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well welcome everyone to our ablenet webinar of the day I'm glad that you're able to join us I see that a few people are still hopping on so don't worry if you hear me talking and you've just jumped in we're just starting today's topic is switch assessment now I've covered this topic from various aspects before on other ablenet webinars but today we're going to bring a really unique focus that I'm very excited about where we're going to look at specifically how do we figure out the best type of switch to use and the best location for that switch for clients you have muscle weakness these clients have very specific requirements that vary from other populations that we work with so we're going to look at specific assessment considerations that vary when we're working with people of muscle weakness switch types that apply to this population some common switch placements and then top that off with a case study I forgot to introduce myself again I'm Michele lying I'm an occupational therapist and I work in private practice in the Denver Colorado area and I do a lot of switch assessment because the clients that I work with have significant physical limitations and their access is often limited to looking at switches as we know there's lots of ways of accessing assistive technology switches is only one of those types but if that's the best way for our client to access whatever their technology be whether it's a communication device a power wheelchair computers EAB else we need to figure out again where to put that switch and what type to use so while people are still hopping on we're gonna ask you to just go ahead and tell us who you are so we have a good sense of who has joined us for this webinar while people are doing that too this against the end we had a webinar in January January 13th on positioning and access so if that's something you're interested in you can always refer back to that recording because of course the client needs to be very well-positioned to optimize their access and our next webinar is going to be in March March 10th and that's going to focus on switch assessment for people with increased muscle tone alright so so far we've got about nearly 40% of our participants are occupational physical therapists and then we have lots of folks from their assistive technologists and speech-language pathologists etc so thank you to everyone for joining us today great okay so with that said let's go ahead and jump right in first our assessment considerations now we've discussed in previous webinars some general assessment considerations for switch assessment but what's different when we're working with a client who has muscle weakness well primarily active range of motion and force is going to be limited so when we reach out to grasp something say your mug of coffee that is your active range of motion someone else might be able to come along and move your arm further than that that's passive range of motion but your active range that you can move in equals the travel distance that client has to reach a switch also switches mechanical switches particularly require a certain amount of force to activate that switch so in the picture here this switch needs to be pressed activated with a certain amount of force to make that connection that's going to be limited in people with muscle weakness endurance is generally limited and people have muscle weakness too endurance is how long our muscle can keep going so if I'm doing a long-distance run if I was had good enough endurance for that my muscles would require certain amount of strength to be running but also a certain amount of endurance to continue moving along endurance is limited in people have muscle weakness because a muscle fatigues very quickly this impacts the client's ability to hit the switch repeatedly think about a client using a communication device that can require hundreds of switch activations in a day so we need to keep in mind that these switch type use and location need to help the client to maintain their best endurance it also impacts force available over time so perhaps the client can go ahead and activate that switch a few times but if they have to do so repeatedly may require switch that requires less force and if the client is driving a power wheelchair that's that pwc that requires sustained force so the client has to push the switch down and hold it down the entire time they want to sustain movement of the power wheelchair endurance can impact that as well now in the pediatric world we're going to see muscle weakness in clients who have spinal muscular atrophy this is depending on the type of spinal muscular atrophy where we're dealing with profound muscle weakness and switch assessment is very very critical to shame muscular dystrophy congenital myopathies and other type of dystrophies in the adult population the group that has the most challenge with muscle weakness is ALS and that's a situation where we have to really carefully look the best which for a client as well also other muscular dystrophies so in general when we are doing an assessment for switch placement for a cloud muscle weakness we need to determine first where does the client have movement where can they move anything on their body then we need to determine as best we can how likely that movement will persist or be spared now what does that mean well a lot of these conditions that we were just looking at are progressive so we want to make sure that the client can not only activate that switch today but hopefully for as long as possible certain diagnoses tend to be characterized by certain available movements and some of those movements tend to persist longer than others this can be a really difficult call but we need to find out from the client from the team working with them if there are certain movements that they believe are the strongest movements and also longest lasting we also have to determine how much force is behind the available movement so where is the movement how strong is the movement and how much endurance is behind that movement again for repeatability particularly like in scanning and sustained force like in using a power wheelchair now this webinar is not worth very much if it's not something that's really going to help you out so think of a client that you're working with right now a client with muscle weakness if you don't happen to be working with one of those clients now see if you can think of a client that maybe you've worked with in the past as we move through the webinar think of where you might try and place switch for that client and what type of switch you think is going to work out the best now an ideal switch site for our clients uses a small movement a smaller movement is possible an isolated movement meaning we're not pulling in a lot of overflow or reflexes volitional movement under the clients voluntary control with controlled activation sustained pressure if required especially in power mobility and controlled release so let's look at each of these four our clients Kelly I see your comment about the echo check and make sure you're not logged in twice you might be gang an echo if that's the case all right so we want a smaller movement as possible now this is not usually a problem for people with muscle weakness movements are generally small for some of our clients with a lot of tone the movements can be quite large but that small movement may only be possible if the area is well supported so in this picture here let me get my little arrow here we go this is Julien's hand and light in front of his thumb right at the tip of that arrow is a fiber optics which it's embedded in the hand pad of his arm draw now for him to be able to use a very small movement of his thumb to activate that fiber optics which we'll talk about fiber optics here in just a moment his hand needs to be well supported his forearm needs to be well supported his shoulder needs to be well supported so when we are using or taking advantage of very small movements with our clients we need to make sure that that movement is very very well supported we also need an isolated movement now sometimes again more inclined says increased muscle tone and movement might pull in other movement we might see in response to movement in one part of the body less voluntary movement in other areas so we want to make sure this is isolated that's not typically a problem for clients with muscle weakness volitional movement is also not typically an issue non voluntary movements are uncommon in people with muscle weakness now sometimes there might be some muscular fasciculations it's almost like a very small little tremor within the muscle itself but it doesn't usually impact movement very much for example of some of this very small isolated volitional move we're going to take a look at a video this is Julian who we saw in our earlier picture Julian is older now and he is showing a very small movement that he uses to activate a fiber-optic switch so hopefully you're able to see that video but very small movement is just simply flexing that finger rearward and a fiber optics which is a switch that can capture that particular movement so an ideal switch site we want controlled activation that means that the client needs to move towards the switch we want to reduce that travel as much as possible for people with muscle weakness activation pressure to activate the switch we want reduce pressure either using a very sensitive mechanical switch or no pressure using an electronic switch again we'll talk about those switches here in just a moment the client needs to have an acceptable level of speed in being able to activate the switch particularly in scanning this can be impacted by weakness so we need to keep in mind the required speed or anticipated requirements there when we're doing an assessment accuracy may also be impacted by weakness it might be that the client knows exactly when they want to hit that switch but perhaps can't quite pull that together in a timely manner due to that weakness sustained pressure again very important in power mobility some of our clients might be able to sustain pressure against a switch but quickly fatigue out so we have to make sure we're finding a switch that will work for them over a period of time release well release is important particularly empower mobility because that's how is the chair the client needs bill to release consistently and some people with muscle weakness have a little difficulty letting go of the switch because they tend to stabilize against the switch so when you're working with a client if you realize if you notice that they're having a little difficulty letting go of that switch check and see if they're stabilizing against it it might be that you need to provide a little more support for the client themselves to free up that movement a little more so that's a little bit about assessment before we get into the actual switch types on I want to make sure that I answer any questions you have I forgot to mention at the beginning feel free to type in your questions or comments at any time in the chat box if I don't answer right away I will get to it I might just know that we're going to be covering that in a few minutes but feel free to type in any questions that you have at this time or throughout the presentation all right while people are typing in anything we're going to start talking about switch types switches are categorized into two main types mechanical and electrical mechanical switches require pressure to actually activate the switch the switch is closed which causes activation by the force of a body part against the switch these also require travel there's a certain amount of travel that's required to close that switch in electrical switches there is no pressure required but there still is generally some amount of travel it might be very small and there's less feedback in most electrical switches so mechanical switches when you hit that surface you often hear a click some have a louder click than others electrical switches are sometimes file or have a very small amount of noise and that noise might be a distance from the switch itself so for example in a fiber optics which you may not hear anything at the switch surface itself but there is a small box at the fiber optics which is attached to that might even be placed behind the client and that's where the crook is so there's just not as much feedback okay SPC has asked how can you get around increased muscle tone being the cause for difficulty in releasing the switch well you'll have to join us for our next webinar because we're going to be talking about increased muscle tone then because yes sometimes clients with increased tone have difficulty releasing the switch as well so I hope you can join us March 10th for that and we also have another question do you know of any switches that vibrate for feedback there are switches that vibrate and that lets the client know they hit that switch most those are sold by enabling devices the challenge with vibrating switches for people of muscle weakness is that very vibration can actually fatigue the muscle also those switches tend to require a fair amount of pressure to activate the switches surface okay so mechanical switches are the main mechanical switches that we're going to look after people with muscle weakness our plate switches and light touch plate switches ablenet has the spec switch this is a nice small switch it's about maybe 2 inches across it's great for capturing small movements because it doesn't take up a very large amount of space it's also fairly sensitive it only requires 3.5 ounces of force and the travel distance you can see is quite small it's very very small the jelly bean switch actually requires less force it's 2.5 ounces and when we're dealing with muscle weakness and ounce can be very very significant but it is a larger target and that can be a challenge for some of our clients these also have good feedback the microlight which is also available through ablenet requires less force than the specs but it's still very small it requires 0.4 ounces so very very light touch and still a pretty small travel about a quarter of an inch now it only activates let me get my arrow again on the far side so it's kind of a lever type switch if you were to push in this area by my arrow now the switch may not activate where you need to push is on the far side and that leverage helps to reduce the amount of force required now this is a rather fragile switch which isn't generally a problem with people with muscle weakness but it is something to keep in mind I use the switch a lot for if I'm using a mechanical switch it's about the most sensitive mechanical switch that you can get it's also a nice small size has a little tap screw in the bottom for mounting as well adaptive ation has these pal pads they're fairly sensitive I don't know the exact amount of ounces are required activate these but they are a larger target and that can be difficult when we're trying to capture very small movements and adaptive switch labs has this ultra light switch it is similar to the micro light except that the size here is a little more contoured so that someone doesn't have to lift up and over that edge of the micro light switch but it does require a little more force than the micro light switch it's 0.5 versus 0.4 so very similar and it has two taps screws on the bottom surface for mounting as well all right let's take some questions because we definitely have some before we move on to electronic switches we have a question which witch have you encountered that requires the lightest pressure in the mechanical switches the micro light switch is probably our lightest option and then electronic switches which we'll cover here in a second do not require any pressure and amanda has asked you have suggestions for student who can activate the switch but not remove their hand the challenge there if we have a client who can activate but not release then either we need to determine if it's because the client is stabilizing against the switch and if there's a way of providing that stability elsewhere or we need to look for a different site because again it brings us back to that criteria of what's an ideal switch side part of an ideal switch side is that the client can readily release the switch and particularly for power mobility can release that very quickly and consistently and accurately so you might need a look at a difference which site and then I Amanda's also asked any switches with a built-in timer to turn off the switch I think you might be referring to if the client can't remove their hand the challenge there is we want the client to be able to turn off or release that switch independently if at all possible and then Connie is asked which is the most durable will probably not the switches we're looking at BA again we're looking at switches for people with muscle weakness for people who have a lot of tone we're looking at more durable switches and again we'll definitely get to that next time all right we have a pull here which type of mechanical switches are folks using with this population right now spec micro light or others again we're just looking at mechanical switches at this point and while those results are coming in I know Gloria's been visually getting back to a number of you a number of you have said that you're not able to find the PowerPoint should have gotten that with your confirmation email it's simply a PDF of this PowerPoint presentation that's our handout for the day and if you didn't get that you can put something on the chat box and Gloria will go ahead and email that to you so more than half of you are using the spec switch and then about a third the microlight or other for those who marked other if you want go ahead and throw something in the chat box for me let me know which mechanical switches you are liking for people with muscle weakness I'd love to know okay so next we're going to turn to electronic switches so electronic switches that are commonly used for people who have muscle weakness include proximity fiber optic infrared touch sensor and something called the piezoelectric film which is used to detect vibration so let's start with proximity switches these are all electronic switch is that we're going to be discussing and so these do not require activation force but some travel distance is required ablenet has this candy-corn switch and it's a capacitive switch and proximity switches our capacitive switches and in layman's terms this switch can determine our capacity to conduct electricity so if we wave our hand over the surface of this it will activate if your cat puts their paw on top of this it will activate if you put a math book on top of it it will not activate so it has to be something capable of conducting electricity so the client only needs to approach this adaptive switch labs AMD eye stealth products and switch it all cell so many switches sometimes these are sold in an array and those are usually used for power mobility but you can get these as an individual switch as well typically you can adjust the sensitivity on these and that means how close does the client need to get to the switch to activate it so we can capture that very small movement and since this is an electronic switch if we don't have a power chair that this is on and then we can take advantage of that power source we have to plug the switch into something into a rechargeable battery because it does require power one disadvantage of proximity switches for people with muscle weakness at time is that the switch itself is a little bulky and that can be sometimes an issue and this is showing some examples of proximity arrays in this case we have a special half tray and it's hollow and inside we can place for proximity switches for driving a power chair for the left-right and reverse or reset and in this case on the right we have a head array a head array is a very common I'll turn it to the access method for driving and in this situation we have one proximity in the back pad and that's for forward and then we have proximities on the sides for left and right often used both of these for people with decreased muscle strength all right let me check our messages here sorry Oh Amanda I'm sorry I did answer your question Amanda but it sounds like you lost your connection during that time so let me briefly answer that again if the client is having difficulty removing their hand from switch surface then we have two possible scenarios most of the time either the client stabilizing against the surface of the switch you can see if there's something you can do within their positioning to help minimize that tendency to stabilize against the switch give them some more stability or look for a different switch sight because part of the criteria for that ideal switch sight is we want the client to readily be able to release that switch accurately consistently and some people have let me know about some other switches that they are using for people with muscle weakness mechanical switches jellybean pal pads string switch that's interesting shrink switch has a lot of leverage sometimes that's a hard one for people with muscle weakness and Matthews asked why don't I see any responses in the chat area I'm sorry Ike I'm the only one who can see those and that's why I tried to go ahead and answer those verbally and repeat them Jennifer has also said she says I gauge which is another access method that certainly can be very useful for people with muscle weakness great okay I think we've got those answered here Oh Paris is asked any suggestions for proximity switches if only volitional access site is I blink hang in there Paris because we're going to get to I blink very soon and someone else's also asked where do you look to support if they are resting on the switch Powell pad same as Amanda's question if someone's resting on that surface it might be that that's not their best site but hang in I hope this information will help us out with some of these questions so fiber optics we already saw a picture of fiber optics with Julien one of the things that's great about fiber optic switches is we have an extremely small target the surface of a fiber optics which is smaller than a pencil eraser and there's no pressure required because again this isn't electronics which the client just needs to approach the fiber-optic and we can adjust the amount of distance that's required for the client to get to that fiber optics are available from adaptive switch labs AMD I sorry I don't know why that's indented there it should not be spelt products and switch it here's an example of fiber optics mounted within a tray service in this case here on the right the client can rest their hand on the surface of the tray and move a finger or thumb over any and all of these four switch locations now the fiber optic cabling is inside of this hollow tray and these locations can be placed anywhere on the tray service that meets the clients needs here on the left side these switches are in the side of the tray and that's because for some clients with muscle weakness if the client can flex their fingers over the edge of that tray bringing the finger back a little bit and deflections might be an easier movement for that client than moving them on a flat surface back and forth here's some other mounting ideas for fiber optics we saw this picture before of julienne where we've taken that fiber optic switch and put it right through the hand pad this is part of an auto buck arm trough so he has full support of his arm and his hand and over here on the right is another hand pad this is available from Stealth products and here we have three fiber optic switches there's a space here for a fourth and these are mounted in very small about two inch long goose necks so that the exact placement of that fiber optic can be varied to match an individual clients needs this can be placed at the end of an armrest or an arm trough again providing that important support for this very small movement fiber optics aren't always placed just by the fingers or thumbs but these can be placed by the side of the head as well here on the Left we have fiber optics which cabling mounted in some lock line over to the right in a gooseneck and then finally even in a specialized headset all right let's take a quick look at these questions before we get to infrared we have a lot of people on the webinar today which is great that means lots of questions good question is there any future webinars on introduction to switch use like computer programs and toys you can check on the ablenet site to see what some of the upcoming webinars are because I think there are some that are going to cover some of those issues so keep an eye out for that all right infrared switches now infrared is the same technology that's used on the end of your remote control for the television in this case my pointer again maybe there we go these are two little diodes infrared diodes at the end of the scatter switch and the scatter switch was originally developed from University of Michigan and is distributed by ablenet at this time scatter stands for self calibrating auditory tone infrared now we're infrared is really helpful is for capturing eye blinks and for people with profound muscle weakness sometimes eye blinks are what we really need to use for activating a switch for accessing assistive technology so if you look here on the right you could see that same diode that is mounted on a pair of eyeglasses so even if your client doesn't wear eyeglasses they can get a pair of frames or use a pair of frames that I believe still comes with this switch that doesn't have any glass in it and it is positioned in such a way to capture and I blink now this can be adjusted so that it ignores those typical blinks that we make throughout the day just to keep our eyes moist but notice is a more intentional I blink for the client the client needs to really stay very still but generally that's not a problem again for people with muscle weakness enabling devices has an eyeblink switch this also uses infrared technology and you can see that it's mounted here on a pair of eyeglasses there are touch switches that are available as well these do require a little bit of force but not too much the main drawback for some of these particular switches is that the targets are sometimes just a little too big to capture these very very small movement there are also switches that are called a sensor switch in this case there's a sensor that's placed over a muscle it picks up activity in the muscle and particularly for people who have muscle weakness this is often used over the eyebrows so you can have a small sensor I'll show you a picture one a minute that's placed on say a headband place it over the eyebrow and if that person can wiggle their eyebrows around smile frown grimace it can pick up that activity I do not recommend using eye blink switches or particularly sensor switches for people who are using power mobility because there's vibration that comes through the power wheelchair itself and sometimes that can be read by the switch and actually trigger the switch here are several examples of sensor switches and they're available from john johnson enabling devices and there's this newer one called the tinkerer Tron EMG switch so if you see that term EMG these are sensor type switches alright then we have pzo electric film now PG electrical film looks kind of like a piece of saran wrap it's the real piece of film and when it's vibrated it will activate the switch again these are not recommended for power mobility because vibration of the power chair does sometimes lead to the switch being activated and here's two examples on the left is the enabling devices twitch switch this little piece of blue here mounted to this young man's temple area when he makes a face as he grimaces or smiles it wrinkles that little piece of film and that's what activates the switch and you can adjust the sensitivity of that and towards the right side is the am di p vo switch it looks like a sensor switch but it is using this piezoelectric film so earlier I'd encourage you to think about a client a particular client with muscle weakness and think about what type of switch site and switch type might be helpful for them so go ahead think about that client again if you identified one now that we've gone through a number of potential switch types and think about the type that might work well for that particular client alright let me just check our questions you're really quick and then we're going to move into a switch site hierarchy of some potential sites for people who have muscle weakness there's a few questions here that I really appreciate people asking but aren't pertinent to what we're able to cover in our webinar today so I'm going to skip the and we will follow up with you later on okay I think ready to move forward there okay here's our second pool I believe if you could go ahead and mark where your most frequently placing switches right now when you're working with clients who have muscle weakness either by the hands the head specifically the fingers or elsewhere all right and we have a lot of folks again this call so I'll give folks a minute to go ahead and put in their answer there and some of you might be thinking I'm not really putting places switches on clients right now that's fine but if you are where are you putting those switches so it looks like hands are ahead closely followed by the head and then by the fingers and a few other locations as well great all right well let's start with those hands now we already saw these proximity switches if we're using proximity switches by the hands we can use these to capture finger movement but since this is a little larger target sometimes we might capture a little larger movement of the hands these can be actually placed within the tray because as a capacitive switch they will not be activated by the trade themselves it will be activated by someone's hand over the tray by placing this underneath the tray now the client rather than having to lift up and over a mechanical switch simply needs to slide over the location of the proximity switch and that requires less strength we can also capture finger movement on the left here we have two examples of doing that with fiber-optics which is again we've seen this picture of julian with a little fiber optic switch in the hand pad of an arm drop here we have another client for Reed who has a custom-made arm and the fiber-optic is placed on the edge of this for him to use a slight flexor movement and over here on the right is Christopher and he's using a microlight on a gooseneck and he's extending his finger slightly and activating that switch and that's working well for him now this is during an evaluation notice he has some strapping here and he has an arm trough his arm wasn't staying within that arm trough we recommended a better support system for him to keep him in alignment with the switch here's two more examples of capturing finger movement this is Farid again this is when Farid is laying in bed he spends a lot of time in his bed he has a custom-made arm trough in bed and he pulls his finger back towards this fiber-optic switch to activate it we're gonna watch a video of this in just a moment and this is Krista and Krista has a micro light mounted right in front of her fingers and she extends to activate those and in the background besides her dog I believe we also see Jill Pullman she's a speech therapist I work with extensively she's very very smart all right so let's watch a video for Reed activating this fiber optic switch in bed nice how you're moving towards that great so hopefully you were able to see that well depending on your connection speed he has a very very small movement with almost no force this way she's able to capture that movement we're able to calibrate the activation distance and since no force is required this works very well for him and we're now going to watch Krista again she has a mechanical switch placed in front of her fingers the micro light the advantage of the mechanical switches we don't need a power source in her manual chair and she extends her fingers with a very small movement activate this switch so you can see that very very small movement that she is using further down our hierarchy is using the head and the side of the head can work very well for a lot of clients even clients with muscle weakness because we have a lot of leverage behind that head movement and here are two clients who are using aspects which by the side of their head and get that arrow again there we go so here is Joe using aspects which by the side of his head here it's mounted on a stealth headrest actually all three of these are mounted on a stealth headrest this is Brady and he has a switch by the right side of his head and down below this is AJ and he has a jelly bean right by his cheekbone and all of them are using a very small movement to activate those switches now we can also capture movement under the chin or by the side of the chin using either jaw or head movement this is a special headset that's made from adaptive switch labs and it has a little hollow aluminum tube at the end that's pliable and we've put some fiber-optic cabling through this it can be aimed right at the side of someone's jaw and capture a very small movement again with no force less use sites but sites that can be very helpful with this population is at the eyebrow using sensor switches and I blink using infrared switches now I'm going to get to these questions but one of the questions that we've had is from Stacie is I blink should I use fiber optic or sensor for eye blinks you definitely want to use infrared fiber optic actually that fiber-optic light can be damaging to the white of the eye so do not use fiber optics it is possible to capture I plans for fiber optics but it's not safe so infrared is safe to be directed towards the eye another potential switch light is at the mouth but usually movement of the tongue and control of sip-and-puff switches is not possible for most clients who have muscle weakness particularly clients who have ALS sip-and-puff simply doesn't work the client has to maintain air pressure within the mouth and that doesn't work for those clients because of issues with the soft palate placing switches by the feet usually requires two larger movement for people with muscle weakness but depending on your client and where they are in the progression of their condition that might be an option usually placing a switch by the outer knee or above the knee requires again a rather large movement but I'm always surprised that a lot of clients with muscle weakness can use some hip a deduction to access a switch by the inner side the medial side of their knee and here's two examples of that now this is Julian again who has a fiber optic up here in his hand pad but by the inside of his knee has a micro light switch and this is mounted on a swing-away joystick mount actually but he's able to use some hip a deduction and access this switch over here on the right is for reid and he has proximity switches these yellow switch is here by the inner knees and we had to raise his feet a little bit to unweight the distal thighs just enough to allow him that hip a deduction this is a movement that's often spared in clients who have spinal muscular atrophy movement at the thumb and forefinger and hip a deduction are common movements paired in that particular condition so if you're still thinking about that client and hopefully I've already thought about a potential switch type to use think about where you might try to place that switch for that client as well all right let's get back to some of these great questions Kristy has asked is one particular proximity switch known to be more durable and accessible for young kids and some of the concerns are that this which maybe has to be moved between shares and positions because yeah usually for someone with muscle weakness we don't worry about durability as much these proximity switches are actually very very durable the ones that I've had most experience with are the ones from adaptive switch labs and starting to get a little more experience with these stealth products ones they're pretty new and they're pretty darn durable so I haven't had a problem with durability there and let's see I see your question about Huntington's disease that again is a different population we're dealing with today I would encourage you to join us for our next webinar just lack of time I apologize and Julie you said just I think mostly thank you so thank you very much for your comments and Jacqueline has asked are there vendors where you can try all these switch products definitely most of these companies will send you a switch to try out with a client to see if it works a lot of these switches it's just yes if it's going to work you really do have to try that out so I would encourage you to contact the manufacturers and see if they have someone in your area that can help you out or if you can try that some of the larger assistive technology clinics will have these in stock or if the school has an assistive technology team etc when these actual to child with Duchene muscular dystrophy benefit from switches like these absolutely as that condition progresses these young men definitely need switches and those switches need to consider just everything we've been talking about that smaller travel distance and low force low activation force Jenny's asked are there any switches are more appropriate or more easily adaptable to clients with significant cognitive impairments typically people with muscle weakness do not have the cognitive involvement that we see in other populations but that brings up a good question this might be helpful April 14th we're having the third part of the switch assessment series and we're going to be talking about how do we figure out switch assessment how do we develop switch skills for clients who are just not engaged and oftentimes that's because of cognitive impairments where it's more difficult for the client to readily see where the switch can be beneficial for them so that might be a helpful webinar all right and great that questions for Gloria good okay so our next order of business and this webinar is a case study so we've seen some pictures of Julian already but let's put this in context at the time of this particular evaluation Julian was 8 years old I've known Julian since he was about 2 and he is actually odd just starting college now so his access have changed over the years but we're gonna take a quick peek and what his access needs were when he was about eight Julian required a combination of switch types and sights to meet his needs and at the time his primary need was accessing his power wheelchair he is verbal he is on a ventilator he has become more difficult to understand over the years bomb so he does use some other technology but this time primarily we are looking at power wheelchair to move the wheelchair forward he used a fiber-optic switch mounted by his right thumb and we've seen this picture a few times now so this is mounted throughout through the hand pad simply took a little drill bit popped a hole right through the thumb right nuts with uh so much through the foam oh my gosh that's a faux pas and put that fiber-optic right in there and then the cabling is underneath the arm trough the cabling is very fragile you need to be protective of that so when he moved that thumb over the fiber-optic sight it would activate it and move his chair forward to stop he would pull his thumb to the side he also had to proximity switches on his chair that were built into the headrest so the proximity switch that's mounted in this pad by the right side of his head turn the chair to the right the proximity switch that was mounted by the left side of his head did not turn the chair to the left this was a reset switch the reset switch places the chair into a different mode of operation and that allowed him to redefine what his driving switches did so for example if he pressed activated this reset switch then the next time he approached the right switch instead of turning the chair to the right he would be able to control his power tilt system we put the research which by the left side of his head because it was here weakest switch site and you didn't need to hit the reset switch as often as the other switches to turn left we actually placed this little micro light switch by the inner side of his right knee this required him to move that leg a bit to the left we wanted this to be as intuitive as possible and so this allowed him to drive the chair turn the chair to the left by bringing his leg in that direction so let's review our take-home message here and then we'll go ahead and take any last-minute questions when we're doing determining the best switch access for people our muscle weakness it's important that we look at small activation travel little or no activation force either using very sensitive mechanical switches or electronic switches which require no force it's important that we can accommodate change because many of these clients have a progressive condition and that we bring in adequate postural support to help this client to maximize the abilities that they have all right so let's take some more of these great questions can you so someone has asked sorry sometimes the questions go along kind of fast in the chat box here if a client has a degenerative conditions such as Duchene muscular dystrophy is it more advisable to select a switch that will work at the clients ultimate level of functioning or to change the diapers which the client deteriorates that's a good question particularly with Deschenes i find that i end up changing access method so with power mobility as an example I might start that client with a standard joystick we might do some programming to accommodate changes in muscle strength eventually changing to a mini proportional joystick and then ultimately looking at switches the main reason for that is we're helping the client to be as independent and efficient in their acts as possible as they have those changes rather than immediately going to something like fiber optics which is where the client would lose that proportional control and Monique has asked why do you set the left heads which is reset and not turn to the left again that was his weakest sight so in general with power mobility we want the strongest switch light to move the client forward because that needs to be activated and sustained for longer periods of time and then the weaker switch sight for reset because that's not a timed activation if the client doesn't hit reset right away it's not a big deal or if they don't let go of reset right away not a big deal so reset I put in that weaker switch sight and that was Julian's situation okay and I know and Jeanette I hope I'm saying your name right you wanted some information on the candy-corn switch let's see here I just have to go up to your visional question I apologize the oh dear I'm trying to find your question about the candy corn switch so just hang on just one moment here we go can you send an email about how you would have a student use the candy corn either finger or hand it really depends on that individuals requirements so you want to again getting back to beginning of this webinar I look at what's the available movement for the client what's the available travel and force and then match that to the best switch if the candy corn matches that if the client has enough movement to activate that and requires no force then that could be a good option if they have a smaller movement than that which would be required by the candy corn switch you may want to look at fiber optics and see if I miss any questions here what vendors do you recommend for micro light and proximity switches those again are listed right in the webinar they're micro lights available from ablenet proximity switches you can get from a variety of companies they are available from ablenet also available from other companies all right Gloria did I missed any questions in there we just have a lot of questions and I want to make sure I didn't miss anything if we wrap this up and we run out of time don't worry we'll go ahead and try to follow up with you by email so I want to thank you for attending this webinar here today and make sure that you have my contact info want to remind you too that on March 10th we're having the second part of this series where we're going to talk about switch assessment for people with increased muscle tone and we had a number of questions about that and then also our third part on April 14th specifically looking at how do we determine where to put a switch for clients who just aren't very engaged in the process Mary's asked to have some type of chart to help determine switches based on certain attributes I do not I've tried it's really kind of I've had I've struggled getting that information into some type of a chart it's too many gray areas Jennifer's asked what can people operate with their switches besides mobility all sorts of things communication devices electronic aids daily living switch toys computers yes you can use these for computer access as well great so I hope again this information was helpful to you we're almost out of time please fill out the survey that will show up after we are done with this webinar so that we can get your feedback it helps ablenet and myself to determine how to better present this information what other information we need to make sure we're providing to you so thanks thank you on behalf of ablenet we'll right at the top of the hour and we will go ahead and sign off today and I hope that you can join us for the next ablenet webinar thanks everyone