Assistive Technology for Kids with Multiple Disabilities - Chau Nguyen

I'm really excited to be here. I've been attending A11yNYC events since 2017, when I was participating in an event talking about adaptive fashion, so I'm really excited to be here. Today we're going to talk about assistive technology for kids with multiple disabilities. And Nora and I came up with this because quite frequently we see a lot of technologies that are created for people with disabilities that are inaccessible to the students that we're working with. We see some really amazing adap

tive game controllers like the Xbox. However, the vast majority of our students cannot access that due to their movement patterns, timing, endurance, and things like that. So, you'll be seeing me use some assistive technology throughout this talk, and then at the end we'll be playing some games on the computers and you can ask us more about those assistive technologies. Okay, so my name is Chau, I am a Southeast Asian woman with long, dark hair. wearing black. I'm Nora Henry. I'm a caucasian wom

an with long brown hair wearing white. All right. And since I already got a nice introduction, Nora brag about yourself. So I got my Master's of Science from the University of Scranton. I've been an occupational therapist for seven years and I'm specifically interested, in my work right now, in ensuring that what our students have at school, and the accessibility and the accommodations that they have, carry over with them as they graduate into adulthood, and so that they can continue being activ

e participants in the activities that bring their life meaning and joy. All right. So, we have many goals for you today. We want to introduce you to our students at iHOPE, and to show you how our students have different disabilities and how we can accommodate that. We want to talk about occupational therapy and assistive technology. We want to show you how to use commonly used technologies that our school uses, and ultimately we hope to influence you in creating more inclusive and accessible dig

ital games and activities for people with disabilities Again, we work at the International Academy of Hope, also known as iHOPE. We're located in Midtown and we are a school for kids and young adults, ages 5 to 21, with acquired brain injury. You can see a picture here of a classroom with a teacher in front raising his arms up in celebration, and students looking on. How many of you are familiar with occupational therapy, to start? Okay, great. Most people think we help people find jobs. We don'

t help people find jobs, but we could help people get the skills that you might need to have a job. So really, we use occupations to enhance participation. There's lots of different ways we do that. It could be rehab, so building skills that were lost as a result of injury or illness, rehabilitation. So, building new skills, focus on health and wellness, and then also adapting. So, just like all of you here, we all do lots of occupations throughout our day for our students. When they're at schoo

l, we're helping them with their meaningful occupations, which are participation in their academic activities, in the classroom play, in leisure, self care, and vocational activities. So, we work on a lot of skills as occupational therapists to help our students participate in the activities that they want to do. And this can include motor skills, so moving themselves or interacting with other objects, and this can include strengthening and endurance, fine motor skills, bilateral coordination, w

hich is using both hands, and gross motor skills, lots of motor-related activities and therapies that we can be doing with our students. Something a little less known is we work a lot on process skills, so more of those cognitive skills that are supporting those motor skills and other ways to participate. So this can be organizing time, which means are our students initiating a task. Can they continue through the task? And then can they stop the task. We also work on sustaining performance. Are

they attending the whole time? Do we provide supports to help redirection? We also work on applying knowledge and adapting their performance. So, how they can use their own skills to adjust and adapt any given activity. We can probably talk about process skills for five hours, but we have to move on, and it's a really amazing and fascinating part about occupational therapy that people know a little less about. We are known for working on sensory processing, so accommodating differences in vision

, hearing. For some students, they could be overstimulated or understimulated in many of their senses, including touch, vision, hearing, vestibular, means movement. So, a lot of our students really seek out movement, and others might be afraid or do not like movement. And also proprioceptive input, so that means understanding where your body is in space, but also accepting or. deep pressure really. a lot of our students really benefit from deep pressure and others dislike it. So, we do work a lo

t on understanding different sensory systems to help our students through their occupations. We do a lot of therapies to support different skills, but we have to remember that we are focusing on participation. We do not see our kids as, this kid has sensory processing difficulties. We see them as, this part of them affects their participation, and how can we make it better for them, so that they can more easily do the things that they want to do. We're going to talk a little bit about our studen

ts, they all have acquired brain injury, and Nora's going to show you. Yeah, so all of our students are really unique and they have really individualized setups in the classroom to help them participate. On the screen, you'll see two pictures. In the first picture, we have a male student who's lying down on a bean bag, and there is a camera mount with a green mechanical switch mounted above his forearm, that he's using to communicate with his teacher in an academic session. In the second picture

, we have a female student. She has two switches. They're positioned right below her thumb, and she uses those to communicate throughout her classroom activities. And then, in the next picture, we have a student who's seated upright in her wheelchair, and she's using a big red switch to take pictures of herself on an Apple computer. So, again, our students have acquired brain injury, and this can include many different diagnoses. Most of our students have cerebral palsy. They can also have traum

atic brain injury or seizure disorders. Are most of you familiar with these types of diagnoses? Okay, great. Something that a lot of people are not very familiar with, and I definitely wasn't starting out as an OT, is what's called a Cortical Visual Impairment, and this is brain based visual differences. So, most frequently the anatomy of the eye is intact, and so there's differences and signals from the input and output of information from your brain into your eyes. So, this screen could look v

ery fragmented to some with Cortical Visual Impairment. And we do a lot of accommodations so that our students can more successfully use their vision. You can see this slide. We have a black background with yellow text. Most frequently yellow and red are colors that are best seen by people with Cortical Visual Impairment, and we like to use high contrast san serif fonts, movements, so, you know, animations inbetween the slides to catch their visual attention. Reduce visual complexities, so we do

n't need crazy patterns on the page. We give increased time to respond to those visual stimuli, so it can be between seconds to even minutes. And add other sensory components, so if vision's difficult for them, we might add more auditory components to an activity. This is an example of how we make images digitally more visible to our students with CVI. So, again, we have the black background, we add a red or a yellow or whatever color that the student sees best around the image so that they can

see it better, and this is easily done on PowerPoint. I'm using Canva and that's really easy to do. So, we try to do that for every digital material that we are presenting to our students who have cortical visual impairment. So, let's talk about some of the motor differences and other differences related to brain injury. Our students move differently. It can be with how they're moving, we have full range and we can move in all directions, and for a lot of our students, they might move in certain

directions, maybe forward, backward, maybe not the same range of motion, or they can be hyper mobile as well. And processing movements, so a lot of our students might take up to minutes to process a movement to access a switch like this one. So, we are always accounting for those differences. And, just like us, you may wake up one morning and your body feels different than it did the day before. Our students are just like that too. Every day their body might feel different, so they might need m

ultiple modes of access throughout their day to account for endurance and all of those factors as well. And then, if you remember those pictures that Nora was showing you, we've had students who are lying down, they were accessing a switch with their forearm, or their thumbs, or their hands. But some of our students have the best movement in their head, so we are mounting their switches on their wheelchair so that they can access with their head. It could be a movement like this, right there. Ok

ay. \We are also accommodating sensory differences, so our students can really enjoy touch, or really dislike touch. And we are accounting for those activities to make sure that they can best attend to a task. So, for our students who may like textures, we might add textures to a switch. We also account for auditory and hearing differences. Some of our students have little or no hearing, and some of our students might have little to no vision, and some students might have both of those things. S

o, we're always accommodating and understanding those differences, and individualizing how we are presenting activities and providing those adaptations. We also have communication differences. Our students use alternative and augmentative communication. You can see a picture here of a child sitting in a wheelchair with a communication device mounted to their chair. Some of our students use devices such as this one. This is called a step by step, this is a speech output device. I press... Hello,

hello. Welcome to Accessibility NYC. So, you can record a bunch of messages on here, and every time you hit it we'll have a different message. So, we have a couple, we have one at that table that can only do one message, and then we have one at that table that has, I think, the same message as here, if anyone wants to try it, and then we can play with it later and record your own messages, and we can do really fun activities. We tell jokes, really have conversations with people, and even intervi

ew people. So, it's a really great tool for our kids who are not using the more high tech communication devices. So, we meet our students where they're at, we focus on their strengths and their differences. We don't see our students as, you know, they have reduced range of motion, and they are, they are not very strong, we don't see them like that. We understand that they have challenges related to their differences, and then we help them do activities by focusing on where they're at, and focusi

ng on that participation. And I think that's a huge strength of occupational therapy, we just celebrate those differences, and make sure that the world is more accessible, inclusive, for them. All right, so we'll talk about assistive technology, and durable medical equipment. So, we're going to talk about some switches and some of the things that we use with our students. You've seen me use this switch right here. This is a spec switch, mounted onto, what do we call this mount.? Goose neck mount

. So, this is a flexible mount, and we have a switch velcro'd, and this is a mechanical switch, meaning that you need to apply some force to this switch. So, this is the most commonly used switch. We also have a wobble switch, so this can be activated in more directions than that button switch. And then the one that you see at the top, we have this black and silver switch, and that's called a micro light switch, so you can access with very light touch. So, many different mechanical switches that

benefit our students differences. For the ones who are very strong, we might give them this, a bigger version of this switch, and they can hit the switch as hard as they can. We also have softer ones as well. And if you look at the mount Chau's using, as well, if you think of how much force somebody has, if a child pressed really hard on that switch, that mount would move, where this one over here, if you give it a good tap, that mount you can secure and it will stay in place a lot better, so

that's just another thing we're thinking about when we're looking at the individual needs of our students. Yes, and quite frequently we are mounting these to their wheelchairs. We'll talk a little bit more about mounts in a second. So, we also have proximity switches. You can see that orange and white switch. As the name says, you do not have to touch the switch, you just have to get in close proximity. This is another proximity switch, this is called a honeybee switch. It is a yellow and black

switch with sensors. So then, when you get close, I don't know if you can hear the beep, but it beeps to tell you that it's being activated. And then this one you can calibrate to how far or how close that you're going to activate the switch, which is really great for our students who have smaller movements and hitting a mechanical switch could be very difficult and affect their endurance. And we want... we give switches to give access, not for a workout. We also have electrical switches. This o

ne is a neuro node. It is a white switch with a black logo, and you attach it to a student's body where they have trace muscle movements, so it can sense some of the electrical stimuli from the muscles, the electrical currents, so then the child can access those switch adapted activities. So, it's pretty complex. It's a really incredible piece of technology, I think. It's pretty advanced technology where a student may... You might not be able to see their movement with your eye, but their though

t, like how their brain is telling their muscle to move, it picks up, so it's pretty incredible. So, we talked a little bit about mounting. We are accommodating how strongly our kids are accessing the switches. Some of our students might need subtle adjustments throughout the day or even an activity. So, this one is great, you can constantly adjust it to wherever it needs to be, because our students can move differently, even within the hour, during activities due to fatigue, or their movement

s are a little less consistently in one place. We also accommodate seating and positioning. We have four images here of different types of seating devices. We have a manual wheelchair, we have a stroller, we have an activity chair, and we have a power wheelchair, and we are using these technologies for every single one of these equipments. And so, I have this one on this chair. Normally, I would not put a device on the back rest, because that will be really uncomfortable, but you can kind of thi

nk about where you might put a mount. Anywhere on the chair can be pretty complicated sometimes, because there's only so much metal on the chair that you can attach it to. So, hopefully later you can definitely take the mounts off of the table and play around with them, and see how you, where you would put it for the access that you're looking for. You would put a mount differently for, if someone was using their foot or their leg to access a switch, and differently for the head or the arms. So,

let's talk about adaptive play, that's why we're here. OTs have the best jobs, because we get paid to play with kids, and it's such an amazing job. I hope that you get to see OTs in action, aside from our videos. We use switch adapted toys, so we can do our own adaptations. Nora's going to show some of the things that we have. So, we have a dinosaur toy, and we add some hardware to this toy, so then you can attach a switch to it, and then the child can better access the toy, versus using a real

ly tiny little switch that is very difficult for them to turn on and off. So, we do more than just have the animal move, we have dinosaur fights, we do bowling, we attach paint brushes to them and they do some really incredible art as well, so our students really enjoy these toys. And we also have commercial toys that are adapted as well. This is... So, I love this video. This is a boy who is using a head switch to turn on the toy, and he must have done this at least 20 times. He just loves scar

ing himself, and it was so motivating for him to do so. I believe he's using the switch on the left side, and it's likely that he has his right side switch attached to a communication device like this one, so he can make comments about it. So, that's one way that we can do switch adaptive play. And we love the holidays, because at drug stores you have all these holiday toys that you can switch, adapt, which is really great. This is... So, one of my OT students made a catapult, out of a remote co

ntrol car that released the catapult. So, you can see, the student presses the button at her tray, and then I am the target. And so, that was really fun. So, you know, you can get really creative with the ways that you play. A remote control car doesn't just have to go in the four directions, you can attach it to things. And kids just really liked getting their therapists all soaking wet, it was really funny. Do it again. It's a switch. Do you want to swing water? So, we have a student here usin

g a single switch to activate a blow dryer. Sometimes we wet our own hair, sometimes we bring in a staff member's dog and we give them a bath, and then the students get to dry it off with the hair dryer, and it's a really interactive fun way to have kids help with, self care. And then we have hair dryers with a game, using two switches. So, our student is controlling both hair dryers, and seeing which person wins. So yeah, you can get really creative, and our OTs are so incredibly creative at i

HOPE, so have such a great time playing. When we're thinking about playing, leisure, those are activities that are really supposed to be restorative, so they're supposed to be fun, exciting, and motivating to the student, especially for our students. A lot of what they're asked of during the day is really difficult for them, so finding these moments of just, like, joy that are fun and motivating, and also build skills, is really important. In this picture, I had one student, I was having a littl

e hard time finding stuff that was motivating for her, and so I had mentioned that she... we have scissors that can be plugged into a switch, and you turn them on and they can cut, so I told her that she could cut my hair, and she was overjoyed by the thought of it. So, that was... We'll really just go to any length to find something that's meaningful and motivating, and... And how much hair did you get chopped off? I think she cut 10 to 12 inches off. So yeah, [laughter] go big or go home. This

is a computer game that we use with our students. It's a website called Help Kids Learn, you have to have a subscription for it, and they have a lot of amazing switch adaptive games. However, there's very few websites that offer games that can be accessed with one or two switches, and you can play with them later. I'm going to show you some pictures of them, and we'll have them on our computers when we're done with this. This is a game that requires two switches. You can see it's CVI friendly,

so there's a black background, simple pictures, and then one switch can build the rocket, and then the second switch, the astronaut can come in, and then it launches. So, this is a great way for students who can use two switches, or a motivating way for students to learn two switches with two different functions. We also have games, so we have a variety of eight games here, that are all activated with a single switch. So, you might see, they might have movements and just some strong visuals with

the hit of a switch. So, it can be very simple to a little more complex. So, we also call that cause and effect. So, how did our students access these computer games? We do have hardware that supports that. This is a switch interface, this is an amazing piece of equipment. What you can do, you can see in this picture here, you can plug in up to five switches, you can see where the arrows are pointing, and then we have the color coded rows, to pick out which switch function you want. So, you can

move your mouse, you can press space, enter, left click, right click, double click, arrows, for whatever computer activity that you want them to do. So, you can make basically anything, switch adapted. Oh, why did I do that? Okay, well, that's the switch then. So, I'm going to go back. And so, I've done some really great online shopping with my kids, they're really motivated when you say they can use your credit card on Amazon. So, then I will just hover over 'click credit card', and they'll us

e their switch, and then they get to purchase that, and then the item arrives, and then they can open it and see what we bought together. So, only get the cheap stuff though. But it's really fun to do the online shopping, especially with our older kids. The school we work at, there are students aged 5 to 21. So, as they get older and their interests are changing, we're keeping up with the tech to help them continue to engage in meaningful activities across the lifespan. There's lots of different

vocational activities that our students can participate in, with a couple of different tools and adaptations. The first thing we have is a picture of a power link, it's a white circle and it has two outlets. Basically with this tool, anything you would plug into the wall to turn on, can be plugged in to switch it up. So, you think of things like a blow dryer you saw earlier. If we're doing cooking activities in the school's kitchen, we can use a blender to turn on and off to make smoothies, any

sort of thing we're making. A coffee grinder. Sometimes we'll have the students grind coffee, and then they'll have a coffee sale in the school and sell to staff. Hand mixers. We also have a tool called a pour cup, so, as you press the switch, it will pour out ingredients. We'll use that in cooking activities to measure ingredients, pour ingredients. We also then can use that tool during art projects to pour paint, in games to, like, pour out a dice, to roll the dice, so we can get really creat

ive with those. And, here is a video of a student using switches mounted by his head to turn on a blender, and he's actually helping to blend his own lunch in this this video. And I think, for a lot of our students, they really enjoy being a part of the activities, and it can be really empowering and motivating to have control over a lot of these activities. Some other vocational activities we do with our students are housework or office work. So, with the power link that I mentioned, we could p

lug a vacuum into it. They can help mom and dad at home turning the vacuum on, turning the vacuum off. In our school, students will help... admin will plug the paper shredder in, and they can turn it on to shred paper. The pour cup they can use to water plants. We've had students who've had class pets like a fish, and they can change the water, they can use the pour cup to feed the fish. We have therapy dogs who come in, and they can give the dog a treat using these tools. So, really, just with

one piece of technology, we can do a lot of different activities. Up on the screen you'll see a picture of a what's called a Tapio Interface. It's a small white usb, and then, with an adapter from Apple, it can be plugged into an iPad to make iPad activities accessible, similar to what you saw with the switch. Something we use a lot at iHOPE, is something called a recipe. It's an accessibility feature that's built into Apple products. Basically anything you would do with your finger, tap the mid

dle of the screen, swipe right, swipe left, scroll up, scroll down, a custom gesture, you can program in so that when the student hits their switch, it will do that gesture for them. This feature has really opened doors for a lot of our students, because there's so many things students are motivated for on the iPad that they can then do completely independent, whether they're at school, at home. We do a lot with recipes at our school. Here's just a few of them... so they can take pictures..., P

ress the little button on the iPhone to take the picture. With that, we can make it a two switch activity. So, one switch can take the picture, one switch can change the orientation of the camera, so they can decide if they want to take a selfie or take a picture of something that they see. They can scroll on Instagram, so you can make that recipe, scroll up, scroll down. A lot of times they'll take pictures for classroom activities, and then they can scroll through them, and they can scroll and

tell us, I like that one, or delete that one, or we can create the recipe to scroll right and then scroll back left. We use this a lot for access to books, so a lot of books that you'll find on the Internet, you tap a specific place to turn the page, or it's a tap in the middle of the screen or a scroll left to right. We'll also do a lot on Spotify, Pandora, they can make their own music playlists and then control them, so we can set it up for them to play, pause, scroll through a playlist, sam

e thing for controlling podcasts. And then also online shopping, often we'll have them scroll on Amazon, when they see something they like, we use a voice output that tells us to stop, or I want to buy that. So, really, the opportunities for them to participate on the activities are endless with this feature. Which brings us to, unfortunately, there are a lot of barriers to accessibility, I know we've mentioned a few. One that Chau mentioned at the beginning, some accessible things that are avai

lable, like the Xbox controller, other adaptive controllers, are not accessible to our students and their needs. Also, if you think of websites that already exist for children to play games, a lot of those websites are really visually complex. And if you think of companies who are making websites for children, that's what attracts children, bright colors, lots of fun pictures, that's not really suitable for our students. Also, on these websites, you'll see there's a lot of ads and popups that ca

n get in the way of accessibility. Some of these games are also really complex, they're based in timing, in repetitions, which for our students and their motor demands are very difficult. Then we're also thinking about what interfaces we use on the computer. So, up here you see two images side by side. In the classroom, a lot of times when our students have projects, we'll have them look through images on the Internet and pick the ones they want to use on their poster board, or if they're design

ing a blog or making a scrapbook, we want them to be a part of that process, and when we're setting up that activity for them, we want to make sure we have the best interface. So, on one side, you'll see the interface that Google has when you Google images, and so, initially, when you Google the image, you'll see a row of multiple items, and then, as you click on one, it will, on Google, it gets slightly bigger on the side. So, up here we have a picture of dogs. But, as you can see, there are 1,

2, 3, 4, 5, 6... 6 and a half pictures of dogs on the screen, especially with students who have CVI, as Chau talked about, this image is really visually distracting. You almost don't even know what image you are looking at. On the other side, you'll see what Yahoo Images interface looks like, and, on this side, you see one picture of a cat, it's blown up. It's taking up almost half the screen, and they've blacked out the rest of the background. So, when we're working with our students, we would

tend to pick the Yahoo interface, it's easier for them to look at. There may be settings on Google where you can change how that looks, that's not something we've figured out. It wasn't actually always like that, that's something that's changed in a few years. But it's something we're thinking about, as we train families, as we work with ourselves, really just what is easier and more accessible to our students. This next thing, almost an obvious one. Money. So, we have a picture of a board game

up here, it's called Pie in the Face, it's a bright yellow box on Amazon. You can buy the Pie in the Face board game for $17.99 Enabling Devices actually has a commercially sold switch-adapted version, which is awesome, the cost of that is $154.95, which is way more than double the price of it. With the Enabling Devices board game, it also does come with a switch to use the board game, so that would be another cost for the family. It also doesn't come with a mount to mount that switch, and thos

e things add up, and, as you see today too, tech can be tricky. So, if it breaks, which it may, or you need troubleshooting, it can cost a lot of money to have accessible activities. And then, just general limited opportunities. At our school, we almost have this hub of accessibility for our students, that is amazing. We have a lot of access to tech, we have a lot of knowledge, between the people who have trained us, our peers, but that's not always true for when they graduate, there's a lot of

red tape. One of the funding sources in New York City adds complexity to that. They'll pay for adults with disabilities to participate in activities in the community, but the activities have to be activities that anyone can go to, because they're looking for inclusion. On the other side of that, you have students who are like ours, when they go to those programs, or they go to cooking classes that you or I would go to, they don't have any of this tech available to them, so that kind of leaves th

em with not much to do when you lose the school setting. Same with the websites that Chau was showing you: Help Kids Learn that she mentioned, that's a website that our school purchases, that our students can then use. When they leave us, they lose access to that. Right now, there's also not a lot of access to caregivers, for people to support them, as they go to these activities. There's a lot to think about in maintaining what is created in the school setting, and carrying that over through th

e course of a lifespan. So, if you want to learn more about what we do at iHOPE, you can follow us on Instagram, @IHOPENYC, and you can also contact me and Nora, my email is Chau@HelloChau.NYC, and Nora is Nora.Henry@YAI .org. Please reach out to us, we love talking about accessibility for our students and we want to advocate for the best for our students. But now, I would love to have you all come up here and try some of the technologies. We would love for you to record your own messages, and h

ow you might think of an activity, and how someone might have different messages on there for that. We have our games, we're going to have some computer games up here. Play around with the mounts, see how it's not always easy trying to figure out where to mount these. So, that is all we have right now. Does one have any questions before we start playing? We'll start with a question from YouTube, It'd be helpful to discuss, identify any tools or approaches or organizations that try to work and pl

ay with children who are cognitively disabled, not injured, no physical trauma or disease. I guess just a question on, maybe tools or, approaches for cognitive disabilities. So, I think, a lot of times, if kids receive the services that they are mandated for with ADA laws, and hopefully they are at a place that has accessible education, they're going to get a lot of that through their schools, or if they have outpatient activities as well. Unfortunately, some of the organizations that offer assi

stive technologies to students, those are pretty hard to find, and for parents too, on top of managing their kid's school medical needs and their other children, no one has time to figure that out. Nora, what else do you have to say? Yeah, I would just recommend too, OPW D is a New York State service for people with disabilities that families can register their children with, I believe it's once they turn eight years old, and then there's lots of resources within there that can connect to servic

es you may be interested in. Yeah, and I'm hoping that it's not just a therapy, like occupational therapy, speech, or physical therapy, that introduces, although we help with the access component, but there are so many ways that other people can be aware and provide those assistive technologies as well. In using the neural switch, can you give some examples? Yes. So, we actually had gotten a trial of that switch to use at our school, we used it a lot with students who had really limited mobility

. One student I used it with, a lot of the movement she gets is in her head, so she can do kind of like an eyebrow raise, or a slight turn of the head, so we tried it in a lot of different places. The first place we tried was to... It comes with something that you can stick on to skin, we would stick it right there. So, when she moved her eyebrows up, you could see on the screen kind of like the movement of the muscle, and when it hit a certain threshold, that would activate the switch. And then

, we tried on other parts of the body as well, like something as small as a shoulder raise, that wouldn't be enough to hit a proximity switch, but then could be picked up by that neuro node switch. I don't know if you have any other examples. I don't. That's a really great, description of that. I really like the examples you all showed for doing the highlighting of the images, and you mentioned yellow, and the red for the borders. Is there a technique or tool you use to add those to the images,

that you'd recommend? We use a lot of readily available... a lot of people have Microsoft PowerPoint, and creating those black backgrounds, and then removing backgrounds of images, then adding the glow feature on them. After you do it a couple times, it's really easy, and it provides that adaptation. You can also do it on Canva, a lot of people are using Canva nowadays. I never use Photoshop, but I'm quite certain you can do it on Photoshop. There are easy ways to add those accessibility feature

s. We had one more question from online, this was around the recipes. Are the recipes shareable among occupational therapists, or is there a community of recipes that exist? I can speak to that. Inside Apple products, there are a few recipes that are pre-programmed. I believe it's, tap the middle of the screen and swipe left to right, where to use those. You would just have to plug in a switch, or use a Bluetooth switch to set that up. And then, from there, you are just creating your own recipe,

so it's individual to each device, you have to program it in. It sounds complex at first, but actually, once you get doing it, it becomes pretty intuitive. Thank you. [Applause] So, this we add what's called a battery interrupter, so we had to make a little hole, but then we put a piece of copper, and we solder it onto a mono jack, and then you can make it switch adapted, so most toys that have batteries and have an on off button can be switch adapted. Yeah. And you can also imagine some of our

kids have a hard time sustaining, so we do have equipment as well that, we can time it so then you can have one switch hit equals X amount of seconds or minutes, which is really great because for some kids just doing that, it might take away all their energy they have for the day. So, yeah. This will have... If you have a hard time seeing this, I can help you, but it has directives on producing, recording, and this one you can record many messages. Oh, yeah. So you can do, Hi, my name is Chau.

Welcome to Access NYC. Bye. Hi, my name is Chau. Welcome to Access NYC. Bye. So, they can use it right here, we can attach another switch, and then they are going to be accessing to say what they want to say, or if it's like on conversation, they wait. So, there's so many skills, opportunities, for them to communicate. So, yeah. So, this little device here can be plugged to other toys as well? Any toy that has this mono jack situation right here. So, we do have to adapt a lot of toys, because mo

st toys don't come with that, so that's one of the things that prevent kids from playing with what they want to, because I think, especially with single switch users, you need a lot of time to interact and I think, even PR wise, people, you do need a lot of time to be thinking about those things, and being patient, and learning that patience as a 10 year occupational therapy is nothing to me, but, for most people, be like, Okay, when is it happening? And then you'll be like, Okay, hit the switch

. And it's not about that, it's about playing with the toys. Exactly. Yeah. So, this is a microlight switch, it just needs a light touch. And then, we can bend this in all different ways that support our students. So, why don't you play around, it's a really heavy duty mount. So, we want to keep switches in the same spot all the time, so we use mounts so then we can guarantee that it's going to be in a similar spot, also, if a kid is in a wheelchair, and they need a switch at their head, and we

might not have that hardware on the chair to put that on. So, yeah. So, you can imagine sometimes we have races with two or more of these, and the kids are using that and it's really, really awesome. So, thinking about more than just like it walking, but it's really fun for the kids. So, yeah. That really grips the table. Oh yeah. Yeah, it is very strong. So many angles that you can get, because, quite frequently, we have to get to these really specific angles, really hard to get to from certain

parts of the wheelchair or table. So, yeah. iHOPE is a private school, right? Yes. It's a private school. Yeah. Your standard special education school might not have all those accommodations that benefit the students, which is why we exist. We would love to say any accessible education school can provide that, but we know it's the case, especially with our students, a lot of times they're just sitting in front of iPads all day, because no one really knows what to do. In addition, all of our stu

dents need at least one person helper, paraprofessional, with them at all times, and some of our students have 24 hour nurses. So, thinking about the range of disability that benefits from that support. So, we rely heavily on grants. We do have a fundraiser called Art Speaks, where kids make their own adaptive art using a lot of assistive technologies, and we raise a lot of money that way. Some kids have other funding sources to get these things, but, ultimately, insurance is not paying for this

. You know, you're lucky if your school has two switches, and then what are you going to use with the switch? So, it's a huge barrier to that, and we wish that it can be offered to everyone. Also, these switches are very expensive. They're very durable, but they can start at $60 and up, like more than that. Yeah, they can be hundreds of dollars. So, you can 3D print switches. They don't last long, but you can 3D print switches. Yeah, you have got to do a little bit of soldering, but you can do t

he hardware. We have a few, but they don't last very long, but when our kids are like that [bangs switch hard] on it, it's not going to last very long. So, yeah. What are other things that you guys, also, helping them like to practice, like motor skills or anything? Skills like other than playing with switches? Yeah, we do a lot of activities with daily living, helping them dress themselves, helping them do toileting, wash their hands. We help them access their materials. We do a lot of position

ing, so a lot of kids have very specific positioning of their bodies that can help them throughout the day, so what they might need for academics might be different for play, and also accommodating their health. Most of our students are wheelchair users, and sitting in a chair all day, it's really hard. So, we do have time outside of their chairs to do recess, and they might do activities lying down. But, think about how you sit in a chair with the 90, 90, 90 degree, we do strive for that, but a

t the same time, it's very tiring. So there's so many little... these decisions, and accommodating, and fatigue, and all these things that are what we do in OT. So, to get here, to get the mounting, to get the positioning, to get the right activity, to accommodate vision, I think some people forget like what goes into that, versus, Oh, you just play, anyone can do that. I'm like, No, I wish everyone can do it, but that's why we have OT. So, we have speech, physical therapy, vision therapy, heari

ng, we have academics, we have music therapy, we have an artist with cerebral palsy leading an art group with her communication device. And then, we get to do some amazing out of school trips, pre-covid, we go to the Met, have New York City Ballet come to us and do adaptive dance, We are developing a swimming program right now, so we do so many amazing things for our kids that they might not have the means to access otherwise. So, it's a really special place, but you're not going to see the fund

ing and all this equipment everywhere. So, yeah. Because our kids vary so much. So, we do have materials that are generally accessed by all of our kids, but then we have some smaller adaptations that we can do, like we can use a slant board. Some of our kids use black background, but a lot of it is positioning related, so we individualize everyone. But every student has a one to one paraprofessional with them. They all have hours of therapy, that's not just work, it's like engagement, access, th

ings like that. So, they have a team that can support that, and hopefully it's carried over at home. And we have computer games. They're a little fussy, but we can try if you want... How do you get access to these newest technologies? Do you have vendors that come to you, like you have vendors? Yeah, we get a lot of free stuff, because people are like, Oh, you're a school, and then we rely on grants and like fundraising for a lot of it. So, it's tough, a not perfect situation, but more ideal tha

n 99% of what you see out there, and that's not always how we want to do things. So, let's try... this bumper cars game and... Hi, I'm going to take this and set up some switches. So, we have different colors so you access each row. Okay. And then you... So, it takes a second to understand that, and so I'm going to use space right here and I'm going to, because it's right here, Space Green. So, this is space, enter, left click, right click, we have our arrows... You can play a game with two peop

le. I don't have two switches right now. I don't want to take away a switch from anyone, so this is going to be a one-sided game, and so the kids will be playing, and like, who's going to win? And you've got to really use your switch. So, it's bumper cars, and then I would have another switch here, so then the other car can move, and then we can keep track of who's going to get the highest score. So, that's one way that we can play, make it interactive. It's not just one student playing one game

for themselves. So, this one you want to hit the other car. So, for other ones, we have basketball, we have sequential games as well. We use that a lot for our younger kids, but our older kids like it too, so this has... it's counting, but it's with song, and it's simple, and it plays, so it goes up to five, so there's many varieties of that. So, very simple, but something that our kids really enjoy. Some of our young adults like it, like what else can we make that you can use a single switch f

or that. We can also read digital books using this, using some websites, so we have Tar Heel Reader. And, we didn't get to show you this, but this is like very switch adaptable. It is the least sexy webpage I've ever seen in my life, but you can make your own books. You can space and enter to turn the pages back and forth, and then we can read together. So, it's a really interactive experience, so things like that for access to books. And then our kids can write the book and they love being real

ly savage about it, so then we ask, and yeah, so there's so many things that we can do, but we need more. And that's why I'm here today. So, yeah.