CLINICAL PERSPECTIVE

Written by: LISA ROTELLI

Navigating the complex needs of children with multiple disabilities can be challenging.

So can navigating the large amount of people working with a child – each with their own goals and ideas. Many children with a disability have an overwhelming number of adults and professionals working with them daily. Parents are trying to decipher all the information they are getting from each person, all while wanting their child to be able to participate with those around them.

Some of the people included in this process are:

• Aide

• Teacher

• School OT/ Clinic OT/ Private OT

• School PT/ Clinic PT / Private PT

• School AT professional

• Speech language pathologist (SLP)

• Vision therapist

• And more

Each of these people has their own goals, expectations and judgment of the capabilities of the child, and rarely do any of them match.

Imagine being judged by this many people, with their own tests and expectations. Our education system is set-up to test capabilities of all children and then teach to minimize any deficiencies. This simply does not work for children with multiple disabilities. Motor pathways develop from experience, which these children are sorely lacking in.

We must use a different approach when we are not sure what the child understands. For this reason, starting with motor learning can diminish doubt in a child’s potential. Augmenting mobility with consistent and easy access develops understanding, expression, wants and likes. This process develops both switch sites and training protocols. Once we understand access and training requirements, we can develop lessons, goals and expectations. Literally “Moving to Learn.”

If the team members cannot agree on whether to use powered mobility as a clinical tool for learning and how to do so, the child will not have the opportunity to move past being tested on things that they may not understand — let alone be successful at expressing understanding. Building consensus is key.

Every person on this team has a role and obligation to help a child grow and learn, starting with the belief and knowledge all children learn through activity and experience. The entire team should be a part of developing an activity to encompass all their professional requirements.

For example, activity-based mobility training is not just addressed by occupational and physical therapists. Depending on the age and experience of the student, the following team members can participate:

• Teacher: Colors, numbers, letters and whatever the rest of the class is learning.

• Physical and occupational therapists: Mobility, manipulating objects.

• Speech/School Assistive Technology Professionals:Understanding the use of augmentative communication devices, communicating, writing.

• Aide: Training and care of the student, supporting wants and needs.

Designing an activity with all the goals and needs of each team member is critical and continues to build consensus.

An Example:

A power wheelchair set-up for access with switches must use consistent switch placement. One switch assigned for each direction that will be required, going to something, and turning to get something. The power wheelchair or the switches are not the activity. Getting to the designated activity is.

If the classroom is learning numbers or colors, have multiple stations set up along a route with colored objects to pick up and take. The end goal may be gathering one of each color and then counting how many as the objects are placed in a basket. The child can also use an AAC device with one of the driving switches to communicate how many colors, which colors, or where the colors went.

In this example, giving a child experience with colors and counting can be used to work on educational concepts, communication and even mobility. This is oversimplified and needs to have meaning for the child but is an example of how we can work as a team for the development of a child and not in isolation on our own goals. This type of training is supporting motor development that you can build on — going, stopping, turning, navigating and communicating.

Certainly, everyone can get on board with teaching activities to support development.

Everyone on the team needs to be a part of this educational path. We must stop testing and start teaching to achieve positive outcomes.

CONTACT THE AUTHOR Lisa may be reached at LROTELLI@ASL-INC.COM

Lisa Rotelli, director of Adaptive Switch Laboratories Inc., has had a lifetime of experience starting as a clinical coordinator for a rehab hospital in Northern California. She also served as a rehab manager for a large rehab equipment supplier and a rehab specialist for one of the major manufacturers of rehab wheelchairs. She is certified by the University of Tennessee at Memphis as a seating specialist and the University of Misericordia in Pennsylvania in pediatric seating. She specializes in alternative access and drive control systems and has designed several drive control systems for severely involved clients. She presents at national conferences to all levels of clinical therapists, suppliers and educators.