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Switch technology in therapeutic recreation programming: an idea whose time has come.

For the last 10 years occupational, speech, and physical therapists have used adapted battery operated toys and switches, combined with play activities, as therapeutic intervention tools for children with severe physical and/or cognitive disabilities. More recently, computers have been used as appropriate play activities for children with disabilities as young as 9 or 10 months of age. Therapists outside of therapeutic recreation have used these technology tools to facilitate communication, choice-making, fine-motor skill acquisition, concept development, and postural control. Although benefits of such intervention should not be undermined, there are important factors of play and leisure yet to be addressed.

Work and play are viewed along a developmental continuum, with play continuing to serve adaptive function in adulthood (Kielhofner and Barris, 1984; Matsutsuyu, 1971). During play, children have the opportunity to discover what effect they can have on objects and people in their environment and to develop and test social and occupational roles. As children move around and explore their world, they receive information through their senses, gain knowledge about the nature and properties of objects, and develop rules about their own location in time and space (Robinson, 1977). Skills developed during play permit children to interact with and respond to demands of their own environment (Anderson, Hinojosa, & Strauch, 1987). This, in turn, leads to perceptual, conceptual, intellectual, and language development and, it has been argued, to the eventual integration of cognitive abilities (Levitt, 1975); Weininger, 1979; Weininger & Fitzgerald, 1988).

Playing to Learn

Young children, even infants, quickly learn their interactions with their environment produce effects. Infants learn cause and effect relationships by manipulating objects in their environment to produce movement and/or noise. Later, children begin exploring their environment, opening and closing boxes and doors, playing peek-a-boo, and hide and seek. This is followed by constructive play, using toys and objects in the environment to create and learn. Social play provides an opportunity for children to play and grow together, learning to play by rules and using cooperative skills. All of these activities develop skills used as adults both in work and in leisure pursuits. These skills are necessary for growth and development. The non-disabled five-year-old entering kindergarten has already gained considerable knowledge about his/her environment and his/her relationship to it through participation in age-appropriate play activities. If a child is physically unable to explore his or her world in the traditional sense, and this is believed to be a child's primary method of learning, can we realistically expect this child to perform at the same level as the five-year-old who is not disabled? Perhaps a child's inability to play is a reflection of our own shortcomings. Perhaps the problem is our own inability to meet the needs of that child. Children with disabilities need these same opportunities in order for development to occur.

The Challenge

For years therapeutic recreation specialists have struggled to provide services for children (and adults) who are severely physically disabled or multiply disabled. Most programs require a great deal of assistance for these individuals, in many cases, total dependence (i.e., hand-over-hand manipulation of toys). When this level of assistance is required, does play, in the true sense of the word, really occur? The older, school-age child may sit in a regular classroom in which music is being taught, but he is unable to manipulate instruments or sing. This may be integration, but is he or she really included? Finally, an adult with disabilities may attend many sporting events and thanks to legislation, have a place to sit, but is this satisfying his or her desire to compete?

What about those clients labeled severe/profound? These clients may be unable to sit or hold up their heads. In many cases there appears to be no functional or purposeful movement and little or no response to the environment. These clients most definitely need opportunities to explore with technology. The concept of active stimulation has been researched and developed by Zuromski, (1984). "This concept is built on Sellgman's theory of learned helplessness. When a person expects that the important events or outcomes in his/her life are independent of his or her response, it retards the ability to learn that responding works and as a result there may be adverse reaction, primarily depression (p.2)." Recreation professionals are currently providing passive stimulation. Generally, clients go on outings to concerts and movies, they are put through the motions of swimming or playing a game, they are pushed in their wheelchairs in races. Recreation professionals do this in hopes that participants will respond, although they are passive recipients and have no control over what is occurring. With active stimulation, participants learn that their own actions cause things to happen that they like. Active stimulation may involve using a switch to develop cause and effect. Initially the participant may not be aware that he/she is creating this action, or it may appear that there is no response. However, if the stimulus is removed and the switch remains, the participant may actually continue to try to create a response, and when none occurs this reduces the number of efforts.

Meeting the Needs of All Clients

It is a general philosophical belief of recreation professionals that freely chosen recreation activities are enjoyable to the participant. Second, it is believed that recreation/leisure has inherent value in childhood, up through and including, adulthood. Third, it is believed there are always benefits to participation in recreation activities, regardless of whether or not the person has a disability. Recreation professionals over time have been asked to be resourceful in many ways. Perhaps one of the most common ways has been to have fun with minimal funds and/or facilities. As a result, many new and innovative programs and fundraising ideas have been created. Meeting the recreation needs of individuals with severe disabilities should be viewed as a similar challenge.

Benefits of Using Technology

Technology may not fall into the traditional activities of therapeutic recreation. However, in this age of technological revolution, it should be considered as a possible leisure activity for all people, both with and without disabilities. There are many arguments for inclusion of technology in recreation programming. It provides...

... an avenue for independent participation. Any person with any disability can successfully use technology independently. Children as young as 9 months may benefit from environmental awareness and exploration through switch use.

... an opportunity for competition (even with peers who are not disabled). Excitement of competition and lessons learned from both winning and losing can be discovered through switch technology. Competition using switch-accessible software that includes games for individuals, as well as cooperative teams are available. Also, switch operated basketball shooters and soccer kickers that can be attached to wheelchairs allow more active participation in the actual sport.

... an opportunity for expression and creativity. Artistic efforts are just a switch away with activities such as switch spin art and switch air brush, as well as a variety of computer programs that permit creative freedom with the hit of a switch. In addition, a variety of musical applications provide opportunities for participation and expression using the computer, electronic keyboards, tape player/stereos, or other electronic devices combined with switches for access. Expressive communication is also a possibility from simple choice-making to switch word processing.

... an opportunity to make choices among activities. For the first time children may choose between toys or games simply by hitting a switch. They may choose a non-technology related activity by hitting a switch paired with a tape recorded message saying "I want to play outside".

...multi-sensory stimulation. Tactile and/or motor input to a switch results in multi-sensory output that includes auditory, visual, and motor feedback. This occurs through lights/pictures, sounds, and movement responses and/or participation. opportunity for inclusion. Technology provides opportunities for inclusion, not just integration, in activities with non-disabled peers. Through the use of a switch interfaced with a stereo or tape player, the switch user may control the music for a game of musical chairs; play Nintendo or computer games with switch modification; participate in making popcorn and drinks at snack time using a power adapter and switch; participate in school plays or productions with pre-recorded lines or music accessed through a switch. Through the use of a switch operated bowling ramp, children are participating independently in a community setting with non-disabled peers.

... self-esteem. Obviously if a person's life changes from total dependence to one of independence, choices, self-expression, etc., their self-esteem will likely increase.

... a tool for the recreation therapist working in a team setting. The ability to use switches successfully with toys and in leisure activities may also enable the participant to use a communication device, an electric wheelchair or a computer, supporting therapeutic goals of other disciplines. It may provide educational opportunities such as learning colors, numbers, body parts, and special relationships, supporting opportunities for classroom inclusion.

... an aid in prevention of "secondary disability" (Missiuna & Pollock, 1991). "Increased dependence on others, decreased motivation, lack of assertiveness, poorly developed social skills in unstructured situations, and lowered self-esteem are a few of the difficulties that may be experienced by children with disabilities (Clark, Riach, & Cheyne, 1977/1982; Levitt & Cohen, 1977; Mogford, 1977; Phillip & Duckworth, 1982; Missiuna & Pollock, 1991)." "These secondary disabilities have an impact not only on the child's play and development, but also on later functioning in the school setting, the community, and the work place" (Missiuna & Pollock). Recreation therapists can play an integral role in the prevention of secondary disability by providing an opportunity for free play experiences using technology as an intervention tool.

... most importantly FUN! Technology is no longer just for aspiring engineers. It can be challenging and enjoyable for many different people.

Guidelines for Choosing Technology Equipment

Children who are physically unable to manipulate traditional toys can participate in play activities using battery operated toys or other battery operated devices and simple micro-switches, or electrical adapters and micro-switches. These simple modifications allow the user to turn on any battery operated or low-wattage device simply by activating a single switch. Switches usually consist of an input area that the user touches in some way to activate. The switch has a cord with 1/8 in. mini plug on the end. This plug goes into the receptor of the adapted toy or device. The toy is adapted by interrupting the current to the battery, permanently or with a copper wafer adapter. Either method has a 1/8 in. mini jack permitting input of the switch plug. (see Figure 1)


There are two basic types of switches: momentary and latching. A momentary switch will require the user to maintain contact with the switch as long as operation of the device is desired. A latching switch enables the user to activate the switch once to turn the device on and again to turn it off. A number of switches are available to match any reliable motor skill (even as minute as an eye twitch). Most are relatively inexpensive or can be easily constructed. The selection and placement of an appropriate switch is essential to the successful use of the toy or device. There are several guidelines to assist in this area:

* identify/match the switch with the most reliable motor movement of the user;

* match sensitivity of switch with the motor abilities of the user (effort required to activate);

* determine if user responds best to switch with auditory feedback or no feedback;

* identify degree of travel (amount of movement required before switch is activated);

* determine best location of switch mount according to motor movement reliability and convenience of access. Mount should be such that set-up is minimal;

* determine how the switch will be utilized (toys, computer, communication, mobility, etc.) and make sure it is compatible with all devices; and

* determine aesthetic preferences (color, size, appeal to user).

There are several pieces of equipment available on the market to assist in identification of switch placement. These are typically adjustable to enable the therapist to change the switch position as needed. Once an appropriate and effective location for the switch is established, a more permanent device should be constructed or purchased. This should be mounted to the user's wheelchair for convenient access in all activity areas.

Switches can vary tremendously in size, shape, sensitivity and method of activation. Table 1 lists a selection of commonly used switches, physical description of each, and common placements for each.

Table 1 Commonly Utilized Switches
 Switch Description Mount
plate switch Usually 3[inches]-6[inches] in
 diameter. Pushing the hand, head,
 switch results in activation.
 Some provide elbow, knee
 an auditory click when
 activated. foot, etc.
 Swensitivity varies between
lever switch 4[inches]-6[inches] in length.
 May or may not have auditory usually head
 feedback. Has limited travel. or cheek
leaf/tape switch 4[inches]-6[inches] in length.
 No auditory feedback. Toggle head, cheek,
 or bend to activate. Very
grasp switch Switch inserted in pillow, pad,
 or small cushioned usually hand
 grip. Squeeze to activate.
sip/puff switch Sip or puff on straw to
 activate. Sensitive but mouth
 requires lip closure and breath
switch String can attach to finger,
 arm, etc. Pull to usually hand
 activate. or finger
mercury switch Mercury switch capsule enclosed
 in protective head, hand
 material. Activates when held

This is certainly not a complete list, but a good sample of what is available. Switches range from relatively simple switches listed in Table 1 to more complicated movement sensor and light sensitive switches. With some simple soldering skills most switches are relatively easy to manufacture for as little as $5.00 to $25.00 in materials. Retail prices range from $25.00 to $300.00.

Switches interfaced with toys are certainly a good place to start, but what if the client is an adolescent or even a senior adult? The AC adapter allows low wattage devices such as tape player, fans, lamps, card shufflers, popcorn poppers, blenders, even some microwaves to be used with a switch. In addition, most computers, with an inexpensive interface, allow input from the switch instead of the keyboard. There are literally hundreds of games, graphic programs, and other computer activities that can be accessed with a switch. Using a switch may literally be turning on the light for many clients previously thought too severe or unresponsive.

Technology Programming

Technology is a tremendous programming tool for people with all types of disabilities, but it is also vastly appealing to those without disabilities. The Nintendo and personal computer markets are certainly evidence of this statement. This makes combining technology programs for people with and without disabilities relatively simple. Modification of the game is rarely necessary and the appeal is present for both groups. Innovative programs around the country are using technology as a programming tool: Computer Camp, a program offered by Lekotek of Georgia and Computer Olympics, a program offered by Colorado Easter Seals Center for Technology, both open their programs to children with disabilities and their siblings or friends to provide a fully integrated activity. Children with and without disabilities participate side-by-side in computer related activities, many of which include competition or cooperation between the participants. Accommo dations are made only by providing appro priate software and hardware, sometimes with modifications, but segregation is never an option.

The Children's Habilitation Center in Iowa uses switch technology in its residential setting for children with disabilities in every aspect of recreation programming. For inclusive purposes, non-disabled peers from the community are invited to come and participate in Nintendo and computer game competitions. Community outings are made to bowling alleys where the switch accessible bowling ramp is used. According to therapists at the center, technology has made passive participants into active participants.

Technology Related Resources

There are many people in the community who can be helpful in implementing a technology program. An electronics background is not necessary to perform most of the adaptations, however a knowledgeable person may help save valuable time and energy. Some suggested resources include, electrician's unions, Telephone Pioneers, students/teachers at local technical schools, senior citizen centers, military personnel, TV/electronics repair shops, civic groups, and scout troops. Radio Shack is a retail store found in many communities where supplies are available and staff is knowledgeable. Additional resources and commercial vendors are listed following this article.

Although this article has emphasized use of technology with individuals who have more severe impairments, applications are certainly appropriate for all individuals, regardless of their level of ability. Anyone with a disability can benefit from technology. It is not an expensive activity to start and slowly build upon. Even computers are relatively easy to access through donations or second-hand purchases. Typically, a second-hand computer is not broken, the owner has simply outgrown it and wishes to upgrade. Switches are even more economical to access and require little knowledge to use. Equipment typically lasts a long time, but it is important to budget for additional equipment each year in order to add new items. Technology offers a way to work on functional and age-appropriate activities that are appealing to the participant. Long term, it may be the most cost effective program therapeutic recreation professionals offer.

Selected References

Anderson, J., Hinojosa, J., & Strauch, C. (1987). Integrating play in neurodevelopmental treatment American Journal of Occupational Therapy, 41, 421-426.

Clarke, M.M., Riach, J., & Cheyne, W.M. (1982). Handicapped children and preschool education [Report to Warnock Committee on Special Education, University of Strathclyde]. Cited M. Phillip & D. Duckworth (Eds.), Children with disabilities and their families. Windsor, England: NFER-Nelson. (Original report published 1977).

Kielhofner, G., & Barris, R. (1984). Collecting data on play: A critique of available methods. Occupational Therapy Journal of Research, 4, 150-180.

Levitt, S. (1975). A study of the gross-motor skills of cerebral palsied children in an adventure playground for handicapped children. Child: Care, Health and Development, 1, 29-43.

Levitt, E., & Cohen, S. (1977). Parents as teachers: A rationale for involving parents in the education of their young handicapped children. In L.G. Katz (Ed.), Current topics in early childhood education (Vol. 1, pp. 165-178). Norwood, NJ: Ablex.

Matsutsuyu, J. (1971). Occupational behavior-A perspective on work and play. American Journal of Occupational Therapy, 25, 291-294.

Missiuna, C., & Pollock, N. (1991). Play deprivation in children with physical disabilities: The role of the occupational therapist in preventing secondary disability. The American Journal of Occupational Therapy, 45, 882-888.

Mogford, K. (1977). The play of handicapped children. In B. Tizard & D. Harvey (Eds.), Biology of play (pp. 170-184). London: Spastics International.

Phillip, M. & Duckworth, D. (1982). Children with disabilities and their families. Windsor, England: NFER Nelson.

Robinson, A.L. (1977). Play: The arena for acquisition of rules for competent behavior. American Journal of Occupational Therapy, 31, 248-253.

Weininger, O. (1979). Play and education: The basic tool for early childhood learning. Spring field, IL: Charles C. Thomas.

Weininger, O., & Fitzgerald, D. (1988). Symbolic play and interhemispheric integration: Some thoughts on a neurpsychological model of play. Journal of Research and Development in Education, 21 (4), 23-40.

Zuromski, E. (1984). Active stimulation programming: An alternative to "learned helplessness". Washington State Department of Social and Health Services Overview, 12, 1-5.


Ablenet; 1081 Tenth Ave. SE; Minneapolis, MN 55414; 1-800-322-0956; Switches, universal switch mount. Linda J. Burkhart; 8315 Potomac Ave.; College Park, MD 20740; (301) 345-9152; Switches and guides on how to use them with toys and computers.

R.J. Cooper and Associates; 24843 Del Prado #283; Dana Point, CA 92629; (714) 240-1912; Switch accessible software developer.

Closing the Gap; P.O. Box 68; Henderson, MN 56044; (612) 248-3294; Annual technology conference/monthly newsletter.

Colorado Easter Seals' Center for Adaptive Technology; 5755 W. Alameda Ave.; Lakewood, CO 80226; (303) 233-1666; Newsletter/public domain software.

Don Johnson Developmental Equipment; 1000 N. Rand Rd.; Bldg. 115; Wauconda, IL 60084; 1-800-828-2443; Switches, mounts, software.

Educational Resources; 1550 ExecutiveDr.; Elgin, IL 60123; 1-800-624-2926; (708) 888-8300; Software and Accessories.

Lekotek of Georgia, Inc.; 1955 Cliff Valley Way, Suite 102; Atlanta, GA 30329; (404) 633-3430; Software, training.

National Lekotek Center; 2100 Ridge Ave.; Evanston, IL 60204; (708) 328-5514; Manual of recommended software, training.

Trace Center; 1500 Highland Ave.; Rm. S-151, Waisman Center; Madison WI 53705; (608) 262-6966; Adaptive equipment/resources/information.
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Title Annotation:includes resource list
Author:Crouse, John; Deavours, Margaret N.
Date:Jun 22, 1993
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