Learning Switch Access for Computers and Communication Apps


What is switch access?

There are a number of alternative access systems that assist users of technology who have physical disabilities that make it difficult to use mainstream tools such as a keyboard and mouse.  

A person who may only have one or two reliable physical movements may be able to use switches if the switches are placed in the correct place, and/or they are able to repeat the physical movements to use them.

Switches and other alternative access methods come in a large range of sizes and can be placed almost anywhere to accommodate most types of movement. The largest group of switches are for limb or head operation.

 

(image source: https://cadanat.com/)

These include simple lever or pressure switches that can be used with a single movement of any part of the body. These range from grip and thumb switches, pressure switches, tilt or posture switches, touch and proximity switches. Some switches can be operated by suck, blow, blink (like nous), muscle, sound or almost any other voluntary action.

Switches provide people with disabilities access to education, recreation, socialisation, and communication. They can enhance independence and participation through access to toys, communication devices, computers, appliances, and power wheelchairs. 

Follow these 3 steps to teach switch access

To teach switch access, it is essential to assess the client’s baseline to set achievable learning milestones and provide the required resources. 

It is important for the client to be settled and ready for each session. Some important aspects that need to be considered are: 

  • comfortable positioning
  • having a support person present
  • eliminating any distractions that may be present (for example, too many people around, music, toys etc.)

For some users the first few sessions may be disorienting, so take the time to explain what they will be doing and why, and remember to take things slow

Linda Burkhart has written a number of informative articles on teaching switch access and scanning. Here, we have focused just on switch access. She proposes 3 steps to guide the learning process:

  • Experimental learning
  • Making something happen
  • Playing with two switches

Each step is them broken down into small, achievable tasks that shape your clients’ behaviour towards effective switch access for communication and interaction. 

 

Experimental learning

At this stage, the goal is to provide the user with a range of experiences that encourage them to look, listen and respond in a positive way. 

A multi-sensory learning experience is recommended to stimulate the client’s senses. For example, some cause and effect software now feature programmes that enable users to look and listen to the animations without having to control them. Sometimes it may be necessary to go beyond a computer screen and incorporate music, toys or colourful tactile materials to stimulate different senses. Each person is different, and therefore each approach will need to be customised. 

It may be useful to identify what motivates your client. This could be achieved by exposing your client to different objects and stimuli and gauge their response to them- are the responses positive or negative? Check these assumptions with family members, as they will have more insight on the user's preferences. In this sense, all learning needs to be personalised. The more senses that are incorporated into the learning experience, the better the outcomes. 

Modelling is often used to show a client how a switch can activate other toys or devices, and the teacher/therapist verbally cues the client, so that they know exactly what is happening and the steps taken to achieve it. If a person is learning to use a physical switch, the therapist/teacher can use "hand-over-hand” to help the user begin to associate the switch with a motivating reward. The therapist/teacher will need to cue the client by telling them what they are doing, but they do so by focusing on the activity, rather than the input device. For example, if the switch is used to access music, they would say "more music", rather than "press the switch".

Most sessions are kept short, so that attention doesn’t waiver and the tasks aren’t too overwhelming. This is particularly important for individuals with severe and multiple disabilities. 

At this point the therapist/teacher looks at the following outcomes: 

  1. client shows interest or pleasure in the sounds, images or movement patterns, looking more intently and for longer periods
  2. client briefly tracks objects moving in the horizontal or vertical plane
  3. client shows consistent interest in the experiences, reacting and showing positive responses to familiar images, sounds and activities
  4. client tolerates and participates in the shared exploration of the switch, including method of activation
  5. client reaches out toward the switch
  6. client independently explores the switch and its method of activation

Making something happen

To shift from the experiential phase, the client needs to develop an understanding of "cause and effect". This means that the client understands that they are able to extend influence and control over their immediate environment (an action on their part causes a response, either from other people or objects around them). 

This understanding is imperative to all future learning, and is not something that can be taught directly. Users develop this understanding through experiencing it in a range of different contexts. Access technologies and their associated software can provide clients with a broad range of developmental and age appropriate experiences of cause and effect- particularly switches which provide a less challenging way of interacting with technology, by just "pressing a button” to make something happen. Looking for switch training software ideas? AT and Me have written up this article that captures a number of great suggestions

Therapists/teachers recommend for their client try to achieve four skill areas through switches: 

  1.  Press and hold: the client presses the switch and holds it down to trigger an effect. This is thought to be the best way for a client to experience cause and effect, because the effect only occurs while they are pressing the switch. It reinforces the notion that the user is making the effect happen.
  2. Press and let go: the client presses a switch to start an activity that plays for a set period of time irrespective of whether they let go of the switch or not. Here, the therapist/teacher would try to encourage them to release the switch. This skill is difficult to grasp, as the effect is not explicitly linked to the pressing of a switch.  
  3. Repeat press: this is also referred to as 'switch building', where the client is asked to press the switch a number of times to gain a reward, or to complete a simple sequence. 
  4. Turn on and off: this skill is also referred to as "latching", where the client presses the switch to start the activity, then presses it again to stop it. An example of this would be 'playing' and 'pausing' a video clip in a media player. 

For all areas, the client needs to focus on the activity that results from using the switch, rather than on the switch itself. For example, if a switch is being used to operate a media player loaded with their favourite videos, the therapist/teacher would prompt them to use a switch by saying "Play the video", rather than saying "press the switch", so that their attention is not diverted away from the screen. 

At this stage the therapist/teacher encourages their client to focus on the effect they have created, as it provides them with a clear reason to use the switch. It's also important to provide opportunities to practice using the switch throughout the day to see whether there are differences in the usability. 

Playing with two switches

This final stage introduces the use of two switches in a free-play environment- there is still no formal expectation of using the switch for scanning. Here, the client learns to "start and stop" or select "this or that". It’s still about exploration and providing opportunities to demonstrate a preference. The client should be provided with time to explore the effects, rather than being told to look for or seek a specific effect.

  1. Start and Stop: in this activity, two switches are used to operate one activity. For example, one switch could start the mBot and another could stop it. 
  2. This or that: the two switches are connected to different activities and the teacher/therapist encourages the client to explore the effects that occur when they are activated. 

The aim of this stage is to gauge whether the client is able to operate two switches, before progressing to teach them to use the switch-scanning method. 

Want to know more about how you can use Nous with other switches? Check out this article