document resume - eric · document resume ed 286 315 ec 200 494 author smith, christopher, ed. ......

DOCUMENT RESUME

ED 286 315 EC 200 494

AUTHOR Smith, Christopher, Ed.TITLE Discovery '84: Technology for Disabled Persons.

Conference Papers (Chicago, Illinois, October 1-3,1984).

INSTITUTION Wisconsin Univ.-Stout, Menomonie. Stout VocationalRehabilitation Inst.

REPORT NO ISBN-916671-61-5PUB DATE 85NOTE 264p.; For selected individual papers, see EC 200

495-504, ED 248 480, and EC 200 506-512.PUB TYPE Collected Works - Conference Proceedings (021)

EDRS PRICE MF01/PC11 Plus Postage.DESCRIPTORS Assistive Devices (for Disabled); Biomedicine;

*Communication Aids (for Disabled); Computer AssistedInstruction; *Computers; Computer Software;*Disabilities; Elementary Secondary Education;Management Information Systems; PhysicalDisa'ilities; *Rehabilitation; Sensory Aids;*Technological Advancement; *Technology;Transportation; Writing (Composition)

ABSTRACTThirty-nine papers from the conference "Discovery

'84: Technology for Disabled Persons" are presented. The conferencewas intended to provide an overview of the areas in whichtechnological advances have been made, including the applications ofcomputers and other related products and services. Conferencepresenters represented fields of education, counseling, specialeducation, vocational rehabilitation, and computer science. Thepapers in the current volume address topics dealing with various waysin which computer technology can enhance the lives of the handicappedand disabled, biomedicine (including a paper on biomedical techniquesfor post head trauma victims), environmental control (includingissues such as the management of incontinence), transportation issuessuch as a functional urban paratransit system, and communicationissues such as a communication system for nonvocal physicallyimpaired persons. (CL)

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CENTER

RESOURCRES INFORMATIONENTER (EIC)

This document has been reproduced 1114received from the perSOn or organizationoriginating it

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Discovery '84:

TECHNOLOGY

FOR

DISABLED

kRSONS

CONFERENCE

PAPERSa.

8187

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)"

University of Wisconsin-Stout

Stout Vocational Rehabilitation

Institute, SEHS

Office of Continuing Education

TECHNOLOGY FOR DISABLED PERSONS

CONFERENCE PAPERS

Edited byChristopher Smith

University of Wisconsin-Stout

DISCOVERY '84

October 1 - 3, 1984Chicago, Illinois

Sponsored byUniversity of Wisconsin-Stout:Office of Continuing Education

Stout Vocational Rehabilitation InstituteSchool of Education and Human Services

Materials Development CenterStout Vocational Rehabilitation Institute

University of Wisconsin-StoutMenomonie, Wisconsin 54751

BEST COPY AVAILABLE3

Copyright © 1985Materials Development Center

Stout Vocational 1Rehabilitation InstituteSchool of Education and Human Services

University of Wisconsin-StoutMenomonie, Wisconsin 54751

ISBN: 0-916671-61-5

All rights reserved.Other than instructors who are permitted to photocopy isolated articlesfor noncommerical classroom use without fee, no part of this book may bereproduced or utilized in any form or by any means, electronic or mechanical,including photocopying or recording, or by any information storage or retrieval

system without permission in writing from the publisher.

TABLE OF CONTENTS

EDITOR'S NOTES ivCONTRIBUTORS vi

THE CONFERENCE PAPERS

Bringing Computers to the Handicapped.James B. Abbey 1

Microcomputer Activities in a Senior Day Care Center.Ruth Zemke 5

Control Data Disability Services: Division Overview.Stephen Wastvedt 12

Force Capabilities of the Physically Handicapped at SelectedAutomobile Driving Controls.

Harold F. Risk 15

Incontinence - A Disabling Problem.Patricia A. Wilson and Merry Jo Dallas 28

Real Time / Real Behavior: Using a Microcomputer forEvaluation and Training.

Charles H. Santee 38A Communications System for the Non-vocal Physically Impaired

Person.

Howard Lambert 40User Acceptance of a Robotic Arm.

Margo K. Apostolos 43

Strategies for a Functional Urban Paratransit Service.

Robert M. Jimenez, Thomas A. Jordan, William A. Lazar, andDavid J. Sanchez.. 48

/ Enabling Handicapped Nonreaders to Independently ObtainInformation: Initial Development of an Inexpensive Bar CodeReader System.

Alan VanBiervliet 56

2 Integrating Communication, Computer Access, EnvironmentalControl and Mobility.

Barry A. Romich and Carol B. Vagnini 66The Potential of Artificial Intelligence in Aids for the

Disabled.John Boyer 74

The Connecticut Special Education Network for SoftwareEvaluation (ConnSENSE).

Chauncey N. Rucker, Francis X. Archambault, Jr., andKristie Y. Davis 82

An Improved Row/Column Scanning System.Lawrence Weiss 88

Designing Technology Centers for Illiterate Adults.Terilyn C. Turner 93

A Redesigned Parapodium: New Horizons for the ParaplegicChild.

Martha Gram and Edwin Kinnen 98

The Computer as a Cross Occupational Tool in the VocationalPreparation of Disabled Persons.

Marguerite Harmon and J. Edward Cotgageorge 102

A Placement and Management Information System for LocalPlacement Programs.

Fred Menz and Diane Gleiter 108

Missouri LINC Assistive Device Service.Malcolm Flanagan and Donna Dunafor 119

Employment Opportunities for the Handicapped in ProgrammableAutomation.

Richard Swift and Robert Leneway 123

Automating Your Rehabilitation Facility with Microcomputers.Rita M. Glass 128

Self-help Groups for the Disabled: Professional Involvement.

Bruce F. Pamperin 135

r Bridging the Technological Gap.Robert Lazow, Barry Roff, Jeffrey Solomon, and DanielWartenberg 142

Biofeedback Training as a Factor in the Personal/Vocationaldjustment of Rehabilitation Students.

John See 148

A Study in Conversational Protocol Between Communication AidUsers and Non-users.

James R. Brooks 153

/ The State of the Art of High Tech Aids.Mary E. Brady 155

lt,The Holistic Application of High Technology for Conversation,Writing, and Computer Access Aid Systems.

Barry L. Rodgers 165

0 Writing to Read: A Computer-based, Language Experience,Writing and Reading System, as used with HandicappedChildren.

Eleanor R. Kirkland 176

A Modified Optacon: Towards an Educational Program.Paul Bach-y-Rita and Barry Hughes 187

Establishing a Computer Network for Connecticut.Chauncy N. Rucker, Francis X. Archambault, Jr.,and Tom B. Gillung 194

L Developing a Computer-based Learning Tool for Handicapped

Students,John J. Joseph 200

Abledata: A Computerized Product Guide.Marian Hall 204

Using Multiple Databases in Rehabilitation Operations.Dave Shafer 209

Advancing the Transdisciplinary Field of Augmentation andAlternative Communication Techniques and Aids.

Patricia L. Cashdollar 214

'Biomedical Techniques for Post Head Trauma Victims.Judith V. Doney 219

Special Students, Technology, and Basic Skills Education.

Louis Frillmann 224

Sensory Aids Demonstration and Training Center.Jerry A. Kuns 231

ii

1( Utilization of Technology: Consumer Perspective.

Margaret C. Pfrommer 237

Project Interact: Microcomputer Software for Vocational

Rehabilitation Facilities.Robert C. Robbins and George C. Young 243

AUTHOR INDEX 249

PAPER INDEX 251

iii

Editors3 Notes

Technology is enhancingthe lives of millions of peoplewith disabilities. A nationwidesurvey conducted fifteen yearsago revealed that 6.2 million peopleused a total of 7.2 million assistivedevices. Today more than 7,000different assistive devices areavailable; the number grows daily.

Technology does not haveanswers to all limitations causedby disabling conditions, but therapid pace of investigation byand for persons with disabilitieswill certainly continue to adddevices that increase the workpotential s of many to the marketplace.

Douglas Fenderson of the NationalInstitute of Handicapped Research,wrote in the August, 1984 issueof the Journal of RehabilitationAdministration that he saw moreresearch emphasis being placedon the problems associated withdisability limitations. He sawcontinuing research in functionalelectrical stimulation of impairedmuscles, robotics, sensory replacementby nerve interface, biologicallycompatible prosthetic, orthoticand mobility devices, and implantableinfusion pumps; in essence, Dr.Fenderson forsees a continued techno-logical explosion in the rehabilitationfield. Thus, professionals invocational rehabilitation, specialeducation, and vocational education,as well as persons with disabilitiesand their advocates need to keepabreast of these developments toenhance their lives and the livesof their constituents.

Discovery '84: Technologyfor Disabled Persons was designedto provide an overview of the manyareas in which technological advances

have been made, including the appli-cations of computers and otherrelated products and services.The participants and presentersof Discovery '84 arrived in Chicago,

V

Illinois from 39 states. Theseteachers, counselors, specialeducators, vocational rehabilitationspecialists, therapists, computerexperts, and interested otherscame to learn about advances madein computer technology and themany innovations in teanologypresently impacting the rehabilitationfield. And learn they did; 84presenters conducted over 100sessions, reporting research results,discussing software modifications,showing computer and computer-related

equipment designs, and demonstratingtechnologically innovative productsand services. In addition, 38exhibitors packed the exhibitionhall with the latest devices.

From all these educationalpresentations, the 39 papers hereinbound were gathered. The paperscover the rehabilitation-relevanttechnological aspects of computers,biomedicine, environmental control,transportation, and communication.This book of conference paperswill expand the impact of Discovery'84 beyond Octobe;. 1-3, 1984,and will hopefully lead innovatorsto the imaginative spark thatpreceeds the development of newideas.

This book is the culminationof well over a year's worth ofeffort on the part of many staffmembers at the University ofWisconsin-Stout. Discovery '84was jointly sponsored by two units.The Office of Continuing Educationand Summer Session, part of Stout'sDivision of Academic Affairs,coordinated the conference sitepreparation, advertisements, andpresentations, lead by Directorof Continuing Education and SummerSession, John Van Osdale and Conference

Coordinator, Janet Roehl. TheStout Vocational RehabilitationInstitute, within the School ofEducation and Human Services,

screened presentations, providedon-site coordination, and publishedthis book, with leadership fromExecutive Director, Paul Hoffman.No undertaking of this magnitudeis ever achieved without the cooperation

of many minds and hands. Thanksare due to the staffs of both unitsfor pull ing together to providethe ultimate benefits to you, ourmost valued constitutents.

The herculean task of turningpapers of various styles, alongwith sometimes illegible copy editingnotations, into a camera readyform was ably executed by MaryBates. Mary and our word processingtroubleshooter, Darlene Shane,completed the processing and proofingwith skill and good humor. I thankyou both.

The ideas, products, services,and opinions expressed in thesepapers reflect the thinking oftheir authors. Their inclusionin this publication does not necessarily

constitute endorsement by the officeof Continuing Education and SumerSession, Stout Vocational Rehabilitation

Institute, or the Material s development

Center of the University of Wisconsin-Stout.

Christopher SmithFebruary, 1985

vi

9

1

Contributors

James B. AbbeyComputAbility Corporation101 Route 46 EastPine Brook, NJ 07058

Margo K. Apostolfis

Stanford UniversityPO Box 2768Stanford, CA 94305

Francis X. Archambault, Jr.ConnSENSEUniversity of Connecticut, U-64Storrs, CT 06268

Paul Bach-y-RitaDept. of Rehabilitation MedicineUniversity of Wisconsin - MadisonMadison, WI 53706

John J. BoyerComputers to Help People, Inc.1221 West Johnson StreetMadison, WI 53715

Mary E. BradyTrace Center, Waisman CenterUniversity of Wisconsin - Madison1500 Highland AvenueMadison, WI 53705

James R. Brooks3343 Grand River Dr NEGrand Rapids, MI 49505

Patricia L. CashdollarISAAC

2797 Hemphill RoadKettering, OH 45440

Merry Jo DallasDept. of Textiles & ClothingColorado State UniversityFort Collins, CO 80523

Kristie Y. DavisEASTCONN Regional EducationService Center

North Windham, CT 06256

vii

10

Donna DunafonMissouri LINCUniversity of Missouri - ColumbiaColumbia, MO 65211

Judith V. DoneyNew Beginnings Ministr;es, Inc,PO Box 31408Jackson, MS 39206

W. Malcolm FlanaganMissouri LINCUniver-ity of Missouri - Columbia609 MarylandColumbia, MO 65211

Louis W. FrillmannMill Neck Foundation, Inc.PO Box 100Mill Neck, NY 11765

Rita M. GlassManagement Information ServicesNational Easter Seal Society2023 W. Ogden AvenueChicago, IL 60612

Diane GleiterResear.h & Training CenterStout Voc. Rehabilitation InstituteSchool of Education & Human ServicesUniversity of Wisconsin - StoutMenomonie, WI 54751

Martha C. Gram, R.P.TBirth Defects CenterDept of Pediatrics

University of Rochester MedicalCenter

Rochester, NY 14642

Marian HallNational Rehab. Information CenterThe Catholic University of America4407 8th Street NEWashington, DC 20017

Marguerite D. Hannon, M.S.Community Outreach Program for

the Deaf268 W Adams StreetTucson, AZ 85705

Barry HughesDept. of Rehabilitation MedicineUniversity of Wisconsin - Madison600 Highland AvenueMadison, WI 53706

kobert M. Jimenez, M.A.San Francisco Stroke ClubSan Francisco, CA. 94110

Thomas A. Jordan, B.A.Director of Special ProjectsPublic Utilities CommissionSan Francisco, CA 94110

John J. JosephJ. Jordan Associates1127 Oxford CourtNeenah, WI 54956

Edwin KinnenProfessor of EngineeringBirth Defects CenterDept. of PediatricsUniv. of Rochester Medical CenterRochester, NY 14642

Dr. Eleanor KirklandCalifornia State Univ.School of Education

6000 "J" StreetSacramento, CA 95819

Jerry A. KunsSensory Aids Foundation399 Sherman AvenuePalo Alto, CA 94306

Howard LambertCollege of Science & MathematicsWestern New Mexico UniversityCollege StreetSilver City, NM 88061

William A. LazarVice PresidentLuxor Paratransit VansSan Francisco, CA 94110

viii

Robert LazowAltro Health & RehabilitationServices40 East 30th StreetNew York, NY 10016

Robert Leneway

National Industrial Center forHandicapped Employees (STIRC)Alber DrivePlainwell, MI 49080

Fred E. MenzResearch & Training CenterStout Voc. Rehabilitation InstituteSchool of Education & Human ServicesUniversity of Wisconsin - StoutMenomonie, WI 54751

Bruce F. PamperinDept. of Sociology/Social WorkUniversity of Wisconsin - StoutMenomonie, WI 54751

Margaret C. PfrommerIllinois COPH2030 Irving Park RoadChicago, IL 60618

Harold F. RiskCtr. for Driver Education & SafetySt. Cloud State UniversityWhitney House

St. Cloud, MN 56301

Robert C. RobbinsMetro Industries, Inc.1086 Brentwood CourtLexington, KY 40511

Barry L. RodgersTrace Center, Waisman CenterUniversity of Wisconsin - Madison1500 Highland AvenueMadison, WI 53705

Barry RoffAltro Health & Rehab. Services40 East 30th StreetNew York, N.Y. 10016

11

Barry A. RomichPrentke Romich Company8769 Township Road 513Shreve, OH 44676

Chauncy N. RuckerConnSENSEUniversity of Connecticut, U-64Storrs, CT 06268

David J. SanchezFamily & Community MedicineUniversity of California1001 Potrero Avenue, Bldg 80San Francisco, CA 94110

Charles H. SanteeLyons Township High School100 South Brainard AvenueLaGrange, IL 60525

John SeeStout Voc. Rehabilitation InstituteSchool of Education & Human ServicesUniversity of Wisconsin - StoutMenomonie, WI 54751

Dave ShaferHuman Resources CenterEmployment Research & Training

CenterI.U. Willets RoadAlbertson, NY 11507

Jeffrey Solomoniltro Health & Rehabilitation Services

40 East 30th StreetNew York, NY 10016

Richard SwiftNational Industrial Center for

Handicapped EmployeesAlber DrivePlainwell, WI 49080

Terilyn C. TurnerConsultant to the St. Paul Fou,idation

1080 University AvenueSt. Paul, MN 55104

Carol B. VagniniPrentke Romich Company8769 Township Road 513Shreve, OH 44676

ix

Alan VanBiervlietDept. of Rehabilitation &Special Education

University of ArkansasLittle Rock, AR 61820

Daniel WartenbergAltro Health & RehabilitationServices

40 East 30th StreetNew York, NY 10016

Stephen WastvedtDisability Services DevisionControl Data CorporationBox 0

Minneapolis, MN 55440

Lawrence H. WeissZygo Industries, Inc.PO Box 1008Portland, OR 97207

Patricia A. WilsonDept. of Textiles & ClothingColorado State University314 Gifford BuildingFort Collins, CO 80523

George C. YoungMetro Industries, Inc.1086 Brentwood CourtLexington, KY 40511

Ruth ZemkeAssoc. Professor of OccupationalTherapy

University of Southern California12933 Erickson Ave., Bldg. 30Downey, CA 90242

12

bmiaSING COMPUTERS TO THE HANDICAPPED

JAMES B. ABBEY

ABSTRACT

Over the last two years J.A. Pres-ton/ComputAbility and United CerebralPalsy of New York City have had manydiscussions regarding bringing computers

to the handicapped. As an extensionof "The Handicapped Source" and its

products, ComputAbility contractedwith United Cerebral Palsy of NewYork City to act as consultants ina "Needs Assessment Study." Thisstudy focused on the clientele ofUCP of New York City and how computerscan be used throughout the agencyand by as many clients as effective.

A period of twenty days overseveral months was spent by our teamin interviews, organization analysis,class and client/staff monitoring,project definition and feedback analysis

on projects. This effort resultedin a comprehensive written reporttargeting specific areas where integration

of computer use for UCP's clientelewill be most applicable.

With the advent of low costmicrocomputers, the opportunity toprovide new techn logical aids forthe handicapped has broadened. Comput-

Ability, through its division, "TheHandicapped Source," offers a varietyof software and hardware productsgeared to the handicapped. Theseproducts assist the handicapped inmany ways including, vocational,educational,communications,environmentalcontrol , and entertainment. In addition,

the handicapped have the same "rights"as anyone to have access to thistechnology.

A Needs Assessment

"The relevant question todayis not whether computers will be

used to help solve instructionaland communication problems of thehandicapped, but rather how theywill be used and how they will effectthe education of the handicappedin the next decade" (Watson, p. 670).

"For a physically disabled childwho has limited access to the worldof motion and spatial relationships,

for a learning-disabled child whoshows a flair for geometric problemsolving, and for a nonverbal child

who is blocked in establishing commun-ication, developing a facility inusing a computer can be regardedas an essential educational experience"(Weir, p. 342).

13

2 Discovery '84 Technology for Disabled Persons

Goal: Bringing Computers to theHandicapped

Bringing computers to the handicappedis a process that involves many stepsto be successful. Bringing computersto the handicapped does not mean justallowing the handicapped the use ofcomputers in school or for specialpurposes. The goal of this projecthas been defined as allowing all indi-viduals access to computers and providing

a computer to each and every handicappedperson who can use one. In orderto accomplish this goal, U.C.P. mustreach two objectives: 1) Implementcomputers throughout the agency toallow access to computers by all its

clients; and 2) get the appropriatelegislation passed that will helpprovide computersfor any handicapped individual needingone. Once these two objectives havebeen achieved, the process of BringingComputers to the Handicapped willbecome only a process of time andeffort to supply the computers.

United Cerebral Palsy of NewYork City (UCP) has realized the impactthat the computer industry is makingon society. To capture this technologyand put its benefits to use by andfor the handicapped, a Needs Assessmentwas conducted among the UCP programs.To i nvesti gate those areas most appropriate

for integration of computers and to

evaluate the needs of the clients,UCP teamed with J.A. Preston Corporationand its subsidiary ComputAbility Corpo-ration.

By its association with J.A. Preston

and ComputAbility, UCP has made a

strong connection with the computerindustry and a commercial providerof products for the field of rehabili-tation. This association is one ofthree priority actions seemed necessaryby J. C. DeWitt of the American Foundationfor the Blind in New York, New York,for a computer program to become trulysuccessful. At the Discovery '83

Conference on Computers for the Disabled,

sponsored by the University of Wisconsin -

Stout and Closing the GAP, Mr. DeWitt

drew the following conclusions in

his presentation:

"First, I suggest that potentialand actual users meet and worktogether to form a consensus ofwhat approaches need to be taken.Second, developers and manufacturersshould work more closely togetherin order to increase general acces-sibility, compatibility and reduceredundant efforts. Third, I wouldlike to see major companies incomputer technology brought intocloser working relationships withdevelopers and users, by helpingcompanies identify common productdevelopment and marketing approaches.

By joining forces with leadersin the industry, impaired individuals

have a better chance of obtainingaccessible products at a costthey can afford" (DeWitt, 1983).The objectives of the Needs

Assessment Study are:1. Present the current influence

and growth of computer usage in

educational and rehabilitationsettings.

2. Define the needs and methods bywhich UCP of New York City canbring computers to the handicapped.

3. Outline how to integrate and coordinate

key activities to achieve optimumoperational efficiency and effective-ness.

4. Identify those individuals atUCP who will participate in theimplementation of the program.

5. Define and outline costs involvedand the timeframe to implementthe programs.

Recommendations:

The Needs Assessment investigationand our research have led us to concludethat:

* There is no reason not to giveaccess to computers to all, includingthe handicapped. We have seen fromthe current state of the art andthe implementation of computer technology

throughout the world that the computer

14

Discovery '84 Technology for Disabled Persons 3

Cool:

Objectives:

Strategies:

fBRINGING COMPUTERS TO IHE HANDICAPPED 1

Implement Computersel U.C.P.

Get Computers FundedFor Individuals

U.C.P. Defined Strategies

Training Staff Hardware Software Programs

*In-service

*On-the-job

*Conference

*Seminars

*Self-study

*Videos

*BCH Coordinator

*Facilities Coordinators

*Project Specialists

*Consultants/Specialists

*Bio-engineers

*Administration Personnel

*Hardware SelectumModel

*Functional Needs

*Hardware Needs

*Hardware Availoble

has the potential to greatly impactthe handicapped.

* There are a number of uniqueopportunities for the handicappedand their use of computers. It is

probably the most important deviceto free the handicapped from manyof the restrictions placed on them.

* Many of the current projectsunder way at UCP relating to computershave developed models for successfulimplementation of computers throughoutthe agency. With the proper stepsthe expansion to all clients can be

successful as well.* The time is appropriate for an

agency such as UCP to begin the process

*Software SelectumBEEP

Model Early Education/LOGO

Cognitive Eval/Retraining

Industrial Ares/Graphics

Adult Education

*Development Personal Computing

Entertainment/Socializatio,

Home Life Supplement

Augmentative Communication

Speech Lab

Portable Communicator

Open House

Parent Awareness

Vocational Training

P. A. C. T.

Job Training (word processing

Job Enrichment

Employer Awareness

Environmental Control

Independent Living

Residential Living Centers

Home Banking/Shopping

Medical Monitoring

*Library

*Evaluation Teem

of bringing computers to the handicapped.

The following section outlines ourrecommendations and the details ofthe various steps and model s to implement

in this process.To best present the steps to

take to Bringing Computers to the

Handicapped the diagram above outlinesour recommendations:

A Summary of Conclusions

The Needs Assessment Completedat UCP indicated a tremendous needfor consortium of large non-profitorganizations servicing the handicapped,national distributors of rehabilitation

15


efforts to develop proper programsand products, widespread use of computers

by the handicapped will not becomea reality. Each member of the consortiumhas a very crucial role:

* In addition to contributingthe necessary inputs for productfunction, the servicing organizationsare in the best position to worktoward the advocacy of the handicappedin getting legislation passed toget computers paid for.

* The distributors have theresponsibility to build the propermarketing and service programsto support the users of the productsas well as to provide the product.The distributors are in the bestposition to provide the adaptations,installation, training, and serviceto the users.

* The manufacturers must becomeintimately familiar with the needsof the handicapped so that theproper interfaces and functionscan be built into products. In

addition, programs must be setup to offer products through thedistributors specifically for thehandicapped at reasonable prices.The first steps in the creation

of this consortium have been takenwith UCP of NYC who are conductingthis Needs Assessment with the assistanceof the J.A. Preston Corporation andits subsidiary ComputAbil ity Corporation.

The next step has been initiated withthe interest expressed by I.B.M. todiscuss the process of bringing computers

to the handicapped. All of the partiesrequired for successful implementationof the goal of bringing computersto the handicapped are being assembled.

* UCP of NYC is one of the largestnon-profit organizations serving thehandicapped.

* J. A. Preston Corporation isa major distributor of rehabilitationproducts throughout the world.

* ComputAbil ity Corporation hasthe expertise to provide the adaptations,

installation, and service requiredby handicapped users.

* I.B.M. is the largest computermanufacturer in the world and has

products that have become standardsin the computer industry.

Interest has also been expressedby Kessler Rehabilitation Instituteto participate in the consortium.Kessler offers a unique client population

as well as a different form of healthcare from that of UCP.

With proper cooperation andplanning the products and servicesneeded for widespread use of computersby the handicapped will be readywhen the models recommended in theNeeds Assessment have been implementedby UCP and have shown positive results.

REFERENCES

Watson, P. "The Utilization ofthe computer with the hearingimpaired and the handicapped."

American Annuals of the Deaf 124(5),p. 670.

Weir, S., Russell, S.J., & Valente,J.A. "Logo: An approach to educatingdisabled children." Byte 7(9),p. 342.

Dewitt, J.C. September, 1983. "Computers

for the Disabled: A Ccntradictionin Terms?" Conference Papers: Dis-covery ' 8 3: Computers for theDisabled.

16

MICROCOMPUTER ACTIVITIES IN A SENIOR DAYCARE CENTER

RUTH ZEMKE

ABSTRACT

The Fullerton, CA Senior DayCare Center incorporates microcomputeractivities into the daily activityprograms of frail elderly citizens.The computer activities are blendedwith familiar activities and includethe use of commercially availablesoftware and hardware. Game showand board games provide the basisfor some activities, while the productionof art works, banners, and greetingcards produce useful objects and asource of pride. Music is enjoyedby clients. The synthesizer actsas a disc jockey for sing-alongs anddances. A few of the inexpensivecommercial programs are particularlyuseful as adaptations for common sensory

and motor limitations of group members.In general, the elders at the SeniorDay Center are definitely a part ofthe microcomputer generation.

What comes to your mind whenyou think of medicine, old people,and technology? Life support systems?Pacemakers? Intensive care units?At the Fullerton Senior Day Care Center,in Fullerton, CA, they think of theApple II+microcomputer. While geriatricsand technology have been linked inall of the "high tech" ways firstmentioned, the relatively "low tech"linking of frail elderly people andpersonal /home microcomputers is relatively

unexplored. Microcomputers have removedsome of the mystery from technology,and they have begun fitting into ourdaily occupational routines. So,while children are practicing multipli-cation tables on the school's micro-computers and their parents are adjustingto microsystems at work and possiblyat home, some grandparents are fittingan Apple II+ into their round of dailyactivity in the Senior Day Program.

Program

The Fullerton Senior Day CareCenter is a program of the YMCA.It is designed to provide a communityservice for a target population thatincludes the slightly confused ormoderately disabled elder, possiblyon a fixed or limited income. Theseclients are usually under a physician'scare and cannot spend their day hoursalone as they need some assistancein carrying out daily activities.The Center provides an alternativeto institutional care when assistiveprogramming and support systems areneeded by the client rather than24 hour medical care. The goalsof the Senior Day Care Center are:1. To provide frail elderly personswith a community service designedfor their care and interests; 2. Tofoster independent living; 3. Topostpone or prevent institutionalplacement; and 4. To give respiteto families.

To meet these goals, the Centeris open from 6:00 AM to 6:00 PM,Monday through Friday, in an attractiveactivities building at FullertonPark, convenient to freeway access.The community's health, social,religious,

and other agencies provide a high

level of service to clients and theirfamilies as needed. The Center meetsall standards and regulations ofthe State of California/CommunityCare Licensing. The program is fundedin part through Title III, the FederalOlder Americans Act. Program feesare based on the client's daily lengthof attendance and income, on a slidingscale.

An extensive program scheduleis planned which contains both routinesand variations. Some of the routinesare breakfast, lunch, and nourishment

17


schedules, remotivation reminiscenceprocedures, and mil d to moderate exercise.

Variations include birthday and holidaycelebrations, picnics in the park,and the reception of visitors fromthe nearby preschool program.

Galles

To many of the Senior Day CareCenter's clients, the most recognizedpart of the computer system is themonitor, a color television set.This familiar object allows a very

nice transition into the use of thecomputer for activities that are likemost TV game shows. Clients haveseen day-time TV shows or perhapseven remember prime time quiz showsfrom years back, prior to the scandal-ridden shows of the demise.

Word Ganes

One example of a simple activitybased on this game show style is theeducational game by Scholastic, In.,called Square Pegs. Players are confronted

by a board with numbered squares behindwhich are hidden words or phrases.The object of the game is to correctlylocate identical pairs. Correct answersare rewarded by a sequence of lights,bells, whistles and graphics commonto the game and arcade programs.The program is simple to understandand operate and can be set for a singleplayer (against the computer) or fortwo players. One common adaptationused for aames of this sort is todivide ,e group into two teams.A staff member, volunteer, or anotherclient enters the responses for bothteams. The need fir this adaptationvaries with the client group's abilityto handle interactions with the computerand participate in the game. Userconstructed games allow the simplicityor complexity of games using pairedwords or phrases to be developed thatare appropriate to the group.

The Game Show u :s animated colorgraphics to present a wide varietyof topics in the style of the popular

game "Password." This game is playedby two teams. Each team has a partneron the computer screen 1 ike the celebrity

"regular" on TV game shows. These"regulars," Joe and May, help theirteammates guess a mystery word byproviding helpful hints or clues(Zwalokow, Rowe, & Perry, 1982).The disk contains ready-to-use mysterywords and clues organized into 16categories. Some of the followinghave been appropriate for our groups:1. Animals - name the animal ; 2. American

History - important people and places;3. A, B, C, D, F, G, or H Words -

easy vocabulary words beginning withwhichever one on the letters waschosen; 4. Advanced Vocabulary -more difficult vocabulary, providinga challenge for our more alert players;5. Famous Cities - clues from factand fantasy; and 6. Computer terms -a challenge for the occasional groupmember interested in the computeritself. Additional subject diskettestermed "Learningware," include wordrecognition from language, science,and social studies classwork. Theseprograms are suggested by the developersas appropriate for ages 6 - 9 yearsor 9 - 11 years. People, placesand things programs are those suggestedfor use by ages 9 years to adult.The subject movies and televisionfor ages 11 years to adult.

The ability to create one'sown categories, clues and answersis one of the most useful aspects

of The Game Show. This menu-drivenoption allows staff to develop subjectareas that reflect personalized topics,often those concerning current programthemes. Subject areas may be developedgradually as the theme is presentedin the program activities. A targetword is entered with alternate acceptableforms, along with up to ten cluesof less than 38 characters. Eachitem may be saved on the disk untilthe subject area has enough itemsfor a game, or the theme has been

completed in the activity program.This way The Game Show reinforcesmaterial from the weekly program

18


theme, recent adult 1 earning experi ences ,

or other topics concerning sharedprogram experiences. According toone client, "It's like having ourvery own TV show!" The programs reflectthe experiences of the clients andcan be developed at a level of difficulty

providing "just the right challenge"for moti vation and optimum participation.

Another computerized game showformat under consideration for useis the Tic Tac Show, also by ComputerAdvanced Ideas, Inc. Once again,the word identification format is

used, this time with the clues/questionsencased in a game of tic-tac-toe.The master disk includes 14 topicsfrom myths to math, with additionalsubject di skettes available on el ementary

school level language, math and socialstudies, history for ages 9 yearsto adult and sports facts for ages11 years through adult. The authoringsystem again allows the user to developitems appropriate to a current topicfor the group. The primary benefitof the additional program would bea format change as the novelty ofthe present program formats and rewardsequences wears thin.

Other word games we have consideredinclude the traditional hangman gameand a Spa:ish language version. Thesegames lacked sufficiently positiveresponses from the group to considerthem an improvement over their paperand pencil versions. The databaseof famous sayings available withinthe programs was attractive, but staffdid not feel that asset offset thecost. The Spanish Hangman by GeorgeEarl (1983) (Spanish to English orvice versa) was considered becausesome clients have English as a secondlanguage, and many Southern Cal ifornians

have a familiarity with basis Spanish.The Spanish translations, however,were often not of the vernacular familiarto members of the group.

A more popular word game is theCrossword Magic program. With thissoftware, it is possible to createa crossword puzzle that ranges in

size from a three by three square

to twenty spaces by twenty spaces.The puzzles, created from your choiceof words and clues, are not of thetightly knit format used in.newspapers.They have more blank spaces. Puzzledevelopment is an interactive process.Individuals or groups can choosethe theme, enter words and watchthe puzzle develop on the screen.The visual presentation may stimulatenew word ideas that bridges gapsor links earlier words. In the newerversion, Crossword Magic 2.0, thecomputer can be commanded to tryagain by repositioning (R) a wordif an alternate placement is possible(Stanton, Wells, Rochowansky, andMell in, 1984). Entering clues foreach word can be an entertainingproject for an alert individual as

the clues can be as factual or humorousas the person's own style.

It is possible to save an incompleteor completed puzzle, to completeor edit one later, to simplify clueswhich are too difficult for the clientgroup and to otherwise modify thepuzzle to satisfaction. The puzzlemay be printed in hard copy usinga dot matrix printer for use withtraditional paper and pencil . Blank

spaces and clues can be listed foraddition later. The puzzle may alsobe solved on the monitor screen inthe play mode. Keyboard entriesprovide cursor arrow movement; thespace bar controls cursor changesfrom horizontal to vertical. Entered

answers may be saved for 1 ater completion

or modification, if time runs short.This program, with graded levelsof participation possible, providescognitive and social stimulationfor most group members at their individual

participation ability level . Stimulation

is provided through puzzle development,

theme vocabul ary recall , word recognition

or simply spelling practice.

Bbard Games

1 ,

A variety of games of the "board"


variety are available for personalcomputer systems. These are amongthose games of interest to our clients.The ubiquitous Bingo game, for example,has its counterpart version, ComputerBingo, which produces caller numbers(B17, etc.) in the form of visualpresentations on the monitor. Witha speech synthesizer, the computercan actually call out the numbers.The novelty of the computer Bingogame is its primary benefit. A humanBingo caller is infinitelymore adaptableand flexible and has the ability toadjust presentation style to maintainthe group's attention and interest.Similarly, the versions of Checkers,Chess, and Odin (or Othello) are ofinterest primarily to individualswho do not have an appropriate humanpartner available for the game. Theseindividuals have a greater interestthan most clients in interacting withthe computer system.

The Checkers (1984) game includes16 levels of difficulty, instant replaysof moves, and the ability to adjustover 50 program parameters to experimentwith the way the computer works/playsthe game. Few of these options areuseful to our clients because of theircompexity. Othello is a strategygame played on a 8 x 8 board wherethe object is to control the mostsquares. Each player must place acolored tile on a square to trap atleast one of the opponent's piecesbetween two of their own. The piecesare two sided. When trapped theyare fl ipped over to become the colorof the successful player. Toe playis quite simple, but to play wellis difficult. The different visualperspective produCed from a two dimen-sional graphic representation on a

monitor screen and the attention/know-ledge requirements of even simplegame interactions are too difficultfor some group members. Althoughthe Odcsta versions of these gamesare deemed definitive for each gamein a review by Stanton, et al (1984),

they are little used by our clients.

Computer Art

Art activities have been popularwith many as a leisure activity.

They are increasing in attractionas computer art using graphic capabilities

and a variety of input devices becomesavailable ("College to offer", 1982;

"Computer- inspired art ", 1982; Williams,

1982). Artists use computers toproduce two-dimensional stills andanimation; they are also applyingcomputers to choreography, lightshows, and sculpture (eeterson, 1983).Art activities have been an importantpart of the activity program at theSenior Day Center, and the comi42teris providing variations on this familiar

theme. The Versawriter digitizer,the newer Koalapad digitizer, theGibson light pen, and most recently,the AppleMouse II, have all providednew opportunities for art activitieswith clients.

The digitizer drawing boardsare used by various group membersto trace simple patterns and picturesor to design their own drawings.The Apple II+ high resolution (HIRES)capabilities (192 rows of 280 pixels-picture elements-each) produce thepictures on the color monitor (Williams,

1982). Since the center uses a colortelevision monitor, there is moreerosion of the graphic quality thana comparable computer monitor wouldprovide. Computer monitors reprcducea greater number of the picture elementsand, thus, provide a better qualityreproduction of the input. Nevertheless,the group finds sufficient interestin the presentation of their ownwork on the screen (the "Hey, lookwhat I did!" phenomenon is definitelynot limited to childhood years) tocontinue to explore this medium ofexpression. "Paint brush" size options,combined with color choice and shading(dot mode) options, allow a lot ofroom for exploring even simple designs.Mirror imaging seems to be very enjoyable

to our artists. A pattern in onepart of the screen can be automaticallyreversed for a lovely symmetrical

20


pattern across the other half or quarterof the screen. Variations can bestored and a hard copy can be producedon the dot matrix printer. We donot have a color printer availablefor the ultimate in hard copy. Editingand revision can produce a seriesof variations which can lead to extensivediscussions comparing the artisticqualities and personal preferencesfor one version over another. Thelight pen with its accompanying machinelanguage software (LPS II, 1982) providesa completely different form of inputby touching the pen to the screen.It also adds commands to the Appiesoftlanguage available on the computer.While we can easily see the benefitsof this method for the new user overkeyboard entry, with our client groupthere was some anxiety to overcomebefore they could feel comfortableusing the light pen. While a keyboardhas the familiar look of a manualtypewriter, the monitor is a somewhatmagical electronic gadget to them.Turning dials, etc. to control thetelevision and perhaps even dustingor wiping the screen clean is comfortable,

but to actually write on the screenseems dangerous to some. So a transition

from the digitizer system of makinga line or mark to what we thoughtwould be an easily accepted link between

moving a pen on the screen and producingaline physically and visually contiguous

to it, was not so simple. Fear ofbreaking the screen and producingan explosion, or misusing expensiveequipment, or of danger from beingso close to the rays emanating fromthe screen, had to he dealt with.Once again, we find that technologyitself produced negative and positivereaction from different people. Thesepsychological responses may be moreimportant than anything else in theacceptance of technological advancesfor adaptations, work, or leisure.

Psychological rejection of techno-logical advances is not limited tothe uninitiated, however. Apple IIowners who have had a chance to usea Lisa or a Macintosh probably enjoyed

21

the experience; but, they don't automat-ically reject their familiar machines.Having invested money in hardwareand software and invested time ingetting to know their machines, theymay reject the need for a "mouse."However, for the best of two systems,our resident computer hobbyist, JeffCoyle, Program Assistant at the SeniorDay Center, has purchased the AppleMouseII and its packaged soft%lire, BillBudge's MousePaint (Durkee, 1984).Mousepaint is a freehand drawingprogram. Through the use of varioustools, the movements of the "mouse"are converted into brush strokes,lines, curves, patterns and shapes,.If you want to move part of the pictureyou can draw an editing box aroundit and use the "mouse" to drag itto another part of the screen. At

the top of the screen is locateda list of menus, such as file, edit,aids, or font (for text). The "mouse"allows easy access and review ofeach menu. Thus through the potentialsof digitizers, light pens, and the"mouse," our clients have a varietyof options for the production ofcomputer artworks.

Printing

Producing an object, such as

hard copy of a puzzle or art work,is very satisfying ("look at whatI made!"). Two pieces of softwarewhich have allowed some very pleasurablemoments for the group include BannerMa is from Phoenix Software (Star,19 and The Print Shop.

Banner Magic produces long bannerswith letters up to 7 inches tall.It is great for holidays, birthdays,and other celebrations. These bannerscan be painted or colored after printing,thus providing several participatorylevels as well as decoration forthe Center. The Print Shop has beenused to develop greeting cards whichgroup members have sent to friendsand relatives. With a staff memberhandling the program, the group orindividual makes their choice of


border pattern, background pattern,text front and message. At one pointduring this activity, the message"We grow too soon old and too latesmart!" was rejected by the group,because "Computer people like us maybe old, but we must be smart, too!"The group is looking ahead to theChristmas holiday for a real opportunityto use their cardmaking skills.

Music

Music has always been anotherfavorite activity at the Senior DayCenter. Sing-along is featured everyweek as well as occasional visitsfrom such groups as the retired SeniorsVolunteer Program (RSVP) Kitchen Band.The computer offers yet other optionsfor this enjoyable activity. An AlphaMusic Synthesizer allows staff membersand volunteers to enter the tunesof many beloved, familiar songs.Although the synthesizer is not a

favorite instrument of many of theelders in the group, they do liketo use its organ mode to hear theirfavorite hymns. Song sheets havebeen prepared and printed by the computer

whether the song leader is in good

voice or not the group is ready togo. In fact, a "disco" option allowsan album-like group of chosen titlesto he played randomly. This optionis popular for dancing.

Adaptation for Disability

Some of the available softwareand hardware for the computer makesit particularly adaptable for group

members with sensory or physical disa-bilities. For example, the Echo 11

Speech Synthesizer (Kory & Kory, 1982)and its Echo Com program allows usersto select t6-19-i and sentences fromthe user geaerated menu. One manenjoys adding words to the list which"astonish" the ladies when they seethe menu or hear "those words" in

the synthesized speech. For visuallyimpaired clients who wish to participatein banner making or the production

of an easily readable letter withlarge type, the Talking Typewritersynthesizer says each letter as youtype it. The Textalker option sayswords as they are typed. The Textalk-er Blind option has a letter or commandmenu which is searched by movementof the arrow keys. As the cursorpasses the letter or command, itis spoken by the synthesizer, enablingthe visually impaired client to producewritten materials like other groupmembers.

Summary

Others have noted that computingis a small, but growing pastime forolder persons (Chin, 1984). In MenloPark, CA at the Little House SeniorAdults Community Center, and at Adel phiUniversity in Garden City, New York,the elderly art. involved in computercourses. While our clients at theFullerton Senior Day Center are notin full health, they too find somelearning, some fun, same work, andsome social status in their computeractivities. In a conversation aboutcommercials for computers, someonesuggested a motto for the Apple:"as old as Adam and Eve, as new astomorrow:" Much of the time, wefeel that would be an excellent mottofor our clients as well!

Acknowledgements

The cooperation of Sue Kaiser,Director of the Fullerton SeniorDay Center and Jeff Coyle, ProgramAssistant and computer hobbyist inpreparing this presentation and paperis gratefully appreciated. Apple11+, AppleMouse II, Applesoft, Lisa,and Macintosh are trademarks of AppleComputer. Inc. Versawriter is a

trademark of Versa Computing, Inc.Koalapad is a trademark of Microlllus-trator, Inc.

REFERENCES

Chin, K. (1984). The elderly learn

22


to compute. InfoWorld, 6(19),24-25, 27-28.

Checkers. (1984). Computer program.tvanston, IL: Odesta.

Chess 7.0 (1984). Computer program.Evanston, IL: Odesta.

College to offer computer art. (1982).Popular Computing, March, 14-15.

Computer Bingo. (1982). Computerprogram. Culver City, CA:Continental Software.

Computer-inspired art. (1982).Popular Computing., April, 10.

Crossword Magic. (1983). Computerprogram. Sunnyvale, CA: L & SComputerware.

Durkee, D. (1984). A mouse for therest of us. BYTE, 4(March), 168-171.

Earl, G. (1984). The Spanish Hangman.Computer program. San Antonio,TX: George Earl.

Kory, M. & Kory, F. (1982). EchoSpeech Synthesizer. Computerprogram and manual. Carpinteria,CA: Street Electronics Corp.

LPS II. (1982). Computer program.Mine, CA: Gibson.

Microcompiter- Senior Day CareOdin. (1984). Computer program.---nanston, IL: Odesta.Peterson, D. (1984). Genesis II,

Creation and recreation withcomputers. Reston, VA: RestonPublishing Company, Inc., A Prenti-ce-Hall Company.

Square Pegs. (1982). Computer programand manual. .1m+2. Jefferson City,MO: Scholastic, Inc.

Stanton, J., Wells, R., Rochowansky,S. and Mellin, M. (1984). TheBook of Apple Software, 1984.Los Angeles: Arrays, Inc., TheBook Division.

Star, B. (1982). Banner Magic.Computer program. Lake Zurich,IL: Phoenix Software, Inc.

Williams, G. (1982). A graphicsprimer. BYTE, 2(Nov.), 448-470.

Zawol kow, 1E7 Rowe, P. & Perry,T. (1982). The Game Show. Computerprogram and manual. Berkeley,CA: Computer-Advanced Ideas,Inc.

23

CONTROL DATA DISABILITY SERVICES DIVISION OVERVIEW

STEPHEN WASTYEDT

ABSTRACT

Control Data Corporation, a multi-national company with four billiondollars in sales and fifty seven thousandemployees worldwide, has been involvedin developing and delivering trainingprograms to meet the educational and

vocational training needs of the disabled

for over a decade. The attainmentof marketable job skills for any individual

is very important. For the disabledindividual seeking competitive employment,

obtaining these marketable skillsis absolutely critical.

To meet this critical trainingneed, Control Data has implementedcomputer-based clerical training programsat two well established rehabilitationagencies; Sister Kenny Institute inMinneapolis, and the InternationalCenter For The Disabled in New York.In addition to these rehabilitationagency-based training programs ControlData is also offering individual compu-ter-based vocational training in theareas of programming, office technologyand telemarketing to disabled individual s

who are confined to their homes.Because the programs offered

are designed to specifically meetthe needs of the competitive marketplace ,

the input of business has been critical.This input has been to provide entrylevel job requirements and has ledthe development of competent graduateswho can obtain jobs in the competitiveemployment market.

Control Data has long been aworld leader in the development anddelivery of computer technology.When the capabilities of this technologyare applied to the lives of the severelydisabled, the results can be dramatic.An illustration of this can be foundin tt,e following case:

7t is 7:00 a.m. on a typicalweekday morning in Charlotte, Michigan.The majority of workers in this central

Michigan community are preparingto commute to their pl aces of empl oyment.

For Kirby, a 35 year old man confinedto his bed because of severe arthritis,

a daily commute is not possible.His arthritis has fused all the jointsin his body. Through the use ofcomputer technology, however, Kirbyfunctions well as a designer of compu-ter-based courseware for ControlData in Minneapolis, Minnesota.By using PLATO R, Control Data'scomputer-based learning system, Kirbyis able to transmit and receive instan-taneous communications with his workgroup, hundreds of miles away in

Minnesota.Kirby's situation is an example

of the opportunities opened whenthe capabilities of computer technologyare combined with the capabilitiesof disabled individuals. His $25,000annual income provides clear evidencethat these capabilities include atransformation from economic dependenceto independence in the lives of severely

disabled individuals.Control Data has developed a

series of products and services thatare specifically designed to meetthe vocational training afld employmentneeds of the disabled. This activityis driven by a strategy to developand del iver vocational training programs

that provide disabled individualswith skills to successfully competein competitive empl oyment. By obtaining

24


vocational skills training in areasof high employment need, disabledindividuals will be able not onlyto integrate themselves more fullyinto society, but also to reach theirfull potential.

Historically, the traditionalmethods of education have been minimallyeffective in the delivery of vocationalskills curricula to severely disabledindividuals. Control Data's experiencein delivering vocational trainingprograms to this population has demon-strated that the individualized componentof training delivery allowed throughcomputer-based education, has provenextremely effective in providing disabledindividuals with marketable vocationalskills training.

The vocational skills trainingdirected to the disabled is deliveredby two Control Data Programs. A descrip-tion of each of these programs follows:

Homework Program

For decades, American corporationshave been faced with the problem ofdeciding what to c!o with employeeswho have become severely disabledduring their employment. Not onlyare corporations faced with the highcost of providing disability benefits,whether direct or indirect, but theyare al so faced with the loss of aproductive, often hi ghly skilled employee.

In the case of an employee who has

become severely disabled, the companymust make a choice. Does the companyallow this individual to collect disability

benefits and remain unproductive,or does it make P. n attempt to retainthe employee either by making anyjob accommodations necessary to allowthe individual to resume his jobresponsibilities or by retrainingthe individual in a new skill notlimited by the disability?

The control Data HOMEWORK Programtrains individual s who have becomeseverely disabled in the high demandskill s of computer programming, tele-marketing, and office technology.Skills training is provided by delivering

25

an intense, computer-based curriculumin their homes via a PLATO computerterminal. The time needed to completethis training depends upon the curriculumselected and the speed at which thestudent can move through the componentcourses.

The student is guided throughthe selected curriculum by a ControlData certified instructor. Mostcommunications between student andinstructor are via the PLATO computer.This technologically advanced methodof communication has proved highlyefficient in the cost-effective deliveryof an intensive vocational skillscurriculum.

In addition to del ivery of thevocational skills curriculum, thePLATO system has al so proven veryvaluable for the delivery of a coursein daily living skills. An exampleof this is the Independent LivingSkills curriculum which has beendeveloped by Control Data. Thisseventy hour curriculum is designedto provide individuals with mobilityimpairments information useful intheir daily lives. The course willprovide information that will helpdisabled individuals make the decisionsabout their capabilities for independentliving.

Project With Industry Program

Control Data has operated a

Project With Industry program (PWI)

for the past four years. The purposeof the PWI Program is to developrelationships between Control Data,State Departments of Vocational Rehabil-itation, and other rehabilitationagencies. These agencies refer disabledindividuals qualified for employmentto be considered in business facilitiesacross the the country.

The Control Data PWI also hasa training component. To optimizeemployment opportunities, disabledindividuals must obtain marketablejob skills. Through computer-basedLearning Center at Sister Kenny Institute

in Minneapolis and the International

t


Center for the Disabled in New York,disabled individuals are given trainingin high demand clerical occupations

leading to competitive employment.Approximately 140 disabled people

per year are currently receiving training

through these two programs. Both

programs al so have a very active placement

component which includes the participation

of large local employers. This stronglink between the training and placementcomponents of these programs has resultedin placement results that exceed thestandards obtained 53, training programsusing traditional learning methods.

To optimize the competitive employment

of disabled individuals, Managers,co-workers, and personnel professionalsmust be given a sense of awarenesstoward the disabled. T3 accomplishthis goal , a day long seminar entitled"Managing the Disabled" is offeredby Control Data.

At this seminar, usually facil itated

by a disabled individual , the participants

receive an awareness of some issuesinvolved with a disability. Thissense of awareness involves not onlythe work pl ace, but al so the dailyliving experiences of the disabledperson. Through a heightened senseof awareness, course participantsincrease their ability to effectivelyinteract with the disabled. This

seminar is currently being offeredin Control Data facilities acrossthe country. Plans have been madeto offer this seminar to other companies

in 1985.

Summary

Control Data will continue todeliver effective training programsto train disabled individual s in skillsthat will enhance their ability toobtain competitive employment.

We believe that the individualizedinstruction capabilities of an effectivecomputer-based training program willcontinue to provide disabled individualswith cost effective vocational trainingthat has proven its marketabilityin the competitive employment market.

With 80% of disabled individualseither unemployed or underemployed,it is critical ti-at effective trainingstrategies must be continued to be

developed and del ivered to prepare

di sabled individual s for competitiveemployment. Control data views thissituation as a vital area of need,and will continue to aggressivelyimplement training and employmentstrategies that will address thatarea of n....d.

26

FORCE CAPABILITIES OF THE PHYSICALLY HANDICAPPED ATSELECTED AUTOMOBILE DRIVING CONTROLS

DR. HAROLD F. RISK

ABSTRACT

The major purpose of this studywas to investigate force capabilitiesof severely physically handicappedpersons at selected automobile drivingcontrol s. The study was undertakenin order (1) to develop guidelinecriteria for the selection and prescription

of hand controls and driving aids,(2) to assist in the selection ofthe optimal directions and configurationof force, and (3) to provide quantitative

data for evaluating the driving potentialof a physically handicapped person.

During the study, five differenttests were administered to 54 physicallyhandicapped subjects. They were (1)

grip strength, (2) steering wheelforce at the 3, 6, 9, and 12 o'clockdriving positions, (3) hand controlfo'rce in the forward, aft, up, anddownward directions, (4) twistingstrength, and (5) physical reactiontime.

An analysis of the data collectedin research investigation suggested:(1) Individuals varies widely in strengthcapabilities due to different diseasesand injuries. The higher the spinalinjury, and the more severe the neuro-logical impairment the lower the strengthresults. (2) There was no significantdi fference between the 3, 6, and9 o'clock grip positions. (3) Theaft force direction of the hand controloffered the best direction for brakingforce. (4) Twisting forward on thehand control for acceleration offeredthe most favorable maximal force.(5) Reaction times were slower thanthe .24 seconds used as a norm. Subjectswho suffered a closed head injuryhad lower reaction times. Other disabledpersons with slow reaction times werevictims of upper spinal cord injuries,quad-polio, and major neurological

27

impairments. (6) The majority ofthe subjects tested were unable toexert enough force to stop a vehicleunder emergency driving situations(100 force pounds or more). Fifty-twoof 54 subjects had means below thevehicle's required stopping value,as established by the SAE. (1) Handdominance played no significant rolein steering force, braking or grip.

Some implications of the study:(1) Further testing and researchis required to clarify the relationshipsbetween more specific diseases andinjuries in regard to force capabilities.

(2) A study is needed that comparesthe effects obtained on the testingdevice with the actual driving successof the physically handicapped individual.

The Physically Disabled

The questions that arise inconsidering automotive driving bythe physically disabled are practicallythe same as those important to able-bodied

drivers. Of primary concern, thelargest majority of traffic accidentscan be linked, at least in part,to driver error. It is necessary,therefore, to precisely as possibleunderstand the complex nature ofthe driving task in order to properlyguard against such errors. The drivingtask involves the reception of vitalinformation, physical action basedon this interpretation, and the dynamicresponse of the vehicle. In orderfor this sequence to operate efficiently,

a baseline minimum, although unknown,level of mental and physical abilityis required.

The physically disabled uriverhas an obviously 1 ower 1 evel of potential

abil ity when compared with the ablebodied driver. Due to the uncertaintyabout the levels of skill and strength


required, it is not presently knownthe degree to which these reducedabilities will affect the drivingtask. Augmentation of the lower levelof ability of the physically disabledthrough the use of assistive adaptivedriving aids is possible. However,

the degree of augmentation necessaryand the degree achieved are like theneeded level of abilities, not known.Similarly, it is not possible at thistime to state whether presently availableadaptive driving aids are adequate,except perhaps in the cases of thosecurrently using them. While the physicalcapabilities necessary for drivingan automobile with or without specialequipment is not presently known,some information is available on thecapabilities of various disabled groups.The abilities of those with spinalinjuries are better understood thanmost. The functions remaining aftera spinal cord injury are most clearlydefined and several qualitative discussions

are available. It should be noted,however, that capabilities vary withtime and at least one study has showna significant decrease in motor activity.Other forms of muscul oskel etal handi caps

have been evaluated with respect toestablishing a recognized standardof disability, but these standardshave not been directly associatedwith driving.

The most significant way to assesscapability is to look at the remainingfunction and determine if it is sufficient

for driving, with or without adaptivedriving aids. Limited categorizationsof this kind are available and haverecently been extended to includea wider range of limb involvement.

Special equipment available forthe physically handicapped includessuch simple devices as left foot accel-erators, spinner knobs, and left handgear selectors. Right hand or pushbutton directional signals are alsoavailable and the list extends up

to full hand controls. New on themarket are "less effort" or "zeroeffort" steering and braking systems.These systems give the more severely

handicapped person a chance to drivea motor vehicle. In addition, variouscustom built solutions to specialproblems have been devised. Bothregular automobiles and vans havebeen converted for use by disabledpersons with vans preferred in severedisability cases as wheelchair entrycan be more easily accomplished.

One thing that is immediatelyapparent in reviewing the currentequipment design and developmentefforts for the physically disableddriver is that, apparently no safetystandards exist for such devices.Also the acceptability test protocolfor custom designed devices has beenlimited to qualitative judgments,themselves limited to deciding whetheror not the person can physicallyexert the effort needed to drivethe vehicle.

Need for the Study

Millions of physically handicappedAmericans depend on their automobilesfor mobility and independence. As

more and more physically handicappedpersons discover the economic, socialand personal advantages that drivingoffers, the number of operators usingadaptive automotive driving aidswill increase.

The housing trend today is toward

suburban living. Many people livein the small towns immediately surrounding

large cities; their occupations,educational facilities, and shopping

needs are in the city. Most people

view the automobile not as a luxury

but as a definite necessity; thisis particularly true of the physically

handicapped. Decentralization ofliving presents physically handicappedpersons with the prospect of a lifeof isolation within this home if

some mode of independent transportationis not made available (Rowley, 1953).

Fortunately, many devices havebeen created to assist the physicallyhandicapped in boarding and operatingan automobile or modified van. Special

apparatus are available from driving

28


equipment manufacturers serving theneeds of the handicapped which makeit possible for those with paralysisor amputations to operate an automobile(Rusk & Taylor, 1953).

There has been little researchon driving with hand controls andpractically no quantitative data aboutforce input capabilities at variousdriving controls (steering wheel andhand controls used for braking andacceleration).

Purpose of the Study

The major purpose of this studywas to investigate the force capabilWesexhibited by severely physically handi-capped persons on selected automobiledriving control s. The studywas undertaken(1) to develop guideline criteriafor the selection and prescriptionof hand controls and driving aids,(2) to assist in the selection ofthe optimal direction and configurationof the force, and (3) to provide quant-itative data for evaluating the drivingpotential of a physically handicappedperson.

Methods

Five force capability tests wereapplied in this study. The vestswere conducted at the University ofIll inois Rehabilitation EducationCenter at the corner of Oak and StadiumDrive, Champaign, Illinois.

Subjects

The subjects were 32 physicallyhandicapped males and 22 physicallyhandicapped females between the agesof 19 and 47 years (average age =

26.97). Subjects were selected bytelephone solicitation from handicappedstudents whose names and addresseswere on file at the University ofIllinois Rehabilitation Center andfrom the names and addresses of handicapped

University alumni. In addition, severalsubjects were drawn from the localarea via the Division of Vocational

29

Rehabilitation. The purpose, procedures,and criteria of the study were thoroughly

explained; at that time the prospectIve

subjects consented to or declinedfrom participation in the study.

The Study Materials

1. A Budd Portable DigitalStrain Indicator Model p-130.

2. A Switch and balance systemModel BS-6

3. A Hewlett-Packard RecorderModel 7402 A

4. Risks Driving Potential OperabilityModel (Patent pending)

5. Metal film Strain Gaugestype C9-121 with a gaugefactor of 2.03 + .50% anda resistance of 120 + .20%.Used for the hand controlbraking test.

6. Metal film Strain Gaugestype EC6-121B-R2TS witha gauge factor of 2.04 +1%. Used for the twist andsteering tests.

7. A Jaymar Grip Dynamometer8. A miniature traffic control signal

(three phase, @ 5 feet tall ).

Procedure

In the course of the study,five different tests were administeredto the physically handicapped subjects.They were:

Grip Strength

Using a Jaymar grip dynamometer,each physically handicapped subjectwas tested to determine the gripstrength of both hands. For thosewith little or no grip (i.e., somehigh level quadriplegics have littleor no grip) the grip test was stilladministered to document that fact.

Steering Wheel Force

The second test determined how


much constant and predictable forcethe subject could exert on the RicksDriving Potential Operability measurementModel. Subjects were placed in frontof the Model (all subjects were inmanual or electric wheelchairs) withtheir hands resting comfortably intheir laps. The steering wheel was

then adjusted to clear the subjects'laps and abdomens by approximately3 to 4 inches. If the distance wasinadequate, the experimenter wouldadjust the Model to meet the requiredclearance distance. The subjectswere then instructed to lock theirwheelchairs into position (3 to 4

inches from abdomen) or the experimenterwould secure the wheelchair in somesuitable fashion (another person wouldhold the wheelchair) for those unableto perform the task.

Four common grip positions weretested on the steering wheel potionof the Model. They were: The threeo'clock grip position, the six o'clockgrip position, the nine o'clock gripposition, and the twelve o'clock gripposition. Each driving grip positionwas tested five times per hand perdirection (clockwise and counterclockwise). The experimenter designatedthe appropriate starting hand andgrip position. For those unable togrip the steering wheel with theirhand, special steering devices wereinstalled on the steering wheel to

attain the proper security of thehand for testing. The steering devices

included: a spinner knob, a quaddriving post, a quad cuff, and a tri-post

steering device.Subjects were given instructions

to exert their maximum sustained (notexplosive) force on the steering wheel.As force was exerted, permanent measure-ments were recorded on a strip chartrecorder.

The Model was cal ibrated periodically

(after each subject) and initiallychecked by hanging known weights fromthe four different grip positions.Weights were hung in increments of5 pounds for the purpose of calibration.

Hand Control Force

The purpose of the third testwas to determine the amount of forcesubjects could exert on the hand

control portion of the Model. Four

different directions on the handcontrol were tested. They were:forward, aft, upward, and downward.Since the subjects were already inthe Model after the steering test,no new positioning was necessaryto complete the hand control test.

The subjects were instructednot to use any part of their wheelchairsor surrounding equipment as addedsources of stability; this wouldgive faulty data and informationconcerning their force capabilities.Also, special instruction was givenon how to position the hand on thehand control. In basic arrangement,the subjects hand was to grasp thecontrol with the palm on the handgrip and the arm and wrist as levelas possible. Howcver, upper spinalinjured subjects were allowed (and

a few others) to elevate their elbowsslightly to better accommodate shoulderand scapula muscles; these are themuscle groups that they use or woulduse for driving.

In the event the subject hadlittle or no grip(mostspinal injuries),the subjects would pronate, supinate,or position the forearm one-halfbetween pronation and supinationto perform the forward and aft direction

tests. Under normal driving conditions

this would be an automatic positionfor these individuals, in the afore-mentioned directions. In addition,

these same forearm positions wereused in the upward and downward tests.

Further instructions requestedthat subjects exert maximum sustainedforce on the Model hand control in

the randomly selected direction,with the predetermined hand. As

force is applied, permanent recordswere recorded on the strip chartrecorder. A total of five trialsper direction per hand were given.

30


Twisting Strength

The twisting strength test wasincorporated into the hand controlsystem on the Model and was derivedfrom a Wells-Engberg hand controlsystem which would potentially usewrist extension and wrist flexion.Once again, no new positioning wasnecessary as the twisting test wasincorporated into the nand controlsystem.

Subjects were required to demonstrate

their twisting ability by performingon the Model five times per hand perdirection. The two directions ofrotation for the twist were clockwiseand counterclockwise.

Physical Reaction Time

A physical reaction time testwas incorporated into the hand controlon the Model and was an integral partof the testing procedure. Subjectswere required to observe a miniaturetraffic light (keyed by the experimenterwith the strip chart recorder) whichwas connected to the Model. Whenthe red light went off, they wereto apply force (both hands were testedseparately) in the forward directionof the hand control as fast and ashard as possible and to hold it forat least two seconds.

Readings were permanently recordedon the strip chart recorder. Fromthose recordings reaction time, detection

time, and mean reaction time forceswere collected.

Summary

In the course of the study, fivedifferent tests were administeredto 54 physically handicapped subjects.They were: grip strength, steeringwheel force at the 3, 6, 9 and 12

o'clock driving positions, hand controlforce in the forward, aft, up, anddownward directions, twisting strength,and physical reaction time.

Dependent group t-tests wereused to compare the minimum force

poundage necessary to stns the automobil eas exerted by the right and lefthand. Dependent group t-tests werealso used for twisting, and griptests.

A two-way repeated measuresanalysis of variance was used forthe steering force and hand controlforce tests. A priori t-tests wereused to make a directional comparisonof the hands in the four directionsof both force tests.

Presentation and Discusionof Data

Steering Wheel Force

The mean force exerted (in pounds)on the steering wheel at each ofthe four separate o'clock grip positions

is presented in Table 1; these meansare also graphed in Figure 13. Standarddeviation and 95% confidence intervalsalso appear in the table. Basedon inspection of the raw data, itwas noted that about 3% of the subjects(2 of 54) exerted force on the steeringwheel which was below the two poundminimum specified as necessary bythe Society of Automotive Engineers(SAE). Roughly five percent (5%)of the subjects (3 of 54) exerteda dead steering force below the 3.5pounds required for a parking maneuver(also defined by the SAE).

Table 1

Mean Steering Force (in foundo) of FoarSeparate Steering Grip Position.:

Confilivec InteElik

Source Number Mean S.D. Low Hie,

3 o'clock 216 58.14 53.71 50.93 65.36

6 o'clock 216 53.60 45.18 49.54 59.66

9 o'clock 216 59.69 52.44 52.66 66.22

12 o'clock 216 39.82 36.36 34.y4 44.u9

Total 864

From Table 1 and Figure 1, it

can be observed that the mean force

31


exerted was approximately equal for

three of the four separate grip positions,

i.e., three, six, and nine o'clock(53.6 to 59.69 pounds). The meanforce exerted at the 12 o'clock gripposition was about 15 to 20 poundsless than that exerted at the otherthree positions. Discussion of theconfidence interval evolves aroundthe fact that there was such a varietyof disabilities tested. At the 95%confidence interval, the range wasfrom 34.94 to 66.72.

60 53.14 59.69

53.60

50

40

30

20

10

39.52

Figure 1

9 12

Steering Grip -Oslticrs

Kean ! ring Force (in pounde.) of

Four , ,.rate Steering CripPooitlons

The analysis of variance (ANOVA)

of the mean force exerted at the fourseparate o'clock grip positions appearsin Table 2. A significant F ratioof 7.85 (df = 3,860; p o 0.001) wasobtained. A priori comparisons amongmeans revealed that the mean forceexerted at the 12 o'clock grip positionwas significantly less than the meanforce exerted at any of the threeother grip positions (Table 3, df= 430, p o 0.001). A more detail-eadiscussion of these findings appearsin the following sections.

Table 2

Analysis of ftriance Sumaary for SteeringWheel Crip Positions

Source

3etween

Groups

Within

Groups

Mean

AL Square

3 17648.90

860 2249.49

p c .05

7.85 .0001

The mean force achieved duringthe steering wheel tests was foundto be higher than initially expected.For a few subjects (3 percent) it

was a difficult or an impossibletask to obtain a steering force of15 pounds. When total trials wereexplored, there were 15 subjectswho had some difficulty in obtainingthe necessary poundage at one ofthe four grip positions. Sixty percent

of the subjects could not exert 50pounds; 74.3% could not exert 75pounds and 85% could not exert over100 pounds in steering force. All

of these figures are important toconsider when determining the subjects'emergency driving capabilities.For example, a flat tire on the frontof a vehicle dramatically increasesthe steering force requirements.

Ten subjects exhibited extremeweakness due to severe injury ordisease. The weakness was most notablein quad-polio, C-4 spinal injuries,Kugelberg-Welander disease, C-5 andC-6 spinal cord injuries, and in

two victims of arthrogryposis. All

subjects were below the two poundautomotive required value (SAE),at two or more of the driving positions,

which would indicate unfavorableperformance in steering any standardlyequipped vehicle. This does not

mean that just because those whowere found operatively deficientcould not drive in the future, ratherthere would have to be extreme modifi-cations in the present steering wheelmechanism for the safe operationof a motorized vehicle.

The low means obtained at thetwelve o'clock grip position couldbe attributed to the lack of gripand leverage. Additionally, thetwelve o'clock grip position requiresgood use of elbow flexors, shoulderhorizontal abductors, biceps andshoulder extensors acting togetherto exert the necessary turning actions.

It was found that there wasa significant difference betweenthe twelve o'clock grip positionand the other three grip positions

32


(3, 6, and 9). Therefore, it is believed,based on the data, that the twelveo'clock grip position woul d be detrimental

in most situations in regards to theexerting of maximum steering force.The twelve o'clock position offers1 imi ted force ca pa bi 1 i ti es , poor emergency

driving position and causes unduefatigue for those physically handicappedindividual s who may drive from thetwelve o'clock grip position.

Table 3

Differences Among Means at eachof Four Grip Positions

GripPosition Mean

Kean Differencea

3 6 9 12

3 o'clock

6 o'clock

9 o'ca..ck

12 o'clock

58.14

53.60

59.69

39.82

4.54

-

-1.55

-6.09

1,02a

13.7db

19.8,c

at . 4.15. p 4 0.000b-t 3.49. p 4 0.001

Ci 4.48. p

The majority of the subjectstended to put their whole body weight(by leaning into the task for maximumsteering at the twelve o'clock gripposition. The leaning action wasto compensate for the loss of vitalbalance muscle groups (abdomen andback muscles). Additionally, a significant

tendency for loss of upper body balancewas particularly prevalent at thetwelve o'clock grip position. Most

notable were those with high traumaticspinal injuries, some subjects witharthrogryposis, and quad-polio victims.

Directional Force of the SteeringWheel

The mean force exerted on thesteering wheel in both directions(Clockwise or right and counterclockwiseor left) is presented in Table 4.The standard deviations and the 95%confidence interval al so appear inTable 4. The mean for the clockwisedirection (58.21) was over 10 poundsgreater than that of the counterclockwise

33

direction (47.41); these means weresignificantly different (Table 5,

t = 3.33, df = 862; p 1/4 0.001).The analysis of variance of the meanforce exerted in the two directionsappears in Table 6. A significantF ratio of 11.06 (df = 1,862; p 1/4

0.001) was obtained.

Table 4

Kean Steering Force byDirection of Rotation

Force

Direction Number Mean S.D.

Confidence Interval

Low High

Clockwise

Counter-Clockwise

432

432

58.21

14.41

51.92

43.10

53.30

43.34

03.12

51.49

Total 864

It was found that the clockwisedirection (right) produced the bestor most favorable direction of rotation.The large standard deviation indicatesthe wide dispersion of capabilities.The mean 10 pound difference couldbe valuable when exploring the subjects'potential s with respect to drivingemergencies and loss of power. Byidentifying the strongest rotationdirection, subjects can be made awareof specific driving deficiency.

Table 5

Analysis of Variance Summary for Steer1.4Force Rotation

Source dfMeanSquare 1 -< .05

BetweenGroups 1 25178.75

WithinGroups 862 2276.48

11.06 .0009

Hand Dominance

It was found that hand dominanceplayed no significant role with respectto applicable force at the steeringwheel. This result was surprisingas the majority of the general population

is stronger in the dominant hand.


It can be surmised that the handicappedsubjects were generally affected equallyin both limbs. Once an injury orillness has been accured, it becomesdifficult for the subject to rebuildmuscle strength and endurance. This

is not to say the person could neverdrive, only that strength has been

permanently lost.

Minimum Values of Steering

The mean force exerted at thefour separate grip positions was compared

to the minimum values specified bythe SAE to determine if the measuredforce exceeded those minimums. A

priori t-tests were conducted. It

was found that all mean values exceededthe SAE suggested minimum exertedforce needed to steer the vehicle.

When the mean force data werecompared to the required minimum valuesthat the automobile required, it wasfound that there was a significantdifference between all grip positionsand both minimum values (2.0 and 3.5pounds). Several individual subjects

performed below the minimum values.The most prevalent disabilities wereC-4 spinal injury, quad-polio andWelander's disease. Therefore, subjectswith these disabilities would requireadditional "booster" systems on thesteering units of their vehicles tocompensate for the loss of physicalstrength. Many companies now producesupport systems for motor vehiclesgiving weak individuals possibilitiesfor steering.

Braking Force

The mean braking force in poundsfor each of the four independent directions

is presented in Table 6; these meansare also graphed in Figure 2. The

means ranged from 36.01 (upward force)to 68.86 (aft force). The standarddeviation and the 95% confidence interval

also appear in Table 7. The largestandard deviations indicate the widedispersion in capabilities of subjects.From inspection of the raw data, it

was noted that over 21% (11 of 54)failed to meet the 15 pound minimumfor normal driving stopping requirements

as specified by SAE. Roughly 63%(34 of 54) of the subjects testedpossessed a valid drivers license,but failed to exert the SAE recommended100 pounds necessary for an emergencystop.

Table 6

Mean Brnking Force for the FourIndependent Directionn

Force

Direction

Confidence Interval

Nuabe. JAR S.D. Low High

Forward 108 68.40 54.40 51...03 71.73

Aft 108 68.86 53.94 58.65 79.08

Down 108 40.28 32.92 33.99 46.56

Up 108 36.01 34.95 29.34 42.65

Total 432

70

60

50

40

30

20

10

66.40 68.85

40.28---_ 36.01

Forward Aft Up Down

Figure 2. Mean Braking Force for theFcur IrdependentDirections

The analysis of variance of tnemean force exerted at the four independent

force directions appears in Table7. A significant F ratio of 16.62(df = 3428; p 4 0.001) was obtained.A priori t-tests comparison amongmeans reveal ed that the mean forceexerted in the upward direction wassignificantly less than the meanforce exerted in any of the other

34


three force directions (forward, aftand down). Additionally, the downwardforce direction was significantlyless than the force mean exerted atthe forward and aft direction.

Table 7

Analysis of Variance for BrakingFUrce Direction

Source df

BetweenGroups 3 33795.83

VithinGroups 42B 2032.93

Total 431

MeanSquare P4.05

16.62 .0001

There was a significant differencebetween the way force was applieJto the braking control. Degradationof performance was drastically noticedin the upward force direction. Amajority of the subjects mentionedthat the upward force direction wasvery awkward. They indicated thatthey, personally, would not want todrive a vehicle equipped with handcontrols which worked in the upwardforce direction. This study indicatedthat the upward force direction onlyoffers approximately one-half theforce as the forward and aft forcedirection.

The majority of those subjectsmost notably weak on the braking test(C-4, C-5 spinal injuries, arthro-gryposis imperfecta, stroke victims,and multiple sclerosis victims) performedbelow standard on the upward forcedirection. The large standard deviationindicates a large dispersion in capabil-ities.

The forward and aft force directionsproduced the most favorable resultswith respect to braking force. It

would, therefore, seem logical forexertion of optimum braking forcethat the hand control mechanism workin one of the two identified directions.Currentlj, the majority of the handcontrols on the market do work inthose directions.

Forward Braking Direction

There was no significant differencebetween the forward mean (68.40)and the aft mean (68.86). However,it can be noted from Table 8 thatthere was a significant differencebetween the forward mean (68.40)and the upward mean (36.01) (t =

5.21; df = 108; p 4 .001). Therewas also a significant differencebetween the forward mean (68.40)and the downward force mean (40.28)

(t = 4.60; df = 108, p 4 .001).

Table 8

Difference Among Means at Each of theFour Braking Force Directions

Force Direction Mean Forward

Mean Difference

Aft Up Down

Forward

Aft

Up

Down

68.40

68.86

40.28

36.01

- .46 28.12

28.46

32.39

32.85

4.27

t 4.60, p y 0.001bT 4.73, p y 0.001ci .92, p y 0.001

This finding was not surprisingand adds to the validity of the testas a mJasurement of braking forcedirection. It could be anticipatedthat with additional subject: thedifference would also reach statistical

significance. However, much meredata would need to be collected forthe upward and downward force directionin order to make clear assumptions.

Grip Force

No significance tests were conducted

on the grip data. It has long beenthe contention of professional educators

working with physically handicappeddrivers, that grip is not necessaryfor driving. Table 10 contains themeans for both the left and righthands.

In general, the results fromthe grip force test were lower than

35


those identified in a review of litera-ture. There was, however, no significantdifference between the two grips.

Grip does not need to play a

major role in the driving task. Foryears there have been many companiesthat manufacture attachments to variousparts of he hand controls and otheraccessories of the vehicle to compensatefor the loss of grip.

Table 10

Mean Grip

Left Hand Grip Right Hand Grip

Mean 45.33 44.09

Reaction Time

The mean reaction time (lefthand = .48 seconds and the right hand= .48 seconds) at the braking controlis presented in Table 11. A priorit-test comparisons were done; those

results are also presented in Table11.

The comparisons show that theaverage reaction time for the physicallyhandicapped subjects was twice aslong as it should be, as found in

previous research by other authors(Gart, 1959). However, the obtainedresults of .48 seconds are still wellbelow the .75 second average usedfor the able bodied driver.

Table 11

Mean Reaction Time

Source

RightReaction

Minimum

LeftReaction

Minimum

Huber Dean S.D. t clf F.4.05

yi .48 .229 7.77 53 .000

.24 000

.46 .236 7.5 53 .000

.24 000

Those individuals with the mostnotably slow reaction times werethose subjects with brain tumors,severe closed head injuries (uslally

from automobile accidents), and cerebralpalsy.

Emergency Stopping Force

The mean force exerted withboth hands (right andleft)wascomparedto the minimum values specified bySAE to detc:iine if the measuredforce exceeded those minimums foran emergency stop. A priori t-testswere conducted and those resultsare summarized in Table 12. it wasfound that neither hand exceededthe SAE suggested force of 100 poundsfor a maximum force emergency stop.In fact, the subjects obtained meanswere roughly 35 pounds less. It

can be noted that the right handemergency force (59.31) was notablyless than the left hand force (65.67).

One of the most important findingsof this study was that the handicappedsubjects were unable to exert enoughforce to stop a standardly equippedmotor vehicle under hard emergencysituations. From the study results,it could be speculated that not beingable to apply ample dynamic forceto the brakes is a major contributingfactor to many handicapped personsbeing involved in serious automobileaccidents.

Table 12

Mean Emergency force

Huber Mean E sif P4.05

RightReaction 54 59.31 47.90 -6.24 53 .0001

Minimum 100 100.00 00.00

LeftReaction 54 65.67 53.15 -4.75 53 .000t

Minimum 100 100.00 00.00

Driving Profile

36

Tables 13 and 14 display the


test results of two different physically

handicapped subjects, Table 13 displaysthe data for C-4 spinal injury victimunable, based on strength data, todrive a conventional vehicle. Theleft hand of the victim produced lowand unacceptable force results. Thebraking results are all below theminimum 15 pound braking requirements.

Table 14 displays those resultsof C-6 spinal injury victim with thephysicp1 strength to drive a conventionalmotor vehicle. All test results wereabove the required minimums. Although

Table 13

Force Capabilities of a Physical HandicappedPerson Unable to Drive Based

on Strength Data

Steerilligf'orce

the grip data was low, it would Playno significant role in his drivingpotential.

A two-way repeated measures analysisof variance was used for hand controlforce abilities. Factor A was leftversus right hand, while Factor Bwas the motion of the hand in thefour directions.

The analysis of data collectedin this study were directed towardunderstanding and explaining theforce variance among the variousstrength tests.

'Pablo 14

Force Capabilities of a lysically Handicapied

Person Able to Drive Basedon Strength Data

Left Hand Steering flight ) O'clock driving positionLeft Hand Steering Right 6 O'clock driving positionLeft Rand Steering Right 9 O'clock driving positionLest Hand Steering flight 12 O'clock driving position

3.02

3.49!./13..30

Steering Force

27.91Left Italia Steering Right 3 O'clock driving position

Right Hand Steering Right 3 O'clock driving position 4.42 Left Rand Steering Right 6 O'clock driving position 50.46

Right Hand Steering flight 6 O'clock'driving position 4.65 Left Rand Steering Right 9 O'clock driving posiWn 46.51

flight Hand Steering Right 9 O'clock driving position .5) Left Hand Steering Right 12 O'clock driving position )2.33

Right Hand Steering Right 12 O'clock driving position 2.03 flight Hand Steering Right ) O'clock driving positionflight Hand Steering Right 6 O'clock drivine position

43.9645.5s

Loft Hand Steering Left 3 O'clock driving positionLeft Hand Steering Left 6 O'clock driving position

0.eo

Right Hand Steering Right 9 O'clock driving positionRight Hard Steering Right 12 O'clock driving position

45.):io.14

Left Hand Steering Left 9 O'clock driving positionLoft Hand Steering Left 12 O'clock driving position

2.06los Left Hand Steering Left ) O'clock driving position 21.16

Left (laid Steering Left 6 O'clock driving posit:on )j72Right Hand Steering Left 3 O'clock driving position 4.65 Left Hand Steering Left 9 O'clock driving position 2535Right Hand Steering Left 6 O'clock driving position 2.62 Left Hand Steering Loft 12 O'clock driving position is.ERight Hand Steering Left 9 0',4,ok driving position 2.44 flight Hand Steering Left J O'clock driving position 33.24

Right Hand Steering Left 12 O'c At driving position 3.09 Right Hand Steering Left 6 O'clock driving position 16.74

flight Hand Steering Left 9 O'clock driving position 16.98

flight Rand Steering Left 12 O'clock driving position 29.77Brake Force

Brake ForceLeft Hand Forward 7.29Right Hand Forward 3.90 'eft Rand Forward 35.00Left Hand Aft 7.09 flight Rand ForwardRight Fend Aft 6.25 Left Hand Aft

.9t.45

40.43

Right Hand Aft 48.41Left Hand Up .42

flight Hand Up 6.51 Left Hand Up 9.73Left Hand Down 7.65 Right Hand Up 26.46Right Hand Down 7.0c Left Hand Down 26.46

Right Hand Down 4.79Twisting Force

Twisting ForceLett Hand Forward 7SLeft Hand Back .63 Left Hand Forward 2.22

Right Hand Forward .00 Left Hand Back 2.72

Right Hand Back .00 flight 'Land Forward .22

Right Hand Back 2.16Orin

Grip

Left 67Right .00 Left 1.33

Right 3.67Reaction Cata

Reaction Data

Reaction Time Left RandDetection Time Left HandX Force Reaction Time Left Hand

fleacticm Time Right RandDetection Time Right HandX sJrce Reaction Tim. Right Hand

.55

.42

7.92

.17

.23

6.72

Reaction Time Left Iland

Detection Time Left HandX Force Reaction Time Left Hand

Reaction Time Right RaniDetection Time Right HandX Force Remotion lime Right Hand

.57

.20

)9.5.3

7).:c

)3.5)

37


Conclusions and Discussion

An analysis of the data collectedin this investigation revealed findingsdescribed earlier. These findingssuggest:

1. Individuals vary widely instrength capabilities dueto different diseases andinjuries. Generally, thehigher the spinal injury thelower the strength results;the more severe the neurological

impairment, the lower thestrength results.

2. The 9 o'clock steering wheelgrip position offers the bestforce driving position. Thisfinding refutes previous beliefsthat it is always best to

drive with the right hand,brake and accelerate withleft hand. If only concernedwith maximum steering, the9 o'clock steering positionmust be considered. In the

automobile, the person wouldbe able to support the elbowon the left door arm restwhen in a normal driving situation.

3. The aft force direction ofthe hand control , used forbraking test, offers the best

direction for braking force.Contrzry to current hand control

design, the study found thatthe more strength force is

produced in the aft directionthan in the forward pushingdirection. This could suggestthat equipment companie's needto change braking force direc-tion. However, comfort andease of use must be considered.

4. The twisting forward actionof the hand control offersthe most favorable directionfor maximum force. Althoughtwisting forward producedfavorable results, the awkwardaction that was required toobtain positive force wouldlimit its usefulness.

5. Reaction times were slower

than expected but were abovethe minimum .24 seconds.They exceeded the tirrp period

which is genera'ily acceptablefor able bodied drivers.The reaction times rangedfrom .20 seconds to overone second. Those who had

longer reaction times weresubjects suffering from a

closed head injury. Otherpersons with slow reactiontimes were victims of upperspinal cord injuries, quad - polio,

and major neurological impair-ments.

6. A majority of the subjectstested were unable to exertenough force to stop a vehicleunder emergency driving situations

(100 force pounds or more).Fifty-two of fifty-four meanswere below those requiredfor stopping. This findingis of major importance forit suggests a greater emphasismust be placed on emergencydriving techniques and brakingtechniques. If the subjectis unprepared for such a

situation, the probabilityof being involved in a brakingrelated accident is greater.

7. Hand dominance plays no signi-ficant role in steering force,braking or grip.

8. Grip plays no vital rolein steering and the brakingtasks. No evidence was foundto suggest that grip is a

vital function in order toattain a better steeringor braking force score.

9. Victims of severe spinalinjuries and neurologicaldiseases generally producedthe poorest results. Thesesubjects had major impairmentsand had difficulty with allstrength related tests.This finding suggests thatthere is a need for more"less effort" driving systemsso as to enable more minimum

38


strength persons to drivemodified vehicles.

10. The 12 o'clock grip positionshould not be used as a drivingposition based on strengthcapabilities and the awkwardsteering action. Subjectsconsistently complained aboutthe uncomfortabl eness of thetwelve o'clock position.

11. Al though not practical , a

driver could be instructedthat the best strength directionis steering clockwise. Therefore,

if the driver had a choiceof steering in either direction,he could choose the clockwisedirection. There was a signi-ficant difference betweenthe directions of steeringforce.

12. Due to the muscle groups requiredand the awkwardness of theaction, the upward force direction

should not be used for eitherthe braking or acceleratingaction on a conventional hand

control driving system. Subjects

would often try to rest theirarm on their legs so as toobtain a better result whentrying the upward force test.

Recommendations

On the basis of the data resultingfrom this investigation, the followingpoints are recommended:

1. Persons who are suspectedof having any general physical weaknessshould be thoroughly tested and screenedbefore driver education instructionbegins. By testing the subject priorto driving, time and effort can be

saved in the determination, pro orcon for driving.

2. Further testing and researchis required to clarify the relationshipsbetween specific diseases and injuriesregarding force capabilities. Arespinal injured persons less likelyto become drivers than neurologicallyimpaired drivers?

3. Repeat the tests but have

categories of diseases and injuriesrather than grouping them all together.Too much of the lower input levelsget hidden within the data.

4. Repeat the tests using largerpopulations of physically handicappedsubjects. There is a need to gatherdata on a more diverse group of subjects.

A comparison needs to be made betweencomplete spinal cord injured subjectsand incomplete spinal cord injuredsubjects. There needs to be moreknown about the degree of injuryand its relationship to driving.

5. Repeat the steering wheeltest using five different grip devicesto determine if one or more devicesoffers improved steering results.

6. Repeat the reaction timetest using a more accurate electronictiming device. Many devices wouldhave to be explored in order to determinethe most effective and efficient.

7. Study the effects obtainedon the testing device with the actualdriving success of the physicallyhandicapped individual.

39

INCONTINENCE - A DISABLING PROBLEM

PATRICIA A. WILSONMERRY JO DALLAS

ABSTRACT

The management of incontinenceis an important aspect of daily livingfor any person experiencing this problem.In order to assist incontinent personsand caregivers, research efforts havefocused on determining existing problemsin managing incontinence and bestsolutions for those problems. Interviewswith nursing directors, caregiversand incontinent persons shed considerablelight on problems in managing thisdisability. To choose satisfactorysolutions, the incontinent personand/or caregiver must be 1) awareof products designed for incontinence,their availability and cost, and2) knowledgeable about the performanceof various types of disposable andreusable products. The product evaluationincludes an investigation regardingthe ease of application, ease of removal,

odor containment, maintenance of normalskin condition, urine retention, overallproduct aesthetics, and personal comfort.Consumers should not be limited tochoosing only Oisposables or onlyreusabl es; they should be able to

choose the right combination of featuresfor t h2 i ndi vi dual ' s maximum psychological

and physical well-being.

Introduction

In 1979, Mar .:1stam (1979) estimated

that there were between 8 and 9 millionpersons in the United States whosuffered from incontinence, basedon the incidence of incontinencein England. These incontinent peopleinclude elderly and handicapped peopleyou may know, as well as inconspicuouspeopl e--your neighbors , riur co- workers,

yourself. Frequently, these personsare not readily identified becauseincontinence, or a lack of controlover the bl adder or bowel s, is a

condition that has been "kept in

the closet" by the medical profession,by the media, by societal attitudes,and by afflicted persons themselves.

Recent advancements in the technology

of products associated with incontinence

are surfacing in national television,magazine, and newspaper advertising.Per!laps national attention to "toxicshock syndrome" and the resultingneed to develop improved sanitarypads has paved the way to greateracceptance of the pro bl em of incontinence

and the use of sanitary pads to managemi -1r leakage pro bl ems . Developmentsin sanitary napkin products, suchas the use of extra absorbent fibers,lightweight waterproof fabrics, andadhesive anchor strips, have beenused in some of the newer incontinentproducts designed for the older child.and adult. Advertising for all ofthese products has begun to bringincontinence "out J f the closet",al though the word "incontinence"is never mentioned. These ads oftenshow well-dressed suburbanites, usuallyel derly men and women, feeling freeto play golf or attend card partiesin their "dependable" oversized andextra-absorbent pad. In addition,toddlers are shown in ads "talking"

40


to mom about the comfort and easeof wearing the latest in disposablediapers. The new larger sizes andextra absorbency may imply use withlarger children or small adults.

Statistics on the consumptionof disposable products and advertisingslogans lead layman to believe thatdiapers are not only disposable, butindispensable. Many nursing homesuse disposable products; it has beenfound that disposables now enjoy a60 percent lead over cloth reusableproducts (Chanko, 1983). Disposableshave become a way of life for today'smoms. Eighty percent of hospitalnewborns wear them home (Pacific NewsService, 1983) and the"premiedisposablediaper has been newly developed.Ads expose consumers to new developmentslike the "hourglass" design, elasticized

legs and waists, and adhesive tapesthat replace pins and can be fastenedagain and again.

Frequently, new products solveone problem, but create new problems.Sealing off wetness is suspected topromote overhydration and irritationof the covered area. More skin rashesand bed sores may occur with thesesealed disposables than with the useof cloth products. Disposing of dispos-ables is suspected of contaminatinglandfills and water supplies (PacificNews Service, 1983). The sterilizationZ1rcloth or reusable products wouldcontrol these health problems, butmost home washing and drying practicesare not adequate to stop bacterialgrowth. Diaper services and commerciallaundries are "self-regulated" toprovide sanitary products, but thesecare practices may be too harsh foranything other than old fashioned100% cotton cloth diaper.

It is popularly thought thatcloth products are more cost effectivethan disposable products because theycan be rvsed, even though initiallya reusable adult diaper costs tentimes more than a disposable ($5.66versus .59). Considerations of conven-ience, the availability of laundryfacilities, the cost of laundering,

sensitivity in handling, and embarrassment

may override the long term cost savingsof reusables.

Previous Research

Research efforts in the managementof incontinence have been underwayin England since, at least, 1968.In that country, specialty pantiesfor the incontinent have been availablethrough a variety of sources. Twoinnovative models, at that time,were the Kanga pant, a reusable pantywith a disposable pad fitted intoa water-proof pouch, and a gelulosepad used like a sanitary pad, pinnedto reusable panties or tied to a

belt. Development of similar productsin the United States seemed to lagbehind England. As late as 1980,products similar to those availablein England were limited.

In response to the apparentlack of satisfying products and tothe lack of knowledge regarding productsand sources of procurement on thepart of the incontinent patient andfamilies, Dallas and Wilson (1981)undertook a study to develop comfortable,

functional and aesthetically satisfyingpanties for physically handicappedwomen and girls with adaptationsfor the special needs associatedwith self -help and urinary incontinence.

Designs and adaptations were developedto provide for the management ofurinary incontinence featuring improvedfit and comfort, and simpl ified dressing

and undressing, especially duringto i 1 eti ng . The modification of commercial

panties to accommodate individualneeds and preferences provide greateracceptance than "specialty panties"that appeared too different fromcurrent trends. Adaptations hadthe further advantage of requiringless sewing skill on the part ofthe women and girls or their families.Various types of diaper-like insertswere developed, including one whichincorporated a knitted olefin covering,this provides a dry layer againstthe skin, yet allows the urine to

41


pass through the fabric to pads ofhighly absorbent materials. It wasapparent that the solutions to pantyproblems required an individualizedapproach. Continued experimentationswith products and designs yieldeda proto-type combining preferred featuresderived form an earlier preferencestudy of new materials and modificationsof diaper-like inserts.

A more recent study concentratedon the evaluation of a commerciallyavailable disposable product in aninstitutional setting (Beeber, 1980).Dr. Beeber and staff divided 276 totallyincontinent patients into two groups.

A control group of 127 subjects continuedto receive their usual care, whilethe test group of 149 patients worea disposable brief as their only incon-tinent care product. The staff monitoredthe physiological aspects associatedwith wearing the brief for comparisonto the usual care procedure. Theusual care included the use of disposablebed pads, frequent clothing and beddingchanges, and make-shift cloth diapers.Bedding and clothing protection, skindryness, patient comfort, convenience,ease of application, ease of removal,and odor containment were scored bynurses and aides when comparing thedisposable brief to conventional care,Nurses also assessed the patients'perceptions. Of the 149 whi worethe brief in the test phase, 53 weresufficiently alert for staff to interprettheir responses. Although subjectivein nature, the major difference inthe control and test groups was theperception that the quality of lifeimproved in 40 out of the 53 patientswho wore the brief, because they hadincreased mobil ity and reduced embarrass-

ment. The staff preferred the briefbecause it reduced their workload,helped patients by allowing them moreindependence, and improved the odor,appearance, and mood of the ward.This study, which evaluated the useof a popular disposable brief, appearsto be an exception to more commonevaluation practice, on word -of -monthcomments from nursing staff or aides.

Other caregiving companies may seeklittle or no user feedback.

Focus of Current Research Efforts

Although the incidence of urinaryincontinence was felt to be significantin the general population (Mandalstam,1979), and a major problem with disabledpersons (Dallas and Wilson, 1981),the National Institute of Ageing(1981), targeted the elderly as a

group that would greatly benefitfrom studies related to the managementof urinary incontinence. It wasprojected that urinary incontinenceaffects one in ten persons over 65years of age and is an importantfactor contributing to institutionali-zation (NIA, 1981). A current studyby Dallas and Wilson, funded by theAmerican Home Economics Associationin 1982, focuses on elderly womenin nursing homes for the developmentof a base of information that maybe generalized to all women disabledby urinary incontinence. The objectivesof this study are 1) to determinethe incidence of incontinence amongelderly women in nursing home settings2) to determine management practicesand products used in these homes,3) to determine satisfaction levelswith these products both from thestandpoint of the nursing home andthe patient, and 4) to assemble examplesof currently available disposableand reusable products as a basisfor the degolopment of an informationalpackage. It is hoped this packagecould be used by incontinent personsas well i caregivers to aid in thesclection process of products thatmeet individual needs.

Methodology and Resources

In January 1982, the six nursinghomes in Fort Collins, Colorado,were selected for the study. Nursingdirectors at each of the six homeswere interviewed to determine theextent of urinary incontinence amongtheir female patients and to collect

42


data specific to management practices,products used, reasons for productselection, care practices for reusableproducts, and estimated costs associatedwith maintaining the incontinent patient.Of the six directors interviewed,four expressed a willingness to continue

with the study. In each home, nursesand/or caregivers were asked to complete

a questionnaire for each female patientexperiencing urinary incontinence.The questions developed a pati :nt

profile that included evaluation ofthe degree incontinence, degree ofassistance in dressing and toiletingactivities, and general well-being.In addition to the profile, productperformance, judged by the nurse orcaregiver, was determined for eachproduct used with each patient. Products

were evaluated on the followingbasis: ease of application, easeof removal , odor containment, maintenance

of patient' s normal skin condition,urine retention capacity of product,overall aesthetic qualities of productand comfort to the patient. Eighty-sevenquestionnaires were completed, coded,and analyzed (Statistical Packagefor the Social Sciences, SPSS). Frequencydistributions were produced for eachquestion.

Results and Discussion

Initial interviews. The nursingdirectors of the six care facilitiesgave substantial insight into theproblems associated with the managementof incontinence in predominantly elderlyfemale patients. Out of 391 femalepatients in the six homes, 195, 49.8%,were identified as incontinent. This

figure was consistent with an earlierstudy by Dallas and Wilson (1981)and with figures reported in an unpublis:ied

paper on the proceedings of a workshopon urinary incontinence in the elderlysponsored by the National Institute

of Ageing (1981).The methods used for the management

of this problem varied. Four of thesix facilities used a bladder trainingprogram together with various products

43

designed to manage incontinence.According to the directors, the degreeof incontinence, the patient' s mobil ity,

and the cost of products were themain determinants in the choice ofproducts used by the homes. It appeared

that a wide variety of products werein use.

From the four nursing homesthat continued in the study, additionalinformation was collected regardingthe costs associated with the managementof their incontinent female patients,preferences of the home for disposableversus nondisposable products andlaundry practices used by the homesfor reusable products. Generally,the costs of products were includedin the overall patient care cost.Some private patients purchased products

directly, from the home or othersources. Costs per patient per dayvaried among the homes and dependedon the types of products in use andthe number of required changes perday. It appeared that the nursinghomes paid different amounts forthe same product, dependent uponsupplier used and the volume beingpurchased. Costs were estimatedby the directors to range from $6.00per day per patient for disposablebed pads to $12.00 - $15.00 per dayfor disposable pads used with reusablebriefs. ATTEND brand briefs averaged$.51 per change.

The reasons given for preferencesbetween disposables and reusabl eswere stated as lower cost, less odor,patient psychological well-being,patient physical well-being, andconvenience. It was apparent somedirectors felt that disposables wereof lower cost than rausabl es. If

feel ing was justified by ary formalanalysis was not known. The questionsposed were open ended, thus the directors

could volunteer any responses theydesired. One director noted thather home was considering a changeto reusabl es based on informationthat a reusable brief-disposablepad system was more cost effectivethan disposables. This change has


not yet occurred. However, the directoris still considering the idea. It

appears that homes have an increasein interest in product selection sincethis study began two years ago. If

the home used reusables, the directorwas asked how the products were laundered.Practices varied, but one consistentrequirement was the heating of washwater to at least 165F. This factor,plus the use of industrial strengthwashing aids, shortens the usefullife of most reusables.

Questionnaires. Questionnaireswere completed for 87 patients. Thepatients were not evenly distributedamong the home with some having ahigher population of incontinent females.

Also, homes varied in the number ofcaregivers willing to take part inthe study. Patient ages ranged from29-95. Fifty of the 87 were chair-boundand three were bed-bound. The bladderrehabilitation potential was judged"poor" in 58 percent of the 87 patients.The type of incontinence was recordedusing definitions of each type toassure each caregiver used the samecriteria. Reflex incontinence wasthe most prevalent type in 51 outof 87 patients. Forty-four percentof the patients were on a bladderrehabilitation program involving theregulation of liquid intake and twohome checks of the patient. Somepatients are not suitable candidatesfor this training program due to theseverity of their incontinence orother health related reasons.

In some instances more than uneproduct was used by a patient. Forexample, bed pads would be used atnight and disposable briefs or diapersduring the day. The number of changesrequired ranged from 1-2 changes per24 hour period to as high as 9-10changes. Thirty-six of the 87 patients,41%, were changed 7-8 times per day.Colorado law requires that the patientbe changed every two hours, if necessary.

Questions related to generalhealth revealed that pressure soresand skin irritation on the lower torso

did occur in some patients, but werenot considered a serious problem.Most patients required assistancein dressing and toileting activities.Since patient attitudes are importantfactors in the study, the caregiverswere asked to describe and rate thepatient's general attitude towardthe products used in managing theirincontinence. Fifty percent of thepatients were identified by the caregivers

as not sufficiently alert and/orcognizant to be able to evaluatethe products. A common responsewas that the patient is in a generalstate of confusion. To ascertainthe patient's level of activity,a question was asked about participation

in nursing home activities as wellas activities outside the home.Outside activities were limited inmany instances, which may or maynot have been related to the patient'sincontinence.

Table 1 shows the products inuse by the 87 patients. Only theATTENDS brief, reusable bed pad andthe POLY GUARD 11 disposable bedpad were used by large enough numbersof patients to justify further analysis.

TABLE I

PRODUCTS IN USE WITH 87 FEMALE

NURSING HOME PATIENTS IN FOUR INSTITUTIONS

Products NO YES

Tnanquktay Pad

Attend6 Brief

Attend:6 Pad

Reusable Bed pada

Poty Gaud II Disposable Pad

Kotex Pad

86

24

81

55

75

81

61

6

12

11

a various tradenames were beint used

Table 2 shows the product eval uation

for the ATTENDS brief which was usedby 63 of the 87 patients. Generally

44

Discove '84 Technology for Disabled Persons 33

the ATTENDS brief was evaluated as"good." The evaluation of urine retentionwas most varied. It received a largernumber of "excellent" and "poors"than the other criteria. It is notknown what products have been usedin the past that may have served asa basis for comparison by the cargivers.

TABLE 2

PRODUCT EVALUATION OF ATTENDS BRIEF

USED BY 63 OF 87 PATIENTS

Criteria Poor Flair Good Excellent

Ease of Application 6 19 33 s

Ease of Removal 2 18 38 5

Odor Containment 0 8 52 3

Maintenance of Skin 2 12 42 7

Urine Retention 7 11 31 14

Overall Aesthetics 2 10 48 3

Comfort to Patient 3 10 47 3

Totals 22 88 271 40

While the ATTENDS brief was anacceptable management alternativefor 63 incontinent women in four FortColl ins nursing homes, caregiversstated that for certain mobile andactive residents, a reusable productmight be a desirable alternative.Many of these patients preferred toselect and use products which theycould care for themselves. One ladywas observed laundering the disposableproducts she had been using. Severalwomen were aware that the disposableproducts were adding non-recoverablecosts to their care.

Research in Progress

A pilot study to compare themerits of disposable and reusableproducts was undertaken. To date.,five women have participated. Thewomen were each shown a collectionof currently available reusable anddisposable products and asked to select

products or indicate product featuresthey felt would meet their needs.Products were then purchased or prototypes

constructed for each woman. Concurrentlythe women were asked to identifyand weigh the criteria used in theselection of products for the managementof incontinence. Such criteria asappearance, comfort, maintenance,cost, odor containment, and absorbency.vere listed. A wear schedule fortwo or more products was then estab-lished. After a trial wear period,the researcher, patient and/or caregiver

were asked to evaluate the performanceof each product based on the predeterminedcriteria. The performance for eachproduct worn was then measured byassigning values to the selectioncriteria and performance rating usinga system reported by Smith and Block(1982). While the results of thesewear studies have not been analyzed,the product, source, and 1984 costfor each item are listed by type(see Appendix). They have been grouped

by purpose according to manufacturer'ssuggested use. More products arelisted than have been evaluated todate.

Summary

The ongoing research of Dallasand Wilson has focused on the incidenceof incontinence among elderly womenin nursing homes, satisfaction withcurrent practices in the managementof incontinence, new developmentsin disposable and reusable products,and the evaluation of satisfactionwith current practices from the patient's

viewpoint. The ultimate goal is

to inform consumers who are managingthis problem. It is assumed thatconsumers should not be 1 imited tothe use of only disposables or onlyreusabl es, but should be able tochoose the right combination of featuresto provide individual solutions.

REFERENCES

Beeber, C. R. (1980, March). Freedom


for the incontinent. AmericanJournal of Nursing, 80 (3), 483-484.

Dallas, M. J. & Wilson, P.A. (1981).

Panty design alternatives for womenand girls with physical disabilities.Home Economics Research Journal,9 (4), 336-346.

Chink°, K. M. (1983, September 15).Institute gets to bottom of cottondiaper merits. Daily News Record,11.

Pacific News Service. (1983), February

18). Disposable diapers big business,big headaches. The Collegian, 11.

. (1981) Researchon urinary incontinence in theelderly. National Institute onAging, Catalog of Federal DomesticAssistance (number 13-866, AgingResearch .

Smith, B. F. & Block, I. (1982).Textiles in Perspective. NewJersey: Prentice-Hall.

Appendix

INcoNTENENcz PRODUCTS

TYPE/TRAMIAM DESCRIPTION MANUFACTURER PRICEa RETAIL OUTLET OROTHER SOURCE

STRESSb RwATED

A. Liners1. Depend Shield

2. Sears Dispos-able LinersRegular

3. Sears PlasticBack ReusableLiner

4. Attends PantyLiner

5. Dri-PrideContent II

Fads

6. Dri -Pride

Content IIwith adhesivestrip

7. Dd.-PrideContent Pads

B. Briefs1. Depend Under-

garment

2. Attends

Disposable pantyliner with ad-hesivE strips

Adheres to pantiesor brief

Snap in liningused with Searsbrief

Disposable liner.Adheres to panties

Disposable pad withvinyl backing

Disposable padwith vinyl back-ing

Disposable

Disposable open

side brief withreusable elasticstrap and buttons

Disposable inconti-nent brief

Kimberly-Clark Corp.Neenah, WI 54956

Sears, Roebuck & Co.Chicago, IL 60684

Sears, Rcabuck & Co.

Procter & GambleCincinnati, OH 45202

Dri-Pride Division-Weyerhaeuser Corp.Freemont, MI 49412

Dri -Pride

Dri -Pride

Kimberly-Clark

Procter & Gamble

46

Reg. size12/$2.49

Reg. size Sears50/$8.49

$7.99 Sears

$.50 er Institutionalsupplier

96/$17.50 Sales rep.

96/$21.75 Sales rep.

Med. size Sales rep.96/314.95

Reg. size3015.49

SearsPharmaciesDiscount stores

SearsPharmaciesDiscount stores

Sm.-12/$5.99 SearsMed.-1,/$7.49 PharmaciesLg.-12 $10.99


TYPE/TRADENAVE DESCRIPTION MANUFACTURER PRICEa RETAIL OUTLET OROTHER SOURCE

b. Briefs (cont.)

3. Sears Inconti-nent Brief.Used with

100% polyester knitdrop-front and snapup sides or pull-on

Sears, Roebuck & Co. $10.00 1 Sears

Liners A.2,3

4. Mesh StretchBrief - Usedwith liners

Reusable briefof nylon elastic

Sears, Roebuck & Co. 3/$4.99 Sears

A.2

5. Sears RibbedKnit Brief

Reusable brief of

nylon and spandexSears, Roebuck & Co. 3/$5.99 Sears

Used with

Liners A.2

6. Tranquility Brief-reusable Principle Business Starter sett PharmaciesBrief and Pad Pad-disposable Enterprise, Inc. 1 brief &

Dunbridge, OH 43414 5 pads/$12.00Brief-$8.99 1Pads -25/$12.99

7. Futuro Patient Reusable plastic Division of Jung Starter sett Pharmacies

Aids pant; disposableliner

Products, Inc.Cincinnati, OH

$17.92Pant-$8.90 9

45202 Liner-25/$11.02

8. Dignity Reusable cottonbrief; disposablepad

unavailable Starter se44

1 brief5 pads ,14.95

Pharmacies

Pads-25 $9.86

9. Sears Pant &Liner

Reusable pant-100%tricot; disposableliner with Super-

Sear, Roebuck & Co. Pant-$4.99Liners-25/t6.49

Sears

Sober adheres topant

10. Dri-Pride100° cottonrant aryl Pad

Reusable pant withdrop front andsnap-up sides;disposable pad

Dri-Pride Pant-$8.50Med. size pads-72/$22.95

Sales rep.

11. Dri-PrideContent Pants

Reusable pant usedwith liners A.5,6,7

Dri -Pride Pant-$7.50 Sales rep.

****4.44.4*4-04444**446441-**WW********44**************44**444W*WW****-WWWW*WW******4w*******************40.4*m4

UREc RELATED

C. Liners1. Depend Shields Disposable panty Kimberly-Clark Super- Sears

liner with adhe-sive stripe

12/$4.99 PharmaciesDiscount. stores

2. Sears Dispos-able liner

Super-Sober poly-mer; adheres tobrief

Sear, Roebuck & Co. 25/$6.99 Sears

3. Attend PantyLiner

Disposable lineradheres to panty

Procter & Gamble $.50 9. Institutionalsupplier

4. Sears Plastic-Back ReusableLining

Snap in liningused with Searsbrief

Sears, Roebuck & Co. $7.99 T Sears

4

P


TYPE/TRADENAME DESCRIPTION MANUFACTURER PRICEa RETAIL OUTLET OROTHER SOURCE

C. Liners (cont.)

5. Dri-PrideContent Pad

D. Briefs1. Sears Inconti-

nent BriefUsed with A.2,3C.2,4

2. Sears BestIncontinentPrief

3. resh StretchBriefUsed with C.2

4. Sears RibbedKnit Brief

5. Kanga Inconti-nence Pantsand Pad

6. Depends Under-

garments

7. Attends Brisis

8. Dri-Pride

Content Pant

9. Dri -}ride 100%

Cotton Pants/Pad

10. Dri-brideVinyl It

11. Dundee Reusable

IncontinentBrief

Disposable pad;holds up to850 c.c. urine

100% polyester knitwith drop-front,

snap-up side orpull on

100% nylon tricot -

vinyl coated,cotton flannellining; dropfront with snap-u?sides or pull on.Used with C.4

Reusable brief ofnylon elastic

Reusable briefof nylon andspandex; usedwith C.2

Reusable pant withdrop-front andVelcro closureand disposablepad

Disposable openside brief

Disposable briefs

Reusable pant;used with linerC.5

Reusable pant;drop-front andsnap-up side;

disposable pad

Reusable pant

Reusable brief-100% cotton,Absorba-fil &Barigard; drop-front and snap-upclosure

Dri-Pride

Sear, Roebuck & Co.

Sears, Roebuck & Co.

Sears, Roebuck & Co.

Sear, Roebuck & Co.

Kanga HospitalProducts Ltd.P. O. Box 39Belmont RoadBolton, BL7, 9QN

Kimberly -Clark

Procter & Gamble

Dri-Pride

Dri-Pride

Dri -Pride

Dundee Mills, Inc.111 West 40th St.New York, NY 10018

48

Heavy-96/$25.50

$10.99 9.

$15.99

3/$4.99

$3/5.99

Pant-2/$5.54Pad-lpkg/$5.40

Super-30/$18.99

Sm. -12/$5.99

Med. -1,/$7.49

Lg.-12 $10.99

Pant -$7.50

Pant-$8.50Heavy pad-

72/$25.50

Pant-$8.00

Sm.-$13.00Med.-$15.25Lg.-$17.85

Sales rep.

Sears

Sears

Sears

Sears

Home nursing SupplyHeadquarters RoadWest Wilts TradingEstate

Westburg, WiltsEngland

Sears

PharmaciesDiscount stores

Sears

Pharmacies

Sales rep.

Sales rep.

Sales rep.

Institutional

sales rep.


TYPE/ThADblIAIE DESCRIPTION MANUFACTURER PRIC.Ea RETAIL OUTLET OROTHER SOURCE

D. Briefs (cont.)

12. UnigardIncontinentPants

E. Diapers1. Sears Disposable

IncontinentPants

2. Sears Incont'.-

nent Brief

3. Sears AdultDiapers with

Absorba-fil

4. Amboes AdultDiapers

5. Uri -Pride Adult

Diaper

6. Dundee AdultContainmentFads

7 Dundee AdultSnap Contain-ment Pads

8. Unigard Inconti-nent Pads

Disposable pant;

drop-front andsnap-up closure

Super-Sober;adhesive tabs

Disposable briefwith elastic legs;adhesive tabs

Reusable diaper;Bari -gard backing

Disposable;adhesive tabs

Disposable diaperopen sides,

reusable tapeclosures

Reusable diaper;100% cotton;Absorba-fil andBari-gard

Reusable diaper;elastic waist back;

snap-up closure

Medical-Surgical Div. unavailable

Parke Davis & Co.Detroit, MI 48232

Sears, Roebuck & Co. 10/$5.99



unavailable 1011.00

Dri-Pride Sm.-96/$39.50Med.-96/$43.50

Ig.-96/$47,50

Dundee Mills

Dundee Mills

Disposable Parke, Davis & Co.

$8.00 a

$8.00 4

unavailable

Sales rep.

Sears

Sears

Sears

Pharmacies

Sales rep.

Sales rep.

Sales rep.

Sales rep.

a Prices may vary from outlet to outlet.

b Stress incontinence is termed as an occasional discharge in small quantities caused by activities

that stretch lower abdominal muscles and put pressure on the bladder such as coughing, laughing,

stooping or sneezing.

c Urge incontinence is an involuntary emptying of bladder with or without warning. This type of inconti-

nence may occur several times a day or night and is generally associated with nerve or phybical

impairment.

49

REAL TIME / REAL BEHAVIORUSING A MICROCOMPUTER FOR EVALUATION AND TRAINING

CHARLES H. SANTEE

ABS1RACT

This presentation emphasizesthe need for the inclusion of an evaluation

mode in most, if not all, instructionalsoftware. It points out the computer'srole in simplifying the visual observationof behavior in an instructional setting.The author presents a series of programsshowing the development of more sophis-ticated evaluation techniques. Thepresentation focuses on two piecesof software. The first software programused to map and reinforce motor patterns

for physically handicapped persons.The second program was designed tosimplify observation in any instructional

setting, and to assist in recordingthe frequency and duration of up to60 simultaneous events.

Recording the observation ofbendvior can be an error prone ativity.Observation of certain types of behaviorcan be extremely difficult, if notimpossible. The author demonstratedthe development of two programs; developed,

hoi.efully, to adv.nce the scienceof measurement by the applicationof microcomputer technology.

Observation Station

Observation Station is a micro-computer program designed to assistin the recording of direct visualobservation of behaviors. The programuser can define up to twelve individualsand up to 6 different behaviors (or

if desired up to 72 individual events).The file of behaviors and individualscan be saved on disk for future use.At the cross section of the matrixof individuals anti events shown onthe video screen is a character.This character (or key) is pressedon the keyboard to indicate thatthe behavior described fur that individual

has been initiated. The characteris pressed once again when the behaviorhas terminated. The computer recordsthe beginning and ending time ofthe behavior. The operation of thisprogram is similar to those of 72individual stop watches recordingobservations. After the instructoror observer terminates an observationperiod, they can call up a writtenreport of the following information:I. The frequency of each behavioral

episode.2. The average duration of behavioral

episodes across the observationperiod.

3. An adjusted frequency count whichwould estimate the expected frequencyof occurrence for a standard timeperiod. (i.e., how many timesmight the behavior be expectedto occur in an hours period.

4. The average frequency and durationfor one behavior across individuals.

5. The average frequency and durationfor one individual across all

behaviors.

In addition, the program allows thecontrol of recorded or synthesizedsound or music as a medium of reinfor-

50


THIS OBSERVATION BEGAN AT 00:00:00

THIS OBSERVATION ENDED AT 00:02:20

THE OBSERVATION LASTED

NAME MEASURE

140 SECONDS

BEHAVIORS

TALKING EYE CON AVERA

ABLE count 5 2

adj. count 128.57 51.43 90.00

duration 10.60 13.50 12.05

BAKER count 4 3

adj. count 102.86 77.14 90.00

duration 8.50 7.33 7.92

CHARLIE count 3 1

adj. count 77.14 25.71 51.43

duration 8.00 22.00 15.00

AVrRAGE adj, counr 102.06 51.43

AVERAGE duration 9.03 14.28

cement while the observation is takingplace. Through a "Plug'n'Power" device,

electrical apparatus in the externalenvironment can be used as potential

sources of reinforcement.

MOVERMovement Mapping and Diagnosis

This software allows the creationof a visual map of the subject's movementthrough space. The individual is

attached to a joystick with a piece

of elastic. The software allows theuser to create any desired patternas a target for movement training.It can be used to evaluate the motionof individuals performing meaningfultasks in sheltered workshop settingssuch as bench assembly. The printoutincludes the number and percentageof "hits" to a designated pattern,if desired. An additional statistic

is the average amount of movementthat occurs within regularly sampledintervals. This provides a highlyprecise measure of the speed and accuracyof individual movement for any specified

movement pattern_

Conclusion

These two programs briefly highlightsome unique measurement applications,the untapped potential of the microcom-puter as a tool for assisting inexisting measurement, and the expandinguse and role of measurement intonew areas. Some of the programsdeveloped by this author may be reviewed

in a column the author writes ona monthly basis titled "The EducatedGuest" in "Hot Co Co," a computermagazine written for the Radio ShackColor Computer. The program "ObservationStation" was created by the authorto run on the Radio Shack Color Computer,

The Radio Shack Model III or IV. and

the IBM - PC. For further information

on this program write:

Dr. Charles H. Santee8 S 045 GrantWestmont, IL 60559

REFERENCES

Santee, C. H. (Dec. 1983 - October1984) The Educated Guest (a columnon educational computing), HotCo Co, Peterborough, New Hampshire.

51

A COMMUNICATION SYSTEM FOR THENON-VOCAL PHYSICALLY IMPAIRED PERSON

HOWARD LAMBERT

ABSTRACT

The program WRITEIT/SAYIT isa communication aid for non-vocalpersons who cannot operate a typewriterkeyboard. To use WRITEIT/SAYIT, onemust be able to activate any one offour switches corresponding to theinputs 0, 1, 2 and E(enter). (SeeSystem Requirements" below.) Letters,numbers, punctuation, words, and wholesente-Ines of the operator's own devisingmay be selected using these four inputs.These selections are remembered bythe computer and spoken by the voicesynthesizer. Also, WRITEIT/SAYITcan be used to learn how to read sincethe selections can be repeatedly displayed

on the screen and spoken by the voicesynthesizer.

Operation

When the program WRITEIT/SAYITis started, the operator is askedif instructions are needed. If theyare, the following instructions areprinted on the screen and spokenby the voice synthesizer:

Remember, when you are mostanywhere in the program selectE for next page or to continue.

Select 0 and E to return tothe main menu.

Select 0 0 and E to have choicesspoken. (The current screenfulof possible choices will be

spoken by the voice synthesizer.)

Select 0 0 0 and E to removeyour last choice.

To make a choice, select thenumbers next to what you wantfollowed by pressing E.

The following main menu willthen appear on the screen:

1 = YOUR STORAGE SPACE2 = WORDS

10 = LETTERS OF THE ALPHABET11 = NUMBERS AND PUNCTUATION12 = UTILITIES

Item Selectiwi

Each possible choice is listedtogether with its corresponding codenumber. Iii order to select an item,the operator selects the keys thatcorrespond to the item's code numberfollowed by selecting E(enter).For each activation of the 0, 1 or2 key, the corresponding numr is

52

Discovery '84

stated by the voice synthesizer.The fifth key is a backspace, butthe operator may remove an incorrectchoice of a code number by addingany choice of numbers until the wholenumber starts over agair (no codenumber is larger than three digits).By pressing 0, 0 and E, each screenfulof choices will be spoken by the voicesynthesizer. Each section of theprogram that the operator enters is

identified by the voice synthesizerand all of the operator's selectionsare displayed and spoken.

Available Selections

The operator's own choices arein YOUR STORAGE SPACE (select 1 and

E from the main menu). In the WORDSsection (select 2 and E from the mainmenu) there is a basic word list ofapproximately 300 words and an extendedword list of approximately 2700 words.(The selection of a word is basedon knowing the first letter of theword in the basic word list sectionand knowing the first two lettersof the word in the extended word listsection.) The letters of the alphabetare in LETTERS OF THE ALPHABET (select1, 0 and E from the main menu) andnumbers, punctuation and other symbolsare in NUMBERS & PUNCTUATION (select1, 1 and E from the main menu). The

UTILITIES section (select 1, 2 andE from the main menu) enables theoperator to start over, print outhis or her choices (obtain a hardcopy); switch between the basic wordlist and the extended word list andto add or remove items frcm YOUR STORAGESPACE.

Example

Suppose the operator wants to

write the following message:

MY ADDRESS IS 108 OAK ST.

Step 1 Clear everything that hasbeen selected so far and changeto the extended word list

Technology for Disabled Persons 41

if necessary.

Step 2 Go to WORDS and select MY,ADDRESS and IS then returnto the main menu.

Step 3 Go to NUMBERS & PUNCTUATION,select ; blank space, thenselect 1, 0, 8 and a blankspace. Return to the mainmenu.

Step 4 Go to LETTERS OF THE ALPHABETand select 0, A, K, a blankspace, S and T. Return tothe main menu.

Step 5 Go to NUMBERS & PUNCTUATIONand select the period. Return

to the main menu.

If desired, the operator maynow save this selection as one itemin YOUR STORAGE SPACE. Th. operatormay also want to practice seeingand hearing MY ADDRESS IS 108 OAkST. This can be done by repeatedlyactivating the E key from the mainmenu.

Changing Files from the Computer'sKeyboard

Using the computer's keyboarddirectly, another program calledCHANGE (on the same diskette asWRITEIT/SAYIT) allows a helper toadd or remove items from YOUR STORAGESPACE and the basic or extended wordlists.

System Requirements

The system demonstrated consistsof the following components:

1. Radio Shack color computerwith 64K of memory and extendedBASIC.

2. One disk drive.3. VOTRAX voice synthesizer.4. Radio Shack TP-10 printer.5. Comrex Monitor.6. Modified Prentke Romich special

5 key keyboard. (The modification

is to allow the keyboardto plug into the right joystickport on the color computer.)

In general , the special 4 (or

53


5) key keyboard may be any devicethat inputs a different voltage tothe right joystick port for each keyactivation.

The total cost of this systemwas approximately $1,600.

Summary

WRITEIT/SAYIT is already beingused successfully by several cerebral

palsy victims who cannot speak andcannot operate an ordinary typewriterkeyboard. Also, one of the victimscannot read, but since most of WRITE-IT/SAYIT is spoken by the voice syn-thesizer, she is using the programto learn this skill too.

54

USER ACCEPTANCE OF A ROBOTIC ARM

MARGO K. APOSTOLOS

ABSTRACT

The purpose of this study isto explore user acceptance of a roboticarm. The focus of this project wasan assessment of attitudinal changesof selected quadriplegics in responseto the presentation of two orientationprograms on the use of robotic arms.One program included a discussionof aesthetic sequences of roboticmovement, industrial design, and kineticart. The other program in contrast,presented the 'standard' introductionto the robotic arm which involvedutilitarian sequences of robotic movement.

This study used an industrialrobotic arm. This manipulator aidhas been programmed for use by quadri-plegics as a personal assistant ina rehabilitative setting. Thus, thepotential users of this study aredisabled individuals.

The whole study is a series ofinvestigations of the hypothesis thataesthetic movement of a robotic armcan affect an individual's attitudetoward the acceptance and use of robots.The aim of the project is to developa positive relation between man andmachine. This exploratory researchis being conducted in collaborationwith the Rehabilitation Research andDevelopment Center of the Veteran'sAdministration Hospital of Palo Alto.

Introduction

An increase in the number anduses of working robots has presentedthe problem of user apprehensionand possible anxiety in relationto these mechanical instruments.Apprehension and anxiety are factorswhich contribute to the significanceof this study of user acceptanceof robotic arms. Investigationof consumer reaction and user acceptance

of everyday utilitarian productshas been the work of industrial de-

signers. The work in this fieldmerges art and technol ogy, as demonstrated

through the relationship of utilityand appearance in the design of commonlyused products. The Bauhaus Schoolof Design had a tremendous impacton industrial design, art, and archi-tecture. At the Bauhaus, artistsand engineers worked together todemonstrate a unity of art and technology

through the visualization and experimen-tation of design from both aestheticand utilitarian aspects. Kineticart, as an outgrowth of the Bauhaus,represents the effect of scientificand technological progress ina creative

and abstract sense. The works ofkinetic art are symbolic representations

of the unity of art and technology.

An aesthetic orientation programhas been developed to sensitize potential

users of the robotic arm. The aestheticssession will feature a visual displayillustrating the evolution of robots,the products of industrial design,the influence of the Bauhaus, andworks of kinetic art.

The Robotic Ann

This study will investigatethe movement of an industrial roboticarm, also referred to as a roboticmanipulator aid. The robotic arm

55


used in this study is located at theRehabilitation Research and Devel-opment Center at the Veteran's Adminis-tration Medical Center in Palo Alto,California. This system is an industrialmanipulator-PUMA 250 by Unimationwith six degrees of freedom. Thesystem is operated in Val driven by

a Z-80 based zilog micro-computersystem which also recognizes voicecommand and hand control (joystick).

The robotic arm consists of ashoulder, arm, wrist, and hand (inter-changeable grippers) with a minimumof three articulations:

1) extend and retract2) swing and rotate3) elevate and depress

The wrist has increased range of movementwith the ability to bend, roll, spin,and swivel. The arm has three pathsof motion and three of the wrist whichprovide a total of six degrees offreedom. The robotic arm is characterizedby the ability to perform with repeatability, reliability, high speed perfor-mance, precision, and accuracy. For

this study, the robot arm will remainmounted to a stationary tabletop base,although a mobile base is available.

Rehabilitative Robotics

file idea of a personal robothas been applied in a medical, rehabili-tative setting. Dr. Larry Leiferof the Rehabilitation Research andDevelopment Center and Professor ofMechanical Engineering at StanfordUniversity has identified the applicationof advanced robotic technology forseverely disabled persons in:

1) activities of daily life(eating/hygiene)

2) personal clerical tasks3) vocational tasks4) recreation

Dr. Leifer (Leifer, 1981) has usedthe robotic arm in a rehabilitativesetting to give the severely disabledperson more direct control of personalspace and a greater feeling of indepen-dence.

The purpose of using a robotic

arm to assist the disabled is based

on the idea of replacing the functionof the missing limb and not its anatomy:

Thus, the robot is not to be confusedwith a prosthetic device. The roboticmanipulator aid has been an experimentaldevice used with quadriplegic patients.Quadripegia, the paralysis of fourlimbs, impairs the individual's abilityto manipulate. This condition isa typical result of traumatic spinalcord injury with damage to the cerebralcortex, which controls the hand/armfunction. The individual is withoutsensation and muscle control in thetorso and legs and with little musclecontrol or sensation in the arms.Leifer reports that the higher brainstem controls are usually not damagedfrom the paralyzing injury and thequadriplegic is generally withoutimpaired mental functions. Severelydisabled persons may ue physicallyimpaired but mentally alert; thus,the use of an advanced technologicalinstrument appears to be a feasibleal ternative.

The man/machine interface is

of paramount concern in adaptingthe robotic arm by the quadriplegicpatient as a personal assistant.The robot must be viewed as a helpfulinstrument rather than a harmfulthreat. Leifer reports, "The usefulnessof artificial limbs had been limitedmainly by inadequate sensory feedback.Movements performed without sensoryfeedback are awkward. Visual feedbackof gross limb displacement is not

as easy to manage as kinestheticfeedback." The visual feedback fatiguesthe user because of the constantattention level (Leifer, 1981).

Leifer also states, As the

robot processes human input, theinformation transfer between manand machine must be carefully managed.Every physical disability reducedour capacity to transmit, receive,or process information. Therefore,we should have the user specificgoals, the system attempt to achievethese goals, and the user supervisethe system's operation" (Leifer,

56


1981). The robotic arm as a personalassistant to the quadriplegic is controlled

by the patient through a voice controlmode. The OMNI Book of Com utersand Robots reported,17N7 fiFst ouse o drobots may al so debut as caretakersfor invalids. Unimation, workingwith researchers at Stanford University,

is attempting to modify a Puma robotto understand simple spoken commandsto aid paraplegics" (Davies, 1982).

The use of the robotic arm asa personal assistant has a significantrole in establishing an independentliving environment. Attendant carefor the physically disabled is anarea of concern (Crewe, 1983):

personal care is one of thefirst areas of human activityin which an individual learnsto become ine,ependent . Yetit is still one of the lastareas in which a severely physically

disabled individual can becomefully independent. To be dependentin the care of one's own bodyis to renounce much of one'spersonal autonomy. To manageone' s own personal care is to

reclaim one's sense of worth.

Barbara Angius of the Rehabil i tati on

Research and Development Center hasreported, "Recreation tasks providea challenging and motivating way toredevelop skills and provide leisureactivities for the disabled person.Devising creative robotic applicationsfor recreation will be among the majorobjectives in the future researchand evaluation of the robotic manipulatorfor the severely disabled" (Angius,1983). Angius describes specificrecreational tasks targeted for userapplication as the control of boardGames , painting, video games, anddance choreography.

This case study features dancechoreography fof a robotic arm aspart of an experimental treatmentprogram in the attitude assessmentstudy. Choreography, as demonstratedthrough aesthetic sequences of the

robotic arm may enhance creativediscovery in a non- utilitarian sense.

The aesthetic characteristicsof the movement will be identifiedby defining various criteria of theaesthetic patterns of movement.The identification of these aestheticcharacteristics of robotic movementis largely a subjective appraisal.While specific criteria have notbeen established to determine theaesthetics of robotic movement, thisstudy is based on differentiatinga practical utilitarian approachand a non-practical choreographicapproach in introductory sessionsfor use of the robotic arm. Theuse of a robotic arm to perform utili-tarian tasks as designated by specificcomputer programs is common. The'work' of the robot is often demonstrated

by the efficient, staccato type movement

sequences which are devised froman aspect of efficiency rather thanan immediate aesthetic appeal. Roboticmovement that is designed to be funct-ionally efficient is not always aesthe-tically pleasing.

As part of this project an attemptwas made to present aesthetic movementof a robotic arm, in the form ofchoreographed sequences of roboticmovement synchronized with music.The mechanical features of the staccatoaction of the robotic arm are contrastedwith "aesthetic" maneuvers. Theaesthetic features a more sustainedeffort in the actions, smoother tran-sitions from point to point, morecurved lines replacing many of thestraight and sharp angular motions,and a varied sequence in the timingof movement sequences to break upthe constant speed characteristicof the practical patterns of movement.The aesthetic maneuvers explore therelated movement el ements of theaction quality, flow, shape, andtiming in various movement phrases.

In this project, the integrationof the sounds of music, the formsof sculpture, and motions of dancewas sought. The choreography ofsynchronized robotic movement has

5'7


been devel oped as part of the experimental

aesthetic orientation session anddemonstrates the aesthetic dimensionof the robotic manipulator aid. Chore-

ography, the art of making dances,uses dance as a series of rhythmicmotions in time and space to expressideas through movement. Dance andchoreography suggest direct humaninvolvement in the programming ofmovement sequences for the robot;however, a "dancing" robot and robotic"choreography" may be used only asa metaphor. The choreography fora robotic arm combines the logicalapproach of science with the sensuousapproach of art in a blend of artistic -

scientific creativity.The idea of "de-humanized dance"

is not entirely foreign; the 1960works of American choregrapher AlwinNi kolais were based on this concept.The Nikolais dancers moved in mechanicalimagery, virtually stripped of theirhuman identity through technical effects.The dancers were manipulated throughspace and time by the control s ofthis master choreographer. The ideaof computerized choreography can be

compared with the notion of "chancedesign" in dance as demonstrated bythe collaborative efforts of choreo-grapher Merce Cunningham andcomposer/musician John Cage. TheCunningham/Cage style has influencedthe experimentation of computerizeddance choreography.

Experimental Design

Overview

This study examines the effectsof two orientation programs on potential

users of a robotic arm: one basedon the currently used conventionallecture and another based on an aesthetic

approach added as a supplement tothe conventional program. The investi-gation is being conducted in collaboration

with the Rehabilitation Research andDevelopment Center of the Palo AltoVeteran's Administration Hospital.The purpose of this study is to assess

user acceptance of a robotic manipulator

aid.The hypothesis of this study

is that the aesthetic orientation,based on a visual presentation whichfeatures the principles of industrialdesign, the Bauhaus, kinetic art,and synchronized robotic movementwill improve the impact of the orientation

program by affecting individual attitudestoward the use and acceptance ofa robotic arm. Attitudinal change,

measured by a pretest and posttest,will reflect the effect of thesetwo orientation programs on the subjects

involved in the study.In Phase 1 of the study, the conven-

tional orientation session includedan introduction to the robotic manipulator

aid through a lecture based on thepractical and utilitarian aspectsof this device. The aesthetic orientationsession was based on a lecture, individ-ualized instruction, slide presentation,and videotaped segments designedto sensitize members of the groupto the robotic arm. Each sessionwas approximately thirty minutesin length. A follow-up study, Phase2, will explore the effect of theaesthetic orientation on the actualtraining program for use of the robotic

arm.

Two subjects are participatingin the training procedures for useof the robotic aid. Robotic choreographywill be attempted by trainees. These

subjects will actually attempt touse the arm in a simple aestheticperformance. A post-posttest willfollow the training and choreographysessions.

Interpretation of the Projected Findings

The results of this study shouldindicate whether an aesthetic orientation

to the robotic arm and follow-uppractice session, where the arm is

used to perform aesthetic movementsequences, can affect user acceptanceof this instrument. The aestheticorientation is not intended to replacethe conventional session but to expand

58


the scope for the introduction to Leifer, L. J. (1981). Rehabilitativethe robotic arm. An aesthetic approach robotics. Robotics Age, May/June,which includes a visual display, and 4-15.the actual choreographic trainingmay be valuable in improving attitudesgenerated in user acceptance and overcomingrobot anxiety.

Educational Irnpl i catiOn4

The robotic arm has been usedby quadriplegics in everyday settingsto gain an independent control oftheir living environment. The aestheticdimension of robotic movement canperhaps influence the adaptabilityof potential user acceptance of thisrobot.

The aesthetic implications mayexceed the impact of the attitudinalinfluences suggested by this study.The method (7 synchronized roboticmovement, as machine choreography,may be further developed as a formof creative expression for the physicallydisabled. While the artistic andtherapeutic values of this roboticinstrument and the subsequent methc,dof synchronized robotic movement havenot been established, the possibilityof extending the use of the roboticarm into an instrument of aestheticand creative channels must be pursued.

REFERENCES

Angius, B., Englehardt, K. G., & Leifer,L. J. (1983 June). Recreationalapplications of a robotic aid.6th Annual Conference on RehabilitationEngineering, San Diego, CA.

Apostolos, M. K. (1984). Exploringuser acceptance of a robotic arm: Amultidisciplinary case study.Stanford University School of Educa-tion.

Crewe, N. M., & Zola, I. K. and Associ-ates. (1983). Independent livingfor physically disabled peop e.rail Francisco, CA: Jossey-BassPublishers.

Davies, 0. (1981). The OMNI bookof computers and robots. New York:Kensington Publish-firgrorp.

59

STRATEGIES FOR A FUNCTIONAL URBAN PARATRANSIT SERVICE

ROBERT M. JIMENEZTHOMAS A. JORDAN

WILLIAM A. LAZAR, JR.DAVID J. SANCHEZ, JR.

ABSTRACT

San Francisco, like other urbancenters, has had many policy discussionconfrontations over adequate transpor-tation services for the disabled andthe elderly. Fragmented attemptsto provide services has failed becauseof inadequate training, faulty equipment,

escalating maintenance and servicecost and a failure of public institutionsto develop a comprehensive policyon access, use, and management. TheSanFranciscoPublicUtilitiesCommissionand the Police Commission initiateddiscussions on the perimeters of theseproblems.

In this limited study, the partici-pant-observer is a user of ParatransitServices and, thus, provides a uniquevision of the handicapped-travelerin San Francisco. In this study,the Luxor Paratransit Services providingtransportation services for the elderlyand handicapped through the Departmentof Community Medicine U.C.S.F., willbe reviewed. Planning continues toimprove overall service with specialfocus on hospital utilization, outpatientservices, and extramural activitiesthat enable the handicapped to participate

more fully in the enriched activitiesof San Francisco.

The paratransit program alsoreviews the training and capabilitiesof all staff, comprehensive routinemaintenance of all vehicles, and theuse of two-way radios with back-upfrom emergency units.

The program's major barrier islimited resources for meeting theneeds of the great numbers of handicapped

and elderly citizens who now requirethese services. Continued expansionof these services will elicit collabor-

ative strategies; strategies initially,undertaken to provide the highestdegree of accountability, sensitivityto the unique needs of handicappedand elderly persons and safety, andconvenience.

Some recommendations are: auniform survey of the handicappedpopulation, a demand drivers systembased on defined standards of serviceand reliability, a ComprehensiveTraining and Screening program withnational standards for drivers, useof a simplified dispatch system basedon direct communication, and theformulation of a nationwide para-transit broker network with a toll-free800 number.

San Francisco: The Setting

San Francisco travel ers enjoyseveral transit advantages. It is

a compact 49 square miles, nestledon the ti p of a peninsula no morethat seven miles on each side. It

has a moderate climate, kept withina few degrees of cozy sixty-to-eightydegree temperature by the warm PacificOcean; this makes the outdoors enticing.

Sweltering heat and freezing col dare almost unknown. A visitor tothis city may be uncomfortable ifunprepared for the fog; it can be

chilly to people in sun shorts, butquite normal to those accustomedto its regularity. It rains in thewinter when San Franciscans thinkit should. Annual precipitationis about 22 inches.

The public transporation systemis inexpensive and reliable, runningon a twenty-minute schedule; it is

convenient to the able-bodied traveler,providing a network of cross-connections

60


throughout the city. Distances areso abbreviated that the annual cross-city"Bay-to-Breakers race, from the FerryBuilding on the waterfront to thecity's beach by the Pacific Ocean,has perennially attracted thousandsof runners. Last year an estimated80,000 hardy runners made the course.

San Francisco's hilly terrainis a major disadvantage to travel.Providing lofty views of all the BayArea, and creating a scenic backdropto local sights, San Francisco's manysteep, precipitous streets wreak havocon brake linings, gas mileage, andthe short-winded pedestrian.

Problems for the Disabled

For the estimated 80,000 disabledcitizens in wheelchairs, on crutches,and using canes, the city's ruggedhills make it impossible in some areas,to traverse the two or three blockdistance to the nearest bus stop.

Public municipal transportation,with modern wheelchair lifts and comput-erized schedules, claims to providemass transit for everyone's needs.However, it overlooks the disabledperson unable to get to the bus stop,or, as in so many cases, is unableto go from the bus stop to the hospitalclinic, bank, or store. The peoplehaving the greatest need for adequatemobility, thus have gone without untilthe governing fathers put aside debatesabout cost-effectiveness, "the greatestpublic good," and other limited ideas,and considered the plight of the disabledtraveler.

"How," they might ask themselves,"does a person on crutches walk downhill

without falling breaking his nose?"And, "what if someone's wheelchairloses its brakes and crashes downhillinto a tree,...or veers into the pathof an oncoming vehicle?"

Accessibility Needs of the Disabled

The issue is clear. San Franciscois a beautiful city, worth enjoying.

There are 35 legitimate theaters,6 cabarets, 8 night clubs, a dozensymphony, opera, and ballet auditoriums,

and 31 downtown movie theaters (50

more in the neighborhoods). Threeferry boats run to Marin County,Angel Island, and Alcatraz. Thereare more than eight municipal piersfrom which to fish. Outdoor concertscan be held almost anywhere, fromGolden Gate Park to Aquatic Parkto Candlestick Park. At Candlestick,in season, can be seen the sometimeschampion Forty-Niners and Giants.The city has five commercial televisionstations and one PBS station; all

welcome guests to their studio audience.

There are so many restaurants, itwould take years of every night diningbefore you needed to return to a

restaurant. The cuisine is as variedas the faces in a crowd: epicureanItalian or French cooking, Mexicanfood, Spanish food, Chinese, Japanese,or Vietnamese dishes. There is thefive-mile long, manmade Golden GatePark, with trees, plants, and flowersfrom all over the world; 19 museums,75 art galleries, 3 universities,and 8 colleges.

There is much to do in San Francisco,

and much reason for getting involved.Academicians from increasing disciplines

have stressed that immobilizationthru isolation may produce EEG abnorm-alities and widespread impairmentsof intellectual and perceptual processesin adult experimental subjects.This has important implications foradvocates of improved access by disabledpersons to the outside world. Nothingis gained by society or if disabledpersons stay home and vegetate.A stimulating environment activatesforces within disabled persons thatmay lead toward natural recovery.This holds promise for those whowish to return disabled persons toproductive, tax-paying lives in oursociety. It seems ohvious in a citywith the rich diversity of San Francisco,

that fulfilling this return to societylies in providing a viable paratransitservice for disabled citizens.

61


The Problem of Mobility on aLimited Budget

With such a beautiful city andbountiful activity devices it seemsthat anyone, including the long- neglected

disabled, would be highly motivatedto find access.

There seemed to be no viablealternative to mass transportationbecause of the difficulties cited.As the existing paratransit servicewas limited to medical visits only,the only alternative was taxi service.Only the affluent can afford to payfor this taxi travel, now costing$1.30 to enter the cab, and $1.20for every mile thereafter. At thisrate, a short trip downtown mightcost six or seven dollars.

Some disabled persons were veryclever in accessing transportation.They, frequently, joined the cityrecreation centers for handicappedpersons to receive the free ride to

the center. They then skipped thecenter's activities, bearded a cab,and went shopping in stores closerto the center than to their own homes,thus economizing on cab fare. Otherpeople used taxi scrip meant for medicalvisits, got off at the doctor's officenear shopping centers, and paid fora cab to go shopping. Since theyoften chose stores near the doctor'soffice, they paid a minimum in cabfare and realized a great savings.

A Limited Paratransit Van Service

A publicly supported van servicehas meanwhile appeared, seeming toanswer the needs of the disabled in

San Francisco. Sponsored by the cityand a subsection of a neighborhoodcommunity center, the vehicle wasequippedwitiatailgatelifttotransportpersons in wheelchairs. Supportedprimarily by federal funds, thesevan services were nearly free to disabled

riders, but had major limitations.1. The rider had to reserve their

ride several days in advance,and, therefore, could make

no last-minute changes in

plans;2. Passengers rode in groups.

They were picked up and droppedalong a prescribed route,so the riders had no assuranceofarrivingattheirdestinationon time. Any delays alongthe route accumulated, a

few minutes here, a few minutes

there, making any ride a

test of patience becausethe vans ran so agonizinglyfar behind schedule;

3. The vans were very old andhad seen many miles beforebeing converted to paratransituse with a bubble top anda wheelchair lift. Breakdowns

plagued many because inadequatemaintenance had let the vansdeteriorate until they werewobbly, coughing hulks ofmetal sadly reflecting thelow esteem in which eightythousand disabled San Franciscans

were held, sitting on ripped-open

seats amidst choking fumes;4. No communications existed

between the vans and thedispatching office. A drivercould not report a breakdownor a delay. More importantly,they could not get help inan emergency;

5. The system was not cost effec-tive. Because of unreliableservice. Passengers usedthis means of paratransitless than the company hadanticipated; the budget ranin the red, and the citybecame Cssatisfied withits contracted service.

Improved Paratransit Van Service

As a result of inappropriateservices, the City's Public UtilitiesCommission and the Police Commissioninitiated discussions, public hearingsand Community Task Forces to betterdefine the acute needs of disabled

62


and senior citizens. Surveys, expansionofseniorEscortServices,andOrientationmeetings with Hospital OutpatientServices and Clinics, focused on thecontinuing problems of access, useservices and staff training. Thebasic issue remained: the lack ofa functienai paratransit van serviceto give the highest degree of accessand service nettlorking needed forthis unique population.

Luxor Paratransit Van Servicesbecame one provider to undertake thischallenge for San Francisco. ThisParatransit Van Service has threeyears to demonstrate that the problemscan be resolved. In its first year,Luxor is making an effort to avoidthe mistakes that made prior serviceunreliable. The vans they purchasedwere brand new, top of the line, andmade specifically for the job; nothinglike the broken down old nags usedin the past. Each van has a radiolink to the dispatcher, and easy patch-into police communications and emergencyservices. Since vans are large, rollingmetal ovens when subjected to thesun's hot rays, each van is equippedwith air conditioning. The interiorof the vans were carefully plannedfor comfort, giving special care tothe handicapped rider. Seating isprovided for three ambulatory pas-sengers, leaving three floor positionsfor wheelchairs. The passenger seatsare plush, soft, and comfortable,fitting the stereophonic sound fromthe van's radio. Comfort, reliability,and safety were of paramount importancein the selection of the vans. Theydid not come cheap. The new vanswere expensive, thus, Luxor startedwith four vans, far fewer than thesixteen, reconditional previous vans.Planning for improved service is basedon attracting more clients and addingto the number of trips per month,thus increasing revenue from the city.Four vans would be enough becausebreakdowns would not be a problemwith the rigid, preventative maintenanceprogram planned. Shop time wouldbe short, each van down for inspection

and service only minutes at a time.

Dents or scratches would be repairedand repainted immediately. No van

would appear on the streets lookingshabby, like the prior ones. Washing,waxing, and vacuuming of the vanswas to become as important as keepingthem supplied with gas, oil, andwater. The four vans, of the firstyear have now been expanded to a

fleet of seven, plus four reservevehicles.

Schedules are punctual and,because of a two-way radio, allowf3r last-minute changes and emergencies.

Now, a rider needs only to reservea day in advance, cpposed to thetwo-day requirement of the previouscontractor. Also, because of improvedscheduling, it is possible for a

client to be picked up or droppedoff anywhere in the city, at anytime, for whatever reason. A disabledperson, using this new system, isnow able to visit any of the previouslydetailed joys of the city; and theyneed not be lonely when going out,for Luxor Paratransit Van serviceallows a person to accompany thedisabled rider. This person doesnot need to be a paid attendant,but can be a date, a relative, ora spouse.

On a space available basis,a person can go on short notice.This brings the practical lead timedown to twelve hours. Emergencysituations can receive even fasterservice than the practical limit.

The key to this success is a

clear communication hookup betweendriver and dispatcher. The formercontractor's system used an order-takerto answer the phone, putting a bufferbetween the client and the dispatcher.This caused some agonizing delaysand some frustrating moments. Luxor's

system allows a quick yes or no responsedirectly from the dispatcher. Callersno longer hear the discouraging andtoo familiar "I'll let you know later,"often the equivalent of "no", becausethe caller frequently hung up in

disgust.

63


Selection and Training of Drivers

Luxor's paratransit van driversare chosen for their proven experienceand reputation as passenger carriers.As an added criterion, a prospectivedriver is sent on a run accompaniedby two of Luxor's regular van drivers.The driver's attentiveness to trafficand courtesy to passengers is evaluated.

After a basic orientation tothe company's goals, services andoperations, the new driver participatesin a Sensitivity Training Workshopconducted in two four-hour sessionsby a personable, recovered formerm.s. paraplegic who (as shown in Table2 Sensitivity Training Workshop) teachesbody language, facial expressions,and communication with deaf or learningdisabled persons. The training helpsthe driver think and feel like a disabledperson, Cl us able to anticipate manyneeds. Drivers are also taught tomaneuver the van as closely as possibleto the destination point, and to assistthe disabled person out of the vanand into the building, even carryingthe client if necessary.

The radio system provides excellentback-up by police, fire, public healthand marine services. Under this system,

a driver can respond to an emergencycall in which a disabled person is

stranded by a run-down wheelchairbattery or bent wheel, pick up thewheelchair, get it to the wheelchairshop for repairs, and return it,ready for use. This year, a frequentuser of this paratransit system,a spinal cord injured wheelchairpatient was NOTIFIED at home thather mother had been injured at theLaguna Honda Home (for the elderly)and was being taken to San FranciscoGeneral Hospital by Ambulance. The

daughter called the Luxor ParatransitDispatch, who in turn called thePolice Dispatcher and Hospital ServicesUnit. By the time the mother wasbrought by ambulance to the traumacenter her daughter had already arrivedby paratransit and she met her motherwith the trauma unit special team!

To maintain valid oversightLuxor requires drivers to be on timefor pickup 95% of the time or havetheir pay docked (Table 2). Users

of this service are encouraged tocontact the Chief Dispatcher of LuxorSystems, the Public Utilities Commission,

Director of Special Projects, orthe San Francisco Police Permit Unitregarding comments or concerns onthe quality of service.

PARATRANSIT DATA: July 1, 1933-June

Table 2

30, 1984

Contractor Cost lltrips shared

rides

11 lift -

assistedparticipants reported

reliability

A $266,225.84 45,603 45,603 950 100% 15 min

B 307,871.60 59,023 59,023 575 99.46%

Luxor Van 311,606.25 20,153 20,158 400 97%Srvice

624,223.04 135,852 21,690 1,365 65%

ToLdls $1,509,926.70 260,636 126,316 20,156 3,29t)

Broker 1)5,000.00Total 51,64'x,926.76

64


Service Cost and the DemandDrivers System

A sample sheet of statisticsfor August (Table 3) reports 1,350clients at a cost to the city of $116,284.

This overall monthly figure reflectsthe 86 rides a day at the equivalentof 15 cents per t 1p.

access headway with the unit on Para-transit services. Even though, con-tractors are not required to provide24 hour service on holidays, service,contractors like Luxor Van Servicedo provide them. The independentvariable continues to be thedriver - dispatcher and client interaction.

Direct communication based on continued

Table

Statistics for August - 1484

3

1358 $116,2841231 106,554127 9,730

training and performance standardsare the basics for the implementationof a functional Urban Transit system.

Although handicapped and elderlypersons have more degrees of freedomin regard to the use of transit servicestoday, key areas must be addressedto insure the highest degree of access,utilization and performance.

Recommendations

**************************************************)

Total Clients10%50%

Average Limit: 85.6

II. Number of wheelchair clients certifies = 458

Number of active lift-van users = 115

III. Males = 510 Females = 1155

Each rider is expected to pay40 cents a ride or to purchase a monthlypass for $2.50. Under Luxor's ParatransitService, passenger usage has increasedresulting in a decrease in overalloperating costs. The justificationfor this expense to the city is easilymade. Every one of the disabled persons

in San Francisco is a potential assetto the city, especially if recovered,employed, and paying taxes . An i nvestment

made now in this area, is likely toreturn its benefits in time of need.After all , don't we put a great dealof money into fire hydrants, not expectingeveryone to go into service extinguishingfires , but to have one around whenit is needed.

As a summary of costs: The firstcontractor made 600 runs a month;Luxor has as many as 2,542, loweringthe per unit cost and resulting ina savings of $1,500,00.

Summary

San Francisco has made significant

6J

1) Initiate and maintain harddata on this unique populationusing proven survey techniques;

2) Formulate Regional DemandDriver System based uponuniform service and reliabilitystandards;

3) Formul ate a ComprehensiveTraining and Screening Programwith National Standards andAccreditation. Core areasinclude, Vehicle Safety,Communication Techniques,Sensitivity Training, Stress,and CPR units, Police andZoning Requirements, andDriving Techniques;

4) Institute Hospital and ServiceFacility orientation fordrivers, police, and hospitalpersonal to increase continuityof services, minimum waittime and enforcement procedures.

Quarterly inspection of vehiclesby appropriate governmentagencies;

5) Use a simplified dispatchsystem based on direct communi-cation.

6) Establish a nationwide paratransi t

broker network to facilitateaccess of transport services


regardless of region or sectorof the country. Developmentof a toll-free 800 numberfor facil i ti es and local systems.

Coordinated Inter-Paratransit Serviceof the Future

Paratransit service can becomemuch more valuable to the disabledif expanded from one city to intercitytravel. Consider how much betterattended this conference might havebeen (Discovery '84, Chicago, Ill.,October 1-3, 1984), and the vast improve-ment to the quality of the conference,

if disabled persons were providedsmoothly operating information andfacilities. Suppose that computerterminals existed to tell the disabledtraveler what to expect at his orher destination in terms of accessibility,

luggage handling, airport van service,and accessible hotels and restaurants.The disabled traveler of the futt.,se

ought to be able to rely on reservationsthat automatically take into accounthis special needs. Cooperativescheduling

between cities could let the disabledtraveler move from one city to anotherwithout noticing much difference.The day is near. We have the technologyat hand and simply need to use it.

Table 1SENSITIVITY TRAINING WORKSHOP

GOAL: To raise the awareness of those persons servicing the needsof the elderly and handicapped. Who they are, what they're like,what they need and how to best serve them.

I. Body mechanics/patient handlingA. Your body and how to use it properly- simple anatomy and illustrations- what happens to your body when you're driving all day

B. Transporting, transferring and seating your clients(hands on experience)

- wheel chair from curb to street, street to curb- w/c up and down ramps, walkways and steps (3 to 4)- loading clients onto and off van or vehicle- safety measures

C. Escorting mobility impaired persons, those with assistivedevices, the blind and hard of hearing

- on the stairway- on a hill- boarding and de-boarding

D. When the client starts to fall downWhat do you do?

II. Communications (verbal and non-verbal)A. Identifying hidden disabilitiesB. Experiencing disability and limitationsC. Language barriersD. Common problems and how to deal with themE. Expectations of the driver by the client

66


F. Expectations of the client by the driverG. Facts vs. fiction about the elderly and handicappedH. Dealing with the difficult client or behavioral problemI. Making the client feel comfortable and secureJ. Conversing with the elderly/handicappedK. What is patience and understanding?

III. Stress management and reductionA. What is STRESS?B. The effect of stress on your body

C. How stress affects the people around youD. How stress is expressed/manifested physicallyE. Various exercises, methods and strategies to alleviate stress

(that can be done in a few minutes)

II

6'7

ENABLING HANDICAPPED NONREADERS TO INDEPENDENTLYOBTAIN INFORMATION: INITIAL DEVELOPMENT OF AN

INEXPENSIVE BAR CODE READER SYSTEM

ALAN VANBIERVLIET

ABSTRACT

A large number of mentally retarded,physically handicapped, and visuallyimpaired persons are unable to obtaininformation from the available symbolsystems (i .e., printed words and numbers).

Those individuals remain unduly dependent

upon other for their information needs.The primary purpose of this proz;ect

is to evaluate an inexpensive, reliable,portable bar code reader that transcribes

printed bar code into synthetic speech.These bar code readers will enablehandicapped persons to independentlygain information and retrieve seldom-usedor forgotten information. For example,this technology will enable handicappednonreaders to "read" recipes, menus,first aid instructions, bus schedules,and board game rules. For many years,this technology has been used to obtainreliable information for merchandiseinventory and sales. This projectwill first evaluate the durabilityof the reader and the intelligibilityof its sy'ithetic speech. Followingthese experiments, the efficacy ofusing the bar code reader as an aidin learning meal preparation and emergency

skills will be examined using a combinedal ternating treatments and multiplebaseline design. In addition, thedevice will be evaluated in regardto its usefulness as a teaching aidfor handicapped readers using an alter-nating treatments design. The useof a bar code reader as an efficient,self-operated information retrievaldevice appears promising and deservescareful development and evaluation.Bar code readers have the potentialfor increasing the independence ofa 1 arge number of handicapped individuals.

This project represents the firstexamination of the application of

bar code reader technology as a practical

aid for handicapped nonreaders.

Importance of Program

Written language and other standardsymbol systems are available to mostindividuals for obtaining information.A large number of handicapped individuals,

however, are functionally illiterateof their ability to gain informationfrom the available symbol systems.

This includes many mentally retarded,physically hlndicapped, visuallyimpaired, and other handicapped persons.

Sartain (1976) has estimated that13 to 15 percent of the populationof the United states is illiterate.Without the use of a functional symbolsystem, many handicapped personswill forever remain unduly dependentupon others for their informationneeds . Most available self - instructional

aids in daily living (e.g., cookbooks),work (e.g., automotive manuals),and leisure (e.g., board game rulesand theater schedules) are designedto be read, thus perpetuating thehandicapped nonreader's dependency.

The development of an effectivesystem for independently gaininginformation from a variety of sourcesis a critical need for many handicappedpersons who cannot read. These individ-uals need a means to gain new information

and retrieve seldom-used or forgotteninformation_

Alternative Information Systems

Braille:

Braille has been develo9ed asan al ternative symbo 1 system to circumvent

some of the debilitatIny effectsof visual deficits. However, Braille

68


requires very fine tactile discrimination

skills. It has been estimated thatonly about 4 percent of the legallyblind individuals in the U.S.A. learnto effectively use Braille (American

Foundation for the Blind, 1981).

Pictorial instruction:

One alternative symbol systemthat has been successfully used toteach moderately and severely handicapped

individuals is called picture readingor pictorial instruction. Pictorialinstruction involves teaching individualsto obtain information and instructionsfrom simple pictures sometimes accompanied

by printed words (Spellman, DeBriere,Jarboe, Campbell, & Harris, 1978).When cued by pictures, learners aretaught to select items, perform specificactions, "read" the pictures in anordered sequence, and perform actionsin the order depicted. Learners whohave acquired the skills to followpictorial instruction may be ableto use picture books to solve problemsand to learn new tasks. Picture bookscan also be used as reminders of howa task is performed. Pictorial instruction

has been used successfully to teacha wide range of skills including:meal preparation (Johnsor & Cuvo,1981); Martin, Rusch, James, Decker,& Trtol, 1982; Robinson-Wilson, 1977),housekeeping skills (Spellman et al.,1978), schedule and calendar skills(Spellman et al., 1978), public trans-portation skills (Vogelsberg & Rusch,1980), and vocational skills (Wa.ker& Berg, 1983). Although many moderatelyand severely handicapped individualshave learned to use picture skills,some younger and more severely handicapped

individuals never learned to use he

picture cue system (Spellman et al.,1978). As an alternative symbol system,

pictorial instruction has severaldisadvantages. These are: 1) manyactions and objects are very difficultto depict by a picture or photograph;2) some individuals do not learn totranslate pictorial symbols into actions;

3) the system is of little benefit

for severely visually impaired persons;and 4) currently there are neitherstandard rules governing what symbolsto use nor rules concerning the syntactic

arrangement of the symbols.

Audio cassette players:

Another procedure for obtaininginformation is to store the infor-mation on cassette tapes which canbe played back at any time. Perera

and Cobb (1978) described the LearningThrough Listening Project which usedtape-recorded materials for teachingvisually impaired students. The

"Talking Book" system also uses thisprocedure. Many visually impaireapersons use cassette players to storeand retrieve information on a dailybasis (e.g., university studentsuse this procedure for taking classnotes). This procedure enables handi-capped individuals to access informationin a wide variety of settings withreliable, inexpensive equipment.The primary disaL:vantage of thisalternative is that the searchingand scanning skills that are necessaryto find a particular piece of infor-mation on a tape are too complexfor many handicapped persons.

Hi-tech converters:

Several devices have been developed

to convert text into either auditoryor tactile stimuli for visually impairedpersons. Examples of these devicesare the Kurzweil Reading Machinewhich produces synthetic speech fromprinted materials (Goodrich, Bennett,De L'Aune, Lauer, & Mowinski, 1979;Selvin, 1981) and the Optacon whichproduces a tactile stimulus to the

reader's fingertip (Moore & Hunt,1981; Thurman & Weiss-Kapp, 1977).These devices, however, are fairlyfragile, require considerable skilland training to use (particularlythe Optacon), and they are beyondthe financial range of most handicappedpersons (costing from $3,000 to $52,000).

69


Bar code readers:

Another strategy for effectivelyobtaining information from a varietyof sources is the use of bar codereader technology. For many yearsthis technology has been used to obtainreliable information for merchandiseinventory and sales. Basically thissystem involves passing a light sensitivepen or laser over a printed code containing

bars of varying thickness which correspondto coded numbers. This bar code canbe printed anywhere on an item. Infor-mation regarding the product thatis stored in the machine's memorycan then be accessed and presentedvia a visual display, printed on paper,or spoken aloud with the aid of a

voice synthesizer.

An information system for handicappF:0

persons would consist of a portaldevice which could "read" printedbar code from a variety of sources.The processing unit would then transcribethe code and auditorily present theinformation via a speech synthesizer.

FIGURE 1

BAR CODE READERS

INVOLVES PASSING A LIGHT SENSITIVE PEN OR WAND OVER

PRINTED CODE CON1AINING BARS OF VARYING THICKNESS. THE

DEVICE TRANSCRIBES THE CODE INTO AUDITORY STIIOLI,

RECIPE

ADD 2 TSP. SALT

MUNI;WAND

ADD TWO TEASPOONS OF SALT

TO THE WATER BEFORE BOILING

THE WATER.

BAR CODE READER

Method

At present, however, there isno application of this technologyto the information needs of handicappedpersons. The primary purpose ofthis research project is to developand evaluate a bar code reader systemas a self-directed information andinstructional aid for handicappedpersons.

Objective 1. To repackage the MagicWand so that it meetsthe functional andaesthetic needs ufhandicapped persons.

The first task will involveputting the Magic Wand mechanisminto a smaller less obtrusive package.The new "box" should be no biggerthan 10 by 10 by 4 cm. This taskcan be accomplished by either utilizingcommercially available universalboxes, or creating out of plasticor metal a custom built package.In addition, the power source willbe converted from 4 D-cell batteriesto a more compact battery source.

Objective 2. To examine the performance

of the Magic Wand undera variety of climaticconditions.

In order to be a truly usefuladaptive aid, the bar code readermust be able to function correctlyunder a wide variety of climaticconditions. The Magic Wand willbe tested under col d (below 0 F),hot (above 100 F), high humidity(99%), low humidity (3%), and atvarious atmospheric pressures. Per-formance tests will al so be conducted

under fluctuating temperature andhumidity conditions as would occurwhen moving in and out of buildings.In addition, performance tests willbe conducted following shocks andimpacts resulting from dropping thedevice form table height up to tenoccasions.


The performance tests will beconducted using simple ABAB designswith each condition lasting approximately30 minutes. Transcription or misreadingerrors and the rate of synthetic wordproduction will be recorded undereach condition. These results willbe compared to the performance dataon the Magic Wand which are availablefrom Texas instruments.

Objective 3. To evaluate the abilityof learning disabled,visually impaired , moderatelyhandicapped, and severelyhandicapped personsto comprehend the synthesizedspeech produced by theMagic Wand.

Over the past few years, therehas been a rapid growth in voice responsedevices using synthetic speech. Asthe number of products that incorporatevoice output increases in the educationaland rehabilitation marketplace, thereis a great need for data about handicappedindividuals abilities to comprehendand understand synthetic speech.At the present time, however, thereis very little information in theliterature dealing with how handicappedpersons perceive and understand syntheticspeech. The few research reportsthat are available deal solely withvisually impaired children's and adults'abilities to comprehend syntheticspeech (Brabyn & Brabyn, 1982; Goodrich,Bennett, Paul , & Wiley, 1980; Rhyne,1982; Scadden , 1978). The presentresearch study is designed to extendthis line of research by involvinglearning disabled, moderately anL,severely handicapped, as well as visuallyimpaired young adults and Cider citizens.It is intended that this researchproject will serve to facilitate thedevelopment of a comprehensive seriesof research activities in this area.The research methods that are describedbelow have been adapated from theprocedures that have been used atthe Speech Research Laboratory atIndiana University to study the perception

of synthetic speech by nonhandicappedchildren (Greene and Pisoni , 1982)and adults (Luce, Feustel , & Pisoni ,1981).

Twelve learning disabled, twelvemoderately handicapped, twelve severelyhandicapped, twelve legally blindyoung adults and twelve legally blindelder citizens will participate inthis experiment. All participantswill have normal hearing and theywill be native speakers of English.The learning disabled and visuallyhandicapped persons will participatein a work 1 i st recall test, the moderatelyhandicapped persons will participatein a Peabody Picture Vocabulary Test,and the severely handicapped personswill participate in a verb-noun instruc-tion following task. Each of theactivities will be repeated on twoseparate occasions. Four sets ofwords or phrases will be developedfor each separate task. One setwill be recorded by a male nativeEnglish speaker. The remaining threewill be recorded via the Magic Wand'sspeech synthesizer at three differentpitch levels.

Objective 4: To evaluate handicappednonreaders need fora device such as a

bar code reader ona national basis.

This objective will be achievedby the development, distribution,and anal ysis of a questionnaire.The questionnaires, will ask specialeducators to supply information regardingtheir students' reading skills, abilityto use al ternative symbol systems,and their information needs. Theinformation produced by this surveywill help guide the development ofthe bar code reader system.

Objective 5: To .level op, implement,and evaluate a programto teach moderatelyand severely handicappedpersons to use theMagic Wand to prepare

71


complex meals.

Three to six moderately or severelyhandicapped young adults will participatein this Experiment. Pictorial instructionbooklets (Johnson, 1977; Staples,1975) will be prepared for nine differentrecipes. Bar-code instructions willbe created for each recipe. Six recipeswill be randomly chosen for trainingin a combined alternating treatments(Barlow & Hayes, 1979) and multipleprobe baseline design (Horner & Baer,1978). The remaining three recipeswill serve as generalization probes.At each leg of the multiple baselineone recipe will he randomly chosento be taught using a bar code readerprocedure and the other will be taughtusing a pictorial instruction procedure(Spellman et al ., 1978). Trainingwill occur on one recipe per school/workday, training will systematicallyalternate between the two recipes.The number of teacher prompts, thenumber of independently performedsteps, and the amount of time spenton each task will serve as Cie dependentvariables.

Two important questions needto be asked in regards to the truevalue of a bar code reader systemas a self-instructional aid. Theseare: 1) Whether following trainingindividuals will independently usethe reader to facilitate their performanceacross different types of tasks andsettings; and 2) Whether individualswill independently use the readerto obtain reference information afterlong intervals during which they have"forgotten" how to complete a task.These questions will be answered byconducting unreinforced probes bothduring the training period and followingthe termination of training. If thehandicapped individual is unsuccessfulin these probes, the individual willbe trained on a selected probe item.This sequence of probing then trainingwill continue until generalizationis evident.

Objective 6. To eval uate the effectiveness

of bar coded recipesfor use by visuallyimpaired persons.

Twenty visually impaired personswill participate in this Experiment.These individuals will possess cookingskills, however, they will not havemastered Braille reading. Six recipeschosen from a cookbook written forvisually impaired cooks will be trans-cribed into bar code instructions.The bar code will have raised edgesso that it can be easily locatedtactically. Following brief instructionsin the use of the device, each participantwill be observed attempting to completethe recipe in their own kitchen.Observation data will be recordedincluding the amount of time spenton the recipe, the number of stepscorrectly followed, and the numberof passes made over each bar codeinstruction. Following the completionof the last recipe, the participantswill be asked a series of questionsregarding their satisfaction withthe bar code reader system.

Objective 7. To evaluate the effec-tiveness of bar codeequipped restaurantmenus for use by visuallyimpaired persons.

Menus at a restaurant near theUniversity Campus will be providedwith bar coded information aboutthe selections and prices. Bar codereaders will be available at thetables to read the menus. This restaurantis frequented by visually impairedindividuals involved in mobilitytraining courses. As part of themobility training courses the studentswi i 1 1,e tr.! efl y instructed in theuse of the bar code reader. An observerin the restaurant will record informationon the frequency of use of the devicesand the number of passes made overeach bar coded selection and price.After six to eight visits, over approx-imately four weeks, the visuallyimpaired individuals will be asked

72

Discovery '84 Technoloyy for Disabled Persons 61

a series of user satisfaction questions.

Objective 8. To develop, implement,and evaluate a programto teach moderatelyand severely handicappedpersons to adequatelybehave in emergencysituations.

Three to six moderately or severelyhandicapped youngadultswill participatein this Experiment. Pictorial instruction

booklets will be prepared for ninefirst aid and emergency proceduresnecessary for safely living in thecommunity such as care of burns, careof seizures (Matson, 1980), operatingfire extinguishers, care of sprains,poison emergency, tornado procedures,burst water pipes, and burglary.Bar-code instructions will be createdfor each procedure. Six emergencyprocedures will be randomly chosenfor training in a combined alternatingtreatments (Barlow & Hayes, 1979)and multiple probe baseline design(Horner & Baer, 1978). The remainingthree procedures will serve as generali-zation probes. At each leg of themultiple baseline one procedure willbe randomly chosen to be taught usinga bar code reader strategy and theother will be taught using a pictorialinstruction strategy. Training willoccur on one procedure per day, trainingwill systematically alternate betweenthe two procedures. The number ofteacher prompts, the number of indepen-dently performed steps, and the amountof time spent on each task will serveas the dependent variables.

Objective 9. To evaluate the effectiveness

of the BCRS as a procedurefor mildly handicappedreaders to independentlypreview a story.

The present Experiment is designedto serve as a pilot study to beginevaluating the effectiveness of theBCRS as a tool for reading instructionfor handicapped students. It is hypoth-

esized that the wider the range ofproven educational applications ofthe BCRS, the more likely that costswill remain low, the device willbe more widely available for purchase,and the more likely the BCRS willbe adopted as a valuable educationaltool and adaptive devi. 2. Promisingfindings from this initial experimentwill serve as the starting pointfor the development of a more compre-hensive series of research activities.

Several prereading activitieshave proven to be effective in improving

handicapped students' reading compre-hension (Sachs, 1983) and oral readingbehavior (Rose, 1984; Singh & Singh,1984; Wong & McNaughton, 1980).These strategies have included theteacher providing short verbal statements

about the story (Smith & Hess, 1969),and conceptual statements relatingto the theme of the story (Bransford& Johnson, 1972). This Experimentis designed to nvaluate the effectivenessof using the BCRS for previewinga story before orally reading it.

Six normally hearing 9 to 12

year old students school-classifiedas mildly retarded or learning disabledwill participate in this study.The study will be conducted in a

resource room by the classroom teacher.

Stories of approximately 100 wordsfrom the school's basal reading serieswill provide the reading materialfor the study. The stories willbe matched to the students' testedreading levels. Preview scriptsfor these stories will be preparedand transcribed into bar code. Thesescripts will be designed to providea background to the story, providea brief description of the story,and introduce new words, phrases,and expressions.

An alternating treatments design(Barlow & Hayes, 1979; Kazdin & Hartman,1978) will be used to compare theeffects of two training conditions(see Figure 2). The two trainingconditions will consist of the studentindependently previewing the storyvia BCRS, and the teacher reading

73


the preview script to the student.The design will be limited to onlytwo different training proceduressince it has been suggested that thenumber of independent variables inan alternating treatments design belimited to two in order to facilitatesubsequent data analysis (Hartmann,Shigetomi , & Barrios, 1978).

The students' oral reading ofthe stories will be observed and recordedby the teacher and audiotaped forrating by a second observer. Twomutually exclusive responses willbe recorded: oral reading errorsdefined as a mismatch between textand the child's oral response, andself corrections defined as the child'sspontaneous correction of oral readingerrors without teacher assistance.Following the completion of a story,the teacher will orally administera comprehension test. Each test willconsist of 12 items evenly dividedacross four level s of reading compre-hension: literal, inferential, evalu-ative, and appreciative accordingto Barrett' s taxonomy (1976). Thereliability and content validity ofthe comprehension test will be evaluatedusing the procedures described bySachs (1983). The resulting datawill be presented, graphically forvisual analysis and statistical testssuch as analyses of variance willbe conducted.

Objective 10. To determine the preliminary

costs and benefitsof a bar code readersystem in order toassociate a dollarfigure with the system'soutcome.

A major obstacle to the adoptionof any new procedure is the cost,or imagined cost, of its adoption;it is incumbent upon reclabilitationand education innovators to providethe estimated cost of adopting theirprocedures. Accordingly, the costsof the bar code reader system willbe analyzed. These cost estimates

wi 11 include the price of the equipment,

costs of producing bar coded materials,and the costs associated with trainingindividuals to use the readers.In addition, savings resulting fromthe use of the procedures, includingsavings in training time, staff time,and increases in independence willbe estimated.

Objective 11. To prepare a reportof the research findings,and to prepare documen-tation for the trainingprograms that havebeen developed forthe bar code readersystem.

This component of the Project willinvolve writing a final report containing

an analysis of the .significance ofthe Project and an assessment ofthe degree to which the objectivesof the project have been achieved.In addition, detailed descriptionsand instructions for bar code readertraining programs in the areas ofmeal preparation and emergency procedures

will be produced. This program documen-tation will be written in such a

way that someone unfamiliar withthe bar code reader system couldeffectively conduct meal preparationand emergency care training withother handicapped persons.

Objective 12. To disseminate researchfindings and developedmaterials nationally.

This objective is directly relatedto the function of scholarly productivity

and the sharing with professionalsand other interested persons information,

strategies, and technologies thatwill lead to better services forhandicapped individuals. Descriptionsof the project and resulting scientificfindings will 'e presented at relevantnational and regional conventions.Information about the project willalso be published in scientific andpractice oriented journals. In addition,

74


information will be disseminate:: throughthe ERIC database, and federally fundeddissemination projects.

Conclusion

The bar-code reader system shouldprove to be a time-efficient procedurefor promoting self-control and indepen-dence. The system provides antecedentstimuli in the form of auditory in-structions or information which handi-capped individuals can independentlymanipulate to guide their performance.The bar-code reader system shouldpermit individuals to have greatercontrol over their environments, andreduce the need for major environ-mental adaptations.

It should also facilitate thegeneralization and maintenance ofnew skills. The bar-code reader provides

stable discriminative stimuli whichhandicapped individuals can use toguide their performance across diversesettings, tasks, and time. In addition,the bar-code reader system is potentiallyefficient because:a) it is easily used in new tasksand settings; b) it is easily adaptedto meet differing information needs;and c) its use will likely producca reduction in training time. Theuse of bar code readers as efficient,self- operated information devicesappears promising and deserves carefuldevelopment and evaluation. Bar codereaders have the potential for increasing

the independence of a large numberof handicapped individuals.

REFERENCES

Anastasio, T., & Morgan, J. S. (1972).Facto-s inhibiting the use of computers

in instruction. Princeton, NJ: Educom.Barlow, D. H., & Hayes, S. C. (1979).

Alternating treatments design:One strategy for comparing theeffects of two treatments in a

single subject. Journal of AppliedBehavior Analysis, 12, 199-210.

Barrett, R. (1976). Taxonomy of readingcomprehension. In R. Smith & T.

75

C. Barrett (Eds.), Teaching in

the middle grades. Reading, MA:Addison-Wesley.

Brabyn, J. A., & Brabyn, L. A. (1982).Speech intelligibility of thetalking signs. Journal of VisualImpairment & Blindness, 6, 77-78.

Bransford, J. D., & Johnson, M. K.(1972). Contextual prerequisites

for understanding: Some investigations

of comprehension and recall.Journal of Verbal Learning andVerbal Behavior, 11, 717-726.

Cooley, W. W., & Leiaardt, G. (1974).Evaluating individualized educationin the elementary school. In

P. O. Davidson, F. W. Clark, &

L. A. Hamerlynck (Eds.), Evaluationof programs in community, residential ,

and school settings. Champaign,

IL: Research Press.Goodrich, G. L., Bennett, R. R.,

De L'Aune, W. R., Lauer, H., &

Mowinski, L. (1979). KurzweilReading Machine: A partial evaluationof its optical character recognitionerror rate. Journal of VisualImpariment & Blindness, 73, 389-399.

Goodrich, G. L., Bennett, R. R.,Paul, H. S., & Wiley, J. K. (1980).Preliminary report on evaluationof synthetic speech for readingmachines. Journal of Visual Impairment

& Blindness, 74, 273-275.Green, B. G., & Pisoni, D. B. (1982).

Perception of synthetic speechby children: A first report.Research on Speech PerceptionProgress Report No. 8, IndianaUniversity, Bloomington.

Hartman, D. P., Shigetomi , C., &

Barrios, B. (1978). Design consid-erations in applied behavioralresearch. Paper presented atthe annual meeting of the Associationof Behavior Analysis, Chicago,IL.

Heward, W. L., Test, D. W., & Cooke,N. L. (1981). Training inserviceteachers to use technology. TeacherEducation and Special Education,

4, 15-26.Horner, R. D., & Baer, D. M. (1978).

Multiple-probe technique: A variation


of the multiple baseline. Journal

of Applied Behavior Analysis, 11,

189-196.

Irvin, L. K., Crowell , F. A., & Bellamy,G. T. (1979). Multiple assessmentevaluation of programs for severelyretarded adults. Mental Retardation,17, 123-128.

Johnson, B., & Cuvo, A. (1981). Teachingmentally retarded adults to cook.Behavior Modification, 5, 187-202.

Johnson, J. L. (1977). How to producepicture books. Parsons, KS: Univeristy

of Kansas, Bureau of Child Research.Johnson, S., & Bolstad, O. (1973).

Methodological issues in naturalisticobservation: Some problems andsolutions for field research.In L. Hamerlynck, L. Handy, & E. Mash(Eds.) Behavior change: Methodology,concepts and practice. Champaign:Research Press, 197

Karlan, G. R., & Rusch, F. R. (1982)Correspondence between saying anddoing: Some thoughts on definingcorrespondence and future directionsfor application. Journal of AppliedBehavior Analysis, 15, 151-162.

Kazdin, A. E., & Hartmann, D. P. (1978).The simultaneous-treatment design.Behavior Theraphy, 9, 912-922.

Leader, M. A., & Klein, D. F. (1977).Reflections on instituting a comput-erized psychosocial history ina clinical facility. ComprehensivePsychic , 18, 489-496.

Luce, P. A., Feustel, T. C., & Pisoni,D. B. (1981). Capacity demandsin short term memory for syntheticand natural speech. Research onSpeech Perception Progress ReportNo. 7, Indiana University, Bloomington.

Martin, J., Rusch, F., James, V.,Decker, P. J. & Trtel , K. (1982).The use of picture cues to establishself-control in the preparationof complex meals by mentally retardedadults. Applied Research in MentalRetardation, 3, 105-119.

Martin, N. (1977). Hearing aids forchildren. In W. Hodgson & P. Skinner(Eds.). Hearing aid assessmentand use in audiologic habilitation.Baltimore: Williams & Wilkins.

Matson, J. L. (1980). Preventinghome accidents: A training programfor the retarded. Behavior Modifi-cation, 4, 397-410.

Mezzich, J. E., Dow, J. T., & Coffman,G. A. (1981). Develooinganefficientclinical information system fora comprehensive psychiatric institute:

1. Principles, design, and organiza-tion. Behavior Research Methodsof Instrumentation, 13, 459-463.

Moore, B., & Hunt, H. (1981). Optacon:A versatile communication tool.Journal of Visual Impairment &

Blindness, 75, 343-345.Perera, T. B., & Cobb, E. S. (1978).

A minicomputer-based learninganalysis system for optimizingPSI instructional materials forthe visually handicapped. BehaviorResearch Methods & Instrumentation,Tb, 231-237.

Read, R. (1981). When the cook can'tlook: A handbook for blind andvisually impaired cooks. NewYoll(y Continuum Publishing Corp.

Rhyne, J. M. (1982). Comprehensionof synthetic speech by blind children.

Visual Impairment and Blindness,76, 313-316.

Robinson-Wilson,M. (1976). Picturerecipe cards as an approach toteaching severely retarded adultsto cook. In G. T. Bellamy (Ed.),Habilitation of the severely andprofoundly retarded. Reportsfrom the Specialized TrainingProgram, Monograph, 99-108.

Rogers, E., & Shoemaker, F. (1971).Communications of innovations.NY: The Free Press.

Rose, T. L. (1984). The effectsof previewing on retarded learnersoral reading. Education and Training

of the Mentally Retarded, 19,

49-53.Sachs, A. (1983). The effects of

three prereading activities onlearning disabled student's readingcomprehension. Learning DisabilityQuarterly, 6, 248-251.

Sartain, H. W. (1976). Instructionof disabled learners: A readingperspective. Journal of Learning

76


Disabilities, 9, 489-497.Scadden, L. A. (1978). Kurzweil Reading

Machine: Evaluation of Model One.

Journal of Visual Impairment &

Blindness, 72, 415-418.Selvin, H. C. (1981). The Kurzweil

Reading Machine: False hopes andrealistic expectations. Journalof Visual Impairment & Blindness,75, 76-77.

Singh, N., &Singh, J. (1984). Antecedentcontrol of oral reading errorsand self-corrections by mentallyretarded children. Journal ofApplied Behavior Analysis, 17,11-119.

Smith, R., & Hess, K. (1969). The

effects of prereading assistanceon the comprehension and attitudesof good and poor readers. Researchin the Teaching of English, 3,

166-171.Spellman, C., DeBriere, T., Jarboe,

D., Campbell, C., and Harris, C.(1978). Pictorial instruction:Training daily living skills.In M. E. Snell (Ed.) Systematicinstruction of the moderately andseverely handicapped. Columbus,OH: Charles E. Merrill.

Striefel, S., Wetherby, B., & Karlan,G. R. (1976). Establishing generalized

verb-noun instruction. Followingskills in retarded children. Journal

of Experimental Child Psycholoa,22, 247-260.

Stapes, K. S. (1975). Cooking frompictures. Fargo, ND: North DakotaState University.

Thurman, D., & Weiss-Kapp, S. (1977).Optacon instruction for the deaf- -blind. Education of the VisuallyHandicapped, 9, 47-50.

Vogelsberg, T., & Rusch, F. (1980).Community mobility training. In

F. R. Rusch & D. E. Mithaug (Eds).Vocational training for mentallyretarded persons. Champaign, IL:

Research Press.Wacker, D. P., & Berg, W. K. (1983).

Effects of picture prompts on theacquisition of complex vocationaltasks by mentally retarded ado-lescents. Journal of A lied Behavior

Analysis, 16, 417-433.Welliver, P. W. (1973). Don't overjudge

technology by the "technologist."Faculty Forum, College of Education,Pennsylvania State University,August 14.

Wong, P., & Mc Naughton, S. (1980).The effect of prior provisionof context on the oral readingproficiency of a low progressreader. New Zealand Journal of

Educational Studies, 15, 169-175.

77

INTEGRATING COMMUNICATION, COMPUTER ACCESS,ENVIRONMENTAL CONTROL & MOBILITY

BARRY A. ROMICHCAROL B. VAGNINI

ABSTRACT

The technology of today offersthe people of our society the opportunityto reach level s of achievement neverbefore possible. We all use machinesfor communication, transportationand entertainment and in performanceof our jobs. Technical aids are al soavailable for people with physicalhandicaps to help them reach goalsin educational , vocational and personalpursuits. Through the use of appropriate

aids, individuals who are physicallyhandicapped can real ize an overallimprovement in the quality of life.

Two primary population groupsthat can be debilitated by physicaldisability are:

a) high level spinal cord injury(SCI) and

b) severe involvement with cerebral

pal sy (CF).

These population groups appearto represent the largest groups withneeds in the area of physical disability;

people with other diagnoses alsobenefit from the use of technicalaids designed around the needs andcapabilities of these two groups.Other disabilities include musculardystrophy, multiple sclerosis, amyotrophic

lateral sclerosis and others.The needs of these population

groups can be divided into four areas:a) Communicationb) Computer Accessc) Environmental Controld) Mobil ityOf the four areas, communication

is by far the most important. For

nearly everyone, achievement is closelytied to the ability to communicate.The more effective a person' s communi-cation skill s, the more promisingthat person' s future. Conversationalcommunication is generally not a

problem for the SCI population asthey retain their speech. For theperson with severe cerebral pal sy,

communication should be the firstneed addressed.

The transition to an informationbased society has greatly assistedpeople with physical handicaps.These people were a burden in thedays of agricultural or industrialbased society. Today, many disabledpersons can be productive. A physicalhandicap does not have to affecta person' s ability to access, processand communicate information. Today

78


no person should be provided witha communication system, environmentalcontrol or powered wheelchair withoutconsidering an access to computers.

After communication and computeraccess, a person should be providedwith a means of operating variousappliances in his surroundings. An

environmental control system satisfiesthis need.

Finally, people need to be mobile.Most people with high level SCI andsevere cerebral palsy need a powered

wheelchair to be mobile. The issueof wheelchair control needs to be

addressed.

Control Interfaces

The control interface is thatportion of a technical aid or aidsystem through which the user operatesthe aid or system. It may be an integral

part, as in the case of a built-in

keyboard, or it may be a separatecomponent. Figure 1 represents a

person using a technical aid to performa task.

PERSONRole of control Interface In teak Performance

FIGURE 1.

Control interfaces can be categorized

in a number of ways. For the purposeof this discussion, they are categorized

in two areas:a) Input from the user.b) Output to the technical aid.Input to the control interface

is provided by the person. This requiresthat the person have some controllablecapability that can be monitored bythe control interface. This capabilityis usually within one of the followingareas:

A. Physical Movement

B. PneumaticC. Myoe ectricD. Sound

As indicated in Figure 1, helpfulfeedback can be provided to the userat various points in the performanceof a task. One source of this feedback

is the control interface. The simpleclick of a switch that tells theuser it has been activated can signifi-cantly enhance performance. Tactilefeedback of a keyboard, audible beepsand indicator lights are other examples

of how this important function canbe implemented. As a person becomesfamiliar with the operation or thedevice, proprioceptive feedback withinthe body may further enhance performance.

In some cases, no standard controlinterface will provide optimum perform-ance. In this situation, a customunit should be designed and fabricated.

While effectiveness in taskperformance is emphasized other factorsalso influence the selection andapplication of a control interface.

These include psychological issues,

environment, appearance, set-up time,training effort, maintenance, costand other practical matters. Frequently,compromises are made between oneor more of these factors and theperformance of the system. However,since optimal performance shouldbe the primary goal, any compromisesshould be recognized and communicatedto all, including the technical aid

user.

Communication

This area addresses the expressive

communication needs of people withoutfunctional speech. These people,generally, are physically disabledto the extent that they cannot usepen or pencil, type, or sign. Con-

sequently, their ability to expressthemselves is severely impaired.

The goal for providing a person

with a communication aid should beto achieve the fastest, most effectivecommunication possible. As previously


indicated, a person's life achievementis largely determined by his abilityto communicate. The process of selectingand applying a communication aid,thus, becomes very important.

Three factors determine the expressive

speed of a person using a communicationaid:

a) Selection speedb) Number of selections neededc) Amount of information retrievedSelection speed refers to the

speed with which the user can makea selection from the array of possibleselections. For example, using a

keyboard, how long does the user taketo locate and activate a key? Numberof selections needed refers, to thenumber of selections that need to

be activated to retrieve information.The amount of information retrievedis thz. last issue. Typical systemsmight offer only a single letter orother character, a string of characters,words, phrases or complete sentences.All three of these issues determinethe rate a person will be able tocommunicate. Communication can be

divided into three areas as indicatedin Figure 2:

a) Selection techniquesb) Processingc) Outputs.

SELECTIONTECHNIQUE PROCESSING -i. OUTPUTS

EXPRESSIVE COMMUNICATION SYSTEM

A number of selection techniqueshave been developed to address thewide range of physical capabilitiespresent in people with severe communi-cation impairment. These 1-electiontechniques can be divided into thefollowing classifications:

a) Direct Selectionb) Scanningc) Encoding

The selection technique thatprovides the best performance eor

a particular person will be a functionof the physical capabilities exhibitedby that person.

For most people with the physicalcapability to use a direct selectionoperating technique, it can offerthe fastest performance.

While scanning techniques arerelatively slow by comparison, theyhave the advantage of very littlephysical demand on the user.

Typically, older electroniccommunication aids were designedto use only one selection technique.Today, aids based on microprocessortechnology can operate using differenttechniques. For both the clientand the rehabilitation professionalthis can be an important asset.When selecting an aid, considerationmust be given to the future needsand capabilities of the user. Abrain stem injury, for example, mayimprove physically with time, however,a person with a progressive neurological

disorder is expected to lose physicalcapability. If the communicationaid cannot change, it will becomeuseless and/or inappropriate. Processing,the second area in the topic of communi-cation, addresses the way the selectionmade by the Person is used to generatecommunicati .1.

In the simplest systems, thereis no processing. Each selectioncorresponds to a fixed characteror character string. Better systemsprovide the programming of characterstrings.

The recent state-of-the-artin commercially available systemsis the concept of levels. With thisapproach, each location in an arrayof selections could have many meanings.The primary meaning, referred toas the base level , could be retrievedwith a single selection. However,any of the other meanings could beretrieved by first selecting a newlevel, then selecting from withinthat level. This would correspondto having an entire vocabulary ina book, for example of 100 pages,each with 128 entries. The first

80


page would be fixed and offer accessto the ASCII character set. The other

99 pages would have entries of characterstrings built from the first page.While this system has proven to be

functional , it does have limitationsthat were not immediately obvious.A major fault is the difficulty forthe user to remember where particularstrings have been stored. The conceptof levels and location (pages and

entries) is not conducive to memory;it is too arbitrary.

A generalized concept calledabbreviation expansion has been promotedby the Trace Center, University ofWisconsin, Madison. This system is

an attempt to better match a person'snatural language process. With thisapproach, frequently used, longercharacter strings are representedby short character strings. For example,

"Hel 1 o. How are you?" could be represented

by "HH?".Another system, called Minspeak,

has been proposed by Bruce Baker,a linguist now working in this field.Minspeak, now commercially availablefrom the Prentke Romich Company, is

a further attempt to speed communi-cation by making use of normal languageprocesses.

Minspeak is based on five basicprinciples:

a. Full sentences contain moreinformation than smaller unitsof communication.

b. Much of a person's routinecommunication needs can be

satisfied by a set of carefullychosen fixed sentences.

c. Sentences can be summarizedby a sequence of concepts.

d. Concepts can be representedby symbol s .

e. Logical organization of sentences

can further increase communication

speed.Although the concept of Minspeak

is more difficult to understand andmay require a greater time investmentto implement, Minspeak appears to

offer performance well beyond its

"level and location" based predecessors.

Microcomputer technology has permittedthe linguist' s proposal to becomereality. Without that technology,it would only be an idea.

The last area within the topicof communication is that of outputs.Typical communication aid outputsinclude:

a) Correctable displayb) Printerc) Speechd) Data

The combination of these appropriatefor a particular user will be a function

of the expected needs of that person.Microcomputers frequently contain

hardware features that permit themto be used as communication aids.Indeed, attempts have been made todevelop programs that make particularunits useful as such. However, therehas been no widespread success inthis area. The issues that mustbe considered in such a venture arecomplex. People who know microcomputersgeneral ly don' t appreciate the complexity

of the issues relating to physical,psychol ogi cal and I i nguistic capabilities

and needs of the users. Further,the process of disseminating softwareand providing the education and support

that is needed can be difficult.Al so , the volatility of the microcomputer

market has di scouraged software developers

from making investments In this area.The recent withdrawal from the marketby Texas Instruments and Timex areprime examples.

If a microcomputer were to be

successfully programmed for use asa communication aid, the cost ofa complete system to the user wouldstill be substantially higher thancommon for mass market items usingthe same microcomputer. The reasonis that very little of the cost ofa communication aid is the cost ofproducing the hardware. The majorityis the cost of development and theprovision of services.

Frequently, microcomputer enthusiasts

will develop a system for a particularuser. While this approach does providesomething for someone who had nothing,

81


it almost always results in a systemtnat is less effective than the bestpossible. Consequently, the levelof achievement of the user will be

limited. In addition, new ideas andtechniques are continually being devel-oped. When commercially availablesystems are used, the developmentof updates is practical and olderunits can be imprrved. Routine serviceis another issue. Extreme carc mustbe taken to consider the potentiolresult of this approach.

Computer Access

The information revolution is

under way. The tool of the informationage is the computer. Today the micro-computer is used in a wide varietyof applications. Many tasks thatused tc be performed manually arenow much more effectively accomplishedusing computers. Many Jobs are beingcreated around the need to access,process and communicate information.For people with phy:ical handicaps,this situation opens up many opportunities

and offers new levels of personalachievement. However, if those peopleare unable to use computers, not onlywill they be deprived of those opportun-ities and achievement, they will be

taking a relative step backward inour society.

For example, the microcomputeris now common in the public schoolclassroom. Able-bodied students useit as part of their normal education.if the disabled student is unableto use it, he is deprived of thisnew educational opportunity availableto the rest of the students.

Perhaps the most common productiveapplication of the microcomputer isa word processing system. This functionis useful in educational, vocationaland personal activities. It may bemore valuable to people with severephysical handicaps than to able-bodiedpersons as the disabled often don'thave the alternative of writing ortyping.

Computer access can be accomplished

in differelt ways. Of course, theideal situation is the use of a standardkeyboard. Sometimes the use of a

mouthstick or head mounted pointerpermits this. For those unable tooperate the standard keyboard, alter-natives must be sou ht. One of theeasiest approaches is the additionof a keyguard to the keyboard. A

keyguard consists of a flat surfacemounted over the keyboard to supporttIle hand. This permits the personwith cerebral palsy to stabilizethe hand. A hole over each key permitsthe keys to be activated. For keysthat must be pressed in combinationwith another Vey, such as SHIFT andCONTROL, latching mechanisms canbe included that will hold them clownThiF feature is nreded for a person

who can use only single finger,mouth stick or headpointer. To enter

CONTROL "S", for example, the userwould first press CONTROL, then "S",then release the CONTROL key. For

people who are unable to operateeven a guarded keyboard, other alter-natives must ue sought. Sometimesa control interface can be connecteddirectly to the computer, perhapsthrough the game paddle ports orin parallel with one of the keys.The program can then be modifiedor a special program can De writtento monitor the status of the controlinterface. Generally, the modificationof standard software or the development

of custom software to duplicate thefunction of standard software hasserious faults. The main problemis that the investment is only usefulfor that one program and the processmust be duplicated for each new program.Also, the overall performance willalmost always be less than the bestpossible. A far better approachis to modify the hardware to permitaccess by the disabled person. Mostsoftware is written under the assumptionthat the user will enter informationthrough the computer keyboard. Therefore,

a generic solution to the problemis to provide the disabled personwith a means of entering information

82


into the computer in a manner thatlets the computer think the informationis coming from the keyboard. Hardware

is available for several microcomputersthat will permit this. The deviceis called a keyboard emulator.

Keyboard emulators are typicallyconnected between the keyboard andthe central processing unit (CPU).They accept ASCII (American StandardCode for Information Interchange)characters from an external deviceand enter them into the computer asif they are keystrokes on the keyboard.Normally the keyboard remains active.Therefore, in a classroom the computercan be used both by able-bodied anddisabled students.

At this point, the issue is oneof providing disabled persons witha means of generating ASCII characters.Several alternatives exist. An expressivecommunication aid may be able to providethe characters.

The comnwnication aid, whichshould be a portable battery powereddevice, is often mounted on the user'swheelchair. It can be connected tothe keyboard emulator using a cable.

However, a wireless telemetry systemwould provide a clear environment.If the user operates a powered wheelchair,

wireless data tel emetry permits independent

mobil ity.

For the person without a communi-cation aid with data output, otheralternatives are available. A personwith high spinal cord injury normallywould not need a communication aid.One approach for that person could')e blowing and sucking on a tube toenter dots and dashes in Morse codefor the ASCII convertor. Two switchinput using an Apple computer hasbeen developed at Northwestern Univer-sity. Another approach could be the

use of head movement to make selectionson a keyboard matrix.

A microcomputer with an appropriateprogram could he dedicated to the

function of an ASCII generator. Theprogram running on this computer wouldmonitor a control interface operatedby the user and would respond with

ASCII characters or strings.

Environmental Control

After communication and computeraccess, the next need of a person

with a severe physical disabilityis the operating of various electricaldevices in his surroundings. Typical

environmental control systems cananswer and dial the telephone, turnpowered devices on and off, dim lamps,position the electric bed, and operateother special accessories such asirl_..coms, nurse's calls, page turners,

evision channel selectors, etc.Today, operations from the premise

that everyone needs to be able tooperate a computer, the approachto environmental control has changed.Environmental ccntrol systems areavailable that are controlled throughASCII characters. This means thatthe person who uses a computer oris able to generate ASCII charactersnow has the power of an environmentalcontrol system without the need forany additional physical capability.

As with communication systems,it is possible to create an environmental

control system using a microcomputer,peripheral hardware and an appropriateprogram, aile the performance ofan environmental control is not nearlyas important as the performance ofa communication aid or computer accesssystem, there are still some issuesthat should be considered. One isoperation during a power failure.When power fails, most accessorieswill not be functional because oftheir dependence on electricity.However, a function that may be quiteimportant, particularly for a person

wi -,h severe physical disability,is the telephone. If the environmental

control is based around a "mains"powered microcomputer, then nothingelse will function when power fails.Comm9rcial environmental controlsgenerally offer a standard or optionalbatter:' backup to keep the telephonefunctitA irtact.

53


Integrating Communication,Computer Access and Environmental

Control with Mobility

Much work has been addressedto the separate areas of communication,computer access, environmental controland mobility. The first three ofthese areas inherently integrate.However,littlehas been done to integratethese with the area of mobility.For people with less severe levelsof impairment, integration is notnecessary. These people have enoughphysical capability to be able touse the conventional solutions tothe separate problems. But peoplewith limited capabilities may onlybe able to use one technical aid.For example, since a person's potentialfor achievement is closely tied tothe ability to communicate, it makessense to use the total physical capabiliLy

toward that end. Without integration,no capability may be left for thecontrol of other aids. If the controlof the technical aids acdressing allareas of need can be integrated, thenthe same capability can be used inall areas.

Based on work completed by theRehabilitation Engineering Centerat the Univer ity of Tennessee inMemphis, Prentke Romich Company ispursuing this area. PRC is presentlyunder contract with the United StatesDepartment of Education to assemble,evaluate and develop a marketing planfor such a system.

IN ADM DATATPIANSIAITTI

THE LANEY SYSTEM

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The Lainey System, named aftera prototype user, primarily usescommercially available components.Additional components are soon expectedto become commercially available.The first system demonstrated usesan optical headpointer as the controlinterface and is based around thePRC Express 3 or Minspeak. A standardwireless data telemetry system andkeyboard emulator provide computeraccess.

Powered wheelchair control is

provided by a joystick simulator.The original powered wheel chair electronic

control package is retained. Therationale for this has facets. First,the powered wheelchair manufacturerknows the power and control requirements

of the wheelchair and motors and,therefore, should be able to developa more reliable and effective system.Second, when a failure does occur,the local dealer is in a much betterposition to quickly service the systemas replacement parts are more likelyto be stocked locally.

Computer access is providedby a wireless data telemtry system.The transmitter is connected to theExpress 3 or Minspeak and the receiveris connected to the computer keyboardemulator.

Environmental control, whilenot a priority of classroom students,is important at home. Using an environ-mental control system that can acceptASCII characters, that function isavailable to the user without anyadditional physical capability require-ment. Using the wireless telemetry,for example, the user in his livingroom could transmit a code to theenvironmental control in the bedroomwhich in turn transmits over thepower line to the pt,,er control module,turning the stereo beside him on.

At the time of this writing,Prentke Romich Company plans to makethis entire system available.

Summary and Challenge

Even ..:th all of this exciting

84


technological progress, new problemsare being created. Now that functionaltechnical aids are available, we mustaddress the task of getting them tothe people for whom they have beencreated. First, is awareness building-.People who need, or who have clientswho need, technical aids must becomefamiliar with the capabilities thatthese systems offer. Those rehabilitationprofessionals who select and applytechni:al aid systems must then learnhow to do so in a manner that bestserves the interests of the client.Finally, funding for technical aidsand the necessary corresponding servicesmust be provided. In all of theseareas we are making progress, butmore work is needed.

For people with severe physicaldisabilities there has never beena better time in history. As neverbefore, these people can be activeand productive members of our society.With technical aids in the areas ofcommunication, computer access,environ-mental contrc' and mobility, peoplecan set and achieve goals in educational ,

vocational and personal pursuits.

THE POTENTIAL OF ARTIFICIAL INTELLIGENCEIN AIDS FOR THE DISABLED

JOHN J. BOYER

ABSTRACT

This paper explores the possibilities

for apr- 4ing the knowledge of Artificial

Intelligence research to aids forthe disabled. Though many computerizedaids have been developed, some ofthem quite sophisticated, very fewof them have been " intel 1 i gent" in

the sense that they make use of knowl edge.

Because Artificial Intelligence is

still a rather unfamiliar field, thispaper begins with a definition ofthis branch of computer science.By way of background the areas ofbasic AI research are then surveyed.The areas of applied research mostrelevant to the development of aidsfor the disabled are then discussed.Because disabled persons typicallyhave "input" and "output" problems,the provision of a good linkage betweenhuman and computer is then explored,with emphasis on direct connectionto the nervous system. Finally, someareas of applied research specialto disabled persons are examined.

This paper concludes with suggestedguidelines for determining if an aidis "intfllicient".

This paper is a satellite's-eyeview of an almost unexplored partof the computer usage world. A prelim-

inary library search turned up nopapers with the keywords "disabled"and"artificial intelligence." However,the territory which must be surveyedto comprehend how artificial intelligence

techniques can be used to help thedisabled is very large. So my surveymust be very brief indeed. Researchin this field is continuing at Computersto Help People, Inc.

What is Artificial Intelligence

1.1 Definition

Artificial Intelligence is theattempt to program digital computersto exhibit certain types of behaviorand perceptual abilities which canbe regarded as "i ntel 1 i gent" i f exhibited

by a human being. These behaviorsand a bil !cies are spelled out in

Section 2, which describes areasof basic AI research.

1.2 Boundaries

Lower Limit: Artificial Intelligence

does not include numerical problemssuch as statistical analysis or thesimulation of physical phenomena,nor does it include -ecord-keepingfunctions or data processing. UpperLimit: At present this is undefinable.It is probably set by the amountof computation that can be performedbetween the occurrence of an eventand the time when a response to it

must be made.

86


Areas of Basic AI Research

2.1 Conputer Vision

This perceptual ability wouldenable a computer to examine a scenewith TV cameras and respond to it

in much the same way as a person.At present, industrial robots guidedby vision can perform some simpletasks; computers which can producea fairly good description of a singleimage are operating in laboratories,but these computers require 20 7.inutesto analyze an image. More powerfulmicrocomputers will, in the near future,make it possible to build vision systemsthat can be used on the street andin the home.

2.2 Understanding Written Language

Such a perceptual ability wouldenWe a robot to accept commandstyped in ordinary English, or it wouldenable the computer to answer questionsposed by people who are not computerliterate. Question-answer programsof this type are now commerciallyviable. Work is also proceeding onmachine transition of one languageinto another.

2.3 Understanding Spoken Language

This is another perceptual abilitywhich would make computers more accessible

to noncomputer literate people. Consid-

erable progress has been made in the

recognition of words carefully spokenby a single speaker, with a pausebetween words. Understanding normalspeech, however, is a formidable task,requiring information from disciplinesas diverse as acoustics and linguistics.Laboratory machines can perform thisfeat with a limited vocabulary, butthey are much too large and expensivefor general use.

2.4 Modeling Human Mental Processes

Basically, this is an attemptto learn more about the only "intelligent

machine" we know, the human brain.It is accomplished by formulatingtheories of hum-n mental processessuch as memory, problem solving,and belief formation, and then applyingthese theories to produce human-likeresponses when expressed by computerprograms. This work has contributedmany ideas about how intelligentcomputers might be built. The workhas also made important contributionsto psychology.

2.5 Machine Learning

The ability to learn seems morefundamental than both perceptionand behavior to any intelligent entity.It is one of the most difficult abilities

to program into a computer. We wantmore than a machine which just passively

accepts the data that are fed toit. We want a machine which cantake advice and learn frcm experience.Some progress has been made in advice-taking machines and in programs whichlearn from carefully chosen exa ?les,but the general solution remainselusive. True learning seems to

require a degree of creativity thatis too difficult even to apply tobasic research.

2.6 Knowledge Representation

Though neither a behavior nora perceptual ability, this is anotherfundamental area of AI research,It is perhaps even more fundamentalthan learning. The knowledge thatthe machine possesses, whether providedby the programmer or acquired throughlearning, must be stored in a limitedmemory so that it is easily and quicklyavailable for use in reasoning andsolving problems. Fundamental philosoph-

ical questions, such as "what is

knowledge?" and "what is meaning?",are also involved. A great manyschemes of knowledge representationhave been tried. Perhaps the mostpopular is that of "semantic networks."

6'7

76 Discovery '84 Techr.r,00gy for Disabled Persons

2.7 Game Playing

There may be readers who contendthat much human game playing scarcelyqualifies an intelligent behavior.In this I concur, but in games suchas checkers and chess, which havereceived a great deal of attentionin AI, the role of intelligence isundoubted. Early investigation ofthese games developed many of theprincipal AI techniques such as heuristicsearch. Some of the best work onmachine learning was produces; by Sam,el(1963) with the game of checkers.Presently, chess programs can playat the grand master level , thoughno one expects a computer to becomeworld chess champion any time soon.

2.8 Deduction and Theorem Proving

Many mathematicians and philosopherswould like us to believe that thisis the quintess.:ntial intelligentbehavior. Al though computers canuse deduction to solve simple problems,they have yet to find a significantnew mathematical theorem. Perhapsthe most important contribution oftheorem proving is the introductionof the language of formal logic intoAl. This language is one of the mostuseful ways of representing knowledgeand some of the newest AI programminglanguages are based on it.

2.9 Planning and Problem Solving

To plan is to determine a courseof action before taking it. Intelligenceis required both to fGres, ' possiblefuture events and to pick a sequenceof actions to achieve a goal. Robotsespecially need the ability to plan,

and not surprisingly, much of theplanning research has been completedusing real or simulated robots. Problemsolving is closely related to planningbecause problem solving requires thediscovery of a sequence of moves thatwill produce a desired configuration.

2.10 AI Programming Languages

Research in this area is concernednot so much with hew computers canbe made to perceive or behave aswith how they can be programmed todo so. Artificial Intelligence programsare very large and complex. Themain bottleneck in the wider application

of AI may be the difficulty of writingthese programs. The earliest specialprogramming language for AI was LISP,developed by John McCarthy at MITin 1960. Without it, the developmentof AI would have been much slower.It also contributed fundamental ideasto the broader field of computersci nice. Even today, LISP is used

for writing many AI programs. However,it is being displaced by PROLOG (Clocksin,

W. & Mellish, 1981), which is basedon the language of formal logic andis more expressive.

2.11 Program-Writing Programs

One indication of intelligenceis the ability to find things outfor oneself, without having everythingspelled out. Since AI programs areso difficult to write, workers inthis field are naturally very interested

in endowing computers with the abilityto write their own programs. This

would also give the machine a specialform of learning, maybe even theability to lift themselves by theirown bootstraps. Programs have beenwritten which can turn specificationswritten in stylized English intoa complete program; they can alsoproduce programs from examples ofthe desired program; but alas noneof these program-writing programsseem to hold promise of relievingAI researchers of even part of theirburden.

2.12 AI Architectures

Perception and intelligent behaviorrequire a material substrate--a brainor, just maybe, a computer. Thefield of computer design is termed

88


"computer architecture," hence thename of this area of AI research.How does an AI computer differ froman ordinary computer? For one thing,it must be able to do many thingsat once. For another, it must be

good at manipulating symbols insteadof manipulating numbers. Perhapsmost important, it must have specialfeatures that make programs writtenin AI programming language run asfast as possible. Many such machineshave been built or attempted. TheJapanese, with their "fifth Generation"computer projects (Feigenbaum, E.,& McCorduck, P., 1983), are makinga major effort in this area and hopeto outpace the united States in whatis probably the next computer revolution.

Application Areas Relevant to the Disabled

3.1 Robots

The desire for robots that domore than rivet and spot weld is a

primary motivation for the basic researcharea of planning and problem solving.The area of computer vision has alsogrown from this desire. In the early1970's, Winograd (1972) wrote a programthatundarstoodEnglishkeyboardcommandswell enough to control a robot picturedon a TV screen. The use of Englishcommands in a practical robot, however,must await developments in machinelearning; AI architecture developmentsare also needed. Robots can obviouslybe very helpful to the motor-impaired,and can also serve as guides for theblind.

3.2 Intelligent Vehicles

From a computer scientist's pointof view, the principal differencebetween a robot and a vehicle is thatthe latter must often follow a map.Hence, intelligent vehicles cruciallydepend upon the basic area of knowledgerepresentation. On the other hand,an intelligent vehicle needs onlyto be told the destination; this might

be accomplished by means of a simplekeyboard. The utility of such a

machine for the blind hardly needsto be stated. Persons with severemotor impainaents would also findit useful.

3.3 Expert Systems

An expert system is a computerprogram that can answer questionsand give advice where human expertsare usually required to give a qualityanswer. The best existing expertprogram is probably MYCIN (Shortliffe,E.H., 1976) MYCIN can diagnose infectionsand make therapeutic recommendationswith an accuracy equal to that ofmost physicians. The catch, of course,is that MYCIN knows nothing aboutany other kind of disease, nor doesit have any bedside manner. Expertsystems depend heavily upon knowledgerepresentation. While research isunder way to enable expert systemsto learn from experience or observation,

most of them must simply be fed knowledgeby a "knowledge engineer" workingwith a human expert or group cf experts.A possible application of expertsystems for the disabled would bethe prescription of aids and services.Ophthalmologists, for example, typicallyknow little about low vision aids,and would welcome the chance to consultwith an expert, even a computerizedone. Expert systems will also beneeded as part of intelligent, computer-

aided instruction systems.

3.4 Intelligent Computer-aidedInstruction

This description means thatthe program does much more than presentlessons on the screen, ask for answers,and select the next klsson basedon the student's responses. Sucha program "knows" very little abouteither the course material or thestudent. An intelligent CAI systemcontains a representation of thecourse knowledge and a reasoningfacility that makes it, an expert

89


problem solver and problem generatorin the subject matter. It can alsoconverse with the student in somewhatthe same way as a human teacher.Finally, the program builds a modelof the student, so that it can conjecturewhat his/her misunderstandings areand take remedial action. Many connections

to the basic areas of research areimplicit in the foregoing description,as is the connection to expert systems.The potential of intelligent CAI programsfor the disabled challenges the imagina-tion. To cite just two possibMties,such programs might be used to acquaintblind or deaf children (or even adults)with the worlds of 'vision and hearing.

3.5 Artificial Intelligence for Micro-computers

Up to the present, most artificialintelligence programs have run on

large "mainframe" computers, or atbest desk-size minicomputers. If

such programs are to be useful on

the street, in the home, or the workplace,

they must run on machines which are,at worst, desk top size, like mostof today's personal computers. Texas

Instruments has made a step in theright direction with its NaturalLink(Hassett, J., 1984) program, whichenables the user to access the DowJones Information Service in English.Other companies are also introducingAI products which run on machinessuch as the Apple and the IBM PC.Trie Japanese are working night andday on both machines and programs.More efficient knowledge representationsand better AI architectures are theprimary needs, but advances in naturallanguage under tanding are also neededto make such systems really acceptable.

3.6 Intelligent Information-RetrievalSystems

The NaturalLink program mentionedin the previous section, and the INTELLECT

(Hassett, J., 1984) program alludedto in Section 2.2, are examples ofsuch systems. Similar systems could

be very helpful for accessing libraryservices, so a handicapped user couldsimply ask for the information heneeds using his own terminal, whichwould have adaptations he might need,and receive this information in plainEnglish. With advances in AI architec-

tures, it will be possible in thenear future to store a considerablelibrary in a space the size of afiling cabinet drawer, and the userwill be able to roam at will throughthis store of information, adding,deleting, and annotating as he chooses- -

all in English. This will be ofgreat benefit to disabled students,lawyers, engineers, etc.

3.7 User-Friendly Computers

Basically, this is what we'vebeen talking about in the last twosections. But user-friendly computers,computers that the user feels comfortablewith which he can operate withoutreading the manuals, are more thanthis. They are also computers thatcan be programmed, perhaps not inordinary English, but at least ina stylized version of English, thatdon't have to be told every littledetail of the program. They arealso computers which learn abouttheir users so that they know whatto expect under given circumstances.Like the ICAI systems discussed inSection 3.4, they might build upa model of the user's mental processesand might have some understandingof psychology. (Programs which mimicvarious types of psychotherapy havealready been tried.)

3.8 Making AI Comprehensible toOrdinary Programmers

This is an important issue,because AI has developed in the hothouse

atmosphere of academia. If AI techniques

are to be widely applied, both theprogram and the programming languagesin which they are expressed mustbe understandable to more peoplethan computer science casters. Indeed,

90


they are often not comprehensibleeven to this elite. Much of thisabstruseness is due to the use ofquasi-mathematical forms of expressionand to habits of convoluted thinking.AI programming is not for everyone,but simpler techniques should be within the reach of most programmers.

The Ih Interface

This section is included becausedisabled persons typically have "input"or "output" problems. In precedingsections, i .e., on user- friendly computers,I have discussed what might be calledthe "cognitive interface." Discussionof the physical link between humanand computer now seems in order.

4.1 The Inadequacy of °resent Interfaces

Although the most common humancomputer interface--the combinationof keyboard and TV screen--has obviousdisadvantages for persons with eithersensory or motor impairments, it is

true that with special adaptive devicesa disabled person can have a better"linkage" with the world through acomputer. At least a limited abilityto understand speech, will be a greatadvance when it comes, but it willnot help the nonverbal. Technologyis now arriving for another type ofinterface, as applicable to the disabledas to the nondisabled; it will puteveryone on an equal footing.

4.2 Direct Connection to the NervousSystem

The statement has been made,and may well be made again, that thecomputer is the most potent mentaltool ever invented. Why not, then,bypass possible inoperative organicsensors and effectors and connectit directly to the nervous system?Computers which are small enough tobe implanted inside the body are alreadyavailable. The chief problem is theprovision of power and, of course,the actual interface. Research has

91

been conducted at the Universityof Utah and el sewhere on the implantationof electrodes in the cochlea, orinner ear. A long series of experimentshave been completed by Dobeel (1979)and his colleagues in which electrodeswere implanted in the visual cortexof human subjects and stimulated,with encouraging results. It is

my feeling, however, that this latterapproach is unduly invasive and dang-erous. It is better to make theconnection to the peripheral nervoussystem which is more robust thanthe brain and can regenerate if amistake is made. At present thiscan actually be done, though crudely.

4.3 Towards Symbiotic Human-ComputerSystems

It is the dream of every disabledperson to have free access to allinformation, and to control as muchof the external world as his/hernon-disabled counterparts. Computertechnology and neurophysiology areprogressing to the point that a humanbeing and an intelligent computercan be linked into a truly symbioticentity in which each member doeswhat he/she/it is best capable ofdoing. The human has full scopefo,. exercising imagination, intuition,and creativity. The computer hasits abilities for fast calculationsand for precise logical reasoning.In the case of a sensorially deprivedhuman being, the computer would alsoprovide enough perceptive power thatthe human could use his adaptiveability to learn to interpret theexternal world through the artificialsenses. A motor-impaired personwould be able to control his environmentor a vehicle through thought alone.Although this concept of a human-computer

team is applicable to everyone, itis quite possible that disabled personswill be among the first to put itinto practice.

80 Di3covery '84 Technology for Disabled Persons

Special Application Areas for the Disabled

Al though the general application

areas discussed in Section 3 will

be of great advantage to the disabled,there are also a few applicationswhich are unlikely to be taken upin any other content. These are discussed

in this section.

5.1 Perceptual Aids

Two principal types of aids for

the sensorially-deprived are likelyto be developed; visual guidance systemsfor the blind and phonetic transcriptionsystems for the deaf. The formerwould guide a blind or deaf -blinduser safely through an urban environment,perhaps even enable him to drive a

car. Formidable problems in "sceneanalysis" must still be overcome,but one of the greatest difficultiesis conveying the perceptual informationthrough auditory and tactile channelsof limited capacity. A perceptualaid of this type is now under developmentat the Smith-Kettlewell Eye ResearchInstitute in San Francisco. I am

working on such a device, but takinc;a different approach.

A phonetic transcription aidfor the deaf would monitor a conversation

and produce a phonetically-spelledtranscript of it in a written form,perhaps on a video monitor (TV screen),or in Braille for deaf -blind users.It would al so be capable of identifyingvarious speakers for its user. Such

a device might be relatively easyto build, yet the complexities ofspoken language requires some under-standing of the subject matter tomake an intelligible transcript.Greater advances in the understandingof spoken 1 anguage are, therefore,needed before it can become viable.

5.2 Intelligent Environment - ControlSystems

The term "intelligent" meanshere that the environmental control

system will respond to commands in

normal speech and not just the isolatedwords that most current systems canhandle. It will learn about theneeds and desires of its user, sothat it will be capable of adjustingthe environment without exr! icitdirections.

5.3 Intelligent Wheel chairs

An intelligent wheelchair imposesmore stringent requirements thanyour ordinary, run-of-the-mill intelligentvehicle, because of its small size

and peculiar operating environment.It should be adaptive, learning howto adjust to its user; it will respondto spoken commands and it may incorporate

an environmental-control center.It might al so contain perceptualaids and effectors, as well as

information-processing facilitiessuch as an intelligent word processor.

5.4 Helper Robots

The intelligent wheelchair discussed

above is practical ly a robot witha human user providing the majorityof the control and decision- makingfunctions. Helper robots capableof independent operation will become

feasible before the general problems

of robotics are sol ved, just as industrial

robots are feasible now. Experimental

machines are al ready in existence.A robot arm developed at John Hopkinshas been helping quadriplegics feedthemselves and do office work fora number of years. A guide dog robotdeveloped in Japan has successfullyguided blind users along paths markedout with special "landmarks." These

devices, however, are quite unintelligent,

as they lack learning ability ahtido not respond to natural language

commands.

Concl usions

Based on the above, I wouldlike to propose the following gui del i nes

for determining whether an aid is"intelligent." A device may deserve

92

Discovery '84 Technology for Disabled Person;: 51

this adjective if it satisfies oneof these guidelines to a high degree,or several of them to some degree.

1. Does it have some perceptualability, i.e., can it analyzea scene or understand humanlanguage?

2. Does it have an internalmodel of its user, so thatit an guess his/her stateof mind?

3. Does it learn?4. Can it reason logically,

drawing conclusions frompremises?

5. Can it make plans?6. Is it self-programming?

Acknowledgements:

I wish to acknowledge the contri-butions of Abbi-jane Laue,whoseassistancein research and discussion of materialhas been invaluable.

REFERENCES

Barr, A., Chohen, P. R., Feigenbaum,E. A. (1982). The handbook ofartificial intelligence, (Vols. I,II, & III). Los Altos, CA: WilliamKaufmann, Inc.

Clocksin, W. & Mellish, C. (1981).Programming in Prolog. Springer-Verlag.

Dobelle, W., Quest, D., Antunes, J.,Roberts, T., & Girvin, J. (1979).Artificial vision for the blindby electrical stimulation of thevisual cortex. Neurosurgery, 5(4),521-527.

Duda, R. (1981, September). Knowledge-based expert systems come of age.BYTE, pp. 238-279.

Feigenbaum, E., & McCorduck, P. (1983).The fifth generation. Reading,MA: Addison-Wesley.

Hassett, J. (June, 1984). Hackins,in plain English. Psychology Today.

Hochmair-Desoyer, I. J., Hochmair,E. S., Burian, K., & Fischer, R. E.(1981). Four years of experiencewith cochlear prostheses. MedicalProgress Through Technology, 8,107-119.

Paxton, A., & Turner, E. (1984).The application of human factorsto the needs of the novice computeruser, Int. J. Man-Machine Studies,20, 137-156.

PsYMology Today, (December 1983),17(12Y

Samuel, A. L. (1963). Some studiesin machine learning using thegame of checkers, in Computersand Thought, ed. Feigenbaum, E. A.,& Feldman, J. (1963). New York:McGraw-Hill Book Company.

Schneider,W.,Schmeisser,G. &Seamone,W. (January, 1981). A computer -aidedrobotic arm/worktable system forthe high-level quadraplegic.Com i.pr:.

Shortl iffe, E. H. (1976). Computer-basedmedical consultations: MYCIN.New York: American Elsevier.

Winograd, T. (1972). UnderstandingNatural Language. New York:Academic Press.

Zaden, L. (1984). Coping with theimprecision of the real world:Interview with Lofti A. Zadeh.Communications of Vie ACM, 27

-(4), 304-311.

93

THE CONNECTICUT SPECIAL EDUCATION NETWORKFOR SOFTWARE EVALUATION

(ConnSENSE)

CHAUNCY N. RUCKERFRANCIS X. ARCHAI4BAULT, JR.

KRISTIE Y. DAVIS

ABSTRACT

This presentation overviews theactivities of the Connecticut SpecialEducation Network for Software Evaluation(ConnSENSE). The overall goal of

this project is to develop and fieldtest a statewide model that evaluatesthe effectiveness of special educationmicrocomputer software and to disseminatethe results within Connecticut andbeyond. To insure that this goal

is achieved, we have developeda softwareeval uation model and instrument, conducted

a software needs assessment, trainedteachers and administrators to evaluatesoftware, evaluated microcomputersoftware, developed a disseminationmodel to be used by the Connecticutstate Department of Education, anddevel oped a special education microcomputerusers group. We believe that theseactivities are helping special educationteachers and administrators throughoutConne 'icut to select more effectivemicr, iputer software and therebyto deliver a higher quality instructionto handicapped children.

During the past week, IBM rockedthe computer industry by announcinga new family of integrated softwaredesigned to challenge the ever-expanding

set of highly successful but smallersoftware companies (Rasie, 1984).Given current software sales of about$2.7 billion and projected salesof $23.5 billion by 1989, this moveinto the software business arenamight have been anticipated. outthe issue of access to quality softwaredesigned for educational applicationsremains. In fact, many analystsand experts, including Terrel Bell,

U.S. Secretary of Education, haveargued that this is precisely theissue that will determine whethermicrocomputers can have their muchheralded long -term educational impact(Bell, 1984).

The Connecticut Special EducationNetwork for Software Evaluation (Conn-SENSE) was funded by the ConnecticutState Department of Education, Bureauof Student Services, as a vehiclefor insuring that special educatorsthroughout the state have accessto information on "software thatworks." During the past year thisproject began the long and arduousprocess of software evaluation andinformation dissemination. Belowis an overview of the project, theprocedures which we used for softwareevaluation and dissemination, andour achievements to date.

Project Design

General Design

The overall goal of Connecticut'sSpecial Education Network for Software

v.

Discovery '84 Technology for Disabled P'rsons 83

Evaluation (ConnSENSE) has been todevelop and field test a statewidemodel to eval uate the effectivenessof special education microcomputersoftware and to disseminate the resultson a statewide basis. To achievethis overall goal the project hasdeveloped a software eval uation modeland instrument, conducted a softwareneeds assessment, training teachersand administrators to evaluate software,eval uated microcomputer software,developed a dissemination model thatcan be used by the Connecticut StateDepartment of Education, and developeda special education microcomputerusers group. Details on these activitiesfollow.

Special Education Software EvaluationInstrument

Several approaches have beenproposed for the eval uation of educational

software. However, only a few havebeen developed with the specific needsof the handicapped in mind. Consequently,

ConnSENSE's first major activity wasto develop a model and instrumentfor the evaluation of special educationsoftware. The ConnSENSE CoursewareEvaluation Form that emerged relieson previous work in the general areaof software evaluation (e.g. Microsift,EPIE, MCE Inc., etc.), while beingsensitive to the specific needs ofhandicapped children.

Cons i s tent with much of the 1 iterature

on evaluation in general and softwareevaluation in particular, our instrument

calls for both descriptive and evaluativeinformation. Descri ptive informationincludes general concerns (e.g., title,author, publisher, etc.), hardwareconcerns (e.g., memory requirements,disk and printer requirements, needfor speech synthesizer, etc.), publisher

support policies (e.g., preview, backup,and guarantee) , publisher claims concerning

suitability for specific handicappingconditions, and general program goalsand objectives.

Evaluative information is providedon a five-point Li kert Scale for specific

items relating to the general categoriesof Program Documentation (e.g., avail-ability of supplementary teacherand student material , operating instruc-tions , etc.), educational validity(e .g. , content accuracy, adherenceto accepted 1 earning/teaching practices,

relationship between content andobjectives, etc.), Presentation/Instructional Quality (e.g., suitabilityof screen displays, use of branchingand feedback, availability of helpscreens, etc.), and Technical Qualities(e .g. , reliability, ease of use fordesignated population, etc.). In

addition to ratings for individualitems, an overall rating is alsoprovided for each of the generalcategories. Evaluators are alsogiven the opportunity to commenton strengths and weaknesses. A four-point

Li kert Scale (4=excellent, 3=good,2=fair, 1=poor) is used for the overallrating.

Although we feel that this infor-mation is important for an overallevaluation of educational courseware,much of what has been described canbe found in instruments designedfor the eval uation of software producedfor the general population of students.However, it is "special educationcourseware" which is the major concernof this project. Thus, bases in

part on work by Rucker and Vautour(1978), we have included two othergeneral sections on our instrument.The first concerns the level of skillrequired for the student to use thesoftware. The second concerns theextent to which the software canbe modified so that it might be usedby children with various handicappingconditions. With information in

the first of these areas, a specialeducation teacher will be able todecide whether the courseware matchesthe skill level of a particular student ,

regardless of whether the coursewarewas developed for handicapped children.

With information in the second areathis same teacher will be able todecide whether courseware that doesn'tfit a particular skill level can

95


be modified for a particular student.It is these two areas in the ConnSENSECourseware Evaluation Form that areunique to the needs of handicappedstudents.

Looking firstat the skills category,we ask evaluators to provide informationon the software's reading level and

interest level. A continuum of manualdexterity is provided ranging fromthe used of paddles to touch typing.lo accommodate the visually handicapped,a continuum of text size is included.Some of the other skill areas includecol or discrimination, speech (for

voice activated programs), hearinglevel, eye-hand coordination, andsequential memory requirement's.

Rucker and Vautour (1978) pr)poseda rationale for modifying IEPs forhandicapped children that has utilityin terms of modifying courseware forhandicapped children. These modificationsfall into the four areas of presentation,performance, content, and time. Presen-

tation modifications in the instrumentinclude print size, use of a speechsynthesizer, and graphics. Performancemodifications address ways a student

displays mastery of a specific skillor concept. Examples in the instrumentinclude snout via voice, switches,light pen, etc. Exaf;:plec of contentmodifications are programs that allowthe teacher to input spelling wordsor letters for a letter recognitionexercise. Two additional items thatdon't quite fit these categories,but are nontheless important, havealso been included in the evaluationinstrument. These are the kind offeedback presented (e.g. , sound, graphics,

and animation), and the type of rein-forcement schedule utilized (e.g.,

consistent or random). The last partof our instrument provides evaluatorswith an opportunity to give an overallassessment of the courseware and to

offer some summarized comments onthe courseware' s strengths and weaknesses.

It displays a rating for each of thefour major evaluation areas plus anoverall "grade." There are also comments

on the skill level required and any

modifications possible. Finally,there are summary statements on thesuitability of the courseware withparticular groups of children.

TheConnSENSECoursewareEvaluationForm was reviewed by various contentexperts in special education andmodified, based on their comments.The form was then field tested atthe University of Connecticut withthe first cadre of software evaluatorsin March of 1984. Further modificationswere made after this session. The

second cadre of evaluators (May,

1984) contributed additional modifications

that resulted in the present formof the instrument. Software usedby special educators can be categorizedinto either management software (e.g.,IEP development, record keeping,etc.) or courseware. Further, withinthe latter grouping is material designedfor most children for "regular" education

and material that publishers claimis specifically designed for handicapped

children or can be modified for them.Although the ConnSENSE CoursewareEvaluation Instrument was designedwith this latter type of softwarein mind, it can be used to evaluateeither type of courseware. However,the instrument is not suited to theevaluation of management software.The SECTOR project at Utah StateUniversity has developed an instrumentfor this purpose.

Evaluate Connecticut Special EducationMicrocomputer Software N&is

ConnSENSE completed a Connecticutspecial education microcomputer softwareneeds assessment in October of 1983.Some of the results of that surveyare:

1. Eighty-seven percent of the schooldistricts had one or more computersavailable for special educationstudents.

2. Seventy-six percent had Apples(range 1-157), 39 percent had

Radio Shacks, and 26 percenthad Commodores. Three percenthad Ataris or Texas Instruments,

96


and we only found one IBM beingused for instruction with handicappedstudents.

3. Special education students usuallygained access to microcomputersin a special class or resourceroom (79 percent), but they alsoused them in regular classes (57

percent) and computer rooms (53

percent).4. Over half of the respondents indicated

a severe need for high qualitycourseware for children withlearning disabilities.

5. Microcomputers were being usedmost for computer instruction(63 percent) and word processing(43 percent).

6. Areas of future need focus primarilyon administrative uses of microcom-puters, such as record keepingand IEP development.

Select and Train a Cadre of SpecialEducation Evaluators

The Connecticut Special EducationResource Center (SERC) announced theproject in a special October 1983mailing. This described the projectand solicited special education teachersand admini :trators actively usingmicrocomputers who wanted to be trainedin using our software evaluation instru-ment. A similar request for volunteerswas included in the first projectNewsletter. We planned to selecta cadre of about 20 people to trainfrom those that responded.

Over 300 people responded tothe first mailing, however, and 75percent of them indicated that theywanted training in software evaluation.Moreover, this number grew to over500 after publication of our Newsletter.Although the project did not plan

to train more than 20 teachers, weended up training two groups of 14.In addition, as will be discussedbelow, we made arrangements with Con-necticut State Department of Educationso that the needs of those still interested

could be addressed.The training involves a thorough

description of the instrument, trialuse of the instrument to evaluatea particular piece of software, andcomparisons of responses on the evaluation

instrument to this sof..ware. After

this the cadre began evaluating otherpieces of software from the projectcollection.

Obtain and Evaluate Special EducationMicrocomputer Software

Project staff wrote to softwareproducers to request their cooperationin our evaluation effort. The initial

list of companies was drawn fromthe LINC Resources list. Response

to this first request was slow, probablybecause we wrote tc companies withouthaving the names of appropriate company

official-. Nonetheless, we got theimpression that some companies werereluctant to provide free copiesof software for review. Thus, wedecided to purchase our software.This solves the problem of supplyand also resolves any conflicts thatmight result from receiving freesoftware.

As the software began arriving,the project staff reviewed it todetermine whether it was (a) relevantto special education instructionor management, (b) in an area thatfits established Connecticut specialeducation microcomputer needs, and(c) free of major technical errors.

Software which meets these criteriais evaluated by at least four ofour cadre of special education softwareevaluators having the particularexpertise required. Their reportsare assembled into an overall evaluationreview by the project staff, andthis review will appear in the nextissue of the ConnSENSE Bulletin.

Dissemination Model

The project has assisted theConnecticut State Department of Education

in the development of a model for

disseminating the results of softwareevaluations across the state. The

9'7


ConnSENSE Bulletin, mentioned earlicr,is the major component of the dissemi-nation model. The first mailing ofthe newsletter (January, 1984) wassent to (a) all special educationadministrators andsupervisorsthroughoutthe state, (b) others who may haveattended the first Connecticut Micro-computer Conference on Special Education(10/82), and (c) those who respondedto the announcements in various publi-cations. Our aim was to disseminatethe Newsletter to all special educationadministrators, supervisors, teachers,pupil personnel workers, and others,including parents, interested in specialeducation microcomputer software.

Three issues of the ConnSENSEBulletin were published during the1781-78T year. The content of thefirst has been described above. Thesecond Newsletter went out in Apriland described the results of the needsassessment questionnaire and providedinsights on special education hardwareand software usage in Connecticut.It also included comments receivedregarding the more popular specialeducationsoftware. This issue containedour first set of five courseware reviews.The newsletter also contained statewidehighlights regarding computer usagewith handicapped students, a questionand answer section, and a calendarof computer events. In this and thefollowing newsletter, the readerswere encouraged to consider attemptingin-depth field studies in their schooldistrict. Finally, the readers wereencouraged to join SpecialNet so wecould expand our computer network.A third issue published in Augu.,'

contained similar information as wellas 15 additional courseware reviews.

ConnSENSE constitutes a usersgroup of people interested in computersand the needs of handicapped students.Our membership is over 900 at thispoint. The project supported an annualConnSENSE meeting at the Universityof Connecticut in July of 1984. Nearly200 members attended a day of workshopsand presentation highlighted by a

keynote presentation on the DLM Arcademics

Software by Jerry Chaffin and BarbaraThompson.

First Year Reflections

In reviewing our first yearof operation, we feel we have accomplished

a great deal. We have an instrumentthat is providing useful informationfor software reviews. We have completeda statewide needs assessment on computeruse with handicapped students. Wehave trained in excess of 30 teachersand educators in software evaluation.Have evaluated more than 20 piecesof software and published the reviewsstatewide. Our Bulletin seems tobe popular and useful. We have a

very large group of special educatorsinterested in computers and the needsof handicapped learners. This grouphas held its first meeting, and thefuture looks good for continued exchanges

of ideas.The future looks bright for

ConnSENSE. The State Departmentof Education, through SERC, willfund at least six one day softwareevaluation workshops et regionallocations as in the Fall of 1984.hese should include at least 240

special education teachers and admini-strators. We will attempt to pickthe most promising evaluators fromthese workshops to return for anotherday of evaluations. We hope to evaluateat least 50 more pieces of softwareand publish these evaluations in

three issues of the ConnSENSE Bulletin.During the first phase of the

ConnSENSE project we had hoped toconduct a feasibility study of computernetworking within Connecticut. Fortu-

natel;:, the State Department of Education

issueo a Request for Proposals onthis subject, and, as a result, wewill be moving in this area. A newproject, ConnNET, has been fundedby the Connecticut State Departmentof Education, Bureau of Student Services,

and will be housed at the Universityof Connecticut Special EducationCenter. Its activities will include:initiating Connecticut bulletin board

98


on Special Net, developing and dissemi-nating a Connecticut Special Net, evaluating

telecommunications equipment needsof Connecticut school di stricts, selecting

30 school districts for SpecialNetsubscriptions and training, traininglocal school district and State Department

staff in SpecialNet use, and developinga technical assistance plan for thestate to use in continuing ConnNetactivities.

These activities, combined withthose begun during the past year,will allow us to take another steptoward imprr.sving computer educationservices within our state. Moreover,

by collaborating with other statesal so engaged in software evaluationand telecommunication activities (e.g.,Florida, Utah, and Kansas) we maybe able collectively to make stridesthat none of us could make alone.

REFERENCE

Bell, T. (1984, January 19). Education

secretary criticizes some schooluses of computers. The HartfordCourant.

Rasie, L. B. (1984, September 26).Software move reflects major IBMstrategy shift. The Hartford Courant,pp. A15, A18.

Rucher, C. N., &Vautour, J. A. C. (1978).

Don' t forget the regul a.. clasroom

teacher! In B. B. Weiner (Ed.),

Periscope: Views of the individualized

education program. Reston, VA:

Council fcr Exceptional Children.

99

AN IMPROVED ROW/COLUMN SCANNING SYSTEM

LAWRENCE H. WEISS

Introduction to Row/Column ScanningABSTRACT

Row/Column scanning is an efficienttechnique for any technology requiringspell ing by nonspeaking persons.Several computer access devices havebeen developed using this single switchuser system. In this paper, the essentials

of row/col umn scanning devices areoutlined. The advantages and disadvantagesof the use of these devices by personswith disabilities are examined.

Row/Column Scanning is a fairlyrapid and very powerful techniquefor accessi ng a 1 arge number of selections

with a single vol itional action.The user must have very good

visual tracking skills and not besusceptible to uncontrolled reflexaction caused by the strobing lights.

The individuals that have themost to gain by the use of Row/ColumnScanning devices are those with onlyone vo' itional action (like ALS victims)

or those who, although they .havepointing skills, need access to devicesat all times without expending excessenergy (like some with Cerebral Pal sy).These "single switch users" havenothing without some type of scanningaccess technique. Whatever is gainedis significant, namely an infiniteincrease in capability. Any gainafter that is gravy.

The variety of needs of thesingle switch user include communication,

mobil ity, and environmental control.

They need these for education, employment,

acts of daily living, end a littledignity for an existence where it'sgenerally denied.

There is no doubt that systemscould be accessed more quickly bydirect means such as pointing (withbody parts, body held or worn toolslike mouth sticks, eye gaze, remotepointers like light beams, etc.),or by an encoded direct means suchas Morse Code. But usually, thesetasks cannot be performed exceptunder specific circumstances.

We must always keep in mindthat although scanning techniquesare relatively slow, they are consistentand effective. A user will neverbe a conversationalist at 200 pluswords a minute, but may become aneffective communicator at 6 plus

100


words a minute.

Essentials for Row/Column Scanning

There are some essentials foreffective use of a Row/Column Scandevice:

1. The device must be designedwith an understanding ofthe criteria of Row/ColumnScanning: i.e, the presentationof the scanning display and

the layout of informationon the display panel arecrucial.

2. The technique for use ofsuch a system needs to be

taught to the user from the

beginn'ng.The fundamentals for a proper

Row/Column Scanning device were func-tionally presented in the Tufts Inter-active Communicator (TIC) developedby R. A. Foulds et al., in the early1970's. A number of matrix scanningdevices were available before thattime and some have emerged since.Few, however, followed the guidelinesthat were in place in t'.1 TIC.

Qualifier:The following comments

are specifically pointingout shortcomings in alternatesystems. There are validreasons for the systemsto be the way they are.This is only an attemptto clarify the design charac-teristics of efficient Row/Column

scanning devices.

The most critical oversight ofRow/Column Scanners is the presentationof only one light at a time duringthe scan of both the rows and thecolumns. The user's tracking skillsto select an item from the matrixbecomes limiting.

The second oversight is to presentthe user with only one row at a time,and to then scan that row. In this

case, motor reaction time to the changing

visual presentation of information

is restrictive.The third area of concern is

the continual changing of the displayto apply predictive techniques inan attempt to reduce overall selectiontime. These procedures detract fromthe learned experiences of a fixeddisplay while also increasing reactiontime as described above.

The severest viol ation to effective

Row/Column Scanning is the display

panel layout. There seems to be

great hesitation to deviate fromthe 'norm'. The use of straightalphabet (A, B, C, etc.) and thetypewriter (Q, W, E, R, T, etc.)layouts abound. It has been provenover and over again that these layoutsare as much as 40% slower than a

Frequency of Use layout.

"Well then...," how did theoperate?

The entire matrix was alwaysin view. All the lights of eachrow were presented during Row Scanning(the entire row was illuminated simul-taneously). After selection of arow, each light in that row illuminatedsequentially until one was selected.The selected light flashed and RowScanning resumed. The flashing period

was a confirmation and correctiontime wherein the selection was negatedif the operating control was actuated.

The alphabet layout was Frequencyof Use with most common charactersin the upper left corner and numbersneatly grouped for easy reference.

The user would fixate on thecharacter to be selected and NOTON THE FLASHING LIGHTS. The operatingswitch would be actuated when thedesired character was illuminatedduring Row Scan and, without lookingaway from the desired character,the user waited for it to illuminatea second time (during Column Scan)to make the final selection. There

was ample time during the confirmationperiod to locate the next selection.

These characteristics were subse-quently plagiarized for use in the

101


ZYGO model 100 Communication System.Observation of users showed withouta doubt that scanning speeds fasterthan .25 secs/step were possible,even by those with severe athetoidcerebral palsy or advanced A.L.S.

The actual output (in words perminute) wasn't as high as indicated.Although the scan speeds were high,so was the false selection/correctionactivity. It was difficult for mostuses to 'catch' the first rows orfirst columns after switch actuation.The alternatives were to either waitfor the scan t;) wrap around and catchthe row or column on the second pass,or to actuate the switch multipletimes to force the scan back to thebeginning without making an actualselection.

Another approach to assist theuser was to leave the first row andthe first column blank; the user couldn'tget to them anyhow. This defeatsthe entire concept of the layout.

Design of a More EfficientRow/Column Scanning Device

The primary consi derations , therefore ,

in designing a Row/Column Scanning'keyboard' for computer access byprofoundly physically handicappedindividuals were a way to reduce theeffects of missing the early rowsand columns and to pay considerableattention to the information layout.

The Scan

After careful observation ofa number of Model 100 users it wasdetermined that there appeared tobe a reaction time to actuating acontrol switch to select the earlyrows and columns. Furthermore, thereaction time seemed to exist witheveryone, those who were able bodiedwith good reaction as well as thosewho were physically disabled. And,it didn't matter what the scan speedswere; while working at one's bestspeed those first rows remained elusive.

Also, it seemed that when the

scan was in its 'steady state', thatis continuously scanning, each individual

could catch the desired selectionwith considerable accuracy.

The reaction time was not tothe steady state scan...it was tothe change in presentation. Whenthe row was selected, the body neededto react to the new presentationand it wasn't primed to do so. Evenmore prominent was the change fromthe flashing confirmation to thetop row.

The solution was to providea "non-linear presentation" (PatentPoolied For). The scan, rather thanbe uniform with the timing of eachstep the same as the one before,was slowed down after each actuationof the control switch and graduallyincreased to the preset steady staterate.

If the steady state time perscan is 't', then after an entrystrobe the first row of lights wouldremain lighted for a time greaterthen 't', like 1.5't'. The nextrow would remain on shorter time,and so on until the fifth row, werethe scan would revert to sts timeper step.

Faster scanning speeds can beused with this technique withoutthe customary missing of the earlyrows and columns. It is obviousthat the selection time for a perfectuser would be longer than withoutthe added delays, but for the imperfectaverage user, overall selection timeis greatly improved due to the reductionof the error/correction selections.

The Display Panel

For purely electronic considerations,

the display was restricted to an8 x 8 matrix. Multi-levels werenecessary to accommodate even thebarest of selections. The alphalayout was the easiest: stay withthe TIC layout. Since selectionof levels and operational functionsseemed to be less important thanthe characters, they were delegated

102


to the eighth col umn, with the fundamental

level at the top, in the shortesttime to access position.

As in the TIC layout, the numberswere to take a cleanly formatted appearance

since they have no Frequency of Useorder. Also, for similar reasons,the mathematical functions were neatlygrouped adjacent to the numbers.

The Return key was put in theclosest space available at the outsideof the alpha pattern since it is themost used computer key. The punctuation

and the other computer functions filledin the gaps.

Levels I, then, contains lowercase characters, primary punctuation,numbers, and math functions. Level

II, just as with the computer keyboard,contains upper case characters andthe other punctuation and symbols(and a bonus of six function keysin row eight). Level IV is the controllevel and functions just as on thecomputer. Levels III, V, and VI (and

the six squares in the bottom rowof Level I) are user-programmable.

Frequency of Use Research

ZYGO Industries , Inc. has undertaken

the development of a program for theAPPLE II to determine effectivenessand efficiency of various displaypanel configurations.

At present, the program allowsthe introduction and storage of anytext and any alpha-numeric pattern

(called the "board"). The program

will process text with any boardand display the number of charactersin the text, the number of selectionsthat needed to be made, a normalizedtime to have scanned the text, anda unit of measure (the normalizedtime divided by the number of selections)

for reference.The program then provides the

quantity in the text of each itemon the board to that ranking.

Of the text tried, improvementsto the TIC layout remained below1%.

Future refinements of this program

will include the ability to workwith multi-levels and include allthe functions on the display panel.Although the present program allowsthe use of blends up to four charactersto be in the board, the future versionswill allow larger groups and phrases.

Advantages of Row / Column Scanning

1. Consistency. There is anacquired skill in using a Row/ColumnScan device much like that of a typist.The location of elements to be selectedis always the same and , more importantly,

the timing for access is always thesame. For example, let's look atspelling the words that contain theletter 'e' in this sentence alone.The :e' follows 'space', '1', 'w',

's', 'h', 'b', 'p', 'h' and '1' a^ain,lts , the 'apostrophe', 's' and 't'

again, and then 'n'. If the sentence

was being directly selected froma keyboard with one finger therewould be the consistency of lo(.ation,but the motions to get to the 'e'

would be all over the keyboard.Realize that with Row/Column Scanning,the time to select each 'e' would

be exactly the same regardless ofwhat preceeded it. This speeds upthe selection process with improvedaccuracy as a user gains experience.

2. Positioning Insensitive.Single switch use allows operationfrom virtually any position, andfrom varied positions, with similar

103


ease. For someone with reliable headcontrol it may be practical to usea head actuated switch while sittingin a wheelchair, a different switchwhile in bed, still another from thetherapy mat. Someonewithlowerextremitycapability might use multiple switchesthat do the same thing (in parallel).,They could be arranged for knee actionand foot action, in order to reducethe fatigue of using either set ofmuscles while allowing continued useof the scanning device.

Direct Selection techniques requireproper positioning to the device inorder to be effective. That severelylimits the potential operating timeof the majority of users.

3. Exercise. The continueduse of a single switch strengthensthe associated muscles to where userscan continue to function for prolongedperiods, not only daily but for extendedyears.

4. Learning Time. The techniquefor Row/Col umn Scanning i s straightforward

and easily learned in a short time(sometimes it's instantaneous). Othersin the user's environment could alsointeract with the scanning device(i.e., for assistance in arrangingprogrammed messages). The user needsonly to have a switch positioned andthe scanning device in view in orderto operate it.

Disadvantages of Row/Column Scanning

1. Tracking Skills. The usermust nave tracking skills that aresophisticated enough to follow thescanning lights and actuate an operatingcontrol in concert with the lights.Very poor tracking skills that cannotbe improved should preclude the useof a Row/Column Scanning device.(A Linear Scanning device might beappropriate).

2. Visual Skills. The usermust have eyesight good enough tosee the lights as well as the informationcontained within the auditorily, i.e.,a person or device can present rowsand columns verbally with selections

made by cues from the user. In thiscase the user's auditory skills andability to comprehend the auditorycues would apply).

3. Strobing. The strobinglights may cause undesii.ed seizureeffects in some individuals. Thiseffect must also be considered ftrothers in the environment of theuser. Although the user may notbe affected, others who may see thedevice might be.

REFERENCES

Beukelman, D. R., Yorkston, K. M.,Department of Rehabilitation Medicine,

University of Washington, Seattle.Damasco, P. W., Foulds, R. A. (1982).

"The Development of CommunicationDevices Based on the PanasonicHand Held Computer", Proceedingsof the Fifth Annual Conferenceon Rehabilitation Engineering,19.

Foulds, R. A. (1972). "A CommunicativeAssist for the Nonverbal SeverelyHandicapped," M.S. Thesis, Engineering,

Tufts University.Roy, 0. Z., Charbonneau, J. R. (1974).

"COMHANDI," Aids for the SeverelyHandicapped, 89-98.

Vanderheiden, G. C., Grilley, K. (1975)."Normal vs. Predictive Scanning,"Non-Vocal Communication Techniquesand Aids for the Severely Physically

Handicapped, 37, Fig. 15.ZYGO Industries, Inc. (1983). "Row/Column

Scanning," TETRAscan II Brochure.Ibid., "Scan Linearity, " Technical

Specifications.Ibid., Display Panel.

104

DESIGNING TECHNOLOGY CENTER FOR ILLITERATE ADULTS

TERILYN C. TURNER

ABSTRACT

111 iteracy has been called the"hidden handicap" because adults with1 iteracy probl ems are adept at camouflaging

their di sability through years of

practice and neccessity. The developmentof technology and the advent of micro-computers open new possibilities forbasic literacy instruction. The designand operational requirements of a

technology-assisted basic skills centerare described, using an existing centerin North Carolina and one being plannedin Minnesota as models.

Literacy is a "hot" topic now.To be more specific, illiteracy isa hot topic, which is c-eceiving national

attention from the press, the WhiteHouse, and several large businessconcerns. To those of us who havebeer. in the literacy field for sometime,

the attention is somewhat astonishing.In some ways it is a great relief;I no longer have to explain whatI do for a living. People have heardof functional ill iteracy, even if

they are not entirely clear whatit is, or what should be done aboutit.

The more difficult aspect ofthis new national consciousness is

simplistic solutions to a complexand enigmatic problem. The suggestionthat by simply recruiting enoughvolunteers, the problem will vanish,

is a widely promoted myth, particularlyby those reluctant to invest capitalin literacy efforts. Likewise, a

recent "innovative" program designedto train work study students as tutors,was viewed with disdain by many educators

who have been impl ementating thatsolution for the last five years.In other words, we are seeing oldsolutions to an old problem.

Adult functional ill iteracyis a crucial probl em affecting theeconomic, social , and political vitality

of America's communities (P1 oetz ,

84). An estimated 23 million Americanslack the basic reading and writingskills necessary to function effectivelyin our society. An additional 30

mill ion are estimated to be marginallyable to cope with the demands ofdaily life (Hunter, 79). The 1980census affirmed the accuracy of these.earl ier figures, indicating that20% of our citizens do not have highschool diplomas, and skill level

required to function effectively

105


in our society is spiraling upward.Think, for example, of the secretary

trained to use a dictaphone, who nowmust use a wordprocessor; or thinkof the auto mechanic who receivesmanual s and updates on the repairof electronic equipment in our automo-biles. The literacy measures movesteadily upward, paicularly withthe advent of technology. Those whoonce were literate, no longer areliterate in our fast-paced, infor-mation processing society.

Add to this the stigma attachedto ill iteracy, and you have a real

emotional nightmare. It is a pleasurefor me to be in this group, wherestigma is understood. Illiteracy:ias been call ed the "hidden handicap"because adults with a literacy problemare adept at camouflaging their disability

tnrough years of practice and necessity.Difficulty with reading and math

is synonymous with stupidity in oursociety. The possibility of ridicule,and the fear of disclosure have kepta majority of functional illiteratesfrom "coming out of the closet."It is estimated that all the literacyprograms combined are currently reaching4% of the illiterates needing assistance(Hunter, 79).

Clearly, something other thanan old solution is needed to addressa problem of this magnitude. What

I will suggest as a move in the rightdirection, is the incorporation oftechnology into existing literacyprograms. While there is a growinguse of microcomputers in elementaryand high schools, this new technologyhas yet to be used in adult basicinstruction in any substantive way.

Computer-assisted instructionhas been used on a limited basis in

several experimental programs. Byfar, the largest amount of researchin the field has been conducted onControl Data Corporation's Plato System.Plato's Basic Skills Program was designedby the University of Illinois, theNational Science Foundation, and ControlData Corporation (CDC) in 1962. ThePlato Basic Skill s program has been

used extensively in schools throughoutthe U.S. The data collected by thiscompany and others show remarkablegains in reading and math using thePlato System (Lieberman, 83).

The principal drawback to usinga mainframe computer was its expense.The cost of leasing eight CDC terminalsfor one year was $45,000 in 1979,excluding monthly charges for serviceand maintenance. The cost of eightterminals could not be justifiedwhen two full-time instructors couldhe hired instead. Other problemsincluded hardware glitches, softwaredesign, and the fact that instructionwas 1 ',aged to a fourth grade leveland auove.

In the 1 ast five years, themicrocomputer has brought about arevolution in computer usage. These

sel f-contained units allow a flexibilitypreviously not known with the on-lineterminal s. They are portable andrelatively inexpensive. Advancesin tecnnology and the advent of micro-computers open new possibilitiesin the area of basic 1 iteracy instruction.

The computer has some strikingadvantages over other forms of instrui;tion

for functional illiterates. Unlikethe classroom or even the tutoringsituation, the computer is totallypri vat and personal. A computeris infinitely patient, never hurryingor rejecting the learner. Numerous

studies have shown the beneficialeffect of microcomputers on adultself - concepts and self- esteem (Moyl es ,

82). Technology provides the opportunity

for fl exible scheduling, since itis available twenty-four hours a

day.

From the standpoint of adulteducation, probably the most excitingattribute of the microcomputer isits ability to allow the studentto control the learning process.Technology empowers the learner.The functional illiterate who hasal ways been dependent on anotherhuman being for deli tery of instruction,

is suddenly placed in control ofhis own learning. It is truly a

106


revolutionary experience.The question I raise at this

point is, if technology is an appropriate

means of instruction for illiterateadults, why aren't there more computersin adult basic skills programs? I

think there are two answers: one philo-sophical , and the other, practical.Meier:ienry (82) has indicated thatadult education emphasizes goals andobjectives that are internally derived.Likewise, Vacc (83) describes thefield of adult education as highlyhumanistic ana process-oriented.This is in direct contrast to thebehavioral approach found in mostsoftware design. The product orientation,competency-based instruction, andsequential skill development of mostmicro programs leaves adult educatorscold.

The second reason that microcomputers

are not a major part of adult literacyinstruction is their cost. Even thoughthe hardware costs are dropping atan astoeo shi ng rate, the investmentis still seen as a luxury with littledemonstrated value by the majorityof adult educators. Historically,adult education has received the leastamount of funding in the total educational

spectrum. It is not surprising therefore,

that technology would receive a lowerpriority than hiring a teacher.

At this point I would like togive an overview, as I see it, ofthe current use of technology in adultbasic skills programs. Since I am

assuming that many of you are currentlyusing microcomputers in your programs,I think it is helpful to see whereyou fit on a continuum, and to finda frame for your experiences.

I am positing a hierarchicalranking of microcomputer usage, basedon proximity to the learner. Thelowest level , or minimum level, isalso the most prevalent, namely, manage-ment. Microcomputers are used tomaintain student test scores, records,and grades. In the case of literacycouncil s, they are used to generateletters and mailing lists. Plus,databases and wordprocessing are used

l/MM/MCM.1111.11

quite frequently as management supportfor existing programs. There hasbeen some attempt in several cities

to match students and tutors (volunteers),

through zi pcode matching. The capability

certainly exists, but I am unawareof any literacy program that is actually

doing it.

Table 1

Current Use of Microcomputers

in Basic Skills Instruction

I. MANAGEMENT

11.

A. STUDENT RECORDS --DATABASING

B. MAILING LISTS/LETTERS--WORDPROCC. STUDENT-TUTOR MATCHING

IPSTROCTIONAL SUPPORT

A. READABJUIT FORMULAS

P. TEST/TEXT MATERIAL--WORDPRC. GAMES/PACKAGES

III. DIRECT INSTRUCTION

A. SUPPLEMENTALI. COMYERCIALLY AVAIP. AUTHORING SYSTEMS3. TEAChER MADE

B. PRIMARY1. COMMERCIALLY2. EXPERIMENTAL

BLE

SING

,.ESSING

AILABLE--PIATO,CC:DEVELOPED

The second level of microcomputeruse is for instructional support.This is the most rapidly growinguse of technology for adult basicskill instruction. Adult basic education

and literacy programs use readabilityformulas to determine the readinglevel of their materials. Unfortunatelymany of the existing readabilityprograms are more compl icated thantney need to be, providing abundantuseless information.

Wordprocessing is also usedby many teachers to generate testsand text material in basic literacy

1 U'7


instruction. Games and crosswordpuzzles requiring the use of a printer,allow instructors to enrich theirteaching by supplementing instructionwith computer generated materials.One particularly fine example of thiswas in a language experience classwhere the instructor was developinga lesson on reading signs. Afterthe board was filled with signs suggestedby her students, (ex. stop, yield,railroad crossing), she used a programcalled, "Crossword Magic" to generatecrossword puzzles for each student.The crossword puzzles incorporatedthe signs as the answers to the puzzle.This supplemental use of the microcomputer

for instruction, allows the instructoror teacher to remain in control ofthe learning experience.

The third level of current micro-computer usage in basic literacy programsis for direct instruction. In thevast majority of cases it is usedas supplemental to the primary program.Reading or study skills labs willpurchase one or two Apple's, and usethem for drill and practice exercisesin conjunction with an existing program.Typically, the material is commerciallyavailable software. In some cases,an authoring system may be purchasedwhere the teacher is actually calledupon to develop the software. Evenless frequently, software is developedby teachers at the site. This is

usually in response to frustrationwith locating appropriate software.

The least used application oftechnology is, in my opinion, themost interesting; that is, the useof the microcomputer as the primarymeans of instruction. One reasonfor lack of microcomputer use forprimary, direct instruction is thelimited number of total curriculadeveloped.

The two principal curricula developed

for commercially available basic skillsinstruction on the microcomputer are:PLATO and CCC. Other programs hat.se

been developed and are used experi-mentally or in limited markets. However,these two dominate the market at the

present time. Both have difficultywith the lowest end of the spctrum,adults whose reading level is belowfourth grade.

Having described the range ofthe current state of microcomputersin basic literacy instruction inthe ne,on, I would like to describea center that is combining all ofthe different levels in one instructional

program. In operation for one year,the ABLE Center in Charlotte, NorthCarolina, attempts to combine thebest features of each of the methodologies

used currently in Literacy instruction.The Center uses classroom instruction,tutoring, and the computer. It is

unique because the microcomputeris the primary means of instruction.Cablevision, radio, telephone, andthe newspaper are instructional mediaused currently or soon to be addedto the ABLE program. The organizationalstructure includes the use of profes-sionals, clerical, and volunteers.The hardware is a combination ofCDC Vikings and Apples, all usedas free standing units. Softwareis a combination of Plato Basic Skillsand Apple programs frequently designedfor children, but generic enoughto be used with adults.

I am presently designi an

adult literacy center for St. iul,

Minnesota. I view this new centeras one step beyond the ABLE Center.The St. Paul Center will deliverprimary instruction to functionalilliterates, always pushing technologyto its limit in a total and comprehensive

educational program. This new Centerwill have three additional components.It will be designed to train adulteducators to incorporate technologyinto their programs by providinga combination of internships, conferences,

andworkshops. It will be sIn experimental

model for research to provide desperately

needed information on the use oftechnology with functionally illiterateadults. The Saint Paul Center willalso provide incentive grants, toencourage, through matching fundsthe use of technology for hardware

108


and software acquisitions, by literacyservice providers.

In conclusion, I would like tosuggest three fruitful areas for expansion

and experimentation in the use ofmicrocomputers for functionally ill iterate

adults. The first is the use of word-processing packages, such as BankstreetWriter, for teaching reading skillsto adults. IBM's Read to :.rite program

is built on this model. There iscurrently limited experimentationwith this use of the microcomputer.Second, use modems to access information

for learners. An entire program couldbe designed around the use of electronicchalkboards and sports informationacquired through database access.Finally, I think our greatest hopefor breaking the back of illiteracylies with interactive video.

The military has, by far, completed

the most extensive work in this area,and is just now sharing it with basicskill educators. The field of trainingand development in business and industryhas had the funds to develop superbinstructional materials. Combiningthe mesmerizing quality of televisionwith the interactive capability ofthe computer promises a new way oflearning for the functional illiterate(Currier, 83).

We have just begun to explorethe technological capabilities ofcomputerized instruction. There is

new hope for the illiterate. Centers,

such as the ones in North Carolinaand Minnesota, may provide new directions

for solving the dilemma of functionalilliteracy.

REFERENCES

Currier, R. L. (1983). InteractiveVideodisc Learning Systems. High

Technology, Nov., 51-60.Hunter, C. S. J. & Harmon, D. (1979).

Adult Literacy in the United States.

New York: McGraw-Hill, 2-30.Lieberman, M. & Wheeler, F. (1983).

Evaluation of Plato, Umana School.Boston, Mass: Harvard GraduateSchool of Education, 29, 13.

Mei erhenry , W. C. (1982). Microcompute"s

and Adult Learning. Adult Learning.

Chicago: Follett.

Moyl es, L. & Newell , J. (1982).Microcompturs ir. a Postsecondary

Curriculum. Academic Therapy,18:2, 149-155.

Ploetz, G. (1984). Evaluation Project,

Object Description (unpubl ished

manuscript). St. Paul, Mn: Literacy

"85.

Vacc, N. N. (1984). Computers in

Adult Education. Lifelong Learning,

7:6, 26-28.

109

A REDESIGNED PARAPODIIMNEW HORIZONS FOR THE PARAPLEGIC CHILD

MARTHA C. GRAMEDWIN KINNEN

ABSTRACT

This presentation describes a

recently completed redesign of theToronto parapodium and the possibilitiesthe redesign represents for youngchildren with Spina Bifida. A numberof previously too difficult dailyactivities are now possible for youngparaplegic children using this newmodel. The separation of functionbetween the hip and knee joints allowsparaplegic children to approach manyeveryday tasks, such as sitting andstanding from a chair, without assistance.

In the past twenty years, medicalmanagement for children with myelomen-ingocele has improved dramatically.During this period, the trend hasreversed from most infants with myelom-eningocele dying, to a trend of mostinfants surviving. Shunt procedures,although not without complications,now effectively manage hydracephalus.Also, self-catheterization, urinarydiversions, and the artificial sphincter

have greatly reduced kidney damagedue to reflux. These two medicalprou(dures in addition to early closureof the spinal defect, have contributedgreatly to the trend of survival.

The increase in survival ininfants with myelomeningocele hasalso greatly increased the number-of children with paraplegia. Thisincrease has now presented a challengeto the habilitation field to developtherapy and orthotic devices whichmaximize the paraplegic child's potential

for independence.

Most orthotic devices designedfor paraplegia before 1970, consistedof metal side bars attached to shoesand connected at the hips by a pelvicband, they were then strapped to

the legs by means of knee pads, thighand calf bands. All of these padsand bands were fastened by buckleswhich made getting in and out oftracing a very time consuming task.Velcro has m,Ae fastening strapsa much simpler process, however,all of these hip-knee-ankle-footorthoses, then and now, still requireda child with complete paraplegia,reduced sk:n sensation, and proprioception

from joints to hold onto a walkeror crutches to remain in standing.Although paraplegic children havebeen able to walk if strapped intothe bracing and given crutches or


a walker, they have not been ableto remain in standing with their handsfree to handle toys once they arriveat their intended destination. Unlike

the adult paraplegic, frequently awalker until an accident or illnesscaused his paraplegia, the child paraplegic

has no previous normal experiencewith balance and standing to recall

and use as a resource while usingbracing. It is therefore not surprisingthat most paraplegic children in standard,separate leg bracing exhibit greatfear of the standing position.

In 1970, Walter Motloch, designedthe only orthotic device to addressthe paraplegic chfld's need to havefree hands while free standing. This

device consisted of an oval shaped

foot plate, metal side bars, a pelvic

band, knee supports and hip and kneelocks. This was the first time thata paraplegic child could stand andplay without fear of falling.

Although the original parapodium

was a major conceptual breakthrough,therapists and clinics who used theparapodium for a period of years,became aware of functional problems

created by the Toronto design. Themain problem was that the hip andknee locks of the original design

worked together. This meant thatthe child had to either be fully extendedand locked, or fully unlocked andunsupported. This complicated severalvery important daily tasks. One,

the child could not bend over to pickup objects he dropped to the floor

during play. If the braces were released

at the hip to allow bending, the kneealso unlocked leaving the child withno support for standing. Two, thechild, trying to sit down or standup, had to collapse both hip and kneeat once to sit, and to stand had to

get his body fully extended to lockthe joints. Three, the child whowished to be independent going tothe floor and standing (as do all

young children) had to fall forward

fully extend to get to the floor andto return had to have enough arm powerto pull his body fully extended to

a standing position. Most very youngchildren found these tasks eithertoo frightening or requiring toomuch arm strength to be a functionaleveryday activity. For this reasonchildren stood and walked using theparapodium, but did not do a lot

of other tasks that could have madethem independent.

In 1975, the biomechanics teamat the University of Rochester, becameinvolved in changing the lock systemso that young children could achievetheir maximum potential using theparapodium. The answer seemed tolic with the lock design. Children

needed to control their hip and kneejoints separately so that they couldunlock the hip joint to bend down

or to sit in a chair but still leave

their knees locked and supported.Because the team focused on youngchildren, it mas also necessary forthe locks to operate easily withthe use of one hand.

Over a period of four years,with the help of two families andtheir children, the biomechanic teamdesigned a parapodium to fulfillthose requirements. The Rochesterparapodium (as it is now called)looks very much like the Torontomodel until closely examined. The

hip and knee joints lock and unlockseparately, each pair cf joints controlled

by a single loop strap. The hiprelease is placed opposite the child'sdominant hand and the knee releaseis placed in the middle of the kneesupport for easy access. Also, each

pair of joints lock automaticallywhen the joint is in extension.

This system was tested and retested,

modified and remodified, until the

present model, being made at thistime, can be easily operated by achild of 24 - 30 months.

With the separation of the hipand knee joint in operation and withthe ease of operation, the paraplegicchild using the Rochester parapodiumhas much more control over his body

during daily activities and the abilityto stand, hands free. The most important

1 1 i

-,


of these daily activities is the abilityto change positions - such as gettingup and down from the floor, or inand out of a chair; or the abilityto bend over at the hip to pick-upobjects from the floor.

Sitting and standing with Rochesterparapodium can now be done by thechild swiveling to a chair, unlockingthe hip joint to allow a bend andthen sitting while keeping the kneeslocked and supported. Once the childis seated the knee joints unlocked.This control of joints gives the childmuch more confidence and security.

The child using the Rochesterparapodium may now get to standingfrom the floor with much less useof strength and energy. Rather thanpull ing to standing full locked, thechild may now unlock the hip jointwhile prone on the floor, and graduallypush-up and walk himself into a jack-knifeposition - standing on hands and feetthen swivel to a chair or walker topull his upper body fully erect.This process requires much less strengthand balance and brings this activitywithin reach of a 24 - 30 month old.

The other functional activitythat has made the biggest differencein the child's daily life is the abilityto pick up objects that are droppedto the floor. Previously, a childwearing the toronto parapodium couldnot drop an object during play andretrieve it because they were unableto unlock the hip joint and keep theknee joints engaged. With the separatelocking of hip and knee, of the Rochestermodel , it is a relatively simple procedure

for the child to unlock his hip jointwhile holding onto a chair or table,bend over, retrieve the lost object,and push back to standing. A smalladvance, but one of great consequenceto the paraplegic child.

These activities give the paraplegicmuch more security and independencefor moving around his home or schoolwith little or no assistance. Manychildren in braces are still unableto change position from sitting tostanding or to lie on the floor, without

adult assistance. This is oftendue to Jock systems on many bracestoday that either require two handsfor operation or more strength andcoordination than a 24 - 36 monthold child usually has.

Approximately 50 children in

upstate New York and another 50 aroundthe U.S. and Canada have been fittedwith the Rochester Parapodium. Somechildren fitted in the early stagesof the development of the RochesterParapodium are now six and sevenyears old. Clinical observationof those children indicates thatearly age standing, approximately12 to 15 months of age, has reducedfracture incidence, reduced deformityof leg bones and promoted more normalbone growth. The pelvic portionof the Rochester Parapodium neededto be lengthened because six andseven year old children do not Pxhibitthe shortened trunks typical of SpinaBifida children who have not stood.These children also have developedwell proportioned legs. They spent,on the average, 5 to 8 hours perday in their parapodium doing a varietyof activities from rolling and crawlingon the floor to walking and gettingup and down from the floor. Theirsecurity in standing has resultedin a positive attitude toward thestanding position and more willingnessto spend long periods of time inthe parapodium. In fact, makingadjustments rapidly enough to satisfyboth child and parent became a teamproblem. The children themselvesdid not want to be out of their bracefor more than part of a day.

A pilot study done by the University

of Rochester suggested that childrenwearing the Rochester Parapodiumare more outgoing, and initiate moreinteraction with peers than evenchildren with less paralysis usingstandard separate-leg bracing. Moreformal studies are now being doneby the University of Rochester andThe Ontario Crippled Children Centerto document physical, psychologicaland perceptual-motor skills of children

112


using the Rochester Parapodium in

comparison with those of paraplegicchildren using other devices.

A number of the children trained,as pre-schoolers, in the RochesterParapodium have made an excellenttransition later to other types ofbracing, including standard separate-leg braces, and reciprocating braces.Balance and functional abilities,such as getting down or up from thefloor and sitting or standing froma chair that were learned in the Rochester

Parapodium were retained and transferred

to other types of braces with minimaltraining. In fact, even childrenwith T-12 leisons transferring tostandard hip-knee-ankle-foot orthosesand remained community ambulators.Early years of standing seemed toestablish in these children a self-concept

as a standing, walking person.Although the Rochester Parapodium

is not the best device for all SpinaBifida children, it fulfills a veryspecial need for the child with completeparaplegia. Observation of childrenusing the Rochester Parapodium overa period of six or seven years, leadsus to feel that the physical and psycho-

logical benefits of early standingwith hands free and a period of securestanding and wal king during the development

of basic mobility skills, is wellworth the effort it requires.

For those who wish to explorethis device further, contact the BirthDefects Center at the University ofRochester Medical Center, Rochester,New York. A film entitled "All by

Myself" is available, which visuallyportrays the possibilities for theuse of the Rochester Parapodium.Additionally, the Rochester Parapodiumcan be purchased in kit form, to be

fitted to the child by an orthotist.Lastly, a training manual is availableto assist both parents and professionalsin the maximization of the child'suse of the Rochester Parapodium.

REFERENCES

Brown, J., Gram, M., Kinnen, E. (1980).

Parapodium design with knee andhi p locks. Orthotics and Prosthetics,

34, (2), 14-20.Gram, 14., Kinnen, i., Brown, J.

(1981). Parapodium redesign forsitting. The Journal of AmericanPhysical Therapy Association,61 (2), 657-660.

Gram, M. (1984). Using the Parapoduim -a manual of training techniques.bik- rb-66TITifir 1is: Eterna Press.

Hamilton, E., Motloch, W. (1972).Development in techniques for

ambulation for Spina Bifida children.

Canadian Physiotherapy Association,24 (1).

Motloch, W. (1971). The Parapodium:An orthotic device for neuromusculardisorder. Artificial Limbs, 5

(2), 36-47.

113

THE COMPUTER AS A CROSS OCCUPATIONAL TOOLIN THE VOCATIONAL PREPARATION OF DISABLED PERSONS

MARGUERITE D. HARMONJ. EDWARD COTGAGEORGE

ABSTRACT

This research, project #128AH40008 funded by RSA grant #6008893445,involving 120 deaf and hearing impairedpersons, is in the first year of athree year process examining the effectsof computer training on subsequentsuccess in achieving vocational goals.The subject population has been dividedinto two groups: workers in transition,operational ly defined as persons partici-pating in academic programs. Methodsthat will contribute to the acquisitionof computer skills, is the initialphase of accomplishing the ultimateproject, goals are discussed in thispaper. These methods include: Indexingof Occupations, Activities book Outline,Specialized Computer Software (NameThat Industry, Name My Occupation),and Adapted Computer Software. Eachmethod is described in the contextof the services of which it is a part.These methods are finally relatedto the development of a theoretical,cross-disability model of vocationalservices.

Introduction

Recent technological advancesin the workplace are radically alteringthe tasks assumed by humans. Thecompute. is the prime advance. In

addition to production and supportactivities, the computer has becomea workplace tool in varied occupationalareas. The worker prepared to usethe computer as an adjunct to jobtasks will be more able to competein the job market. Disabled personsare at a significant vocational disad-vantage and require dual accommodationin the technological work environment: one

accommodation to their physical impair-ment, and one accommodation to computersand their function. These accommodations

dictate a process of interchangeablecomponents dictated by the handicappingconditions targeted. The first phasein developing such a model is thedevelopment of the model's methodological

basis. This paper subsequently providesa discussion of the model and themethods by which it is being implemented.

Problem Statement

Disabled persons are inadequatelyprepared to compete in non-serviceoccupational areas because of pervasiveuse of computers and the lack ofpreparation of disabled persons in

the use of computers. Workers whichare "high tech" in nature, such aselectronic technicians and more commontrade and clerical workers such assecretaries or auto mechanics usetechnology in their workplaces.Common to all these jobs is the useof the computer as a tool and theneed for skill ed workers who areable to complete assigned tasks byusing a computer.

114


In order to establish hypotheses,assumptions about the research environment

were made. Validation of these assump-tions was required prior tc the develop-

ment of the model process.

These assumptions were:

1) The computer impact on theemployment of disabled personsin various occupational areas

is dependent upon:a) the relevance of the

occupation for the employment

opportunities of thetarget population,

b) relevance of employmentgrowth in that occupationand,

c) impact of the computeron the method of performing

the job task.

Therefore, it is possible to indexthe occupational areas according tothese criteria and establish a geographic,

population specific, occupationalcluster.

2) The impact of the computerupon occupational areas willvary by degree and can be

rated accordingly.3) The identified limitations

of the target population (in

this case deaf and hearingimpaired persons) can be overcome through an interventionstrategy which relates theuse of a job specific computertool to the "deficits of theindividual ."

This requirement, to test assumptions

about the impact of computer technologyon occupations across industries,resulted in the need to develop anindexing of occupations. This indexis the basis of an interactive modelbetween three "real world" factorsand the research/service environment.The indexing is discussed in the method-

ological portion of this paper. The

interactive model can be represented

graphically.

LABORMARKET

DEMANDS

CLIENTNEEDS

IlSERVICES

VOCATIONAL OUTCOMES

The methods to be developedto resolve this problem must be a

consequence of the interaction amongthe demands of the local labor market(e.g., use of computers, skills required,education required, etc.), the needsof the target population (e.g., physicalaccommodation, academic remediation,etc.), and the anticipated actualvocational outcome. This interactioncreates an environment that needsa methodology to address the serviceneeds of the population.

Hypotheses

The previous discussion leadsto the following hypotheses. Thefirst relates the project to a longi-tudinal effort. The second hypothesesis tested in this research phase.

I. A service delivery modelwhich replicates the useof the computer in the workplace

will increase participantemployability and improvecareer choice.

II. An instructional model which

uses the computer as a tool

for providing career andcomputer information will

115


improve acquisition of computerliteracy skills.

Subjects

The target disability populationis deaf and hearing impaired persons.In the subject population, 84% hada profound hearing loss and sixteenpercent had a moderate loss. Theinitial student group of 25 personswas evaluated and 14 persons wereselected on the results of vocationalevaluation screening and career choice.All participants were involved in

a summer work program and used computersin some capacity on the job.

Method/Instrumentation

Following is a discussion ofthe instruments used in the provisionof project services. These instrumentsare both agency developed systemsand modified commercial hardware/softwaresystems.

A

ti

5

C

1. The labor market survey systemincludes a number of employercontact and questionnaireforms. These range in contentfrom standard job analysisto employer specific informa-tion, such as current and

VISTRIBUTIOR CHART

COMPUTER IMPACT,

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projected computer use peroccupation, growth forecastsand relevance for employmentfor the deaf. The combinedlast three information areasrepresent the APPLICABILITYfactor which will be discussedlater. All of this infor-mation is compiled into a

central INDEX RATING SYSTEM.The Index Rating System supplies

information about an employerand the areas of industry,occupational title, employerrequired training and education,

computer usage for the joband applicability for a deafperson. 1 he Index RatingSystem ultimately assignsan al phanumeric rating toa occupation/job for a particular

employer. Computer use is

assigned & value from 1 to6, with 1 representing nouse and 6 representing continual

use. Applicability is ratedA, B, or C depending on thenumber of information areasthat are pertinent to thespecific job (see above).An a means that al 1 threeareas apply. This systemestablished an ongoing databasefor al 1 labor market/occupational

information for the projec+..

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116


2. ACTIVITIES BOOK OUTLINE (ABO).This instrument is used to

provide a structured approachto teaching both computerliteracy and career exploration.The book is designed to allowhands-on learning supplementedby discussion and lecture.The ABO is divided into foursections: administration,lesson, projects, and appendix.Each lesson is designed to

introduce an introductoryconcept in both careers andcomputers. After a discussionof the material the participantperforms an exercise withthe computer that furtherdemonstrates and reinforcesthe concepts presented. Afterthree weeks of program involvement,

the client begins a project.

The project combines newlyacquired computer literacyskills and information relevantto their vocational interestarea.

3. NAME THAT INDUSTRY (NTI )

This is a software instrumentdeveloped within COPD. Thisprogram reviews, in a highly

graphic format, the majorlocal industries. Information

about growth projections,percent of the work force,and major occupations withinthe industry are included.After the information hasbeen reviewed, the programasks a series of questionsand requires the user to answerthese questions.

4. NAME MY OCCUPATION (NMO )

This is another inhouse generatedsoftware instrument. This"game" formatted program asksquestions about occupations;the computer tries to guessthe occupation, the participantis thinking about. If thecomputer guesses incorrectlythe participant inputs thecorrect answer and a questiondistinguishing their thought

about occupation from theincorrect computer guess.The participants teach thecomputer about occupationsand learn themselves.

5. PREVOCATIONAL SCREENING (PVS).In an effort to have betterunderstanding of each client,the PVS is administeredto al 1 prospective clients.The areas reviewed are JobAwareness, Interests, Needs,Work Habits, Daily LivingSkills and Skills and Abilities.

This is not intended as a

comprehensive vocationalevaluation. The VALPAR Micro--ComputerEvaluationandScreeningAssessment (MESA) is theprimary diagnostics tool.It is coupled with a participant

interview to get an ideaof prelimirary barriers thatneedattenticn before a trainingor employment track is taken.A further component is the

VALSEARCH Job Bank. Thisis a database that providesthe participant and the counselor

a fast review of 13,000 listings

from the Dictionary of Occupa-tional Titles. A client'scurrent vocational and edu-cational functioning,determinedby MESA, is compared to similarareas outlined by the Department

of Labor Handbook for AnalyzingJobs.

6. SOFTWARE. The computer softwareused for training includesa list manager, a word processor,

and the LOGO language. Adap-tations and specific procedureshave been 'made to introducethe basic concepts of eachof these instruments to theparticipants.

The pretest-posttest controlgroup design is used for this project.The t-test for independent samplesis used as the statistical analysisof the project. This will provide

a means to compare gain scores as

117


a way to determine the effects ofparticipation.

Treatment

Each student received a basiceight week program. Options for anintroduction to the computer in technical,

clerical, machine and general industrialareas were provided in the program.The project attempted to provide infor-mation about each area. This informationcombined both Dictionary of OccupationalTitles and Occupational Outlook Handbookinformation and the locally generatedIndex Rating information. Pretestingprovided the basal level of careerand computer understanding duringthe last two meetings, participantspresented their projects to the group.The type of information presentedvaried across groups. For example,the clerical group focused on wordprocessing procedures while the technicalgroup focused on basic programmingconcepts. In the final class, allparticipants were posttested usingthe same diagnostics as the pretest.

Results

The indexing of occupations has

created geographically relevant labormarket i!,formation and led to actuallabor market participation by studentsin a temporary sett-,ng.

To date, th? results supportthe reliability of the methodologydeveloped. Methodological reliabilityin terms of a pretest-posttest hasbeen applied to only one group. TheSpearman Rank order correlation ofrs = .60, p 1/4 .01 indicates test/retestreliability for the pretest - posttestbeing used.

Preliminary results specificto the student population show anaverage increase in test scores of8.5 points or a 56% increase in thetest score individually. Group resultsindicate a 98% increase in mean score.Information area increases were equalwith a 66% increase in both computerliteracy and career exploration areas.

Discussion

The results indicate that themethods being employed are effectivefor assisting workers and studentsin the acquisition of labor marketinformatio ., occupational informationand basic computer use skills. As

the subject population is limited,no definitive statement can be maderegarding the strength of the relationship

between the acquisition of the information

and the impact this has on the individ-ual 's success on the job or in trainingin a specific occupational area.

Implications for the applicationof one method, the Index Rating System,relates to other vocational serviceprograms. The addition of the IndexRating System has required some changesin the format and interviewing inthe job development area. Use ofthe computer to store and retrievethis information has resulted ina more organized, time saving methodof reviewing employer contacts.The addition of the VALPAR AccessProfile has allowed for a more compre-hensive initial approach with employercontact. Employers have reportedthat they perceive a greater effortto understand their specific needs.The implication has been that bothsides involved have a clearer under-standing of client and program needs.

This approach to employer contactal so supports the development ofABE methods. The model being developedattempts to incorporate (job) vocational

specific reading, math and languagerequirements as part of the ABE training.

The project goal is to create a functional

and tangible ABE program for partici-pants. Participants will have a

chance to improve academic skill sand become more competitive employees.As an added feature, academic materialsare provided that the client automatically

sees as useful.Finally, the validation of the

interaction between labor marketdemands, disability needs, and vocational

outcome results in a process model.This model can be represented graphically:

118


It is important to recognizethat in order to transfer this model:1) local labor market indexing mustbe completed, 2) disability specificneeds must be identified, and 3) disability

specific services must be developed.

WORM* OwNIabs

...._ 0 11111001000

21 2124000

This model and activities represent

only the initial phase of the project.Further activities will include theapplication of this model to workersin transition groups. It is ass--,,d

that modifications will arise fromthe changing needs of clients, andthe labor market.

REFERENCES

Bowe, F. (1984). "Employment Trends:1984 and Beyond Where the JobsWill Be."

Computers for the Disabled (1984).Conference Papers, pp. 3-7.

Education in Arizona (1984). ArizonaLabor Market Newsletter, Vol. VIII,No. 6.

Fennerson, D. A. High Tech/High Touch:Making Good on the Promise.

Jobs in High-Tech Industries (1983).

Arizona Labor Market Newsletter,Vol. VII, No. 6.

Vocational Education Planning -;ciLk

Force. (1983). Annual and FiveYear Comprehensive Vocational Education

County Plan for Pima and SantaCruze Counties.

119

A PLACEMENT AND MANAGEMENT INFORMATION SYSTEMFOR LOCAL PLACEMENT PROGRAMS

FREDRICK E. MENZDIANE GLEITER

ABSTRACT

A placement and management infor-mation system (P /MIS)is under development

for a network of Projects With Industry.The P/MIS is designed to serve threepurposes for placement specialistsand managers of placement programs:(1) provide placement personnel immediateaccess to up-to-date information onjobs/employment opportunities withintheir locale; (2) provide placementpersonnel immediate access to up-to-dateinformation on handicapped personsseeking employment within that locale;and (3) provide managers with collatedstatistics and reports of placementactivities at placement offices servinga locale or region. The P/MIS wasconceived to be modified to accommodatea local placement effort's methodsof documenting and classifying bothjob and person data. It uses DBaseII, a widely available data-basemanagementsystem, and is designed to run oneither an IBM-PC or IBM-XT. The P/MISwas developed and is being testedcollaboratively by the Research andTraining Center, University of Wisconsin-Stout (Menomonie, Wisconsin) and theElectronic Industry's Project WithIndustry, Electronics Industry Foundation(EIF/PWI, Washington, D.C.).

This paper-demonstration coversthe origin, development, status, speci-fications and examples of the P/MIS'scurrent applications. First, thepaper overviews the development, structureand specifications for the P/MIS,along with examples of applicationsfor the system in the EIF/PWI. Ademonstration of P/MIS's data entry,search, edit and reporting capabilitiesfollows. Questions and potentialapplications of the P/MIS in local

placement activities are exploredto complete the presentation.

Origin of P/MIS

In 1932, the Research and TrainingCenter initiated a line of researchthat focuaed on the placement ofhandicapped persons in competitiveemployment. Under that line, theCenter would explore, from both theperspective of the handicapped personand the employer the incidence andproblems associated with accessingand retaining jobs. As those researchefforts were defined, we found consid-erable attention being given to developing

computerized job-person matchingsystems. Such systems (Botterbusch,1983) were almost exclusively basedupon use of the coding system developedby the Department of Labor for classifying

the 13,000 plus job titles listedin the Dictionary of OccupationalTitles (DOT). The jobs were clarifiedby temperament, demands and aptitudesrequired. In order to accuratelyuse these job-person matching systemsin a local job market, job analyseswould be conducted to determine andsubsequently code, the characteristicsand demands of each job. This insuredthat jobs available in the localmarket were accurately classified,even though they may have the sametitles as ones listed in the DOT.The skills, abilities and job historiesof applicants also needed to be encoded.By using various statistical algorithmswith the individual profile, a probablematch or series of matches betweenthe person and DOT encoded jobs wasthen derived. The computerized job-person

matching system represented a majoradvancement in placement technology.If vocational evaluation data are

120


conscientiously used as inputs andif the job-person searches are usedfor exploration and counseling witha handicapped person, the range ofoccupations that might be availableto handicapped persons can be considerably

enlarged. Counselors, placement special-ists, vocational evaluators, and handi-capped persons can use these systemsto discover transferable skills,aptitudesand temperaments. Transferable skillscould possibly be applied in a rangeof jobs and occupations never beforeconsidered.

These computerized placementsystems depend on DOT classificationsof jobs. They work best when bothdata on jobs and data on applicantsaccurately relate to that coding system.

Elaborate classification systems donot, however, easily solve the placementproblem often faced at local levels:the problem of matching individualswith jobs when neither applicant norposition has extensive data.

Placement personnel have indicatedto us that a clinically- oriented approach

was typically used in these cases.Files of information on applicants,were consulted, reviewing the workhistories, training experiences, functional

problems, and economic and employmentneeds. The placement specialist workedwith a relatively limited number ofemployers. With those employers maintained

direct contact, developed an extensiveknowledge of preferences and needs,and obtained a dynamic understandingof the jobs available, the generaldemand for those jobs and reasonableaccommodations and benefits that couldbe expected to be made. The placementspecialist were unlikely to conductan extensive job analysis to acquirethe depth of information needed toencode a specific job using the DOTsystem. They were, however, likelyto have the extensive client informationrequired to do a computerized person-jobmatch. What we found missing fromcomputerized systems were softwaredesigns that assumed the placementspecialist would use a clinical-approachwhen trying to match people and jobs

(in contrast to using a computerized-approach. Such systems could beaccommodated to a local setting andwould actual ly help placement specialists

build on their use of clinical skills.

Overview of the P/MIS Development

The Electronic Industry Foundation's

Project With Industry (EIF/PWI) estab-lished a network of PWI placementprograms in key cities around thecountry. Each PWI was primarilytied to the electronic industry withinthe geographic area. While eacharea office would operate independently,

loosely affiliated with the nationalEIF/PWI, all would conduct placementunder a common "brokerage" model.Under the brokerage model, each PWI

would be responsive to employer needsfor new employees and to the needsof handicapped persons for meaningfulemployment. Awareness of both needswould be maintained through regularmeetings of advisory committees thatincluded representatives from industryandrehabilitationagencies (facilities,vocational rehabilitation programs,community groups). Functionally,the PWI would serve as a broker betweenindustry and community resourcesby keeping track of the jobs availableand the handicapped persons thatcould perform the jobs. The PWIwould screen (clinically) both jobsand applicants for best matches,and refer handicapped persons tothe jobs for which they were bestsuited. These PWI's used informationprovided by referring rehabilitationprograms information provided byemployers, and any other informationon both the handicapped person andthe job they :ould retrieve throughsite visits to the employer or throughquestioding the referring agencyand potential applicant.

Most of the basic concepts whichwere integrated into P/MIS originatedfrom collaboration with EIF/PWI.The basis for the system evolvedfrom several sources. First documentreviews and interviews were conducted

121


during site visits to several of theEIF/PWI area offices. Conversationsand interviews were also conductedwith industry leaders and their personnel

office staff. Finally, informationwas gathered during ongoing conversations,discussions and reviews with the EIF/PWInational staff, particularly Pan Sheehey,

Senior Field Supervisor for PWIs.

From this we developed what is best

referred to as the "worst possiblecase." We tried to conceive boththe full structure of a clinically- oriented

placement system and the full set

of variables which should be includedif that system were complete. Whilereviewing the features and structuresdescribed below, it is apparent thatwe achieved this objective for P/MISdevelopment. Time and effort wasexpended to elaborate the concept,review its logic, commit to its devel-opment, and aid in its testing byEIF/PWI. The 13/MIS will be implementedand evaluated in the EIF/PWI network.However, as you will see, the structureand software system can fully meetthe needs of many different kindsof placement efforts. Our developmentplans call for demonstration withinthe EIF/PWI network over the nextyear. Evaluations of that demonstration

should indicate its usefulness forother placement programs with an ongoing

need to track handicapped personsand jobs and formulate best person/jobmatches in their community.

Features, Structure and Use of the P/MIS

Basic Features

The P/MIS was developed usingDBase II. 0!"r intent was to allowit to be usf:d by peopl e with verylittle familiarity with microcomputersand no computer programming experience,as well as by more sophisticated microusers. For the novice, it was to

be simple and workable. For the users

experienced in P/MIS (or DBase), its

use could expand with their levelof skill development. The seven basicfeatures (fully or partially developed)

of the P/MIS are as follows:1. Menu driven., All the functions

and capacit es of the systemare linked together througha series of explicit menus.Similar kinds of activities(e.g., adding and editingspecific files) are containedon the same menu. The usercan branch forward or backward

from menu to menu to enter,edit, search or report datacontained in the system.

The user can quit P/MISfrom any menu.

2. Modular design. The P/MISis a series of small interrelated

files. Each file (applicant,job, or employer) containsa limited, but highly relatedset of information (e.g.,all data on wages, workinghours, and fringe benefitsfor a job are together).The files are linked togetherunder a hierarchy. Because

each file is small , a modularapproach increases the speedwith which individual andlinked files can be searched.Equally important, though,is that the modular approachal so makes it possible forthe experienced user todelete unnecessary filesor link in new files as

local needs require, usingDBase II. For instance,in a rehabilitation facility,a comprehensive vocationalevaluation may be conductedon many applicants for place-ment. A separate, linkablefile could be establishedto retain this informationin a form compatible withcodes used in the Dictionaryof Occupational Titles.This module would then becomethe basis for exploringoccupational alternativespresent in other systemslike the Automated InformationSystem, Interstate Job Banks

122


or the state OccupationalInformation System.

3. Full screen entry. All data

are entered, added or changedusing pre-formatted screens.Each screen corresponds toa data file. On the upperportion of the monitor a

form is presented. Thisform looks very much likea typed page. Each variableis fully described on theform and spaces are providedfor appropriate informationentry (e.g., if money isto be entered, only numberscan be entered). promptsare displayed beneath theformatted screen describingthe information to be entered,the types of values allowedor lists of codes that mustbe used. All informationabout an applicant or employercan be entered at one time;movement to successive screensoccurs automatically whenthe user is in the data entrymode.

4. Full screen updating. Allscreen (and therefore files)can be edited or have recordsselectively added as informationchanges or increases. Forediting, the contents ofa specific screen are presentedand only those fields requiring

correction need be alteredwhen updating takes place.Additional records can be

conveniently added (e.g..,

new job entries for an employer)

without reentering all otherinformation. Again, thespecific formatted screenand corresponding promptsare presented. A reasonableset of subroutines help toassure that duplicate informaticnis not entered.

r. Searching and displaying...

records. Searches can beconducted on any variablecontained in any file.

A search may be conductedfor an exact variable contained

in any file. A search maybe conducted for an exactvalue of a variable (e.g.,

JONES, JOHN, A), a numberof entries having a certainstring of characters (e.g.,all names beginning withJO) or a number of specificentries (e.g., several different

names). The results ofthese searches can be savedon disk, displayed on themonitor, or reproduced inhard-copy. A basic setof searches typically conducted

are included for the noviceuser. More complex searchescan be developed by themature user using variationsof DBase II's FIND and LOCATEfunctions.

6. Archive records.. A historicalrecord can be produced foreach applicant or each job/em-ployer once that job/employeris removed from the system.These archived records areintended to provide themanager the capacity toevaluate the productivityof individual staff membersand the program's use ofits key job and applicantssources. A typical recordwould retain informationon who, what, when, amountof activity and outcomefor either the applicantor the job. More complete /com-

plex archive records canbe designed by the user.

7. Reporting. Reports canbe developed which quantifyinformation on the charac-teristics and job seekingactivities of applicantsor on the specific jobsand employers maintainedin the local P/MIS. A minimumset of standard reportsare planned which summarizeprocess data and outcome

123


data on applicants, jobsand employers. These reportscan be produced on a monitor,printer, or disk file. This

report feature also providesa method for transmittingsummaries to other micro-pro-cessors equipped with communi-cations packages, DBase IIand P/MIS.

Contents and StructureWhen this system was designed,

we attempted to include all typesof relevant information that may con-ceivably be included about jobs andapplicants. However, we realizedthat not all of this information wouldbe used by some placement programs.Because P/MIS is modular, information

which is ultimately retained underan adapted P/MIS is restricted bythe needs of the local setting. In

practice, if a file/screen of informationis not needed, that module can bedeleted. Likewise (in theory, aswe need to test thi feature), ifinformation on applicants (e.g., familysize, referral source) or on employersand jobs (e.g., descriptions of productlines, which jobs are actually included,work shift, benefits packages) containedon a given screen, is not needed,then those parts of the system canalso be excluded without detrimentto P/MIS's abilities. Because allinformation is local and entered andmaintained locally, what actuallyis used determines what is included

in the P/MIS.As an interactive placement and

management system, P/MIS was conceivedto allow placement personnel to deal

with information on jobs and applicantsin very much the way that a placementspecialist would describe an employer'sneeds and requirements or an applicant'sskill s, capacities, needs and restriction

and then work with that informationto find a job for a person, or personspossible for a series of jobs. While

conventional coding systems can be

used (e.g., DOT), its search capacitiesdo not require elaborate encoding

of jobs and applicant work historiesor skills. We designed it expectingthat the people are more likely touse it if "real word descriptors"are the basis for the system. Wheneverpossible, the user is expected toenter English words and descriptorsfor jobs and applicant variables.These descriptors are searched andprovide the basis on which the placementspecialist identifies potential appli-cant-job matches. There are twomajor sets of files on the P/MIS:applicant files and Employer files.P/MIS allows the user to search theApplicant files, for an individual,

persons with similar characteristics(skills,training,experience,functionallimitations), persons with differenteconomic and compensatory needs,or search to determine file activityand status in job seeking. Likewise,P/MIS allows the user to search theemployer/job file, seeking jobs whichrequire certain attributes (workhistory, skills, experience, training,working conditions) or provide specified

advantages (level and quality ofjob, wages, benefits), seeking employerswhich conform to specific regionalconsiderations or to survey employerhiring practices within the servicelocale. Finally, updating and off- loading

capabilities allow managers to produce

individual applicant or employerprofiles, produce quarterly and annualplacement summaries, and developcustom reports based upon both applicant

and employer activity.Figure 1 provides an overview

of the general structure of P/MIS.

As is evident, P/MIS is a two-sidedsystem of information on Applicantsseeking jobs and Employers with jobs.Each separate box represents a screen(and file) of information the placementperson would see when inputting orexamining information on a job orapplicant. The small boxes, labeled

"A .... Z," indicate that there canbe multiple records in the file forthe applicant or employer. For instance,

an Applicant may have several WorkExperiences and an Employer may have

124


APPLICANT

SID:

I To Be Ti Developed I

and Added'

ActivityRecords

Archive

Records

Personal

Data

MobilityFunctional

Needs

lOrkExperiences

Skills.

Interests andAptitudes

[EmploymentPreferences

CI

CEfFslirnYER

Employer

Overview

r General

Employment

Information

Mobility andFunctional

Consideration.

Specific

JobEntries

Training andExperiencesRequited

11

Job liet1Cflt

andConditions

Figure 1. Structure mf the Placement/Management Information System.

many Job Entries. At the bottom ofFigure 1, boxes, Activity Recordsand Archive Records, are producedfor management and market researchpurposes. An Activity Record is producedwhenever an applicant is referredfor job interview and contains elementary

information on who is referred, thejob and employer, on prospective wagesand benefits, and on outcome of thejob referral. The Archive Recordis produced (for permanent storage)for either the applicant who leftthe system or the job removed fromthe system. The record summarizesactivity information, wage and benefitsinformation, outcome or placementresults, and provides limited abstractsof basic applicant or employer data.

On each side of the P/MIS, severaldifferent screens (and files) arerelated to each other by a hierarchy.On the Applicant side, Personal Datais at the top of the hierarchy asthis file (also screen) contains basicinformation on the applicant, wherehe or she lives, and his or her demo-graphics (e.g., age, education, ethnicgroup, VR status); this data is generally

r10 W!Deve oiled

1 and Added

Act vity

Records

ArchiveRecords

unchanging. This screen/file is

followed (linked is another way ofdescribing this relationship) byinformation on the applicant's Mobilityand Functional Needs, including disa-bilities, ability and desire to travel,restrictions imposed by disabilities.Each of the applicant's work experiencesare separate records in the WorkExperience file. These records containinformation on skills used, occupationalarea, level of employment, tenure,reasons left, general working conditions,

and wage and fringe benefits received.Each specific attribute possessedby the applicant is also enteredin the Skills, Interests and Aptitudesfile as a separate record. Thisfile retains information on workrel evant characteristics of the attribute,

such as amount, type, length andoutcome of training and specificskill s or aptitudes which might betransferable. The Employment Preferencesscreen/file details the type(s) ofjobs, occupations, vocational rolesand working conditions the applicantwould prefer and the extent of wageand fringe benefits the applicant

125


would need.On the Employer side of the P/MIS,

the hierarchy begins with three singlescreens covering the most general,unchanging features and provisionsof an employer. The first screen(file), Employer Overview, storesand presents basic information onthe company or corporation: whereit is located, typical jobs that areavail able, its general products orservices, names of other divisionsof the corporations, and such informationas may be of interest to a placementperson as they survey companies forpotentially placing applicants. That

screen is followed by the GeneralEmployment Information screen. General

Employment Information relates to

where and who to contact at the personnel

office, ti ps on how to get to thepersonnel office, and the types andannual value of various fringe benefits(insurance, retirement, training,paid leave) available to employees.The next screen (file) details FunctionalConsiderations which the employercan make for employees. This informationincludes detail s regarding accessibilityto and on the worksite, employer prefer-ences regarding disability groups,functional limitations which can be

accommodated by the employer and avail-ability of public and company providedtransportation.

For each job the employer hasavailable (as opposed to the jobswhich the employer may have), thereare three separate screens. First,

Specific Job Entries lets you knowthe total number of different jobsavailable with the company, the nameof the job, its occupational area,

the level of the job, a brief description,

its priority and el i jibility for tax

credit, some general comments aboutit, data on number of persons neededfor the job, and a projection of thejob's future with the company. The

Training and Experience Needed screendetails the minimum educational level

required, typical types, time andoutcomes of training which are acceptable,

and typical job experiences, tenure

and skills which would be useful

for the job. Finally, Job's Benefits

and Conditions summarize informationon when and how regularly a person

would work, the specific fringe benefitsto be provided, and the annual valuefor wages earned, for fringe benefitsand for wages and fringe combined.

One might begin a typical job -ap-

plicant match by looking for allemployers which typically employpeople as ASSEMBLERs or ENGINEERs(search Type in the Employer Overviewfile) or for all employers who currently

have such jobs open (by searchingon Job Title in the Specific JobEntries file). Once a number ofpotential employers are found, a

variety of information about theemployer and those jobs might be

displayed and examined, printed inhard copy or saved to be used inyour search for qualified applicants.For instance, you might want to knowwhether all jobs were at one employeror the age offered by various fringebenefits packages at different employers.

You might next go to the applicantside of the P/MIS to develop a listof potential applicants. A searchof ;:he Work Preference file for applicants

who list ASSEMBLER or ENGINEER asjobs in which they would be interested

might produce a reasonably sizedlist of potential applicants. Before

contacting any of the applicantsor referring them to the employer,you might want to determine whetherthe empl oyer(s ) can meet their functional

needs, by contrasting what is in

each applicant' s Functional Needs

file with what is in the employerFunctional Considerations file.Then, too, you might want to decidewhich of the employers can meet theirwage and fringe benefit needs, asdetermined by contrasting the benefitslisted in the applicant's Work Preference

file with those listed under Benefitsand Working Conditions for the job.If a small number of possible applicantswere identified, you might at this

point contact the employers and applicants

to see whether a referral is desired.

126

Discovery '84 Technolcgy for Disabled Persons 115

Should no reasonable matches be found,your search might expand to your listof potential applicants. A greaternumber of potential applicants mightbe accumulated for instance, fromsearches of both the Work Experienceand the Skills, Interests and Aptitudefiles.

Whether one started the searchfrom the applicant side or the employerside, the same outcome could be achieved,because of several considerationsmade in P/MIS's design First, similarkinds o informpti on are placed together.

The screens of information one reviewsare basea upon how the informationis likely to be used in placement.For instance, training and work experience

needed for a particular job are oftenexamined together; wages, hours aadfringe benefits are considered together;and functional needs and considerationsare often evaluated separately fromwages. This results in smaller fileswhich make it possible to rapidlysearch for information in each file.Second, the similarities that existbetween the information one woulduse while looking for a job to thatwhich would be available on jobs beingoffered by an employer were particularlyconsidered and stressed in designingeach side of the P/MIS. Occupationalareas covered for jobs available couldbe searched to find ones which aresimilar or identical to ones in whichan a ppl i cant might have had work experience

or have been trained. Fringe benefitneeds of the applicant could be comparedto fringe benefits options availablefrom different companies to identifythe best match. Work Experience andJob Preference files could be searchedto find applicants who might be prospectsfor a particular job.

Third, the use of English wordsand word chains in attempting person-jobmatches are integral in the majorityof searches. For instance Englishwords and descriptors are used toname, describe jobs, skills, training,work history, interests, work preferences,

occupational areas, job levels, trainingand experience requirements. Fourth,

as a menu format is used to facilitatemovement between entry, editing andsearch functions, a menu format wasalso designed to guide the user throughthe typical searches. A search forinformation on job availability ina given company only requires enteringthe name of the company and the titleof the job. A search across P/MISfor all jobs of a particular kindrequires entry of the job name (or

a string of characters) and designationof which screen/file is to be searched,

Finally, although specific filescontain data on only a few variables,files on each side of the systemcan be 1 inked, the results of thesearch accumulated for subsequentdisplay and/or print out. Searchescan then be made of the oppositeside of the system. More complexsearches can be formulated by theuser as P/MIS is developed underDBase II, which has powerful filesearching capacities. As the useracquires experience using P/MIS,greater use can be made of P/MISthrough development of increasinglyfine tuned file searches.

Applications and Adaptation to Local Use

We envision the P/MIS applicableto a variety of settings, eitheras part of a total information systemor as a stand alone placement system.Among the immediate applicationswe see are:

1. Placement programs and placement

services. These are thegroups for which the P/MISwas originally developed.Local placement programs,whether publicly fundedor funded on a fee basis,typically work with a finiteset of employers and jobsreferred by those employers.The P/MIS provides the capacityto build an on-going baseof information on availablejobs, benefits, and needswith this set of employers.Information on individual

127


empl oyers can be amendedas greater precision is

achieved regarding the employerrequirements (skills,abilities,preferences), working conditions

(functional needs whichcan be met), and benefits(wages, various fringe benefitpackages). Li kewise, theP/MIS format can be usedin a structured interviewwith potential applicants.With assistance, an applicantcould conceivably enterhis/her own data. Data acquiredfrom applicants and employerscould be shared by severalempl oyment/placement specialists.

2. Vocational rehabilitationcounsel ors doing placement.Like private placement programs,

a vocational rehabilitationcounselor typically usesa key set of empl oyers (augmented

by additional jo' informationfrom various sources). Almostall of the information containedin the applicant side ofthe system relates to thosevariables the counselorwill most often address,as job and career optionsare explored with a client

during his or her rehabilita-tion. Use of the P/MISby a counsel or can beginquite early in the rehabilitation

process; by the time empl oyment

is viable, information onclient's skills and needscould be very accurate andgreatly increase the likelihoodthat the client would be

pl aced i n a position commensurate

with his/her job and careergoals.

3. Rehabilitation facilitiesand sheltered workshops engagedin placement. Facilitiesand workshops are increasinglyengaging in placement activities

with their client populations,either under contract withvarious state agencies or

as an independent function.The P/MIS can be the corefor a more expansive MISfor facilities as modules(l inked files) are addedto - to keep track of pro-duction, wage and hourdata from work adjustmenttraining, vocational evaluation

findings, other servicedata, and financial data.

As would be the case for

the rehabilitation counselor,a comprehensive pictureof the client can be acquiredunder typical facility andworkshop programs and greaterprecision accomplished in

identificatiou of job optionswhich are preferable foreach client. As with botha regular placement programand a vocational rehabilitation

counselor, the facilityplacement personnel will

typically relate to a finite,ongoing, core set of employers.

The P/MIS allows the facilityplacement person to maturein his or her acquisitionand use of information maintained

on the local empl oymentmarket.

4. Other potential applications.The range of applicationsis only limited by fourfactors: First, the primaryapproach to placement assumesa clinical review and matchingof applicants with employmentoptions, rather than use

a completely mechanicalperson-job process. Second,a primary core of employersmust be identified and developed

within the local servicearea. Third, the staff inthe local office must agreeupon descriptors and labelsthey will use for certainperson and job variables(e.g., for skills, occupational

areas, demands, functionallimits and level of work).

1.28


Fourth, placement is anongoing activity, sufficientnumbers of applicants (25

to 50 per year might be reason-able) and a sufficient numberof core employers who havevarious job needs must beavailable to justify investingio the equipment and software.

If those factors are present,then some of the potential applicationsof P/MIS might be made by the following:Hospitals and outpatient clinics serving

deinstitutionalized and traumaticallyaffected p soos, private rehabilitationservices, corporations and industrydoing in-placement and out-placementof their own disabled or displacedworkers, schools and training programstransitioning handicapped studentstf..% t!:e world of work (both for occupational

exploration and placement), communityand consumer groups active in placement,and groups maintaining an ongoingsurvey of a community's resources(people and jobs).

Specifications and Requirements forInstallation of P/MIS

The P/MIS was designed to be

used with Aston-Tate's DBase II Relational

Database System. DBase II is widelyavailable in formats for most micropro-cessors (e.g., Apple, IBM, Radio Shack,Hewlett Packard, etc.) and can beused for many applications other thanthe P/MIS (e.g., bookkeeping, mailinglists, inventory control, custom pro-gramming). While it retails for $700from the manufacturer, it can be acquiredfrom some suppliers for under $500.In theory, code for running P/MISunder DBase II should be usable onany micro for which there is a versionof DBase II. We have not tried allsystems, however.

The microprocessor on which wedeveloped the P/MIS was an IBM-PC.The minimum requirements to use thefull P/MIS as it is presently configuredincludes ar IBM-PC with two 320kbdrives, 128k memory, a Hayes 1200b

modem (with Smartcom II), and EpsonFX-80 dot matrix printer, a display(monochrome, color or graphics) and10 double density, dual sided disks.The P/MIS is currently containedon 4 disks: Two program disks (one

each to hold DBase and the Applicantand Employer programs) and two datadisks (one each to hold databaseand indexed files for Applicantsand Employers). The remaining 6

disks are for back-up of the programand data files (4 disks) and to archivepurged records from the Applicantand Employer sides of the program(2 disks) . Cost for such a configuration

would run between $3200 to $4000.Displays of formatted screens

are very similar on color, graphics,and standard monochrome monitors.Monochrome provides the greatestdetail (blinking, fore/background,underlining), color the next best(because of alternating definitionof input/fixed data), and graphicsthe least preferred (bright and lightcharacters tend to loose definition).

The Hayes modem is not necessaryunless part of your need is for inter-location information sharing or ifyou intend to use information inyour P/MIS while accessing the variousoccupation, training and job banks(e.g.,youstateOccupational InforalationSystem) or any of the computerizednational placement systems (e.g.,Automated Information Systems outof Spokane, Washington).

While the P/MIS is designedto run as a two-sided (Applicantand Employer) database system onan IBM-PC, it is more efficientlyrun on an IBM-XT with its 10 meghardisk or ar. IBM-PC with a 5 or

10 meg hardisk add-on. With eitherof those hardware configurations,no disk-switching is required; both

the Applicant and the Employer programsand databases can be accessed fromone set of menus. This is the mostpreferred arrangement, as applicationsfor matching potential-jobs and potent-ial-employees are most direct andconsiderably faster. This configuration

129


(with similar peripherals as above),runs around $4500 to $5500.

REFERENCES

Botterbusch, K. F. (1983). A comparison

of computerized job matching systems.

Menomonie, Wisconsin: The Materials

Development Center, University-Stout.U. S. Department of Labor. (1977).

Dictionary of Occupational Titles(fourth edition). Washington.DC: Government Printing Office.

130

MISSOURI LINC ASSISTIVE DEVICE SERVICE

MALCOLM FLANAGANDONNA DUNAFON

ABSTRACT

Missouri LINC is a state fundedproject providing various supportservices to Missouri Vocational andSpecial Education teachers secondarywho are teaching vocational skillsto handicapped students in secondaryand postsecondary institutions. Theseservices include adaptive devices.

Missouri LINC Assistive DeviceService is one component of a statefunded technical assistance programthat assists vocational and specialeducation teachers in the preparationof special education students foremployment. The assistive deviceservice, however, is the one componentthat is designed for preschool throughpostsecondary school levels. Theremaining services will be identifiedin order for the reader to understandthe structure of the total program.

Information Assistance includes thecollecting and retrieval of resourcematerials, an incoming WATS line(in-state only), SpecialNet (MOLINC,a state electronic bulletin boardand VOCED, a national electronicbulletin board), and booths at statemeetings. Thisinformationdisseminationincludes assistive device informationproducts as well as products fromthe program as a whole. Publicationsinclude bi-monthly newsletters, twopage teacher-oriented publicationswith resource lists, and papers ormanuals. The latter are designedto provide assistance with pressingissues. Consultation is availablefora limited number of school districtsper school year where LINC staffvisit with school staff, on site,to assist in improving services.A plan is developed and followedby LINC staff. From consultations,two major activities have developedthat have state-wide significance.Courses and Conferences range fromcredit courses to one and two dayconferences. Transition to Workis a component new to the programin 1984. This component is beingdeveloped together with one publicschool district as a demonstrationprogram. Entry Level Skills CriteriaProject training is a major component

131


for the 1984-85 school year. Thisis one of the components that grewout of consultative services. Theseentry level skills criteria, originallydeveloped by area vocational-technicalschool instructors, and instructionalmaterials, developed by special education

instructors, have gained sufficientattention that approximately twentypercent of the school district staffin the state will be trained in theiruse during the development activitiescarried out each year in relationshipto selected components.

Assistive Device Services

These services may be used by

school district personnel with eitherthe in-coming WATS line or Special-Net. When requests are made, staffask a limited number of questionsin order to clarify the needs of thestudent, they then research the requestand provide information to schoolpersonnel. Services are informationalonly, as qualified professional specialists

are not members of Missouri LINC staff.The information usually contains dataabout assistive device/adaptive sourcesfor the purchasing equiprient, listsof distributors in or near Missouri,and consultants who provide servicesfor a fee. Conference presentationsand workshops are available upon requestby local education association staffor professional organizations. Commercialdistributors have been especiallycooperative in providing displ ayequipment

at all presentations when requested.The largest number of requests

have been for communication devices.Other areas where requests have beenmade in fairly large numbers are,computer access, enlarged print, andwriting aids. Requests have alsobeen made for devices to help transportstudents safely.

Because many people requiringour services have limited knowledgeabout the technology available to

assist them, Assistive Device Servicestaff have attempted to help publicschool professionals (teachers, speech

therapists, school administrator's)clarity their needs. A one-pageworksheet that includes items fordefining the handicapped individualsstrengths and weaknesses, environmentalconsiderations, and solutions as

well as some practical matters suchas portability and accessibility.The worksheet is included as Table1 at the end of this article.

One of the most exciting endeavorsMissouri LINC Assistive Device Servicesstaff have been :s-volved with is

adopting a work station for a young

woman with cerebral palsy. Thisyoung woman came to Missouri LINCin 1981 as a trainee in data entrywork. She could not operate thekeyboard in a conventional mannerdue to poor control. Keyboard modifi-cations were, therefore, made. In

1983 the Assistive Device Servicestaff became involved with providingthe most efficient input system forher. Exploration included evaluatingvoice recognition possibilities andscanning devices. These modes wererejected after a long evaluation.She is now using a new model of anadapted keyboard and a more prau,,,a1head-stick. She is employed at Missouri

LINC as a part-time Data Entry OperatorI. Most of her job is performedindependently. One function shestill requires assistance with is

placing floppy disks in disk drives.Research will continue until she

is as nearly independent as our cap-abilities will allow. Copies areavailable at no cost.

Summary of Detailed Studyand Summary of Research and Results

Missouri LINC Assistive DeviceService is a low budget service designedto provide information to teachersand parents of exceptional children.

Information is distributed throughoutthe state through newsletters, otherpublications, displays at conferences,and presentations to school staffand conference participants.

132

Discovery '84

ASSISTIVE DO

Technology for Disabled Persons 121

609 MarylandUniversity of Missouri-Columbia

Columbia, M:ssoun 65211

800/392.0533

Guidelines for Selecting and Locating Assistive Devices

Name Age

1. Define the problem.

2. Possible Solutionsa)

b)

c)

3. What does the device need to do in order to best tap thestrengths of the student')

4. Target Area of Need. Check all appropriate areas:Academic HomeVocational OtherRecreational

*List specific s rtings that present problems.

5. Program Considerations

Yes No

Other Concerns:

Will modifications or adaptations effectively in-crease productivity?Can adequate training time be provided for theintroduction of the device?Can staff be provided to carry out training?Is there adequate space for the device?Is accessibility a problem? Please specify.

6. Consult with Support Staff and others.- Teachers -Parents- Physical Therapist -Community Contacts- Occupational Therapist

Do any of these people have ideas or materials available? (Manytimes, there is a wealth of talent in your own community forbuilding your own device)

133


7. Contact other sources for additional information.

-Missouri LINC Assistive Device Services 1-(800)-392-0533-Local medical /hospital supply companies-Local Hospitals*Occupational Therapy/Physical Therapy Depts.- Rehabilitation Services-State Department of Education-Consultants 1-(314) 751-4909- Local Service Agencies:

Lions Club - VisionOptimist Club - HearingBell Telephone Pioneers - EngineeringOthers...

8. Contact Distributors

*Have you explored the possibilites of hands-on experience? (Manycompanies will loan equipment for try out purposes for up to two

weeks.)

*Invite the sales representative to come demonstrate the devicewith the student,

*Spend as much time as possible training on equipment to

determine its effectiveness.

9. Consider Cost and Contact Funding Sources

Have you contacted:Insurance CompaniesState DepartmentLocal Service Agencies

10. Purchasing Equipment

Rehabilitation ServicesParents

What services are provided by the company?Warranties guaranteesLocal Representative for Servicing and MaintenanceLoan/LeaseOther Services

Is the device expandable in terms of its capability to "grow withthe student".

*When purchasing microcomputer assistive devices, consider itsability to interface with either existing or other systems.Prepared by:

134

EMPLOYMENT OPPORTUNITIES FOR THE HANDICAPPEDIN PROGRAMMABLE AUTOMATION

RICHARD SWIFTROBERT LENEWAY

ABSTRACT

The possible uses of numericalcontrols interfaced with computersinclude the opening of employmentwindows for persons with severe disabil-ities. Areas that show promise arecomputer aided design, computer aidedmanufacturing, computer aided engineering,

computer integrated manufacturingsystems, and programable automation.Numerical control systems are describedand their occupational outlook examined.The potential of these employmentareas to be filled by a workforceof persons with severe disabilitiesis great, but educational steps mustbe quickly taken.

Ben Cey, a bright 22 year oldexmachinist from Flint, Michigan,came to Michigan's State TechnicalInscitute and Rehabilitation Center(STIRC) in 1978 after a diving accidentparalyzed him from the neck down.

Ben came from a family of metalworking auto makers. His fatherwas a tool and die maker, his brothera welder, and grandfather a retired

foreman in a local GM engine plant.After graduating from high school,Ben got a job as a milling machineoperator and was paid a higher wagethan the 12% of his classmates whowent on to college could expect toearn after college graduation.

That was before his accidentmade his old job unaccessible. Ben's

vocational rehabilitation counselorreferred him to STIRC for a new programto train the severely handicappedin computer programming. This projectwas initiated with the assistanceof the IBM corporation and the WestMichigan Data Processing industry.It appeared to offer great promisefor Ben in retraining to become abusiness application computer programer.

In spite of good aptitude scores,extensive interviews and much hardwork, Ben was failing in his "onlychance for a good career." In a

termination meeting with the center'sstaff that included Ben and his parents,it was suggested that perhaps numericalcontrol (NC) programming might be

an alternative for Ben to try.It wasn't very long into this

pilot program when it became apparentthat a high level quad like Ben couldbe trained. One of the biggest problemsencountered were sketches and drawings.Mouthstick and CP drawings were oftenunrecognizable. In the meantime,however, the center drafting program

235


was desperately trying to survivetechnical obsolescence with the intro-duction of Computer Aided Design (CAD)to the industry. With some specialhelp from the State RehabilitationOffice in Michigan the center acquired

.r CAD stations with plotters.le addition of these CAD stations

also provided an answer to the problemwith drawings by students with upperlimb physical impairments. The realquestion: Could a quad be placed?was answered when the AC Spark PlugCompany hired Ben as an NC programmer.Since that time, other severely handicapped

students have been successfully trainedand placed in the manufacturing industryas NC programmers.

A Computer Integrated Manufacturing

System (CIMS) that will link two language

graphic terminals through a DEC computerto both a N.C. controlled millingmachine in the Machine Tool traininglab or a three dimensional CNC routerin the Cabinetmaking Shop has beenpurchased and should be installedin 1985. With a CIMS system it is

conceivable that a high level quadlike Ben could use a mouthstick ona graphic tablet to custom design,machine and manufacture either woodor metal parts from his bed at home.This capability comes at a time whenthe new "just in time" inventory systemsare demanding that suppliers automateinto CIMS or evaporate.

NC -CNC -CAD-CAN-CIMS -CAE -PA

"NC" Numerical Control Programming

NC dates from 1951 although it

did not become widespread until themiddle '60's. Prior to 1951 mostmachine tools were hand operated/controlled or equipped to make onepart automatically, continuously.This type of mass manufacture certainlyplayed an important role in this country'sdevelopment but required large expenditures

for single purpose machines and neces-sitated long production runs and largeinventories. Henry Ford's Model T

comes immediately to And - al 1 identical,

made for years.As in common with most new processes

it was originally believed NC wouldquickly "take ever" and relegateconventional machine tools to thescrap yard. However, many of thenew NC controls were difficult toprogram, broke down, and were difficultto repair as they required a serviceperson well versed in electronics-hydraulics and mechanics. The needfor this type of service person stillplagues the industry.

Programs for early NC machinetool controls were developed manually.Lengthy mathematical computationsand complicated geometry/trigonometrysketches/mechanical drawings werethe order of the day.

Computer Aided NC Programmingmoved out of the laboratory testingenvironment and into manufacturingabout 1964. In common with NC'sbeginnings, early attempts at ComputerAided NC programming were troublesome,frustrating and costly. Many languageswere promulgated, virtually everymachine tool or control manufacturerhad a proprietary language, usuallythey ran only the owners brand ofmachine tool or control.

In order to program a shop fullof various makes and types of machines,management was saddled with fiveor six languages; costly and cumbersomeat be:.., this was often a nightmare.

In the early 70's languagesthat would operate a wide varietyof machine tools became available.Again, many were offered but fewsurvived.

NC languages are genera:1y identi-fied/classified by the ,amber ofaxes they will control. Generalmanufacturers use 2 to 3 axes whilesophisticated aerospace- defense industries

use as many as eight. There areonly three general, axes length- width-

height, but any tool or partinclination/rotation is consideredaxis.

136

Discovery '84 Technology for Disable., Persons 125

"CNC" Computer Numerical Control

A CNC control basically is a

standard NC control :1. Equipped with a keyboard

so that programs can be enteredor modified and,

2. Equipped with a memory tostore programs or routines,and,

3. With several computationalfunctions built into thecontrol.

It is "smart" control , if youwill. Most CNC applications are in

small shops that do not have a programming

department nor access to a computer.CNC controls are not as capable asComputer Aided NC Programming butthey are Better than manual machineoperation and considerably less costlythan Computer Aided NC programmingeither time shared or in-house.

"CAD" Computer Aided Design

This is the creation of manufacturing

drawings by use of CRT keyboard lightpen and plotter. It replaces drawingsdone by a draftsman. Systems rangefrom those capable of only simpledr%Awings to those with analyticaldr:sign abilities capable of lengthymathematical computations.

CAD/CAN, CAE, CINS

These attempt to merge designdrawing, end engineering areas withNC programming. Basically they createthe NC programs at the same time thatthe drawing is created.

CAD-Computer Aided DesignCAM-Computer Aided ManufacturingCAE-Computer Aided EngineeringCIMS-Computer Integrated Manufact-

uring Sy7tem

PA- Programmable Automation mergesCAD, CAM, CAE, CIMS with automatedproduction techniques such as roboticsand computer inventory retrieval systems.

"NC" Programmers

NC Programmers are generallyclassified by:

1. Machine tool, lathe, mill

2. The number of axes they canprogram. A two axes programmerearns about $16,000 to $20,000and seven axis aerospaceprogrammers about $50,000to $60,000.

The level the STIRC programprovides training for is a 2-3 axes,

mill program. The level of mathematicsneeded increases dramatically asthe programmer level increases.

Employment Outlook for PA

In a recent study conductedby the congressional Office of TechnologyAssessment, the net change in nationalemployment caused by programed automation

"will not be major in the 1990's,

it will however have some definiteeffects on some individuals (likethe handicapped) and some regions(such as the Midwest).

The study indicates that the

potential long term impact of programmable

automation on the number and kinds

of jobs available is enormous. However,

the Office of Technology Assessmentexpects that job creation by PA producers

to be less than the job loss. This

is also supported in a study by Timand All an Hunt of the W. E. Upjohn

Institute for Employment Researchin Robotics. The Hunts' al so expect

a skill twist; hi ghly trained engineers ,

programmers, technicians and repairpersons

will be in demand as replacementsfor relatively untrained operators.

So, while P.A. will create newaccessible career opportunities forsome well trained physically handicappedpersons, like Ben, it can expectto bring to light many more 1 earLing

disabled persons whose problems wouldnot have surfaced in the days ofhigh paid assembly work.

13'7


Education

According to the U.S. Bureauof Labor Statistics, 21% of all Americanworkers are still involved in manufac-turing (28% in Midwest), thus, productionautomation can continue to be countedon as a force to reshape Americaneducation.

It demands a strong foundationof basic skills to build analyticaland problem solving skills. Theseskill changes indicate the need foreffective education and career guidanceservices for youth and adults to headin the right direction.

Working Environment

While telecommuting (workingvia terminal at home), is possible,it is not likely to be widespreadfor a variety of social, management,and traditional reasons. The overallworking environment will become moreaccessible as a prerequisite to automationand less physically hazardous, thus,less work related physical disabilitiesshould occur. There is some concernexpressed in the OTA report that relegatingthe craftsman' s skill to an "errorfree machine" may result in the increaseof psychological hazards for someworkers. The lack of trained PA workersmay affect the rate of growth in PAapplication. Much more on-the-jobtraining and retraining can be expectedto occur on the factory floors.

Sheltered workshops can alsoexpect to feel the impact. At GoodwillIndustries in Kalamazoo, Michigan,a CNC router turns out wood partstwo shifts a day for the assemblyof a variety of high quality productssuch as wood wheeled, back rollersand computer furniture. These productscan also provide increase in self-esteem

to the sheltered workshop participantsover printed circuit board assemblyand/or subassemblies. These highquality products can provide the workshopwith profitable return investmentthat may he used, eventually, forhigher wages for workshop employees.

Robotics

Robotics is currently generatinga great deal of attention. Verylittle information is available toassist the vocationalrehabilitation/special educationcommunity in counseling educatorsand students for these training programs.

How big will robotics be? How quicklywill it grow? What occupations willbe created? Will unemployment drama-tically increase because of robots?Are we training workers whose skillswill become obsolete? Does roboticsmake a good "fit" with handicappedworkers? Such questions were addressedin the Hunt study.

In a trade off between job placement

and job creation, jobs are semi-skilledand unskilled. The skilled jobscreated requires significant technicalbackground. This supports the notionthat the future labor market willdemand greater skills from workers.

Quite surprising is the presentlymodest size of the robotics industry.U.S. robot population has been placedat 7,000. Some of the most sophisticatedcapabilities attributed to robotsare not yet in widespread use. Oftenrobots are used with existing automatedproduction equipment.

According to the Hunt study,there is no question that many robotictechnicians will be employed. However,most of these technicians will be

retrained by the auto industry; littleoutside hiring is expected. Thus,only a small number o; robotic technicians

were used in other industries before1990. An oversupply of robotic tech-nicians because of high student interestis a real area of concern. Afterall , the function of robots is to

eliminate human labor, not increaseit.

In examining the robotic positionsavailable, the National IndustrialCenter for Handicapped Employment(NICHE) repo;ted that changing themotors, gears, and arms of a robotwould not make a good vocationalfit for most physically handicapped

138


persons. Thus, rehabilitation traineesshould avoid embracing this occupation.

Rehabilitation Engineering

With the new CIMS it is possiblefor a rehabilitation engineer to designand manufacture one-of-a-kind adaptivedevices for storage in a data basememory. They could be transferredor changed for similar problems ata later date. It also provides anopportunity for limited productionruns that are quick, easy, and cheap,even for small numbers of handicappedpersons needing non-mass market devices.This eliminates the need for inventoriesof such devices; they can now be madewhen needed.

Summary

The opportunities and challengesof programmable automation are greatfor handicapped persons, but theirfuture and ours lies in field awareness.It is hoped that this program is astart in that direction.

REFERENCES

Congressional Office of TechnologyAssessment , Computeri zed ManufacturingAutomation: Employment Educationand the Workplace, U.S. GovernmentPrinting Office #052-003-00949-8.

Corri2an, Richard. "Choosing winnersand losers," National Journal SpecialReports: High Technology PublicPolicies for the 1980's.

Education Cnmmission of the States(1982). "Education for a hightechnology economy," National Governors'Association Annual Meeting, August8-10, Afton, Oklahoma.

Feingold, S. Norman and Miller, NormaReno. Emerging careers: New occu-pations for the year 2000 and beyond,Garrett Park Press, Vol. 1.

Gates, Max. (1982). "Robotics nopanacea industry officials say,"The Grand Rapids Press, March 14,p. 2J.

Gottl ieg , Daniel. (1983) "High technology

training surges," High Technology,Vol. 3, No. 10, p. 70-73.

Hunt, H. Allan and Timothy L. Robotics:Human resource implications forMichigan. The W.E. Upjohn Institutefor Research.

Levin, Henry M. and Rumsberger, RussellW. (1983). The educational impli-cations of high technology, Institutefor Research and Educational Financeand Governance, Stanford University,Project Report No. 83-AY, February.

Levin, Henry M. and Rumsberger, RussellW. "High technology potentialfor creating jobs may be exaggerated,"The Washington .Post.

Long, James P. and Warmbrod, CatharineP. Preparing for high technology:A guide for community colleges,The National Center for Researchin Vocational Education, The OhioState University, Research andDevelopment Series No. 231.

Maxwell , G.W., West, Linda Nai res. (1980).Handbook for developingcompetency-based curriculum fornew and emerging occupations:A handbook for California vocationaleducation.

Nisbitt, John (1983). "The new economicand political order of the 1980's.People's Business, Vol. 8, No. 9,September.

Nelson, Bryce. (1983). "Computers:Worker menace? The New York Times,September 4.

Nicholson, Tom, Fineman, Howard andRuiz, Rick (1982). Growth industriesfor the future, October 18, p. 83.

139

AUTOMATING YOUR REHABILITATION FACILITYWITH MICROCOMPUTERS

RITA M. GLASS

ABSTRACT

This apaper presents a systematicway of evaluating facility needs forcomputers. The uses of computersby rehabilitation facilities are discussed

and the automation audit is proposedas a logical first step leading tothe use of a computer for an informationmanagement system.

Also presented is a the NationalEaster Seal Society's Storage, Tracking,Analysis, and Reporting (NSTAR) PatientManagement System. NSTAR is presentedas an example of a special purposedata based designed to deal with info,'-mation flows unique to the rehabilitationprocess.

If you are considering automatingyour agency, I'd like to assist youin making a wise choice.

YOU DON'T NEED TO BE A COMPUTEREXPERT TO BUY THE COMPUTER THAT IS

RIGHT for your agency. Be systematicin making your decision.

Six principles to keep in mindwhen considering whether to automateyour agency:

I. DO YOUR HOMEWORK - A smartbuyer should learn how a computerworks and how to use it. You canacquire this understanding in severalways. By:

-enrolling in seminars and classesoffered by colleges and universities

-reading books,magazines,newspapers- contacting industry groupsand associations- joining computer societiesand user groups

The purpose of doing your homeworkis to give you a basic understandingof computers and how they can be

used in managing your agency's totaloperations.

2. BUY THE COMPUTER YOU NEEDConsider the business, office, financial,client and fund-raising managementfunction of your agency.

. BUY THE COMPUTER YOU CANAFFORD - Make sure you know the totalcost of a computer before you buyit that the system you are consideringmust be within your budget.

4. BUY COMPUTER SOFTWAREFIRST - Software is the set of instruc-tions you feed your computer. Findand purchase the software that meetsyour unique needs as a rehabilitationagency.

140


5. BUY A PROVEN PRODUCT - Buy

software with a proven track recordfrom a company or organization that'ssecure. Many custom software developers

are not going to be around tomorrow.If you purchase a software system,be sure it can be maintained and tech-nically supported by the experts thatknow your rehabilitation business.

6. TAKE TIME FOR YOURDECISION - If this is new territoryoff, wait until you have the time;preferably, make the time to planand educate yourself before you buya computer.

What does a Computer Do?

Basically, computers accept infor-

mation (input), process the input,file the results, and display or printthe results. They do it faster, moreaccurately, more consistently thanpeople do. That's all a computerdoes. Now, how does a computer doit?

Most people are surprised tolearn that computers are not verysmart. They are fast and accurate,but cannot think. The high technologyis there simply to detect the presenceor absence of electronic impulse.Computers process and store information

in terms of these impulses. Groups

of impulses are called "memory."A computer accepts input from

the user through a keyboard. The

keyboard looks similar to the keyboardof a typewriter.

To process information, the computer

has a central processing unit (CPU)

and memory. The CPU interprets instruc-tions and manipulates data storedin its memory. It also issues commands

to the other components of the computer.Memory can be RAM (random access

memory) or ROM (read only memory).RAM is the memory readily accessibleto the user. It's the user's worktable. ROM is not accessible or alterable

by the user. It can be examined butnot changed.

Results of the information filed

can be displayed on screen, a televisionset, or a cathode ray tube (CRT).

The keyboard and screen togetherare known as a terminal.

All of these components of thecomputer system are known as hardware.They are anything you can bruiseyour knuckles on. The other components

of a computer are known as software,the sets of instructions given tothe computer hardware to file informa-tion. They are usually on diskettes,floppy, or "soft," square records.There are two types of software:operating and application.

The operating software controlstee overall operations of the computer.

It translates the information, controlsthe components of the computer, andkeeps track of what's going on.

Application software handlesthe specific business and programneeds of the agency. The computersystem you select should be ableto run the unique application softwarenecessary to conduct the day-to-dayfunctions of your agency.

All rehabilitation agencieshave standard operations similarto those of any business. 'Their

computer software needs are similarto business's. Unique needs relateto their specialized service deliveryand fund accounting requirements.

Any computer your agency considersshould be able to use available softwarethat meets both standard and uniquebusiness/service needs.

Automation Audit

An agency seriously consideringautomating should first hire a profes-sional computer/rehabilitation consultant

to perform an automation audit.This is a computer needs assessmentcovering an entire agency and allfacets of its operation.

An automation audit determinesyour agency's short and long-termautomation needs. Through prioritizationof these needs and appropriate allocation

of resources, the efficiency andeffectiveness of your overall operations

141


can be improved.An overall look at an agency's

automation needs assures that computerselection will be compatible withtotal software needs.

A good automation audit addressesthe necessary phase-in period precedingpurchase and software implementation.

Finally, a thorough automationaudit assures the purchase of equipmentholding computer power (memory) adequatefor three to five years that is compat-ible, upgradeable, and expandable.

The consul tant doing your auditshould be familiar with personal andmul tiuser/multi tasking micro-andsupermicrocomputers.

A personal microcomputer, sometimescalled a business computer, is a

single -user system; it is a personal

productivity tool.A multiuser/mul titasking micro-

ccmputer will allow several personsto use the system at the same time.Staff from di fferent departments in

an agency can carry out various taskssimultaneously.

Consultants unfamiliar with multi -

user /multitasking supermicrocomputersmay recommend minicomputers, someof which have memory but are threeto four times the price, of personalcomputers. These often prove impracticalfor a multiservice agency's businessoperations.

The automation audit consultantmust be familiar with a variety ofsoftware in order to recommend thecomplete set for your facility needs.The software you purchase must be

easy to load and operate. As userswill likely be novices, the softwaremust be user friendly. Professionalsshould be able to make it work withina reasonable period of time afterstudying the manual and practicing.Software that is not well documentedshould not be considered. Check themanuals that accompany software.Those that are easy to read and welldocumented can indicate software quality.

Four areas of operation needto be addressed in determining thehardware and software needs of most

rehabilitation services agencies:1. Basic. office automation2. Business/financial application3. Service del ivery/programs4. Fund raising/development

Basic Office Automation Software

The hi ghest vol ume automationneed for most agencies is officeautomation, specifically word processing.

Staff in all departments of youragency may benefit from word processing.A simple data base is also a must(a software system that allows youto file and retrieve informationin selected fields).

Some agencies can use electronicmail , sharing messages among departmentsThFiugh their terminals.

Business graphics constituteanother type of office automationsoftware used by agencies interestedin portraying statistical data invarious graphic formats. Specialprinters are required for full graphicuse.

In most medium-sized agencies,a terminal is used for office automation.

Business/Financial Application Software

The most-used software afterword processing is an electronicspreadsheet (Multiplan, Visicalc,Supercalc, etc.). This special purposedata base provides a great tool forbudgeting; it allows users to storeand manage data with calculation,comparison, and percentage capabilities.

A well-automated fund accountingsystem is another key tool for theefficient financial operation ofany agency, covering general ledger,accounts payable, accounts receivable,etc. Fund accounting systems shouldnot be confused with cost accountings.ystems. Computer salespersons unfamiliar

with specialized rehabilitation-relatedaccounting procedures often try tosell cost accounting systems thatdo not meet the accounting practicestandards recommended for your agency.

Payroll , clinic bill ing, job

142


costing and other accounting utilitiessoftware may be needed to meet youragency's financial needs.

Service Delivery Programs

Because this software must usuallybe custom built, available packagescan be risky, poorly documented, andfull of bugs (errors) or applicationsthat will not work for your uniquepurpose. Systems that track and manage

a full range of services offered toyour clients should be consideredin automating your agency. Look forsoftware written by a known agencyor programmer. Try to purchase a

system written on a data base; everyagency will need to customize softwareto meet its specific and singularneeds (e.g., referral sources arenot the same among agencies). Clientinformation tracking and manageanalidiftsoftware written on a data base willa low your agency to customize thedata you enter and retrieve it, withouthiring a programmer. Customized software

written on a data base should allowyou to design and generate reportsthat are unique to your agency's reporting

systems. Custom client managementsoftware written in or as a data baseallows custom report formats to be

developed. Data bases, built intoor interfaced with custom software,have the necessary power and depthto address your agency's unique reporting

requirements. Another plus for databases within custom software productsis that data bases are relativelyfree of the errors, that arise in

software developed specifically foryour agency.

It is in the area of client infor-mation, tracking, and management thatmost agencies mistakenly purchaseor have programmed unusable softwarecosting as much as entire computersystems. BUYER BEWARE!

Fund Raising/Development

Rehabilitation agencies are in-

creasingly called to generate outside

revenues to meet their resource needs.The market has a myriad of fund-

raising software. High donor profiles,

mail and donor list management systems,special events, planned giving, telethon,

and neighbor-to-neighbor campaignsare all available.

Before considering specializedfund-raising software, look at agood word processor, a simple database, and mail merge software.

These three inexpensive piecesof off-the-shelf software enablemost agencies to handle most of theirfund- raising activities. They don't

need to be cu:_tom built.A high-donor profile can be

developed simply by selecting specificfields on a simple data base (name,

age, friends, special interests,donor history, etc.)

By incorporating word processingand mail merge software, an agencycan generate, inhouse, customizedletters and mail lists for selectedsmaller groups of donors. Maintaining

larger mail lists in house (over

5,000) is impractical for most agencies

because of the amount of typing timeand analysis (prospecting,merge/purge,updating, etc.) required.

Choose a fund-raising softwaresystem that has a successful use

record. Ask others who use the systemfor their opinions. Beware of software

salespersons claiming that theirfund- raising systems will do allthe things you desire.

Service bureaus or mail houses

that spe:ialize in sophisticatedfund- raising programs now marketproducts that can be run inhouse.Selecting software systems form estab-lished houses or bureaus assurestechnical expertise. You buy theexperience and capability of dataanalysis for future planning andexpansion of fund-raising activities.

In summary, agency directorsattempting to automate their facilitiesmust address all aspects of their

business. They must willingly learn,use consultants, and strategicallyplan for computerization.


Automation takes twice as longto implement as to plan. The learningcurve is steep for all staff and manage-ment.

The right equipment is essentialbefore automation begins; the bruisesfrom the fall may otherwise, be painful.

Custom Database Softwarefor Rehabilitation Facilities

Following is an example cf acustomize. data base that can be effec-tively used by most rehabilitationfacilities known as the NSTAR PatientManagement System.

NSTAR is an acronym that standsfor:

National Easter Seal Society'sStorage,

Tracking,Analysis, andReportingPatient Management System

NSTAR is an example of a specialpurpose data base. A data base isa computerized tool that allows thestorage and retrieval of informationabout various subjects in a numberof ways. Typically, a computerizeddata base will allow rapid retrievalof stored information, searches forinformation on given topics, sortsarrangement of stored information,and the printing of reports. A specialpurpose data base is a computerizedrecord keeping system dedicated toa single purpose.

NSTAR has been designed to assistin managing the information flow inany rehabilitation setting.

Great care has been taken tomake this software quick, powerful,and easy to use. There are only fourteenquickly-mastered basic commands.

The data base is composed ofa collection of records, one for eachpatient in the census. Informationmay be entered into each patient recordat pa ti ent entry, and eval uati on throughout

the treatment period, and at dischargeand follow-up. The information entered

can be used to produce a large numberof reports, al 1 of which may be customized

to specific needs.I n fact, almost every aspect

of NSTAR may be customized to adjustthe software to fit specific needs.This customization process is discussedthroughout this document.

The rehabilitation` process maybe conceptual ized as containing severalsteps, as illustrated in the accompanyingfigure. These steps include entryinto the service system, intake,evaluation, interdisciplinary teamstaffing (program planning), programimplementation, periodic programprogress review, and subsequent discharge

from service or re-entry into furtherevaluation and service. Throughoutthis process, and evaluation of theclient program is also taking place.

ISA 1-21EMINI/IIMM11.41 IPMCNON

8PROGRAM

EVALUATION

4-.

2-i

EVALUATION 117",?' STAFFING

3

1

IMPLEMENT

REVIEW

1v

DISCHARGE

I

6

11

7

1FOLLOW-UP

1

The Rehab Process

For our example, patient entry

144


into the service system occurs at

the time of referral, either to a

centralized referral bureau or to

the rehabilitation agency. The servicesystem includes the rehabilitationservice agency, but also exteAds farbeyond the scope of the agency toencompass generic service agenciesand community resources. All of theservices and resources in the servicesystem cooperate in a coordinatedfashion to address the needs of patients.Entry into the service delioxy systemacknowledges the person as a potentialrecipient of rehabilitation service(s),but does not necessarily guaranteeadmission into active services. A

determination of the need f.,r service

and the propriety of the availableservice settings for meeting needsmust be completed prior to admission.This determination is based on a setof admission criteria pertinent tothe service agency's target servicepopulation. It is in the individual'sbest interest to minimize the periodof time between referral and admission(or the determination that admissionis not appropriate).

Intake

At the time of admission, thepatient is involved in a set of INTAKEactivities. These include all initial

interviews and information collectiontasks necessary to begin a comprehensiveservice file for the patient; this

comprehensive file is known as a UNITRECORD (or CASE RECORD). All informationconcerning the patient from entrythrough case closure is maintainedin the unit record. It is a portion

of this record that is maintainedby NSTAR.

Evaluation

Following the intake, the patientis involved in a period of evaluation.Therapists and other examiners employstandardized testing instruments andprocedures to determine the patient'scurrent presenting rehabilitation

problems during evaluation. Thisprocess is essential for establishingthe areas in which rehabilitationservices should be rendered. Theevaluation may be of several types,

such as etiological diagnosis, whichseeks to determine the underlyingcauses of a rehabilitation problemor descriptive (behavioral) diagnosis,which seeks to determine the functional

effects of a rehabilitation problem.

Staffing

After an evaluation has been

completed, the patient, the staffof the agency, and (if necessary)the patient's family meet to discussthe findings of the intake and eval uation

processes. Based on joint agreement,this group, know as an INTERDISCIPLINARYTEAM, constructs and INDIVIDUALIZEDTREATMENT PLAN, a plan for servicesagreed upon by all concerned parties.This individual plan contains serviceobjectives designed to address thediagnosed rehabilitation needs andpertinent supporting information,such as the projected length of treatment,

parties responsible for renderingtreatment, and methodologies to beemployed. The process of constructinga plan may involve gathering opinionsfromspecialistsinseveral disciplines,such as speech therapy, audiology,physical therapy, occupational therapy,social work, psychology, work adjustment,

vocational services, counseling,skilled nursing, and medical services.This team effort is called a STAFFING.Staffings ma, occur several timesin the course of treatment; the teaminitiates, and then periodicallyreviews, the priority rehabilitationobjectives.

Implementation and Review

Implementation of the objectivesoutlined in the individual plan is

the responsibility of the therapistsand paraprofessionals assigned duringthe staffing. Progress notes of

patient (client) response to treatment

45


(work experiences) must be maint'inedby the direct service staff ancl by

the coordinating staff that supervisethe rehabilitation process. Basedon these daily notes, periodic progressreviews are made; the review can leadto subseruent modification of theindividual plan by the team or bythe team's designate.

Discharge and Follow-up

A client may, as the result ofa progress review, be scheduled forimplementation of new rehabilitationobjectives, further evaluation, furtherdiscussion by staffings teams. Addi-tionally, if all objectives for treatment

have been substantially met, dischargefrom active service into a more appro-priate environment can be made. Followingdischarge from active service, thepatient/client progress in the newenvironment is measured periodicallyh%, a proces; known as FOLLOW-UP.Re-admission to the program, ongoingcounsel in and support, or other supportingactions may be used by the team, if

necessary, to assure the patient'swell- being. Ultimately, the patient /clientwill need no additional services.Independence from :1:pport is statedas a (:ASE CLOSURE.

Closure and Program Evaluation

Closure may occur because ofcomplete (or substantil)rehabilitationof the patient (positive closure),or the inability of the service agencyto further address the patient's rehabil-itation problems in a costeffectivemanner. Certainly, positive closureis the overall goal of all rehabilitationservices. The percentage of patientcases successfully concluded and theave,.age length of time required tobring about positive closure are important

statistical measures that can be usedto determine a rehabilitation agency'sefficiency and effectiveness of servicedelivery. The cost of services renderedper patient can be determined basedon length of treatment. These and

other measures are used as internalindicators of costeffectiveness andas marketing tools in the continuingsearch for additional funds frompublic and private sources. Thederivation of these measures in viewof the agency's overall objectivesand the subsequent feedback of resultsto administration and service personnelare functions of PROGRAM EVALUATION.

Using NSTAR

The NSTAR Rehabilitation Systemincludes mechanisms for collectingpatient intake information, as wellas evaluation, staffing, implementationand review, discharge, and Follow -up

information. Program evaluation,demographic analysis, and even appliedresearch, are supported through thesoftware's versatile data manipulationand reporting mechanisms.

NSTAR was designed and programmedby Jerry Bedwell, Associate, TechnicalOperations, Management InformationSystems of the National Easter SealSociety.

Dr. Rita Glass, Director ofManagement Information Systems forthe national Easter Seal Society,wrote the curriculum and assistedin the system design.

146

SELF-HELP GROUPS FOR THE DISABLED: PROFESSIONAL INVOLVEHENT

BRUCE F. PAMPERIN

ABSTRACT

This paper presents a model ofprofessional involvement with self -help

groups for disabled persons. A definition

of self -help is offered. The professional ,

as a change agent, is defined in relation

to four subsystems: (1) change agentsystem, (2) client system, (3) targetsystem, and (4) action system, This

model of practice is then relatedto four stages of problem solving:(1) assessment, (2) planning, (3)

implementing, and (4) evaluation.The professional is defined as an

expert in the problem solving process.A developmental model of transitionsthrough which the disabled personpasses is then outlined: (1) impact/

affinity, (2) recoil/unity, and (3)

accommodation/self-generation. Finally,

two cautions about the relationshipof the professional to the self-help

movement are offered.

An impossible situationprevails when we beginto think that any one groupor groups of experts cansolve all human problems.Mental heal th workers arebound to fail when theydo not recognize theirown limitations and whenthey try to maintain a

superordi nate positionas the "hel pi ,ig expert."(Silverman, 1978)

Self help groups have come ofage. They are changing the humanservices landscape and, yet, manyhuman service professionals havelittle training or knowledge aboutthe nature of self -help groups.There are many reasons for this lackof understanding. It is the purposeof this paper to provide human serviceprofessional s with a framework forstarting self-help groups with clientpopulations currently not servedin their communities. Therefore,this paper is intended to lay outa model of self -help groups whichare sponsored by a professional.It does not intend to discuss thephilosophy or directly the advantagesof self -help groups over more traditional

professionally based methods of inter-vention with target populations.The reader is referred to a number

of recent authors who have discussedat length the relationship betweenprofessional practice and self-helpgroups (Silverman: 1982, Gartnerand Riessmann: 1984).

This paper is divided into foursections. First, a conceptual model

is presented which identifies thefour subsystems a professional works

with while building a self-help group.This model operational izes the systematic

model of social work developed by

147


Pincus and Minahan (1973). The subsystemsare as follows: (1) change agentsystem, (2) client system, (3) targetsystem, and (4) action system.

Second, once the four subsystemsare identified, the change agent andaction system are prepared to starta problem solving process. The problemsolving process developed here is

divided into four tasks: (1) assessment,(2) planning, (3) implementing, and(4) evaluation. This model of problemsolving directs the activities ofthe professional , emphasizes the fouraspects that lead to a complete under-standing of the problem, and helpsto choose strategies that resolvethe problem.

Third, after the professionalhas helped in the organization ofthe client group, the process of mutualsupport begins. In this section thedevelopmental transitions that individualspass through are discussed, usingthe framework identified by Silverman(1978). The three transitions are:(1) impact/affinity, (2) recoil/unity,and (3) accommodation/selfgeneration.

Fourth, in the final section,two issues about the relationshipof the professional to the self-helpgroup are examined. The professionalmust gu rd against becoming too successful

and taking control of the group.Professional practice occurs withinthe context of bureaucratic regulationthat values standardization and unifor-mity. These two traits can defeata serf -help group. When people jointogether to solve common problems,they work best when creative problemsolving is encouraged and allowedto flourish. Standardization stiflescreativity and spontaneity. Self-helpgroups can al so become a substitutefor needed professional services.At a time when social service programsare undergoing reexamination and budgetsare being reduced, we must guard againstcreating quasi self-help groups thatmask human suffering in the name ofself - reliance.

First, let me define self -helpgroup. Al fred Katz and Eugene Bender

(1976) developed what I believe tobe the most complete definition ofself-help groups. In this paper,I include the role of the professionalchange agent for facilitating a sel f-help

group.

Katz and Bender (1976:9) state:

"Self -help groups arevoluntary, small groupstructures for mutual aidand the accomplishmentof a special purpose.They are usually formedby peers who have cometogether for mutual assistancein satisfying a commonneed, overcoming a commonhandicap or life-disruptingproblem, and bringing aboutdesired social and/or personal

change. The initiatorsand members of such groupsperceive that their needsare not, or cannot be,met by or through existingsocial institutions. Self-helpgroups emphasize face-to-facesocial interactions andthe assumption of personalresponsibility by members.They often provide materialassistance, as well asemotional support, theyare frequently "cause"oriented, and promulgatean ideology or values throughwhich members may attainan enhanced sense of personalidentity."

Four Subsystems of Self-Help Groups

Change Agent System

Pincus and Minahan (1973:63)define the change agent system asThe change agent and the people

who are part of his agency or employingorganization." Although the termchange agent can refer to anyoneinvolved in the change process, Pincusand Minahan limited it to individualsprofessionally employed. Therefore,

148


the change agent system refers to

the professional and the agency thatemploys him. The change agent represents

the professional 's knowledge, valuesand procedures for providing methodsof planned change to an individual,group or community. Previous experienceshelp shape the change agent's orientationand approach in the problem solvingprocess for clients requiring services.These experiences are substantiallyinfluenced by the values, historyand mode of operation of the employingagency. Each agency has its own uniquehistory and special mission. Disabled

individuals are serviced by a wide

variety of social service agencies,including mental health agencies,rehabilitation (both public and private),

social service agencies providinghome living opportunities, and otherrelated services. Although each agencyhas a special function, none are identified

as the principle agent for the development

of self-help groups. Thus, the changeagent refers to all professionalsworking wi th di sabl ed persons irrespective

of their professional training andemploying agency. However, the changeagent must be sensitive to prevailingvalues that influence and shape theiragency. Only by careful planningwill the change agent receive sanctionand cooperation from superiors. The

agency may provide valuable resourcesto the change agent including: meeting

rooms, mailing lists, access to experts,

and knowledge of client problems andstrengths.

The Client System

Pincus and Minahan (1973:63)define the client system as "peoplewho sanction or ask for the changeagent's services, who are the expectedbeneficiaries of service, and whohave a working agreement or contractwith the change agent." A disabledclient's system could include thefollowing persons: The disabled person,

family members, caregivers in a group

or residential living facilities,other organizations attempting to

provide alternative social servicesto the disabled population, or parentsof such disabled as developmentallydelayed persons.

After a change agent has been

approached by a client group, a contract

will need to be written that identifiesroles, establishes goals, and developscriteria for evaluation. Early inthe group is formation, the professional

needs to guard against providingtoo much structure and consequentlymakingthe group dependent on his knowledge.One role of the sel f-help group profes-

sional is as an expert on the processof group dynamics.

The Target System

Pincus and Minahan (1973:63)define the target system as the"People Who need to be changed to

accomplish the goals of the changeagent." Based on other attemptsto establish self -help groups, wecan not assume that all individuals

interested in the disabled personsupport the establishment of thegroup. For example, a physicianmay have serious doubts about hispatient's participation, believingthat these groups are unnecessaryor interfere with the overall medicalplan for which he is responsible.In this situation, a strategy needs

to be developed that obtains thecooperation of the reluctant physician.Providing articles or examples ofphysicians using self-help groupsmay encourage support.

In another example, a reluctant

spouse may be overly protective ofthe disabled spouse. They mightfeel threatened by the group membersor the group facilitator, fearingthat they will be displaced and losetheir role; perhaps a role that hasprovided them with ego satisfactionand a purpose in life. In this situation,

a separate group may be establishedto provide support for the spouse.This is a proven and important componentin the recovery strategies of alcoholic

149


families.

The Action System

Pincus and Minahan (1973;63)define the action system as "The changeagent and the people he works withand through to accomplish his goalsand influence the target system."The professional should develop a

team to meet the goals of the clientsystem. In order to build a team,the professional prepares a list ofinfluential people that can provideassistance in the establishment ofa group. Action team members mayinclude, but are not limited to, socialservice personnel who provide referrals,and physicians who help prepare a

client for referral and identify themas part of the treatment process.News media, such as radio, TV andthe newspapers, can be extremely helpfulby making the public aware of theself-help group.

Problem Solving with the Four Systems

Once the four systems have beenidentified by the change agent, anoverall conceptual framework of plannedchange needs to be designed. Theproblem solving process provides a

framework of four stages. The stagesare used to identify tasks. A linearor sequential ordering of the problemsolving process is not assumed. Thefour stages overla, and can occurat more or less the same time. Thefour stages are: 0) assessment,(2) planning, (3) implementing, and(4) evaluation. However, for thepurposes of clarity, the stages aredefined as separate tasks. A briefsummary of these tasks follows:

Assessment

Assessment refers to the collectionof data about a problem that a populationis undergoing. An assessment includesa listing of potential strengths andcurrent weaknesses in the disabled

person's environment. Potentialsources of information for the assessmentinclude the disabled person, socialservice professionals, family members,medical professional s, cl ergy, vol unteers ,

scientific literature, and otherexperts.

Conducting an assessment isa difficult activity. The most importantprinciple to remember is to keepan open mind. Far too often assessmentsare limited by the theoretical frameworkin which a professional has beentrained, such as client centeredor psychodynamic. Frequently, a

single theoretical framework determinesthe outcome of the assessment. Theproblem should determine the mostappropriate methodological solution.In assessment stage, a clear definitionof the problem develops and a statementof how group membership can alleviateproblems and enhance coping skillsthrough mutual support is defined.Frequently, the definition ncludesa coordination role for prof'.. ..tonallybased services.

Planning

Once a problem statement hasbeen developed a plan of action maybe created. The planning processshould include members of the actionsystem. A detailed plan of whatis to be done by the various individuals

is developed in this stage. Suchitems as where the group will meet,how new members will be recruited,what the focus of meeting will be.

Meetings may be planned aroundgroup discussions of spontaneoustopics, talks given by "experts,"the sharing of common problems eachface or the sharing of how otherscope with similar problems. Theself-help group should emphasizethe members wants and needs and notmimic existing programs developedfor other populations. A writtenplan may be useful in recording thedecisions made.

150

Discovery '84 Techrology for Disabled Persons 139

Implementing

After the plan has been developed,it is implemented. Carrying out theplan starts the process of self-help.During the implementation of the plan,the observant professional identifiespotential leaders who will replacehim when the group is sufficientlyself directive. The plan may needsome modification during its implemen-tation. Dates, times, and locationsmay need to be al tered in order toconform with members' schedules.The implementation stage is a time

when evaluation is also conducted.This brings us to the next stage,evaluation.

valuation

Evaluation is divided into twotypes; formative and summative. Formativeevaluation is conducted for the purposeof improving the group as it develops.For exampl e, the meeting times maybe altered because of conflicts withother meetings or responsibilities.The professional may have spotteda member who dominated the first fewsessions and will need to help thatindividual recognize their impacton the group and learn more appropriatebehavior. Formative evaluation mayalso involve the resolution of inter-personal conflict or the provisionof structured learning experienceson group dynamics in order to learnmore about group relations. Formativeevaluation provides feedback to thegroup so corrections may be made asthey learn how to give and receivesupport from one another.

Summative evaluation pertainsto the overall worth or success ofthe group. It also refers to theevaluation completed at the end ofthe group project. Important questionsinclude: Did the group learn to maintain

itself? Were new members acceptedinto the group? Did the members benefit

from the group experience? This is

only a partial listing of potentialquestions that would De asked for

a summative evaluation.

The Three Stages of Transition

Silverman (1978) has developedan integrated model of the developmental

transitions self-help group participantpass through. Silverman's modelhas three components: (1)impact/affinity, (2) recoil/unity,and (3) accommodation/self-generation.These developmental transitions arepresented and discussed below:

Impact /Affinity

Impact/Affinity is the firsttransition in the i ndi vi dual ' s adjustment

to disability and membership in a

self-help group. First, the individualexperiences the shock of having adisability. This role status changeis frequently abrupt; new ways ofcoping with life are required. Becauseof the new status as a disabled indi-vidual , previous social ization experiences

become inadequate; this results in

the need for resocial ization to understand

newly imposed limitations and to

avoid any tendency toward learnedhelplessness.

The self -help group developsan affinity between the newly disabledand others who have been disabledfor some time. Recognization thatthey are not the only person withthis particular problem and seeingothers who are able to cope withthe problem provides role modelsfor the new member. Experiencedgroup members provide support andencouragement. The new member isencouraged to discuss their feelingsand problems with others who knowfirst hand about the shock of beingsuddenly disabled. Experienced members"teach them the ropes."

This stage of developmentaltransition is first marked by a feelingof al oneness that is replaced by

a feel ing of group belonging. The

al oneness is exchanged for a sense

of hope. New friends and all ies

provide enjoyment and companionship

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while learning to adjust.

Recofi/Unity

During recoil/unity transitionthe new member spends much of histime learning about his new status.Information about his disability ispresented and experienced individualsshare how they have coped and offeradvice. This period of resolutionis a full immersion into the cultureof disabled persons. Language, jokes,dress, and other symbols of the cultureare internalized and become acceptedas part of a new identity. The self-helpgroup functions as a primary resocial-ization group designed to supportthe individual through mutual inter-action. It helps the individual regaintheir confidence.

Accmmodation/Self-Generation

Accommodation occurs when theindividual begins to achieve veteranstatus with the other members. Theshock of their disability is placedin perspective; they begin to seethat others may need their help, justas they were helped. The group providesmoral support and reassurance. Themain task for the individual is to

fit pieces of their previous lifestylewith their current lifestyle. Theoriginal shattering experience is

left behind and a new whole identityis created.

Self-generation may include rolereversals, from help seeker to helper.Not all members choose this status,but fir some it provides great satisfaction

and rewards, and it insures continuanceof the group. The group also needsto remain open, allowing members toleave when they are ready. Self-helpgroups must guard against being paterna-listic and prepare the individualfor the community. A schematic repre-sentation of this model is found inbelow.

Limitations of Professional Involvement

Self-help groups sponsored by

professionals can extend professionaland agency bureaucratic tendenciestoward standardization. The strengthof the self-help movement lies notin professional superordination andcontrol but in the control placedwith the group members. This issueof control is similar to the teacher-student relationship. The teachercan easily dominate and influencethe student but must not, otherwisethe student fails to learn what theteacher has to offer-freedom; thefreedom to create and act as an individual

fully capable of making informedchoices. If the professional becomestoo responsible the group will notbe able to grow and nurture the memberswho seek understanding and coLfort.The professional relationship tothe self -help group should be muchlike that of the gardener providinga fertile environment for the creativeprocess to flourish and take hold.

A second warning is offered.Current national policies towarddisabled persons are being reexamined.Old value assumptions about the govern-ment's involvement in assisting thedisabled are being questioned. Whileserious questioning is always healthy,the current questioning is premisedon the reduction of government involvementand, therefore, expenditure. Now,as the family is being called uponto take more responsibility, theself-help group could be called uponto supplant more traditional social

services. At stake is the overallquality of life for some of our mostvulnerable citizens. Self-help groupscannot become alternatives to profes-sionally based services when thereis a need for these services.

Summary

The future of self-help groupsfor disabled persons rests, in largepart, upon the skill of the professionals

that help create these alternative,

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nonprofessional model s of self-helpand mutual support. In this paper,a working model of professional involve-ment was outlined. The professional 'srole was defined relative to foursubsystems: his agency, the clientpopulation, persons to be changed,and the team created to establishthe group. The problem solving processwas offered as a framework for determiningwhich task to work on when tryingto establish the group. The fourproblem solving tasks are: assessment,planning, implementing, and evaluation.

The disabled person's relationshipto the group was defined in termsof the developmental transitions thattypical individuals are likely topass through. These transitions markthe individual's adjustment growth.The transition periods are: initialshock, learning to cope, anti the inte-gration of their new lifestyle.

The limitations of self-helpgroups sponsored by professionalshave serious implications for boththeir eventual independent functioningand overall role in the disabled person'slife. Professionals should avoidtaking too much responsibility inthe creation of the group. Fosteringdependence will eventually lead tobureaucratic domination and, thus,the corruption of the nature of self-helpgroups.

Finally, self-help groups cannotsubstitute for professional serviceswhen they are required. These groupsserve a unique and much needed purpose,but they should not become substituteservices to support budget cutbacks.

SCHEMATIC DIAGRAM FOR STARTING A SW-HELP GROUP

The Professional Subsystems

Change Agent SystemClient SystemTarget SystemAction System

Problem Solving (APIE1

AssessmentPlanning

ImpleventingEvaluation

Group Formation

Members IdentifiedLocationTopics

Expectations

Developmental Transitions

Impact/AffinityRecoil/Unity

Accommodation/Self-Generation

Become Helper In Group

+Cycle Repeats

Outcomes

REFERENCES

Leave Group

IJoins Community

Gartner, A., & Riessman, F. (Ed.).(1976). The Self-Help Revolution.New York, NY: Human Science Press,Inc.

Katz, H. A., & Bender, E. I. (1976).The Strength in US: Self-HelpGroups in the Modern World. New

York, NY: Franklin-Watts.Pincus, A., & Minahan, A. (1973).

Social Work Practice: Model andMethod. Itasca, IL: F. E. PeacockPublishers, Inc.

Silverman, P. R. (1978). MutualHelp Groups: A Guide for MentalHealth Workers, DHEW PublicationNo. (ADM) 78-646.

Silverman, P. R. (1982). Peoplehelping People. The Modern Practiceof Community Mental Health, ed.Schul berg, H. C. & Kill ilea , M. SanFrancisco , CA: Jossey-Bass Publishers.

:153

BRIDGING THE TECHNOLOGICAL GAP

ROBERT LAZOWBARRY ROFF

JEFFREY SOLOMONDANIEL WARTENBERG

ABSTRACT

The policy of deinstitutional izationof the mentally ill coupled with thedawning of the age of technology hasexacerbated the historical difficultiesfaced by vocational rehabilitationprograms in successfully providingemployment for their clients. Thetraditional gaps between the functioninglevel of the client and the demandsof the mainstream employer have, conse-quently, widened. The "Bridging theTechnological Gap" Project (BTG),a three year demonstration projectfunded by the U.S. Department of Education,Rehabilitation Services Administration,aims to use microcomputer technologyin the rehabilitation of the psychi-atrically disabled. Through the useof a custom designed microcomputersoftware package, clients receiveremediation in areas of specific cognitivedeficits. The addition of this approachto traditional rehabil itation effortsis intended to increase the employabilityof the mentally ill.

The Crisis in Vocational Rehabilitationfor the Psychiatrically Disabled

For the past several years therehave been significant advances inthe field of computer technology,particularly with the introductionof the microcomputer. The resultof these advances has been the creationof a shift in the types of empl oymentopportunities available in post-industrialnations, such as the United States.While jobs were once plentiful inunskilled and semiskilled labor-intensiveindustrial work sites, changing conditionshave decreased these opportunitieswhile empl oyment openings in technol ogi caland service oriented fields haveincreased (New York Times 1983; LaborMarket Information Network, 1982).

This shift in job opportunitieshas had a profound effect on thepsychiatrically disabled. Oftenthe work experiences they have receivedin vocational training programs andsheltered workshops have been gearedto an industrial/manufacturing environ-ment. Once it was sufficient tolearn repetitive industrial assemblywork, manual filing or typing; now,the new worker demands require theability to operate a microcomputer,perform word processing, data entry,and/or automated record and bookkeeping.In addition, employers are increasinglydemanding that personnel be flexibleand adaptable, use independent judgementand be ready to continue learningduring the course of employment.(National Institute of HandicappedResearch, Dept. of HEW, 1976); Griffiths,1974; Rehabilitation Services Adminis-tration, 1979).

The impact of these labor markettrends has been hightened by the

154


movement of persons with chronic disa-bilities into vocational rehabili-tation as a result of public deinsti-tutional ization policies. These indi-viduals have been characterized asapathetic, dependent, rigid, lackingin initiative, and tending to avoidnew experiences. When consideredin the context of the current labormarket trends, these behaviors, areantithetical to those being soughtby employers . Thus , attempts to increasethe employability of these individualsshould go beyond the updating of skilltraining and address these basic functional

deficits.

Bridging the Technological Gap

Al tro, in response to this need,proposes to improve the basic cognitivefunctions currently in demand in thelabor market, but deficient in thementally ill. The primary tool to

be used in this effort is the computer.The introduction of the microcomputerinto the treatment regimen representsan innovative attempt to integratea powerful new technology into thefield of psychiatric rehabilitation.The microcomputer is ideally suitedin many ways to the task. It has beencalled "user friendly" because it

can be easily accessed and tailoredto the needs of individual users.In addition, micros can be programmedto not hurry the user by moving atthe users work pace. It can al so

provide immediate feedback in a non-

judgmental , stimulating manner. Theattributes of this technology maywell extend the powers of the individual

interacting with it, particularlyin the areas of intellect, ego functionand cognition. (Chartrand and Williams,

1982); Imprint Software, 1982; Anastasinand Wang, 1981; Robl eyar , 1981).

Al tro' s "BTG" project tests thispremise by remediating basic cognitiveand behavioral deficits through theuse of the microcomputer and customdesign software. The project willtest the hypothesis that specificattention to these deficits and tradi-

tional rehabilitation will not onlyimprove functioning in the targetedareas but will also enhance employa-bility.Specifically, the project will :

1. Create microcomputer software -

applications that will focus

on building flexibility,impulse control, attentionand concentration, masterycompetence, and problemsolving ability.

2. Provide vocational trainingin fields requiring microcomputer

skill, such as data entry,word processing, and bookkeeping.

The efficacy of this new approachwill be determined via a rigorousevaluation effort that assesses theimpact of the cognitive enhancementpackage and skills training individually

and as used together.

Project Progress

As the project approaches theend of its first year, software packageshave been developed and are currentlybeing pretested for "fine- tuning."The project hardware, ten Apple Macintosh

microcomputers, have been purchased.These machine are described as thirdgeneration computers. They havesimplified user interaction by makinguse of simplified command structures(Mace, 1984).

Needs Assessment

Needs Assessment took a two-prongedapproach; a review of existing softwarein use in rehabilitation and/or education,

and an in depth analysis of the cogni-tive /behavior deficits within theAl tro population.

Al tro surveyed the progressmade over the past several yearsin the use of microcomputers as an

interactive learning device withlearning and physically disabledchildren in the field of education.In addition, the use of microcomputersas a rehabil itative tool with adultswho have lost cognitive functioning

155


as a result of head injury was examined.Microcomputer software available forthese populations are as diverse asthe population. However, one of thecommon concepts in all of these appli-cations is that microcomputer softwareeoablesindividualstoinitiateactivitiesthat can change an individual's environ-ment, and in turn, the individualis effected by that environment.This principle was to be central to

the software development. (Papert,

1975; Papert, 1980; Gable, 1980; Weir,1982; Hannaford, 1981; Weizenbaum,1976; Gianutsos, 1982).

Concurrently, a pilot study wasconducted to identify the specificego/cognitive areas in which Altroclients, with their often severe/chronicpsychiatric disabilities, have problems.The Bellak Ego Function Scale wasused as a primary tool for targetingthe areas of greatest deficit amongAltro clients. Ego Functioning asidentified through the Bellak Scalehas been found to be predictive ofemployability among the psychiatricallydisabled. Measures were also obtainedfrom WAIS scores and from the behavioralobservations and evaluation of Altro'sclinical and workshop stuff. (Bellak,Hurrich & Geidman, 1973; Ciaridielloand Sobkowski, 1983).

Cognitive deficits among thepsychiatrically disabled were identifiedusing the findings of the pilot.The areas identified by the BellakScale that showed the greatest functionalimpairment, and appeared most amenableto remediation through use of themicrocomputer, were Adaptive Regressionin the Service of the Ego (ARISE),

Drive Regulation and Control, andMastery Competency. Staff ratingsand the Picture Completion subscoreon the WAIS indicated that attention,concentration and memory were otherdeficits in need of remediation.

The existing software was examinedin relation to identified needs.It became apparent that no availableprogram would meet the particularneeds of Altro clients. Therefore,it was decided that custom software

should be developed using the principlesof existing materials. Four softwaremodules were developed. One corresponded

to each of the deficit areas identifiedabove. This series of software modulesis called COGITO.

Software Development

The first module to be developedfor COGITO was designed for ARISE.ARISE has been defined as the "capacityto relinguish well-formed secondaryprocesses to allow for the creativeutilization of more primative modesof thinking." It is associated withthe functions of flexibility andadaptation. The software modulecontains training tasks that requirethe user to switch response sets.It also requires graduated adaptationsto different response sets (Norello,1974, p. 52).

The first component of the ARISEmodule provides a good example ofCOGITO software. It requires theuser to move one box over a secondbox using special keys on the keyboard(such as a sequence of S,F,E,X, thatmoves the box up and down and leftand right). A legend in the monitorcorner indicates what movement eachkey provides. At set intervals thelegend changes requiring the playerto switch to a differeni, set of letters

to move the box. When the clientdoes not switch to the new keys,an error is recorded. (See Figure1).

The second domain, Drive Regulation

and Control or Impulse Control is

described as "the capacity to appro-priately control the expression ofdrive derivitives: the degree towhich aroused drives affect behavior."The module for this area containstwo components. First the user mustrespond repeatedly to a stimuli andthen inhibit that response relativeto a cue. The second focuses oninhibiting a user's response andthen responding appropriately toa cue. (Norello, 1974, p. 51).

156


Figure 1

Me Wit ControlMoOMEIOBOMBIES RLTRO liEiHaial:Ma0

k

ERRORS

1

TORt:s1

A

W

X

The third area targeted for inter-vention, Mastery Competence, is "capacity

for successful planning and masteryover environment." The user mustlearn to adapt to the demands df acomputer constructed environment.Mastery is related to the client'sability to follow directions, manageresources, and attain goals. (Norel lo,

1974, p. 55)The final module was developed

for Attention, Concentration and Memory.This area is defined for this project,as the ability to discriminate betweensimilar cues, remain on task, increasethe amount of time on task and resistfatigue on task. This module requiresthe user to correctly discriminatepairs of pictures. This becomes moredifficult in a second version whenthe user has to discriminate betweenpairs of pictures with a visual and/orauditory di stractor present and withvarying amounts of response time allowed.In a third version, the user is requiredto match picture pairs distributedat random in a four by four arrayfrom memory. This version is mademore difficult by again adding anauditory di stractor.

Al tro is presently in the processof pilot testing and refining thesoftware for the four described domains.In addition, it is investigating otherareas of possible intervention withsoftware applications.

Program Eval uation

The evaluation of the Bridgingthe Technological Gap program willbe conducted under the auspices ofthe Altro Institute for RehabilitationStudies, an autonomous arm of theagency that conducts educational ,research, and evaluation projects.

The primary purpose of the evaluation

is to test the hypothesis that thecritical factor in the rehabilitationof severely disabled mentally i 11

persons is the remediation of basiccognitive and behavioral deficits.The assumption is that specific attention

to these deficits together with tradi-tional rehabilitation will not onlyimprove functioning in these specificareas but will also enhance employabil-

ity. The secondary hypothesis tobe tested is that in cognitive/behavioral

remediation will be most effectivetogether with microcomputer skill straining.

The specific experimental hypothesesare as follows:1. The computer remediation program

wing "COGITO" will significantlyimprove: Flexibility /adaptability,impulse control , mastery competenceand memory, attention, and concen-tration.

2. Clients participating in thecomputer remediation programusing "COGITO" will significantlyimprove vocational functioning;specifit.ally work appropriatebehavior. productivity, and placement

into competitive employment.3. The computer remediation program

using "COGITO" will be effectivewhen used in conjunction witha microcomputer skills trainingprogram.

Subjects

The Project population willconsist of Al tro Health & Rehabilitation

clients meeting the following criteria:1. Minimum of an 8th grade reading

level ;

157


2. Minimum WAIS Full Scale IQ of85;

3. Adequate finger dexterity to operatea computer keyboard;

4. Will ingness to use the microcomputer.

Sample - Eligible clients will be

randomly assigned to one of the followingfour experimental groups:

CROUP A

CROUP B

GROUP C

GROUP D

COG ITO

X

X

MICRO

TRAINING

X

X

TRADITIONAL

REHABILITATION

X

x

x

Each group will have 10 subjects.Subjects are projected to remain inthe program for a maximum of 9 months.

Method

All subjects will be given theproject test battery prior to entryinto the program. The test will be

repeated after four and one half monthsand after nine months. If a subjectcompletes the program prior to ninemonth, post-test measures will be

taken at that point. The length ofstay will be' accounted for in theanalysis. A three month period followingthe training cycle will be allowedfor placement into employment.

Instrumentation

Measures of program effectivenesswill be made at three levels. LevelI will measure performance on computertasks. This will have built-in scoringmechanisms. Level II will use validatedpsychometric instrum nts that corresponddirectly to each of the program modulesto test the generalization of acquiredskills. Level IIIwill test generalizationto broader areas of functioning includingwork related behavior, productivity,program attendance, self esteem, andsymptomatology encapsulation.

Analysis

Each hypothesis will be testedvia a multiple analysis of variancethat assesses the significance ofchange over the course of the project.The interrelationship between thelevels of measurement will be establishedvia an analysis of covariance.

Client training in the "BTG"PrJject begins November 15, 1984.For further information contact:

Mr. Robert LazowProject DirectorBridging the Technological

Gap Demonstration ProjectAltro Health & Rehab Services3600 Jerome AvenueBronx, New York 10467(212) 881-7600

Demonstration Project supportis provided by the United StatesDepartment of Education, RehabilitationServices Administration, Washington,D.C.

REFERENCES

Bellak, L., Hurvich, M., & Geidman,H., "Ego functions in the schizo-phrenics, neurotics and normals:A systematic study of conceptual,diagnostic, and therapeutic aspects."New York: John Wiley and Sons.

Black, B. (1977). Substitute PermanentEmpl oyment for the Dei nsti tutional i zed

Mentally Ill. Journal of Rehabili-tation, 32-39.

Ciaidiello, J. A., M. E. & Sobkowski,S. L. (1983). Ego Functioningand the Vocational Rehabilitationcf Schizophrenic Clients. Paperprepared by Community Mental HealthCenter-Rutgeis Medical School.

Ed Anastasia, E. & Wang, C. Index

to Computer Based learning, Vol. IV.Educational Communications Division,University of Wisconsin.

Ed Chartrand, M J. & Williams, C. D.(1982). Educational SoftwareDirectory. A Subject Guide toMicrocomputer Software, Corporate

158


Monitors, Inc.Gable, A. & Page, C. The use of artificial

intelligence techniques in computer-assi!:ted instruction: '4n overview.

International Jnurr?.1 of Man andMachine Studies 1980, 12 (3),

259-282.Gianutsos, R. et .al . (1982). Personal

Computing and the Transformationof an Injured Brain into an ActiveMind. Presented at the AmericanCongress of Rehabilitation Medicine(Houston, Texas, 3).

Griffiths, R. D. (1974). Rehabilitationof chronic psychotic patients,and assessment of their psychologicalhandicap, an evaluation of theeffectiveness of rehabilitationand observations of the factorswhich predict outcome. PsychologicalMedicine, 4, 316-325.

Hannaford, A. & Sloane, E. (1981).Microcomputers: Powerful learningtools with proper programming.Teaching Exceptional Children,14, 54-57.

Ibid. Page 92

Inforworld, Vol 6 (23) June 4, 1984.International Software Directory,

Vol . 1., Microcomputers: Update.April 1982, Imprint Software, 1982.

Labor Market Information Network,"Employers' Views on Hiring.

Lamb, R. (1971). "Rehabilitationin Community Mental Health." SanFrancisco Joseph Bass Inc.

Mace, S., Drexel U. Meet the Macintosh;A University Consortium Busilyin Progress.

National Institute of HandicappedResearch, Department of Health,Education, and Welfare, Post - employment

services and mentally disabledclients. REHABILITATION BRIEF:BRINING REHABILITATION INTO EFFECTIVEFOCUS, (1976), 6(2), 1.

NEW YORK Times, "Labor Study FindsEconomy of City Now More White-Collar Than Ever," Saturday, March13, 1983.

Novello, J. R. (1974). A PracticalHandbook of Psychiatry, Springfield,Illinois, Charles C. Thomas publisher.

PAPERT, S. (1980). "MINDSTORMS."

New York: Basic Books.Papert, S. (1975). Teaching Children

Thinking. JOURNAL OF STRUCTUREDLEARNING, 4 (3), 219-229.

Rehabilitation Services Administration."Characteristics of Persons Rehabil-itated by State Vocational Rehabili-tation Agencies, Fiscal Year 1976-1978," (Annual Report, 1979).Milwaukee, 1981.

Robleyar, M. D. (1981). When it

is "GOOL COURSEWARE"? Problemsin developing standards for micro-computer software. EducationalTechnology 21, (10), 47-54.

Weir, S. (1982). The computers asa creative educational tool.American Annals of tne Deaf, 127(5),

690-692.4

1 5y

BIOFEEDBACK TRAINING AS A FACTOR IN THEPERSONAL/VOCATIONAL ADJUSTMENT OF REHABILITATION STUDENTS

JOHN D. SEE

ABSTRACT

This pilot project was designedto compare the effects of two typesof biofeedback training on the personal/

vocational adjustment of rehabilitationstudents.

Thirty-three volunteer studentswere randomly assigned to three experi-mental groups: 1) EMG biofeedback,2) Thermal biofeedback, and 3) Control.The two treatment groups receivedten weeks of standardized biofeedbacktraining.

The outcome criteria were post-testscores on the POMS (Profile of MoodState), the Internal External Locus

of Control Scale, and the VocationalMaturity Scale.

The results of this study showedthat those students who received bio-feedback were significantly (.05 level)less depressed and confused, as measuredby the POMS, than were their counterpartsin the control group. These results,however, must be seriously questionedin light of the high drop-out rateof the volunteer subjects (27%).

This paper reports the first phaseof a pilot project in biofeedbacktraining which began at the Universityof Wisconsin Stout in the spring of1984.

The initial findings derived froma ten week study of the use of biofeedback

training as a factor in thepersonal/vocational adjustment ofgraduate and undergraduate rehabili-tation students at UW-Stout.

Background

Research evidence strongly suggeststhat biofeedback training may havea valid role in non-medical settings

such as rehabilitation facilities,correctional programs, or wellnessprojects in industry, and yet therehas been very little comprehensiveresearch done in this area.

Biofeedback in its simplest form(muscle relaxation or thermal training)has been shown to have a salutaryeffect on a wide variety of emotionalconditions which interfer with normalfunctioning. The following listis a sample of client conditionsseen in rehabilitation settings whichmight be helped by biofeedback training:

- general anxiety and tension- adult situational reactions

(the recently disabled)- adolescent situational reactions

(troubled teenagers)- phobic reactions to specific

situations (test taking,job interviews, etc.)

- poor motivation or lack ofinterest

- problem drinking or chemicalabuse

- lack of concentration- rebelliousness or hostility- withdrawal

- fear of failure- lack of assertiveness

A common finding in the literatureis that clients who successfullyengage in biofeedback training oftenexperience an increase in self- awareness

acid a he i ghtened appreciation ofthe control they have over theirown destinies. They are describedas showing more self- confidence,increased motivational levels, and

160


a stronger commitment to "act" onthe environment rather than to be

victimized by it.If this observation proves correct

for rehabilitation clients, we mightexpect to see an improvement in theircapacity to participate in, and profitfrom, the rehabilitation processif biofeedback as training is provided.

In this project, biofeedback isconceptual ized as a standardized well ness

component that can be instituted in

various rehabilitation settings usingmoderately priced equipment operatedby minimally trained professionalstaff. It is important to stressthat the use of biofeedback in thisproject differs substantially fromthat provided in a biofeedback clinicwhere clients are treated for medicalor psychological problems r2quiringcareful diagnosis and individual treat-ment. This research deals only withthe types of biofeedback that arewell established and for which thereare essentially no medical contra-indi-cations; i.e., thermal training andelectromyography (EMG) training for,idividuals without organically-basedmedical problems.

Purpose of Study

The specific purpose of this studywas to investigate the relationship,if any, between a packaged ten weektreatment program in biofeedback andchanges in personal/vocational adjustment

of the subjects as measured by post-testscores on a battery of psychometricinstruments. The thirty-three subjectswere randomly assigned to a control

group, a treatment group that receivedonly EMG training, and a treatmentgroup that received only thermal training.

Literature Review

The biofeedback literature is

not conclusive regarding the relativemerits of EMG and thermal trainingin the treatment of stress or anxiety.

In their summary of the biofeedbackfield, Katkin and Goldband (1980)

state that EMG and EEG (brain waves)are the two fundamental approachesto the treatment of anxiety. This

prevailing sentiment seems to be

illustrated by Zimberg (1980) in

his discussion of alcoholism, whenhe state that:

"EMG biofeedback has been foundto be the most useful for anxietyreduction. It is not usefulin the treatment of activelydrinking alcoholics but can be

helpful in post withdrawal wherethere is often prolongedneurophysiological hyperactivityof the central nervous systemand increased muscular tensionalong with the feeling of anxiety."

Still many experts in the fieldof biofeedback see thermal trainingas a viable means of inducing relaxationand combating psychological tensions.

Barbara Brown (1977) in Stressand the Art of Biofeedback states:

"There are two principle biofeedbackprocedures whose primary focusis stress reduction. These aremuscle (EMG) biofeedback to assistin learning muscle relaxationand temperature biofeedback,which produces more internalrelaxation effect."

She goes on to state that:

"Temperature training for relaxation

effects is generally performedusing hand or finger temperature.There has been no solid physio-logical evidence that temperaturebiofeedback results in a general

relaxation effect, but a particulartype of internal relaxation effectis inferred to occur from thesubjective reports followingtraining and from the reliefof pain in tension and migraineheadaches."

Gaarder and Montgomery (1977) state:

...there are a growing number

161


of clinicians who have developedpartial ity toward the generaluse of finger temperature feedbackas a general method for thetreatment of stress relatedsyndromes and who may not useother modalities as a result.Their good results seem to validatetheir taking this position,although thorough comparativestudies are not yet available.

Daskin and Crow (1981) cite a

study where thermal training was usedas a part of a rehabilitation programfor prisoners. TN experimenter "feltthat the prisoners' success in thermaltraining was accompanied by an increasedsense of self-mastery which permitteda more honest and open explorationof ideas designed to bring about changesin self image."

The abstract of Elmer Green'spaper (1974) on the use of biofeedbackin the treatment of alcohol ism anddrug addiction states:

"A voluntary biofeedback programis described which includes trainingin temperature control and relaxation

meditation. It is concluded that,aided by biofeedback, a personcan learn to modify emotionalreactions so that continuous psych-ological stress will not perpetuatechronic somatic distortion."

The potential of Thermal trainingsuggested by the above authors corresponds

closely with the clinical opinionof the staff of the Biofeedback Laboratory

at the University of Wisconsin-Stout.(Personal Communication). They haveused thermal training with considerablesuccess in the treatment of stressrelated emotional disorders in collegestudents.

So, while EMG appears to be the

treatment of choice for anxiety reductionat this time, the empirical underpinningis not strong arid it would be prematureto discount other biofeedback modessuch as thermal training. This is

especially true as thermal equipment

is generally less expensive thanEMG or EEG equipment and is easierto maintain and operate.

Methodology

Subjects

Vocational rehabilitation studentswere invited to participate as subjectsin the biofeedback research. Thepurpose and nature of the researchwas explained to them. Those whovolunteered to take part signed aconsent form and were randomly assignedto one of three groups: EMG, thermal,or the control group. Those in the

treatment groups were scheduled toreceive 10 individualized biofeedbacksessions (one per week) conductedby student biofeedback techniciansfrom the University of Wisconsin-StoutBiofeedback Lab. There were elevensubjects in each of the three groups.

Equipment

The EMG instrument was a CyborgJ33 Muscle Trainer. The thermalinstrument was a Cyborg J42 FeedbackThermometer.

Procedure

The actual biofeedback sessionsfollowed a standardized format.The initial session was primarilydiagnostic and educational. Thetechnician collected biographicaland medical data on the client, gavean explanation of the general procedures

to be followed, and introduced theclient to the equipment. A trial"hook-up" took place during whicha baseline measurement was recorded.It is frequently desirable 'at the

beginning stage to give a brief ex-planation of the autonomic nervoussystem and how biofeedback can teachpeople to consciously control bodilyresponses which were previously thoughtto be unconscious or reflexive.It is essential that the client seethe connection between biofeedback

162

Di5covery '84 Technology for Disabled Persons 151

training and stress reduction. Theyneed to appreciate that the self-controlthey develop in biofeedback will providethem with a new skill for coping withthe tensions and anxieties of dailyliving.

It was also during the initialsession that the client was introducedto the concept of daily home relaxationpractice. Systematic relaxation orautogenic training is an integralpart of virtually all biofeedbackprograms for anxiety reduction. Thetechnician explained the importanceof home practice and attempted to

get a commitment from the client toconscientiously practice daily forthe next ten weeks. The clientswere given cassette tapes which guidedthem throug'r, the systematic relaxationsequence. They were also allowedto check out portable tape recordersif necessary.

The remaining biofeedback trainingsessions followed a standardized format.These sessions were approximately30 to 45 minutes in duration. The

client was greeted, blood pressureand pulse rate were checked, and therewas a discussion about the progressbeing made with the home practice.The thermistors or electrodes werethen attached and with the clientin a sitting or reclining position,the biofeedback signal was presented.The te-Anicians were wc.11 trainedin the clinical strategies that assistclients to reach successively deeperlevels of relaxation. client progresswas charted for each of the remainingnine training sessions.

Dependent Variables

At the end of the ten week programeach client took the fol 1 owing psychometric

tests: 1) Profile of Mood States(POMS), 2) Rotter's Internal-ExternalLocus of Control Scale, and 3) The

Career Maturity Inventory-AttitudeScale.

These instruments were chosenbecause of their face validity andlogical relationship to personal/voca-

tional adjustment.

Statistical Analysis

The hypothesis to be tested andthe statistical analysis are as follows:

Hypothesis #1. There will be no

significant di fference

between subjectsof the three groupsrelative to personal /vo-

cational adjustment.

This hypothesis will be analyzedusing a three group ANOVA design.The groups will be compared on eachof the three criteria of client gain(scores on the POMS, scores on theLocus of Control , and scores on Vocational

Maturity).

Resul is

A major limitation of this studywas the high drop-out rate and/orlack lo compliance of the volunteersubjects. Of the original twenty-twosubjects assigned to the two treatmentgroups, six (27%) withdrew. Theparticipation rate of the remainingsixteen treatment subjects variedfrom four to ten sessions, with anaverage participation of 6.5 sessions.Because of the drop in the samplesize it was decided to combine theEMG and Thermal groups into one treatment

group which would then be comparedto the control group. It was alsodecided to double the size of thecontrol group in order to increase

the power of the stati tical analysis.This was accomplis 5y randomlypicking eleven more ubj.cts froman existing pool of volunteer studentswho had taken the same battery oftests under similar circumstances.Their scores were compared to thoseof the eleven subjects in the controlgroup. No significant differenceswere found between the two groupson any of the outcome measures, sothey were combined to create a controlgroup with an N of 22. The analysis

163


then became a series of t tests comparingthe treatment group of 16 subjectswith the control group of 22 subjects.

The results of this analysis is

shown in Table 1. Significant differenceswere found on two scales of the POMS.Both the Depression-Dejection Scaleand the Confusion-Bewilderment Scalewere significantly lower (.05 level)for the treatment group. There wereno other significant differences foundon the POMS scales, nor were theresignificant differences found on theLocus of Control Scale or the VocationalMaturity Scale.

real difficulty of keeping clientsmotivated to continue with theirbiofeedback training once the noveltyhas worn off. The subjects in thisstudy who had the higher levels ofparticipation tended to be femalegraduate students assigned to theEMG treatment group.

A replication study is currentlybeing conducted at UW-Stout in whichcollege credit and grade are contingentupon the level of participation.

It seems that, for some, biofeedbackis not its own reward.

REFERENCES

Table 1

Dependent Variablea

A. Profile of Mood States (PIP'S)

1. Tension - Anxiety

t .166 (non Big)

2. Depression- Dejectiont -1.8111 (eig at .05

level)

3. Anger-Hootilityt -.51414 (non sig)

h. Vigor-Activityt 1.103 (non Gig)

5. Fatigue - Inertia

t . .32 (non sig)

6. Confusion-Bewildernentt - -1.769 (sig at .05

level)

B. Internal-External Locus ofControl Scale (statistical

C. Career Maturity Inventory-Attitude Scale (statistical

Group /1 Group /2

Brown, B. (1977). Stress and theArt of Biofeedback. NY: Harper

MO andThermal Control

Subjecta GroupCoined Subjects

(N . 16) (N 22)

Y - 13.38 7 - 13.00S - 6.01 s 7.16

7.75 Y - 12.86

S - 6.18 S 10.64

. 7.69 2 . 9.18S 5.72 S - 9.51

- 18.00 Y - 15.646.56 S 0 6.19

0 10.38 . 9.73. 6.42 S . 5.66

7 . 6.69 7 - 9.27

s - 2.78 s - 5.17

. 8.50 8.54toot not indicated)

- 40.53 Y - h1.00test not indicated)

and Row.Danskin, D., & Crow, M. (1981).

Biofeedback, an Introduction andGuide. Palo Alto, CA: Mayfield?Wishing Company.

Gaarder, K., & Montgomery, P. (1977).Clinical Biofeedback: A ProceduralManual. Baltimore,MD: The WilliamsandWilkins Co.

Green, E., Green A., & Walters, E.(1974). Biofeedback Trainingfor Anxiety Tension Reduction.Topeka, KS: Conference paper,the Menninger Foundation, ResearchDepartment.

Katkin, E. S., & Goldband, S. (1980).Helping People Change, Chapter14: Biofeedback. NY: PergamonPress Inc.

Zimberg, S. (1982). The Clinical

Summary and Conclusion

The results of this study suggestthat those students who received bio-feedback training were significantlyless depressed and confused, as definedby the POMS, than were the studentsin the control group. This finding,however, must be seriously questionedin light of the high drop-out rateof the volunteer subjects.

One practical implication of thisstudy is that it emphasizes the very

Management of Alcoholism. NY:Brunner/Mazel.

164

A STUDY IN CONVERSATIONAL PROTOCOLBETWEEN COMMUNICATION AID USERS AND NON-USERS

JAMES R. BROOKS

ABSTRACT

Problems in the communicationinteraction between communicationaid users and nonusers are discussedin this paper. The extent to whichunderstanding and meaning are exchangedand how well turn taking is accomplishedare explored. For 23 years the authorcould not communicate with the spokenword. Communication enhancement has

changed his world.

/65

I am going to address some ofthe problems in the communicationinteraction between communicationaid users and non-users. I think

it will have important implicationson the refinement of new systems.The main purpose of communicationaids, as I see it, is to integratenon-verbal people into our society.A society which places great emphasison the spoken word.

In interactions, we look at theextent to which understanding andmeaning are exchanged and how wellturn taking is accomplished. Turn

taking involves speaking in turn.If one person is addressed directlythat person should respond beforeany further interaction proceeds.These are some of the problems communi-cation aid users encounter in interacting

with others.Principally people do not understand

how communication aids work. Afterthey understand, they will wait fortheir turn to interact. Sometimesthey talk about a communication aiduser, but not with the user, andin simpler terms. Turn taking isa problem at times. It takes a relatively

long time. Some people ask new questions

while the communication aid useris trying to answer their first question.

This results in an inappropriateresponse. Also, people tend to speakslower and louder when talking toa non-verbal person, probably thinkinga communication aid user has troublehearing too.

Communication a i d users shortentheir responses to facilitate turntaking and to speed up conversations.It is assumed that if someone hasone handicap he must have others;it is safer to assume this is truethan it is not.

Because it takes communication


aid users longer to encode a response,sometimes users don't initiate conver-sations. This is because users aretoo busy catching up on questionsgenerated when people do not understanda communication aide user's response.They sometimes ask others to clarifythe response rather than the commu-ni:ation aid users themselves.

Turn taking, which is so fundamentalto communication, is a problem whichI and other communication aid usersmost frequently encounter. It wouldbe nice if communication aids hada signal that would tell people towait while we finish our preparation,just as speakers say "Wait a minute,I'm thinking." That would allow usto finish our train of thought andkeep them from asking new questionsbefore we are finished with theirfirst question.

It is a matter of education aboutcommunication aids for the non-user.Education may also answer the problemof people assuming that if a personhas one handicap they must have others.I believe that education will bestcome from integration of handicappedpersons into all levels and areasof our society.

The communications technologyis superb today and it will only getbetter. What is needed now is publicunderstanding and acceptance of communi-cation aids and their users. In orderto accomplish this, more study ofthe interaction between users andnon-users needs to be completed.Both parties must be willing to makemodifications and accommodations inorder to achieve the fundamental goal

of communication, the exchange ofmeaning, ideas, and feelings.

I have a vested interest in thisarea. For 23 years I could not communicate

in the socially acceptable way, thespoken word. People who cannot communicate

through speech are cast aside by theirpeers. That hurts. Isn't it sadthat we place so much emphasis onthe ability to command the language?

Now that I can talk, a whole newworld has opened up for me. It is

wonderful . I am now accepted byour society just as other people;that is the way it should be. Remember,I said it is wonderful for me, it

truly is, but the memory of how itfelt before I could talk is, andalways will be, with me. That isone of the main reasons I have dedicatedmy life to communication enhancement.

Today, it is totally unnecessaryfor anyone experiencing a speechhandicap to go through the awfulexperience of being left out of socialactivities. I honestly believe thatspeech is a gift. Those of us whohave that gift have the awesome respon-sibility of speaking up for our friendswho still need communication aids.If even one person does not have

communication aid, that is onetJo many.

166

THE STATE OF THE ART OF HIGH TECH AIDS

MARY E. BRADY

ABSTRACT

This paper describes currentproblems in high technology aid designand appl ication, and currently available,

practical strategies to address theseproblems. It also raises questionsto help you find possible solutions.The Author's goal is to "de-bunk"some of the "hype" of technology withoutlessening the hope offered byhigh-technology aids.

When Barry Rodgers and I discussed

doing this presentation several monthsago, we tried to think of a topic

that would be timely and worthwhileto you, and would draw from our workat the Trace Center in a way thatwould convey the direction of ourresearch and development projectsrather than just a description ofcurrent activities. We got to talkingabout the needs of the field, andthe role that a federally-fundedcenter plays in meeting those needs.Therefore, I will be talking aboutthe current state of the art in applyingtechnology to communication.

I will be describing what I

see as some of the current problemsin high technology aid design andapplication,andsomecurrentlyavailable,practical strategies to address theseproblems. I will also be raisingquestions and challenging you tohelp come up with some possible solu-tions. What I will be talking aboutis far from ideal yet it representsgreat progress and some tantalizingopportunities. My goal is to de-bunksome of the hype in this area withoutdeflating any of the hope offeredby high-technology aids.

My intention in the first partof this presentation is to detailsome of the rather well-known butseldom discussed features of variouselectronic communication aids. I

will spend a fair amount of timefirs, defining the terms I'll be

using, because I feel that one ofthe biggest problems we have in com-municating about the whole area ofcommunication aids, computer accessand interface devices is a lack ofsemantic agreement. So if you willbear with me, I will be definingeach of the terms I intend to use,and if you hear me using a term thatyou're unclear about, let me know

167


and I will attempt to define it forthe purposes of our discussion.

Now for the disclaimer. Muchof what I will be presenting in mysection of the talk does not necessarilyreflect anyone's opinions but my own.How intelligible is a certain synthesizer?

How easy is it to read an LCD display?These opinions are subjective, tosay the least. Little if any empiricalresearch exists to guide us in decisionsrelating to many of these subjectivejudgments. I feel a need to statethis even though, it would seem obvious.In our rush to obtain reliable adviceand information in this area we oftenoverlook the necessarily subjectivenature of this information.

In a very recent discussion I

had with a communication aid manu-facturer, I was warned that what I

say this afternoon might be takenas "gospel" because of my affiliationwith the Trace Center. I don't knowwhether that's true or not, but onething this same gentleman said didcause me to temper some of the moreemphatically biased statements I wasprepared to make. He said that manypractitioners of his acquaintancein the field of augmentative commun-catior.s feel paralyzed in their attemptsto prescribe an aid because somethingbigger and better is always just aroundthe corner. Anyone who has purchaseda microcomputer knows the painfultruth of that statement. Indeed,something "bigger and cheaper" usuallyis announced, if not appearing onthe shelves of your local computerstore, the minute you get your computerhome. However, that should not bea reason to delay a decision indefi-nitely. We have to weight the valueof acquiring a device which is "better"in some way against the value of havinga device which may not be optimalbut is at least functional today.Especially in the case of applyinga device with a young child, or a

young person in the educational system,delay and resulting missed opportunitiescan mean irretrievable loss. So,I must preface my statements by saying

that the critiques I am going tooffer should not convince anyoneto delay a decision on acquiringair aid system. Peoples' immediateneeds are important and deserve tobe met now, not when it is easierto make a decision, because in theforseeable future it is not goingto be any easier to make a decision.

We all appreciate the dilemma,however. It reminds me of an incidentthat occurred to me recently. I

wonder how many of you may have hada similar experience. A friend andI were driving home, I was at thewheel and he was giving directions.Well, my friend has CP and his speechis quite difficult to understand.It sometimes takes several passesand then some guesswork. At anyrate, he's navigating and I'm driving- not the best of all possible situations,

but probably better than the reverse,given his incoordination and my poornavigational skills. At any rate,I was having a hard time understandingwhat he was saying at one point andwe became lost. Or so I thought.I had to pull off the road so I couldconcentrate on what he was sayingand figure out where we had gonewrong. By this time my friend waslaughing hysterically which madehim all the harder to understand.The point at wnich he had begun em-phatically trying to communicatea few minutes before, was the pointat which I had decided we must belost, since my friend was flailingaway at me. When we got itall straight-ened out I found.that he was tryingto tell me we were right on track,not lost, going in the right directioneven though I had taken a wrong turna few blocks back. Right. Thanks,Bill, for the cncc.aragement.

So, my point to you is thatcommunicative delay can be as dangerousas making a wrong turn, or choosinga device which will be improved uponor made obsolete in the future.One of the emerging design criteriaamong manufacturers and rehabilitationengineers in this field is modularity,

168


allowing hardware to be upgraded asimprovements become available. This

should ease decision-making for theconsumer. Sometimes, I know, we al so

feel that we have only one shot, andwe have to make this financial investmentthat is not refundable or replenishable.This is another feature of decision-making

on aid systems that often works againstus. But, we'll be getting into theseissues later in our discussion.

For now, let's define some terms.We will be talking here about conver-sation, control and computer accessaids. What we are trying to conveywith that big mouthful of words is

the idea that "communication aids"as we have known them now nee : to

serve a number of functions beyondface-to-face conversation. Here arethe three function areas we have iden-tified:

1. Under the heading of "conver-sation" we include face-to-faceconversation, defined as

interaction in real time,and also telecommunicationneeds, defined as real-timemessage sending and receivingover distance.

2. Under "control" we includethe operation of environmentaldevices, as simple as battery-operated toys and electricaloutlets, or as complex andsophisticated as environmentalcontrol units and robots,

3. Under "computer access"we include writing (or wordprocessing) and the abilityto use standard and specially -

designed software.I had mentioned modularity as

an emerging design criteria for manu-facturers and rehabilitation engineersearl ier. Another emerging designcriteria that can be seen reflectedin most of the commercially-availableaids is the provision of these threefunctions. In fact, one aid systemcurrently on the drawing boards atTrace has been named "TRINE" to reflectthat three part functionality. I

guess you can think of it as the holy

trinity if that helps you to rememberit. Not all popular aids providethese three functions, as we willsee later.

Having defined the functionsof an aid system, let us now lookat the components. I will be talkingabout five major components of aidsystems.

1. The physical interface is

that part of the aid systemthat connects with the user'sbodily control site. It

may be a keyboard, touchpanel , voice control , joystick,

eye switch, electrode, headpointing device, mouthstickor any other method or devicewhich i s used to send information

to the central unit. It

is at this end of the system,hopefully, that you willfind whatever physical cus-

tomization is necessaryfor an indivi, al user.

2. The selection techniquerefers to the method bywhich the signals fromthe physical interfaceare interpreted. Scanning,encoding, direct selectionand combinations of theseselection techniques areall used. The selectiontechnique is not necessarilydependent on the aid orthe physical interface used.As with modularity and tri-functional ity, the trendin recent years by mostmanufacturers and rehabilitation

engineers has been to designaid systems which are capable

of supporting various selection

techniques. Some aid systemsare, however, designed tosupport a particular selection

technique; this is not neces-sarily unwise, though it

may limit the marketabilityof a particular device.The Tetrascan and Scanwriter,for example, support onlyscanning, but they do so

169


in virtuoso fashion.3. Acceleration techniques

are used to speed up messagerate or to increase contentderived from whatever meansof information transferis available. Rate of infor-mation transfer remainsthe single largest stumblingblock to the effective useof aid systems. Given thefact that the vast majorityof aid system users arenot capable of ten-fingeredtyping, and that not eventen-fingered typists cankeep up with a usual conver-sational rate of around200 words per minute, accel-eration techniques mustbe used to enhance communicationrates. Encoding, whichI mentioned before as a selection

technique, can also be usedas an acceleration technique.When 3 digits are used torepresent a phoneme, encodingis being used as a selectiontechnique. At the same time,and on the same aid system,three different digits mightbe programmed to output anentire word. In this caseencoding is used for bothselection and acceleration.The Phonic Ear Vois 140is an example of this technique.

Another common example of anacceleration technique would be theuse of menu items used to indicateselections. B1 issymbol s representan acceleration technique, althoughthey are of course much more thanthat alone, they use a symbol to representan idea. Recent examples of accelerationtechniques include the Minspeak systemfrom Prentke Romich Company, the Lolecoprogram from Adaptive CommunicationSystems, and Speedkey, coming soon(we hope ) from the Trace Center.In all of these systems, one or twoselections, be they pictures, lettersor numbers are expanded by the aid

system to represent a word, phraseor sentence to the message receiver.Other examples of acceleration techniquesinclude anticipatory scanning andword and letter frequency layoutschemes commonly in use on many aidsystems.

4. Output forms or actuatorsyou can think of as simplythe end result of this streamof information from theaid system user to the messagereceiver. Displays, whetherLCD, LED, CRT, VDT or anyof the other dynamic typeacronyms you can come upwith are in this category.So are printed output, voiceoutput or output in theform of action by any otherdevice such as a turtleor an environmental unit.

5. Finally, to complete thispath of information transfer,we must tal k about the underlying

processes involved in theformulation, coordination,and execution of communicationand control activities,including language, motorcontrol systems, perceptualmotor coordination, cognitiveprocesses, etc. This is'he area that we know leastabout. As engineers, clini-cians, teachers and edu-cational technologists,we have only begun to designtool s which will allow usto study these processesin our clients. And wefrequently make fallaciousassumptions about the unknowncapabilities of memory,language learning and socialskills required by thesemarvel ous high technologydevices we are busily creating.

If, as one author has namedit, augmentat 9 communicationis the "dark continent"of rehabilitation, surelythe underlying processesinvolved in the application

170


of these aids is the "darkcontinent" of augmentativecommunication.

Thus far, I have described thefunctions and the components of a

complete high technology aid system.Let us now look at some of the com-mercially available systems on themarket and begin to name names. Mypurpose here is not to provide a

blow-by-blow comparison of the individual

systems I will mention, but ratherto see how well the entire field measuresup to providing the user with necessaryfeatures, and to stimulate discussionof the ways in which these necessaryfeatures might be better provided.

I will mention 4 different aidsin my discussion. Each of these havebeen presented at this conferenceand they are on exhibit. Each representsa slightly different approach to theproblems they address. Once again,let me stress that my intent is not

to evaluate the performance, qualityor technical specifications of theindividual aids, but rather to point

out features and similarities in thefield as a whole. I do not have,and I do not believe anyone has, thedata to demonstrate that one of theseaids is any better than another.Some lack certain features. Somewould be more appropriate for a givenindividual than another. There areliterally dozens of aids on the marketthat may be very similar or even superiorto the aid systems I will mention.

I will mention these four aid systemswhich are well known and are eachprominent for varying reasons. I

will mention the Express III, the

Tetrascan and c:anwriter, the PhonicHandivoice, and SpeechPac. The

commonality that these aid systemsshare is portability, voice outputand fairly heavy marketing in thisfield. Beyond that the similaritiesend. Let's take a look at how wellthe three function areas are servedby these and all other currently available

aid systems.

Communication

In the first area, communication,let's look at a particular outputform - voice. How good is it? How

intelligible is it? How useful or

necessary? Certainly, it seems tobe the hottest development in augmentative

communication in the last few years.John Eulenberg spoke for a lot ofpeople when he said that if radarranges and coke machines can talk,so should communication aids be ableto help people talk. So far so good.

I think we can all see the advantagesto providing a natural-sounding,artificial voice to a person wholacks the motor control to producespeech. However, (SLIDE) do currentcommunication aids actually talk?We know that they make sounds whichthe message retriever can learn torecognize to varying degrees. However,

it must be said that the currentlyavailable synthetic speech in theseaids is far from 100% intelligibleto the untrained ear. In fact, ifI were to hazard a guess, and, believeme, I know that this is hazardous,I would have to say that my experiencewith four of the five aids I've mentioned

would lead me to guess a ratio ofless than 50% intelligibility onunique messages to the untrainedlistener. Several points must beremembered in this discussion:

171

1. Speech synthesis technologyisstill improving dramatically,and some existing voice-outputaids will be upgradeableas the improvements continue.

2. Voice output, even if largelyunintelligible to untrained1 i steners , may serve an important

function for the user inestablishing control overhis s environment, gainingattention, or conferringstatus upon the user. Voiceoutput has been shown toprovide a strong reinforcerand motivational tool as

feedback to pre-schoolers


in language-learning tasks(Meyers, 1983).

3. In some cases, those receiversin the user's immediate environ-ment will become expert listeners,

and the intelligibility ratiowill rise; it has been demon-strated that many listenerscan with relative ease andrapidity, acclimate to a synthetic

speech "vIcent."

On the other hand, questionsmust be raised about the functionalityof synthetic speech which is lessthan 50% intelligible. Intelligibilityis extremely subjective; much of whatwe glean from everyday conversationsis derived from context: positionalindicators, emphasis cues, inflection,listener's expectations. This makesintelligibility difficult to isolateand study. How well will a child'speers be able to understand or accepthis synthetic speech? Studies inthis area are only, beginning, andour observational experience is limited,but it is time to open up discussionof these issues.

If voice output is seen as a

necessary and desirable feature ofthe aid system sought, what limitingfactors should be taken into account?For one thing, an additional outputform is absolutely necessary whenusing voice output inoisy environmentscurrent synthetic speech systems donot function well , because of bothlow volume and increased discriminationdifficulties. In some cases volumecan be increased through the use ofan external amplifier, but this doesnot solve the increase(' noise ratioproblem. In some systems, the voiceoutput draws enough power from theaid to necessitate dependence on anotheroutput form for use when the chargeis low or depleted. As wi th any electronic

aid. use, non-electronic backup systemssuch as a pointing board, cards orat the very least, visible "yes-no"signalling descriptions written ona prominently displayed card shouldbe considered.

Yet another factor to considerin thinking about the applicationof synthetic speech is how flexiblethe device user can be. One aid-userwith whom I frequently converse byreading his written display had a

very hard time making a synthesizerperform for him because it was extremely

intolerant of spelling errors andother extraneous or missing characters.Unlike a human de-coding the writtendisplay, a synthesizer is unableto automatically filter out typos,thus introducing an additional noiseelement into the information transferequation. And many aid users haveeducational deficits which includepoor spelling and memory skills.

In their current manifestation,I believe that speech synthesizerscan best be thought of as perhapsproviding additional speech cuesto the listener, as well as soundeffects and signalling capabilities.They may also provide the user withan additional expressive outlet.In constructing exceptional pronoun-ciations the user can exercise creativity

and express his own personality ina new audible way. This has undeniablevalue. However, I do no.. believethat the current aid user today isenabled to "talk" with all that termimplies, by the mere addition ofsynthetic speech capability, andit does not serve anyone's interestto pretend that he is.

Just a footnote before I desertthis controversial topic. I wasrecently told, by a person who shallremain nameless, that we at the TraceCenter have had our appreciationof synthetic speech spoiled by listeningto the Decial k too much,. Perhapsthat's true. The DecTalk is larger,heavier and much more expensive thanany of the speech synthesis technologyI' ve been talking about so far.There can be no argument that itis also much more intelligible.It was not battery-operable, butwe have adapted one unit for portablebattery-operated application, mountedon a wheelchair. The price difference

172


between the DecTal k, which has 11

voices including several women's andchild' s voices, and the synthesizersI' ve been referring to in currently-existing aids, is about $4000.

I have a friend who was a singingteacher until he hit a high E a littletoo hard. Workman's compensationallowed him to purchase a voice outputaid system while he underwent 7 weeksof voice rest. And among all of thisman's observations about his vocalodyssey, one stood out among the others.He was fond of saying that he is grateful

for the Vol kswagen aid system thestate of Missouri allowed him to purchase,

but he reminds listeners that his

former voice was a Cadillac. If youhaven't heard the DecTal k I have a

phone number you might be interested

in trying. But only if you like Cadil-lacs.

The closest real time "talking"that I have personally heard froma commercial aid user came from aman who would be described as a "mastertool user." Using phonemic inputand digitalized speech output on thePhonic Ear Vois 140, I have observedan expert user holding an oral conver-sation in real time, at a slowed butfunctional rate of speaking. But

phonemic input al so has drawbacks.It cannot be directly transcribedto traditional orthography writtencommunication. This expert user mustaudio tape any messages he needs toconvey, as written output is not enabled

by this method or device. Those already

familiar with traditional orthography,spell ing, would have to learn a new

phonemic orthography. And, on thisparticular aid, text-tospeech andcomputer access capabilities are totally

absent. Yet, for the single functionprovided, the Vois 140 would seemto fall into the category of a toolrather than a toy.

Telephone Use

The capabilities of syntheticspeech for telephone communicationare of great interest currently.

At least one device has been createdexpressly for the purpose of telephonecommunication via synthetic speech.How effective is it currently? Again,

the answer is unknown. Two thingscan be stated. Synthetic speechmay actually be more intelligiblewhen filtered through the telephonetransmission bandwidth than whenunfiltered. This somewhat peculiarartifact is due in part to listeneracceptance of a natural voice transmitted

via telephone which is also missingsome of the aural information presentin face to face communication. Thisobservation is unqualified: the onlysure way to satisfy yourself as toits validity is to try out the devicein question over the phone and formyour own highly subjective, biasedopinion as I have. There reallyaren't enough of these devices inuse yet to collect information ontheir functioning in the real world.

Secondly, user techniques needto be developed to assist in successfullyapplying synthetic speech to telecommu-nication needs. An answering tapewhich alerts the caller to the systembeing used and includes some brieftips on how to proceed has been usedby one client I know of. Unfortunately,in this case user and caller intolerance

of the signal-to-noise ratio in theaid system's synthesized messagesresulted in a failure to use thesystem at all . It should be notedthat the user in this case had a

temporary disability, and consequently,

perhaps, a lessened motivation tomake the system work.

For many people the telecommunication

function is critical to support in-dependent living. Telephone usageis absolutely necessary for safetyand health reasons. As consultantsand clinicians, we should be likely

to notice this need since we arefrequently on the other end of theline trying to retrieve what is oftena very information-poor message.Why have we not responded to thisneed? All of the expensive,limited-function devices on the market

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will not supplant effective trainingto telephone communication techniques.Here are some simple strategies I

have found in use by some augmentative"masters."

1. The person using a combinationof natural speech and augmentedcommunication should checkthe accuracy of the transmissionfrequently. One person I

talk to does this by endingmost sentences with "Right?"and waits for an affirmativebefore going un. If he getsa "No, sorry" his next utteranceis preceded by "Okay" beforehe launches a repeat or a

variation of the utterancewhich was not properly received.

2. Similarly, the message receivershould echo the transmissionif there is any doubt aboutits content and offer anopportunity to correct it.

3. The message-sender shouldknow when to give up pronouncinga word or phrase and spellit. The receiver can assistby asking for spellings ifnecessary.

4. One individual I know andcommunicate with by phoneon a weekly basis uses aninterpreter very effectively.His phone calls are alwayswelcome because the firstthing he does is to set thetopic and the length of theconversation, as well as theexpected action he is seekingin calling me. All of ourphone conver sations shouldbe so succinct! This individualhas learned to dispense withstatements about our nealthor the weather as well. He

respects my time and the limi-tations of this particularmode of communication. Whenwe need to talk privatelyor in greater detail , hecalls my computer via modemand puts a lengthy treatisein my electronic mailbox.

Or, we speak interactivelyvia computer. At his endhe can type about 16 wordsper minute using a mouthstickand straight spelling. Onmy end I can talk with someonein my office, read the paper,watch TV or file my nails;use that time. if it's theend of the day I can leanback and catch my breath.I have found this particularmode of long distance communi-cation very relaxing, andam in all honesty much morewilling to converse withthis person at length eventhough he is using a slowaugmented rate.

Somehow we need to incorporatethese techniques of augmentativemaster communicators into the useswe make of electronic telecommunicationdevices. I am not at all sure thatwe are currently developing theseails in tandem with the master toolusers who can provide this information.

Written Display

No discussion of voice outputwould be complete without takinga look at the visual displays accompanying

voice output devices. I will statecategorically that at this stageof the game, with voice output beingwhat it is, an alternate writtenvisual display is necessary to backup the voice output. Four of fiveaids mentioned have both dynamicLCD displays and built-in printers.However, it is extremely difficultto read the LCD displays in actualinteraction. Consider the Autocom.For all of its shortcomings, onething it did have was a clear, readableLED display. It even has a separate,modular, tiltable display unit whichcould be mounted to face the messageretriever. How important is face -to -face

communication, eye contact, facialexpression, gestural cues? (turnback on audience) Well, maybe it's

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not really important. Maybe face -to -board

communication is just as good. Before

I have the manufacturers jumping upout of their seats let me say thatI appreciate the technical problems

involved with providing the kind ofclear, readable, modular display I'mtalking about. But we should aciiitthat while the LCD displays have allowed

us to solve one technical problemin the power supply area, their useactually represents decreased functional ity

in another area to the aid user.Can we perhaps find a technical solutionto this problem? One which is affordable?I would submit that we can't untilthe importance of the visual display

is first recognized. And what aboutthese printers? How are they actually

used?The printer on the Epson HX-20,

which is the core of both the SpeechPacand Words Plus systems, is very noisy.

It requires additional communicationtime to first send text to the printer,

wait for it to print, advance thepaper, and .hen rip and read. I have

been told by an Epson user that thisnoise inhibits his use of the printer,although with encouragement he has

been willing to make greater use ofit. The printed output is invaluablefor private conversation and messagesthat take a long time to compose.

Control and Computer Access

I will touch only briefly onthese areas. They are covered in

more detail in several of the presen-tations at this conference.

As mentioned before, tri-functional-ity has become almost a standard inthe augmentative field in the past

several years. Computer access andremote operation of devices in theusers' environment are seen as absolutely

necessary functions for multiply-handi-capped people having cognitive impairmentas well as for those who are cognitively

intact. Software development forthose with mental retardation, learningdisabilities, brain injury and language

disorders has progressed markedly

over the past several years.What, then, is the rationale

for an aid design which does not

provide either of these functions?Would it be possible to implementthe apparently successful selection

and acceleration techniques of thePhonic Ear aids in a configuration

which allows computer access andcontrol functions?

All of the other aids thus farmentioned - The Express, the Tetrascan,

and SpeechPac - not only provide,but readily facilitate computer accessand control functions.

The Tetrascan has a built-inkeyboard emulating interface; the

other aids mentioned, with exceptionof the Phonic Ear aids, interfaceeasily with available emulating interfaces

which are now available. Thus, trans-

parent access, defined as the ability

to use standard software withoutnecessitating standard keyboard input,is now readily avail able. This represents

real progress from first specializedsoftware and then intermediate, low-costsolutions such as the adaptive firmware

card.Another development that is

currently available in this functionarea is the provision of a wirelesslink, whether infra-red or some othertechnology, to provide remote controlof a standard computer or environmentaldevices from the aid system. This

has been implemented on the Tetrascanand the Express III.

The major problems in this arealie not in the design or functionalityof the existing devices, but in avail-

ability and cost. Environmentalcontrol units may cost as much asall the other components of the aidsystem combined, including the computer.Keyboard emulators must be specificallydesigned for the particular computerthey are to be used with; thus, theperson wishing to use an aid systemwith a computer in a vocational settingwill be frustrated unless the computerhe wishes to access happens to bean Apple II+, He, or IBM-PC. And

with new computers appearing constantly,

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this is not a trivial consideration.Being tied to a particular computerlimits mobility.

S Lana ry

Now that we have discussed someof the problems in all three of thefunction areas defined, I would liketo desert my tirade about the shortcomings

of currently available solutions anddirect your attention to some questionsand problems which transcend the re-sponsibilities of manufacturers.

I must thank Larry Weiss of Zygofor alerting me to this publicationof the Office of Technology Assessment.It' s called Health Technology CaseStudy 26: Assistive Devices for SevereSpeech Impairments. This is an excel lentpublication and I highly recommendit to you.

In this document, the situationof aids provision is likened to thesituation of orphan drugs - Thoseneeded by too few patients to maketheir development and manufactureby pharmeceutical firms sufficientlyprofitable. I would like to suggestthat we are involved in an orphanfield - one in which insufficientresources across the entire spectrumlimit the availability of effectivesolution strategies.

Of course it is unfair to blamemanufacturers for this situation.A vicious circle where lack of knowledgebegets errors, and where errors begetfrustration with service deliverysystems exists. Manufacturers shouldnot be responsible for the fundingof devices, or for the research oninterfaces and acceleration techniques.Yet, in the absence of any other activityin this area, they are often castin this role. Because there is virtuallyno funding available for researchor training of clinicians or users,or for adequate information dissemination,

we seem to spend an inordinate amountof energy chasing elusive solutions.I would like to quote briefly fromthis OTA document:

"There is an old axiom in medicine

that when there are many differenttreatments for the same disorderthe likelihood i s that noneof them works very well. Fromthe perspective of the severelyphysically di se:led nonvocalperson, the same principle appliesin finding a payment mechanismfor the assistive communicationdevice that will meet his needs:The many potential sources forfunding disguise the realitythat reimbursement can be verydifficult and sometimes impossibleto obtain. Because no singleagency in government or theprivate sector is specificallyauthorized to assist this population,all tend to say it is not theirresponsibility and try to shiftthat responsibility elsewhere."(Office of Technology Assessment,193)

One last thought I would liketo offer for your consideration thisafternoon. We have heard a greatdeal about the communication revolution,

the explosion, the marvels that canbe wrought by the decreasing priceof technology. How many of the problemsI have identifies an be solved bydecreasing hardware costs alone?We need to set goals - what is it

we can accomplish and want to accompl i sh?

Isn't it time that we begin to decrythe orphans status of this fieldand discover not simple solutions,but real ones?

REFERENCES

Heal th Technology Case Stud./ 26:Assistive Devices for Severe speechImpairments (Washington, D.C:U.S. Congress, Office of TechnologyAssessment, OTA-HCS-26, December1983).

Meyers, L. F. (1984). Unique contri-butions of microcomputers to languageintervention with handicappedchildren. Seminars in Speechand Language, 5, 23-35.

176

THE HOLISTIC APPLICATION OF HIGH TECHNOLOGYFOR CONVERSATION, WRITING, AND COMPUTER ACCESS AID SYSTEMS

BARRY L. RODGERS

ABSTRACT

In order to successfully usehi gh technology for conversation,writing, and computer access aid systems

I believe we must apply it holistically.A holistic approach is one where allthe components necessary are in place.Recognizing the difference betweentechnological toys, tools, and appliances

and recognizing that aid systems aretool s that will allow us to use ourexperience with other technologicaltool s to identify the necessary componentsto apply high technology successfully.This will suggest among other things,that providing services such as ongoingtraining to comfortably use the aidsystem in real situations is as important

as providing the device itself. Manyof these services will be providedby a professional "Aid System Integrator."

In the future, the physical part

of high tech aid systems will ride

on the COATTAILS of general purpose

computer devices. Many high techaid systems will be designed usingoff the shelf portable computers in

a standardized modular aid systemI call the GAIN System. Finally,in order for high tech aid systemsto be used successfully third partyfunding sources will provide ongoingsupport for holistic application andmuch of this will be for needed services.

A Holistic Perspective

I suggest that by using a holisticapproach to the application of hightechnology that we greatly 1,-,crease

the chance it will live up to its

promise for improving the lives ofdisabled people. By holistic application

I mean making available al 1 the components

of the support system that are necessary

to use high technology effectively.With a holistic perspective we understand

that the whole system is greaterthan the sum 'f the parts and thatparts by themselves are relativelyuseless. This suggests that thepotential value of hi gh technology

will only be reached when all the

components necessary to totally useit are in place.

In order to successfully usehi gh technology for conversation,writing, and computer access aidsystems we must apply it holistically,we must create a complete applicationsystem. If any parts are missingor malfunctioning the usefulnessof high tech aid systems is greatlydiminished or destroyed. This is

anal ogous to the successful use ofmicrocomputer systems. A typicalcomputer without an appropriate task,appropriate software, effective docu-mentation, a trained operator, electric

power, or a desk to set it on is

useless.In order to apply high tech

aid systems holistically we needa perspective that helps identifyall the components necessary. I

would like to give you a perspectivethat does this. I hope that it willhelp you think about what is neededto successfully use high technologyfor disabled people. I believe thati f we hol d cl ear vision of whatis needed we will be able to find

177


ways tr provide it.To make it easier to understand

this visiun of the holistic applicationof conversation, writing, and computeraccess aids I will describe it asif it will definitely be used in thefuture. Of -course it may not, butI think this perspective of the holisticapplication of high tech aid systemshas much to offer in helping to realizethe potential benefits of high technelogyfor disabled people.

1. By comparing technologicaltoys, tools, and appliances we recognizethat high tech writing conversation,and computer access aid systems aretools. We recognize that

systemsother

tools the results obtained with themdepend as much on the skill of theuser as on ThFq=7.17-7ThrlarThis suggests in turn that in thefuture providiaLIEOITZEELL12to comfortabVy use the aid _systemin real situations 4s as importantas providing th-F-17-lystcm itself.

The technological toys I am referring

to are promoted as useful tools butlack real usefulness. They are actuallyintriguing demonstrations of the possi-bilities of technology and I callthem technological toys because theyare primarily novelties. They aretypically more trouble to use thanthey're worth. They are often hardto set up, often turn out to be harderto use and more expensive than moretraditional approaches, and they haveto be pampered or they will get outof adjustment or break. An exampleof toys that are sold as tools arethe $12 magic kitchen slicer, dicersoccasionally advertised on TV. Ifyou've ever bought one of these, asI have, you know that after the noveltywears off they end up in a closet.How often do you really need a halfgallon of sliced onions?

Appliances are devices that dosomething without requiring skillfrom the user. A perfect applianceis "goof" proof and is completelyautomatic. The results are independent

of the skill of the user. A selfdefrosting refrigerator is a goodexample of an appliance. All youdo is plug it in. There is no skillto learn that affect: the results.It maintains its internal environmentautomatically. Most pouple todayare more familiar with automaticappliances than they are with tools.

Tools to me are devices thatare used by a skilled person to dosomething necessary in their dailylife. The chief characteristic ofa tool is that the results obtainedwith it depend on the skill of thetool user. A good example 2f a toolis a kitchen stove. It helps youcook but the results you get dependon your skill as a cook. With thesame stove I may be ,Vie to heata can of chili while anuther personis able to create a gourmet meal.The results yoL get with the stovedepend. on how skilled a cook youare.

A good tool is a work of art.Learning to recognize a good toolis sometimes difficult unless you.re a master tool user. Subtle differ-ences that are o, ten difficult orimpossible to descri Le make the difference

between a tool and a fine tool andd piece of junk. How do you quantifythe difference between a knife thatfeels good in your hand and one thatlooks the same but does not feelas good.

Conversation, writing, and compiter

access aid systems are tools hecausethe results obtained with them dependon the skill of the user. They requirea commitment on the part of the userto practice and develop skill inapplying them to everyday needs andsituations. They are tools becausethey must be improved by observingtheir use in different real situationsto do important necessary tasks.By learning to recognize high techaid systems as tools people can avoidbeing frustrated by trying to usetechnological toys.

High tech aid systems must bemore than technological toys because

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people depend on them, have to livewith them, are judged by the resultsthey get with them. Good tools makeany task easier. Toys can make anytask difficult. Even a master carpenterwill find it impossible to make a

square cut if she or he has to usea toy saw. Technological toys thatare tried as aid systems will be rejectedbecause they're more trouble thanthey're worth. People will not be

dependent cn toys.Conversation, writing, and computer

access aid systems wi 11 never be appliances

either. At best conversation, writing,and computer access aid systems willbe tools that act as effective mediumsof communication. Aid systems willnever work independently of the user

the way an appliance can. That wouldbe analogous to having a telephonecarry on a conversation for you.It would be like having your mothertalk for you. Most people want tospeak for themselves.

People often confuse good toolswith appliances. The telephone isa good tool and can be confused withan appliance because it is relativelyeasy to use and is very reliable.However, it is not automatic. For

a given purpose such as selling it

still has certain advantages and certainlimitations. It is up to the userto maximize the advantages and minimizethe limitations. The telephone itselfcan't help with this. Some peoplecan be very persuasive on a telephone.Others have difficulty sounding sincere,The results of the conversation stilldepend the skill of the user justas the results of conversation usingany other conversation aid will dependon the skill of the user.

The fact that conversation, writing,

and computer access aid systems willnever be appliances suggests thatusers will always have to spend time

i energy to develop skill in using,successfully. Users will understand

that these systems can never be automaticlike other appliances, that no super

computer can converse for them justas no person can converse for them.

They will understand that the resultsthey get will depend in large parton training and on their determinaticnto develop skill.

Conversation and writing aidsystems are like musical instruments.Musical instruments are superb examplesof what I mean by tools because thequality of the music depends on the

skill of the musician. A fine guitaris a fine tool and a virtuoso guitaristis a master tool user. Musical instru-ments are like conversation and writingaids because they are mediums of

communication. The dedication, training,

practice t'le, and skill requiredto communic with a musical instrument

demonstrates characteristics requiredto use a conversation, writing, orcomputer access aid successfully.A good conversation aid user literally"plays" their aid system the waya musician plays a musical instrument.This requires training and practice.We don't expect to get music fromsomeone by simply putting a saxophonein their hands. Mastering an instrumentrequires an understanding on thepart of the learner that it may taketime before they can make satisfactorymusic and that they will need thehelp of a teacher.

This points out the importanceof making aid systems that will be

easier to learn. If all conversationaid systems were as difficult to

learn as a violin is for nondisabledpeople then very few people couldbenefit from them. It points outthat good aid systems will be as

beautiful, reliable, and practicalas a good guitar. It points outthat effective and ongoing trainingto comfortably use the aid systemin real situations will be as important

as providing the system itself.It points out that developing mechanisms

to accumulate wisdom about successfulstrategies for aid system use fromthe master users and mechanisms to

pass that wisdom on to new userswill be an important component inthe evolving usetAlness of aid systems.

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2. Recognizing high tech aidsystems as tools allows us to understandthat high tech aids are perfectedfrom actual use over time. It allowsus to understand that aid systemdesigner /developer /manufacturers willbe people who get their primary satis-faction from seeing their systemsused successfully in real situations.They will also be people who liketo continuously perfect and improvetheir systems.

Tool s are perfected over time.Most common hand tools have been perfected

through generations of use by mastercrafters. This is an important differencebetween a "technological toy" anda "tool ." Technological toys appearand di slppear quickly and thus neverget improved and refined to the pointwhere they are really useful.

A true technological "tool" mustgo through a series of cycles of im-provement. These cycles consist offield use by the master crafters whouse the device day in and day out,followed by refinement by the toolmaker based on the feedback of thesemaster craters. To get a useful tool ,

I think takes at least 3 cycles andmay take many more. A characteristicof truly useful tools is that theyare always undergoiiig refinement.After thousands of years of use thereare companies that are still refiningthe kitchen knife.

In the future, we will be ableto recognize conversation, writing,and computer access aid systems thatare truly useful tools by observingtheir refinement over time. Orphansystems that have stopped evolvingwill be recognized as bad risks.Systems that are undergoing continuousrefinement from actual field experiencewill be highly valued and sought after.Systems that have visible and viablemechanisms for fostering their improvementin use will be the most prized ofall.

Tool s are made by toolmakersand toolmakers can be distinguishedfrom puzzle solving toymakers. in

the future, we will distinguish toolsfrom technological toys by understandingthe characteristics of toolmakersas compared to puzzle solvers. I

believe that technological toys areoften made by puzzle solvers. Puzzlesolvers are people who are motivatedand get much satisfaction from solvingpuzzles.

New technological opportunitiesare like puzzles for them. Theyplay with technology to see whatthey can get it to do. They treathigh tech components as puzzle piecesto be fit together into a devicethat meets some idealized and abstracteduse. The internal question is often"I wonder if this device can do that?","I wonder if this microprocessorhas enough power to do a text tospeech translation?" However, oncethe puzzle fits together, once thedemonstration has been made, thatpuzzle becomes boring. The puzzlesolver then moves on to somethingelse.

The toolmaker is a differentbreed entirely from the puzzle solverbecause the toolmaker gets satisfactionfrom seeing his or her tools usedby people. Piecing together a deviceand getting it to operate is onlythe first and perhaps least importanttask of the toolmaker. The toolmakeris interested in perfecting the devicein use. This means getting peopleto try the device, watching themtry to use it, questioning them onhow to improve it, taking it backand fine tuning this or shaving alittle off that or even throwingit out and starting over.

To the puzzle solver it reallydoesn't matter whether or not thetec.inological device meets a realneed or is really useful. she satis-faction for them comes from solvingthe problem as first abstracted intheir mind. This abstract postulateis the challenge. Even though somepuzzle makers imagine that they havecreated a tool , it can be very frustrating

for them to have someone actuallytry to use their device. This is


because al 1 the real conditions andlimitations spoil the sense of satis-faction the puzzl e solver gets fromthe perfection of their abstract solution.

On the other hand, the toolmaker'smain satisfaction comes from seeingthe tool used by people. The toolmakergoes to great lengths to get feedbackfrom the master crafter, the mastertool user. The real lire complicationsand the inevitable compromises areexciting challenges to the toolmaker.The art of making a useful tool is

as much a concern with how peoplework as with what technology can do.

Good toolmaker! are recognizedas artists. Like other artists theymust constantly see their work in

context. They must constantly makeprecise compromised judgments thatrely on their ability to see the entiresystem including the person usingit at once; to be able to anticipatethe subtle interplay of the componentsthat will create a synergistic whole;to create a system that works unexpectedly

well .

3. Recognizing high tech aidsystems as tools al so allows us to

use our experience with other hightech tools to identify the functionsnecessary for holistic application.Holistic application is providingeverything necessary to be successful.

The holistic application of a

hi gh tech aid system will requirethe following components:

1) Locating people who can makeuse of the aid system.

2) Establishing their needs andcapabilities and the potentialbenefits of an aid system.

3) Sel ecting and acquiring appropriate

system components includingspecial market hardware andsoftware, and general market

hardware and software.4) making simple modifications

to hardware and software ifnecessary to make ',it compat-

ibl e.

5) Assembling the aid system.6) Mounting the aid system on

the users wheel chair, shoulderbag, bed, etc.

7) Fitting the aid system tothe user including adjustments,modifications, and initialcustomization.

8) Selecting the most effectiveaid system training aids(manuals, video tapes, demon-stration programs, etc.)

9) Initially training the userin the basics of the systemand how to optimize it forthemselves.

10) Training the people in Lhc

users environment who willneed to help the user maintainthe aid system.

11) Providing ongoing trainingto make sure users get allpossible benefit from the

aid system12) Being on call to answer subsequent

questions about the aid systemas it is being used.

13) Providing ongoing preventivemaintenance and replacementof worn-out parts.

14) Providing repairs.15) Updating the system when

significant improvementsin available functions makeit desirable.

16) Periodically evalcating thedegree of integration ofthe aid system in the user'slife and providing suggestionsor further training as necessary.

17) Using information gainedfrom users in the refinementand improvement of the aidsystem.

18) Providing a different moreappropriate aid system whenthe user , needs or capabilities

change.

19) Providing a different moreappropriate aid system whensignificant advances in aidsystem design make more usefulaid systems available.

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Notice that only item #3 focuseson the hardware and software itself.The other 18 items relate to servicesto support the user and the systemover time. This points out that whenhigh tech devices are "Holisticallyapplied" services such as systemsintegration and ongoing training willbe at least as important as the devicesthemselves.,

4. In the future, in order toprovide many of the functions of holisticapplication there will be a professional"Aid System Integrator" working foraid system users or third party funders.

Many of the services requiredfor holistic application of high techconversation, writing, and computeraccess aid systems require a personwith unique knowledge and experience.I call this person an Aid System Integrator

because they will be able to integratethe components into an appropriateaid system and because they will be

able to help the user integrate theaid system into their lifestyle.There are al ready people doing thiswork but in the future they will havea clear identity and role and be committedfull time to this profession.

fhe Aid System Integrator willbe the user's technological consultant,advisor, and advocate helping himor her get the most from availabletechnology. The Aid System Integratorwill work for the user in puttingtogether the most appropriate aidsystem i n conjunction with other therapists

such as speech and language pathologists,

seating specialists, and occupationaltherapists. They will provide theprimary support for the aid system.They will provide many of the serviceslisted earlier including helping usersselect, put together, setup, and learnto use aid systems. They will provideongoing evaluati 'n, training, adjustment,

modification, and repair of the aidsystems.

In the future, the Aid SystemIntegrator will work for aid systemusers or third party providers on

a fee for service basis. They willnot represent a single designer /de-veloper /manufacturer but will workwith al 1 designer /developer /manufacturers

just as an independent insuranceagent works with many di fferent insurance

companies . They will be paid forservices in the same way other profes-sionals such as dentists and accountantsare. They will establish long termrelationships with their clients.

The Aid System Integrator willbe comfortable with high tech devicesand will be trained to confidentlyassemble aid systems from devicesmade by different manufacturers.They will he a special kind of toolmaker.

One who assembles tool systems fromavailable components. They willhave a technicians knowledge of elec-tronics and be comfortable with simplecomputer programming tasks. Theywill also be trained in locatingresources. A big part of their serviceand expertise will be in keepingup with what is available for specialneeds.

Aid System Integrators willal so be people oriented. They willbe trained to be good teachers.They will teach people to becomeproficient with their systems andto feel good about air.; them. Theywill be comfortable. working togetherin a team with other clinicians suchas speech and language pathologistsand occupational therapists. Theywill be the sort of people who getsatisfaction from seeing their systemsused successful ly in daily serviceby their clients.

5. In the future, the physicalpart of high tech conversation, writing,and coin uter access aids will rideon t e CWT. ITacomputerized devices.

Most of the physical part ofthese aid systems will be designedarcund general market high tech com-puters. I call this approach toaid system design the COATTAILS APPROACHwhich is an acronym for Computer

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Opportunities Applied To TechnologicalAids In Linked Systems.

Computer Opportunities refersto the opportunities to makepowerful yet inexpensive aidsystems from general purposecomputers as well as from otherhigh tech consumer devices suchas phone based environmentalmonitors and remote controlledentertainment systems. Thesegeneral market high tech deviceswill cost less and less withmore and more capability.

Appl ied to Technological Aidsmeans that we will apply thistechnology to making electronicaid systems for writing, conversation,

and device access for disabledpeople.

In linked Systems means thatthe aid systems will be systemsconfigured by linking generalmarket devices to specially madedevices. The special marketdevices will act as accessibleinputs for the general marketdevices. The linked system ismodular and expandable with almostunlimited possibilities.

The COATTAILS Approach will be

widely used because it will be moreeffective to make aid systems by pro-gramming and configuring general marketdevices tnan it will be to manufacturefrom scratch the entire aid system.There will by many reasons for this.Among them that this approach willrequire less capital investment, lessdevelopment time, will be more efficientfor small production, will be less

expensive, require less manufacturing

expertise, will be more customizable,and will significantly reduce thetime it takes to bring out a refinedupdated aid system.

Most of the "work" of "manufacturing"

the aid systems will be in researchingaid techniques, programming the generalmarket devices, and in creating the

effective training materials thatwill be part of the aid system.Relatively little work will be in

t~aditional "manufacturing."In the COATTAILS Approach manu-

facturers will be using off the shelfdevices that anyone could buy separately.

This will make the costs of "manufac-turing" the system obviously separatefrom the cost to manufacture thehardwzn'e . It will be obvious thatthe value added to make an aid systemis in development, programming, andtraining materials. Developing goodsoftware and effective trai ni ng material s

is expensive now and there are no

indications that it will get significantly

cheaper.For this reason, users will

understand that the aid system theyget from the designer /developer /manu-facturer via their Aid System Integrator

is worth significantly more thanthe cost of a naked computer. In

fact the "cost" of holistically applyingthe high tech aid system may havelittle or no relationship to thecost of the hardware.

6. In the future, many hi ghtech aid systems will be designedusing a standard portable computerin a standardized modular systemI call the GAIN System.

This is one kind of COATTAILSaid system. It will be designedaround battery powered portable com-puters. I call it the Gain systembecause of tne gains in versatilityand cost benefit ratio and becausethis is an arcronym that stands forGeneric Aid I/O Network.

Generic means that any brandportable computer may be suitable.

183

Aid in this case means a high

tech computer based conversatioh,writing, and computer accessaid system.

I/O stands for Input/outputand refers to how special input


or output devices will be connectedto the generic computer to makean aid system. The connectionsthemselves will be generic ornonspecialized using standardports already present on thegeneric computer.

Network implies that the systemextends in several possible directions

from the adaptive computer to

the user and from there extendsin many possible ways to otherpeople and devices.

The GAIA System will be basedon a general purpose battery powerednotebook computer acting as an adaptivecomputer. The adaptive computer runsspecial software that allows it toadapt to the person using it. Thesoftware for the adaptive computerwill be designed to take advantageof whatever communication/controlcapabilities a person has.

The GAIN System uses the standardinput and output RS-232 ports on theadaptive computer. Specially madeinput devices, such as a chin control,will connect to the adaptive computerin a standardized way. Speciallymade interfaces allow the output ofthe adaptive computer to control othercomputers and other devices that a

person needs access to in their culture.These specially made interfaces connectto the adaptive computer in standardizedways. By linking with other electronicdevices in a person's environmentthe adaptive compu+er becomes partof a letwork that extends indefinitely.Thus the Generic Aid I/O Network gains

access and gains power.

Here are the defining "attributes"of the GAIN System:

1) Uses a genE.ral purpose batterypowered computer (Epson HX-20,Radio Shack Model 100, etc.).

2) Makes use of the computer'sstandard input and outputports.

3) Uses special market and generalmarket input devices with

stationary devices.4) Uses a special market wireless

link to connect the systemto stationary devices.

5) Uses a keyboard emulatinginterface to access a standardcomputer.

6) Uses a Special market remotecontrol emulator that candirectly control generalmarker stereos, TVs, lights,telephone answering machines,emergency call systems, micro-processors, coffee pots,etc.

Here are the main benefits or"features" of the GAIN System:

1) Inexpensive hardware.2) Modular can be tailored to

particular needs.3) Requires no hardware modifications

to the off the shelf computer.4) Portable but networks with

stationary systems.5) Can control standard computers

running standard software.6) Can be upgraded via software

alone and the software canbe modular to make changesand revisions easier.

7) Allows a manufacturer todevelop an aid system withouthaving to 'manufacture" hardware.

Taken together GAIN impliesthe synergetic effect where the resultingsystem will be greater than the sumof its parts, a new gain. GAIN systemswill be multifunction modular aidsystems that are less expensive,more versatile, upgradeable, repairable,

and improvable, and therefore, morelikely to be truly useful to a disabledperson.

GAIN systems will often be "con-figured" or put togetner rather than"manufactured,." Since the physical

part of the systems will be in largepart inexpensive off the shelf devicesand since most of the cost of theGAIN Systems will be in integratingthese components with appropriatesoftware and user training, the GAIN

14


Systems will more clearly serviceintensive. It is likely that pricing,delivery, and support will use the"service" model rather than the "product"model. For example, an environmentalcontrol system may be packaged anddelivered the way come home securitysystems are today. .i.ou pay the profes-

sional security system designer forthe time it takes to evaluate yourneeds and install and support yoursystem. The cost of the componentsis listed in the bill under "parts."To look at this another way, you payycur dentist for her or his time andthe cost of materials is usually negligiblein comparison. You don't go to a

dentist to buy a filling and get freeinstallation.

7. In the future, when fundingsources are needed they will provideongoing support for everything neededto "holistically apply" high techaid systems including needed services,

Funding by third party sourcesfor high tech aid systems will includeall the costs for making the systemstruly useful. Society will have anunderstanding and acceptance of theongoing need to support both the userand the aid system and this understandingwill be reflected in policies by fundingagencies.

To see how this would work inthe future for high tech aid systemswe can use the example of a mobilitysystem consisting of a van, a wheelchairlift, and a wheelchair. The purposeof the system is to provide ongoingreliable mobility for a person so

she or he can contribute in a regularjob. What is the cost per year tosupport part of this system? Let'ssay the van with wheel chair lift andmodified controls cost $11,000. Is

this a one time cost to provide mobilityfor a person so that they can holda job and participate in society?No, we know that it costs much more"over time."

In the future, part of the yearlycost would be computed as follows.

In Wisconsin this van would lastabout 8 years before it rusted out.A 20 year old person needing mobilityfor 50 years or so would need atleast 6 vans or a van every 8 years.This would be about $11,000/8 yrs= $1375/per year. The cost of thevan does not include maintenanceand repair so we must add an additionalamount for that. At 10 cents a milefor maintenance on the van and 10,000miles a year we must add $1000 ayear. Thus this part of the costto give a person mobility via a vanis about $2375 per year.

This is still only part of thecost to apply the van technologyholistically. In the future thecost to learn to operate the specialcontrols of the van will be covered.Since each new van might have differentcontrols the training will be paid

for every time it is needed. In

addition, the regular maintenanceand repair cost on the wheelchairlift have not been added in yet.They will also be covered. The wheel-chair is intrinsic to this systemso ongoing maintenance and repairfor it must be addedin. Like everythingelse wheelchairs wear out so thecost to replace the wheel chair periodical-

ly must be added.What about the cost to consult

experts about the best kind of liftand the most appropriate controlsystem to select for each new van.The technology will continue to change.

Driving and the vans themselves willlikely change with time. Only anunbiased expert will be able to makea good decision about what kind ofsystem to get. In the future theservices of this expert will alsobe paid by third part funding sources.

Thus, there are many ongoingcosts that must be covered to succeLsfully

provide mobility with a van and wheel-chair. Vans are relatively easyto learn to drive and easy to maintaincompared to many computer based conver-sation, writing, and computer accessaid systems. These systems may requireeven more ongoing support. Therefore,

185


in the future if third party fundingsources are needed they will support

all the costs necessary to apply thehigh technology for aid systems holis-tically. This will include:

1) The cost of evaluation services2) The cost of system integration

and assembly services3) The cost of the hardware and

software components of thesystem

4) The cost of initial trainingservices to learn to use theaid system

5) The cost of ongoing trainingservices related to developingskill in using all the powerand versatility of the aidsystem (this is differentfrom and in addition to speechand language therapy,occupational

therapy, etc.)6) The cost of periodic maintenance

services (cleaning keyboardsand switches, adjusting andtightening mountings, etc.)

7) The cost of normal periodicparts replacement (like nicadbatteries every 3 years)

8) The cost of repair servicesfrom equipment failure oraccidental damage (LCD displaygoing bad, spilling juiceon the keyboard, etc.)

9) The cost of periodic systemupgrade for both the materials(software and hardware) andthe installation and trainingservices (this will be necessarybecause manufacturers willrefine systems over time fixingbugs and adding features)

10) The cost of replacing thesystem after its useful lifetimeis finished (this will be

necessary when the users physical

or mental capabilities andneeds change even if theiraid system still operates)

11) The cost of comprehensiveinsurance to fix or replacethe system if it is damaged

or stolen.

It is worth noting again thatmost of these costs will be services.

To Sum Up

In order to apply high technologyeffectively we need a holistic visionwhere all the parts necessary tomake a whole system are in place.

By comparing technological toys,tools, and appliances we recognizethat high tech writing, conversation,and computer access aid systems aretools and that like all tools theresults obtained depend as much onthe skill of the user as on the quality

of the tool. This suggests in turnthat in the future providing ongoingtraining to comfortably use the aidsystem in real situationsisasimportantas providing that aid system itself.

Recognizing high tech aid systemsas tools allows us to understandthat high tech aids are perfectedfrom actual use over time and thataid system designer/developer/manu-facturers will be people who gettheir primary satisfaction from seeingtheir systems used successfully inreal situations and they will be

people who like to continuously perfectand improve their systems. Recognizinghigh tech aid systems as tools alsoallows us to use our experience withother high tech tools to identifythe functions necessary for holisticapplication, where holistic application

is providing everything necessaryto be successful. In order to providemany of the functions of holisticapplication there will be professional"Aid System Integrators" workingfor aid system users or third partyfunders.

The physical part of high techaid systems will ride on the COATTAILSof general purpose computer devicesbecause this approach is more.effectivein developing aid systems into tools.Many high tech aid systems will be

designed using a standard portablecomputer in a standardized modularsystem I call the GAIN System. Finally,

in order for high tech aid systems

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to be used successfully third partyfunding sources will provide ongoingsupport for holistic application andmuch of this will go for needed services.

By understanding aid systemsas tools we will be able to use ourexperience with other tools to helpcreate ways to provide and use aidsystems appropriately. By using thismodel we can develop appropriate approaches

for designing, manufacturing, selecting,

improving, learning, using, payingfor, maintaining, insuring, repairing,and replacing high tech aid systems.

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"WRITING TO READ": A COMPUTER-BASED, LANGUAGE EXPERIENCE, WRITINGAND READING SYSTEM, AS USED WITH HANDICAPPED CHILDREN

ELEANOR R. KIRKLAND

ABSTRACT

"Writing to Read" i s a computer-based

program designed to teach studentsto "write to read." The program is

based on the philosophy that studentswill learn to read more effectivelyand efficiently if taught to write,therapy and using the encoding oftheir normal language as the initialprocess in learning to read. Usingthe computer, the "Writing to Read"program helps children develop theskills required of successful writersand readers. It teaches the childrenphonemic constituents of the Englishlanguage, not only the 26 lettersof the alphabet, but also the 42 Englishsounds represented in many differentways. The program teaches the combiningof sounds and letters to create words,and the combination of words intosentences. Finally, the program teachesthe writing of illustrated stories,the bindage of pages into books, andthe reading of books to peers andethers.

The children take great pridein their work. The program has been

a "great success" with the childrenwho have a variety of problems/disabil-ities.

Today we have many concernsregarding the education of our children.There is concern over the numberof "illiterate" children, particularlythose at the secondary l evel . Accordingto Council on Literacy, functionalilliteracy costs more than $224 billiona year. We pay the price of incompetentjob performance, lost tax revenue,crime, welfare payments and remedialeducation.

Some college and universitystudents cannot pass writing andreading tests at the 9th-10th gradelevels. In many schools across thecountry we find large numbers ofnew immigrants with little or no

English. In addition, we have largenumbers of children with communication/reading problems, and children withlearning physical disabilities whichdeter learning. Of all studentswho fail, reading failures receivethe most attention. Reading failureis the most commonly studied academicsubject in learning disabled research.

Certainly writing and readingare very important skills; they areimportant no matter what the students'grade level. They effect careersthat lie ahead and a student's abilityto become a productive adult andcitizen.

Our country's industrial climateand our own life styles are changingrapidly. Electronics, robots, andcomputers are more prevalent, partic-ularly computers. They are now oftenappearing in large numbers in theschool. Many people think that thecomputer has a great potential in

education. I believe this is correct,if we are more careful in the selectionof software. Much programming softwareis very poor, of no better valueto the teacher than another dittoor work-book page. A lot of work


still needs to be done to improvethese programs.

We Must Do Somethingto Solve these Problems

Research has shown that all childrenacquire and develop language skillsin the same order and sequence withoutregard to where they were born orthe language that they speak. Throughoutthe world, children produce the samesounds in the same order; this is

primarily due to their physical develop-ment. The first sound made by infantsthroughout the world is "aaah." "Aaah"

doesn't require any control; merelyby opening their mouths and emittinga small amount of air they produce"aaah," a short vowel. Next, soundsare produced with some lip control,first "mmm" then a combination of"mmm" and "ah" to form "Ma." Youknow what happens. A woman is standingclose by; she hears the child say"Ma," which is repeated become, M;. -ma.With a little encouragement the infantsays "ma, ma, ma, ma" because it is

fun, and so it goes. Researchershave found that the word for motherstarts with "mmm" in mos.': languages.For instance, mutter in German, andMadre in Spanish.

Gradually, sounds string togetherto form the syllables and words spokenaround the children. As they acquirelanguage, they stop making soundsnot included in their native language.For example, an English speaking childwill stop making the "gutteral" soundsof German, the rolling "Rs" of Frenchand the "Cl icks" of some African languages,

unless they later learn these languages.In the development of language

skills, children first listen; theyhear the language being spoken aroundthem. Second, they speak; they beginto make sounds and later words toconvey messages and to communicatewith others. It is interesting tonote that all children throughoutthe world, speak first of the samethings: people and things aroundthem (nouns) and things they do (verbs).

Third, they write. Researchers haveshown that the scribbles of all youngchildren include shapes and formsthat resemble letters of the alphabet,numerals, musical notes, and familiarlooking symbols such as "X" for RailroadCrossings found it, this society.These scribbles gradually begin tolook like familiar words. Many childrenwill write something and then tellyou what it is they wrote, or theywill ask you what they wrote. Thefinal step is reading; reading whatthey have written, or what someoneelse has written.

As we know this is the naturalway children learn to write and read,why do we continue to use methodsor procedures thatconfusemanychildren.All children have something to say.All children like to see what theysay in writing; if it can be written,it can also be read.

"What I can say -I can Write and

What I can Write -I can Read!"

Through the use of the computer,the "Writing to Read" program developsthe skills required of successfulwriters and readers. Students learnthat speaking can be made visible;they learn that making words visibleis called writing. They are taught,at first, to write words the waythey sound. The philosophy, wasdesigned and developed by Dr. JohnHenry Martin. The program is basedon his philosophy that children willlearn to read more effectively iftaught to write, to encode theirnormal language, as an initial processin learning to read.

A personal computer (PC), equippedwith voice output and color graphics,plays a central role in the program.Other program components are workjournals that parallel computer lessons,a listening library of children'sclassics, typewriters, printers,and games.

The PC, using a digitized voice

189


attachment to eliminate the "nasalsound" associatedwithcomputerdvoices,"comes with 30 diskettes. The structureof the "Writing to Read" program is

deceptively simple. Based on 30 keywords and their phonemes, the programteaches children to write words theway they speak them, the way theysound phonetically. For example,in the first lesson the "C" in Catis taught as "K" sound, not a "see"

sound. The English alphabet uses26 letters; the English languages42 phonemes. Represented 500 differentways, the letters and phonemes areneeded to speak all the words of English.For example, the sound is the same,but spelling differs, for the "oo"

in school and the "ough" in through.It is no wonder that English is themost difficult language to write andread.

Consistent use of a phonemicspelling system allows children towrite, and use their rich vocabulary,at a much earlier age than if requiredto learn all the inconsistencies ofEnglish spelling. As children developtheir writing proficiency, they beginto recognize these inconsistenciesand adjust their writing to textbookspelling.

In the program, phonemes aredisplayed 'ound the perimeter ofthe PC scree,,. As the computer "voice"cal 1 s out a sound or word, the appropriate

phonemes leave the perimeter and moveto the center of the screen. The

computer section of the program, in

which the children spend 30 minutesworking in pairs, relies heavily onrepetition. In the first lesson,there are 33 repetit'ons of the word"cat"; the computer says "cat," and

asks the children to spell it usingthe keyboard.

The program is individualizedto the extent that the learning-cyclesare self-paced. The computer waitsfor the correct response and doesnot respond to a wrong response.Thus, if a child is asked to typeor write "cat" and an error is made,the incorrect letter does not appear

on the screen. In a mastery testat the end of each cycle, studentsare asked to write the words theyhave just learned. If two errorsare made, the computer recycles theinstruction.

Each of 10 cycles consists ofthree key words. The cycle alsobranches out to introduce other wordsthat can be formed using the samesounds. The 30 words introducedin the 10 cycles, introduce the childto the 42 English phonemes.

Other computer based instructionuses games, including a game thatrequires the child to write the word"mouse" fast enough to keep a picturedcat from catching a pictured mouse.Another game, the "silly sentences"segment, intends to introduce childrento sentence construction. The childrenare asked questions such as "Didyou ever see a pig in a bed?" (Pig

and bed are 2 words introduced incycle 2.); the children are showna funny picture of "a pig in a bed"and helped to write a sentence.

Because of successful evaluationsof the "Writing to Read" programduring its early years (1978-81),Dr. Martin was moved to copyrighthis computer-based teaching system.Dr. Martin and IBM teamed up to developan evaluation of the "Writing toRead" system in schools nationwide;approximately 10,000 children (kinder-garten - 2nd grade) in six statesparticipated in the study conductedin the Fall of 1982. The evaluationwas extended through the school year(1983-84) with approximately 15,000children involved in the program.The evaluation in 1983-84 includedchildren with problems and disabilitiesas well as -various grades and agelevels. The program is being evaluatedby the Educational Testing Services,Princeton, N.J., and the resultsof the evaluation will soon be available.

For the evaluation, IBM loaned

computer equipment and publishedthe program's printed and audio ma-terials. (IBM owns copyright tothe program.) The printed materials

100


included "Teacher's Manuals" thatprovide additional materials, suggestions,

and activities to assist in the operationof the hardware.

In 1982, a second study of programuse by Kindergarten - 2nd grade childrenbegan. In June 1984, this particularportion of the study wa: completed.A report is being written which willshow the progress of children whohave problems in writing and readingusing the "Writing to Read" program.As this conference concentrates on"Technology for Disabled Persons"below is described the use of "Writingto Read" in four schools in the servicearea of Cal ifornia State University,Sacramento.

Over the past two years, approxi-mately 600 students have participatedin the Sacramento program. The onlystudents that began the program in1982 and did not complete all of thephases, moved from the area. Thegroup was very diverse and had manydifferent problems. For example,the groups included: 1) A large numberof Asian children, including approximately50 Omongs , hil 1 peopl e from Laos ,

who did not have a written languageuntil several years ago when missionaries

working with them helped develop amethod to put tnei r language intowriting. 2) A special day cl ass consisting

of 4th, 5th, and 6th grade learningdisabled students (12 boys and 1 girlsranging in age from 12 to 18 years).These children were placed in thespecial class to help remediate their1 earning , social , and emotional problems.

3) A group of children placed in theResource Special Education Centers,and 4) A Special Education Center.The school had added a special wingdesigned specifically for SpecialEducation. A central "Writing toRead" center housed all of the hard/soft-ware. Off the center are four classroomswith large open doorways: #1 is a

self - controlled 1st and 2nd gradesEMR class. #2 is a self-contained2nd and 3rd grades EMR class and #3is a self- contained 4th-6th gradeEMR class. The fourth room is the

Special Education Resource Special istCenter. A schedule was developedfor each classroom to participatein "Writing to Read." This is ideal,because the teacher can move fromthe center to the classroom and monitorall students easily. An additionto one of the schools in the pastyear was a special first grade classwith many Asian children and othersat the readiness stage.

A program inservice was providedto di rectors, specialists, classroomteachers, a ides and administratorsbefore the centers were put intouse. Informative meetings were alsoheld for parents and others interestedin the program. The staff of eachcenter and school met once a monthto di scuss the programs, problems,suggested changes, and other topicsrelevant to the program.

Because of the density of thestudent population, the "Writingto Read" program was modified slightlyfrom the original used with Kindergartenand First/Second Grade children.All of the participants, however,did follow al l of the steps and procedures

of the 10 phases of the program.The modifications were made to meetthe needs of the children. For example,for work on the computer or journalsan English speaking child was pairedwith an Asian child - particularlythe Hmongs who had the greatest problemswith writing. To help these childrendevelop their vocabularies and anunderstanding of writing thought/sen-tences, group activities were organizedfor both English speakers and veryEnglish limited Hmongs. In the firstsequence, they learned the wordsCat, Dog and Fish and three soundsymbol relationships of the words(e.g. the c, the a, and the t ofcat ) . Pictures of cats from thePea body Kit were used to developvocabulary. Staff and students talkedabout the pictures of cats, whatcats looked liked, what they ate,what they did, etc. and the group,then created a story. The storywas written on the board, read, and

191


reread. The story was finally writtenon a chart and placed in the "writing"corner. The children were encouragedto copy the story and illustrate it.After exposure to the three wordsin Phase I (cat, dog, and fish, introducing

10Englishsounds),andafterperticipatingin the process mentioned earlier,a Hmong student wrote:

"I see dog.Dog eat fish.I crying."

The picture he drew to illustratehis story was a dog with a fish inhis mouth.

This was remarkable as he had

only been in the program for aboutfive weeks, knew very little English,and had done very little writing beforeentering the "Writing to Read" program.

In some cases, because of thedifference in problems, levels ofability, etc., it was impossible topair children who went to the SpecialEducation Resource Center. Consequently,some children worked on their ownat the computer and journal stations.

They did, however, participate withother children in some of the otheractivities.

During the "inservice" held priorto the program initiation, teacherswere encouraged to use the programin their classrooms and to encouragechildren to read their stories toother children in their class. Becausethere was concern over spelling witholder students (if they were encouragedto "write the way it sounds"), thefollowing procedures were used.

When the children com lete theexercises in the journal, they areasked to write a story using the threewords and the sounds introduced inthat cycle. They learn that theycan write everything they can say.With the help of the teacher or aide,they learn to rewrite, to improvethe clarity of their thinking on paper,and to use the correct phonemic symbolto their words . The ahlts are encouraged

to give clues such as, "do you remember

the sound you heard at the end of"fish"? but not to tell the childhow to write the word.

A great deal of "word processing"actually takes place in the writingof stories. After correcting theirwriting with the help of an adult,the children type their study onthe PC, read it on the screen and,if written to their satisfaction,their story is printed. The printedcopy is edited more carefully withthe older children.

In the editing process therhildrenare taught how to write words asthey appear in books, and to writeparagraphs (indent). They then taketheir edited story, with suggestedchanges, to a typewriter and producea finished product they can be proudof. They paste their story on a

piece of colored construction paperand illustrate it. The stories arethen taken to the classroom, readto others, posted on bulletin boards,or bound in a book.

At the "writing station" thechildren use typewriters to producethe "final edition" of their story.Many children, when put through thepainstaking effort of writing witha pencil, tend to forget the wordthe letters express. Witha typewriter,the letters are perfect and can beput together into words more rapidly.The children take great pride in

their writing.The progress the children made

in writing stories was amazing.This process was eventually usedwith all of the children except theearly readers, or students new tothe program.

I found the multi- sensory approachmost helpful for those children whohad learning problems or some physicaldisability. Each child uses all

of his senses when working on thecomputer, (1) he sees the word, (2)

he hears the word, (3) he says theword. and (4) he writes the word.Learningis being reinforced continually.Some children who lack small and/orlargemotorcoordinationhavea difficult

192


time holding a pencil, writing betweenthe lines, forming the letters in

a certain way, etc. These childrenhave ideas (many of them), and theyknow the words to describe, defineand communicate their ideas, but theycannot put them on paper. They can,however, press the keys on the computeror the typewriter. They can see theirwords in writing and they can readthose words. One very uncocTainatedchild had a difficult time holdinga pencil, writing on paper by touchingthe dotted line, and drawing a circleor circling to the left to make a"C." He completed the first phaseof the program and was introducedto cat, dog, and fish, and was doingthe "mastery test" that asks eachchild to write the words cat, dog,fish, giving one opportunity to doit correctly. The computer "voice"said "write cat." The boy wrote caton the computer, it appeared on themonitor because he did it correctly.He called out "Wow, I can Write! ";it was this child's first feelingof success in writing.

Children with minimal motor control

can use special gadgetry such as sensitive

micro-switches, light pens, or joysticks to reach beyond their physicalrestriction and learn language throughinteraction with the computer.

Another example: Robert is a

child who had been retained in firstgrade and now was in second grade.His past teachers dll commented thathe had done nothing for almost threwyears, that it was like "pulling teeth"to get Robert to provide a response,pay attention, etc. He had been assignedto the Special Education ResourceCenter. One day, while visiting theCenter, Robert came up and said witha big smile "I can write cat." His

friend, standing next to him, said

"He can write dog, too." Robert replied,"I can write fish, too." Congratulationsand hand shaking were given. Several

weeks later, again when Robert wasin the Center, he read a story hehad written in his journal:

"Dogs get the cats.Dogs always get the cats.

Cats get the fish.Cats always get the fish."

"Always" was the only word he

needed help with. This story waswritten after Robert had completedPhase I of the prcgram. This samechild went from the 6th percentileto the 98th percentile in the readingportion of the WRAT test.

Teachers have indicated thatnot only are the children improvingin writing and reading skills, theyare also enjoying their experiences,becoming more independent, and takingmore responsibility for their learning.The children are taking pride in

their work, particularly their writingof stories and books.

The program provides more timefor the teacher to give attentionto children with learning problemsor disabilities; and to plan stimulatingactivities to encourage languageskills. It gives the children anopportunity to write of their ownpersonal experiences, and to sharestories with others.

Computers will not take theplace of teachers in the classroom,as has been suggested by some concernedteachers. Machines can't hug, so

the teacher's role is all important.

N New StudentR Returned Student EVALUATION

(T3.'84)

RSP Resource Special EducationProgram

NEP Non-English ProficiencyLEP Limited English Proficiency(CIA Title IFEP Faulty English Proficiency

Test Given: WRAT % Imp. Percentile Improvement

Student Classification Reading Spelling

Grade Level Equiv. % imp. Grade Level Equiv. % Imp.Average % Imp. (N) 1.1 (1 yr., I mo.) 21.2% 1.5 28%Highest Gain (N) 2.5 28% 1.8 31%Average % Imp. (R) 2.7 33% 2.3 21%Highest Gain (R) 2.9 63% 1.4 13%

NEPAverage % Imp. (N) 1.6 18% 1.2 11%Highest Gain (N) 1.8 49% 1.7 12%Average % Imp. (R) 1.75 23% 1.9 26%Highest Gain (R) 2.1 30% 2.5 3%

LEPAverage % Imp. (N) 1.0 14% 1.8 29%Highest Gain (N) 1.5 48% 2.6 43%Average % Imp. (R) .9 10% :.5 25%Highest Gain (R) 2.8 32% 3.3 5%

(CIAAverage % Imp. (N) 3.1 68% 3.2 56%Highest Gain (N) 5.3 90% 4.1 90%Average % Imp. (R) 4.0 56% 3.0 88%Highest Gain (R) 4.9 73% 4.3 84%

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Most of the children returnedto the program the second year didcomplete the program (the 10 phasesand the games) by the end of the schoolyear. If they received 50% or moreon the CAT (California AchievementTest) and had been placed in the TitleI program (ECIA) they no longer werescheduled in the center for more reme-diation (at least not for Readingand Writing). The EMR classroomswere added this year, consequentlyvery few children completed the program.They will, however, be tested at thebeginning of the '84-'85 school yearon the mastery test for the phasescompleted; review and drill will be

provided for those phases they hadtrouble with, before moving on tothe next phase. This group of studentsdid exceptionally well for the timespent in the program.

At the end of the '83-'84 schoolyear, there were 14 new children whowere "Tested Out" of the program becausethey had passed 50% in the CAT althoughthey may not have completed all 10

phases of the program. In the groupwere 6 children classified as LEP(L'mited English Proficiency), 1Bilingualchild, and 7 children with FEP (FaultyEnglish Proficiency).

Tcsted Out of Prograta

iiRAT

Student ClassificationLEP

ReadingGr. Equiv. Imp. % Imp.

SpellingGr. Equiv. imp. % Imp.

Average % Imp. 1.6 23% 6.0 27%

Highest Gain 4.2 39% 4.6 68%

FEP

Average % Imp. 3.7 79% .7 53%

Highest Gain 4.5 79% 6.7 84%

I Bilingual Child 4.9 29% 5.o 27%

Why It Works So Wellwith the Handicapped

Suggestions and instructionalrecommendations , for learning disabilities

and reading, have been gained fromrecent research.

1) Because the L.D. learneris inattentive, inactive, and unableto spontaneously generate appropriate

learning strategies, remedial goals

include inclusion of the learnerin both selection and use of learningstrategies. The body of researchin teacher effectiveness suggeststhat direct instruction may be an

appropriate technology for facilitatingachievement with learning disabledchildren. While most of the teachereffectiveness research has focusedon regular education rather thanSpecial Education, an attempt wasmade to relate these findings to

educational interventions for handi-capped learners. It was suggestedthat effective instruction is individ-ualized, directed and academicallyfocused. The "Writing to Read Program"TTUes this individualization.Children work at their own pace.The instructional approach derivedfrom the teacher effectiveness literature

is called direct instruction.Direct instruction can be definedas a set of teaching behaviors whichattempts to maximize student attentionand participation in academic relevanttasks. One important aspect of directinstruction is the relationship ofengaged (or academic) learning timeto allocated learning time and studenteng gement. Student learning is

related to time on task. The engagementof the student in the learning task,thus, becomes a major goal of instruc-tion. The learning environment is

structured to bring this about.It is unlikely that large group

instruction can adequately respondto the diverse learning needs andthe variations in7earningrateinherentin the learning disabled population.The computer-based "Writing to Read"program provides directed instructionand allows each child to move athis rate of learning. Computersare "patient."

2) Direct teaching occurs whenthe instructor demonstrates, models,defines, and explains.

3) Several studies of instruction

with learning disabled students support

194


direct teaching. One study reporteda gain of three years in three monthsfor a reading disabled adult in a

direct instruction phonics program;training focused on the phonics/phonemicskills the individual had not yetacquired.

"Writing to Read" demonstrates,models, defines and explains. It

also teaches the 42 phonemes of Englishand the sound/symbol relations4ipof these phonemes.

4) The research of the lastdecade favors early emphasis in decodingrather than comprehension. Whilethe bulk of the research has takenplace in regular classrooms, it wouldappear that a code-emphasis approachin beginning reading would also benefitlearning disabled. The encoding (the

writing) to decoding (reading) approachof "Writing to Read" provides thisemphasis.

5) Students must focus on therelevant features of the learningtask. This is particularly true forstudents characterized by poor attentionand distractibility. The opportunityto work with the computer certainlymotivates the student and holds hisattention.

6) Skill acquisition is notcomplete until skills can be performedquickly and accurately. We must provideopportunities for supervised practice."Writing to Read" provides the practicerequired to allow the child to respondboth quickly and accurately. Thepractice is provided in a varietyof situations. Another importantdimension of practice is the numberof practice opportunities offeredto the child by the program.

Comments From Teachers and Others

At the last meeting of the year,May '84, teachers and other had a

good time discussing the program.The program was very successful

for many reasons. Some of the positive

aspects of the program as discussedand mentioned by those at the meetingwere:

1. The multi-sensory approachto the English Language:hear the word, say the word,see the word and write theword. Use of all modesof learning: hearing, seeing,touching, and talking.

2. The repetition approachto the lesson aided memoryskills.

3. Change of activities fromone center to the next.

4. Positive reinforcement.5. Self-pacing of students.6. Use of typing for those

with small muscle coordinationproblems.

7. Listening skill s are reinforced.

8. The patience of the computer.9. The orderly transition from

one step to the next.10. The journals provide a place

to write words, sentencesand stories and providevocabulary skills.

11. Listening to the storieswritten ty the childrenand input from the teacheron various subjects foreach lesson improved languageand vocabulary skills.

12. Typing stories or sentenceson the computer and printingthem out was an excitingtool to learning. The studentswere delighted at the factthey could read their printedwords to peers, teachers,and parents.

13. Many of the learning handicappedchildren have concentrationproblems (short attentionspan). They also have a

difficult time followingdirections, but they couldnot argue with the computerwhen it told them to dosomething. Many finallylearned that excuses nolonger worked.

195


14. The Special Education ResourceTeacher must develop an IEP

(Individual Educational Plan)for each student. This leadsto concentration on certainareas of instruction. TheWriting to Read Program becamea part of the IEP and reinforcedthe phonics program.

15. Another interesting aspectof the program was the student'scapacity to see phonemicspell ing of words and thenrecognize the actual spellingand being able to spell themcorrectly.

16. The students enjoyed writingon the computer because theycould correct all of theirerrors and have a perfectproduct. It was especiallygood for proof-reading theirown work, which they oftendislike doing.

17. The program encouraged vocabularybuilding in many ways atall levels. The second andthird grade children wereasked to think of some morerhyming words for the newwords from the "Make Word"pages, and write them. Fourth,fifth, and sixth grade studentswere required to find asmany rhyming words as possibleby using a dictionary. Fishis a word introduced in PhaseI to introduce the soundrepresented by "f", "i" and"sh." The children cameup with a large number ofwords such as accomplish,radish, as in rhyming words.In story writing, the olderchildren were required towrite at least a three paragraphstory using the three wordsintroduced in that phase.They had to be very imaginativeto work som'2 of the wordstogether; some of the olderstudents really got into thestory writing and this extendedover to their classroom writing.

18. The program provided moretime for the teacher togive attention to thosechildren with learning problemsand disabilities, to planstimulating activitiesand to encourage languagskills. It gives the childrean opportunity to wriof their own personal e

periences, and to shstories with others.

One school's staff indic"We are pleased to have been aof the 'Writing to Read' pilot prstudy. It is a learning t

our learning center. Conupon funding, we plan to i

the number of IBM computers anto Read software to accommostudents. The 'Writingprogram has provided our parstudents with reading aexperiences and has aidstudents being 'testedECIA, Chapter I, programtheir CAT scores in R

50%."

Recommendati

We would like to se

gram expand to bettermediate students.might include a j

difficult words a

feel intermediatephonetic approachas seeing their

A word procstudents wouldadding to thetypewriters di

some elementof their laThe word prostudent to im

and print a

In coto see thiwords andstudents

n

tox-

re

ted:part

ogram,ool in

i ngent

ncreaseWriting

ate moreto Read'ticipatingd language

ed in manyout' of theby increasingeading Above

ons

e the W.T.R. pro-

serve the inter-Such expansion

ournal using morend pictures. Westudents need the

to reading as wellstcries in print.

essor for elementarye a tool well wortKW.T.R. program. Thed not work well for

ary students becauseck of typing skills.cessor would enable theediately correct mistakes

perfect copy!

nclusion, we would likes program extended to moregroups of words for advanced

I appreciate havirig the

196


use of it this year and am looking forward to using it next year.

AN OBSERVAlloN CHhCKLIST FOR POSSIBLEPRoilLEHS WITH ViSUAL-MOCOR SKILLS AND AUDITORY SKILLS

WIMV or Student

N.,mc of oleictver

SY(114e6 PoSSUILE VISUAL-MOM PRoBLEMS

Age; years months

Date of Observation

Generally Sometimes

I. Do+ the ntudent have difficulty catching, throw lug, orhalting a ball?

. Does the student have difficulty putting block designstogether:

'. Ives the student have difficulty reproducing geometricshapes (e.g., a circle or square)(

4. Does the student have difficulty writing or drawing inlimited space (e.g., writing on lined paper)?

5. Does the student mistime no unusual head or body positionwhen working at a desk?

6. Dove the student seem to confuse numbers, letters, orwords that are similar In configuration?

. Does the student have difficulty putting cartoon in

sequence?

B. Does the student make reversals of letters, numbers, orwords while writing?

SYMPTOMS OF POSSIBLE PROBLEMS WITH AUDITORY SKILLS

I. Does the student have difficulty repeating three to fivedigits in correct sequence?

L. Does the student omit or subetltute sounds in words?

3. Does the student have difficulty following directions givento a group?

4. Does tht, student request repetition of phrases or words?

S. Does the student have difficulty distinguishing rhymingwords/

. !hog' the student fall to identify common environmentalsounds (e.g., sounJ of motorcycle or doorbell)?

7. Does the student watch ethers to find what to do?

S. Does the student continue to have difficulty with elemen-t.ov ',honks such as initial, medial, and finial sounds?

SCORING CRITERIA ARE AS FOLLOWS:

Visual-Motor Skills

"Generally" Responses X 2

"Sometimes" Responses X I

Tole! Responses

Auditory Skills

"Generally" Responses X 2

"Sometimes" Responses X 1

Total Responses

197


N

AN OUSLRVArION UNIICKLIST FOR POSSIBLE

808LEMS IN LANGUAGE AND INUELLEClUAL DEVELUMENT(Cognitive Domain)

SYOPIH; I,F VON:URIC PRWILLMS

Age: years months

(hat! ot ObourvAIon

Generally Sometimes

I. Is....; the ntndent express vague and confused ideas?

1. O.VH the student have difficulty comprehendingactItmS and speeds of others?

I. 18.cm ti. student have dilliculty following simpleAllections?

4. Does the student display inaccurate enunciation and/orprol sssss elation?

5. Wes the student fall to use new words in conversationand communication?

h. Ikmi the student tall to remember a sequence of events?

1. Does the student speak only in short sentences?

8, Does the student have difficulty categorizing and1 lasallyIng (e.g., coat and glevs as clothing ordrill and jigsaw as tools)?

9. Does the student refuse to use language or speech?

10. WeH the student insist upon using gestures and budy:an6uagel

II Does the student hnve difficulty telling a story aboutan illutitrttion or filmstrip?

',CORING CRIILRIA ARE AS FOLLOWS:

-CcevIAlly" Responses X 1 0

"S"mkIimeu" Rpnnues X I

Total Rvup tttt i;e4

i9

A MODIFIED OPTACON: TOWARDS AN EDUCATIONAL PROGRAM

PAUL BACH-Y-RITABARRY HUGHES

ABSTRACT

Persons blind from birth or blindedat an early age do not develop strictlyvisual concepts of a three-dimensionalspace. This results in both developmentaldelays and longer term cognitive andperceptual alterations in their spatialcognition of the objects that populatespace, even their personal self-repre-sentation. This research is designedto develop an educational applicationof the already demonstrated capacityof the human tactile sensory systemto mediate three dimensional , spatial

information, which, in sighted persons,is carried by the visual system.We seek to demonstrate that, withan inexpensive modification to a com-mercially available and widely usedoptical-to-tactile conversation system,Telesensory Systems' Optacon, blindchildren can develop a richer spatialcognition and self-representationbased on heretofore unavailable visualinformation. The research has severalspecific aims: develop visual spatialconcepts, to work with educators ofthe visually impaired, and to introducethis program into an educational setting.

In a recent discussion of thelong-range feasibility ref sensorysubstitution systems in rehabilitation(Bach-y-Rita, 1983), two key pointswere advanced. The first is thatthe most successful sensory substitutionsystems (Braille, sign language andthe long cane) share several common

factors. Among these are the absenceof complex instrumentation, highreliability, and appropriate transduction

of one type of sensory informationinto another. With these systems,the sensory system that carries theinformation to the brain is not over-whelmed; information processing occurs

in a form and rate consistent withthe brain's physiological capacitiesand limitation. Each of the threesensory substitution systems alsohas limitations. In pa.'ticular,

each is capable of transmitting tothe brain only a limited range ofenvironmental information. Braillereaders, for example, can read onlylimited literature. Long cane userscannot perceive overhaigs nor canthey gather information about thespace in front of the cane tip.As a consequence of being deprivedof sensory information, and therefore,being unable to perceptually experiencesome aspects of their world, a blindchild is at a significant developmentaldisadvantage. Some basic 'iisiospatialknowledge was simply beyond theirexperience or understanding. Consider,for example, the following passagefrom Lowenfeld (1955) on some ofthe perceptual difficulties facingthe blind:

199

The sun, the moon, the clouds,the horizon, the sky areinaccessible and can be explained

to blind people only by theuse of analogies from other


sensory fields. This methodmust also be used in explainingto blind people such visualphenomena as shadows, perspective,

and reflection of light.Many objects are too largeto be observed by touch; forinstance, a mountain or a

large building. Other objectsare too small and cannot be

observed by touch with anydegree of accuracy; for instance,flies or ants."

Self - representation is an especially

important cognitive acquisition becauseit has niany other ramifications forthe representation of objects in theenvironment. Self-as-object, forexample, is important because it is

the leading edge of a number of otheraspects of self-identification," suchas the usage of 'I' in language andplay.

For the sighted, vision contributesa disproportionate amount of informationuseful in motor control , spatial cognitionand the construction of self-image.This information is normally beyondthe drocessing characteristics ofthe haptic or auditory modalities.The blind child's del ay in the acquisitionof ' I ' -as-a- co ncept , for example,can be related to the problems ofconstructing a self-image in the absenceof vision.

"The blind child has no sensorymode available to him whichwill replicate his own bodyor body parts. The blindchild is obliged to constitutea body image from the components

of non-visual experience availableto him...but these sensorymodes bind him to egocentricbody and self-experience andcannot lead him easily tothe concept of self in whichthe self an be taken as an

object, the indispensablecondition of 'I'. (Fraiberg& Adelson, 1976:145)

It is our contention that theproblem of such children is not theabsence of sight, but rather an absenceof a means by which visual informationcan be perceived. TheilTOrffed Optacon,we argue, is capable of providingvisual information through the skin;it produces a perceptual system thatFraiberg and Adelson (1976) feltcould not be duplicated without vision.It does simulate vision in a numberof important ways: representingparticular objects in their entirety,extending out beyond the reach ofthe observer, and reducing the needfor gross tactual exploration.

While not capable of processinginformation as simultaneously asthe visual system, the tactile presen-tations through the Optacon offersnumerous advantages over strictlyhaptic or kinesthetic presentations.The latter require the synthesisof sequentially processed informationwhich places a heavy load on memoryand other cognitive processes (e.g.,a face haptically explored cannotresult in the immediate representationof a face: perhaps the outline is

perceived first, then the hair length,then the nose, etc. Each part mustbe perceived, then remerbered andthen synthesized into a representationof a face, or with more difficulty,into one particular face). Not onlyis this a considerably demandingtask, but it is also limited, evenwith practice. The Modified Optaconcan relieve the user of some of thiscognitive burden: certain objectscan be presented in toto (even ifnot in great detail), and withoutthe necessity of sequential touching,or even touching at all

The kinds of experiences discussedin the beginning are precisely thosethat have already been provided blirdsubjects in the earlier TVSS research(see Bach-y-Rita, 1972; 1980 fordetails). The provision of visualinformation via a different sensorymodal ity offers the opportunity forthe young blind subject to developthose cognitive concepts vital for

200

Discovery '84 Technology for Disabled Persons 18q

spatial cognition, perceptual-motorskills, self-representation, andsel f-image. To reiterate, it is by

no means clear that only sight canoffer useful visual information.In fact, our research with the modifiedOptacon suggests that some quasivisualinformation can be made availableand that certain entirely novel ex-

periences (such as the tactile imageof a flickering flame) can be perceived.It remains to be seen, of course,whether the perceptual experiencesoffered by the modified Optacon canhave identifiable 1 on -term devel opmental

benefits. The mo i ie Optacon, wepropose, can provide or supplementthe blind child's experience, usefulin the development of sel f-representati on

in various ways: as a detached observer

(rather than just an active manipulatorof objects in space, as a continuousphysical entity (that is, as a completeobject in space), and as an actor.Further, the proposed Optacon programoffers the opportunity for the childto view him /herself as others do,so that he/she may be provided a meansto reduce the anxiety associated withphysical appearance.

Basic research on the means bywhich the visually impaired code vibro-tactile information about shape, distance,location, orientation, etc. is also

necessary in this endeavor becausethere remains considerable confusionin the literature as to the relativeperformance of the sighted and blindin spatial tasks. Is vision a necessaryor a sufficient, or merely facilitatingaspect of spatial performance? How

does the memory of objects only touchedcompare with that for objects onlyseen? To what extent are differencesin sighted and blind performance attri but -

able to the amount or the type ofinformation provided by vision andtouch?

Evidence for poorer (or even different)performance by the blind on certainspatial tasks is usually interpretedas evidence for the necessity of visionin such cognitive- conceptual development,

and for the seperatenLss of the different

sensory systems. The absence ofvisual information severely lin, isthe subjects' knowledge of external(tactually unperceivable) relationsamong objects: "the congenitallytotally blind lack important aspectsof information, and forms cf organizingit that are easily derived from vision"

(Millar, 1981:310). The modifiedOptacon offers one means by whichthis scope and type of spatial information

can be made available to the blind,and deprived spatial representationsassessed.

Backround Research

Studies with Tactile VisionSubstitution System (TVSS), whichform the background for the presentproposal , emerged from concepts ofbrain plasticity and the potentialfor one sensory system to substitutefor another (e.g., Bach-y-Rita, 1972).The TVSS is a system for convertingan optical image into a tactile display.

After surprisingly little training,subjects are able to recognize commonobjects and to describe their arrangement

in three-dimensional space. By control

of the sensing and imaging device,a television camera, subjects quicklymade di stal attributions (i .e. , understood

patterns as belonging to objectslocalized out in space, and not justagainst the skin).

In order to deliver the imagepicked by a TV camera (under thecontrol of the blind person) to theskin of the trunk, each point stimulated

on the skin represented one smallarea of the image captured by thecamera (much as a newspaper photographrepresents a scene by an array ofdots). A functional 400-point system(20 x 20 matrix in contact with a10 -inch square of skin) was completedin 1968 (Collins, 1970). More than80 blind persons were trained ortested, of whom, 30 received morethan 40 hours of training.

Learning the techniques of cameramanipulation usually occupied themajor portion of the first few hours

201


of training. This included controllingthe zoom lens operation, apertureand focus, as well as directing thecamera to some part of the surround.With this self-induced camera movement,subjects used the camera as part ofa perceptual organ.

The visual analysis 'echniquesand concepts thus developed aere usedin letter recognition, the perceptionof moving stimuli, and the explorationof other persons standing before acamera and the exploration of thesubject himself in a mirror. Oursubjects learned to discriminate betweenindividuals, to determine where theywere in the room, and to describetheir posture, movements, and individualcharacteristics. However, detail,such as found in a photograph of aface, vas particularly difficult toperceive.

We developed several portablemodels of the TVSS which usn an arrayof mechanical or electrical stimulatorsapplied to the skin of the abdomen.Subjects wore a small TV camera mountedon the frame of a pair of glasses,and a vest containing the electronicsand hatteries. Field testing of theTVSS for a limited industrial taskwas also conducted in collaborationwith an electronics company. A blindtechnician was trained in the assemblyof solid-state diodes, a high-volumetask normally performed by sightedemployees. After three months, hewas able to perform the assembly linemicroassembly and inspection taskswith comparable speed and accuracyas sighted persons.

The Modified Optacon

The standard Optacon consistsof a matrix of photocells and a corres-ponding matrix of skin stimulators.The blind person passes the matrixof photocells across the lines ofprint on a page and receives the outputon a stimulus array of 144 (24 x 6)

piezo-electric driven vibrating tipson the fingertip (Linvill and Bliss,1971). The modifications we have

applied to it are quite simple:following the deactivation of thecamera's internal light source, wehave fitted, above the reading aperture,an adjustable telescopic tube andinexpensive biconvex lenses of varyingdiameter and focal length (rangingfrom 11mm x 20mm x 20mm x 35mm).Figure 1 illustrates this arrangement.

Figure 1. The standard optacon (1) modified byfitting an adjustable lens attachment (2) and

angle-adjustable clasp (3) to a lightweightheadpiece. Zoom adjustment is (5).

202


In order to provide maximal mobility

in the scanning of the camera, wehave permitted it to be hand held,to be mounted on an adjustable tripod,or to be mounted on a light-weighthelmet or cap where it can be movedvia head movements. Our primary objectivein the earliest pilot work with fourearly-blind students (ranging in agefrom 13 to 28) has been to replicateas many of the effects documentedin the TVSS research as possible andto develop a systematic teaching programbased on this work. The learningresults found so far have been positive:one of the subjects, who owns hisown Optacon, learned, with eight hoursof practice, to accurately identifythe three-dimensional shape of a rotatingwir4-75-bile, to state its directionof rotation, and to use other monocularcues to depth perception. The othersubjects who had minimal previousexperience with the Optacon, progressedto the same level, but at a slightlyslower rate.

The training program, as it nowstands, is based on the earlier TVSSapproach. What follows is a brief

outline of the basic task domainson which we have based the program.

Perceptual-Motor Interactions

The modified arrangement makessubstantial use of active movementon the part of the user. However,while standard operation of the Optaconis limited to linear scanning alonga printed line, use of the modifiedOptacon requires far more varied motorinvolvement in different directions,over different extents, and oftenin an exploratory non-predictive way.learning to scan in two dimensions,learning to stabilize images, learningto reliably and accurately distinguishmovement of objects in the perceptualfield from movements of self is needed.

Distal attribution,atenmsigntfyindthe user's ability to attribute the(changes in) stimulation at the fingertip to (changes in) distal objectslocated in the functional perceptual

field, is constantly encouraged withverbal reminders and haptic confirmation.Accurate scanning of the perceptualfield, with emphasis on the zoomand threshold manipulations, is alsovital, given the narrowness of thatfield. Novices may also requireexplanation of why, with movementto the right (e.g.), the image movesto the left, and an opportunity tobecome familiar with this.

Much of this aspect of the curriculum

parallels that is used in the standardOptacon approach, except that weuse more variety in line length,width and orientation, and requirethat users continually make comparativeperceptual and memorial judgmentsin practically every exercise. In

scanning lines we emphasize imagestability. We also include activemovements by the user to correctbody position, to rectify the lineorientation, (e.g., if a line is

supposed to be vertical but is not

displayed as such on the monitor,it must be because the subject'sread is tilted). This can also be

used to demonstrate how a line willchange its apparent orientation witha purposeful head tilt, and again,how a change in object orientationcan be distinguished from head orienta-tion. We use both straight and curvedlines. This work eventually leadsto the ability to distinguish theperceptual effects of self-movementfrom those of object movement.

The same objectives are apparentwith more than one line present in

the visual field: that is, we seekto have the user scan accurately,distinguish and correct for lineorientations, as well as make comparisons

between the geometric characteristicsof the lines. For example, we askquestions regarding relative straightness

of the lines, relative lengths, widths,and orientation; whether or not the'ines are parallel; whether theyconnect, and/or intersect and, ifso, at what approximate angle; andAether they form familiar patternsor alphanumeric characters. The

203


ability of the users to comprehendsuch terms is relevant, but it shouldal so be recognized that such exercisesmay provide valuable practice withsuch terminology by a means whichis perhaps more useful than the normalverbal descriptions and haptic ex-ploration.

The gradual introduction of morecompl icated patterns can continuewith the presentation of two-dimensionalshapes. These can take the form ofalphanumeric characters that may alreadyhave been learned by Optacon reading,and of other symbol ic images.

Three Dimensional Objects

Learning monocular cues to sizeand depth is the most time consumingexercise of all, but could offer themost long-term benefits. Depth percep-tion, after all , is one of psychology'sand art's classic problems; even thesighted are faced with this problembecause the very nature of the visualsystem involves a three-dimensionalworld translated onto a two-dimensionalretinal surface. An understandingof how we perceive an object as beinga certain constant size even thoughit may be moving toward or away fromus, or of how we see a set of objectsarranged in depth, requires an under-standing rot so much of the visualsystem but of the kinds of information,'cues' to depth we learn to use.We define a depth cue as a patternof proximal stimulation (in this case,the vi brotactil e pattern from theOptacon) that contains informationabout the (three-dimensional ) spatiallocations of distal objects.

The following topics constituteour work in this area:

(1) Interposition: how oneobject can occlude, orpartially occlude, anotherwhen both are in theprojected line of 'sight'of the Optacon.

(2) Linear perspective:how, for example, parallel

lines appear to convergeas they recede in depth.

(3) Relative size: howan object, which maintainsits true size, subtendsa greater visual angle

and hence appears largeras it approaches the'viewer'.

(4) Motion parallax: howself- movement changesone's perspective ofobjects or object rel ation-

ships.(5) Effects of object motion:

how objects undergochanges in perspectiveas they move (e.g.,rotate).

Supplementary Uses

In addition to offering a meansby which visuo-spatial informationcan be presented to blind users,our hope is that other educationalbenefits may be derivable from useof the motified Optacon. The followingis a partial list of some possibilitieswe have al ready attempted:

(1) Pictorial Representationof Illustrations: Much of what ispresented in print is supplementedwith pictures, photographs or drawings.If the material is considered essential

from an educational perspective,it must be converted to a tactual

format (i .e., geometric figures,maps, etc.). This requires considerablehours of additional effort. If,however, a simplified representationof the picture could be viewed withthe modified Optacon, much of thistime and effort could be saved.The information would be elemental ,

but still convey the main idea ina succinct, time saving manner.

(2) Large -Scale Information:Here the need is to present scaledroom, building, and travel routeinformation in a manner that is efficientto both the modified Optacon userand the information provider.

(3) Daily Living Skills: Here

204


the emphasis would be on specificskills: The information providedwould allow the user to either betterreplicate a function, understand anaction or layout, or perceive thewhole of a subject being discussed.

(4) Signature Development:The opportunity to observe and compareone's own handwriting is important.

For the user to produce his /her signature

and then contrast it, would be a signi-

ficant advancement. With the modifiedOptacon, performance feedback canbe immediate and the user's improve-mert can be self-monitored.

(5) Motion: The concept ofmovement is a difficult one to grasp.The modified Optacon provides an oppor-tunity for the user to perceive motionwithout interfering with it. Thisis in itself a significant opportunity.That it could be applied to the liveillustration of, for example, lawsof physics for academic purposes,would be of real value.

Acknowledgments. This research hasbeen funded by The Foundation forGlaucoma Research, San Francisco.We also gratefully acknowledgethe assistance of Brent Bailey,Todd Devries, Kevin Kirby, MatthewOlaiya, and Patrick Kwanashie.

REFERENCES

Bach -y -Rita, P. (1972). Brain Mechanisms

in Sensory Substitution. New York:Academic.

Bach-y-Rita, P. (1983). Tactile-visionsubstitution: past and future.Int. J. Neurosci., 19, 29-36.

Collins, C. C. (1976T. Tactile TVmechanical electrical image projec-tion. In J. C. Bliss (ed.), IEEE

Transactions on Man-Machine Systems,65- 1.

Fraiberg, S. and Adelson, E. (1976).Self-representation in young blindchildren. In Z. S. Jastrzembska(Ed), The Effects of Blindnessand Ot er Impairments on Ear yDevelopment. New York: AmericanFoundation for the Blind.

J. G. and Bliss, J. C. (1966).

A direct translation reading andfor the blind. Proc. IEEE, 54,40-51.

Millar, S. (1981). Crossmodal and

intersensory perception and theblind. InR. D. Walk and H. L. Pick,Jr. (eds), Intersensory Perceptionand Sensory Integration. NewYork: Plenum.

205

ESTABLISHING A COMPUTER NETWORK FOR CONNECTICUT

ABSTRACT

This presentationactivities of the ConneEducation Computer Ne.

(ConnNET). The overallproject is to develupa special education cowith schools and schl

within Connecticut. :

national computer netwceducators, will serve a!

of this network. Wethrough this project v

communications, betweerState Department, and 1

to provide a positivequality of programs delivered to handi-capped children. To ensure that thisoccurs, the project will develop aConnecticut bulletin board on Special Net,

develop and disseminate a ConnecticutSpecialNet handbook, stimulate statewideinterest in SpecialNet, evaluate tele-communications equipment needs ofschool districts, select school districtsfor SpecialNet subscriptions and training,

train local school district and StateDepartment staff in SpecialNet, anddevelop a technical assistance planfor the state to use in continuingthe Connecticut Special EducationComputer Network.

CHAUNCY N. RUCHERFRANCIS X. ARCHAM[AULT, JR.

TOM B. GILLUNG

)computer revolutioniatic and irreversibleway we conduct the

!ducation. In fact,a recently completed

rvey by Market Data4) suggest that overblic schools now usein instruction, more

number using computerstr.

sued by the Connecticutent of Education in

et 54 percent of Con-districts have micro-

able at the elementarylevels, and 62 percent

of the district have them availableat the high school level (Glass).

More recently, a Connecticutneeds assessment conducted by Connecticut

Special Education Network for SoftwareEvaluation (ConnSENSE) reveals that87 percent of the school districtsresponding have one or more computersavailable for use by special educationstudents. Of those districts, 76percent have one or more Apples,39 percent have one or more RadioShacks, and 26 percent have one ormore Commodores. While these figuresare encouraging, some districts haveonly a few computers available forthe entire system while others haveover 200 and still other districtshave no computers available for eitherinstruction or mana.ment uses.

The ConnSENSE needs assessmentrevealed some other interesting facts.Microcomputers are now being mostusea for computer assisted instruction(63%) and word processing (43%).The respondents feel that in thefuture they would like to use micro-computers more for IEP development(60%), record keeping (57%), budgeting

206


(38%), and SpecialNet (32%) (a national

special education computer network).When asked to suggest topics for futureissues of the ConnSENSE Bulletin,43 percent of the respondents suggestedthe topic of networking. Thus, whilewe are beginning to see computersused more often for special educationinstruction, we also see a definiteinterest in, and a need for, moreadministrative applications of computersand computer networking. This latterissue, the interest in computer networking,

is the focus of the ConnNET project.

Project Design

General Design

The overall goal of this projectis to develop and field test a specialeducation computer network with schoolsand school districts in Connecticut.SpecialNet will be used as the meansto achieve this goal. The realizationof this goal should enhance communicationsamong schools and between the StateDepartment and local school districts

to such a degree that it will have

positive effects on the quality ofprograms for handicapped childrenin Connecticut. To achieve this overall

goal, the project will develop a Con-necticut bulletin board on SpecialNet,develop and disseminate a ConnecticutSpecialNet handbook, stimulate statewide

interest in SpecialNet, evaluate equipment

needs of school districts, selectschool districts for SpecialNet subscrip-tions and training, train local school

district and State Department staffin SpecialNet, and develop a technicalassistance plan for the State to usein continuing ConnNET activities.

Implement a Connecticut Bulletin Boardon SpecialNet

The first activity is to implementa SpecialNet bulletin board forConnecti-cut. As this should provide an addedincentive for Connecticut school districts

to join SpecialNet, %/ark relatingto this activity began as soon as

the project was funded. JoiningSpecialNet opens a vast -rationalinformation base to the local school

districts. The Connecticut bulletinboard will provide the opportunityfor instant communications betweenConnecticut school districts andthe State Department of Education,as well as among the districts them-selves. The Connecticut bulletinboard will function like a StateDepartment of Education electronicnewsletter. Information of particular

importance to Connecticut specialeducation administrators will be

"on line" instantly. It will also

provide a vehicle for educationalleaders to exchange ideas on pertinentissues and, as such, it will be a

powerful communication medium.SpecialNet recommends several

steps for setting up a statewidebulletin board: (a) identify theaudience, (b) out ine the informationbase, (c) decide on the type of bulletinboard, and (d) arrange for the admini-stration of the board.

Identify Audience. The generalaudience for the ConnNet Projectcorsists of the State Departmentof Education, all Connecticut local

school districts, private schoolsand centers of various types, regionaleducation service centers (RESCs),

the Connecticut Special EducationResource Center (SERC), and collegesand universities across the State.The primary audience for this phaseof the project will be the localschool districts and the State Department

of Education. We will select atleast 30 local school districts forsubscriptions to SpecialNet. Theselection process is explained below.

Information Base. The Connecticut

bulletin board will begin as an all

purpose board. That is, this boardwill contain a wide variety of topicsrather than concentrate on a single

theme. In time, a second or thirdbulletin board might be added.

Examples of items added by the

207


project might include:

State Department of Educationmemos

New State policy/proceduresState Department budget updatesStatus of bills in the StateLegislature

Promising practices withinthe state

Notice of meetings/conferencesLists of resources in variouslocations

Recommended special Educationcourseware

Recommended management software

Local school districts might alsoadd items in the categories listedabove as well as the following:

Examples of successful adminis-trative strategies

Position AnnouncementsRequests for informationRequests for technical assistance

It is important to note that ConnNET,State Department, and local schooldistrict staffs may contribute information

under any of these categories, orothers as deemed important.

Type of Bulletin Board. A bulletinboard can be "open" so that any Special-

Net user can access it and add itemsto it, open only to Connecticut users,or closed so that information canonly be added by the project staff.The ConnNET staff and SpecialNet con -

sultants from National Systems Management,Inc. (NSMI) believe that the bulletinboard should be open, at least atthis point, to encourage the greatestnumber of users and contributions.

Administration of Bulletin Board.The project, as described below, willtrain State Department personnel in

the use of SpecialNet, and providetechnical assistance and trainingso that when the project concludesthe State Department will be ableto administer the network. However,

to start, the bulletin board willbe administered by the ConnNET staffat the University of Connecticut.The University will provide an AppleIIe microcomputer with two disk drivesand a monitor, plus a Novation 212AppleCat Modem. The project staffwill work in very close cooperationwith the State Department, sincemuch of the bulletin board contentwill emanate from Hartford.

Develo a Connecticut SpecialNetNandboo

After several discussions withGary Snodgrass, President of NSMI,it was decided that to develop aSpecialNet handbook unique to Connecticut

would be both unnecessary and overlycostly. Instead, the project willuse the handbook that Mr. Snodgrassand his staff have already developedand used successfully in severalstates. Naturally, we plan to modifythis document to meet the specificneeds of Connecticut and this project.In particular, we will include anup-to-date listing of ConnecticutSpecialNet users and a descriptionof policies regarding the use ofthe Connecticut bulletin board.The project staff will supply theseunique aspects and will purchasethe SpecialNet handbook from NSMIfor use in the project.

Stimulate Statewide Interestin SpecialNET

The ConnSENSE project has encouraged

Connecticut school districts to subscribeto SpecialNet. When ConnSENSE joinedSpecialNet the only other subcriberswere the Bureau of Student Servicesand one of the Regional EducationServices Centers. As of August,1984, a total of seven agencies havejoined SpecialNet, and others areconsidering this option. In fact,32 percent of the respondents tothe ConnSENSE computer needs assessmentfelt that they would like to joinSpecial Net in the future. There

208


is interest in SpecialNet, but thisinterest needs to be stimulated.The ConnNet project should do that

by providing SpecialNet subscriptionsto at least 30 Connecticut schooldistricts. Further, the project willtrain personnel from these schooldistricts, the State Department, andothers in the use of SpecialNET.

The ConnNET project was announcedduring the summer of 1984 in the ConnSENSE

Bulletin and at "ConnSENSE '84," a

one 5TEOnference for special educatorsheld on July 18, 1984, at the Universityof Connecticut. Also, it will be

announced soon in a Conbecticut SpecialEducation Resource Center (SERC) mailing.Past experience has shown that a SERCmailing is likely to generate enormoussupport for such a project. The Bulletingoes out to over 900 special educatorsinterested in computers and specialeducation, including all special education

administrators. This represents oneof the largest computer user groupsin Connecticut.

Evaluate Equipment Needs

A telecommunications equipmentquestionnaire will be sent out toall interested school districts.The questionnaire is designed to determineequipment needs to enable the schoolsto link to specialNet. The questionnairewill be returned to ConnNet and analyzed

by the NSMI staff. Individual recommen-

dations for each school district will

be made in terms of the most appropriateand cost effective way to join theNetwork. This analysis will be completed

before the first training sessionso that the results can be discussedwith the participants at that time.

Select School Districts

We believe that project publicitywill generate a sufficient numberof potential subscribers to SpecialNet.The project will develop a mechanismfor selecting school districts ina fair and equitable manner. These

selection criteria will be determined

by an advisory committee. Besidesthe ConnNET staff, this committeewill be made up of the State Departmentof Education project officer, a repre-sentative of the Connecticut Association

of Supervisors of Instruction in

Special Education (CASISE),theConnecti-cut Association of Pupil Personnel

Administrators (CAPPA), a Regional

Education Service Center, SERC, anda Special Education Teacher.

Train School District and StateDepartment Staffs

The project will train staffmembers from the selected schooldistricts, plus designated StateDepartment of Education personnel.In addition to the primary groupof 30 school districts selected forthis project, school districts thathave joined SpecialNet in other wayswill also be eligible for training.

The training sessions will be

conducted in conjunction with NationalSystems Management, Inc. of Washington,

D.C. NSMI ,which operates the SpecialNetsystem, has conducted similar trainingin several states with success.The ConnNET staff will work closelywith NSMI and make all the arrangementsfor the workshops.

There will be three separatetraining sessions for all users corre-sponding roughly to beginning, inter-mediate, and advanced training.These will be spaced appropriatelyto allow users time to practice theirskills between sessions.

The remainder of this sectioncontains a brief description of thetraining. Since the major focusof this project is telecommunications,or computer networking, electronicmail, and electronic bulletin boards,it seemed only fitting to use suchtechnology in developing this paper.What follows was relayed via SpecialNetform NSMI in Washington, D.C. tothe project staff at the Universityof Connecticut. It was down loadedinto the memory of the project modem,read into an Applewriter file, modified

209


slightly and then relayed via telephonelines to the University mainframeand into this paper.

NSMI has considerable experiencein providing training for SpecialNetusers. Over a period of three years,NSMI has conducted hundreds of trainingsessions in every part of the UnitedStates, including training in Alaska,Hawaii and the Virgin Islands. Afull-time Director of Training isemployed to provide this service.The Director of Training calls uponNSMI technical and professional staffto assist in the provision of veryhigh quality on-site training programs.Slide presentations, overhead trans-parencies and video tapes have beendeveloped to make the training sessionsinformative and entertaining.

Training is divided into threeparts:

- Orientation & Beginning Training- Intermediate Training- Advanced Training

SpecialNet is very easy to use.In fact, most system users are self-trained. However, we have found thatformal training helps to assure effective,cost-efficient system utilization.Self-Training manuals are providedfor each user. These include:

- Introduction to SpecialNet:Basic User TrainingIntroduction to SpecialNet:Advanced User TrainingIntroduction to SpecialNet:EditingQuick Reference Card

Orientation and Beginning Training

The full day orientation andbeginning training session is devotedto developing an understanding ofthe communication network. It coverssystem capabilities, equipment procure-hients, and potential applicationsfrom a laymen's perspecti ve . As describedabove, a questionnaire designed todetermine equipment needs or modifi ., cions

to existing equipment is distributed

to participants before the meeting.The questionnaire will be completedand analyzed by NSMI prior to themeeting, so that any recommendationsfor equipment modifications can bedeveloped and discussed with participants

during the meeting.

Intermediate Training

The Intermediate training usuallyoccurs approximately 6-8 weeks afterthe Beginning training. This allowsusers time to practice as well as

become familiar with the electronicmail system. It is important, though,not to let too much time lapse betweenthe two sessions or users may becomefrustrated by not having the opportunityto deal with questions or problems.

Advanced Training

The advanced training is suggested

for SpecialNet users withmicrocomputersor word processors. The focus ofthis session will be on down loadingof text from SpecialNet BulletinBoards as well as batch sending ofmessages.

Develop a Technical Assistance Planfor the State

The Connecticut bulletin boardwill provide the major vehicle forthe state to provide technical assistance

to local school districts. In additionto technical information providedin the bulletin board, users willbe able to correspord directly withthe state Department via SpecialNet.The ConnNET staff will develop a

model for providing this technicalassistance during the project, withthe State Department assuming. theseresponsibilities after the completionof this project.

Input for the technical assistanceplan will come from the project staff,NSMI staff, and the project advisorycommittee. A draft of the plan willbe written by the staff and reviewed

210


by the advisory committee. Revisions

will be made on the basis of thisfeedback and the plan will then be

included in the final report.

REFERENCES

Glass, E. M. (1983). Instructionaluse of computers in Connecticutpublic schools. Hartford: ConnecticutState Department of Education.

Market Data Retrieval. (1984). Micro-

computers in schools, 1983-84:A comprehensive survey and iFiT7iri.Westport, CT.

211

DEVELOPING A COMPUTER-BASED LEARNING TOOLFOR HANDICAPPED STUDENTS

JOHN J. JOSEPH

ABSTRACT

Innovative uses of computer technology

can provide expanded learning opportunities

for handicapped persons. Educatorscan take advantage of computer technologies

without immersing themselves in it.This paper describes the developmentof one computer-based system whichsolved many classroom needs for bothteachers and their handicapped students.

The promise of computer-basedtechnol ogy is often empty for handicappedpersons. The very population thatought to benefit the most from newtechnologies is often bypassed.Economics of scale, high-priced "custom-buil t" devices, lack of in-depthunderstanding on the part of therapists,aides and instructors: these andother reasons stand in the way ofhandicapped computer users real izingthe "high tech promise."

Historically, educators havebeen creative innovators. Desktopcomputers are becoming commonplacein classrooms across the United States.These computers do not come completewith sol utions to all classroom problems.

They do come with a potential forsupporting the efforts of creative,innovative educators. Teachers mustremciber that they are the mastersof their craft, teaching, and thatthese new machines are simply additionaltool s to serve in practicing thatcraft. Like any tool, they are mosteffective in the hands of practiced,expert craftspeople.

A Practical Problem

A learning laboratory at FoxValley Technical Institute's Oshkosh,Wisconsin campus (FVTI-Oshkosh) isa focal point for building fundamentalacademic skill s. Students use thelab to develop prerequisite skillsfor regular vocational or technicalcourses. These students are highschool dropouts, adults returningto the classroom after extended absences,

and handicapped students. All studentsfollow a fairly structured schedulearid, at any point in time, therer,ay be from 2 to 20 of them in thelab. Goals are established for eachstudent and appropriate material s

212


are supplied for the students to mastertheir objectives.

The lab instructor must covera broad range of subjects within a

broad range of comprehension levels.While the lab concept is based onindividual ized learning, there aremany demands for teacher attention.Instructors coach students, maintainindividual progress records, administerevaluations and supply materials forstudy and review.

When physically handicapped studentsare introduced to the learning lab,two distinct problems may arise: (1)if the student is severely handicapped,communication between instructor andstudent may be difficult and constrained.(2) Students may not be able to usenormal methods to complete practiceexercises and assignments. For example,for a student unable to use paperand pencil , it is difficult to demonstrate

mastery of math concepts. The problemis exacerbated if the student is alsounable to communicate verbally.

Teaching severely handicappedstudents requires constant, directteacher-student interaction. Wherestudent teacher ratios are 10:1 orlower, the required individual attentionis available. In the learning labdescribed here, individual time is

not available. If the teacher concen-trates on communicating with the handi-capped student, the remainde. of theclass may be ignored; handicappedlearners may be unable to progresswhen the teacher is attending therest of the class.

Developing a Model

During the 1983-84 school year,FVTI-Oshkosh staff began investigatingthe use of computers as aids for learninglab teachers. Initial discussionsisolated handicappei students as the

first priority for computer use.Defining requirements was the

first order of business. Three primerequirements surfaced immediately:

1. The system must not requiredel icate manual dexterity.

(Student users should nothave to to use a computerkeyboard for input.)

2. The system should providemeans for communication.(Student users should beable to participate in "con-versation." They should havethe ability to record messagesfor later use and reviewby printing output to demonstrate

task mastery.)3. The computer should assist

handicapped students in completing

assignments. (Mathematicalcapability is necessary forthose students who cannotuse pencil and paper.)

These early requirements wereshaped in part by needs of existinghandicapped students. The systemwhich evolved was not intended tosolve all learning/communicationproblems for all handicapped persons.At the time of early planning andgoal setting, two handicapped studentswere using the learning lab. Theywere similar in several respects:both were male, in their early twenties,

afflicted with cerebral palsy, confinedto wheelchairs, and unable to speak.One student had earned a high schooldiploma, the other was working towardthat degree. Although both studentshad fine motor control disabilities,one was more severely afflicted.

Differences in students' abilitiesto use their hands pointed up theneed for a fourth criterion:

4. One system will not servethe needs of all users,even within the confinesof a very small universeof users. (The computersystem or systems must be

flexible; it must be adaptableto a variety of skills andneeds.)

Two additional criteria wereadded, related to the tools employedby any system to be implemented:

5. All hardware is commerciallyavailable at reasonablemarket prices (no premiums

213

202 Disuivery '84 Technology for Disabled Persons

for "handicapped" uet,ignations).

6. Required software to integratethe hardware functions isalso commercially availableat reasonable market pricesor can be developed withminimal difficulty.

The six-criteria model that repre-sented FVTI-Oshkosh requirements describes

the attributes of a computer-basedsystem for use in an educational setting.

It was not intended to define a completesystem for use by all handicappedpersons with communicative disorders.Limitations built into the model wererecognized and accepted.

Developing the Application System

Once the needs were defined,attention turned to development ofthe required computer system. Althoughsimilar systems did exist, there werenone that met all the defined needs.No single piece of hardware was availabletnat satisfied all the defined needs.The hardware finally assembled consistedof an Apple Ile computer, an Epsonprinter, a Power Pad (touch sensitivetablet), and Echo II (a speech synthe-sizer).

The integrating software programswere not available. Learning labstaff decided that custom programsshould be developed- -if developmentcould be completed by outside program-mers. A local software developeragreed to participate in the project,writing the software in return fordesign and testing assistance. Ownershipof the resulting software is vestedin the software development company.

Months of experimentation anddevelopment followed, during whichthe staff explored different layoutsfor the touch sensitive tablet anddifferent functions for the user.Three application packages were finallyinstalled. Two performed all functionsoutlined in the requirements. Oneserved a single function. The basicdifference between the applicationswas the size of the "keys" definedon the touch sensitive tablet. The

three programs are:1. The Speaker II Keys are 1

by 1 inch squares , with numeric ,

alphabetic, and special charac-ters. All functions areaccommodated. The operativeportion of the touch sensitivepad is 12 to 9 inches.

2. The Speaker II Keys are 1-1/2by 1-1/2 inches. Numbers,letters, and special charactersa.-e present. All functionsare available. The entirepad is used.

3. Two-By-Two Keys are 2 by2 inches. Only alphabeticcharacters are present.Only the speech synthesisfunction is available. Theentire pad is used.

Implementing the Software

During the development phase,test versions of the programs wereinstalled in the learning lab. Thehandicapped students tested the systemsand suggested modifications. Studentinterest in the packages was high,but there was a danger that thiswas due to the novelty factor orthe fact that they were receivingadditional attention.

When testing was completed.user documentation was prepared andthe final touch tablet templatesprepared. The User Manual addressestwo audiences: The system user andan assisting aide. Material addresseddirectly to the user defines thefunctions of the system and how touse them. Material directed to theaide describes necessary functionsthat the user may not be able toperform (setting up the system andusing the computer keyboard, forexample).

Evaluating Results

When the completed programswere installed in the learning lab,teachers carefully monitored theresults. The first three model criteria

214


were satisfied: stuaent users couldgenerate verbal and printed communication

and complete math problems.The hardware install ed was, indeed,

commercial ly available. The AppleI le computer and the Epson Printerwere the most expensive of the hardwareitems purchased . These componentsare usable in several other situationswithin the school, so the capitalrisk of installing the total systemwas minimized. (The touch sensitivetablet and speech synthesizer canal so be used in other settiLgs , but

educational software for them is limited.)

Software programs were not availableat the onset of the project; theywere developed as part of the project.While FVTI-Oshkosh spent staff time,defining and testing the systems,they did not have to invest time andmoney required for program develop-ment. (The staff is al so free ofthe ongoing maintenance tasks involvedwith computer software packages.)

Student achievement improved.The math portion of the programs allowedinstructor verifiable calculationof problems. The printing capabilityaccommodated preparation of studentanswers for instructor review. Thespeech synthesis function did, in

fact, allow the nonverbal studentsto participate in conversation.

Most important, time on taskincreased significantly. The observations

were subjective, but instructors concludedthat improved performance was dueto hi gher student motivation and increased

time spent on learning tasks. Anexample may best ill ustrate this point.One of the students had developeda habit of taking a nap during thefifteen minute afternoon break. Afterhe began working with The SpeakerIII, he stopped napping and continuedwork on his s assignments during thebreak.

Conclusions

As a result of their experiencewith this software development, theFVT I-Os h kos h staff arrived at three

significant conclusions.First, computers can be effective

tool s for educators. Teachers mustbe willing to take charge of thecomputers in their classrooms, justas they control any of the othertool s of their trade. Second, handicapped

persons can adapt to and benefitfrom computer-based systems whenthe systems are designed appropriatelyto meet their needs.

Computer software programs donot exist to solve every conceivableneed. Field developed programs arecommonly believed to be the provinceof computer scientists and professionalprogrammers. That is a myth. Thefinal conclusion was that field develop-ment of computer-based systems whichserve a particular group of needsis both possible and practical.

Computer based systems can havea positive impact on handicappedlearners and expand the effectivenessof their instructors. The promiseof computer technology is a stepcloser for handicapped persons.

The project described in this paperis successful because of the visionand persistence of two FVTI--Oshkoshstaff members: Sylvia Gasser, a

Learning Lab instructor, and MartyBrufl at , Special Education Coordinator.They knew what they wanted. Becausethey were will ing to walk unchartedtrails, they got it.

Apple is a registered trademark ofApple Computer Inc . ; Echo II is a

regi stered trademark of Street Electronics

Inc .; Power Pad is a registered trademark

of Chalk Board, Inc.

Control Without Keyboards, The SpeakerII, The Speaker III, and Two-By-Twoare copyright software programs ofJ Jordan Associates.

215

ABLEDATA: A COMPUTERIZED PRODUCT GUIDE

MARIAN HALL

ABSTRACT

ABLEDATA is a specializedresource that indexes commerciallyavailable products useful to disabledpersons. The data base presentlydocuments over 11,000 productsranging from personal care devicesto computers. The informationis continually expanded and updatedis new data is identified. ABLEDATAis available to anyone throughBRS (a database vendor), by eitherthe standard INS subscription (or

BRS After Dark) or by using theservices of a resource center withaccess to BRS (e.g., NARIC, Independent

Living Centers, special libraries).

Using ABLEDATA alleviates the timeinvestment needed to develop andindependently maintain completeproduct files. It al so assistsin locating obscure products fromsmall manufacturers without theresources to do mass-marketing.

Today, everyone is awareof the information explosion;it is particularly apparent withrehabilitation technology. Moreand more devices are being producedto assist people in all kindsof activities, but learning whatequipment exists and how to locateit is a major problem for mostpeople. As the information baseexpands, mechanisms must be organizedto make the information availableto those that need it.

One mechanism available todayis an automated index or database.A database is only a computerequivalent of a printed indexbut with the advantages of quickupdating and the fast informationretrieval.

Hundreds of databases areavailable to searchers throughdatabase vendors. ABLEDATA isone of these databases. ABLEDATAis produced by NARIC, funded bythe National Institute of HandicappedResearch, of the U.S. Departmentof Education. It indexes commercially

available rehabilitation devicesand other products useful to personswith disabilities.

ABLEDATA began in 1977 asa project to index manufacturers'catalogs of rehabilitation products.The initial system was a manualindex, but even at that time theinformation was expanding so rapidlythat the need to computerize theinformation became necessary imme-diately. It was apparent thatif the database was developedaF a central information systemavailable to all, it would resultin a cost-effective service forprograms that needed this information.

By the end of October, 1984,there will be 11,000 productslisted on ABLEDATA making it the

216

Discovery '84 Technology 'or Disabled Persons 205

most comprehensive single listingof rehabilitation product information.In the coming year a minimum of1,500 new products will be enteredand a major emphasis will be onfurther developing the processof updating the data.

Accessing ABLEDATAand Cost-Effectiveness

ABLEDATA, as any database,is designed to be used as a resourcetool , by providing assistance withdecision making and effective servicedelivery. It can be used directlyby persons owning computer terminals(a computer is not necessary) byobtaining a subscription to BRS,the database vendor who maintainsABLEDATA.

Costs of online searchinginclude the BRS subscription, tele-communication costs (e.g., Telenet),and database royalty. For ABLEDATA,daytime searching costs range between$39 and $58 per hour, and eveningsearching on BRS After Dark costs$12 per hour. At first, the costof searching ABLEDATA nay seemunrealistic to resource programsneeding information. The usualresponse is that they already havea person paid to manually trackthe information (collecting, organizingand retrieval as needed) and theorganization does not feel justifiedin authorizing the cost of accessingthe database. At NARIC the averagedirect cost of a computer search(including computer and mailingcharges, but excluding staff time)is $10.00. For that $10.00 thecomputer searches the equivalentof 14 file drawers of product liter-ature, and total staff time involvedper request averages less than15 minutes. The alternative ofmanually searching for the desiredproducts, if all the file literatureis available, takes hours for eachrequest. By using a database toassist the information provider,even a small organization can use

the staff's time to either performother tasks or answer more information

requests. As one therapist observedduring a demonstration searchcosting less than $3.00 of onlinetime, the hospital she workedfor wr,u1 d have to charge thatmuch for hqr time to open justone fil e drawer and start thesearching process.

For individuals, as wellas organizations without accessto BRS, the information on ABLEDATAis available through intermediarysources. Many organizations,including NARIC, answer informationrequests for anyone. Also, mostlarge libraries have 3RS subscriptions

and if the person knows the terminology

to help define the search mostlibrarians can perform the searchat a local library. Many resourceprograms provide searches freeof cost and others charge minimalfees to help defray costs.

Database Content

The products listed in ABLEDATAare categorized by functions,such as personal care, mobility,or communication. The productsare not classified by disability(wi tn the exceptions of SensoryDisabilities, and Nonvocal andSpeech Impaired). The reasonproducts are not classified bydisability is that most productsare used by people with a widerange of disabilities. The sameproduct may or may not be usedby two people with the same disability

depending on the level of dysfunction.

But ABLEDATA is relatively simpleto access a_ the products aredefined by function.

AELEDATA has fourteen major categories of equipment;

o Personal Care o Recreationo Home Management o Ambulationo Vocational-Educational o Sensory Disabilitieso Mobility o Orthoticso Seeting o Prostheticso Transportation o Therapeutics Aideo Communication o Architectural Elements

217 ]


These categories, with furthersub- categories, form the basicstructure of the ABLEDATA Thesaurus.The Thesaurus also has all geneFie

names listed, and for every genericname there is one, or more, product (s)

in the database. The Thesaurusand other searching aids are available

from NARIC to ass Est with searching

the database.Each product document has

the following paragraphs:AN Accession NumberNM Generic NameBN Brand NameMN ManufacturerCD Code Number

AV AvailabilityCT CostDE DescriptionID Identifiers

CM Comments

EV EvaluationThe Accession Number, Generic

Name, Code Num..... , Availability,Description and Identifiers arerequired paragraphs in every product

document. The Brand Name, Cost,Comments and Evaluation paragraphsare compl ete6 when informationis available.

The Comments paragraph is

used for subjective informationabout a product (e.g., safety relatedinformation, use information, accessory

compatibility information). Anyone

may submit information to enterinto this paragraph, but all data

is reviewed for appropriatenessand is edited prior to entry.The Evaluation paragraph is reservedfor formally documented productevaluations, and unfortunatelythere are very few available toadd to the database.

AN

NM

BN

MN

SAMPLE ABLEDATA DOCUMENT

84-01-001318MULTILINGUAL AND SYMBOLICLANGUAGE SYSTEM.TALKING PICTURES.CRESTWOOD CO., 331 SOUTH THIRDSt., P.O. BOX 04513, MILWAUKEE,

WI 53204.CD 618.AV MANUFACTURERCT $18.75, 0783.DE Kit co ns i sting of four components,

a file box containing 110card:, showing the necessitiesof every day life, 10 heavyduty vinyl envelopes, andone metal ring. Each cardhas a picture with a corresponding

word. Reverse side has theword equivalent in English,Spanish, German, French andItalian. There are eightclassifications of cardsseparated in the file boxby colored dividers: room,baz.hroom, health, aids, food,clothing, people, and miscel-laneous. To use, the cardsare placed in vinyl envelopeswhich are placed on metalrings. Metal rings and pictures

can be attached to bed, wheel-chair, etc. User pointsto appropriate card to

indicate needs.ID COMMUNICATION. NONVOCAL AND

SPEECH IMPAIRED. COMMUNICATORS.LANGUAGE SYSTEMS.

CM Useful as an augmentativecommunication aid for nonverbal

individuals. Al so usefulas a language teaching aidfor preschool children , mentally

handicapped children andindividuals learning Englishas a second language. Cards

can be handmade and coveredwith clear contact paperbut handmade price is comparabl e

to price listed.EV Not available.

Searching ABLEDATA

ABLEDATA, 1 i ke al l BRS databases,

can be searched two ways. TheGeneric. Names and Identifiersfrom the Thesaurus can be usedas controlled vocabulary and searchedspecifically as written. Thiswill result in extremely wide-based

218


searches if an Identifier termis used, or in an extremely narrowsearch if a specific Generic Nameis used.

ABLEDATA can also be searchedby free-text searching, which meansany English word or word stem canbe searched on the database. By

combining appropriate words withcareful search strategy techniques,specific features of equipmentcan be searched. BRS does providetraining to learn the basics ofsearching on BRS databases, andNARIC provides workshops on learningto search ABLEGATA.

Summary

There are many advantagesto using onl ine information databases.

Using a database is much more efficient

and cost-effective than manualsearching for specific information,whether it is products or literature.And, while using a database suchas ABLEDATA requires learning simplesearching techniques, it is notnecessary for a searcher to know

computer programming or understandthe mechanics of database storageand retrieval.

ABLEDATA, through BRS andBRS After Dark, is a resource toolfor any information program touse. ABLEDATA is also a placefor users of equipment to sharesubjective information about specificequipment. It can readily be updatedor changed as needed.

ABLEDATA has developed intoa well used central informationsystem to help information providersquickly locate information on products.

It should be noted, however, thatit is not by any means "complete"in the sense that it has everysingle product that is availableon the market. The goal is tomake it as complete as possible,but this will take time.

While learning is necessaryfor every new user of onl ine information

systems, most users will find the

costs are more than compensatedby the major reduction in timewhen compared to manual searching.

For further information aboutBRS or BRS After Dark subscrip-tions please contact:

BRS1200 Route 7Latham, NY 12110(800) 833-4707(800) 553-5566 NY

For more information aboutABLEDATA or NARIC please contact:

219

NARIC

The Catholic Universityof America

4407 8th Street, NEWashington, DC 20017(202) 635-5822

(202) 635-5884 TDD

USING MULTIPLE DATABASES IN REHABILITATION OPERATIONS

DAVE SHAFER

ABSTRACT

Current, fully operationalrehabilitation computer databasesare identified and summarily profiled

in this paper. Operational problemsand their solutions, when enhancedby database use, are presented.Validity and reliability of databaseapplications to solution strategiesand tactics are described. Capital

intensive cost feasible componentsof databases are identified. Utili-tarian processes to access databasesfor operations purposes are outlined.

The harmony between computerusers who are rehabilitation profes-sionals and computers is now withinreach of all rehabilitation profes-sionals. having assembled a talentedteam of top professionals, alltechnologically and computer I iterate,

we have been able to manipulatemultiple databases to the advantageand service of clients and staffin a large rehabilitation facility.

The opportunity to welcometechnology as a way to accessand manipulate information in"just in time" situations has

enhanced the quality of servicesin evaluation, training, counseling,and placement.

The introduction of easyaccess to multiple data baseshas given staff in all four departments

a whole new set of tools for thejob. Inspection of Tables 1-4will show some of our experienceswith these "tool" processes, allof which can be performed withblazing speed and accuracy byhost computers located aroundthe United States. Each databaseoffers internal yet powerful nuances

that aid in crystallizing a rehabili-tation professional 's thinking.

We also use ancillary computer-

based assessment components thatgenerate, interactively, freshaptitude scores as well as otherdata for use in the rehabilitationprocess.

Each database and its components

compress by 80% or more the timeit takes to manually generateand format rehabilitation-relateddata. These databases offer efficienttime management of clients cases.

These databases, used withnational supporting databaseslike ABLEDATA which lists over10,000 function enhancing devices,

220,..,


have shown remarkable progressin the rehabilitation process.

Information utilities likeSOURCE and COMPUSERVE have rapidlyexpanding components that servethe rehabilitation community.For example, SOURCE has establisheda job network that lists 3,000jobs in 40 occupational areas.That component is operated by 65headhunters who never charge a

fee.

How does a professional i-ehabili-

tation team decide which databasemeets their needs? As there areat least 60 competing databases,with more on the way, it is notan easy decision. In Table 5 somequestions are presented that canbe asked of a prospective database.We ask these types of questionsabout any database.

We access at least ten databasesper client daily. All are costfeasible. We bully them to deliverinformation products that aid in

rehabilitation process.Rehabilitation professionals

can acquire skill with these databasesusing a small investment in trainingtime. For example, two days oftutorial training with the Center(or other agency) prepares staffto practice for twenty hours more;the end result is proficient useof the database. We train in thedatabase known as Ability Infor-mation System, of Spokane, Washington.We also provide training with manyother databases.

The benefits of expendingtwo days of staff time, along withthe practice time recommended,can, in the Center's opinion, standthe test of cost and program accounting.

In summary we have acquiredthe capability, via computer databases

and related technology, to:- Construct a composite profileof a client that containsmultiple data elements usefulrestrt:cturable throughoutthe rehabilitation process.

- Discover devices to enhance

a disabled person's physicaland intellectual functions.Generate and compare possiblejob titles on many pointsof a client's composite profile.

Generate possible employersin a geographical area ofinterest to a clieot.Generate many types of datarequested by any member ofthe rehabilitation profes-sional direct service andsupport team.

Perhaps Douglas Benefield, recentlykilled in a test accident in theAir Force's B-1-A, points to thespirit of inquiry at our Centerand NYU. He said, in the week'sbefore his death, "We're alwayslooking at another frontier...theedge of...technological endurance."

N.B. See Appendix A

Table 1

Using Databases to EnhanceA Client's Evaluation

AIS - Using such program componentsas "Title" the vocationalevaluator can exploretruncated job titles.It is common to learnof a job not previouslyidentified in book-basedsearches such as the DOT,e.g., Program Specialist -Employee Health, a high-paying

job with companies likeMobil. This program is

used in one phase of theevaluation program.

ABLEDATA and others - Not infre-quently a client will mentiona job title as his/her quest.Having obtained the physicalrequirements of the job fromAIS, the evaluator can comparethe job's requirements withthe disabling condition ofthe client, as well as functionenhancers in the over 8,000

221.


products in ABLEDATA,Tech-Knowledge and other data-bases. At the same time CIS,JAN and other databases that1 ist at-the-job modificationsmade by employers can offerhope to a disabled clientfor keeping a job title in

their quest.

RehabDATA and others - Allows

the evaluator to identifyother agencies working ona specific problem that is

being experienced by a client.Insights into the client'sproblem are gained by accessingthis database, as well as

ROME and others in the BRScollection of bases.

Table 2

Using Databases to Enhancea Client's Training Program

AIS - The variety of powerful,swiftly operating databasecomponents allow the trainingcoordinator and facultyto enhance their perceptionof skills acquistion needsof the client before, duringand after a training cycle.

ABLEDATA - As impediments to

skill acquisition by a client

occur, due to physical functionlimitation, this databaseallows staff to identifyoff-the-shelf devices to enhance

a function.

RehabDATA (NRIC) - Allows staffto locate providers of a variety

of services clients need duringtraining. (Used with AIS)

SpecialNET - Used by staff toseek suggestions for a particularclient-related problem fromother practitioners.

IJB - Used by staff to identify"hot" job prospects atany of 2000 USES offices.

BRS - Staff uses a variety ofits bases to obtain reli-ability /validity dataon instruments being used.This is one of the manyuses of BRS bases.

Table 3

Using Databases to Enhancea Clients's Placement

AIS - Allows identificationof possible job titlesin light of a disability.Allows identificationof employers in a particularindustry. Some actuallyhave job openings on theday of the search. Allowsmultiple manipulationsof data for control ofmany client variablesin seeking best possiblejob titles.

ABLEDATA/JAN - Both bases allowidentification of deviceseither carried to or alreadyat a job site designed toenhance a physical function.Tech-Knowledge and otherbases also are dedicatedto the same end.

SpecialNET/CARI - Both basesoffer employment possibili-ties. The former by showingopenings, the letter by havinga total client's resume andsupporting materials in memory

for access by subscribingcompanies.

IJB - While only online to USESoffices with compatible equipment,

it still , via fiche, providesdata on jobs for which aqualified applicant was not

222


found for ten business days.(All 2,000 USES offices, mailedto you on the following Mondayof each week-free)

Table 4

Using Databases to EnhanceClient Counseling

AID Allows counselor to searchbased on client INTERESTSwith or without a clientprofile.

Allows counselor to comparea client's abilities basedon work history mid adjustedprofile, by those requiredfor a specific job.

ABLEDATA - Allows counselor toidentify early in the counselingprocess:

Assistive DevicesComponents for LaterAssembly into customdevices

NARIC - Allows counselor to identifyhelping agencies for specificneed in a specific locationwhen coupled with AIS.

CARI - Allows counselor to beginclient training in resumeformatting.

IJB - Allows counselor to demonstrate

current availability of targetedjobs in any location in 50states. Each job shown isavailable for a qualifiedapplicant.

Compuserve - Allows counselorto connect client with manyother disabled persons withsimilar interests nationallyOnline at cost feasible prices.

Table 5

Characteristics of a Good OccupationalInformation Delivery System

1. Make the information accessibleto persons of varying ability,experience and interests.

2. Provide a Means for integratingthe occupational informationwith clients' interests, values,aptitudes, and abilities.

3. Deliver the information throughvarious media.

4. Display and/or deliver theinformation in an attractivemanner.

5. Provide accurate and currentinformation, including thecapacity for updating.

6. Supply local as well as nationaldata.

7. Provide information concerninga wide variety of occupationalgroups.

8. Include such specific informationas (a) job duties, (b) workenvironment, (c) hiring andtraining requirements, (d)terms of employment, (e) hours,(f) current labor market situation,

and (g) long-range outlook.

9. Be available at a reasonablecost which would be compatiblewith poverty-stricken schooldistricts and social agencies.

(14 3


Appendix A

One day through the primeval wooda calf walked home as good calves should:

but made a trail all bent askewa crooked trail as calves all do.

Since then three hundred years have fled,and I infer the calf is dead,but still he left behind his trail,and thereby hangs my moral tale.

The trail was taken up next dayby a lone dog that passed that way:

and then a wise bellwether sheeppursued the trail o'er vale and steep

and drew the flock behind him, tooas good bellwethers always do.

And from that day, o'er hill and glade,through these old woods a path was made

and many men wound in and out,and dodged and turned and bent about,and uttered words of righteous wrathbecause 'twas such a crooked path;

but st '1 they followed...do not laugh,the first migrations of that calf.

Phis forest path became a lanethat bent and turned and turned again

this crooked lane became a road,where many a poor horse with his loadtoiled on beneath the burning sunand traveled some three miles in one,

and thus a century and a halfthey trod the footsteps of that calf.

The years passed on in swiftness fleet;the road became a village street;and this, before men were aware,a city's crowded thoroughfar,

and soon the central street was thisof a renowned metropolis.

And men two centuries and halftrod in the footsteps of that calf.

A hundred thousand men were ledby one calf near three centuries dead,

for men are prone to go it blindalong the calf-paths of the mind

and work away from sun to sunto do what other men have donethey follow in the beaten track,anal out and in, and forth and back,

224


and still their devious course pursueto keep the path a sacred groove

along which all their lives they move,but how the wise old wood gods laugh

who saw the first primeval calf!Author Unknown

225

ADVANCING THE TRANSDISCIPLINARY FIELD OF AUGMENTATIVEAND ALTERNATIVE COMMUNICATION TECHNIQUES

AND AIDS

PATRICIA L. CASHDOLLAR

ABSTRACT

The International Societyfor Augmentative and Al ternativeCommunication (I .S.A.A.C.) existsto advance the transdiscipl inaryfield of augmentative and alternativecommunication techniques and aids.I.S.A.A.C.'s mission is to facilitatethe exchange of information andfocus attention upon work to helppeople with communication difficultiesthroughout the world. Informationand referral services are avail aolefor users, potential users, profes-sionals, family and community memberswho wish to support those usingaugmentative and al ternative communi-cation systems and devices. Publi-cations such as the official newsletter,Communication Outlook, and TheAugmentative and Alternative CommunT:cation Journal are available.Conferences and scientific meetingsare planned. A computer conferencingnetwork is available. Work inthe international field of augmentativeand alternative communication iscomplex and time consuming. Informationis being shared and channeled throughoutthe international community forthe benefit of the professionalsin the field and the augmentativeand alternative communication systemuser.

Introduction

The international Societyfor Augmentative and AlternativeCommunication (I.S.A.A.C.) wasformed in East Lansing Michiganin May of 1983 following the expressedwishes of participants at the2nd International Conferece onAugmentative Communication inToronto, Ontario in November of1982.

The Ontario Institute forStudies in education (OISE), TheAugmentative Communication Service(ACS) of the Ontario CrippledChildren's Centre (OCCC) and theB1 i ssynibol ics Communication Institute(BCI) sponsored the 2nd InternationalConference in 1982, respondingto the needs articulated in the1st International Conference inNovember of 1980.

Penny Parnes , Director ofthe ACS and Vice-President incharge of Conventions and ScientificMeetings for I.S.A.A.C. reportedin the September issue of CommunicatingTogether, "The first conference...attempted to deal with diverseissues such as technology, systems,assessment and applications."

"Behind the scenes at thesecond conference (1982) , therewas another agenda taking place...howwere we going to keep this actionalive; how were we going to promotethe growth of our field; how couldwe keep the spirit of cooperationand the enthusiasm we were feeling?"

When a small group came togetherin May of 1983 through the hospitalityof Dr. John Eul enberg, Directorof the Artificial Language Laboratoryat Michigan State University,each of them could look at their

9')


work with persons who needed a

system other than spoken word tocommunicate and say that indeedthey didn't have time for one moreorganization or obligation. Workin the international transdisci pl inary

field of augmentative and alternativecommunicacion is very complex andvery time consuming. It is a relatively

new field and those who met wereknown to one another from variousprofessional affil iations and published

works.

As they were belaboring thepoint of the work load each wascarrying, they came to the conclusionthat they couldn't afford not to

get organized and share informationkith one another. The researcheffort in the field of high technologydemanded those involved keep abreastof the most recent developments.The thirty-five representativesfrom seven countries decided towork together to advance this relatively

new transdicipl inary field of augmen-

tative communication techniquesand aids. Organizational workbegan. The International Societyfor Augmentative and AlternativeCommunication (I .S.A.A.C.) wasborn and planning for the ThirdInternational Nonspeech Conferencewas started. The Third InternationalConference on Augmentative andAl te;native Communication occurringOctober eighteenth to October twentieth,

1984, at M.I.T., will include overone hundred authors and presentors.Copies of the I.S.A.A.C. ConferenceProgram are available from theSpecial Events Office, MIT, Building7-111, Cambridge, Massachusetts02139.

Communication /I.S.A.A.C.

Communication is the key.I .S.A.A.C. s membership is international

and includes all those interestedin augmentative communication.Users and Potential Users of communi-cation systems and device's, SpeechPathologists /Language Development

Special ists, Educators, Occupational

and Physical Therapists , Rehabi 1 i tati on

Special ists, Social Workers, Linguists,

Engineers, Computer Scientists,Psychologists, Medical Practitioners,Family Members, and CommunityMembers wishing to support thecommunication of those using aug-mentative and alternative systemsand devices are invited to jointhe organization. I.S.A.A.C. brochures

and membership forms are availablein the United States from:

Susan SansoneI .S.A.A.C. Membership Co-Chairperson

New York State Associationfor Retarded Children, Inc.

2900 Veterans Memorial HighwayBohemia, NY 11716

In Canada, contact:

Elaine HeatonI .S.A.A.C. Membership Co- Chairperson

Glenrose Hospital10230 - 111th AvenueEdmonton, Alberta, Canada T5G Cfg

Communication/CONFER

How do all of us communicatewith one another and with communication

system users?The computer conferencing

network of ISAAC is Confer II,a multi - purpose communicationsmedium, developed by Robert Parnesat the University of Michiganand offered by Advertel CommunicationSystems. The ISAAC Confer "conference"

is IPC:AC International Projecton Communication: AugmentativeCommunication) and is administeredby the B1 issymbolics CommunicationInstitute, Toronto, Ontario, Canada.

Confer users connect computerterminal s by telephone with a

central computer to exchange messagesor participate in public discussions.Confer makes group discussionspossible as well as electronicallysending and receiving documentsor data.

227


are:Some of the benefits of Confer

Freedom to use where andwhen convenientMany topics can be discussedsimultaneouslyA written record is producedConcise interchanges takeplace

Friendly atmosphere conduciveto successful communication

To use Confer you must haveaccess to a computer terminal ora personal computer with communicationcapabilities a modem, and a phone.Confer users pay only for the actualcomputer time they use. The totalcost for Confer, including computertime and network charges is approxi-mately thirty cents per minuteor an average of less than fivedollars a day for very heavy users.Confer registration forms are available

from the Blissymbolics CommunicationInstitute, 350 Rumsey Road, Toronto,Ontario, Canada, M4G 1R8.

People in most major citiesof the U.S., as well as thirty-twoother countries world wide, Conferinexpensively through the publicdata communications networks.

If you would like furtherinformation about Confer, or youwould like to arrangiT)Fa demon-stration, please contact:

Advertel Communication,Systems, Inc.

2067 AscotAnn Arbor, MI 48103

Communications/International

According to Dr. John Eulenbergof the Artificial Language Laboratoryat Michigan State University, "ISAACcan be truly effective as an inter-national organization only if itcan link people of similar interestsand similar purposes throughoutthe world. ...Through its publications,

conferences, and other activities,ISAAC lets people in other countries

know about this field and considerthe actions they might take toestablish it at home."

Dr. Eulenberg makes specificrecommendations for fellow membersof ISAAC to share expertise onaugmentative and alternative commun-ication (A&A). This would be

accomplished through programsof

a. visiting professionals;b. scholarships and fellowships;

c. grants of equipment accom-panied by appropriatetraining;

d. development grants inrehabilitation and specialeducation; and

e. support for conferencesand sessions within con-ferences.

The attention of personsworking in the field of A&A technology

is directed to the existence ofan organization and publicationconcerned with appropriate andaccessible technology, includingcommunication aids, for peoplein developing countries:

AHRTAG (Appropriate HealthResources and TechnologyAction Group)

Editor: Ann DarnbroughAddress: 85 Marylebone High St.

London W1M 3DE,United Kingdom

I .S.A.A.C. has a Committeefor Developing Countries chairedby Anne Warrick of the Blissymbolics

Communication Institute. Shestates, The contribution whichmembers from developing countriescan make to ISAAC is recognizedand will be one of the urganizationsstrengths."

Communications/Publications

Publications are anothermeans of communication., The official

newsletter of ISAAC is CommunicationOutlook published by the Artificial

228


Language Laboratory. CommunicationOutlook is a quarterly,technical/professional newsletterprovided as part of membershipdues. Communication Outlook is

available outside of membershipin ISAAC for a subscription rateof $15.00. Communication Outlooksolicits a wide range of itemsfor publication. These includearticles by users or potentialusers of communication aids, aswell as their parents, teachers,speech parthologists, rehabilitationengineers, etc,

Future activities of Communication

Outlook include publishing thefirst update to the CommunicationEnhancement Bibl iograptiy and adding

a consumer forum feature to theNewsletter from consumer membersof ISAAC. For more information,contact:

Kristine PortnoyAssociate EditorCommunication OutlookArtificial Language LaboratoryMichigan State UniversityEast Lansing, MI 48824

Coming January 1985! Augmentativeand Alternative Communication:The Official Journal of the Inter-national Society for Augmentativeand Alternative Communication.Williams & Wilkins will publishAugmentative and Alternative Communi-cation as a refereed, quarterly,TiTTnTisional/scholarly journal.AAC is the official internationaltransdisci pl i nary journal of I.S.A.A.C.

David E. Yoder, Ph.D., is the Editor.Dr. Yoder is particularly interestedi n reviewing well wri tten and documented

case studies and single subjectresearch. Submit four copies ofmanuscript typed double-spacedusing APA style to:

David E. Yoder, Editor, AACWaisman CenterUniversity of Wisconsin1500 Highland Avenue

Madison, WI 53706

Publ ished Proceedings ofthe Third International Conferenceon Augmentative and AlternativeCommunication will be availablefor purchase.

Communications/Organizations

The Rehabilitation EngineeringSociety of North America (RESNA)

has publications of interest available

as does the International Committeeon Rehabilitation Engineering(ICRE). Both organizations haveregularly scheduled cofferences.

The International Projecton Communication Aids for theSpeech Impaired (IPCAS), was startedin 1979 in order to promote activities

and information sharing withinthe field of augmentative communi-cation. IPCAS presently has four

member countries: Canada, Sweden,United Kingdom, and the UnitedStates.

The member countries of IPCAShave decided to award an annualfell owship for the conductionof a study within the field ofspecial relevance to communicationenhancement technology. The topicfor the 1984 study is "Synthetic

Speech as an Aid for Feople withSpeech-Language, and CommunicationProblems." The 1984 fellowshiphas been awarded to ProfessorGunnar Fant, Department of SpeechCommunication and Music Acoustics,Royal Institute of Technology,Stockholm, Sweden. The studywill be conducted in cooperationwith the Swedish Institute forthe Handicapped. The report ofthe IPCAS study is expected tobe available early in 1985. For

more information, contact, ProfessorGunnar Fant at the Royal Instituteof Technology, S-100 44 Stockholm,Sweden.

The results of Arlene Kraat' sstudy of interactive strategiesas a fell ow of IPCAS will be avail abl e

229

ei


at the I.S.A.A.C. Conference atM.I.T., October 18-20, 1984.

The American Speech-Language-Heari ng Association (ASHA) haspublications of interest availableand regularly scheduled conferenceswith sessions specifically addressingaugmentative communication. Forinformation contact ASHA at 10301Rockville Pike, Rockville, MD 20852.

The Consumer Affiliate ofthe American Speech-Language-HearingAssociation is NAHSA,the NationalAssociation for Hearing and SpeechAction. NAHSA is also locatedat 10801 Rockville Pike, Rockville,Maryland 20852. You can callthe NAHSA Hearing and Speech Helpl inecollect at 0-301-897-8682 Voiceor TTY to answer consumer questionsconcerning speech, language andhearing problems.

The TRACE Center at the University

of Wisconsin/Madison periodicallypublishes a list of reprints availablefrom their reprint service specifically

addressing the topic of Augmentativeand Alternative communication.One particular document of interestfrom the TRACE Center is Highlightsof the Current International Communi-cation Aids Compatibility StandardsProposals (ICAC Stds.) The documentcontains the highlights of fiveseparate and independent compatibility

proposals for communication aidsystems. Included are highlightsof the SET, SETSC, KEI, KE1MC andISA Compatibility Std. proposal sas of June 7, 1984 by Barry L. Rod-gers. For information contact:

TRACE Center314 Waisman CenterUniversity of Wisconsin1500 Highland AvenueMadison, WI 53706

Truly we need to polish ourmethods of communication with oneanother. Another 'wed is thatof learning to communicate moreeffectively with the augmentativeand alternative communication system

user. Arlene Kraat's report oughtto shed some interesting lightson that subject. Please see previousreferences.

Workshops and Conferencessuch as Discovery '84 are invaluablefor gettig the word out abouttechnology available today. t:e

need to proceed with the valuableresearch and technology that %/ill

open the doors to the world formany disabled persons. The mostrecent brochure illustrating servicesbeing provided by Good SamaritanHospital in Portland, OR states,Talk to Me: and Speak Your Mind.That is an admirable goal forus all.

Facilitating the communicationamong professionals is what ISAACis all about. Facilitating thecommunication between users ofaugmentative and al terndtive communi-

cation systems and the world in

which they live is what ISAACis all about. Providing informationand referral services to consumersand the professionals who workwith them and with their familiesis what ISAAC is all about. Won'tyou join us?

230

BIOMEDICAL TECHNIQUES FOR POST HEAD TRAUMA VICTIMS

JUDITH V. DONEY

ABSTRACT

Most people who sustain headinjuries are under the age of 30and are injured as the result oftragic motor vehicle or sportsaccidents. The number of deathseach year resulting from head traumais estimated at over 100,000.Of those who survive, 50,000 peopleannually are afflicted with intellec-t ural impairment to the degreethat they never return to a normallife. These figures which clearlyreflect a problem of epidemic propor-tions, are the basis for the term,"The Silent Epidemic." Until recentlythis "lost population" was silentlyand shamefully closeted away andinappropriately placed in psychiatricinstitutions , school s for the retarded,

or nursing homes. Now, rehabilitationcenters with interactive programsof cognitive retraining, neuropsy-chology, as well as traditionaltherapies and medical care, arespringing into operation; withthem biomedical techniques arebeing developed to aid victims'and families' in their return toa more normal way of life.

231

Post head trauma victimshave received a wound and/or injurydue to a direct or indirect blowto the head. As head traumasproduce many different deficits,only a few that are the most commonwill be discussed.

Effects of Head Trauma on Victims

Impaired cognition (a decreasein mental awareness) is evidencedby concrete 1 imitations (the inability

to comprehend abstract conceptssuch as love), long and/or shortterm memory losses, includingmemory lapses, a short attentionspan, the inability to make goodvalue judgments (such as decidingthat watching television is moreimportant than eating a balancedmeal ), and problem solving difficul-ties, especially were specialand sequential abilities are required(such as giving directions tosomeone, or deciding in whichorder to put on clothing). Preparinglists such as the one in Figure1 and posting it in an appropriatelocation helps the victim to dothese types of tasks more indepen-dently.

Figure 1

PERSONAL HYGIEh REMMERS

1. Take S'iwer with Soap

2. Wash Hair with Shaffpoo

3. Comb Hair

4. Brush Teeth with Toothpaste

DRESSING SEQUENCE

1. Undershirt with label inthe beck

2. Briefs with label in back

3. Socks

4. Shirt; button all buttons

S. Use Mouthwash

6. Shave

7. Put on Deodorant & Talc

8. Put on Clean Clothes

S. Pants; zip them op

6. Ben; buckle it

7. Shoes; tie them

8. Sweeter or Jacketwith label in beck


Alarm clocks, timers, watches withalarms, and calendars are goodtool s for assisting the memoryof tasks such as taking medications,doing physical therapy, or keepingdoctors appointments. Diariesal help the victim remember thee is f the past when annotatedwitn at least one sentence a day.

Figure 2

SuA MoN Tue (Ad Thu. PRI SRI-

7 8 q 10 1 1 12 13

14 15 16 17 18 Iq 20

21 22 23 2,14. 25 26 27

28 Z1 30

eed ic-i N eCilysicial Thee

es pikil-loP./ T.1 ).t-I-F)tyli ,,s

Many trauma victims experienceprofound effects on oral and writtencommunication. Victims have difficultyfinding appropriate words and verballycommunicating them. Sometimesthis aphasia is compounded by stut-tering; this problem may sometimesbe lessened if they tap a finger

slowly on their knee and speakat the same rate as the tapping.Written communication can be effectedby a physical disability and/orthe injured brain's inability torelay the appropriate messagesto the hand.

All of the senses can be effected.Hearing acuity might be withinnormal limits, but the brain'sability to identify, select, separate,

and accurately interpret whatit hears may be impaired. Smelling,tasting, and tactile senses usuallydecrease significantly. and sometimescease to fu,.:tion. Visual acuityand perceptions of color, depth,di stance and periphery (tunnelvision) usually decrease; alongwith visual acuity loss is a decreasedability of the brain to accuratelyinterpret what it sees. One wayto aid a color -blind victim inthe selection of clothing, is

to place shirt, tie, slacks andsocks that match all on one coathanger.

When more sensory input is

received by the injured brainthan it is able to process atone time, it becomes confusedand may stop processing anythingbut autonomic functions (suchas breathing and heartbeat).This sensory overload leaves thevictim quite frustrated. Forthese occurences , relaxation therapymay be of great help.

Figure 3

WILY :CuultE OF ACTIVIHES

hgnday Tuesdey Wednesday Thursday Friday

6:00 AR ,ersonal Pei :Mal

NOrship worship& Prayer S °:.yer

P..:,onal Personal Personal

..7.-ship Worship Worship

d Prayer a Prayer A Prayer

7:CO AN Personal Personal Personal Personal Personal

Devorhs Oryorhs Oryorhs Oryot 'ns CwvornsMeditate. keditate. hwdVate. Meditate. Meditat.

8:00 AM Breakfast Breakfast Breakfast Breakfast Break.

& Dress A Dress A Dress & Dress d Dress

11:30 AN Walk Walk Walk Walk walk

12.30 FM Limn Lush Lunch Lunch Lu, h

1:30 FN Map Nap Nap Nap Nap

6:30 PM Sapper Supper Sipper Supper Sipper

11:00 FM Lights Lights Lights Lights Lights

Out Out Out Out

A daily schedule, such as

232

Discovery '84 Technology for Disabled Persons

the one in Figure 3, will helpthe victim with a lack of motivationand poor time management. Small,pocket sized notebooks, with pages

Figure 6

APPOMMEATS

such as Figures 4, 5, and 6, arehelpful in remembering personal

Date Day Time Place

vital statistics for emergencies,keeping track of prescriptions,and appointments.

Oct

Oct

Oct

5

6

7

Fri

Sat

Sun

2:00 PM Rick Fortune ILC

1:00 PM7:30 PM

Bethel - MusicBethel - Church

10:30 AM Bethel - Church

Figure 4 7:30 PM Bethel - Prayer

CLEAN CONTACTSIDENTIFICATION & VITALS Oct 8 Mon 11:00 AM Music Lesson

2:00 PM Rick Fortune ILC7:30 PM Spanish Class

ANNE: Al Ed Dorsey AGE: 2$ NS: Al RACE. C

ADDRESS: 2715 Delta Dr PHONE: (601)366 -8827 Oct 9 Toe 1:00 PM Dr Webster UMC2:00 PM Rick Fortune ILC

CITY: Jockson STATE: MS ZIP: 39213 7:30 PM Bethel - Church

AEDIC ALERT HISTORY 10: 14,428,997

Oct 10 Wed 2:n0 PM Rick Fortune ILCAEDICAID 10: 600-32-7992

Ut4C PATIENT HISTORY 10: 505103

DIAGNOSES:

ALLERGIC TO:

Organic Brain Syndrone (7/9/81)Petit Mel Seizure xTunnel Vision (10' -15u Field)Hearing Discrimination (only 60X)Speech ImpairmentsPoor EquilibriumDuodenal Stress UlcerWearing Contact LensesDilantinhistalet derivatives

WARNING: Startles easily; Prone to violence

Figure 5

PRESCRIPTIONS

&rug Rx hb Date of LastRefill

Ab ofRefills

Benadryl 6006356 Sept 6 '84 0

Lopressor 6008066 Jul 16 '84 0

Fhenoh,rb C-11375 Jun 16 '83 1

'00met 60'0054 Sept 6 '84 0

Valium 4010055 Sept 6 '84 0

Zorprin 6009233 Aug 14'84 0

Harlan's Discount Drugs (601)362-88242918 Delta Drive Jackson, MS

221

Marked personality changesmay also result from head trauma.Depression, inability to toleratestress, childlike impulsiveness,naivety, impressionableness, in-vestigativeness, emotional lability(quick, sudden and wide mood swingsfor no apparent reason), inappropriate

behavior, preoccupation with selfand an increased need for restand/or sleep are to be expected.Victims al so sustain high levelsof frustration due to their inabilityto control their emotions (and

sometimes physical violence),to fulfill their normal functionsin the family's structure, tomaintain good motor control oftheir bodies, and society' s intolerance

and rejection of them in theirpresent state.

What You Can Do to Help the Victims

Professionals, family, friends,and society as a whole can helpthese head trauma victims by showingtheir acceptance; after all, theperson trapped inside of the mal-functioning mind and body hasnot changed. Practice patiencewith them; be understanding andshow the same kind of compassion

233


that you would like to receiveif you were in their place. Don'tbe overprotective and withholdinformation from them; that onlykeeps them dependent on othersand is doing them an injustice.Give detailed information in simplelanguage. Explain all known choicesand allow them to make their ownchoices. New tasks will be moredifficult for the victim to learnso expect repetition. If new sur-rounding and/or people are tobe encountered, role playing aheadof time will make this easier.Don't be afraid to touch the victim;they need to be stroked just aswe do. Discipline is a must, butdo so with love.

Effects on the Victim's Family

If the victim is a spouse,the family role obviously changesfrom one of spouse/spouse to parent/ -

child, with the parent role beingplayed by the uninjured spouse.Most of the responsibility forthe retraining and its reinforce-ment falls on this spouse. Thisreinforcement requires incessantrepetition which tends to makethe uninjured spouse feel likea human tape recorder.

The head injured victim maybe adult in body, but not in mind.The spouse has to think ahead,reason, anticipate all contingenciesand make decisions for two. Thevictim cannot be pampered or pitiedor he will become a domineeringspoiled tyrant.

Spontaneity cannot exist withinthe relationship because the victimcannot cope with unknowns or theunexpected. Words have to be chosencarefully, the tone of voice delivered

must be considered, and the facialexpressions monitored. This self-censorship on the part of the normalspouse is necessary to avoid inap-propriate behavior and, perhaps,embarrassing, violent physicaloutbursts in public. Schedules

for the normal spouse are seeminglymade to be broken, and they invariably

are broken.

Socially, the healthy spouseis not married, but is not a wi dow(er);

they are just in limbo. Theydon't feel comfortable going mostplaces with the victim and can'tleave them unattended, so it is

easier to stay at home. Mostacquaintances and friends won'ttolerate the victim's idiosyncracies.Because of the unusual measuresnecessary to keep the victim undercontrol, most people believe thespouse is cruel, domineering andoverprotective. On duty 24 hoursa day, 7 days a week, and using100% of their attention, energyand time, the spouse finds it

very difficult to enjoy normalsexual relations with the victim,even if the victim is able toperform.

What You Can Do to Help the Family

Professionals, other familymembers, friends, and societyas a whole need to learn how tolisten to the spouse when relatingto the victim's peculiarities;after all, the spouse lives withthe victim on a full time basis.People also need to realize thatthe uninjured spouse has justas many, if not more, needs thanthe victim. Learn to observeindications that the spouse needshelp in coping, especiallyemotionally,

with adjusting to a litc:ong varietyof disabilities. This is extremelydifficult.

Above all, don't put down,disregard, cr ridicule the faithof the victim and his(her) family;it can make the difference betweenlife and death, literally and/oremotionally. For further information

contact:New Beginnings Ministries,

Inc.

P.O. Box 31408Jackson, MS 39206

234


REFERENCES

Marshall, Lawrence F., M.D.; Sadler,Georgia Robins. M.B.A.; Bowers,Sharon A., B.S.N. (1981). Head

Injury. San Diego, CA: TheComprehensive Central NervousSystem Injury Center for SanDiego County.

Rosenthal, Mitchell, Ph.D; Griffith,Ernest R., M.D.; Bond, MichaelR., M.D., Ph.D., FRCS, MRC Psych.,MRCP, DPM; Miller, J. Douglas,M.D., Ph.D., FRCS Ed., FRCSGlas., FACS. (1983). Rehabilitationof the Head Injured Adult.Philadelphia, PA: F. A. DavisCompany.

The Diagram Group (1982). TheBrain: A User's Manual. NewYork: Perigee Books.

SPECIAL STUDENTS, TECHNOLOGY, AND BASIC SKILLS EDUCATION

LOUIS W. FRILLMANN

ABSTRACT

A study of the use of technologyin assisting students with specialneeds to learn basic skills. Issuesof concern to teachers, decision-makers

and technocrats are addressed including:

1. What are the basic skillsneeds of special students?

2. How are these needs different

than those of studentsin general ?

3. Are these needs changing?4. How do people learn basic

skills?5. Which instructional techno-

logies can be used toteach basic skills?

6. What technologies areavailable?

7. What are their capabi 1 -ities....their limitations?

8. How can we determine theireffectiveness, their cost,and the demands they placeon decision-makers?

The writer recognizes thata great deal more must be investigatedabout learning theory, about assessinglearning styles, about determiningeducational objectives and aboutthe handicapping conditions.

The Not Quite" Child

You've seen him betore ashe often identifies himself.He lies concealed in the thicketof educational programming, likea newborn fawn . . . . while wewait for him to "grow out of it."Like a broken clock, he chimesonly on the half hour, missingthe number 12 completely. Playinghim as a record, the young years,and on the wrong speed, he hearsthe di scordant quality of hisown learning, and the clear, groovylaughter of others. Stare ashe may, or gazing pensively, (whatis so crystal clear to childrenyounger and smaller), words andtheir accompanying meaning clumptogether as an inky cage.

Even his wal k appears tobe that of a drunken sail or endeavoring

to navigate a flagstone path,and finally noticing that everyother stone is absent.

He becomes the recipientof drug therapy, the advocateof motor programs, the focus ofcommercially prepared material s,the proof of educational therapy,and a living, daily reflectionof the fact that activity doesnot mean the same as achievement.The not-quite child suffers fromhardening of categories. He maybe condemned for his dissimilari-ties . . . . while his real need

is that of understanding, ratherthan being made to wal k/run/march/live

to the same cadence as others.He rides the high tide of

frustration, crashing into thesea of classroom discipline likea giant breaker, only to become,moments later, the gentle sprayof conformity. His path teetersbetween the soil of productivity

236


and gravitation of academic quicksand.

He is the product of advancementin the space age as well as the

neglected artifact of our educationalignorance in the area of humandeviation. He is the guilt ofprofessional lip service to thereality of individual differences.He is a rambler over bleak cliffsof parental despair, and the GrandCanyon of potential versus perfor-mance. He becomes a man withouta country, with physician, educator,and family all drawing maps - oftenleading him away from things he

knows toward even greater complexi-ties. He ricochets among an avalancheof relevant literature, latestfunding, and professional concern.He becomes the darling of pressuregroups and the adopted child ofparent associations. He is thestraw that breaks the camel's back,the reason for teacher unions,and the Teen-age drop-out.

You've not seen valleys or

mountain peaks until you scan his

testing scores. He is the lengthand breadth of a teacher's TGIF.He defies description, as he is

too young, too old, and too tormented.He fragments evaluations, defiesdiagnosis and confounds all whowould lead him. He is on the rightside of every educational cliche-"study more", "work harder", andon the wrong side of real meaning.

The child conceived, bornand developed out of ambiguityhas rendered a new impetus. He

is forcing us, because of his

"not-quiteness" to review the color,shape, size and intensity of ourdaily COMMITMENT. If he is to

live among us, we cannot allowhim to approach ad'ilthood bewilderedand lost. If we are to live withourselves, we shall desire to takehim to the park and spend manya sunny afternoon romping, listening,and when necessary, letting him

show us Es secret places.

Special Students, Technology,and Basic Skills Education

It has long been the dreamof parents of special studentsand educators to match those students

with appropriate educational techno-logies. Recent issues and demandsplace even greater burdens upondecision-makers as they balancebudgets, initiate training programs,deal with technology specialists,and endeavor to produce the classroom

environment called for by theI.E.P.!

Technology must be placedinto the context of learning theories,

styles, and the determinationof educational objectives. There

is no formula that tell s us whattechnology to use with a specificlearner for a given purpose; andif we did have a formula, wouldwe be able to apply it? Thereare other factors that enter intothe decision-making process, eachfactor is important. Factorsinclude the nonavailability ofequipment, the non-readiness ofstaff or structure, the prioritization

of one medium and not another,the presence of technologicaltool s without the educationalobjectives and many others.

Imperfect as our knowledgeabout the learning process andthe impact of technology, letus acknowledge what we do know:

237

1. We know that technologyis a support system thatcan be used for teachingand learning, to giveus information about"how" and "when" and"where" a student learnsbest.

2. We know that technologymay denote the use ofa systematic processof designing and deliveringinstruction.

3. We know that, under theright circumstances,


technology can do somethings as well as goodteachers, and some thingsbetter.

4. We know that no singlestrand of technologyis more effective thanothers for all purposes.

5. We know that technologyis most effective wheneducators are most familiarwith its capabilitiesand its limitations.

It is vital that we discussand demonstrate the impact of technology

on learning, student achievement,productivity, school faculty andstaff, parents, management, andbudgets.

Issues of concern to educators,decision makers and technologistsinclude:

What are the basic skills needsof special students?

How are these needs differentthan those of students ingeneral?

Are these needs changing?How do people learn basic skills?What instructional techniquescan be used to teach basicskills?

What technologies are available?What are their capabilities?

their limitations?How can we determine their effec-tiveness, their cost, andthe demands they place ondecision-makers?

The writer recognizes thatlearning theory must be investigateda great deal more in addition toassessing learning styles , determining

educational objectives, and inve,;ti-gating the demands placed uponall of the foregoing by so-called"handicapping conditions," beforewe can expect to match specialkids with appropriate educationaltechnologies.

The Challenge for Administratorsin Today's Schools

Articles published sincethe passage of the Basic SkillsAct (Basic Skills and EducationalProficiency Program - Title II

of the Educational Amendmentsof 1978) reiterate the themesthat American education is notable to teach cognitive skillsor to del iver a well-motivatedand hard-working labor force.Where does this leave the educationof students with special needs?While we can cl aim recent breakthroughs

in employability and the passingof diploma exams, we must alsoface the dilemma of structuringand implementing each and everyeffort dedicated t,o the improvementof "learning the basic skills"- however they are defined.

Perhaps our task would bea bit less complex if there wereany agreement between parents,educators, and the general publicabout just what "basic skills"are. Are they only the threeR' s? Must they al so include behaviors,

job responsi bi! ity, human sexuality?

Have our expectations regardingbasic skill s changed with theintroduction of communicationand information technology? Asone job in two is now relatedto information handling (1-SNYDER),that is, col 1 ecti ng , storing,transcribing, receiving, analyzing,packaging, or distributing information,

shouldn't all students (ours included)

be prepas-ed to deal with it?Should basic skill s now includecritical reading, listening, loadsof observational experiences,direct contact with decision-makingprocesses or computer literacy?So, improvement is one thing,defining the problem is quiteanother.

Technology has and will causechanges. Perhaps the one changewhich strikes most boldly at the"past operational stance of far

238


too many schools" is the changeseen in individualization modelsfor meeting the individual needs,

interests, and capabilities ofevery student. P.L. 94-142 wasaimed at just this element. Althoughnot yet fully realized, recognitionthat students of the same age,in the same grade or class, donot have the same educational needsor learning patterns is changingthe way that educators plan anddeliver instruction. Side-by sidewith this change is the paralleldevelopment of strategies thatactively involve students in thelearning and decision-making process.Not an easy time for the "boss",especially when costs are up, enroll-

ment, down, and the budget in a

squeeze.

Learning Basic Skills

We are faced, once again,with many more questions than answers ,

with a critical question up front:WHAT ARE BASIC SKILLS?

Althrugh basic skills areindividually determined, most peopleconsider reading,writingand arithmeticcentral to the curriculum of allschools. Independent living is

still dependent upon skills in

communication and computation.Few persons, however, would limitthe total school offering to theR's and would variously insiston history, geography, citizenshipeducation, science, art, music,and many others; we would quicklyadd mobility training, independentliving skills, auditory training,physical and occupation therapy,behavior modification, job trainingand work experience, and othersto the list.

The year and era of 1984 alsoraises valid curricular concernsfor the '80s and beyond. Willgrammar and spelling lose theirfocus and new impertance be placedon the writing process and thestructure of written products?

(2- ROBIN) Will critical reading,listening and viewing skills becomecentral as society recognizesthe need for citizens to distinguishbetween truth and error, propagandaand fact? Is bilingualism alreadyan outgrowth of communicationand travel opportunities?

For those of us who believethat survival is as importantas graduation, there is a wholenew set of concern. They rangefrom the prevention of institutionalism

to "making it" in the work force.What is basic to others will surelynot be basic to us. Our goalsmay be to focus on the blendingof what we do best with what others

can do to assist our studentsthrough vocational training, workopportunities, and habilitation/re-habilitation. Where do you startwhen you look at the needs of

students who require a daily structured

approach to learn to deal withthemselves, their peers, school,and even basic skills? In sucha context, keyboard literacy andearly exposure to varied formsof technology will prepare them,hopefully, as consumers, employees,and citizens.

Surely technology can and

does deliver instruction, butit is the ability to use the computer

tool that is taking on new lustre:

- to solve problems.- to communicate with others.

to edit language and useof the functions of word -processi rig.

to create graphs and pictorial

devices that assist a

person to learn and to

convey information.

Which Instructional Techniquesare Useful in Teaching

Basic Skills

(It is difficult to imaginean instructional technique thatwould not be useful in teachingbasic skills.)

239


Information Delivery

student-teacher interchange - directedinstruction

lecture - media presentation -

observation - direct experience

Demonstration

displays of physical/mathematicalrelationships

doing by an adult requiring a studentto imitate

Drill and Practice

practice problems or exercisesdesigned to reinforce learninggained from another source

the role of the computer and hand-held devices as scorekeeper, providing

motivational feedback and tailoringtype of practice depending uponstudent performance

Problem Solving

proposing a solution to a stated/gen-atedroleri.ourowniblroanofferingsategyarijoteria-Tsolutions, and then evaluatingand rating

.... Tutorial

small, sequenced bits of a conceptare presented

examples given to illustrate theconcept

drills the learner - provides feedbackon the learner's performance

summarizes the information learned-related it to what's ahead

PLATO - TICCIT - LAPS - even packsfor teachers

learnin,g skills/concepts in a

competitive cooperative environment

people learn when it's fun orchallenging

al lows for practici gig the application

of learned skills

How do People Learn?or How Do People Learn Best?

No matter what is definedas a basic skill or who definesit, elements that lead to learningsuccess in the basic skill maybe common. Ironical]y, we still

havJ much to learn about how people',earn, yet we know from experienceand research supports that peoplelearn:

- When their current and changingneeds, abilities and interestsare accounted for.

pace and individualization

content and learning style

stimulating but not too difficult

flexible instruction and personalattention

- When they are actively involvedin learning.

teacher directed instructionvs. student-led discovery

learning/retaining may welldepend on learning/using

learning to talk by speakingvs. learning to talk bystudying communication

- When they interact with others.

working along vs. learningwith others present (3-CHAMBERS)

Instructional Games level of interaction necessary

240

Discovery '84 Technology for Disables: Persons 229

to produce effective learning4- JOHNSON0

- When a variety of techniquesand materials are used.

variety enhances opportunity

caution raised re: overloadingof sensory modalities

- When the design of the instruc-tional materials is interestingand stimulating.

visual appearance - aural/tactileinterest

color - animation - sound -

FaTIFcs

- When they practice and reviewa skill or concept.

new concepts require reinforcement -

old ones, review

- Simulation.

a representation of the keyaspects of an environment-real or fictional

learner must make decisions,but does not experience thempersonally as in real life

.generally do not teach basicskills - lelrner must applylearned skills

question: which comes first?

- Exploration (Inquiry).

student uses content/conceptintroduced by a teacher or mediaand then

experimentation, exploration,discussion, problem solving,research, application of whatis known, unknown

241

Summary

Contributions of Technologiesto Effective Learning

Meeting the current and changinginterests, needs and abilitiesof individual students

Involving students activelyin learning

Promoting interaction withothers

Providing a variety of techniques

and materials

The design of interestingand stimulating materials

Providing feedback to learners

Providing opportunities to

practice a skill until it

is mastered

Assessing the Impact

of Technology on Education

- What Achievement Gains can

Students make with Media?

test scoreslearning timedegree of retentioncourse completion

- What New Skills and Knowledgewill our Students learn withMedia?

- What Impact will media haveon Attendance, Attrition& Absenteeism?

adult educationcontinuing educationin-service trainingon-the-job trainingworkshops for those who own

personal computers (or

are about to buy)computer time during non-school


hours and weekends

- What Impact will media haveon teachers and other schoolpersonnel?

knowledge about the mediumskills in using the medium -

techniquesskills in using media in

the management of instruction

skills in evaluating relatedmaterial s

skills in designing and developing

materials

Individual Differences

Once upon a time animals decided

they must do something heroic tomeet the problems of a "new world."They adopted an activity (BasicSkills) curriculum consisting ofrunning, climbing, and flying;to make it easier to administer,all Lne animals took all the subjects.

The duck was excellent inswimming, better in fact than hisinstructor, made passing graties

in flying, but was very poor inrunning, so he had to stay afterschool ana drop swimming to practicerunning. The schedule was maintaineduntil his web feet were badly wornand he was only average in swimming.

But average was acceptable in school,so nobody worried about that exceptthe duck.

The rabbit star z.ed at thetop of the class in running, buthad a nervous breakdown becauseof so much "make-up" work in swimming.

The squirrel was excellentin climbing until he developedfrustration in the flying classwhere his teacher made him startfrom the ground-up instead of flyingdown from the tree tops. He alsodeveloped "charlie horses" fromover exertion and then got a "C"

in climbing and a "D" in running.The eagle was a problem child

and was disciplined severely.In the climbing class he beat all

the others to the top of the tree,but insisted on using his own,best way to get there.

At the end of the year, anabnormal eel that could swim exceed-ingly well , and also run, climb,and fly a little had the highestaverage and was class valedictorian.

The prairie dogs stayed outof school and fought the highschool tax rates because the adminis-

tration would not add diggingand burrowing to the curriculum.They apprenticed their childrento a badger and later joined thegroundhogs and gophers to starta successful private school.

ANY LESSONS FOR US??????

REFERENCES

Chambers, J. & Sprecher, J. (1980)."Computer Assisted Instruction:Trends and Critical Issues",Comm. of the ACM, June, p. 336-337.

Johnson, D. (1981) . "Student-StudentInteraction: The NeglectedVariable in Education" , Educational

Researcher, Jai. p. 5-10.Rbin, A. (1980). "Making Stories,

Making Sense", I.ang. Arts,March, p 26.

Snyder, D. P. (1979). "Welcomefo the information Age ", Voc. Ed.,

April, p. 28.

242

SENSORY AIDS DEMONSTRATIONAND TRAINING CENTER

JERRY A. KUNS

ABSTRACT

The Computer Training andEvaluation Center, C-TEC is jointlysponsored by the Sensory Aids Foundation

and the Veterans Admini stration-Western

Blind Rehabilitation Center. The

program offers information andtraining on computers for blindusers. The objectives of thisprogram are: To provide trainingon braille, synthesized voice,and. large print equipment and customsoftware that gives blind individualsaccess to comp .ters. To providecomputer access awareness trainingfor educators and rehabilitationpersonnel . To pro ride specialaccess evaluations of hardwareand software. And to provide publicinformation.

243

We see in current societaltrends an unprecedented move towardthe application of computer-relatedtechnology in our jobs, our educational

institutions, and our daily lives.On the job, computer-related technology

is affecting almost everyone,from typists and machinists to

business managers and social workers.The largest impact of the computerrevolution has been the increasein the speed that informationcan be processed and transmittedto individuals. Access to information

has always been a major educationaland employment barrier to blindand visually impaired persons.Making computers accessible toblind and low vision persons is

a complex, multifaceted task.Most commercial ly avail able hardwarecannot be used without specialaccess devices such as voice synthe-

sizers, electronic braille displays,large print video outputs, andspecial software for managingthese devices.

In order to help individualslearn the operation or applicationof special purpose devices andsoftware, an exciting and innovativetraining program has been created.The Computer Training and EvaluationCenter, (C-TEC) was establishedin October, 1983, under the auspicesof the Federal Department of Education,

Rehabilitation Services - SpecialProjects. C-TEC is a cooperativeproject of the Sensory Aids Foundation

and the Veterans Administration -Western

Blind Rehabilitation Center.The training facility is located

at the Pal o Al to, Cal ifornia,Veterans Administration Hospital . C-TEC

provides both the Sensory AidsFoundation and the Veterans Admini-stration with the capacity to


evaluate recently developed aidsand to participate in the developmentof emerging technology.

The Sensory Aids Foundationhas successfully operated innovativeemployment programs for blind andvisually impaired persons since1975. Over 450 people have beendirectly assisted with job placementor consultation on work-place modifi-cation as a result of these programs.For the past five years, the SensoryAids Foundation has been trainingrehabilitation professionals touse technology to solve employmentproblems for their blind and visuallyimpaired clients. The Foundationhas an international reputationfor its knowledge of computer-relatedsensory aids and has served asa resource for agencies and educational

institutions throughout ti,e UnitedStates and several foreign agencies.The Sensory Aids Foundation publishesa quarterly journal and a subscription

newsletter, Sensory Aids FoundationUpdate.

The Western Blind RehabilitationCenter mainly functions as a programfor sight loss adjustment. Theservice concentrates on assistingvisually impaired veterans withtheir adjustment to changing visualconditions. This service is providedvia a four step rehabilitationapproach: a complete low visionevaluation, training with prescribedaids, orientation and mobility,manual and living skills. Includedin the living skills section is

the Computerized Reading Aids programdesigned to provide instructionin the use of the VersaBraillean Kurzweil Reading Machine.The Veterans Administration researchdepartment provides informationon new computer access equipment.This information is used by theComputer Reading Aids staff andC-TEC personnel to focus on thetrainee's specifi. needs.

The principle objective ofthe C-TEC program is the provisionof one-on-one or small group training

for users of computer access devices.

The training is focused on theoperation and function of hardwareand softivare for computer access.The training is not provided toteach students specific job skills,such as word processing or computerprogramming, however, it doesprovide tne trainee opportunitiesto learn to use the devices andsoftware and to interact withpersonal or mainframe computers.With this experien'e, the personmay go on to the job training,or other programs to learn relevantskills.

Training programs are availableto veterans, non - veterans, andprofessionals who work with peoplewho are visually impaired. Applicantsrequirements are minimal:

1. The need for computerknowledge for education,employment, or personaluse.

2. Adequate keyboard skillsor a definable need foral ternative input mechanisms.

Program Objectives

The primary annual objectivesof the Computer Training and Evaluation

Center are:

1. To impact the successfulrehabilitation of 75blind or visually impairedveterans and non-veteransthrough direct trainingon computer-relatedsensory aids.

2. To train 30 rehabilitationand/or special educationprofessionals in basiccomputer literacy andthe application of computer-

related technology tothe successful rehabilitation

of their blind and visuallyimpaired clients.

3. To serve as a demonstration

center for employers,

244


blind consumers, rehabil-itation and special education

professional s, and thegeneral public.

4. To evaluate computerrelated aids and to publishthe results in professional

journal s and newsletters,and to disseminate resultsto state and federalagencies.

5. To develop new vocationaland educational applicationsof computer-related sensoryaids.

6. In collaboration withSensory Aids Foundation'sempl oyment developmentstaff, to assist 50 blindand visually impairedpersons in exploring,obtaining, upgrading,or retaining employmentin competitive, unsubsidizedwork settings.

7. To develop special needs

software for applicationin employment settings.

Objective I - Direct Training

Direct, one-on-one trainingis provided at the C-TEC site.The original 75 student trainingprojection for the first year ofthe program was based on an anticipated

two trainees per week for an averagelength of training of three days.As the project developed, it becameapparent that an average of fiveor six days was necessary to adequately

prepare the student to use thedevices chosen, and up to ten daysmay be required.

Typical ly, after the firstday of evaluation and training,specific devices are selected thatfit technical and user workingrequirements. Braille output,voice output, or a combinationof both may be used by a totallyblind person together with specialsoftware for managing the displayof information normally seen on

a video display (CRT). Individuals

with severe visual limitationsmay be taught to use special hardwareand/or software to enhance andenlarge the screen displayed print.

The hardware and softwarecurrently being used for trainingare: the Apple IIe computer withEcho II speech synthesizer, Braille -

Edit and work station software;VersaBraille; the Cranmer ModifiedPerkins Brail 1 er; and the IBMPersonal Computer with the Promtwri ter

word processing system, Vis::altekDP-11 , and PC Lens, PC Speaksand Freedom I software programs.

During the first projectyear, 30 individual s receiveddirect training, most were trainedon equipment relevant to theirexisting employment situations.Twenty additional people haveparticipated in group introductorycomputer classes. The goal for

the second year is to providedirect training to 75 individuals.

Objective 2 - Professional Training

Three approaches have beenadopted to achieve the objectiveof providing 30 rehabilitationprofessionals and educators basiccomputer literacy.

First, an introductory computer

course (offered twice a quarter)

addressed the goals of developingan understanding of computers,their accessibility for blindand visually impaired persons,and employment applications.This two-day program includesan introduction to computer termi-nology, equipment, educationaland vocational applications, andaccess devices (braille, voice,and large print). The trainingis provided through didactic pre-sentations, hands-on demonstrations ,

and the provision of lists of

resources and guidelines to usewhen purchasing computer equipment.Fifteen professional s have completed

this introductory course.

245


Although educators and rehabi-litation counselors have participatedin one-on-one training and smallgroup sessions, a second approachhas been developed to provide moreextensive information on computer-related occupations, employment,equipment operation, and interface.A three-day workshop, to be presentedin mid-October for 15 rehabilitationprofessional s, will provide anintroduction to computers, computerjargon, hardware, input/outputsystems, custom software, employmentopportunities, job assessment andaccommodation, and hands-on equipmentdemonstrations. It is expectedthat this program, with some variations,

will be provided by request to

state rehabilitation agencies in

the western United States severaltimes in the coming year.

The third approach under develop-ment, is a teacher training courseto be co-sponsored by C-TEC, theCal ifornia State University atSan Francisco, and the Lighthousefor the Blind in the Bay Area.It is expected that this coursewill be ready for presentationby the summer of 1985. This coursewill be a model that may be implementedin special education school s inother states. It is designed asa three-week program of daily classroom

and laboratory instruction forteachers of blind and visuallyimpaired youngsters, followed bya 10-day computer camp for teenagers.During the computer camp t'-e teacherswill be supervised whil teachingthe use of computer access devices.

Objective 3 - Demonstration Center

C-TEC serves as a demonstrationcenter for employers and-the generalpublic. Regularly scheduled one-hourdemonstrations of software, equipment,and training processes have beenattended by more than 250 persons.Invited conference presentationsand demonstrations have providedinformation to 150 employers during

the first year of operation.

Objective 4 - Hardware and SoftwareEvaluations

A systematic hardware evaluationprocess has resulted in reportson the Mi crobrai 1 1 er, the VersaBraille and the Zorba Computer.Two devices are scheduled forevaluation of effectiveness withthe IBM Personal Computer: the

Professional VERT System and theFrank Audio-Data System. A softwareevaluation plan to be nationallydisseminated, is being implementedwith the creation of softwareevaluation protocol. This is

an attempt to formul ate a standardized

evaluation procedure that willidentify accessible software.Several programs for the managementof voice output information forthe IBM Personal Computer willbe examined along with data base,word processing, and other generaluse programs.

Objective 5 - New Applicationsof Sensory Aids

C-TEC and sensory Aids Foundation

professional staff are jointlydeveloping new vocational andeducational applications of computer-related sensory aids. Throughmeetings with members of the Smith-Kettl ewel 1 Rehabilitation Engineering

Center and vendors such as Tri formati on

Systems, Inc., Enable Software,Syntal ker Systems, Inc ., and Tel e-

sensory Systems, Inc., new approachesto solving problems are beingexplored.

Objective 6 - Employment Assistance

In collaboration with thesensory Aids Foundation's professionalstaff, C-TECH has provided, thefirst project year, direct placementas si stance to 20 individuals interested

in obtaining or upgrading employment.As this project developed, it

246


became a technical resource tomany blind and visually impairedusers living throughout the UnitedStates and Canada. Written andtelephone informational inquiries

average 30 per week.

Objective 7 - Custom SoftwareDevelopment

Specialized software is being

developed on an "as-needed" basis

with the resources available fromthe C-TEC Advisory Committee, theSensory Aids Foundation's profes-sional staff, and technical consul-tation.

For example, a custom softwareprogram is being created to allowa blind emergency dispatcher accessto geographic map coordinates.This program may have use in a

broad range of applications. An

automated radio station computersystem will be accessed througha microcomputer equipped with voiceoutput and special applicationsoftware. The synthesi !ed voicewill provide the blinded operatorwith station operation cues, programing'.nformation, and wire service access.

Subordinate Objectives

Several subordinate objectivesare also being addressed by theComputer Training and EvaluationCenter.

1. A resource library ofinformation on computer -related aids has beenestablished. New resourcesand product reviews arecontinually added. Thereference material s areused for training andfor public informationrequests.

2. A "quick turn-around"braille and large printtranscription serviceis being studied. Current

manual s and reference

materials are being preparedfor trainees by convertingthem to hard or softcopy braille and/orsynthesized voice audiocassettes. Printedinformation can be scanned

by the Kurzweil Reading

Machine or other opticalcharacter reading (OCR)

device and transferredto machines that producebraille. With the supportof vol unteers, it is

planned to make thisquick transcription service

available to the residentveteran population andspecial employment situ-ations.

3. Tape duplication serviceswill be made availableto trainees and consumerpopulation.

Ccnclusion

Evidenced by the statementon the cover page of the Fall ,

1984, Cal ifornia Transcriber,there is an overwhelming needfor information for professionalsworking with the visually impaired."The influx of marvel ous technological

applications to the field of visualimpairment leaves us breathless,bewildered and mind-boggled."This attitude is actively beingchallenged by C-TEC and severalother special training programsfor consumers and professionalsaround the United States. It

is true that there is a strongneed for coordinated resourcegathering, product evaluation,information disseminatioi, andtraining of professionals andblind users in the day-to-dayapplications of computer technologyin recreation, education, andempl oyment settings , and for personal

use. It is believed that throughthe efforts of the Computer Trainingand Evaluation Center and similar

247


programs the positive benefitsof the ever changing access technology

can be managed and understood byboth professionals and consumers,permitting competitive participationin the information revolution.

248

UTILIZATION OF TECHNOLOGY; CONSUMER PERSPECTIVE

MARGARET C. PFROMMER

ABSTRACT

Technology has impacted thelives of persons with disabilitiesin a positive way. However, onlya small number of persons are benefiting

from these technical products andservices. The problem of technological

underuti 1 i zati on has not been resolved,

in my opinion, for three reasons.First, when obstacles to the

application, documentation, reim-bursement, and manufacture/distribution

are identified, they are treatedas inviolable. Second, seldom,if ever, is a direct line of accoun-tability set between thoFe whohave responsibility and the recipients,

or supposed recipients, of thebenefits of technical productsand services. Third, appropriateconsumers are excluded from attemptsto resolve issues and solve problems.

The perspective I am bringingto my subject is that of an experienced

and informed consumer. I am a

typical consumer as I rely ontechnical products and servicesto maintain and increase my inde-pendence and productivity. In

addition, I have for many yearshad the opportunity to work withprofessionals in the research,development, and application oftechnologies. Although this affil i-

ation requires that I functionwith a high level of professional ism,it is understood that my primaryaccountability is to persons withdisabilities. From this uniqueposi ti on I have been able to perpetuate

the consumer perspective.A need exists for an increased

number of well-trained personsto work in al 1 service del ivery

areas of the technical aids forpersons with disabilities identity.Equally important is the needto upgrade the skills of professionals

presently responsible for applyingtechnology.

In order to meet the shortageof qualified professionals, twouniversities, Virginia and Drexel,are currently providing trainingfor clinical engineers. The Univer-

sity of Virginia is acceptingboth engineers and therapistsin its program. The engineerdevelops clinical skills, andthe therapist learns engineeringconcepts. Only time will tell

if this training is adequate andif graduates will get into actual,competent application of technicalaids in sufficient numbers.

by own experiences with inadequate

professional application of technology

led me, several years ago, to

conclusions now supported by the1982 Office of Technology Assessment

249


Report which states "Those providerswho are permitted by the structureof delivery and reimbursement systems

tc prescribe technologies for di sabl ed

people may not always be the mostappropriate ones to do so." Theabove quotation shows that notonly consumers question professionalcompetencies, but that professionalpeers also are concerned. Thoseinappropriate providers are usuallythe parties whose values and goalsdetermine the appropriate applicationof technology.

I have had the good fortuneto work with professionals whoare skillful in their applicationof technology. I also have hadthe misfortune of being the clientof other professionals whose incom-petence contributed to many yearsof unnecessary discomfort, dependence,and isolation.

Biases on the part of profes-sionals often interfere with goodservice delivery.

As a consumer, I object tothe whole idea of rigidly definedgoal s for eval uating the appropriateness

of a technology. Many personswho define goals actually set limita-tions under the guise of "beingrealistic." For example, some profes-sionals have refused to prescribea pneumatic wheelchair control(puff-and-sip) for persons on venti-lators because the professionalslack the knowledge that such personscan make good use of this controldevice.

It is not possible to explicitlystate goals. What is possible,and often happens, is that a prescribed

technology opens opportunitiesundreamed of by any of the prescribers;

a desire and need for additionaltechnology is cra.+.A. In my workapplying technology, I have oftenbeen amazed with the positive syner-gistic effect of good applicationand use of aids. Professionalswho straightjacket themselves byexplicitly defining goals deprivethemselves, their clients, and

the world of the ultimate benefitsof technology. I am convincedthat the misuse and misapplicationof technology causes and perpetuatesdisabil ities.

As an informed consumer,I understand and sympathize withsome of the problems of good servicedelivery. Common complaints frompeople delivering engineeringservices are: (1) they have toput much time and effort intothe search for information aboutthe proper application of technicalaids and their benefits, and (2)

in many cases, in order to receivepayment for their services, theymust search for reimbursement.The investment of time and energyin these two areas reduces thetime and effort that can be expendedin their rightful area of expertise.

The proper application oftechnical aids is a very timeconsuming task. Collection, docu-mentation and better informationsharing could reduce the hoursand efforts.

Unfortunate information gapsexist. I am occasionally contactedby rehabilitation practitioners,vocational counselors, and others,requesting a source of informationfor technical aids in general.It is apparent that these peopledo not have the time or knowledgeto contact many different sourcesand want to plug into one source;they would like to press a buttonand have the answer fall intotheir laps. I question the conceptthat a central data bank is thetotal solution. The informationin such a bank would probablybe limited and the data bank conceptpresently 1 eaves out the knowledgeable

advocate, person who is not a

manufacturer/distributor who canexplain subtle differences indevices and properly apply a particular

device to a specific need.My answer to callers for

general information is there ispresently no one source where

2 :5 0


a person can obtain all informationabout all technical aids. It seemsto me that, at this time, a betterprocedure is to seek clinical engiveer-

ing services to meet individualclient needs. In the process,the practitioner will gain experienceand awareness of other sourcesof information.

Probably the most valuableresource for professionals applyingtechnology is attendance at workshopsand conferences where conferenceproceedings may be obtained andwhere valuable contacts with otherprofessionals in the field mayresult in future interaction.

Professionals in the researchand development area also lacka data bank from which to drawover-all and unified information.Most of the information T_ scattered,know only through the personalexperience of researchers. Although

the journals are useful, the mostvaluable way to gain informationseems to be through personal contacts.

As to those who apply technology,researchers and developers mustspend disproportionate amountsof their time in searching forcurrent information in order to

do the best job possible and toavoid duplication of effort.

There still are other groupswho need good information in orderto better use technology: policymakers, manufacturers, marketers,and distributors of technologicalproducts. Four specific resourcesthat would be helpful to all thesegroups are (1) the greater useof cl iniL.,1 engineers, (2) technicalassistance for the disabled projects,(3) a consumers report on technicalaids, (4) and equipment demonstrationunits.

Although individuals in therehabilitation professions haverecognized the usefulness of clinicalengineering for persons with disabil-ities, the discipline has seeminglynot been accepted as an integral

part of the rehabilitation process.

Few facilities have clinical engineers

on their staffs and only a small

number of vocational counselorsuse the services of engineeringclinics for their severely disabledclients.

Greater use of cl i ni cal engineers

would insure that better selectionsof appropriate devices for individualdisabilities are made.

(1) The clinical engineerworks with disabled personsto become aware of theirindividual needs andthen applies unique technical

aids to meet those needs.(2) The engineer guides disabled

persons through the mazeof available aids byexperience and information.

(3) The engineer makes sugges-tions for modifications(e.g., method of contrunthat may determine whethera disabled person usesor does not use prc-rribeddevices to their fullestpotential.

Other than a few talentedrehabilitation professionals,there are no professionals thatcan provide this service otherthan clinical engineers.

Another service that wouldbe beneficial is the establishmentof technical assistance for disabled

projects. Projects would allowdisabled persons to obtain maximumbenefit from their technical aids.One aspect of such a project couldbe the organization of volunteersfor use in hands-on activitiesand the modification of home areasand/or job sites. Modificationscould include building or alteringwork tables, installing sillipl e

electronic equipment such as environ-

mental systems, changing doorknobs,providing interior and exteriorramps. The proposed service component

could also collect informationabout technical aids and materialsfor use in modification. In some

251


cases, ideas and designs mightbe provided for the user. Furtherhelp could be provided by estimatingcosts, by suggesting sources forfunding, and by supplying standardspecifications for modificationsto doorways, ramps, and other enviro-nmental blocks.

The greatest value to allconcerned probably lies in thedata obtained from follow-up proce-dures. Data may be used:

(1) to see if a particularmod;fication works welland could be appliedto another persons needs.

(2) to gain new ideas.(3) to supply information

to manufacturers of technical

aids that may be helpfulin design modifications.

(4) To provide informationto third-party payersso that they can includethe cost of environmentalmodifications with thetechnical aid.

(5) to provide a realisticpicture of the currentcost of environmentalmodifications.

A consumer report on technicalaids would be of great value tcthird-party payers, prescribers,and users. This would report evalu-ations independent of the manufactur-ers. The evaluation of equipmentcould have three aspects:

(1) testing of engineeringperformance (the technicalspecifications).

(2) studying a device's appli-cability, reliability,serviceability, and main-tenance system.

examining the subjectiveresponses of the userand of professionalsinvolved with its application.

Technical equipment demonstrationunits would be of particular interestto prescribers and third-partypayers. These units could provideadditional assurance that the most

(3)

appropriate technical aid is selectedand the best possible use madeof available funds. What shouldbe of equal importance to agencyprofessionals is that a wise choiceof technical aids including a

careful expenditure of money,has the ultimate result of providinga better quality of life for theirclients with disabilities. Atechnical equipment demonstrationunit ought to meet certain require-ments:

(1) It should offer technicalassistance from knowledgeable

persons who can directa potential user to appro-priate technical aidsand guide him througha process of hands-onuse.

(2) It should provide oraland written informationon technical aids including

their similarities anddifferences, to assistin a final selection.

(3) It should display a

wide variety of technicalaids available for hands-onuse set in simulatedtypical environments.

(4) It should be cooperativelyplanned by all rehabilitation

facilities in the areaso that all would feelcomfortable using theservice as part of theirrehabilitation programs.

(5) Because of the largeinvestment in set-upand maintenance, itshould be located ina densely populatedarea and serve as manypeople as possible.

The opportunity for consumersto try a technical aid beforethey, or their funding agency,makes an investment is especiallyimportant in view of the presentpractice of requiring full paymentbefore a device is ordered.

Even when well-qualified,

X02


well-informed professionals haveprescribed technology for informedconsumers who have made gooa choicesamong the available aids, too oftenthere remain financial barriersto the acquistion of these aids.

The systems of reimbursementthat do not pay for the more expensivetechnologies do not provide optionsfor consumers to use their ownresources to make partial payment.Professionals continue to allowthemselves to be compromised by

the payment system; rather thanprescribe the appropriate device,they settle for one that is afford-able. The outcome is a consumerthat receives only partial benefitsor one that is further handicapped.Reimbursement systems should be

expanded to provide more sophisticated

technologies that clearly can,be justified on the basis of costeffectiveness and/or improved qualityof life. Most modern technologyis really non-medical and shouldnot require the added expense ofa physician's prescription.

There is a reluctance on thepart of some (distributors, forexample) to change the status oftechnologies clearly not medicallyoriented (e.g. wheelchair batteries)to "non-medical" because of thereimbursement system. For theconsumers, this perpetuates theirimage as sick people who dependon the medical system for theirvery existence.

Much technology fur personswith disabilities has been generatedby government-funded research anddevelopment programs. These programshave been criticized for puttinga low priority on production, marketing,

and diffusion activities. It wouldbe more accurate to say that, becauseof their limited resources, researchand development organizations havebeen forced to place a low priorityon those activities. Because researchand development organizations arenot mandated to engage in the pro-duction, marketing, and diffusion

of technologies, any efforts inthis area are not recognized whengrants are being awarded. Actually,

the typical organization, havingput forth great effort in developing

a product or service, is eagerto see it provide benefits to

as many people as possible. It

is the manufacturer who couldbe criticized for not puttingforth efforts to conduct activitiessuch as demographic studies whichcould lead to the developmentof good marketing strategies forthe wide-spread use of technicalproducts and services.

There is a need for betterrelationships between manufacturersand customers. Many companiesare too distant from the peoplewho use their products, thus,they fail to operate with a fine

sensitivity to concerns of theircustomers.

The manufacturer/distributorshould assume responsibility fora reliable product that can be

adequately maintained. If theproduct is good and meets a need,the user will become inevitablydependent upon it. Even the mostreliable equipment breaks down;a valuable service could be providedby loaning or renting a spare.This could prevent a completechange of life style and avoida shift in dependency back tohuman beings.

One observation I have madethrough the years hes to do withthe pricing of certain technicalaids. Some companies bear thecost of their own research anddevelopment. Others benefit fromresearch and development programsfunded by the government. Yet,

those companies that benefit fromgovernment research sell devices

very similar to those offeredby others at approximately thesame cost, with no savings passedon to the consumer.

I have heard the governmentrepeatedly condemned for insensitivity

253


to issues regarding persons withdisabilities and in many areasthe criticism is valid. However,in the area of research, development,and use of technology, governmentfunded programs, even with limitedresources, have played a leadershiprole.

As the private sector continuesto lag behind, I look to the government

to stimulate that sector's interestand to make its own participationmore meaningful . For example,congress might legislatively chartera private organization to providemarketing and production-relatedservices, or to conduct evaluationprojects that are clearly and cleanlyseparated from the functions ofassisting the marketing of products.I very strongly urge that a componentof any evaluation process includea consumers report.

The government has anothergreat need to coordinate the activities

of its separate agencies and depart-ments to bring good products andservices to persons, with disabilities.

This opinion is not mine alone,but is an opinion I have heardexpressed by consumers and pro-fessionals alike.

I would like to see a greaternumber of qualified consumers workingto solve this problem and otherproblems on a national level.Consumers working at the nationallevel need to be truly representativeof the population they serve.Qualified consumers are personswho (1) have a disability, (2)

possess social maturity, (3) usetechnical products and services,(4) participate in consumer organiz-ations or demonstrate good contactwith the community of persons withdisabilities, (5) represent thepoint of view of a sizeable numberof persons with varying disabilities(being aware of a variety of lifestylesand experiences), and (6) possessa working knowledge of the areain which they are participating.

There is a consensus of all

persons involved with technologyand handicapped people that inde-pendence and employability arenot only important human aims,but also sound economic goals.It is generally recognized thatthe good use of technical productsand services will permit personswith disabilities to earn theirown living and/or reduce assistance.

No matter how well peopleare equipped with technical devicesand with personal and intellectualcapabilities, the disincentivesof our society prevent them fromreaching their full potentialfor independence and employability.Disincentives include inaccessibilityto buildings, programs, and facilities,

archaic social security and taxstructures, and attitudes whichimpede role changes.

Encountering and resolvingthe many problems connected withunderutilization of technicalproducts and services can be over-whelming if we permit them tobe, but, along with you, I amready to commit myself to thetask.

254

PROJECT INTERACT:NICRJCONPUTER SOFTWARE FOR

VOCATION!&. REHABILITATION FACILITIES

ROBERT C. ROBBINSGEORGE C. YOUNG

ABSTRACT

Through a detail ed systemanalysis, Project INTERACT hasmerged rehabilitation and productionrequirements to develop an interactivedatabase system. Under a grantfrom the Rehabilitation ServicesAdministration, the project is

developing and testing a comprehensive

client activity, progress tracking,and a piece rate/incentive payrollsystem. This paper discusses theprocess used in developing thecomputer system and the factorsconsidered in making the softwarereadily portable between facilitiesand microcomputer systems.

In September of 1984, MetroIndustries, Inc., received a threeyear grant from the rehabilitationservices Administration to developsoftware for vocational rehabilitation

facilities. Ekecause vocationalrehabilitation facilities generallyoperate with tight budgets, thegrant proposed that this softwarebe developed to run on inexpensivemicrocomputers arid be user friendlyto allow a non-data processingprofessional to operate the system(Norris, 1983b). In addition,the software was to be developedspecifically for use by directservice providers.

These provisions were inresponse to the needs of a typicalfacil ity in respect to budgetingand staff time. As demands foremployee outcomes (job placements,etc.) are increased, trainingtime requirements increase; but

this is not all. As public fundsbecome scarce, accountabilitydemands for funding agencies areincreased (Simon, 1982), and,in turn, documentation requirementsin the form of paperwork are increased,

thus the dilemma is created ofstaff doing paperwork insteadof training, or training and nothaving time to do paperwork.There is also the issue of obtaining

timely training information forfeedback to employees. Oftenanalyzed productivity and othertraining information is not available

for as long as a month, thus limitingthe quality of feedback to thetrainee.

Project INTERACT addressedthese needs by setting the followinggoals:

255


1. Develop a software systemthat primarily is directservice based.

2. Reduce paperwork requirements

for direct service staffas well as for bookkeepingstaff.

3. Provide real time (instan-taneous) informationin the areas of productionand training to aid in

increasing employee perfor-mance.

4. Provide timely informationto facility management.

5. Develop a system whichis both portable andversatile.

Developing the Interact System

Software:To insure a comprehensive

system design, several key resourceswere used. A weekend retreat forfacility staff was held to discussthe Projects's goal s and solicitsuggestions for the proposed system.Each staff member was asked tolist the functions that he/shewould like to have computerized.Direct service staff suggestionswere given prominence, an approachthat is seldom taken in the developmentof a computer system. Usually,the managerial staff decides thesystem's functions. However, oneof the Project goals was to increaseemployee (client) performance.To do this, direct service providersmust have productivity and traininginformation on real time basisand in a per employee format (Bell amy,

Horner, and Inman, 1979). To gainprofessional resource perspectives,two advisory committees data processing,

rehabilitation and education profes-sionals from across the state ofKentucky, as well as from Ohio,Tennessee, and Missouri were formed.These committees were to reviewProject results and make suggestionsfor system development. In addition,a systems analysis/design consultant

was hired; this provided a resourceon a day-by-day basis to answerspecific questions and overseethe development process.

Another valuable resourceused all during the Project development

was microcomputer trade journals.The journal s studied by Projectstaff and pertinent informationwas used to insure state-of-the-artsystem design. This process isstill in use with the Projectstaff.

A detailed facility surveyof the southeastern United States(Indiana and Ohio) was then developedand implemented. Tth: survey wasconducted on the premise thatthe needs of vocational rehabilitation

facilities needed to be identifiedbefore a solution could be developed.

The surv:y addressed the use ofand the need for computers withinfacilities. Briefly stated, theresults indicated that most facilities

did not have in-house computers.Of these, forty-four percent wereplanning to buy a microcomputersystem within the year. Eightypercent of all responding facilitieswere interested in the proposedINTERACT system. After theseinitial steps, the Project staffbegan a formal analysis of MetroIndustries' system.

The system analysis was performed

for all areas of the facility,rehabilitation, production, andfinancial. All forms used bythe facility were collected andcataloged, indicating the keydata elements (pieces of information)on each form. Each staff memberwas interviewed to determine theinformation he/she needed to performhi s/her job. Each form that thestaff member used, was identifiedby information origination, theperson who completed the form,and the receiving party of thecompleted form (e.g., a person,a file, etc.), In addition, eachstaff member was again asked whatthey would like the proposed system

256


to do. This information was combinedwith the forms catalog, to givea clear indication of the informationflow within the facility system.From these catalogs, flowchartswere developed to depict the facilityinformation system. A listingof al 1 data el ements collectedwithin the facility was -lso compiled.A quick look at this list indicatedif a data element was cataloged,or if it needed to be added. Thisanalysis process took about twomonths to complete.

Next was the system design.The considerations were eliminatingduplicate data entry, and tailoringthe system for computer/input.New forms were developed that werein the format of a computer screen;they could however, just as easilybe printed for longhand entry.In addition, report forms werealso developed. These forms metthe information requirements ofboth the direct service and managementstaff. At that time the processes(analysis of information) werenot detailed. Because most ofcost of the copying, compilingand analysis would be performedwith a computer, detailing thefinal processes would occur ata later time. In developing asystem extreme caution should betaken lest some obscure piece ofdata be forgotten. To double andtriple check the newly designedsystem, it was compared in detailto the forms catalogs and flowchart.Then each staff member reviewedthe new system, making sure thathis/her information needs wereincluded.

At this point, a new systemfor Metro Industries had been designed.

One of the Project goals was tohave a system that could be usedby other shops as well: therefore,the new system had to be comparedto systems in other facilities.Three facilities similar to MetroIndustries reviewed the systemandsuggestedchangesweimplemmted.

Next, each member of the advisorycommittees was asked to reviewthe system design with respectto his/her area of expertise.During this review, directorsand managers of eleven (11) facilities

and (2) specialists from the stateOffice for Vocational Rehabilitationcompared this system with theirown and with systems'that theyhad seen in other facilities.Again changes were recommendedand implemented.

In summary, the system analysisand design steps were very importantin developing the computerizedsystem. The suggestions of eachstaff member were considered.All facility forms were collectedand cataloged, indicating theflow of information within thesystem. This flow was then depictedwith flowcharts. A new systemwas designed and compared to theold system to ensure that all

necessary data elements were included.

The system then was compared tothat of other facil ities and reviewedby the project advisory committees.Because of this thorough process,it is felt that the INTERACT systemis complete and capable of easyadaptation to other vocationalrehabilitation facilities.

Hardware and Development Software

The research on hardwareand development software was anongoing process of telephone andmail inquiries about productsreviewed and advertised in industrytrade journals. After a lengthyperiod of research, the Projectstaff determined that a fifthgeneration applications developmentdatabase and a networking systemfor microcomputers would bestmeet the Project's goals. It

was felt that the ability of theINTERACT software to run on a

single microcomputer, as wellas a series of networked computers,was essential in meeting the functional

257


and financial needs of a typicalfacility. Furthermore, it wasfelt that developing the softwarein a language that could be maintainedby a non-data processing professionalalso was essential in meeting theProject's goals. The system thatthe Project staff selected allowsthe software to be run on a singlemicrocomputer or on as many astwenty-four (24) microcomputersnetworked together for informationtransfer. The hardware systemselected is IBM-PCs or compatiblesnetworked with Novell network thatallows most MS-DOS (IBM compatibles)machines to operate together.At present, the Project has sixIBM-PCs, three AT & T 6300s, anda COMPAQ portable networked togetherwith the Novell.

Currently, the system designis being prepared for programmingby a software development firmin St. Louis, Missouri. As is

evident, the INTERACT system wasdeveloped with consideration forthe financial and information needsof vocational rehabilitation facilities.

The INTERACT System

In general terms, the INTERACTsystem integrates the areas ofRehabilitation, Production, Payroll,and Management Information. Because

the software is direct servicebased, it is tailored to meet theneeds of floor supervisors andcounselors. However, detailedmanagement information and payrollinformation is generated by analysis

of the information collected by

the direct service staff. Thefollowing is a partial list offeatures that the proposed INTERACTsystem offers:

Rehabilitation /Training:- Employee Information Master

file- Employee Demographic Information

- Immediate availability of

Employee Medical informationInteractive data entryof daily information byfloor supervisorTraining plans developed,monitored, and updatedon -line

Productivity and qualityinformation available forimmediate feedback to employees

Automated attendance monitoring

and reportingMonthly Progress Reportson training, attendance,productivity, quality,with comments permittedper employeeOn-line activity trackingper employee, i .e., counsel ing,

classes, ancillary services,etc.Automated date-cueing fortraining, attendance, produc-tivity, quality, per employee

Employee information sortedby many different variablesSkill Inventory per employeeindicating activities/jobsemployee has performedalong with productivity,quality, difficulty level,and date last performedAutomated generation ofemployee attendance notices

Production:A comprehensive piece rate/in-

centive payroll systemwhich meets Departmentof Labor requirementsProduction SchedulingOn -line inventory maintenance

and reports

Easy entry of job/activitynumber per job/activity

- On-line job specificationsOn-line productivity andqual ity reports by individual ,

department, and facilityJob/activity Master Fileindicating an activitynumber for jobs, counseling,ancillary services, classes,etc.


- Company Master File indicatingcompany information percompany limitations?

- Automated work orders- Automated job status reports

Automated shipping ticketgeneration

- Job Costing per contract/job

These are some of the more importantfeatures of the system. Informationon features will be available fromthe INTERACT staff.

Advantages of Using the INTERACT Systea

The INTERACT system is anintegrated,user-friendly informationsystem designed specifically tomeet the needs )f the workshopenvironment. It was designed byprofessional rehabilitation/pro-duction workshop personnel whoseobjective was to make the computersystem bend to meet workshop needs.Because of the comprehensive reviewand design, many features willsubstantially decrease the vastamount of paperwork currently takingplace in a majority of the facilities.

The development language beingused for programming provides anexcellent security feature forprotecting sensitive or confidentialinformation from unauthorized person-nel. Used by a network, the softwarewill provide up-to-the-minute infor-mation previously not ava'lableto the average facility. The majoradvantage, however, is that theentire system is being designedusing federal funds, and will beavailable at a fraction of thecost of existing workshop systems.

Cost of the INTERACT Systea

Software:

The software for the INTERACTsystem will be available to facilities

on a net cost blsis. Includedwith the software will be operator

and user manuals, providing thecomplete documentation necessaryfor running the software. Costestimates to date, including therun-time module of the developmentlanguage at $300, plus the costof documentation and duplication,wi 1 1 pro ba bl y be between $500and $1,000.

Hardware:The cost of the hardware

will be contingent on the numberand type of computers a facilityselects, plus the cost of theNovell network. An estimate fora four user system using IBM-PCs,a twenty megabyte hard disk, anda linear bus network from Novell,would be approximately $20,000.A seven user system using IBM-PCs,a sixty megabyte hard disk, theNovell network processor (a starnetworkconfiguration)andaforty-fivemegabyte tape back-up system wouldbe approximately $35,C00.

The system will also be ableto run on a single microcomputerwith a hard disk attached, e.g.,the IBM AT machine. Additionally,the Novell network is not theonly network that will be compatiblewith the system. Several othernetworks, e.g., Omninet, 3COMEthernet, PC Net, and DavongMultilink,

will run the system as well.The costs for these networks vary.Your local computer retailer cangive you the prices on request.

As you can see, the systemis very flexible in cost and equip-ment. Almost any facility ill

be able to find an affordcost effective hardware confi gut ion

that will meet the facilitiesneeds.

Availability of the INTERACT System

The INTERACT software tentatively

will be available to facilitiesby October 1, 1985. However,test faci 1 i ti es will begin implementing

the applications for software

25


by May, 1985. Applications forsoftware test sites are being takencurrently. Test facilities willbe chosen by type of facility,location, and willingness to allocateresources necessary for implementa-tion. If your facility is interestedin being a test site, contact theProject staff.

Summary

The INTERACT system is an

user-friendly, integrated softwarepackage for vocational rehabilitationfacilities. This system includescomprehensive applications in the

areas of Rehabilitation/Training,Production, and Employee Payroll.Management information can be compiled

from these information areas, andformatted into various types ofreports. The system will costbetween $500 and $1,000, includingdocumentation. Availability tentatively

is scheduled for October, 1985.

REFERENCES

Bellemy, G. T., Horner, Ritt.,and Inman, D. P. (1979). Vocational

Rehabilitation of Severely Reta-ded

Adults. Baltimore: UniversrtjPark Press.

Kraemer, K. L. (1978). Local govern-ment, information systems, andtechnology transfer: Evaluatingsome common assertions aboutcomputer applications transfer.Public Administration Review,268-278.

Mason, R. 0., and Mitroff, I. I.

(1973). A program for researchon management information systems.

Management Science, 19, 475-485.Mittenthal , S. D. 1976). A system

approach to human service inte-gration. Evaluation, 3, 142-148.

Norris, D. F. 1.1983a ) . Computersin Local Government: Acquiringa Computer System. Public Works,63-67, May.

Norris, D. F. (1983b). Computers

in Local Goverment: Data Processing

and Information Management.Public Work:, 39-43, April.

Schoech, Dick, Ph.D. (1979).A Microcomputer Based HumanService Information System.Administration in Social Work,3(4), 423-440, Winter.

SimiTn, S. E. (1982). ProductivityMeasurement and Evaluationin Rehabilitation and SocialService Agencies. Journalof Rehabilitation Administration,

60), 161-166.

260

AUTHOR INDEX

Abbey, James B., Bringing Computers to the Handicapped 1

Apostolos, Margo K., User Acceptance of a Robotic Arm 43Archambault, Francis X. Jr., See Rucker, Chauncey N 82Archambault, Francis X. Jr., See Rucker, Chauncey N 194Bach-y-Rita, Paul, A Modified Optacon: Towards an Educational

Program 187

Boyer, John J., The Potential of Artificial Intelligence Aids forthe Disabled 74

Brady, Mary E., The State of the Art of High Tech Aids 155

Brooks, James R., A Study in Conversational Protocol BetweenCommunication Aid Users and Non-Users 153

Cashdollar, Patricia L., Advancing the Transdisciplinary Field ofAugmentation and Alternative Communication Techniques and Aids 214

Cotgageorge, J. Edward, See Harmon, Marguerite D 102Dallas, Merry Jo, See Wilson, Patricia A 28Davis, Kristie Y., See Rucker, Chauncey N 82Dunafon, Donna, See Flanagan, Malcolm 119

Doney, Judith V., Biomedical Techniques for Post Head Trauma Victims 219Flanagan, W. Malcolm, Missouri LINC Assistive Device Service 119Frillmann, Louis W., Special Students, Technology, and Basic

Skills Education 224

Gillung, Tom B., See Rucker, Chauncey N 194Glass, Rita M . fromating Your Rehabilitation Facility

with Microt.omputers 128Gleiter, Diane, See Menz, Fred 108Gram, Martha C., A Redesigned Parapodium: New Horizons

for the Paraplegic Child 93Hall, Marian, Abledata: A Computerized Product Guide 204Harmon, Marguerite D., The Computer as a Cross Occupational Tool

in the Vocational Preparation of Disabled Persons 102Hughes, Barry, See Bach-y-Rita, Paul 187Jimenez, Robert M., Strategies for a Functional Urban Paratransit

Service 48Jordan, Thomas A., See Jimenez, Robert M 48Joseph, John J., Developing a Computer-based Learning Tool

for Handicapped Students 200Kinnen, Edwin, See Gram, Martha 98Kirkland, Eleanor, Writing to Read: A Computer-based, Language

Experience, Writing and Reading System, as used with HandicappedChildren 176

Kuns, Jerry A., Sensory Aids Demonstration and Training Center 231

Lambert, Howard, A Communications System for the Non-Vocal PhysicallyImpaired Person 40

Lazor, William A., See Jimenez, Robert M 48Lazow, Robert, Bridging the Technological Gap 142Leneway, Robert, See Swift, Richard 123Men', Fred E., A Placement and Management Information System

for Local Placement Programs 108Pamperin, Burge F., Self-help Groups for the Disabled: Professional

Involvement 135

Pfrommer, Margaret C., Utilization of Technology: Consumer Perspective 237

249 261

Risk, Harold F., Force Capabilities of the Physically Handicappedat Selected Automobile Driving Controls 15

Robbins, Robert C., Project Interact: Microcomputer Softwarefor Vocational Rehabilitation Facilities 243

Rodgers, Barry L., The Holistic Application of High Technology forConversation, Writing, and Computer Access Aid Systems 165

Roff, Barry See Lazow, Robert 142

Romich, Barry A., Integrating Communication, Computer Access,Environmental Control and Mobility 66

Rucker, Chauncey N., The Connecticut Special Education Networkfor Software Evaluation (ConnSENSE) 82

Sanchez, David J., See Jimenez, Robert M 48

Santee, Charles H., Real Time/Real Behavior: Using a Microcomputerfor Evaluation and Training 38

See, John, Biofeedback Training as a Factor in the Personal/VocationalAdjustment of Rehabilitation Students 148

Shafer, Dave, Using Multiple Databases in Rehabilitation Operations 209Solomon, Jeffrey, See Lazow, Robert 142

Swift, Richard, Employment Opportunities for the Handicapped inProgrammable Automation 123

Turner, Terilyn C., Designing Technology Centers for IlliterateAdults 93

Vagnini, Carol B., See Romich, Barry A 66VanBiervliet, Alan, Enabling Handicapped Nor readers to independently

Obtain Information: Initial Development of an InexpensiveBar Code Reader System 56

Wartenberg, Daniel, See Lazow, Robert 142

Wastvedt, Stephen, Control Data Disability Services: Division Overview..12Weiss, Lawrence H., An Improved Row/Column Scanning System 88Wilson, Patricia A., Incontinence - A Disabling Problem 28

Young, George C., See Robbins, Robert C 243

Zemke, Ruth, Microcomputer Activities in a Senior Day Care Center 5

2s0

262

Paper Index

Main Topic Areas

Artificial Intelligence- 74Biofeedback Training - 148Biomedicine- 219Communication- 40, 66, 153, 165, 214Computers-

Access- 1, 66Activities- 5Employment- 123Evaluation- 38Networks- 194, 204Software- 82, 108, 243Systems- 56, 38, 40, 74, 88, 153, 155, 165Training- 38, 102, 200

Driving Controls- 15Educational Programs- 82, 176, 148, 187, 194, 290, 224

Environmental Control- 66Facilities (Rehabilitation)- 5, 93, 108, 128, 209, 243Head Trauma- 219Incontinence- 28Information Gathering- 56, 88Mobility- 48, 66, 98Physically Impaired- 15, 40, 219Placement- 108Reading- 56, 176, 187Self-help groups- 135Senior Care- 5Services- 12, 48, 82, 119Technology-

Acceptance of- 43Application of- 165, 204Centers- 93-231

Consumer View of- 237Need for- 142, 224Services- 82, 119

document resume - eric · document resume ed 286 315 ec 200 494 author smith, christopher, ed. ......

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