A Monthly Newsletter for Local Branches of Pennsylvania's Assistive Technology
Lending Library
September 2000
Volume 3, Issue 2
A Note from the Editor
One of the most frequent queries I receive from parents relates to what assistive
technology solution will best assist their student with "writing." Because of
the complexity of this form of communication and the various meanings of the
word "writing," this is also one of the most difficult questions to answer.
As such, this issue offers a more in-depth look at both the subject of written
language disorders and information on the numerous lower-tech tools and devices
available in the Lending Library related to the physical aspects of "writing".
We will also continue our discussion of AT solutions for disorders of written
expression in next month's issue on Reading and Assistive Technology. I'll see
ya then! -Anne
By Margaret J. Kay, Ed.D. Psychologist
Diplomate, American Board of Psychological Specialties in Educational &
School Psychology (DABPS), Nationally Certified School Psychologist (NCSP),
Pennsylvania Licensed Psychologist
The term dysgraphia has customarily been used to refer to a disorder of written
language expression in childhood as opposed to a disorder of written language
acquired in adulthood. Written language disorders have also been referred to
as "developmental output failures."
Difficulties in writing have an adverse impact on academic achievement in school
and subsequently on business and industry. It is currently estimated that dysgraphia
costs American industry and business $30 billion per year.
Written language is the graphomotor execution of sequential symbols to convey
thoughts and information. Since writing represents the last and most complex
skill to develop, it is the most vulnerable to insult, injury and adverse genetic
influences. (Deuel, l994**)
Writing represents a highly complex neurodevelopmental process which involves
multiple brain mechanisms. It requires the simultaneous and sequential integration
of attention, multiple information sources, memory, motor skill, language, and
higher cognition.
Gross and fine motor coordination, motor memory, and "kinetic melody" (a term
coined by Luria to reflect the automatic rhythm in the physical act of writing),
require balancing, flexing, and contracting movements as well as simultaneously
stimulating some muscle groups while inhibiting other muscle groups.
In order to self-monitor writing output, visual, proprio-kinesthetic, automatic
motor memory and revisualization feedback mechanisms must be engaged.
Visual feedback mechanisms include eye-hand coordination and visual-fine motor
integration.
Proprio-kinesthetic feedback mechanisms include awareness of the movement and
location of the fingers in space, internal monitoring of rhythm and rate, and
pencil grip.
Motor memory feedback mechanisms include motor plans or engrams, visual-fine
motor coordination to produce symbols, sequentialization, speed, and accuracy.
Revisualization feedback mechanisms include visual memory for symbols, whole
word memory, visual attention to detail and spelling.
All of these skills require developmental readiness and can be improved with
practice.
The primary requirements for written language include an intact central nervous system, intact cognitive ability, intact language skills (both receptive and expressive), motivation, skill development, practice, and emotional stability. Secondary written language requirements include concepts of organization and flow, writing skill, spelling skill, syntax and grammar knowledge, mechanics, productivity, accuracy, visual and spatial organization, simultaneous processing, revisualization, and automatization.
Dysgraphia is often classified as either specific or non-specific (Deuel,
l994). Specific dysgraphia results from spelling disabilities, motor coordination
problems, and language disabilities such as aphasia. The components of motor
dysgraphia are sometimes related to anatomical problems, executive dysfunction,
motor planning deficits, and visual-spatial perception problems.
Non-specific dysgraphia may result from mental retardation, psychosocial deprivation,
or poor school attendance. Some children do not develop adequate handwriting
skills because they have not received enough instruction in written language.
Deuel (1994) has divided dysgraphia into three subtypes:
In dyslexic dysgraphia, spontaneously written text is poorly legible and spelling
is severely abnormal. Copying of written text is relatively preserved, however,
and fine-motor speed is generally normal.
Dysgraphia due to motor clumsiness is associated with poorly legible spontaneously
written text, preserved spelling, and poorly legible copying of written text.
Fine-motor speed in such cases is also generally abnormal.
Dysgraphia due to a defect in understanding of space is associated with poorly
legible spontaneously written text, preserved spelling, poorly legible copying
of written text, and normal fine-motor speed.
Intervention for written language disorders depends upon an accurate localization
and assessment of the student's specific deficiencies. When difficulties are
related to the child's age or grade, age-specific remediation of deficit skills
is recommended. When specific deficiencies are present, bypass strategies may
be useful. When dysgraphia is the result of multiple deficiencies, remediation
and bypass of the problem become more difficult.
Remediation strategies for early elementary age children with written language
problems include writing readiness exercises, instruction and practice using
appropriate pencil grip, formation of symbol skills, practice to increase fluency,
and direct instruction to improve writing organization.
Writing studies indicate that students with learning disabilities benefit most
from instruction that emphasizes writing as a process (Graham & Harris,
l989; Morrocco & Newman, l986). This instructional model emphasizes the
communicative purpose of writing by creating a social context in which students
write for real audiences with real purposes. It is based on the view of composing
a problem-solving process involving planning, drafting, revision, and editing.
At the upper elementary level it is often important to begin introducing bypass
strategies for the dysgraphic student. Examples include shortening assignments,
increasing performance time, grading first on the content of the work and then
on the quality, avoiding negative reinforcement, using oral exams and allowing
oral presentations from the student, and giving tests in untimed conditions.
Bypass strategies utilizing computers and other assistive devices are also helpful
for students with written language disorders. Prior to teaching the use of word
processing software, keyboarding skills should be mastered. An excellent program
to teach keyboarding skills is Keyboarding Skills for All the Grades (l987)
by Diana Hanbury-King (see bottom of page 3). Keyboarding skills are best taught
on a manual typewriter (or a keyboard that has 'stiffer' keys) which requires
force to push down on the keys. This helps to lock in muscle memory for the
position of the keys.
Written language is the ultimate, most complex method of expression. It involves
infinitely complex multiple brain mechanisms, highly synchronized processing
and has multiple sources and locations for the disruption of activity. There
is a need for accurate diagnosis of written language problems, realistic remedial
strategies and realistic expectations for the learner. A combination of accurate
diagnosis, remediation using direct instruction techniques, and the use of bypass
strategies and assistive technology can be useful in supporting the needs of
the learner with written language deficits.
Dr. Kay has been evaluating and serving the needs of individuals with dysgraphia
for over 20 years. Dr. Kay can be contacted by email at: MJK@MargaretKay.com
A complete list of citations for this article can be found at: http://www.margaretkay.com
Reference: Keyboarding Skills by Diana Hanbury-King
This print resource is available through: Educators Publishing Service, Inc.
($12.15 plus $4.95 shipping)
31 Smith Place, Cambridge, MA 02138-1000 ~ (800) 225-5750
Software as a Bypass Strategy in Written Language
Identifying assistive technology writing solutions is best done by focusing
on the task or function with which the person needs assistance, rather than
on the individual's disability label. The chart below gives examples in the
various areas of 'Disorders of Written Language' as described in the article
by Dr. Kay.
Challenge
1.) Dyslexic dysgraphia: spontaneously written text is poorly legible and spelling
is severely abnormal. Copying of written text is relatively preserved, however,
and fine-motor speed is generally normal.
Possible Solution
Word processing software with spellchecker [All laptops come loaded with Microsoft
Word or Works Software] , and text-to-speech software for auditory feedback
[Write:OutLoud code: CA-SW-WROL].
Challenge
2.) Dysgraphia due to motor clumsiness is associated with poorly legible spontaneously
written text, preserved spelling, and poorly legible copying of written text.
Fine-motor speed in such cases is also generally abnormal, and will more frequently
have difficulty with keyboarding
Possible Solution
Word processing software with spellchecker, possible addition of voice recognition
software if keyboarding is laborious or detracts from the writing process [Dragon
Dictate Teen code: CA-SW-DRAGON-T, Voice XPRESS Software code: CA-SW-XPRESS].
Challenge
3.) Dysgraphia due to a defect in understanding of space is associated with
poorly legible spontaneously written text, preserved spelling, poorly legible
copying of written text, and normal fine-motor speed. This includes difficulty
copying text from blackboard to paper and keyboarding spontaneous writing assignments.
Possible Solution
Word processing software with voice recognition software.
Both Access to Math [code: ED-SW-ACCMATH] and MathPad [code: ED-SW-MTHPD] (for
lower grades) and Math StudyWorks II [code: ED-SW-MATH] for secondary grades,
accommodate for written calculation demands in math.
Challenge
4.) 1 or 2 above plus difficulties with word retrieval/word-finding and short
term/ active working memory.
Possible Solution
Word processing software with spellchecker, word prediction software [code for
Co:Writer CA-SW-COWRW] and/or text-to-speech software
[code for TextHELP Read & Write: ED-SW-READ].
Challenge
5.) 1 or 2 above plus difficulty with creative cueing (Mom, I don't know what
to write!)
Possible Solution
StoryBook Weaver Deluxe [code: ED-SW-SBWEAVR] and
Imagination Express Software [code: ED-SW-NEIGH].
Challenge
6.) 1 or 2 above plus Executive Functioning Disorder/mental planning and organization.
Possible Solution
Inspiration (story webbing) [code: ED-SW-INSPW], and Ace Publisher process writing
software [code: ED-SW-PUB].
Writing Aids that Promote Independence
The following items are included in the Writing/Typing Kit available through
the Lending Library (Inventory Code: WR/TYPE-KIT) or can be borrowed individually
utilizing the inventory code indicated.
Steady Write Pen
Shaky hands can make writing illegible. This pen was developed as an easy way
to smooth the motion of writing. Just grasp the base which rests on the paper,
and then write as you would when holding a pen. The ink tip makes contact with
the paper and translates your movements into smooth letters. The pen has a retractable
tip. Refill ink cartridges are available in most stationery stores. Approx:
$10; Inventory Code: WR/TYPE-KIT-STE; From: Sammons Preston
The Arthwriter Hand Aid
The Arthwriter Hand Aid is a versatile tool that helps people with hand or finger
disabilities to eat, write, groom, and perform other daily activities. Particularly
beneficial for anyone with arthritis, missing fingers, or an arm in a cast.
Provides a comfortable grip on a pen, pencil, razor, toothbrush or other utensil
and can be used with many control sticks on motorized wheelchairs. Approx: $7;
Inventory Code: WR/TYPE-KIT-WG; From: Sammons Preston.
Writing-Bird
The Writing Bird is a useful device for those with limited hand coordination,
dexterity, or a weak grasp. Ideal for persons with arthritis or neurological
disorders or for individuals without thumb to finger pinch. It slides along
the writing surface using upper arm strength. Only slight downward pressure
is needed to write. May be used with either hand. Approx: $20; Inventory Code:
WR/TYPE-KIT-BIR; From: Sammons Preston
EvoPen
Ergonomically designed to relieve writer's cramp and reduce arthritis pain,
EvoPen facilitates a functional secure grip posture and comfortably supports
index finger joints. EvoPen has received the Arthritis Foundation Commendation.
Approx: $12; Inventory Code: WR/TYPE-KIT-EVO, From: Sammons Preston.
Soft Pencil Grips
Grips help reduce the fatigue caused by writing with too much pressure. These
soft writing grips will not slip and are contoured to fit comfortably in the
hand. May be used with a pen, pencil, crayon, paintbrush, etc. Approx: $1; Inventory
Code: WR/TYPE-KIT-SPG; From: From: Sammons Preston.
Wanchik's Writer
Holding pens and pencils is made easier with Wanchik's Writer Instruments. Plastic-covered
aluminum hand and hand/wrist orthoses hug the palm and hold the index finger
to give individuals with weakened hand, finger and/or wrist dexterity the support
and control needed to write. This wraps comfortably around the palm, opening
on the ulnar side. Designed to fit pencils and thin ballpoints, these writers
are easy to slip on and off. Just bend for a customized fit. Approx: $22; Inventory
Code: WR/TYPE-KIT-WA; From: Sammons Preston.
Hand Hugger Pencils
Thick, triangular-shaped pencils featuring a unique 3-sided design naturally
promotes an efficient and functional pencil grasp. Approx: $1; Inventory Code:
WR/TYPE-KIT-HHP; From: Sammons Preston.
Ring Pen
Designed to fit any size hand, the Ring Pen is easier to hold and control for
those with limited finger dexterity or unsteady hands. Also helps relieve muscle
pain and tremors and prevent carpal tunnel syndrome, writer's cramp and fatigue.
Endorsed by the American Arthritis Foundation. Can be used on a toes as well.
Approx: $17; Inventory Code: WR/TYPE-KIT-RIN; From: Sammons Preston.
Thumb Buddy Pencil Grip
This stretchy pencil grip keeps thumbs securely and efficiently placed on pencils
and other writing tools. A perfect solution for thumbs that stick out, overlap
on fingers, or for thumbs that get tucked in. Available in small or large. Approx:
$1; Inventory Codes: WR/TYPE-KIT-TB & WR/TYPE-KIT-TBL respectively; From:
The Therapy Shoppe.
Lite-Touch Pen
This pen requires almost no pressure to write. It's built-up, textured surface
makes it easier to hold than standard size pens. An indentation on the pen helps
relieve sore, painful thumbs and aids in gripping. This lightweight, hollow
pen is ideal for persons with arthritis. Circumference measures 2 1/2". Approx:
$6; Inventory Code: WR/TYPE-KIT-RU; From: Sammons Preston
Desktop Writing Slantboard
Durable and lightweight slantboard that provides a smooth 15" x 13-1/2" writing
surface, and a functional 20-degree writing angle for optimal wrist positioning.
Ideal for writing, reading or copying activities. Assists with directionality
difficulties while helping reduce eye and head movement requirements. Features
a stainless steel spring clip, 4 non-slip rubber feet, smooth polished edges,
and a movable pencil clip that securely holds 2 writing tools. Approx: $36;
Inventory Code: WR/TYPE-KIT-DW; From: The Therapy Shoppe.
By Amy Goldman, Project Director, PIAT, Institute on Disabilities/UAP, Temple
Univ.
Why do borrowers have to complete an application form?
The "Request Form" is used to let the staff of Pennsylvania's Assistive Technology
Lending Library know exactly what devices a borrower is requesting, and gives
us information about who is borrowing the equipment.
What is the role of the local branch?
We hope that the local branches will assist borrowers in completing the application
form, and that staff of the local branches will be able to answer most questions
about the process and the form. If there are additional questions, borrowers
should be encouraged to contact their Assistive Technology Resource Center.
Why do you want to know the age and race of the person who will be using the
equipment?
Pennsylvania's Assistive Technology Lending Library is meant to be a program
for all Pennsylvanians with disabilities. We want to make sure we are serving
Pennsylvanians from all parts of the Commonwealth, of all ages, and especially
those who are members of underserved groups.
Why do you want information about the "systems" which serve the "recipient"
of the loan?
Pennsylvania's Assistive Technology Lending Library is an interagency program,
supported by the PA Departments of Aging, Education, Health, Labor and Industry,
and Public Welfare. Those Departments want to make sure that the people for
whom they are responsible are benefiting from the Lending Library, and the information
helps them understand the assistive technology needs of the people they serve.
Why does the borrower have to sign in two places?
It is important that the borrower understand his or her responsibilities when
borrowing assistive technology devices-some of which are quite expensive! Software
companies whose products are in the inventory want borrowers to know that copying
or distributing loaned software is against the law. The Departments want to
make sure that they are not sued regarding any damages, injury, or losses that
occur in connection with a loan.
Why don't you have a way for people to complete the application on the web?
The law requires that we have an original signature on file. However, we do
have a "download-able" version on the website,
http://www.temple.edu/inst_disabilities/atlend
I know the form has had some changes. How do I know I'm using the most current
version?
You should be using the form that says "Revised, May 00" on page four. Please
make sure the "Request Form" is completely filled out before submitting it to
the ATRC for processing!
Franklin/Fulton County MH/MR ~ Franklin County
Human Services Building
425 Franklin Farm Lane, Chambersburg, PA 17201
Contact Person: Laurie Dymond ~ Ph: (717) 264-5387
E-mail: kgmhmr@franklincom.pa.net
Huntingdon County PRIDE, Inc. ~ Huntingdon County
307 10th Street, Huntingdon, PA 16652
Contact Person: Sandra Bair
Ph: (814) 643-5724 ~ E-mail: pride@vicon.net
STEADY-ARM Resistance Arm
The STEADY-ARM Resistance Arm is a coordinational assistive device which uses
resistance to dampen involuntary spastic movements or tremors. This allows users
to perform activities using fine motor skills, such as writing, coloring, cutting
and eating independently. This assistive device comes with various additional
tools designed for different purposes. The Steady-Arm Writing Tool is used with
a variety of writing instruments. The Steady-Arm Cutting Tool is designed to
work in any direction. The blade rotates to always be in the proper position
for cutting. Fiber optics are used to help light the blade for better visibility.
The Steady-Arm Arm Support can be custom fit to the individual. The Arm Support
is for individuals who have intact fine motor skills but need the extra support
and resistance that this device provides. Also very helpful in self-feeding
skills. For training information, see below for details. Approx: $2800, Inventory
Code: CON-STEADY; From: Steady-Arm Company, Inc.
Device: The STEADY-ARM Resistance Arm
The STEADY-ARM Resistance Arm is a coordinational assistive device which dampens
spasticity or tremors. This allows users to perform activities using fine motor
skills, such as writing, coloring, cutting and eating independently. The training
will show the different uses of the Resistance Arm and the tools that come with
the device.
Trainer: Janette Holdren, Sales / Training Manager, The STEADY-ARM Company,
Inc. This event is being hosted by Pennsylvania's Initiative on Assistive Technology
(PIAT)
When: Thursday, October 12, 2000 ~ 10:30 AM - 12:00 Noon
Where: Temple University, University Services Building, Room 403
Broad and Oxford Streets, Philadelphia, PA 19122
For more information, to register, or to request this information in alternate
formats contact Janice Knuth, Training Coordinator, PIAT, at (800)204-PIAT (7428)
voice, (215) 204-5397 voice, (800) 750-PIAT (7428) TTY, 215-204-9371 fax, or
jknuth@unix.temple.edu
Registration deadline: October 6, 2000. Although the training is free, pre-registration
is required.
Pennsylvania Resources:
LDA of Pennsylvannia
Box 208, Toomey Bldg., Uwchland, PA 19480
Ph: (610)458-8193 ~ http://www.ldanatl.org
Berks County Learning Disabilities Association
P.O. Box 6894, Wyomissing, Pa 19610
Ph: (610) 988-8457 ~ http://www.bclda.org/
Bucks County Learning Disabilities Association
PO Box 1179, Southampton, PA 18966-0816
Email: bclda@geocities.com
http://www.geocities.com/Heartland/Estates/2427/
Learning Disabilities Association of Pennsylvania Presents:
Facing the Challenges 2000
October 20 & 21, 2000, Holiday Inn Hotel and Conference Center
New Cumberland, PA (Harrisburg Area)
Workshops Include: Written Language Disorders, Presented by Regina Cicci, PhD.,
Director, Language & Learning Disorders Clinic, University of Maryland Medical
Center, LD and the Law: Goblins and Goodies, Presented by Barbara Bateman, Ph.D.,
J.D., Special Education Department, University of Oregon, Keynote Speaker. Other
topics: Math Concepts, Books on Tape and Advocacy Issues, Wilson Reading Program
in the Classroom, Non-Verbal Learning Disabilities, Educationally Correct IEPs,
Chapter 15 Agreements, ADD and Medications and more. For brochure or information
call 610-458-8193 or email
DRodes1@aol.com. http://www.ldanatl.org
Don Johnston, Inc.
26799 West Commerce Drive, Volo, IL 60073
Ph: (800) 999-4660 ~ http://www.donjohnston.com
Independent Living Aids, Inc.
27 East Mall. Plainview, NY 11803
Ph: (800) 537-2118 ~ Fax: (516) 752-3135 ~ http://www.independentliving.com
Inspiration Software, Inc.
7412 SW Beaverton Hillsdale Hwy, Suite 102, Portland, OR 97225
Ph: (800) 877-4292 ~ Fax (707) 773-2001 ~ http://www.inspiration.com
Intellitools, Inc. NOTE: New Address!
1720 Corporate Circle, Petaluma, CA 94954
Ph: (800) 899-6687 ~ Fax: (415) 382-5950 ~ http://www.intellitools.com
Sammons Preston
P.O. Box 5071, Bolingbrook, IL 60440-5071
Ph: (800) 323-5547 ~ Fax: (800) 547-4333 ~ http://www.sammonspreston.com
Steady-Arm Company, Inc.
PO Box 255, Ulster, PA 18850
Ph: (877) 616-2505 ~ Fax: (570) 358-3122
Therapy Shoppe, Inc.
P.O. Box 8875, Grand Rapids, MI 49518
Ph: (800) 261-5590 ~ Fax: 1-616-863-5976
E-Mail: TherShoppe@aol.com ~ http://www.therapyshoppe.com
This Newsletter is available in alternate formats upon request or visit our
website for text and PDF versions. http://www.temple.edu/inst_disabilities/atlend/
Editor: Anne Macleod E-mail: tq97@philly.infi.net
Pennsylvania's Assistive Technology Lending Library
Institute on Disabilities UAP/ Temple University
Room 423 Ritter Hall Annex
Philadelphia, PA 19122
Call toll-free: (800) 204-PIAT (voice), (800) 750-PIAT (TTY)
http://www.temple.edu/inst_disabilities/atlend
E-mail: piat@astro.temple.edu