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Adaptive switches allow people who have physical and/or intellectual disabilities to significantly increase their control over their entire world. Once someone is able to operate adaptive switches, they are able to control a large array of different equipment. With the activation of a switch, lights can be turned on or off; the door can be opened or closed; the phone answered; email sent and received; etc.
Adaptive switches come in a wide variety of designs. The most common adaptive switches require physical contact with the switch to cause activation of whatever the switch is plugged into. When the switch is pressed, electrical contact is made; when the switch is released, the electrical contact is broken. This is just like how a light switch in a house turns lights on or off. The differences within the various contact-type adaptive switches that are commercially available are: their physical external size; the amount of force required to activate the switch; whether the switch produces a sound when it is activated that provides auditory feedback to the user; and whether the surface of the switch is textured to provide tactile feedback to the user (covered with sandpaper or a fabric, etc.).
Additionally, a variety of “proximity” switches are available. This type of switch does not require the user to actually make physical contact with the adaptive switch. Activation of these switches depends upon the technology being used. Some use a beam of light, visible or invisible, to activate the electronic circuit. When the beam of light is interrupted, the circuit is activated. This can be accomplished by the movement of a body part to interrupt the beam and, if positioned properly, requires very little physical effort on the part of the user.
Sensing the distance between the user and the switch can also activate another type of proximity switch. If a user moves a body part closer to the switch, the switch will activate. When the user moves away, the switch deactivates. This technology is used extensively in wheelchair drive controls that are built into the head arrays of the chair. See Adaptive Switch Labs Website for more information about proximity switches. The Handbook of Adaptive Switches and Augmentative Communication Devices, 3rd Edition is produced by Academic Software and provides a thorough overview of the adaptive switches available and how best to use them.
However, if someone doesn’t have the ability to activate a switch reliably, these switches are of little value to them. Some individuals need to be taught to use an adaptive switch (at least, reliably). For many people, the old adage practice makes perfect is very appropriate and using an adaptive switch repetitively will improve the person’s ability to reliably use the switch. However, it is sometimes difficult to find the proper motivation to practice switch use. It is especially difficult for children who do not appreciate the importance of practice in achieving the final goal of switch mastery. Therefore, it is essential to find activities that are stimulating and provide a big reward for success that doesn’t become boring after just a few repetitions.
Many classrooms are equipped with devices that allow adaptive switches to operate electrical appliances. Visit the Ablenet Website for examples of group activity kits that facilitate inclusion of students who are unable to participate in regular classroom activities due to their disabilities. The problem with the activities that these devices facilitate is that they often become boring because, even though they allow the student to participate in the activity, it doesn’t provide enough “reward” to make it exciting over time. An example of this is using a mixer to make cake batter. In many cases, pressing a switch and holding it down does not translate in the child’s mind to making batter in the same way as the other children who hold the mixer. Even when the switch activation does translate into mixing the batter, making the batter is far removed from the final product, a cake. A far better activity for those who have a short attention span is to make instant pudding. It takes a short time to mix it up, have it thicken, and can be eaten relatively soon by the student so that they can relate mixing it up with the final product. The beaters on the mixer could even be licked to associate the activity of mixing the milk and pudding mix with the final product - pudding.
Adaptive switches can also be used to activate battery-operated devices such as toys, bubble blowers and CD players. For battery operated devices, this is easily achieved by using a Battery Device Adapter, shown below. These devices have a phono jack on one end, into which the adaptive switch is plugged. The other end of the adapter has a copper disk that is inserted into the battery compartment of the toy, between the battery and the electrical contact in the battery holder. The device is then turned on, but it does not activate until the adaptive switch is pressed. (A switch latch and timer device can be used for click-on and click-off operation if the device being controlled dictates the use of that type of control (a radio, for example). Refer to the Adaptive Tech Solutions Website.)
|Picture of Two Battery Device Adapters|
Many companies, such as Enabling Devices and Ablenet, Inc., sell extensive kits for the classroom that provide access to a wide variety of activities to make switch practice and learning readily available and more enjoyable to students who have access limits.
For adults, being able to control their television and change the channels at will is enough motivation for most people to become competent switch operators. People who have physical issues such as involuntary movement, or intellectual limits that make acquiring skills more difficult, often have difficulty with adaptive switch control. For this group of people two issues are very significant: the selection of the most appropriate switch; and, making sure that the switch is positioned so that the individual can access it with the least effort. And of course, they will require practice, and more practice.
In all cases, whether it is in the home or in the classroom, switches figuratively, and literally, can open doors. Many of the activities that we all enjoy can be made available through their use. The Mealtime Partner Dining System is no exception. It has the advantage that it can be controlled using 2, 1 or no adaptive switches. It is able to operate with almost any commercially available adaptive switch (however, it is not recommended that you use a Sip N Puff switch because the food being eaten might clog the tube). The Mealtime Partner brings a different form of motivation to practicing switch use: for every switch-activation, the user receives a bite of food. It is a very natural way of practicing and the user is self-motivated by using switches to acquire food, and thus continue switch use. For even a small snack, several switch activations will have been achieved and within a relatively short time, a user can become a competent switch operator. One of the great joys of Mealtime Partner users is that they can snack without being a burden to their caregiver. They can eat potato chips or popcorn independently for as long as they want! Click here for more information about the Mealtime Partner Dining System.
|Did You Know? Bright colored dishes and glasses, especially red, help those with low vision distinguish between different foods more easily. Light foods contrast strongly against the dishes. Also, a University of Boston study suggests that high contrast between dishes and food helps individuals with Alzheimer overcome a diminished sensitivity to visual contrast and, as a consequence, eat more. (For more on this topic, click here.)|
In many Mealtime Partners Newsletters it is recommended that a clinician be consulted when making decisions relating to meeting eating and drinking needs of those who are unable to be independent. The question is: what type of clinician should you choose? The best answer isn’t a single person but a team of people who specialize in specific areas.
The people who should be included on your list are: the individual’s physician; an occupational therapist; a speech language pathologist; a physical therapist; and, a dietitian. Not all of these disciplines are always needed but it is helpful to consider whether or not they should be involved in the decision making process. Of course, as well as all of the medical professionals involved, the individual and their family and care providers must also be engaged in the entire process.
If health insurance is going to cover the cost of any equipment, a prescription will be needed, and, therefore, the individual’s doctor will be required. However, it is unlikely that a doctor will have an in-depth knowledge of any specific equipment and the selection of equipment will require the skills and knowledge of an occupational therapist. Other specialized skills may also be needed such as a speech language pathologist, a physical therapist, an assistive technology specialist, and a dietitian. In an ideal situation it helps to have all of these clinical specialists involved in deciding what equipment should be provided to someone to facilitate independent eating and drinking, but having their participation is often not possible due to lack of funding.
In general, an occupational therapist recommends eating and drinking equipment for clients. Yet, if the individual who is being evaluated has any difficulties relating to swallowing, a speech pathologist should also be involved in the assessment. Though the lines between the two disciplines are somewhat blurred when these clinicians specialize in feeding, the disciplines can be divided in general terms in the following way: the occupational therapist addresses all issues of getting food, or liquid, into the individual’s mouth; the speech pathologist addresses what types of food and liquid are safe for the individual to eat or drink, and any special positioning that is needed to facilitate safe eating and drinking. When there are swallowing difficulties, the position the client is in when they eat and drink can greatly impact how safely they swallow. Therefore when eating and drinking equipment is selected, seating and positioning when using the equipment must be considered. A physical therapist should provide assistance with modifying seating and positioning and make the necessary adjustments for the tasks of eating and drinking to be performed comfortably and safely. An article published in 2002 entitled “Seating for Task Performance”1 provides a detailed discussion of seating and positioning for task performance. This article offers insight into the necessary weight bearing and support that the body needs to be able to execute tasks at its best possible level, and expands greatly upon this Newsletter article.
When dealing with independent eating and drinking for children, sensory needs must be also addressed. Many feeding specialists are now very aware of the range of sensory difficulties that might exist and are well trained in treating them. It is essential that eating and drinking equipment be selected that considers the sensory needs of the individual. Otherwise they will find the equipment difficult to use and mealtimes will be upsetting and/or unpleasant.
While the clinical experts guide the choice and set-up of eating and drinking equipment, the individual, their family member(s) or care provider(s) must also participate in the entire selection process. If all of them are not fully committed to the selected equipment, it may not be used in the way in which it was intended, or as frequently as might be desired. It is surprising how often the concerns and opinions of a caregiver are overlooked. If the person who will setup and support the eating or drinking equipment does not like the equipment, they won’t support it properly (even when all healthcare providers and family members and the individual that will be using the equipment unanimously agree it is what they want!). Their opinions and concerns must be addressed immediately, and they must be provided training and assistance (at least, in the beginning) to achieve a successful long-term outcome.
Independent Eating in Nursing HomesThe U.S. Census Bureau estimates that 21% of nursing home residents must be fed, while 26% need help at mealtimes. However, The Nutrition Screening Initiative estimates that 40% of nursing home residents are under nourished! Nursing home residents include those individuals who have severe disabilities and require ongoing nursing care, as well as elderly individuals who also need nursing care.
Because feeding a large number of individuals at each meal is both labor intensive and time consuming, mealtimes are often rushed due to inadequate staffing. To allow people to eat at their own desired pace and have a pleasant dining experience, a Mealtime Partner Dining System should be considered. Each certified nursing assistant (CNA) can then care for several residents with no need to rush them through their meals. For more information about the Mealtime Partner Dining System, click here.
The Mealtime Partner Serving a Strawberry Dessert Dish
Click the following link for prices and for ordering the Mealtime Partner Dining System. An appropriate hands-free drinking system should also be considered. To select the best drinking system to go with the dining system, click here.
|The Mealtime Partner Dining System is made in the U.S.A. by Mealtime Partners, Inc.|
1. Kangas, K. M. Seating for Task Performance. Rehab Management: June/July 2002.
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