Switch Buddies: A Package to Facilitate Using Technology to
Encourage Participation in Pre-school Aged Children.
Kidd J., Cook S. and Newell C.
The aim of this project was to develop a package that could be used by
therapists, teachers and families to increase the ability and motivation of a child
with a severe physical disability in using a single switch for communication and
play. Modules were developed to use with children in individual settings, group
settings and within the pre-school environment incorporating the use of computer
software, switch operated toys, powered mobility and communication devices.
Switch Buddies will continue to be refined and evaluated.
Background
It is a widely understood that play is a child’s way of learning and an important outlet for
his innate need for activity. Play helps a child learn to explore, develop and master
physical, cognitive and social skills. It helps a child cope with frustration, anxiety and
failure, and facilitates children in to adapting to their environment and culture. It assists a
child to increase competence in his world. For each child, play is a serious undertaking,
not to be confused with diversion or idle use of time. (Alessandrini, 1949. Simon and
Daub 1993 – cited in Isenberg and Galongo 1997, Cotton 1984, Piaget 1952)
The theories of Lev Vygotsky (1978) suggest that play is a critical scaffold that enables
children to advance to higher ability levels in developing areas. Play provides an
opportunity to develop initiation, planning, problem-solving ability, communication and
social skills. It provides a vehicle for children to practice skills so that they are eventually
able to accomplish tasks independently.
For children with significant physical disabilities participating in play situations with their
mainstream peers can be extremely difficult. Assistive technology can help to equalize
the environment and allow the child to play both alone and with others. As Besio (2004)
observes, technology can offer children with motor impairments many opportunities to
overcome their physical impairment so that they can gain access to play activities and
undergo regular cognitive and linguistic development in the same settings as their peers
without disabilities.
Access to assistive technology equipment, training to use this equipment and
appropriate ideas/activities to apply the use of this technology is a common problem for
families and educators. Becoming familiar and confident to develop fun and educational
leisure activities takes time, a commodity that is in short supply for all involved with the
child. For children who have significant physical disabilities these barriers mean that
they are at risk of not being able to develop play based skills as described above.
The Switch Buddies package was designed to provide background information, activity
ideas, and the associated resources required to assist children who are physically
unable to actively participate in many of the play activities typically engaged in by
preschoolers. A further aim of developing and implementing this package was to
increase the level of confidence of the preschool teachers and parents involved in using
assistive technology and encourage their child’s participation in play at home and at
preschool.
Participants in the Switch Buddies Program
The Switch Buddies resource was initially developed for use with five preschool children
(three and four year olds) with severe cerebral palsy. All the children in this group were
non verbal and had significant upper limb involvement. The children were assessed to
ascertain baseline skills in regards to switch access and communication. Several of the
children had had some limited experience with switching prior to their involvement with
the Switch Buddies group. None of the children had had experience with powered
mobility. From the assessments a profile was developed for each child - see appendix 1
for the profile template.
It was determined from their profiles that it could be reasonably expected that all of the
participating children would both benefit from and require the use of assistive technology
for mobility, curriculum access, communication and play both at the start of the
program and in the foreseeable future. In light of this, the program was formulated to
address issues within these four related core areas. Additionally it should be noted that
an overarching requirement was for all the activities within the program to be both fun
and engaging for both the children and families involved.
Switch Buddies Content
The Switch Buddies package includes twelve modules based on core concepts for
preschoolers. Each module contains:
 lesson plans for centre and preschool based sessions detailing activities for
building skills in the areas of communication, computers, powered mobility, crafts
and games
 “Can I Play Too” – Two ideas for participation in craft or group games were
included for each session
 Handouts with home activity ideas
 A CD ROM containing computer activities
 A CD ROM of PowerPoint books
 Symbols cards/boards for use within the sessions as well as overlays for
communication devices
The package also contains:
 Templates for developing a profile of the child’s abilities
 Templates to allow users to add their own resources to the packages
 Relevant references
The package was intended to provide each child with opportunities to experience play
across different contexts, multimodal switch use, exploration of single switch scanning
as a further development of the child’s switching skills, development of early literacy
skills in conjunction with Augmentative and Alternative communication (AAC) and
participation.
1. Play across different contexts
At the clinical centre: The children were able play with switch toys and use
switches in a game or craft activity. The child’s progress was monitored and
reviewed so that any necessary changes could be made, to increase the likelihood of
success. See appendix 2 for an example of the session plan.
At preschool: It is understood that when considering how well children maintain
their skills after initial teaching, children tend to be much more likely to use their
newly learnt skills when involved in inclusive settings (Foreman 2005). In light of
this, sessions were developed for a group of children at the pre-school, in this way,
the special needs child was just one of the participant’s in the group. All children
experienced using the switch as part of the program. The activities included using
the Step-by-Step Communicator©, and music activities.
Additional activities and ideas were given to the preschool teacher. The aim for the child
with special needs was to continue to enjoy more participation in play activities with
peers. The aim for the teacher was to use the technology to encourage a higher level of
participation in the preschool setting.
The preschool program was reviewed following each session and changes
implemented. It was important that activities were easy for the preschool to
implement if there was to be any carry over of technology to this setting.
At home: Activities were given to the children to continue switching practice at
home. This meant that the centre needed to loan equipment to the children, as they
did not own equipment at the beginning of the group. Switch activities were
developed for the computer and given to the children at the end of each session.
2. Multimodal switch use:
Daniel et al (1995) note that children with severe and profound disabilities worked
best when provided with a variety of multimodal stimuli. Similarly a study by Sullivan
and Lewis (2000) discusses the benefits of motivation, attention and fostering
engagement with the environment that can be gained by use of single switch. In
considering this research it was determined to be important to incorporate multimodal switch use within the Switch Buddies program. Children involved in the
program were given the opportunity to to experience switch-use in the following
situations.
a. Powered wheelchair
Activities were developed for the children to experience mobility in play. For
example, in the music module the children practiced the concepts of start/stop with
the music.
b. Computer games
Commercially purchased programs such as Toyshop© and Jigworks© were used.
Other cause/effect activities were developed using Microsoft PowerPoint
©
c. Communication devices
Simple voice output devices were used for greetings during group time. There was a
communication based game developed for each module.
d. Group game or craft activity
Activities were based on what children of a similar age would be doing at preschool.
One example was ‘bubble painting’. A fish tank aerator tube was placed in a
container of coloured detergent. The aerator was attached to a PowerLink 2 © with a
switch. The children were then able to create bubble paintings.
3. Exploration of single switch scanning as a further development of the
child’s switching skills.
Wagner et al (2006) have highlighted the cognitive demands of linear scanning in
comparison to direct selection on a communication device. Despite concerns
regarding the cognitive load of single switch scanning it was felt that development of
this skill would provide a range of new activity and access opportunities for the
children if they were able to master this technique.
In order to introduce scanning set activities were used in each session.
a. Choices were presented to the children as a form of manual linear scanning.
In ‘circle time’ the teddy activity was deliberately used as a way of practicing
scanning. Teddy’s clothes are placed in a line. The teacher then asked “What
will teddy wear today?” and then pointed to each outfit in the line and waited
for the child to indicate his choice (by vocalization or pressing a noise maker).
Song choices were also made in this way. This method of choice making was
used consistently throughout the group and presented at preschools.
b. Games were developed to teach and encourage scanning
c. Opportunities were given to some children to use scanning with the computer
and the communication devices.
4. Development of early literacy skills in conjunction with Augmentative and
Alternative communication (AAC).
Much has been written regarding the importance of story reading throughout the
preschool years and how it is important in language and literacy development. Light
and Kelford Smith (1993) found that children using AAC were less involved in the
story reading interaction. They seldom asked questions about the story and they
relied on their parents to interpret the stories meaning. A study by Light, Binger and
Kelford Smith (1994) found that children using AAC had few opportunities to
communicate about the story (children did not achieve an active role in the story
reading process) they also had few means available to them to participate.
The Switch Buddies program placed emphasis on story reading and providing switch
based activities that allowed the children to participate in story reading, in controlling
the pace of the story, in interpreting concepts in the story and in applying these
concepts to other situations.
Activities in the Switch Buddies Program were based on a number of children’s story
books. Books were chosen to cover particular language concepts and core
vocabulary as listed by Banajee, M.,DiCarlo, C., and Buris-Stricklin, S. (2003).
Books were scanned into Microsoft PowerPoint© to allow the child to “turn the page”
with a switch. The following strategies provide a picture of how the kinds of strategies
used within the program:
- During group time various activities were based around the story – whilst focusing
on development of related skills such as sequencing, categorization and
development of receptive language. Concepts presented in the books were further
developed during the group session and taken as a literacy activity to the preschool.
- Stories were read onto a Step-by-Step Communicator© or made into PowerPoint
books allowing further and varied switch practice. Additional scanned stories were
given to the child for reading and switch practice at home.
- Vocabulary relevant to the story was made available on communication devices.
Resources within the Switch Buddies program related to a range of systems
including the Step-by-Step Communicator© Tech Speak II©, the Springboard© and
Compartmentalised Sequential Scanner©. Picture Communication Symbols© and
Minspeak © symbols were used in the activities.
5. Participation
Von Tetzchner, S. et al. (2005) considered the issue of language development and
inclusion of children in a preschool setting .They found that
“Inclusive educational settings may promote the development of children using
alternative means of communication when all or most adults and children in these
settings have at least a basic competence in the alternate communication form”.
The focus of the Switch Buddies package was to promote participation of the child
with a disability rather than being content with inclusion only. That is to say the child
with a disability was to be an integral part of the activity not an observer or a
peripheral contributor (eg. Not only just holding the equipment on their wheelchair
tray or cheering for the other children participating in the activity). Additionally the
Switch Buddies program aimed to impact on peers and staff. As the physically
disabled participants became more independent, active contributors to the learning
environment it was envisaged that both their staff and peers would be more aware of
their ability to participate. Additionally it was hoped that peers and staff would gain
greater confidence in knowing the best ways to both interact and have fun with the
children in the program.
Evaluation
Individual goals for each participant were set using the Goal Attainment Scale
(GAS). See appendix 3 for more information about this scale. The team developed
preliminary goals that represented skills that were important for the children to learn
in order to use technology for participation in preschool. Following the first group
session, further information was added to each child’s profile and the preliminary
goals were reviewed, revised and refined. This resulted in a final set of measurable
goals – please see appendix 4 for an example. Preschool evaluation is on-going.
Results
The usefulness of this program was evaluated with a small group of children who
have cerebral palsy. The findings to date are encouraging. The results from the GAS
to date show that each of the children had a positive change in their switching skills.
Results will be discussed further at the ARATA conference.
Client 1
Computer Access
Communication (15
choices)
Step scanning
Powered mobility
Sum of Scores
Pre
-2
t score
30
Post
-2
t score
30
-2
30
0
50
-2
-2
-8
30
30
20.98
0
-2
-4
50
30
35.49
Client 2
Computer access
Communication (15
choices)
Switching in play
Powered mobility
Sum of Scores
Pre
-2
30
Post
0
50
-2
30
0
50
-2
-2
-8
30
30
20.98
+2
-1
-1
70
40
53.63
Client 3
Computer access
Communication
Switching in play
Scanning
Sum of Scores
Pre
-2
-2
-2
-2
-8
30
30
30
30
20.98
Post
+1
0
+1
-2
0
60
50
60
30
50
We would recommend the use of the GAS as an objective measurement of change
for others using the Switch Buddies Program in the future.
Conclusion
While we would continue to refine the Switch Buddies Program over time, the
information contained within the package in its current form may be useful to other
professionals interested in developing children’s use of assistive technology for the
purpose of play. The program has been received enthusiastically by parents,
preschool staff and children and has been adapted for use for a number of other
children (individuals and groups) since the original group concluded. The change
observed through the results of the GAS indicates that use of this package has
resulted in measurable change for the participants involved in the program to day.
The authors see potential for this package to be used in part or full in our clinical
practice.
References
Banajee, M.,DiCarlo, C., and Buris-Stricklin, S. (2003) Core Vocabulary Determination
for Preschoolers. Augmentative and Alternative Communication, 19(2) 67-73.
Besio, S.(2004) Using assistive technologies to facilitate play by children with motor
impairments: A methodological proposal. Technology and Disability, 16, 119-130.
Cotton N.S.,(1984) Childhood play as an analog to adult capacity to work Child
Psychiatry and Human Development, 14(3) 135-144
Daniels, L., Sparling,J., Reilly,M.,Humphry,R. (1995). Use of Assistive Technology with
young Children with Severe and Profound Disabilities. Infant and Toddler Intervention,
5(1):91-112
Foreman, P. (ed) Inclusion in Action , Harcourt Australia (2005)
Isenberg JP., and Galongo, MR., Creative Expression and Play In Early Childhood. 3 rd
ed (1997)
Light J. and Kelford Smith,A. (1993). The home literacy experiences of preschoolers
who use augmentative communication systems and of their nondisabled peers.
Augmentative and Alternative Communication, 9, 10-25.
Light, J., Binger, C., and Kelford Smith, A. Story Reading Interactions between
Preschoolers who use AAC and Their Mothers. Augmentative and Alternative
Communication Volume 10, December 1994
Lueck, A.H., Dote-Kwan, J., Senge, J.C., and Clarke, L. (2001). Selective assistive
technology for greater independence. Re:View, 33(1),21-33
Novak, I., Unpublished presentation titled: Goal Attainment Scaling , 2004
Piaget, J. (1952) , The Origins of intelligence of Children. New York: International
Universities Press.
Sullivan Coleman M.J., and Krueger L., Play and Learn AbleNet Inc, S.E. Minneapolis,
MN. 1999.
Sullivan,M.W., Lewis,M. (2000). Assistive technology for the very young: Creating
responsive environments. Infants and Young Children, 12(4):1031-1038
Von Tetzchner S., Brekke, K., Sjøthun, B., and Grindheim, E. Constructing Preschool
Communities of Learners that Afford Alternative Language Development.
Augmentative and Alternative Communication June 2005 Volume 21(2) pp. 82-100
Wagner, B., and Jackson, H., Developmental Memory Capacity Resources of Typical
Children Retrieving Picture Communication Symbols Using Direct Selection nad Visual
Linear Scanning with Fixed Communication Displays. JSLHR Feb 2006. Vol. 49, Iss 1
pg 113
Vygotsky, L.(1978) Mind in Society:the development of higher mental process.
Cambridge, MA: Harvard University Press.
Appendix 1
Child’s Name
Preschool Attended
Date of Birth
Contact Person
Wheelchair Seating
 Type of Seating System
____________________________________________
 Seat height from floor (including clearance for knees)
____________
 Seat width
____________
 Seat depth
____________
 Back height
____________
 Head Support height
____________
 Head support
_________________________________________
_________________________________________
 Straps
and other supports
______________________________________________
______________________________________________
Seating Photo
Switch Site(s)
 switch position Time to activate switch (3 attempts)
head ®______________________
Tray ®
_____________________
head (L)_____________________
Tray(L)
_____________________
Tray(centre) _____________________
 switch type
________________________________________

mounting of switch
______________________________________________
______________________________________________
Preferred and Disliked Play Activities
_________________________________________
_________________________________________
_________________________________________
_________________________________________
Communication Skills (including device options being considered)
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Goals
1. _______________________________________________________
____________________
2. _______________________________________________________
____________________
3. _______________________________________________________
____________________
Appendix 2
General Program
11.00:
Task:
Circle time:
Greeting
Children will use communication devices for saying Hello and their
name
Learning Outcome:cause effect, communication a greeting and name, accurate
switch activation
Resources:
Communication devices
Set up/Position: circle
Weather
Task:
Children will select clothes for Teddy to wear according to the
weather of the day. Choices will be given in a manual scanning
mode and children will press a switch to select
Learning Outcome understanding scanning
Resources:
Teddy with clothes for weather, symbols
Set up/Position: circle
Task:
Songs
Children will choose songs to sing with a manual scanning mode,
will press a switch to start music or use step-by-step or BIGMac to
sing repeated lines.
Learning Outcome:cause effect, scanning, timing of response, accurate switch
activation cause effect, scanning, timing of response, accurate
switch activation
Resources:
CD player
Set up/Position: circle
11.15:
Game/Activity:
Task:
Learning:
Outcome
Resources:
Children will participate in a group activity or game using the
switch toys or power link
stop/start, turn taking
Switches,
Set up/Position: Table in therapy room
11.30:
Snack Time - outside
11.45
Stations
Powered Chairs
Task:
Children will experience mobility using the powered wheelchairs.
Learning Outcome: Cause/effect (with mobility), stop/start, accurate switch activation
Resources:
Power chair, switch, seating,
Set up/Position: In therapy room
Computers
Task:
Children will use switches to access games or activities on the
computer
Learning
Outcome:
Accurately activate cause/effect software
Resources:
Set up/Position: Table in small speech room
Communication Devices
Task:
Children will play a game with a special emphasis on using a
communication device
Learning
Learning to use communication devices and minspeak or PCS in a
game situation.
Outcome:
Resources:
communication devices with appropriate overlays
Set up/Position: table in meeting room
Gross Motor with switch toys
Task:
Play with switch adapted
Learning
Outcome:
children will use switch for play
Cause/effect switch usage
Resources:
Switch adapted toys
Symbols/Photos for each toy
Set up/Position: In the corridor near the play room
12.45:
Story and Goodbye song/ Home Activity
Task:
The children will use a switch to listen to a story on the computer
or on a Step-By-Step communicator
Learning Outcome Listening, eye contact with computer screen, cause/effect
with computer. accurate switch activation
Resources:
Book, Laptop, Data Projector
Set up/Position: Table
Goodbye Song
Task:
The children will use a switch to activate the goodbye song on a
communication device
Learning Outcome cause/effect, finish a session, accurate switch activation
Resources:
Set up/Position: Table
Home Activity
Task:
Computer – powerpoint CD, ideas for preschool, loan of powerlink
to 2 families
Learning Outcome: Continue to practice switching skills and carry over to preschool
Resources:
CD to take home,
Set up/Position: Home
1.00
Clean up
Appendix 3 Goal Attainment Scale (GAS)
The GAS is an individualized, criterion referenced measure of change, using goals. It involves developing goals that are observable and
repeatable and specifying conditions for performance. Measurable criteria for success with a time frame for achievement are required. It
allows for multiple individualized goals, which can be weighted to reflect their relative importance. Each goal is developed, specifying a
range of five possible outcomes with 0 being the expected level, and with two levels of more favourable and two levels of less favourable
outcomes.
The GAS quantifies change over time and across individuals. This assessment allows subtle, but clinically significant change to be
measured. (Adapted from presentation by Iona Novak 2004) Initially four goals for each child were developed using the goal attainment
scale.
Appendix 4
Charlie
-2
-1
Charlie will move a powered
wheel chair using 3 buddy
buttons mounted on the left
and right sides of his
headrest and one other
location (to be determined
on trial)
Charlie will move and stop on
command a powered wheel
chair using 3 buddy buttons
mounted on the left and right
sides of his headrest and
one other location (to be
determined on trial)
Charlie will activate a buddy
button mounted on the right
side of his headrest to step
scan 4 choices using the
Springboard.
Charlie will activate a buddy
button mounted on the right
side of his headrest to step
scan 4 choices using the
Springboard
and
select
choice using a buddy button
mounted on left side of
headrest
Goals for Switch Buddies
0
+1
+2
Charlie move between 2
designated areas up to 4
metres apart with a powered
wheel chair using 3 buddy
buttons mounted on the left
and right sides of his
headrest and one other
location (to be determined
on trial)
Charlie will drive a powered
wheel chair using 3 buddy
buttons mounted on the left
and right sides of his
headrest and one other
location (to be determined
on trial) between 2 fixed
points that are 2 metres
apart
Charlie will drive a powered
wheel chair using 3 buddy
buttons mounted on the left
and right sides of his
headrest and one other
location (to be determined
on trial) between 2 fixed
points that are 1 metre apart
Charlie will activate a buddy
button mounted on the right
side of his headrest to step
scan 8 choices using the
Springboard
Charlie
will
accurately
activate a buddy button
mounted on the right side of
his headrest to step scan 15
choices
using
the
Springboard.
Charlie
will
accurately
activate a buddy button
mounted on the right side of
his headrest to step scan 8
choices using a row/column
array using the Springboard.
Charlie
will
accurately
activate a buddy button
mounted on the right side of
his headrest to step scan 15
choices using a row/column
array using the Springboard.
Charlie will activate a buddy
button mounted on the right
side of his headrest to step
scan 8 choices using the
Springboard
and
select
choice using a buddy button
mounted on left side of
headrest
Charlie
will
accurately
activate a buddy button
mounted on the right side of
his headrest to step scan 15
choices
using
the
Springboard
and
select
choice using a buddy button
mounted on left side of
headrest
Charlie
will
accurately
activate a buddy button
mounted on the right side of
his headrest to step scan 8
choices using a row/column
array on the Springboard and
select choice using a buddy
button mounted on left side of
headrest
Charlie
will
accurately
activate a buddy button
mounted on the right side of
his headrest to step scan 15
choices using a row/column
array on the Springboard and
select choice using a buddy
button mounted on left side of
headrest