Assistive technology has aided children with multiple disabilities to improve access and participation in their school and home environments. Effective educational outcomes from assistive technology use are dependent upon a coordinated assessment and implementation process. The literature on assistive technology with children was reviewed in order to identify current barriers to its effective integration within schools. These barriers were found to include:  lack of appropriate staff training and support, negative staff attitudes, inadequate assessment and planning processes, insufficient funding, difficulties procuring and managing equipment, and time constraints. A team model for assistive technology assessment and planning is proposed to optimize the educational goal achievement of children with multiple disabilities. Such a model can help target the allocation of occupational therapy resources in schools to best promote educational and broader functional outcomes from assistive technology use.

There is evidence that AT can have significant beneficial effects for children with multiple disabilities. There is also a strong indication, however, that AT is currently implemented within educational environments in a less than optimal manner.

Benefits of assistive technology use

The benefits of AT use for children with multiple disabilities is as a means of enabling mastery or control over their environment, including enhanced exploratory play and independence in activities of daily living. Independence (including development of autonomy and self-determination) was among the most frequently cited benefits identified by parents and teachers.  Other outcomes include enhanced social interactions, increased motivation and self-esteem. A further area that has been demonstrated to improve with the use of AT is skill acquisition and enhancement, such as handwriting, motor skills, reading, visual attention and perception, and maths skills

Problems in the effective application of assistive technology

Studies of AT utilization have suggested infrequent use of prescribed devices in home, vocational and community settings, poor rates of use by teachers and other professionals who work with children with multiple disabilities, and concerns regarding the way in which AT programmes are being implemented at school and at home.

Staff training and attitudes: Lack of suitable training for school personnel, devices provided without the necessary training and follow-up/support services being offered.

Assessment issues:  Assessment of an individual’s AT needs and subsequent identification of appropriate equipment has been called by some researchers a process of ‘trial and error’.  The literature suggests that the deficiencies of AT assessment centre on two major factors: less than comprehensive assessment of individual needs and lack of team involvement in the assessment process.  One other shortcoming of AT assessment is that of inadequate team involvement in the assessment process. In other words, if staff members are not included in the assessment process they tend not to use the technology with the student as intended.  Of equal concern is the lack of collaboration between the school and the home.

Planning issues:  Beyond the process of assessing AT needs and acquiring the necessary equipment, careful planning of the way in which students will use AT to address their goals is critical. Studies that have tracked AT use by students with severe and multiple disabilities in their educational settings consistently reveal a lack of planning for successful implementation.

Funding issues:  A common concern expressed in much of the literature is the high costs of AT devices and the lack of funds available to meet these costs of equipment, repairs, maintenance, replacement and customization.

Equipment issues: Problems reported in the literature in relation to AT equipment reflect difficulties accessing the equipment, criticism of the design and features of specific equipment, and problems in the use and maintenance of equipment.

Time constraints:  Given the difficulties already discussed with respect to obtaining and maintaining equipment and training in its use, it follows that time is at a premium for teachers and therapists who use AT with their students.

Overcoming barriers:

Recognition of the problems encountered in the effective application of AT in schools has resulted in some practitioners developing and undertaking trials of systems and approaches to allow better delivery of AT services to meet individual needs. In addition, many researchers have proposed recommendations to circumvent the AT pitfalls identified in the literature.

Apart from changes to funding mechanisms and equipment access and management, the range of solutions advanced can be grouped into two broad areas: training and support, and assessment and implementation of technology plans.

Training and support:  A multi-faceted approach to training and support is deemed necessary, particularly in view of the range of knowledge and skills required. Knowledge with respect to disability, hardware and software, adaptive devices, systems for procuring equipment, design and construction of individualized equipment adaptations, and the settings in which the technology will be used is fundamental.

Of equal importance is the type of support provided and the way in which this is delivered. Technology specialists often train one or two members of a student’s educational team, as the time required to train large numbers of staff.

Assessment and implementation of technology plans:  The literature supports the need for more effective ways of determining students’ needs, matching these with appropriate AT, and allowing more careful selection of equipment that is guided by forward planning of the student’s future needs.

In summary, there are a number of issues impacting on the current use of AT with children with multiple disabilities. Broadly, these issues relate to resources available to educational staff and the processes used to evaluate AT needs and implement plans. The way forward is the integration of team-based assessment and implementation, with clear identification of individual goals and provision of relevant supports and resources.