Evaluation of methods for teaching electronic visual scanning to children with cerebral palsy: two series of case studies

Abstract

Purpose: To evaluate the effectiveness of two instructional techniques in teaching electronic row–column scanning to children with cerebral palsy. Method: Two case series involving four participants each. Eight children, four boys and four girls (ages 3–13 years), were assigned to one of two intervention groups and completed three baseline and five intervention sessions. One intervention (n = 4) consisted of computer-based activities alone, while the other intervention (n = 4) consisted of a sequential approach starting with paper-based activities and then shifting to computer-based activities. Results: Participants within both groups demonstrated varying degrees of skill mastery (80% accuracy or better) of linear and, for some, electronic row–column scanning within the training phases of the intervention sessions. However, there was no clinically important change in test scores between baseline and outcome measures for either group. Conclusions: Significant challenges exist when studying the effectiveness of instructional techniques for teaching electronic row–column scanning to children with cerebral palsy. These case series provide information regarding the importance of selecting the most appropriate scanning technique to ensure reliable switch activation, carefully structuring the teaching environment to optimize learning, and being cognizant of the impact of fatigue and motivation on performance.

Implications for Rehabilitation

Research and Practice

• Examining the effectiveness of techniques to teach electronic row–column scanning to children with cerebral palsy (CP) is challenging

• Using a case-series approach to evaluate instructional techniques for electronic row–column scanning is clinically feasible as a first step, given the limited number of children with CP in any setting

• Our case-series demonstrated the importance of selecting the most appropriate scanning technique to ensure reliable switch activation, carefully structuring the teaching environment to optimize learning, and being aware of the impact of fatigue and motivation on performance.

Keywords::

• assistive technology
• cerebral palsy
• children
• electronic row–column scanning

Acknowledgements

Much appreciation is extended to all the participants and their families who so willingly gave their time. We thank all the therapists who assisted in identifying suitable candidates. Special thanks is extended to, Jennifer McLean, Heather McEwen, Andria Astorino, Karen Winkler and Stephanie (Smith) Glegg for assisting with material preparation and data collection. Gratitude is extended to Dr. Susan Harris, Professor Emerita in the Department of Physical Therapy at the University of British Columbia for her editorial support and encouragement. Finally, we are indebted to the Children’s Fund, Vancouver Foundation for their financial support of this research.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. This study was funded by the Children’s Fund, Vancouver Foundation (BCM05 007).

Notes

¹Clicker 4^™ by Cricksoft is a reading and multimedia software program that supports text and picture. It allows direct selection and single switch automatic scanning.

²Mayer Johnson manufactures augmentative communication products for non-speaking individuals, including special education software, hardware, and printed materials.

³BIGmack communicator (AbleNet) is a one message communication device activated by touch or an external switch.

⁴Crick USB switch box (Cricksoft) is a switch interface used to access Clicker 4^™ software.

⁵Specs switch (AbleNet) is a mechanical switch measuring 1.4” in diameter.

⁶Ultimate switch (Enabling Devices) is a flexible switch that is easily activated.

⁷Intellikeys keyboard (Intellitools) is a programmable alternative keyboard.