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Understanding individual needs is crucial in employing the right assistive technology, writes Paul Doyle

Sometimes, we don’t know that we don’t know something.

I once carried out an assistive technology assessment for a young man who had sustained a traumatic brain injury and was thought to be totally blind. His eyes were uninjured but the area of his brain that processed the raw data gathered by his eyes had been damaged to the extent that even though his eyes were “seeing”, his brain was not. He was diagnosed as being cortically blind. 

Following discussions with his parents and carers though, it became apparent that something was in fact “going on with his vision”; they described instances of him responding to events like a carer walking across the room or a football rolling across the floor as if he was able to see something. What I eventually realised during this assessment period was that I was dealing with something that I did not know I did not know. 

While I was initially at a loss to understand what was going on with this young man, it became apparent that a common feature in most of the accounts of him “seeing” was that the object of his attention was moving. This was borne out when I attempted to engage the young man with an eye gaze based “shoot ‘em up” game.

The game involved the player using an eye tracking system to aim and fire at a target displayed on a computer screen. Initially, a version of the game where the targets remained static produced no response from the player. However, as soon as moving targets were introduced, a very different outcome was observed. This version prompted him to fully engage with the game to the extent that he was observed moving his whole body in an attempt to align himself with a specific target.

What I did not know at that point was that, of the many different elements of vision that combine to comprise what we commonly known as sight, one specific element and corresponding part of the brain deals exclusively with movement. It had simply not occurred to me. I did not know that I did not know it. This “epiphany” has since led me to consider the challenges facing those teaching and supporting students with PMLD, particularly in relation to the assistive technology used to support them. 

The young man who prompted this thought process was unable to tell me whether the screen I was using was in the right place to accommodate his field of vision, or if the objects on the screen were the right type or size, or that they were not being “drowned out” by a busy or crowded background. I have also found this when working in other SEN settings. Indeed, when collaborating with teaching staff working with young people with PMLD, it is easy to feel as if we are all fumbling around in the dark as we try to work out how to engage a student.

Meeting needs

Coming from an engineering background, I am a great believer in using the right tool for the job and eye gaze technology is very much a part of my assistive technology toolkit. However, just having access to assistive technology in the classroom is not enough. For example, positioning an eye gaze system directly in front of the user (midline) at eye level is a naturally intuitive thing to do but, if we are unaware that a student has little or no central field of vision, we won’t know that we have just effectively hidden the content from them in plain view.

Similarly, choosing the wrong object or stimuli can lead to false outcomes, as happened to me when working with another young person with PMLD. When using a particular software package, the student appeared to be unable to see any of the different shapes, animals or vehicles displayed on screen. However, after a chat with this young lady’s carer and a bit of copying and pasting, we were able to elicit a totally different response; she was now wholly engaged with the activity and was able to track a smiling Ainsley Harriott bobbing around the screen.

Teaching and support staff not only need to be shown how to set up and use technologies like eye gaze based systems; they also need to know how to employ them in the correct educational context, based on an in-depth understanding of the access needs and preferences of the individual students they are working with. 

By adopting a holistic approach to using and embedding technology in the curriculum, teaching staff will achieve better outcomes. They will also be better placed to use the technology in ways which help to secure effective and meaningful baselines from which individual progress can be recognised, measured and rewarded. 

Team work

When the expectations of the professionals involved are not wholly aligned, this can lead to the sad situation of students “falling through the gaps” between what the teaching staff expect the technicians to do and what technical staff thought teachers were doing. This issue is particularly important in the domain of PMLD, as students are often unable to let you know that something is not working for them.

The burden of understanding the nuances of a pupil’s sensory perception should not be placed solely on the shoulders of already hard-pressed teaching and support staff. The benefits of multi-disciplinary teams (MDTs) are well recognised and we should always seek to utilise the relevant expertise of team members, as well as the input of those who have the best clinical knowledge and experience of the student to consider how their impairment might affect their capacity to participate in the classroom. 

If one uses visual technology, for example, one might ask how it might be perceived by the student, where the best location is for placement of the screen or printed resource, as well as the effects of ambient lighting conditions on the student’s ability to see and focus. We should also be careful not restrict ourselves to employing just one type of technology, such as eye gaze, in isolation.

If we are to use the right assistive technology to meet the learning needs of each student, meaningful discussions and the sharing of expert knowledge between professionals is essential. And, of course, we should always be open to the possibility that there may be factors at play about which we don’t know we don’t know. 

About the author

Paul Doyle is an expert witness for assistive technology at Bush & Co., a council member of the British Assistive Technology Association (BATA) and a Director of the Karten Network.

 bushco.co.uk 

 @pauljcdoyle

 @Bush_Company

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