Rehab Dialogue: Children with cerebral palsy in the classroom

Rehab Dialogue Learning through doing: Children with cerebral palsy in the classroom

By Al Cook, PhD, and Kim Adams, PhD (Cand)

rehabdialogue.blogspot.com

Pursuing your best Faculty of Rehabilitation Medicine | Page 5

The incidence of cerebral palsy in Canada is

65,015

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• Children with disabilities need and desire full inclusion in the classroom. Passive engagement through observation is just not enough for these children.

• Research has proven that assistive technologies such as robotics in the classroom help children with disabilities learn and participate.

• Robot intervention can benefit children with other disabling conditions such as muscular dystrophy, poliomyelitis, arthritis, osteomyelitis, congenital hearing defects, absence of arms or legs, hemophilia, diabetes and spina bifida.

• Strategies for using robots can be adapted by teachers to fit individual student needs in a manner consistent with the Alberta Curriculum.

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Chelsea Hagan, 14,

is the only student in her class with a physical disability.

She’s had cerebral palsy since she was born.

Chelsea uses a wheelchair to get around and a communication device to talk to her friends and family.

When she was 11 years old, Chelsea participated in a few robot projects at the Faculty of Rehabilitation Medicine. She controlled Lego robots to do play activities, taking orders and delivering toy food for a sushi party. Chelsea did another robot project with speech-language pathology students where she used the robot to manipulate cards that had phonemes on them (sounds for making words).

To learn math and measurement, Chelsea used the robot to line up non-standard units like straws or toothpicks. Then, she would count them. She also measured the length of objects with the ruler. The robot is controlled by Chelsea’s communication device using infrared technology, much like a TV remote control.

This is how Chelsea felt about using the robots in these projects: What did you like best about the robot?

I can do it myself. I like to do that [the activities] all by myself.

What do you like to do with the robots?

I liked to color with it. It helped me to read.

Did you like using the robot to work on math measurement?

Yes, a lot.

What else did you think about the robot?

I like the robots. They are fun.

I wish I could have one.

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Children with severe physical disabilities such as cerebral palsy are at great risk of developmental and academic delay. These children often have difficulty speaking, walking and using their hands for play, writing or other academic tasks. As young children these physical disabilities limit their learning experiences. It can be difficult to assess their understanding using standardized tests. It is difficult to find activities where they can have practice to develop their skills. As they enter school their opportunities to fully engage in learning are also significantly limited.

Strategic Directions

These limitations have been recognized by the “Setting the Direction for Special Education in Alberta Framework,” an initiative of Alberta Education. This framework identifies 12 strategic directions that are required to reduce the problems faced by children who have severe disabilities in accessing Alberta’s education system across the province. These directions have been accepted by the Government of Alberta. Among the 12 strategic directions we will address in this article are:

Government Response

1. Create provincial tools and models for interpreting the current Programs of Study so that all students have opportunities for learning and growth based on their strengths.

Government will provide tools to help teachers and school authorities adapt and utilize the current Programs of Study and learning and teaching resources for students with specialized learning needs within the context of the student’s school and community. The development of future Programs of Study will continue to include a focus on accessible and assessable material.

5. Implement a provincewide expectation that schoolbased expertise will be in place to support teachers in meeting the needs of students with disabilities and diverse needs within learning environments.

Government will work with stakeholders to develop guidelines outlining role descriptions for teachers, learning coaches, educational assistants, administrators, parents and specialized service personnel who are working in an inclusive education system.

Government will also work with stakeholders to build capacity to support an inclusive education system. This would include appropriate instruction and training for undergraduate students enrolled in Bachelor of Education programs.

7. Increase access to technologies to support the learning of all students.

Government will maximize the power of technology to personalize learning and present material in multiple ways to support the learning of children and youth in an inclusive environment.

10. Develop and implement a model of support for young children who experience at-risk factors that enable programming and support in the most natural pre-school environment along with a seamless transition into grade 1.

Government will work collaboratively with organizations, communities, and families to develop an approach to early learning that takes into account support for pre-school children who are at-risk and provide opportunities for children to begin their early learning experiences in an inclusive setting.

11. Develop an accountability system that measures success at meeting the needs of learners with diverse needs.

(Limitations in being able to properly assess cognitive ability of children have also been addressed as a concern.)

Government will determine system indicators that reflect program goals for students, identify key instruments for measuring students’ outcomes against these indicators, and institute a measurement framework that captures results.

Our Recommendations Affordable robots exist and some are already used in typical science classes in Alberta. Strategies for using robotics in the classroom should be included as resources for teachers.

Strategies for using robots in the curriculum can be adapted by teachers to fit individual student needs in a manner consistent with the Alberta Curriculum.

Methods exist that allow children to control robots separately or in conjunction with augmentative communication devices for play or academic tasks. This gives them the opportunity to be included in classroom activities.

Demonstrated activities, strategies and approaches to modifying the Alberta Curriculum can be developed from research findings and shared through pre-service and continuing professional development programs.

http://education.alberta.ca/department/ipr/settingthedirection.aspx

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Implications for children with severe disabilities Typically developing children learn by watching, talking about what they see, and by doing – actively participating in the learning experience.

Assistive technology has addressed aids for children who experience difficulty with seeing, hearing and communicating, and the Province of Alberta currently funds such technologies.

However, the doing part is often lost for children who have severe physical disabilities. Watching other children play or complete academic activities is often the only mode

available to them for learning. This passive role can be a significant disadvantage early in life when discovery through play typically involves a great deal of handling and manipulating of toys and other objects to discover their properties, learn rules of social engagement with other children, and develop imaginative and creative skills. When children with severe physical disabilities enter school they are faced with many curriculum activities requiring interaction with learning objects in math, fine arts, science and other subject areas.

Cone of Learning - Edgar Dale

After 2 weeks we tend to remember...

HEAR and SEE

90%

Verbal Receiving

Hearing Words Looking at Pictures Watching a movie Looking at an exhibit Watching a demonstration Seeing it done on location

Participating in a discussion Giving a talk

Doing a dramatic presentation Simulating the real experience Doing the real thing

of what we SAY and DO

Visual Receiving

Receiving/ Participating

Doing

ACTIVE

70 % of what we

Reading

PASSIVE

10% of what we READ 20% of what we HEAR 30% of what we READ 50 % of what we SEE

Nature of involvement

Edgar Dale, Audio-Visual Methods in Teachnology, Holt, Rinehart and Winston

What rehabilitation can do

Developing or researching assistive technologies to help children pursue their best is a role rehabilitation plays within the Alberta community. Our research in the Faculty of Rehabilitation Medicine’s Department of Speech Pathology and Audiology has shown that assistive technologies can address the doing or participation part of early discovery and play as well as access to the Alberta Education Programs of Study. Children with severe physical disabilities can participate more fully in discovery and exploration through greater access to the Programs of Study.

Passive learning

Assistive technologies such as single switch access to appliances like electric scissors or blenders can allow children with disabilities to control at least part of an activity, but their participation and engagement is limited.

Other assistive technologies are available to allow a child with a severe disability to control a computer, and the only alternative to passive observation of activities involving the manipulation of objects has been for children to interact with two-dimensional computer simulations of the activity. This can be effective for some activities such as drawing.

A robot controlled by an augmentative communication device allowed a 12-year-old girl with cerebral palsy to participate in science class with other students using robots. She was also able to use a robot to prepare a play for a Greek mythology presentation. She was engaged in active learning of the curriculum content. Her teachers were pleased. The girl showed her great potential and connected with the other students.

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Learning through doing

However, research at the University of Alberta and other international institutions is demonstrating that this computer simulated two-dimensional “manipulation” may not provide the same experience for the child as manipulation of three-dimensional objects does in subjects such as science and mathematics.

Research at the University of Alberta and in Europe has focused on using robots to give children access to play and educational activities. Recent focus has been on the use of low cost educational robots which can be easily built and programmed by teachers or parents to give children more and more access to control as their skills develop. They can be adapted and reprogrammed to be used in many activities, each easily customized to the child.

Computer programs fail to engage children to the same level as robotic manipulation of objects.

Importantly, when a child with a severe disability successfully controls a robot to manipulate threedimensional “real” objects and solve problems, the perception of that child is altered in the mind of the teacher. Children are seen as more capable and that has a transforming effect on the child as expectations rise and expanded educational opportunities are presented. Joanne Friedt, principal at St. Bernadette School in Edmonton, says, “The robot demonstrates to everyone who works with the student that they have so much potential despite their disabilities. We keep discovering how much more potential the students have every day.”

The direct manipulation of mathematical materials using robots controlled by communication devices has been shown to increase understanding of concepts outlined in the Alberta Curriculum.

Children demonstrated their level of understanding as they practiced new skills. Using a robot enabled them to participate in the activity directly. This was found to be more effective in helping the student learn compared to indirect manipulation in which they directed a peer or teacher to manipulate the object for completion of a mathematical lesson.

Active participation, the doing of the task, is key to thorough understanding.

Robotic systems can also provide a means of assessing cognitive understanding by children with severe cerebral palsy and other similar disabilities. Children have been able to display more sophisticated cognitive skills through manipulating the robot than was evident through traditional standardized tests. Success with the robot can be a proxy measure for children who have cognitive abilities but cannot demonstrate them in standard testing.

This is Chelsea Hagan’s favourite robot. She uses it to pick up non-standard units to measure the length of objects.

Future Directions

Recognition that learning through doing achieved by manipulation of educational materials is an essential part of creating access to the full curriculum for learners with severe physical disabilities.

Research has shown that tools and strategies that incorporate learning through doing are successful and effective for children with severe physical disabilities such as cerebral palsy. CP affects approximately one to three out of every thousand children born. This number is much higher for those born prematurely. The Setting the Direction for Special Education in Alberta initiative has set a framework of strategic directions for the Alberta government. In order to provide the right solutions, tools and strategies that incorporate learning through doing are needed.

What is needed from here?

• Assistive technologies and strategies exist—they just need to be made widely available in the classroom.

• Strategies for using robots in instruction have been proven effective for teaching students with severe disabilities.

• The development of a strategy toolkit for teachers would equip them to utilize robots in the classroom with the current curriculum, allowing children with disabilities to participate fully.

Students like Chelsea Hagan need and crave full inclusion. Passive engagement through observation of their more physically able classmates is just not enough for these children.

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Albert Cook, PhD, is a Professor of Speech Pathology and Audiology at the Faculty of Rehabilitation Medicine and Special Advisor to the University of Alberta Provost. He is also the Associate Dean, Research, in the Faculty of Extension. Cook has worked with several interdisciplinary teams to develop assistive devices and assess the effectiveness of technology used by persons with disabilities. He has received international recognition for his contributions. Involved with the I CAN Centre at the Glenrose Rehabilitation Hospital, Cook also served as the Co-Director of the Assistive Device Center in Sacramento, California, helping more than 500 people with disabilities obtain assistive technologies.

A former Dean of the Faculty of Rehabilitation Medicine and Chair of the U of A Health Sciences Council, Cook completed his BSc in Electrical Engineering at the University of Colorado and his MSc Bioengineering and PhD at the University of Wyoming. His research interests include augmentative and alternative communication, biomedical instrumentation and assistive technology design, development and evaluation. His most recent research has focused on the use of robotics with young children who have severe disabilities to develop and assess cognitive and linguistic skills. Cook also co-authored, with Jan Polgar, a textbook popular in occupational therapy programs, Cook and Hussey’s Assistive Technologies: Principles and Practice. This book has been translated into several different languages including Chinese and Korean—the book’s far reach still surprises him. His primary motivation for his work is his son Brian, who was born with a severe intellectual disability.

Kim Adams, PhD (Cand), has a dual position as Assistant Professor of assistive technology at the Faculty of Rehabilitation Medicine and Researcher at the Glenrose Rehabilitation Hospital’s Alexsandar Kostov Assistive Technology Research Lab. With more than 20 years of experience in assistive technology, Adams’ research interests include augmentative and alternative communication, human factors engineering, and assistive technology design, development and evaluation. She is involved with many research projects at the Glenrose’s I CAN Centre.

Adams completed her BSc in Electrical Engineering and MSc in Electrical Engineering with a Biomedical Specialization at the U of A. She is presently a PhD Candidate in Rehabilitation Science. Adams has been a RESNA-(Rehabilitation Engineering and Assistive Technology Society of North America) certified Assistive Technology Practitioner since 1999. She teaches the assistive technology curriculum to occupational therapy, physical therapy, speech-language pathology, and rehabilitation science students at the Faculty of Rehabilitation Medicine.

Rehab Dialogue is a series of interactive articles published by the University of Alberta Faculty of Rehabilitation Medicine. We invite government, health-care professionals and the community to engage in a discussion on various health-care topics where rehabilitation could or should play a greater role, improving function, reducing pain, maximizing potential and quality of life—and sharing the vision for a healthy Alberta.

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