a scribe. Teachers or other caregivers can write down what the learner communicates verbally. The transcriber needs to make sure they write exactly what is dictated without interjecting their edit or opinion. To take it a step further, you can use the dictation tool on Word or Google docs as a way to have the student use modification independently. Read on for more information on software for this skill…
- Software for dictation – there is software built into many computer systems that can transcribe dictated information into written communication. The learner needs to be able to read what is written and correct it for errors. Amazon has a speech to text program. Some others include Apple Dictation, Dragon by Nuance, or Google Docs voice typing.
- Predictive text is an input technology that facilitates typing on a device by suggesting words the user may wish to insert in a text field. Predictions are based on the context of other words in the message and the first letters typed. A lot of devices can have this set up right in the settings. The user simply taps on a word instead of typing it out on a computer keyboard or mobile device’s keyboard. Predictive text can significantly speed up the input process. This can be used on Apple or Android phones, as well as Google G Board, Apple QuickType, or Typewise. Again the user needs to be able to read in order to select the predictive text option or correct errors.
- Text to speech is like a read aloud book or screen reader. This is useful in written communication as the text to speech can read what is written so the user can check for errors.
- Traditional typing is a quick and effective tool for written communication. This can be done via a traditional keyboard and screen, or with adaptive features. There are endless combinations of assistive technology, using different types of keyboards and mice.
- Assistive technology paired with typing or computer work is another means of communication. There is such a diverse amount of assistive technology to use when handwriting is not an option. People with physical difficulties can use a head movement or eye gaze tracking device for output. While this can be labor intensive, it is satisfying to be independent.
- Adaptive Computer Mouse – Users with limited finger dexterity can use a special joystick controller to navigate the computer screen. There is a large trackball mouse, a graphic stylus, a foot mouse, different sized mouse, or a touchscreen option.
- Users with vision/hearing loss, motor, or cognitive impairment can use assistive technology also. Computers can read aloud for those with visual impairment and add closed captions for users with hearing loss.
NOT ALL ASSISTIVE TECHNOLOGY NEEDS TO BE ADVANCED
Many of the adaptations involve computers. This is the most straightforward option. A computer does not have to be the only option. Some people do not have the resources or desire to use advanced technology. Picture symbols can serve as a simple way to communicate. Students tap on the picture to represent a word. You can create a binder with words and pictures, a Velcro board, or picture exchange system. These can be single words or common phrases.
Types of Keyboards that can help with typing
There are different types of keyboards we can consider, too.
These are found on Amazon, so it’s not too difficult of a set-up or hard to access them…
- color-coded and large keyboard– I like this keyboard for students that have tone needs, or have range of motion challenges, and vision needs. The color-coding is great for attention or vision challenges, too.
- high-contrast, large letter font keyboards– This is one I’ve used with students with visual needs.
- small keyboards– these can be used for just one handed typing or range of motion challenges.
- ergonomic keyboards– We use these for a variety of needs including tone or range of motion needs.
- separate numeric keypads– This is something we might use for students that struggle with visual overwhelm or have attention needs.
- early learning keyboards– This one is nice because the letters are color-coded by vowels and consonants. It also uses lower case letters which is helpful for younger leaners.
HOW TO GET HELP FOR finding ASSISTIVE TECHNOLOGY
Much of what therapists and other professionals do for people with special needs is trial and error. Because we are all human, there is not one answer or solution that fits everyone’s needs. I have used a lot of trial and error during my career.
There are times when something seemed like such a great adaptation, but the kid would not use it. Often, one solution was not good enough, I needed multiple layers of adaptations.
Some school districts have specialized therapists for assistive technology. Our district has an OT who is a certified AT specialist. She knows all the new software, products, and different options available. Because this is all she does, she is able to spend a considerable amount of time with our students, problem solving their needs.
In the community there are different organizations to help people with different needs. There are organizations for the blind, deaf, physically disabled, autistic, and more. Also, there are companies specializing in assistive technology that you can contact to do an evaluation.
What I love about being an OT is not having to say, “I can’t fix that.” There is usually some work around, or adaptation I can figure out if I keep trying. My advices is to keep looking, experimenting, asking, and trying to find solutions.
Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.
