As an occupational therapist (OT) that has certification in assistive technology (AT) from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), I compiled a survey in preparation for a national AT conference in 2017. I developed a 10-question survey to determine the current use of writing supports by professionals working with children and adults. The survey was distributed via various social media outlets, a large urban school district, a state AT Tech Act program, and a listserv for school district occupational therapy practitioners. More surveys were completed via social media through Facebook groups, Pinterest boards, and Twitter sources. As of April 2017, over 320 surveys have been completed with some interesting and important results discovered through the survey. The results of the survey and discussion follow below. The survey link remains open for those interested in adding further information for review: https://www.surveymonkey.com/r/HDFMPG3
Summary of Question #1: While most respondents were OTs and OTAs, there were speech-language pathologists, teachers, caregivers, and fieldwork students who made up the other category. ATP is the abbreviation for Assistive Technology Professional which is a certification from RESNA (see resources).
Summary of Question #2: Most respondents classified themselves as having a moderate level of experience in AT and only 2% noted that they had no experience in AT (which was encouraging!).
Summary of Question #3: While the majority of respondents were expectedly working with children given many of the sites for distribution of the survey, there were some who worked with both populations. The other answers included adolescents and one working with ages from 3-26.
Summary of Question #4: The highest number of respondents used AT for handwriting and writing support for those with intellectual/developmental disabilities with a close second and third place for those with autism spectrum disorder and learning disabilities. The other category included visual impairments, genetic issues, cancer, and dysgraphia.
Summary of Question #5: The number one no-tech support for handwriting was the use of grips followed closely by slant boards and adapted handwriting papers. The other items noted included spacers, magnifiers/other VI no-tech items, miniature crayons, wrist/hand weights, use of a scribe, and use of a ‘handiwriter’ for facilitating a tripod grip. This question was answered by almost all respondents.
Summary of Question #6: The most frequent use of mid-technology supports for handwriting and writing were the use of letter formation apps. It was also interesting to note the high number of portable word processors still being used, such as Neos, Fortes, or Fusions. The items listed in other included the excellent Google Read and Write, one-handed keyboarding supports, mini-keyboards, and Chromebooks. Fewer respondents answered this question (see summary below).
Summary of Question #7: Speech recognition apps and software were the top choices for use with higher-tech AT writing supports which included the various speech to text products available within computer operating systems or software such as Dragon Naturally Speaking software. There were a high number of choices of using augmentative communication devices to help with writing which was exciting to note as these AAC devices are very powerful pieces of AT that have the capability to print out what the client “says” with their communication device to write papers, letters, complete assignments, etc. The other category responses included the following: apps for third party keyboard use with tablets, that the speech therapist used these type of devices, that these types of needs would be referred out, or that they were moving away from using portable word processors to use of tablet-based products. Even fewer respondents answered this question regarding high-tech AT supports (see summary below).
Summary of Question #8: It is encouraging to note that a total of 94% of respondents felt that the use of AT supports for handwriting or writing solutions was either important or very important. Respondents who chose ‘other’ noted the following answers: requires time to gain buy-in with AT from staff, depends on students: generally SLD students benefit the most from word prediction software, when they work, sometimes I provided the “low tech” solutions more to satisfy the teacher than the student, response and success of solutions varies greatly, and writing is not generally a “preferred occupation” for children: it is a required occupation.
Summary of Question #9: As was expected the majority platforms were the iPad and other tablets/Chromebooks. There were some responses in the other category that noted previously mentioned AAC devices, portable word processors, paper, laptops not otherwise specified, and classroom Smart Boards.
Summary of Question #10: This question was a “hot topic” as 17% of the respondents took the extra time to write detailed responses for their biggest perceived drawbacks in use of AT in their settings. There was a recurrent theme with the responses regarding the largest drawback to using AT for handwriting and writing being that of monies for purchasing equipment for client trial, monies for client purchase of AT, and monies for continuing education for the professionals. The “Other” responses included the following themes: lack of teacher interest or buy-in which was the number one reason noted, lack of staff follow-through, technology supports need to be embedded into instruction but time and collaboration around this is challenging, limited access to district AT staff, too many areas to choose from as all are a problem, handwriting not being formally taught in schools anymore, technology not always working as needed, AT is not part of the school OT’s job as the AT team performs this training, problem is more than just the mechanics of handwriting as they have problems in all aspects of writing, staff turnover, lack of time for teacher/therapist training, sometimes parents feel their student has more skills to use technology than what the school is observing which creates a mismatch, OTs not always consulted during evaluation for AT, and need more time to learn about new products/implement in the classroom. These responses are important for those on AT teams in districts to be aware of as well as AT professionals in other settings.
Survey Findings: While an excellent number of professionals took the time to complete this survey and excellent information was gleaned from the collection of responses, there were two major areas of concern regarding the use of AT supports for handwriting and writing.
1. While the respondents answered almost all the questions, the three questions elaborating on which no/low, mid, or high tech AT equipment the professionals were using with their clients indicated a trend in that as the technology levels increased, more and more respondents skipped the questions as noted below:
a. There was only one skipped response for no and low tech AT supports.
b. More were skipped for the mid tech question (18=6%)
c. The final question regarding high tech AT indicated almost 34% (81) of respondents skipped the question. Which makes one think that these individuals were most likely NOT using any time of AT writing supports for their clients of any age.
2. The high number of respondents reporting that they felt that staff carryover and monies were drawbacks should lead to professionals advocating for additional time for collaboration between professional staff and for increased funding for equipment for trial use, for client use, and for staff training to keep up with the astronomical rate at which technology continues to change.
In closing, The AOTA Fact Sheet (2016, Occupational Therapy in School Settings), states that the role of OT practitioners is “to support student ability to participate in daily school occupations”. There obviously are a myriad of interventions that we use as OT practitioners incorporating traditional educational and therapeutic supports for writing which do not include technology, yet one of the tools students do have to use in the schools are computers and tablets for assignments and testing. As writing is an important task and skill in many areas of occupation for both children and adults, the trend for the surveyed professionals to skip questions regarding the use of higher technology for clients, to state that this was not in within their scope of treatment (the SLP performed, they referred out, or the AT team did these tasks) and that lack of teacher follow through or lack of monies was was disheartening. For those working with adults, the use of writing is vital for work, education, and instrumental activities of daily living and the use of AT can mean the difference for some clients in being able to attend college, obtain a job, and support themselves financially. AT has been noted to be the “great equalizer” for persons with disabilities and it is critical that persons with disabilities of any age should have the same access to occupational opportunities to level the playing field to maximize their independence in writing using AT supports.
AOTA, 2016. Occupational Therapy in School Settings. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/CY/Fact-Sheets/School%20Settings%20fact%20sheet.pdf
Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). Assistive Technology Professional Certification. Retrieved from: http://www.resna.org/atp-general-info