The switch access measure: development and evaluation of the reliability and clinical utility of a switching assessment for children with severe and multiple disabilities

Abstract

Purpose

Children with severe, multiple disabilities often need to use switches to control their assistive technology. We developed the Switch Access Measure (SAM) to address the lack of validated functional activity-based measures to evaluate children’s success using their prescribed switch(es). This goal-based performance measure evaluates switching ability on 16 skills items (6 motor, 2 visual, and 8 process). This study investigated SAM’s reliability and confidence in scoring.

Methods

Two occupational therapists with switch access intervention experience were trained as SAM study assessors. They independently scored SAM (inter-rater reliability) while viewing 20 study assessment videos where each child undertook at least one goal-based switching activity with their technology, and rated confidence in scoring for each SAM item. The SAM’s two developers independently scored these videos as an inter-rater reliability benchmark. Each study assessor re-scored a subset of 10 videos 2–3 weeks later (intra-rater reliability).

Results

SAM Total score inter-rater reliability was excellent for the two study assessors (ICC =0.82) and the two SAM developers (ICC = 0.95). Inter-rater reliability was lowest (moderate) for Motor Subsection for the assessors, but still excellent for the developers. Intra-reliability for both groups of raters was excellent for Total and Subsection scores. Assessors’ confidence in scoring was high (mean of 84.7% and 86.8% respectively) across items/participants.

Conclusions

SAM is sufficiently reliable for clinical use, permitting clinicians, after SAM training and certification, to include it in their assessments and in development of switch access intervention plans for children with severe, multiple disabilities.

IMPLICATIONS FOR REHABILITATION

• For practitioners new to the field of switching technology, the SAM will provide a comprehensive understanding of all the components of successful switch use that need consideration when working with those needing switch access technologies.

• For all practitioners in this area, the SAM offers a consistent language to support clear communication among professionals, families, clients and their support networks. The SAM also gives quantifiable and reliable data to back clinical decision making, particularly important to support the case for funding of these technologies.

• Use of the SAM will prompt discussions with clients, families and carers and lead to better understanding of strengths and challenges, thus enhancing collaborative working relationships in the pursuit of achieving the best possible outcomes for those needing to use switch access technologies.

Keywords:

• Switching
• assessment
• reliability
• training
• assistive technology
• children with disabilities
• communication

Acknowledgments

We would like to sincerely thank the children and their families for taking part in the SAM reliability study. Thanks are extended to the two OTs who were assessors for the SAM reliability study, and other Novita therapists who contributed to the study.

We gratefully acknowledge the earlier work on the development of the Novita Switch Access Solutions Assessment (NSASA) (formerly Novita Switch Record Form [NSRF]) by Sonya Murchland former profession leader Occupational Therapy at Novita, University of South Australia’s School of Health Sciences Occupational Therapy Honours Students Grace Hoppenbrouwers and Michelle Keane and their supervisors Hugh Stewart and Jocelyn Kernot.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Novita Children’s Services (Novita) (2016–2018).