Charting the Cs logo. Charting the Cs Conference 2025: To Literacy and Beyond Cooperation Communication Collaboration Eye gaze as alternative access method: from overcoming challenges with positioning to creating communication opportunities and making adaptations to general education curriculum. Presentation Date: April 29, 2025 Presenters Names: Julie Andersen, Physical and Health Disabilities Teacher, and AT Specialist Olga Campbell, SLP and AAC specialist Wayzata School District Overview of the session: •Share case studies of 4 eye gaze students and discuss unique challenges for each one. •Strategies for working with our wheelchair bound medically complex students. •Make and Take low tech eye gaze board. •Questions and comments. STUDENT #1: KINDERGARTEN 1.Diagnosis of viral encephalitis. 2.Severe Impact on mobility, speech, and accessing education. 3.Uses TTMT (Talk to Me Technologies) Eye Gaze Device and Grid Software. 4.Positioning for accessing her eye gaze device has been the biggest challenge. Student being held and accessing a communication device with a specialist coaching. WHEELCHAIR POSITIONING Challenge: September - Student not able to access her device when she is in the wheelchair because it needs to be positioned higher (student tends to arch her back). Consider contributing factors: medical trauma, adjusting to the new school/longer day, ongoing medical issues. A person in a wheelchair using with an eyegaze communication device positioned above her. Steps taken: •working with the vendor (TTMT) and their positioning team to acquire a longer arm for the WC attachment •Giving the student and the team time build trust and adjust End result (January): Student is more comfortable and relaxed, she has more stamina for school. Device is now positioned higher and at an angle= better access. A person in a wheelchair using with an eyegaze communication device positioned above her. FLOOR POSITIONING •Best positioning while she is on the floor – at home/preschool. •Challenges with floor positioning: oFinding dedicated space in the classrooms oMedically fragile - students tripping oNot able to see what the teacher or peers are doing oNeed a floor stand to hold the device (1,345$) A child at home using the eyegaze communication device while lying down. •Steps taken: oTried using tomato chair: it is moveable and she can access the eye gaze and see her peers oGetting a floor stand loan from TTMT until we figure out funding for the floor stand oApplying for SubAwards from AT CooP End result (January): Getting the award (1,200$) and purchasing our own floor stand A student using an eyegaze communication device in a kindergarten classroom with a teacher support her. NEXT STEPS •Continue getting used to the tomato chair •On going problem solving for eye gaze issues: camera not waking up right away after the device has been in the sleep mode. Consider remote sessions with the vendor (several sessions with the vendor) A student using an eyegaze communication device that is mounted over her head a teacher sits by her to give support. STUDENT #2: 2ND GRADE 1.Diagnosis of Cerebral Palsy (spastic quadriplegic) 2.Impacts mobility, speech, and overall educational access. 3.Currently uses a PRC Accent Eye Gaze with Unity Vocabulary. 4.Challenges in the area of assessment in math and reading. Student refusal and staff turnover. 5.Current needs; math and reading instruction a teacher holding a low tech eyegaze board and a student looking at an eyegaze communication device. Teacher and student in front of an EyeGaze device video Play video of a teacher and student in front of an EyeGaze device. Kindergarten-1st Grade 1.Social; wants to be with her peers at all times. 2.Giving the time to get used to school, changing support staff. 3.Our role was to continue to advocate for the student; time, staffing, opportunity and space. 4.Respecting her refusal. 5.We trialed the lessons provided through PRC Eye Gaze Reading Curriculum Kindergarten – 1st Grade video Play video for Kindergarten – 1st Grade 2ND GRADE-PROGRESS 1.She has made great gains in using her eye gaze at school. 2.She now wants her eyegaze device on her wheelchair at all times. No longer refusing! 3.She prefers to use the word finder on her eye gaze keyboard. 4.Using low - tech eye gaze board for reading (word identification). Video example A student using a low tech eyegaze board and a teacher holding it for them. WRITING IN 2ND GRADE •General education teacher started using eye gaze with her to produce writing. •Teacher asks her questions and student answers with her eyegaze . •Whatever the student says using her eyegaze the teacher or paraprofessional writes down. •This does 2 things; provides a time for her to explore her eyegaze device and increase her writing skills. illustration of a teacher working with student using an communication device and another student reading a book NEXT STEPS 1.Communication with peers. She is extremely social. How can we create meaningful and organic opportunities for her to strengthen her friendships with classmates? 2.Writing options: to type with the keyboard or using Core on her eyegaze . 3.Reading on the device/apps A child using his AAC device to communicate with another child. Next Steps video Play a video of a child sitting in front of her eyegaze device. STUDENT 3: 2ND GRADE •Diagnosis of arthrogryposis: •Impacts mobility and ability to access his educational environment. •Started with a PRC eye gaze Accent device for communication (about 2 y.o.), but has developed speech (intelligibility is impaired). •Current eye gaze device use: Epic books and a limited number of sites that are compatible with eye gaze. A child in a wheelchair Features needed - device needs to provide access to: •Writing •Reading •Math •Leisure (gaming: Mario cart and Google Maps) •Social connections Images by Drawn To AAC – Canva InsearchofanoptimalAACsystem:wheretostart? Continued Explorevoice/Texttospeechaccess:ExploreEyegazeaccess: •Built in text tospeech options on IOS •IOS 18 eye tracking feature for app control •Atypicalspeech on IOS18control •TD Pilot •voiceITT website.Watch The Stuff of Champions:VoiceITTIntegrations •PCeye and Impact video.•USB add on for Accent devices Exploring voice/text to speech access: Microphone and regular voice control on Ipad - We trialed a Tomosiok microphone - great microphone but did not pick up his voice. - Built in accessibility feature voice control control on iPad, due to atypical speech was unable to access. RULED OUT FOR NOW Atypical speech on ios18 - turned on atypical speech on Siri - not sure how that communicates with notability or notes; did not have consistently good results so far - RULED OUT FOR NOW Voice ITT - compatible with chrome books only, need signed permission from parents 1 month free trial; $49 a month subscription – RULED OUT FOR NOW Exploring voice/text to speech access video Play video for Exploring voice/text to speech access. Exploring eye-gaze access: IOS 18 eye tracker€ for typing and apps • Eye gaze tracking was not efficient for typing •Tried Epic instead and it was hard to navigate TD Pilot or PCeye IOS 18 eye tracker for • Tried eye - tracking feature on gen 10 typing and apps • Required calibration every time your turn on eye tracking USB add on for Accent devices • USB input stick could be used to control an external computer using the PRC Accent device. USB add on for Accent • We would need to switch from Empower to devices toolbox to have access to more environmental controls. • Scheduled appt with the PRC vendor: Everett was able to type in a document and email and search the web. • Notebooks feature in Accent - Exploring USB input stick for computer controls First video Play video of a teacher and student in front of his assistive device. Second video Play second video of a teacher and student in front of his assistive device. A child lying on a pillow •Ordered USB input stick •Updated his device and switched over to NuVoice •Parents scheduled appt with PACER center to explore gaming controls •Work with the Tech office to trial computer and chrome book with Everett •Train staff how to use it for academics Student # 4: High School 1.Diagnosis of quadriplegic cerebral palsy 2.Never tried eye gaze, used scanning method but reportedly was successfully. 3.Current need - eye gaze trial. 4.Initial appt with Tobii - able to activate music videos 5.Parent has not returned required paperwork to begin trial as of January. A group of people looking at an eye gaze device. CHALLENGES FOR EACH STUDENT •Staff thinking eye gaze is a quick fix - and students should be proficient immediately. •Staff turnover. Teacher, Paraprofessional, and Speech. •Technology difficulties; charged equipment, forgotten equipment, broken etc •Student refusal, staff and parent buy in. •Time and Patience! Booker T. Washington, Overcome quote What is Medical Trauma? Psychological distress from frequent/stressful medical procedures, leading to anxiety, PTSD - like symptoms, and avoidance behaviors. Key Aspects: •Frequent Interventions: Stress from repeated procedures and therapies. •Lack of Agency: Feelings of helplessness during medical care. •Sensory Overload: Distress from hospital sights, sounds, and smells. •Fear of the Unknown: Anxiety from uncertainty about diagnoses or outcomes. •Social Isolation: Disruption of routines and social interactions. How Medical Trauma Manifests: •Behavioral changes (aggression, withdrawal, difficulty concentrating). •Physical symptoms (headaches, sleep issues, appetite changes). •Avoidance behaviors, reluctance to trust support providers. Support Strategies: •Trauma - Informed Practices: Use clear, empathetic communication; provide choices to foster autonomy. •Collaboration with healthcare providers. •IEPs with emotional support strategies. •Access to mental health support (therapy, counseling). Requesting Student Permission •Always ask students with complex physical needs for permission before moving, touching, or assisting them.` •Foster a sense of autonomy and respect for their dignity. •Reduce feelings of helplessness or discomfort by involving them in decisions. •Use clear, age - appropriate communication to ensure understanding. •Offer choices to empower students and build trust. •Support their emotional comfort and well-being during interactions. Do Not Touch Signs MAKE AND TAKE: let's make a low tech eye gaze board A screenshot of a game A screen shot of a social media post MAKE AND TAKE LOW TECH EYE GAZE BOARD A box cutter and tape measure on a black foam board. Apply polly pockets to the corners of the foam board. an example of low tech communication board Cut the opening with a box cutter (use duct tape to seal the edges if you want) A white sign with red writing on it low tech communication board Get low tech symbols Charting the Cs logo Thank you! Julie Andersen:julie.andersen@wayzataschools.org Olga Campbell:olga.campbell@wayzataschools.org