Author: lesleyduff

Scottish Intercollegiate Guidelines Network (SIGN) and apps

“The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based clinical practice guidelines for the National Health Service (NHS) in Scotland. SIGN guidelines are derived from a systematic review of the scientific literature and are designed as a vehicle for accelerating the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving patient-important outcomes.”

If you want to know about a particular health condition the guidelines can be very helpful for giving you an overview and an indication of potential therapies that may be available. For those in Social Care/Work they could help you understand treatment plans of your service users e.g. if your autistic clients have comorbid conditions such as epilepsy or depression. There are over 100 guidelines available and the guidelines are provided as downloadable PDF documents.
There is a free SIGN Guidelines app [Android]  and  SIGN Guidelines app [Apple]
They currently have one guideline and an app specifically for autism in children.  

Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders [Guideline 98]SIGN Autism patient guide

NFC Ring – technical uses for your fingers

Thinking more about help for people who may have problems with dexterity found the idea of the NFC Ring quite exciting. Enabling devices as not just wearable technology but jewellery? Unlock doors by wearing jewellery [BBC]
Visit the NFC Ring KickStarter campaign for a video they used that explains the concept and potential uses. This particular project is so new that their NFC Ring blog posts are all about fundraising to get enough money to put it into production though it would appear to be available for sale soon.

Near field communication (NFC) is a set of standards for smartphones and similar devices to establish radio communication with each other by touching them together or bringing them into close proximity, usually no more than a few inches.

Now this ring wouldn’t do anything on it’s own you need to have another device that is NFC enabled, many new smartphones/tables already incorporate this technology. But you could look upon such a ring as an extra button that would do something on the other device as long as the ring is held close to the e.g. phone or tablet device. If you use a fob at work to electronically open doors it’s a very similar principle. Could imagine this also being useful to people who find it difficult to bend their fingers e.g. arthritis in joints.

There are some practical issues like getting the size of fit of the ring right!

Keep an eye on their Twitter account @nfcring for latest developments


Review: The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies

The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies [PDF]

“Abstract. Personal digital assistants (PDAs) offer task management and organisational features that may be utilised to help people with autism spectrum disorder (ASD) function more successfully in the workplace. Additionally, onboard video cameras and addon software applications provide rich opportunities for the implementation of personalised vocational supports for individual workers. This article reports on three cases of workers with ASD who have been trained to use Apple iPod Touch PDAs as vocational supports in the workplace, resulting in improved functional performance and reduced behavioural challenges.

Keywords: Autism, assistive technology, cognition, occupational therapy, personal digital assistant, vocational rehabilitation”

From the Journal of Vocational Rehabilitation 37 (2012) 75–85

Regarding Apple iPod Touch devices:

“…These devices can be carried in a pocket, on a belt clip or on a necklace lanyard, making them appropriate for workers who must use their hands on the job…”

They used the devices to provide the following support

  • task reminders
  • task lists
  • video-based task-sequencing prompts
  • behavioral self-management adaptations
  • way-finding tools, and other supports

One example from the study was a successful pilot with Jeffrey who was having difficulties in his job in a fast food environment. The iPod was worn in a protective case on a belt clip. An occupational therapist worked with Jeffrey to set reminder alarms for tasks, different tasks were given different sounds with additional audio recordings of task notes that could be listened to for extra reinforcement. They didn’t need to use any additional apps, they just used the built-in apps like “Clock”.

You can find details of how to use the built-in apps by going to Apple’s website and downloading the appropriate iPod manual (these are usually PDF files)

e.g.  iPod touch user guide for iOS 6.1 Software (June 2013) [PDF]

Another trial was Lily, a 20-year old woman with Downs Syndrome and ASD. She was employed in a housekeeping duties role.

“…The Storykit application was downloaded from the Apple iTunes Store in order to build verbal and picture-prompting task lists, replacing Lily’s laminated paper prompts…Storykit allows a user to easily create talking picture books…

…The device led to improved work performance, fewer behavioural challenges, and a marked decrease in telephone calls for help to her job coach or mother during the workday.”

In the report they do acknowledge

…It is important to note that each of the three workers had functional cognition, vision, hearing and manual dexterity sufficient to interact with the iPod Touch without the need of accessibility adaptations. Many people with ASD have cognitive, sensory or motor conditions that would make utilisation of such a device problematic…

Once again this highlights how tailored use of any device needs to be to the particular impairments of the individual.

Interesting emerging new role for Occupational Therapists in supporting setting up electronic devices and installing and using appropriate apps. Particularly encouraging is that in each of the three case studies the use of the iPod device helped people complete work tasks with more autonomy and with less supervision in the workplace – one of the factors affecting employment. Some professionals are nervous about technology because they think it will be used to replace their existing jobs, what you can see from a study like this is just how important and valuable their existing skills are if they adapt to utilise new technologies as tools to enhance their roles and make better outcomes for their clients and reduce the stress on clients’ carers.

“…This is an exciting time for anyone in the fields of education, physical rehabilitation and vocational support, where we are seeing a long-awaited merging of consumer products and assistive technologies for all…”

More details about some of the extra apps used:

App: Storykit

So here’s an example of techniques based on a paper-based system being successfully transferred to a hand-held electronic device. Storykit is an iPhone/iPod app, a project of the International Children’s Digital Library (ICDL) created by the University of Maryland’s Human-Computer Interaction Lab.

App: VoCal

VoCal Voice Reminders By GZero Ltd. “…VoCal fuses a Dictaphone, Calendar and Alarm system into one…”

Autistic Children Communicate with Horses and iPads

From Icatha College USA, a project involving Tina Caswell – Clinical Instructor, Department of Speech-Language Pathology and Audiology

With Horses and iPads, Autistic Children Learn to Communicate [Press release]

Interesting to note that they found that the light weight of an iPad device was an important factor

“…traditional assisted speech-generating devices can be cumbersome and heavy and children tend to abandon them due to lack of interest with their limited communication options. On the contrary, iPads loaded with speech-generating applications only weigh around 1 pound, cost significantly less than traditional assisted speaking devices and are more user friendly. …”

In the project they also utilise Dynavox Alternative and Augmentative Communication (AAC) devices.

 

Open University Unit -The autistic spectrum: From theory to practice

The Open University (OU) provides a wide range of courses and is a long-standing centre of expertise in distance and online learning in the UK. Many people already in employment use the OU to gain or supplement existing academic qualifications in subjects such as Social Work. They have provided a free unit:
The autistic spectrum: From theory to practice

Good communication is essential for children with autism and their families

The National Institute for Health and Care Excellence (NICE) (England and Wales) provides guidance and advice to improve health and social care. On 28 August 2013 they published clinical guidelines offering evidence-based advice on the care and management of children and young people with autism.

Autism – research involving phones

This project was sparked by an observation by a clinician from the Autism Resource Centre. She explained that there is a real difficulty getting ASD people to remember to carry cards and/or documentation to be read and used in difficult situations. However she notices that most people will remember to carry a mobile phone with them. So are there ways of making useful information available on such devices so it will always be available in a time of need? Is there any research on this? As I document my search methods I’m always going to try starting with broad searches then refine them to be more specific.

Starting with the “Autism Data”  collection via The National Autistic Society Information Centre Library which would seem to be a good place to start for any research of specific relevance to autism. Let’s try the KISS principle – Keep It Simple Stupid. 

Simple search on ‘phone’ Yields 24 results, search seems to be on the metadata of their records. Brings up records with the phrase ‘phone call’ which is a set of records mostly relating to phone surveys of parents or using phones for charity fund-raising. Unfortunately there doesn’t appear to be a way for me to link to individual search results directly so from now I will refer to the record numbers

  • Record No: 27858
    “…As a younger child, he would pretend to talk on the phone…” This was in the context of language impairment. So even if an individual has a communication impairment the desire to communicate the way everyone else does can still be there. Is a phone an aspirational device for even young children, something they want to use?
  • Record No: 23901
    Author:De Leo G. et al
    Title:A smart-phone application and a companion website for the improvement of the communication skills of children with autism: clinical rationale, technical development and preliminary results
    Source:Journal of Medical Systems, 2011, Vol. 35(4), pp. 703-11
    This looks more promising, hmn how do I get a copy of the article “Journal of Medical Systems“??? Will document a “How to” using an Athens account
    If it has a “companion website” that sounds as if it will be easier to get hold of quickly. From a quick skim of their article they detail a system working on Windows Mobile phones and the technique seems remarkably similar to “Talking Mats” – using visual images for communication. So should bear in mind the importance of using techniques other than solely text (always a good principle for accessibility anyway) and can symbols be more effective for visual learners.

TO BE CONTINUED

Autism Data – The National Autistic Society Information Centre Library

“Autism Data is the ideal research tool for anyone researching autism and Asperger syndrome. It is, as far as we are aware, the only database of published material on all aspects of autism, open for everyone to access on the web. It lists over 30,000 published research papers, books, articles, videos and other materials.”

Autistic spectrum – a rainbow of users

There’s a saying

“if you’ve met one person with autism…you’ve met one person with autism”.

Even in this project we always have to be aware that although we will be using broad labels like ‘autism’ our intention is always to provide uniquely personalised information about individual people. We want to collate people/places/things that are important to only that person. We can’t assume if something works well for one person that it will work for everyone. By the very nature of autism we have to expect varying degrees of ‘success’ or ‘failure’ for different methods but we will never be able to come up with just one approach/tool that addresses everyone’s needs.

Autistic Spectrum

One phrase we will be using a lot is autistic spectrum and the rather horrible but commonly used acronym ASD – Autism Spectrum Disorder. Just like in a rainbow there’s not just one or two colours/issues but a range.

By: Robert Nyman

But we need to start somewhere so let’s take a look at how this condition is currently defined (Beware, this changes over time so will only reflect current thinking).

According to the NHS, Autism and Asperger syndrome:

“…ASD can cause a wide range of symptoms, which are grouped into three categories:

  • problems and difficulties with social interaction – including lack of understanding and awareness of other people’s emotions and feelings
  • impaired language and communication skills – including delayed language development and an inability to start conversations or take part in them properly
  • unusual patterns of thought and physical behaviour – including making repetitive physical movements, such as hand tapping or twisting (the child develops set routines of behaviour and can get upset if the routines are broken)…”

When we are researching resources that would fall into any of the three categories we’ll try to tag them with ‘social’, ‘communication‘ or ‘patterns‘ as appropriate.

disco glitter ball
By: Ewan Topping

Also note the important word ‘grouped’, within each of these three broad categories there’s a vast range of examples. In Scotland, one of the common diagnostic tools used by health professionals is called ‘DISCO’, now before you start boogying on down, in practice this will materialise as the rather less funky title ‘Diagnostic Interview for Social and Communication Disorders‘. This involves working through a whole binder full of structured criteria. Diagnosis is time consuming as it usually also involves interviews with other family members if possible.

Peeters, T. and Gillberg, C.

‘People with autism come in as many shapes and sizes as ‘people with pneumonia’. They have different races, social circumstances, intellectual levels, personalities and associated disorders. They should not be expected to conform to a highly specific prototype or to benefit from exactly the same kind of intervention, treatment or training. First and foremost they are people. It so happens that they are affected by the same (or similar) disorder but this does not make them blueprints of each other.’

(1999) Autism: medical and educational aspects. London: Whurr