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Using the computer during assessment with students who are physically handicapped and nonspeaking : Is… Bentley, Constance Diane 1993

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USING THE COMPUTER DURING ASSESSMENT WITH STUDENTS WHO AREPHYSICALLY HANDICAPPED AND NONSPEAKING: IS IT FEASIBLE?byConstance Diane BentleyB.Ed. (Elementary), University of British Columbia, 1978A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF ARTSTHE FACULTY OF GRADUATE STUDIES(Department of Educational Psychology/Special Education)We accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIAApril 1993© Constance Diane Bentley, 1993In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)Department of f.16tt_L-eilt-/Z.1, The University of British ColumbiaVancouver, Canada_fL>e_c.,et'^&I-Lk_d_oci7-AN_Date  at0.4,L)^/c?7.3DE-6 (2/88)ABSTRACTTraditionally, assessment has been a difficult procedure among children withphysical handicaps who are nonspeaking due to their limited response capacities. Moreaccurate methods of assessment are needed. The use of computers in the assessmentof children with physical and nonspeaking handicaps has considerable promise. Thispilot study investigated the use of the computer as a viable tool during assessment ofchildren with physical handicaps who are nonspeaking.This study was exploratory. Methodological procedures changed as newdiscoveries were made. The study explored the possible advantages of using aMacintosh LC computer with adaptive peripherals (the Unicorn expanded keyboard anddigitized speech) to assess the abilities of students with physical and speechimpairments as measured by performance in an assessment protocol. It attempted toexamine memory abilities. Children were given a series of photographs and/or letters tomemorize under the following conditions:a). standard stimulus exposure and response times (five and 20 secondsrespectively).b). prolonged stimulus exposure and response times (20 and 60 secondsrespectively).c). visual feedback only conditionsd). visual and auditory feedback conditionsThe study addressed the following research questions:1). Does lengthening the stimulus exposure and response times influencestudents' performance in an assessment protocol?2). Does feedback; (visual and auditory combined or visual feedback only)influence students' performance on an assessment protocol?iiObservations and measures were made of 1). the number of questionsanswered, 2). number of items remembered in sequence, 3). number of itemsremembered in a random order, and 4). response times.General conclusionsThe study found that computer based assessment has potential to help studentsdemonstrate their potential because of its flexibility. The computer providesauditory/visual presentations enhancing students' perceptual access and responsefluency and involving students actively. Student responses are more easily interpretedby the examiner as a result of auditory feedback. The assessor's powers areaugmented because the computer presents questions and scores and tabulates results,thereby freeing the examiner to concentrate on and attend to the student.However, there are cautions to be observed when using the computer duringassessment of these children.The usefulness of the computer is limited by its lack of ability to respond quicklyand make adjustments to the assessment situation as perceived necessary by theassessor. The assessor must still be responsible for recognizing students' individualityand the human subtleties that arise during assessment which have not been anticipatedin software programs. The benefits of the computer are not exploited unless anexaminer is present to make sensitive adjustments to the assessment environment inorder to meet the needs of students. The examiner must ensure that the computer'sadvantages do not hamper the powers of the "human" during assessment. Theassessor must see the computer's role as one of augmentation. Assessment must takeplace over time and students must be familiar with the task and keyboard overlay beforeembarking on assessment. The study highlighted the heterogeneity and variability ofchildren with severe disabilities. Software needs to be developed that is flexible enoughto meet the needs of this population.iiiTABLE OF CONTENTSABSTRACT ^ iiTABLE OF CONTENTS^ ivLIST OF TABLES viLIST OF FIGURES viiACKNOWLEDGEMENTS ^ viiiCHAPTER ONE^ 1INTRODUCTION 1Background of the Problem ^ 1Purpose of the Study 2Questions to be Investigated 3Research Questions^ 3Organization of the Thesis 3Definition of Terms 3LITERATURE REVIEW^ 5Assessment of Children with Physical Handicaps^ 5Assessment of Students with Physical Disabilities who are Nonspeaking^ 8The Application of the Computer to the Assessment Process ^ 10Adaptive Computer Technology^ 13A Model for the Computer Based Assessment of Students withPhysical Handicaps who are Nonspeaking^  14Research Questions^  14CHAPTER TWO^ 16METHODOLOGY^ 16Statement of the Problem^ 16Research Questions  16The Subjects^  17Procedure 18Hardware  18The Software^  19Practice Phase^ 20Assessment Sequence^ 21Pilot Assessment Items 22ivMeasures^ 24The Computer Based Cognitive Measure Observation Form ^ 25Summary of Alterations to the Original Procedure^ 27CHAPTER THREE^ 29RESULTS 29Results 29Subject Profiles^ 39^Subject A 39Subject B 40Subject C^ 41Subject D 42Subject E 43Subject F^ 44Subject G 45Subject H 46CHAPTER FOUR^ 48DISCUSSION AND CONCLUSION^ 48Discussion 48Conclusion^ 58Limitations of the Study^ 63Suggestions for Future Research^ 64BIBLIOGRAPHY^ 65APPENDICES 72Appendix A. Sample Overlay^ 73Appendix B. The Computer Based Cognitive Measure Form^ 75VLIST OF TABLESTable 2.0 Summary of Subject Characteristics and Backgrounds^ 18Table 3.0 Summary of Results of Measures of Memory for Photographs^ 30Table 3.1 Comparison Under Standard and ProlongedConditions: Questions Answered^ 31Table 3.2 Number of Items Remembered Correctly Across Condition 1- Standard and Prolonged Conditions^ 34Table 3.3 Average Response Times of Subjects Classified with SevereHandicaps Compared To Other Subjects^ 35Table 3.4 Number of Items Remembered Correctly Across Condition 2- Visual Only and Visual/Auditory Feedback^ 36Table 3.5 Comparison of Subjects' Average Response Times AcrossCondition 2 - AuditoryNisual and Visual Only Feedback^ 38viLIST OF FIGURESFigure 1 Sequence of Presentation of Assessment Items^ 23VIIACKNOWLEDGEMENTSNumerous individuals have contributed in important ways to the preparation ofthis thesis. I wish to pay special recognition to Dr. Sally Rogow, my senior supervisor,who has extended to me her knowledge, time and friendship throughout this year. Shehas served as my mentor - encouraging independence in my inquiry, and providingchallenges to questions which I have ventured to ask. I also wish to thank the secondmember of my committee, Dr. Leroy Travis, for his conceptual feedback and valuablesuggestions in this research. Lastly, I would like to thank Mr. Mike Bartlett, for offeringto me his support in this study.I extend my thanks to the students, parents and staff at the elementary schoolswho participated in the study. In particular, I would like to thank Mr. Mike Bartlett,Provincial Coordinator, Neilane Thomas and Brenda Tosczak, Regional Coordinators ofSpecial Education Technology - B.C. who are to be acknowledged for their cooperationand support in this study.To my husband, Thomas Harapnuick, I owe my profound thanks; for not only didhe serve as proofreader and editor, but he also provided endless support, patience, andunderstanding. Thanks also to my colleagues, Jenny Leong and Cathy Humphrieswho helped to support me throughout the writing of this thesis.The author is grateful to Special Education Technology - British Columbia for itsencouragement and assistance in developing this pilot study.CHAPTER ONEINTRODUCTIONBackground of the ProblemThe integration of students with physical and communicative handicaps into themainstream school environment has given the regular classroom teacher theresponsibility of determining how best to provide appropriate educational programs forthese students. Research studies demonstrate that the achievement of students withspecial needs increases when appropriate educational programs which meet thestrengths and needs of the student are implemented (Salomon, 1972; Snow 1972).Assessment is a necessary component in the determination of the educational needs ofthese students (Zigmond, Vallecorsa & Silverman; 1983). The proper assessment ofthis population is difficult and is complicated by the range and severity of their physicaland motor problems (Anastasi, 1988). This may influence the efficacy of assessment.These children have (or may have) severe speech problems as well as motor disabilitieswhich may affect all four limbs. They may also experience a variety of learningdifficulties which may be evidenced as a decrease in speed of information processing(Riedlinger-Ryan & Shewan, 1984; Koppitz, 1975, 1977; Weiner, 1969) and subsequentrates of responding.Traditional assessment tools which have been standardized on non handicappedpopulations and which require verbal and/or writing skills do not reflect the strengthsand abilities of those children who take longer to process and respond to information.Reavis, (1990), Taylor (1984) and Anastasi (1988) reported examiner difficulties ininterpreting test results. Appropriate assessment procedures are needed for studentswith physical and speech impairments (Hasselbring, 1984). Assessment of studentswith severe physical and speech disabilities requires special assessment devices whichallow students to show their true abilities (Baumgart et al. 1982).1There is research evidence that non speaking children may indeed haveknowledge of language but cannot demonstrate their knowledge in the absence of amode of communication (Thomas et al. 1985). New computer technology makes itpossible to develop assessment tools which are designed to give these students theability to respond. This thesis reports on a pilot project which employed computertechnology to assist in the assessment of students with physical and speechimpairments. The study was based on the belief that students with physical andcommunicative impairments have knowledge and can demonstrate it. There are manyresearch studies which indicate that the abilities of these students are frequentlyunderestimated (Anastasi, 1988). A computer based assessment and the peripheralsdesigned for non speaking and physically handicapped individuals may permit aneffective method of assessment and enrich educational programming.Purpose of the StudyThe purpose of the study was to develop an assessment protocol whichpresented students with access to a response mode. The study examined the effects ofproviding extended viewing and response time. The assessment protocol presentedstudents with two types of feedback: visual and auditory combined and visual feedbackonly. The study considered the effects of two feedback conditions; auditory and visual;and the effects of varying stimulus exposure and response time conditions.The project made use of a computer with adaptive peripherals. A Macintoshcomputer with an adapted peripheral called the Unicorn expanded keyboard wasemployed. The Macintosh computer is widely used in classrooms because of thevariety of educational software available for use with special populations. The Unicornexpanded keyboard is widely used to bypass motor limitations in the physicallyhandicapped. The assessment program called the Computer Based Assessment forMemory software and The Computer Based Cognitive Measure Observation Form wasdeveloped for the pilot project. The software was designed by Motionworks Interactive2of Vancouver, B.C. Special Education Technology - British Columbia, an educationalagency of the Province of British Columbia, sponsored the pilot study.Questions to be InvestigatedThis study explored the possible advantages of using a computer with adaptiveperipherals (the Unicorn expanded keyboard and digitized speech) to assess theabilities of students with physical and speech impairments as measured by performancein an assessment protocol.Research QuestionsThe study focused on the following questions:1). Does lengthening the stimulus exposure and response time influencestudents' performance in the assessment protocol?2). Does enhanced feedback; (visual and auditory combined or visual feedbackonly) influence students' performance on the assessment protocol?Organization of the ThesisChapter 1 will introduce the pilot project, described its purpose and contains areview of the literature regarding educational assessment of students with physicaldisabilities, computer applications to assessment, and the application of technology tostudents with multiple handicaps.Chapter 2 will describe the subjects, the procedures employed and the measuresused in the study.Chapter 3 reports the results of the study and offers a discussion of the findingsand limitations of the study.Definition of TermsAdaptive technology: The technology which allows access to the microcomputerthrough an alternate interface (or input) method other than the regular keyboard.3Unicorn Expanded Keyboard (Unicorn Engineering Inc.): This is one type of alternateinterface system. The Unicorn expanded keyboard is an alternate keyboard and isapproximately 54 centimetres wide by 36 centimetres in height and consists of 128programmable keys or cells. An overlay fits on top of the board. Letters, words,phrases, pictures or other symbols may be placed on the overlay. One large cell canrepresent one function or 128 cells can represent 128 different functions. The deviceallows the user to select items from a display of symbols with a fist, finger, hand or otherbody part.Ke:nx Interface Box: This is an interface device which connects the Unicorn expandedkeyboard to the Macintosh computer.Voice output systems: These systems supply synthetic speech to the visual display ofthe screen. Although most often used as a prosthesis for the visually impaired, it can beof benefit to the physically disabled/non speaking population. Laddaga, Levine andSuppes (1977) found that a high quality speech synthesizer or digitized speech isnecessary for auditory feedback to be of benefit to children.Macintosh LC computer: This computer contains the Hypercard programminglanguage, colour monitor (25 centimetres by 19 centimetres) and digitized speech.4LITERATURE REVIEWAssessment of Children with Physical HandicapsAssessment of children who cannot speak is made complicated by limited motorand communicative abilities. Few instruments have been designed to assess the skilllevels of these children while allowing for their motor limitations (Anastasi, 1988; Dykes,1985; Sigafoos, 1987). Most assessment measures use adaptations of standardizedformal and informal test protocols to determine the specific strengths and weaknessesof these children. These tests have been normed on the nonhandicapped population(Sattler, 1982; Anastasi, 1988). This has not produced a satisfactory solution anddissatisfaction has been expressed with the results (Russel, 1984; Sattler, 1982;Anastasi, 1988).The child who is physically disabled and nonspeaking almost always experiencessevere restriction of movement, skeletal deformities, sensory disorders, seizuredisorders or other medical problems (Orelove & Sobsey, 1991). The single largestidentifiable cause of multiple disabilities is cerebral palsy (Orelove & Sobsey, 1991).Cerebral palsy is a chronic non - progressive condition caused by damage to adeveloping brain. The term cerebral palsy includes a variety of conditions which resultin movement disorders. The three major types are spasticity, athetosis and ataxia(Bobath, 1975; Finnie, 1975).Children with cerebral palsy have a wide range of mobility and motor problems.Some may experience little difficulty while others are severely affected.Motor disorders adversely affect the ability to write, hold books, turn pages, etc.,(Luebben, 1990). Some children may be able to write slowly for short periods of timewhile others lack the required finger and hand control. Accuracy, speed, range ofmotion, grasp, strength and endurance are all affected to different degrees (Haley,Hallenborg & Gans, 1989). Some children are non ambulatory while others may walk5with assistance (Orelove & Sobsey, 1991). Many have additional disabilities such assensory, visual or hearing impairments. There are also physical disabilities that developas a consequence of immobility (Campbell, 1989; Robinson & Hupp, 1986). Typicalproblems include curvature of the spine, permanent shortening of muscles and tendons,partial or total dislocation of the hips and disorders of the hips and ankles which furtherinterfere with movement and cause extreme discomfort. Almost one third of childrenwith cerebral palsy experience seizure disorders (Spooner & Dykes, 1982). Althoughseizures are most frequently controlled with medication, medications themselves cancause adverse side effects which interfere with learning. These children are also proneto respiratory infection (Thompson & Guess, 1989). Frequent health problems, adversereactions to medications and hospitalizations for surgeries further restrict their activityand limit their life experiences.The inability of motor impaired individuals to physically act upon theirenvironments limits the variety of first hand learning experiences (Goldenberg, 1979;Reidlinger - Ryan & Shewan, 1984; Miller, 1986; Dunn, 1991).Cognitive development is not an independent feature ofdevelopment. It grows out of experience. If the quality ofthat experience is impaired, then cognition will becorrespondingly involved. Ayres cited by Miller.(p.183)Thomas et al. (1985) reported a high incidence of language disorders in youngadults with physical difficulties. This higher rate may be attributed to the higherincidence of language disorders associated with some neurological conditions. Physicaldisability also has a direct or indirect effect on the development and use of language.Inability to speak severely limits the development of the pragmatic and communicativefunctions of language. However, there may also be gross speech deficits which do notimpair language. There is a further component to the limitations imposed by the6physical disability. Miller, Yoder & Schiefelbusch (1983), Orelove & Sobsey (1991) andMeyen (1978), report that some children demonstrate immaturity and low self esteemdue to their limited opportunities for social interactions.Despite expressive language problems, many individuals have higher orderthinking and receptive language abilities (Webster and McConnell, 1987). Lenneburg(1967) cited several examples of children who demonstrated delayed language asyoung children but when speech developed, language was used age appropriately.One 14 month old who had been tracheotimized for six months began to babble at anage appropriate level one day after the tube was removed. No practice or experience athearing his own vocalizations was required. Comparable observations were observedin children who were severely neglected by their parents and who appeared to begrossly mentally, physically and socially handicapped. According to Lenneburg (1967),although practice is not the same as learning, it is false to assume that these childrenhave not undergone years of learning; they simply could not respond. He further statedthat there appears to be no general deficiency in the fundamental cognitive skills oflanguage delayed children as compared to normally speaking children. Students'knowledge of language cannot be judged from their ability to produce language asspeech or written communication (Hawkridge et al., 1985; Halliday, 1989). It is crucialfor assessment to be based on the current knowledge and skill level rather than dependon their limited motor repertoire in order for these children to demonstrate their potential(Halliday, 1989).Dykes (1985), stated that attitudes have contributed to diminished expectationsfor the student with disabilities. According to Dykes, attitudes of nurturing andprotection are often maintained for school aged students. Limitations are imposed byattitudes and expectancies of speaking interactors with nonspeaking students (Miller,Yoder & Schiefelbusch, 1983). Often, vocal speakers' level of communication isconsiderably lower than the capabilities of the nonspeaker and responses are notrequired or expected at all. Low expectations lead to treating the student as if he or she7has little knowledge because he can demonstrate so little (Dykes, 1985). For thesereasons, these children have often gone without assessment or have been assessedimproperly This has resulted in inappropriate placement in educational programs.Assessment of Students with Physical Disabilities who are Non speakingChildren with physical or verbal impairments cannot manipulate formboards orother performance materials. Tools which require object assembly tasks, objectsequencing, block design and reproduction and puzzle solving require a variety ofsensorimotor systems such as hand - eye motor coordination to negotiate a motoricresponse. Most traditional assessment tools operate under the assumption thatstudents can move about unimpaired (Bailey & Simeonson, 1988; Boyd et al., 1989).This is appropriate when assessing motor movement, but it is unfair to ask for fatiguingand sometimes impossible motor movement performance during assessment ofintelligence and achievement etc. All too often all that is assessed is the student'sendurance and tolerance.Susceptibility to fatigue makes short testing sessions a necessity (Anastasi,1976). Working against a time limit or in strange surroundings often increases anxiety,which, in turn, intensifies the motor disturbance of children with motor impairments(Anastasi, 1976; Taylor, 1980). Timed assessments are legitimate if the skill beingassessed is that of speed Reavis (1990). However, in the assessment of attentionspan, intelligence or achievement, timed assessments are not appropriate with studentswho have physical disabilities or who cannot speak. Forer et al (1991) stated that it isimportant to provide extra testing time so that disabled examinees can both processinformation and negotiate motoric responses. A study by Ragosta and Wendler (inprogress), found that disabled students require between half again to double time totake the Scholastic Aptitude Test.8Neisworth and Bagnato (1986) point out that standardized tests may serve tocompound the problems because they involve procedures which do not permit ampleresponse time.Reavis (1990), noted that most students with severe disabilities do not perform ina consistent manner. Russel (1984), also observed that a thorough evaluation of theintelligence of nonspeaking children is a difficult procedure. Neisworth and Bagnato(1986) stated that children with special needs have uneven developmental profiles, aredifficult to assess and change rapidly. Motor, cognitive and communicative impairmentsare not mutually exclusive of each other; they interact continually, compoundingproblems of assessment. According to Kraat (1984), nonverbal cues are easilymisinterpreted or ignored.The difficulty in assessment of nonspeaking children is confirmed by Taylor(1984) and Anastasi (1988) who also stated that students' nonverbal behavior is oftenmisread or misinterpreted. They reported that it is important to ensure that theassessment be administered so as not to bias and penalize children with impairedspeaking ability. The results of assessment should not reflect the child's impaired abilityto speakyet many tests assume the child can speak.Appropriate assessment instruments do not exist and assessment personnelhave not been trained to assess these children (Hupp & Donofrio, 1983; Mulliken &Buckley, 1983; Sigafoos, Cole & McQuarter, 1987). Few recently developed tools areappropriate for this population.The items employed by assessment tools may not reflect the life events andexperiences of students with disabilities (Debuskey, 1970; Reavis, 1990; Meyen, 1978;Bennet, 1983; Forer et al., 1991). Taylor (1984) noted that certain types of assessmenttools contain items foreign to many children such as bicycle, keys, etc.. If a student hasnever seen a kitchen stove, or does not know how meals are prepared, common kitchenitems may not be recognized. While some students may recognize a line drawing of abed; others have had too limited life experiences to recognize outline drawings of9"beds". Others may require actual photographs rather than pictures. According toReavis (1990), many assessment tools use only line drawings or the printed word. Littleattention has been paid to the bias against students who cannot explore theirenvironment independently or who live in institutional settings (Reavis, 1990).The Application of the Computer to the Assessment ProcessHasse!bring (1984), found that the computer can be used to overcome some ofthe problems inherent to the assessment process.Computers have been described as flexible, motivating, patient, consistent andcapable of delivering instruction that can be customized to meet the needs of individualstudents (Baumgart & VanWallegham, 1987; Behrmann, 1984). Computers aremotivating to children who usually respond well to sound and graphics (Iacono & Miller,1989). Students will work longer (Hagen & Behrmann, 1984) and for those studentswho are fearful of failure or taking risks due to a long history of failure, the computerprovides a nonconfrontational environment in which to work.Children with physical handicaps may have difficulties attending to the relevantdimensions of tasks, or have memory and perceptual problems (Iacono & Miller, 1989).The computer has been found to help students attend to relevant stimuli in tasks(Iacono & Miller, 1989).A report of the U.S. Department of Education (1983) (cited by Hasse!bring) statedthat computers and computer diagnosticians have the potential to make teachers moreaware of"the ways in which procedural skill and conceptual knowledgecombine to produce good performance  and whichcomponents are deficient in a particular student and helpthem become aware of areas in which their students needfurther work" (p. 20)10Computer - based assessment instruments generally fall into two categories;interactive and noninteractive. Noninteractive programs are used by examiners forscoring, analyzing, and sometimes writing reports (based on commonly usedstandardized tests). This type of assessment does not permit the student to interactwith the computer. Interactive programs use software which enables the student to usethe computer, often without the need for examiner intervention.Some of the generally accepted advantages to using the computer innoninteractive assessment include improved levels of standardization in the proceduresused during test administration, scoring and interpretation; the collection of responsedata in real time; and the development and use of assessment models that werepreviously too complex for human presentation (Fifield, 1989; Repp et al, 1989). Testadministration is the least developed application of computer technology inpsychoeducational assessment to date (Fifield, 1989). Krug (1984) listed only a smallportion of tests (less than 20 c/o) as appropriate for special education settings.Fifield (1989) observed that the computer has helped to alleviate problems ofstandardization by consistent and precise presentation of problems, reliableinterpretation and accurate scoring. Fifield noted that variations in test administrationare sometimes required for students who are unable to work within the constraints ofstandardized procedures. Use of the computer during assessment can free theexaminer from scoring, increase the opportunity for observation and, thus, provide amore thorough examination of student skills and deficits. Beyond these benefits to thestudent, current research also indicates that educators' attitudes and performance canimprove with the use of computers (Walton, 1985; Gardner, 1985). Hasse!bring (1984),cited advantages that include huge savings in examiner time and reducedadministration and errors in scoring. Invalid interpretations of responses can becontrolled more tightly and often eliminated.Overton and Scott (1972), reported no significant differences betweenadministering the Peabody Picture Vocabulary Test in automated style or manually.11Space (1981), Elwood & Griffin (1972) asserted that scores obtained from computeradapted versions of existing paper and pencil tests were essentially the same as eachother. They reported high correlations between computer - administered and face - to -face administrations of the Weschler Intelligence Scale. Fifield (1989), found that inspite of high correlations obtained by computer and paper versions of a scale of socialcompetence, the scores were statistically different. Brinker (1982), stated the computerprovides the educator with opportunities to observe the child during the assessmentprocess (teachers did not have to count responses when computers were used. Insteadthey were able to look at other things which the students were doing while they wereusing the computer). Brinker goes on to state that it is clear that the function of themicrocomputer is to provide teachers with a more detailed picture of the learner.Other researchers (Gardner & Breuer, 1985; Stoddard, 1982; Hasselbring, 1984),report the computer as having been a useful tool in the assessment of thedevelopmentally disabled. They found the computer to produce results which indicatedreliability and validity at a level which was judged superior to traditional procedures.Becker and Schur (1986) state that computer technology can improve the assessmentprocess for developmentally disabled by providing instruments which are moreaccurate, less time consuming and more flexible than conventional assessment tools.Fitch et al. (1984), reported the computer as useful in the screening ofcommunication disorders. It assisted by printing directions on the screen item by item(reducing the chances of errors in administration by presenting items in sequence andnot changing the item on the screen until a response had been given). The computereliminated arithmetic errors by storing responses signaled to it and computing scores.Fay, Okamoto, Brebner and Winter (1982), reported on the use of computer -assisted assessment with individuals who were severely physically handicapped. Theirsubjects had a limited response repertoire (e.g. eye blink). These authors reportedreliability and stated that technology provides a tool for obtaining precise measures ofsubtle responses.12Lillie, Hannum and Stuck (1989) noted that interactive assessment or "on linetesting" must be approached with caution. They say that most studies citing theadvantages of using the computer assume that students are equally able to use thecomputer keyboard. A student who knows the correct response but has difficulty usingthe keyboard may make mistakes for reasons other than not knowing the correctresponse called for on the test. Lillie, Hannum and Stuck (1989) point out that studentswho can use standard modes such as writing, are able to use test taking strategies suchas skipping questions which they feel unsure of, continue with the assessment itemsthey do know, and return later to answer the more difficult questions.Adaptive Computer TechnologyBehrmann (1984), Shell, Horn & Severs (1989), Kinney & Blackhurst (1987),advocate the use of adaptive technology. Behrmann (1988) stated:"Computer technology has great potential benefits forchildren and adults with disabilities. Its power rests in theapplication of the technology as a tool for manipulation ofideas and objects, and as a tool for compensation, to takethe physical or cognitive handicap out of a disability. (p. xii).The Unicorn expanded keyboard can bypass motor problems (Treischmann &Lerner, 1990; Hagen, 1984; Behrmann, 1988). Treischmann (1990) stated the Unicornboard has provided children with physical impairments the opportunity of workingindependently. Shell, Horn & Severs, 1989; Kinney & Blackhurst, 1987) state that theUnicorn board can be effectively used to augment written or verbal communication.Spoken output from the computer may also augment students' ability to understand.In a study done on the benefits of spoken output versus spoken output plus text,(McGregor, Drossner & Axelrod, 1990), students made fewer errors in the voice plus13text condition than in the text condition alone. Hinchley et al. (1977), noted that speechoutput can involve students more actively in the instructional process.Intelligibility of voice synthesis is important (Helsel - Dewart & Van DenMeiracker, 1987; Mitchell & Atkins, 1989) and will only be beneficial to students whounderstand it (Mirenda and Beukelman, 1987; Horn, Shell & Severs, 1986).A Model for the Computer Based Assessment of Students with Physical Handicaps whoare NonspeakingMiller and Sprong (1986), recommended that assessment tools elicit optimalperformance and be well constructed. This study attempts to elicit optimal performanceamong students.The present study is a pilot study of the use of a computer and peripheralsincluding software to assess nonspeaking students. A model which includes the use ofthe computer with adaptive peripherals to meet the response capacities of thesechildren and includes the development of software designed to be adaptable to varyingprocessing modes and processing rates of this population may begin to supply ananswer to the problem of equalizing the assessment process for students with physicaland communicative handicaps. This model will include the development of suchsoftware. The Unicorn board with digitized speech will be used to provide auditoryfeedback and bypass physical deficits.This study explored the possible advantages of using a computer with adaptiveperipherals (the Unicorn expanded keyboard and digitized speech) to assess theabilities of students with physical and speech impairments as measured by performancein an assessment protocol.Research QuestionsThe study focused on the following questions:1). Does lengthening the stimulus exposure and response time influencestudents' performance in the assessment protocol?142). Does enhanced feedback; (visual and auditory combined or visual feedbackonly) influence students' performance on the assessment protocol?15CHAPTER TWOMETHODOLOGYThis chapter describes the subjects, methodology and procedures of the study. Italso describes the alterations which were made to the original procedure as a result ofnew discoveries which were unveiled as the study progressed. Specific justifications forprocedural alterations are offered in the Discussion section of this thesis.Statement of the ProblemThe use of computers in the assessment of children with severe motor limitationshas considerable promise. To develop appropriate educational programming forstudents who are nonspeaking and physically handicapped, more accurate methods ofassessment are needed. By offering a response mode that may circumvent thesestudents' motor limitations and by extending stimulus exposure and response time andallowing flexible presentation modes (such as paired auditory and visual feedback orvisual feedback alone), it may be possible to create an environment more conducive toallowing students to demonstrate their powers.Research QuestionsThis study explored the possible advantages of using a computer with adaptiveperipherals (the Unicorn expanded keyboard and digitized speech) to assess theabilities of students with physical and speech impairments as measured by performancein an assessment protocol (described below). It examined memory abilities byrequesting children to memorize photographs and/or letters under the followingconditions:a). prolonged stimulus exposure and response time (20 second exposuretime/60 second response time).b). standard stimulus exposure and response time (five second exposuretime/20 second response time).16C). visual and auditory feedback conditionsd). visual feedback only conditionsMore specifically, the study focused on the following questions:1). Does lengthening the stimulus exposure and response times influencestudents' performance in the assessment protocol?2). Does enhanced feedback; (visual and auditory combined or visual feedbackonly) influence students' performance on the assessment protocol?The SubjectsThe subjects of this study all had severe physical and speech impairments. Theterm "severe" is used here to describe subjects whose movements were characterizedby unusual limitations in motor fluidity, range of motion, speed and accuracy. The term"severe", when referring to speech impairments, refers to children who are nonverbalbut may communicate through some vocalizations or gestures. Their ages ranged fromsix years to thirteen years. There were six boys and two girls in the study. (The"Special Education Technology - British Columbia" database was used to locatestudents who used Unicorn expanded keyboards). All subjects had experience witheither the Unicorn expanded keyboard, similar adaptive keyboards or a communicationdevice requiring activation by a finger or fist. Subjects did not have hearing or visualimpairments. Ten subjects were selected, but two left the study, one due to illness andanother for unscheduled surgery. The remaining eight subjects were integrated intoregular classrooms with support from an itinerant special education teacher. Subjects'physical disabilities ranged from Cerebral Palsy, Apert's syndrome, Cornelia DeLanguesyndrome, or other forms of brain damage resulting from meningitis and hydrocephalus.Table 2.0 shows the ages and backgrounds of the subjects.Information was available on all subjects concerning visual and hearing acuity,handedness, and medication. Information on the subjects' mode of communication andmethod of responding "yes" and "no" enabled the examiner to make appropriate17adaptations during assessment. Specific adaptations are described at the end of thischapter.Table 2.0Summary of Subject Characteristics and BackgroundsSubject Age GradePlacementDiagnosis Prior ComputerExperienceA 7 yrs. 1 Apert's syndrome (digitdisfigurement) nonspeakingmodified keyboard,Unicorn expandedkeyboardB 8 yrs. Kindergarten Cerebral Palsy (spastic)non speakingMini Unicornkeyboard, Touchwindow screenC 13 yrs. 7 Cerebral Palsy (spastic)non speakingUnicorn expandedkeyboardD 10 yrs. 4 Hydrocephalus, Epilepsynon speakingUnicorn expandedkeyboardE 8 yrs. Kindergarten/1Cornelia DeLanguesyndrome (limbdeficiency) non speakingUnicorn expandedkeyboard,Introtalker(communicationdevice)F 6 yrs. Kindergarten Cerebral Palsy (spastic)non speakingUnicorn expandedkeyboardG 13 yrs. 7 Cerebral Palsy (spastic)non speakingSwitch, Unicornexpanded keyboardH 9 yrs. ResourceroomCerebral Palsy (athetoid)non speakingUnicorn expandedkeyboardProcedureHardwareThe hardware included a desktop computer and a specially adapted keyboard.The desktop computer was a Macintosh LC computer with four megabytes of memory,the Hypercard programming language installed, a colour monitor and digitized speech.Programming was done with the use of the Hypercard programming language which isfound on all Macintosh computers.18The assessment procedure also involved the use of the Unicorn expandedkeyboard connected to a Macintosh LC computer using a Ke:nx interface box (DonJohnston). The expanded keyboard was used to allow maximum access to thecomputer. The Ke:nx interface box was used to connect the Unicorn to the computerand allow input from the device to the computer.For the purpose of the study, eight squares were programmed with a one inchspace around each square. The one inch space around each square was designed toreduce the chances of error by giving the subjects a bigger area in which to maneuver.This was designed to make visual scanning of items easier. The overlays placed overthe squares had either photographs or letters. (Appendix A contains sample overlay).Two different representational levels were programmed into the software to allow forsubjects who worked at lower and more advanced representational levels to participatein the study. (Representational level refers to a level of symbols used to depictmeaning. Symbols used may range from photographs, line drawings, stylized drawings,to the more advanced levels - letters, and the printed word. All of these symbols standfor a real object or represent concepts).The SoftwareThe Computer Based Assessment for Memory (C.B.A.M.) software was designedas a multimeasure device (using two different types of assessment tools; the computerand an observation form). The assessment tool used adjustable features which allowedfor comparison between four different computer assessment conditions; 1) prolongedstimulus exposure time 2) prolonged response time, 3) auditory plus visual feedbackand 4) visual feedback only. The software was designed as follows.The tasks were presented in two phases; the practice phase and the assessmentphase. During the practice phase, subjects were shown one demonstration item andthe examiner demonstrated the responses expected from the subject. The subject thenreceived an opportunity to practice on two sample items. Following this practice, the19student was presented with the actual assessment items. The questions for the practicephase followed this format for both auditory/visual and visual feedback only sections.Practice PhaseThe practice sequence consisted of presenting the demonstration screenshowing one photograph or letter. The practice phase was augmented by examinerinstructions and proceeded as follows. The subject was instructed to watch theexaminer demonstrate how the program worked. The researcher demonstrated theprocedure to the subject. For example, the researcher modeled the task by saying "NowI am looking at the picture of the dog on the screen. Can you touch the dog? I amthinking of it in my head. Try and look at the dog and think of it in you head. Now I amgoing to try to keep the picture of the dog in my mind until I can press the picture of thedog on the Unicorn board.. .Do you see the picture of the dog on your Unicorn board?When the picture disappears, I can press the picture on the board to give my answer.See? Watch." (The examiner entered a response on the expanded keyboard to showthe first sample item - one photograph. The computer timed the response rate (i.e. thetime between the end of the stimulus presentation and the subject's first response).Subjects were given an opportunity to practice by answering the same question thatwas given to the examiner. The examiner said "Now you try it. Watch the screen^Doyou see the picture?" (Examiner points to the screen). Try to keep the picture in yourmind until you can press the same picture on your Unicorn board ^Wait until thepicture on the screen goes away before you press the picture on the board ^Good!"The subject entered the response to the next practice question. The computertimed the response rate. If the subject did not begin to respond within the designatedtime (20 seconds under standard conditions and 60 seconds under prolongedconditions), to the first sample question, the program branched back to repeat the firstsample question. Only one opportunity to repeat the first sample question was allowed.If the subject again did not respond, the program then moved to the second sample20question. If the subject still did not respond within the designated amount of time to thesecond sample question, the program repeated the second sample question onceagain. The assessment procedure was to be terminated if subjects did not respondduring the practice session. The practice phase allowed the examiner to track thesubject's accuracy and make a decision as to whether to continue the assessmentprogram. The assessment was administered if subjects were able to correctly answerone sample question. The volume of the digitized speech was adjusted prior to theassessment phase to ensure subjects could hear the auditory feedback. Subjects'ability to hear the feedback was confirmed through monitoring orientation of body andeye gaze toward the screen in response to auditory stimuli throughout the practicephase.When subjects had completed the practice phase, the assessment phase began.The assessment procedure required subjects to scan the Unicorn board overlay, locatethe item and press the appropriate cell on the expanded keyboard. The Unicornexpanded keyboard "beeped" to show that a response had been registered.Assessment tasks required subjects to memorize the items as well as the sequence ofpresentation. As the assessment program progressed, the number of items increasedfrom two items to four and the representational level became more abstract.Assessment SequenceA question was presented for a predesignated amount of time. After presentationof the item(s), the screen went blank. The computer then started timing the time takento respond (i.e. between presentation time and response). Subjects responded bydepressing the correct square(s) on the Unicorn expanded keyboard. If the subject didnot respond in the predesignated amount of time (20 second under standard conditionsand 60 seconds under prolonged conditions) or made an error, the program continuedto the next question. If subjects made two consecutive incorrect responses, (incorrectbeing a response that is not started in time or is not in the correct order), the program21moved to the next set of questions. Both response time and accuracy were recorded foreach question.After the assessment had finished and when time permitted, subjects were askedto identify the conditions under which they would like to complete further tasks; 1) slowor fast stimulus exposure time; 2) slow or fast response time, 3) auditory/visualfeedback or 4) visual only feedback. They were also asked to identify therepresentational level they preferred to work with. For example, subjects' attention wasdrawn to the overlay and they were asked "Which did you like the best - photographs orletters? Would you like to work with the (photographs/letters) again? Would you like tobe able to see the (photographs/letters) for a long time or a short time? Would you likea lot of time to touch the (photographs/letters) or just a little bit of time? Do you want tohear the computer talk?" Questions were repeated more than once for those subjectsappeared to have trouble understanding. The examiner made the appropriateadjustments to the computer and then asked the subject if the adjustments which hadbeen made were correct. Subject response were confirmed by monitoring eye gaze,facial gestures and body orientation.Pilot Assessment ItemsThe software consisted of Photographs, Line drawings and Letters. Photographsand Letters were used for the purposes of this study. Incorporating all three sectionsinto the assessment would make the session lengthy, tiring subjects and not allowingthem to exhibit their best performance. Items selected were considered to be itemsfamiliar to the subjects. (Both visual and auditory/visual feedback conditions were givenon both Photographs and Letters tasks). The items below were used in the assessmentand presented in the order which appears in Figure I. Alterations to this order ofpresentation were determined by the subject's physical, emotional and cognitive abilityto perform the task and are listed at the end of this chapter. Justifications for thespecific alterations which were made are offered in Chapter Four. Figure I shows thesequence of presentation of the assessment levels.22Figure 1 Sequence of Presentation of Assessment Items1). PHOTOGRAPH MEMORY (Visual/Auditory Items)2). PHOTOGRAPH MEMORY (Visual Items)3). LETTER MEMORY (Visual/Auditory Items)4). LETTER MEMORY (Visual Items)The items in each section were as follows :1). PHOTOGRAPH MEMORY (VISUAL/AUDITORY ITEMS)two photographs with auditory labels: pencil, booktwo photographs with auditory labels: fork, moneythree photographs with auditory labels: apple, pencil, forkthree photographs with auditory labels: money, book, sweaterfour photographs with auditory labels: car, money, watch, sweaterfour photographs with auditory labels: watch, fork, money, book2). PHOTOGRAPH MEMORY (VISUAL ITEMS)two photographs: cup, crayontwo photographs: spoon, handthree photographs: socks, cup, spoonthree photographs: hand, crayon, dogfour photographs: shoes, hand, glasses, dogfour photographs: glasses, spoon, hand, crayon3). LETTER MEMORY (VISUAL/AUDITORY ITEMS)two letter memory with auditory labels: g, ttwo letter memory with auditory labels: r, kthree letter memory with auditory labels: q, g, rthree letter memory with auditory labels: k, t, Ifour letter memory with auditory labels: u, k, j, I23four letter memory with auditory labels: j, r, k, t4). LETTER MEMORY (VISUAL ITEMS)two letters: a, btwo letters: p, othree letters: c, a, pthree letters: o, b, nfour letters: f, o, s, nfour letters: s, p, o, bMeasuresMeasures were made of subjects' responses with regard to:1). length of presentation and response time allowed2). visual combined with auditory feedbackThe assessment software was applied under the following four conditions:1). Standard and Prolonged Stimulus Exposure and Response Time Conditionsa). In the "standard" condition, subjects were given five seconds to view astimulus question and twenty seconds to respond to it.b). In the "prolonged" condition, stimulus exposure time and response time wereextended. Subjects were exposed to the stimulus task for 20 seconds and were given60 seconds to respond.Five second and twenty second viewing times were chosen because more similarexposure times may not have been sufficient enough to yield results indicative of thepotential benefits or disadvantages of using the computer during assessment. This wasalso the case with response times (20 seconds versus 60 seconds). Both conditionswere applied across Photograph Memory and Letter Memory levels of the assessmentsoftware.242). AuditoryNisual Feedback Combined and Visual Feedback only Conditionsc). Subjects were exposed to auditory combined with visual feedback and theirresponses recorded.d). Subjects were also exposed to visual feedback alone. Responses wererecorded.Both of these conditions were applied across Photograph Memory and LetterMemory levels of the assessment software.The Computer Based Cognitive Measure Observation Form Descriptive particulars for each person who was a subject were provided throughthe use of an observation form. See Appendix B. The heterogeneity of subjects withphysical and speech impairments made it important to note the behaviors whichoccurred during the assessment to give a richer picture of the assessment situation andconsider the impact various conditions might have on the use of technology. Theknowledge of those familiar to the subject was considered important in order to structurethe assessment to facilitate optimal performance. Data regarding uses of the expandedkeyboard in the classroom, position and angle of the keyboard and monitor that allowedsubjects to best perceive visual output (left, right or in midline) and target squares on theexpanded keyboard. were gathered through the Observation form from schoolpersonnel.Subjects' behaviors in the following categories were noted:1. motor2. motivation/boredom3. ability to keep place between screen and keyboard4. ability to shift gaze among items on the screen5. attention to the screen/keyboard6. attention to auditory feedback7. familiarity with technology258. self checkingThe study was conducted during regularly scheduled school hours.Assessments were carried out in a quiet room in the school (usually the learningassistance centre or medical room). The assessments were scheduled to takeapproximately 60 minutes. The researcher and an assistant or child care aide familiarwith the student were present during the assessment session. The RegionalCoordinator from Special Education Technology - B.C. also attended. The researcherconducted the assessment while others present observed from chairs situatedapproximately two feet behind the subject.Prior to the assessment session, each subject was briefed by the classroom teacher.The subject was told that two people would be coming to the school and bringing acomputer with them. The subject would be asked to do some activities on thecomputer. It would be the subject's job to use the computer and tell the examiner if thesubject liked the software and if it was fun. Upon arrival, the examiner reiterated whatthe teacher had told the subject. The examiner introduced herself and theaccompanying S.E.T. - B.C. Regional Coordinator. It was explained to the subject thatothers were in the assessment room to determine if they also liked the software and tooffer suggestions to the examiner on how to make it more fun. Questions andconversation lasting approximately five minutes took place to establish rapport with thesubject. The examiner said "Do you like to use the computer? What do you use thecomputer for in your classroom? Show me how you use the computer. Do you have acomputer at home? Do you like to play games on the computer?" In instances wheresubjects did not appear to understand the questions, the examiner talked about topicswhich were more personal to them. Comments were made about the nature of theirclothing, hairstyle, friends. For example, the examiner often said "What a nice dress! Isit new? Are those new runners you have on?" Responses were determined throughsubjects' own mode of communication. In some instances, subjects responded with"yes" or "no" by shaking or nodding their head. In cases where subjects' head control26was more limited, subject responses were determined by monitoring eye gaze, facialexpressions and body language. During the sessions, observer comments were written.Afterwards, the researcher made summary evaluations. Administration of theassessment instrument sometimes changed during data collection to allow for theexploration of conditions which facilitated the subject's optimal performance.Summary of Alterations to the Original ProcedureSome alterations to the original procedure and tasks were made in order to allowsome subjects to participate in the study and facilitate optimal performance. Followingis a summary list of adaptations to the original procedure which were made duringassessment sessions.Procedures were changed by:1). Making assessment sessions shorter. (The shortest session was 20 minutes whilethe longest was 60 minutes).2). Leaving specific sections out of the assessment (e.g.. Letters).3). Increasing practice time on the computer. (Two subjects were given two to threeextra sessions of practice before embarking on the assessment).4). Increasing practice time off of the computer. (Two subjects were asked to identifyitems on the overlay three times before doing the assessment).5). Providing breaks during assessment. (One subject had a ten minute snack breakwhile most other subjects received ten minutes to stretch).6). Repositioning the expanded keyboard and /or subject to allow for easier access.(One subject sat on the lap of his special education assistant to complete theassessment. The Unicorn board was continually moved for three other subjects).7). Not requiring items in the memory task to be remembered in sequence. (The taskswere made easier by allowing subjects to remember items presented in any order ofpresentation).278). Facilitating motor performance by supporting the arm and wrist, helping the subjectto apply pressure and moving the board to locations which were inside the subject'srange of motion.Chapter Three presents the results of the study. A discussion of the results andsuggestions for further research follow in the last chapter.28CHAPTER THREERESULTSThe study aimed to explore how computer - based assessment of students withsevere physical and speech impairments can be adapted to permit optimal responses.The stimulus materials were presented under the following conditions:1. prolonged response time and prolonged stimulus exposure time2. auditory and visual feedback combined or visual feedback onlyThe study addressed two main questions.More specifically, the study focused on the following questions:1). Does lengthening the stimulus exposure and response time influencestudents' performance in the assessment protocol?2). Does enhanced feedback; (visual and auditory combined or visual feedbackonly) influence students' performance on the assessment protocol?Results1). Does lengthening the stimulus exposure and response time influencestudents' performance in the assessment protocol?Table 3.0 lists the number of questions answered under each condition, numberof questions correct, the number of items remembered from the computer - presentedquestions, and the average response time under each condition. Not all subjectsanswered the same number of questions. The category "Questions answered" includesthose questions to which the subject pressed a cell on the Unicorn board. Attempts atquestions were recorded by the examiner during assessment. No response is indicatedby NR. Table 3.0 shows the results of subjects at the Photographs level. Only threesubjects were able to complete tasks at the Letters level.29TABLE 3.0Summary of Results of Measuresof Memory for Photographs ConditionsStandard I^ProlongedFeedback ConditionsSubjects Visual only Visual andAuditoryVisual only Visual andAuditoryMeasuresABCDEFGH6/60/20/2No data3/33/3No dataNo data2/21/20/2No dataNo data3/33/3No data6/62/22/22/22/23/3No dataNo data2/22/22/22/24/44/43/3No dataNumberofQuestionsAnsweredABCDEFGH4/60/20/2No data1/31/3No dataNo data0/20/20/2No dataNo data2/30/3No data4/60/20/20/20/21/3No dataNo data0/20/20/20/20/42/40/3No dataQuestionsCorrect(Itemsrememberedinsequence)ABCDEFGH17/180/5 NR0/5 NRNo data2187/9No dataNo data1/21/20/2 NRNo dataNo data5/92/7No data17/182/51/52/52/57/9No dataNo data4/54/51/52/54/1011/113/8No dataItemsRememberedRandomlyABCDEFGH4.00.0 NR0.0 NRNo data18.315.0No dataNo data6.512.00.0 NRNo dataNo data16.219.0No data7.826.056.029.521.536.1No dataNo data8.546.057.518.014.527.156.1No dataAverageResponseTime(in seconds)NR = no response30Five subjects participated in the assessment under standard conditions. Two ofthese subjects attempted to respond to questions but could not complete their motormovements before time ran out. Under standard conditions with visual feedback only,three out of five subjects answered all questions. Under conditions with both auditoryand visual feedback, three out five subjects responded to all of the questions giventhem. Under prolonged conditions, all seven subjects answered all of the questions.Table 3.1 shows the number of questions presented and the number of questionsresponded to under prolonged and standard stimulus exposure and response timeconditions.Table 3.1 Comparison of Responses Under Standard and Prolonged Conditions: Questions Answered ComparisonNumber Of Questions Answered:Between Standard and Prolonged ConditionsSubject StandardVisualProlongedVisuaVAud.Visual VisuaVAud.A 6/6 2/2 6/6 2/2B 0/2 1/4 2/2 2/2C 0/2 0/2 2/2 2/2D No Data No Data 2/2 2/2E 3/3 No Data 2/2 4/4F 3/3 3/3 3/3 4/4G No Data 3/3 No Data 3/3H No Data No Data No Data No Data31Under prolonged exposure and response time conditions with visual and auditoryfeedback, seven out of eight subjects responded to the questions. All of these subjectswere able to complete their responses to questions within the designated amount oftime.The average number of questions responded to under visual/auditory feedbackconditions with standard time to respond was 1.8 with a standard deviation of 1.2.Given visual and auditory feedback conditions with a prolonged time to respond, themean was 2.7 and the standard deviation was .13. This standard deviation maysuggest that practice had an effect. The order of presentation was 1). Prolonged(auditory /visual conditions) 2). Standard (auditory/visual conditions. It may be thatsubjects were beginning to improve as a result of practice. The average number ofquestions responded to given visual feedback only conditions with a standard amount oftime in which to respond was 2.4 with a standard deviation of 2.3. The mean number ofquestions responded to given visual feedback only conditions with a prolonged amountof time to respond was 2.8 with a standard deviation of 1.6. These results couldsuggest that motor fatigue had an effect as results deviate from the mean under thestandard condition more than under the prolonged condition. The prolonged (visualfeedback only) condition was administered as the third set while the standard (visualfeedback only) condition was administered last.Of the five subjects completing the assessment under both types of visual onlyfeedback conditions, (i.e.. standard versus prolonged) four subjects performed better atremembering items when given prolonged conditions.Under prolonged conditions (visual only), the average number of itemsremembered was 5.2. The highest number of items remembered under this conditionwas 17 and the lowest was 1. Under prolonged conditions (visual/auditory feedback),the mean was 3.7. The highest number of items remembered was 11 and the lowestwas 1. The standard deviation for standard conditions was 3.3 whereas underprolonged conditions it was 1.6. This may suggest that given prolonged conditions,32children with the most severe physical handicaps were able to improve theirperformance.More response time also facilitated accurate responses. It enabled subjects timeto view, process and respond to the stimuli on the screen. This was especially true forsubjects with more severe handicaps. The term "severe" is used here to describesubjects whose movements were characterized by limitations in motor fluidity, range ofmotion, speed and accuracy.Two subjects were able to remember items in sequence, and all subjects wereable to remember, in a nonsystematic order, at least some of the items presented.Three out of seven of the subjects were able to remember more than 80% of the itemsunder the condition of prolonged exposure and response time (20 second exposuretime, 60 second response time). Two out of seven subjects were able to remember40% of the items presented on the screen under prolonged conditions.Out of the five subjects who responded to questions under both conditions, allremembered more items under prolonged exposure and response time conditions(auditory/visual feedback). The mean number of items remembered under prolongedconditions was 8.6. Under standard conditions, the average number of itemsremembered was 5.8. Number of items remembered appears to be dependent uponthe time in which subjects had to respond. The highest number of items rememberedunder prolonged conditions was 21. Under standard conditions, the highest number ofitems remembered was 18 making the range 18. The range for items rememberedunder prolonged conditions was 19. The standard deviation under standard conditionswas 6.8 whereas under prolonged conditions it was 7.3. This may suggest thatalthough lengthening time to respond helped the subjects to remember items, in thiscase, the nature of the distribution of the responses did not change. Under standardconditions, half of the subjects remembered more than 78% of the items.Table 3.2 shows the comparison between prolonged and standard stimulusexposure and response time on the number of items subjects remembered.33Table 3.2 Number of Items Remembered Correctly AcrossCondition 1 Standard and Prolonged ConditionsComparisonNumber Of Items Remembered:Between Standard and Prolonged ConditionsSubject Standard ProlongedVisual VisuaVAud. Visual VisuaVAud.A 17/18 1/2 17/18 4/5B 0/5 1/2 215 4/5C 0/5 0/2 1/5 1/5D No Data No Data 2/5 2/5E 2/8 No Data 215 4/10F 7/9 5/9 7/9 11/11G No Data 2/7 No Data 3/8H No Data No Data No Data No DataUnder prolonged exposure/response time conditions, many subjects could scanthe items on their Unicorn board displays. More than half of the subjects were able tokeep their place when looking back and forth between the screen and keyboard underprolonged exposure conditions.Response times varied widely. The fastest response time was 6.7 seconds whilethe slowest was 66.5 seconds making the range 59.8 seconds. The average responsetime was 34 seconds. Subjects with the most severe physical disabilities had theslowest response times. As stated previously, the term "severe" is used here todescribe subjects whose movements were characterized by severe limitations in motorfluidity, range of motion, speed and accuracy. Subjects with cerebral palsy of thespastic type in all four limbs had the longest response times. Table 3.5 shows theresponse times of these subjects.34Table 3.3 Average Response Times of Subjects Classified with SevereHandicaps Compared To Other Subjects Subject Number of CompletedTasksAverage ResponseTime (in seconds)I.^SeverelyHandicappedB 5 28.0C 4 66.5D 4 23.7G 6 41.0II.^OtherA 16 6.7E 9 17.0F 13 21.9H Did not complete Did not completeHalf of the subjects were able to respond to more questions when given moretime to respond. The remaining half answered the same number of questions underboth conditions. Approximately half of the subjects completing the assessment showeda desire to self correct under both conditions, however only the prolonged time conditiongave subjects' opportunities to self correct. All subjects showed a desire to respondbefore the stimulus exposure time was up and while the stimulus item was still on thescreen.2). Does enhanced feedback; (visual and auditory combined or visual feedbackonly) influence students' performance on the assessment protocol?35Six subjects were able to complete the assessment with visual feedback onlyunder prolonged conditions while five subjects completed this assessment understandard conditions. Seven subjects completed the assessment with auditory andvisual feedback under prolonged conditions while this assessment was completed byfive subjects under standard conditions. Table 3.4 shows the results of assessmentunder the auditory/visual and visual feedback only conditions.Table 3.4 Number of Items Remembered Correctly AcrossCondition 2 - Visual Only and Visual/Auditory FeedbackComparisonNumber Of Items Remembered:FeedbackBetween Visual Only and Visual/AuditorySubject Visual Only Visual/AuditoryStandard Prolonged Standard ProlongedA 17/18 17/18 1/2 4/5B 0/5 215 1/2 4/5C 0/5 1/5 0/2 1/5D No Data 2/5 No Data 2/5E 2/8 215 No Data 4/10F 7/9 7/9 5/9 11/11G No Data No Data 2/7 3/8H No Data No Data No Data^_ No DataWhen the subjects were presented with both visual and auditory feedback(prolonged condition), subjects responded to an average of 2.7 questions whereasunder visual feedback only conditions (prolonged condition), subjects responded to anaverage of 2.8 questions. (It is probable that these findings were greatly influenced bythe effect of practice but tempered by the influence of motor fatigue).The highest number of questions responded to under visual feedback only(prolonged) conditions was 6 and the lowest was two. Given prolonged conditions withvisual and auditory feedback, the highest number of questions responded to was four36and the lowest number of questions responded to by a subject was two. Underconditions with visual and auditory feedback (prolonged), the standard deviation was .13and it was 1.6 without auditory feedback. Auditory and visual feedback appeared tohelp the students given enough time in which to respond.All subjects were able to remember some items. Under auditory/visual(standard) conditions, the highest number of items remembered was five and the lowestwas 0. The average number of items remembered was 1.8. Subjects were able toremember 54% of the items presented under auditory and visual feedback conditions asopposed to 69% under visual feedback only conditions. The average number of itemsremembered under visual feedback only (standard) conditions was 5.2. The highestnumber of items remembered was 17 and the lowest was zero. The standard deviationunder visual feedback only (standard) conditions was 6.4 whereas under conditions withboth types of feedback, it was 1.6. It may be thatUnder conditions with auditory and visual feedback (prolonged), subjectsanswered only four out of 29 (14%) of questions correctly whereas in the visualfeedback only (prolonged) condition, subjects were able to respond correctly to 11 out of33 (33%) of the questions correctly. Under visual feedback only conditions, threesubjects scored above 40% in memorization of items. Subject A, the most academicallyadvanced, performed better given visual feedback alone. This may be due to the effectof practice since visual sections of the assessment were presented second and last.The standard deviation given visual feedback (prolonged) conditions was 5.6 comparedto 2.9 in visual/auditory feedback (prolonged) conditions. This suggests that lessvariance is seen among scores when combined feedback is given.Response times varied from a low of 4.0 seconds under standard (visualfeedback only) conditions to a high of 18.3 seconds, compared to prolonged conditions(with visual feedback only), which had a low of 7.8 and a high of 56 seconds. Givenstandard (visual and auditory feedback) conditions, the lowest response time was 6.5seconds and the highest was 19.0 seconds, compared to a high of 57.5 and a low of 8.537seconds under prolonged (visual/auditory feedback conditions). The slowest responsetime under prolonged (visual versus auditory/visual) was 56.1 compared to 56 undervisual only conditions. Given standard exposure and response time conditions (visualversus auditory/visual conditions), the fastest response time was 6.5 seconds comparedto the fastest response time of 4.0 seconds under standard (visual only feedback). Forstandard (auditory/visual conditions), the slowest response time was 19.0 and 18.3 forconditions without auditory feedback. Table 3.5 shows the subjects' average responsetimes across the two conditions. Response times varied widely.Table 3.5 Comparison of Subjects' Average Response Times AcrossCondition 2 - Visual Only and Visual/Auditory FeedbackCondition 2Subject Visual Only Feedback AuditoryNisual FeedbackA 5.9 7.5B 13.0 29.0C 37.7 28.0D 29.5 18.0E 19.9 14.2F 22.3 18.9G No Data 41.0H No Data No DataUnder conditions with auditory feedback, subjects alerted to the screenpresentation and searched out an "effect" on the screen in response to the Unicorn"beep" and to the auditory presentation of words. They showed awareness of theresponses they had made as a result of these features. As a consequence, 50% of the38subjects showed a desire to confirm and self correct answers. Subjects looked backand forth between the screen presentation and the keyboard under both conditions, butauditory feedback appeared to aid in this process as subjects did not lose their place asoften. The data appears to support the notion that auditory feedback may help studentsto maintain their attention to tasks.It appears as though subjects took advantage of the extra amount of time theyhad in which to respond under prolonged conditions. Fast response times understandard conditions belonged to one subject who was not severely physicallyhandicapped. Practice may have had an effect on this subject. His fastest responsetime was seen during the last set of questions administered. Responses given by othersubjects were much slower. There are many more "no responses" seen under standardconditions. The type of feedback appeared to make little difference to response timesamong subjects.Subject ProfilesSubject ASubject A was eager to begin his work with the computer and completed bothPhotographs and Letters sections. No procedural adaptations were made. the length ofthe session was approximately 60 minutes. He adapted well to the assessmentenvironment shaking his head for "yes" and "no". The subject looked intently at theexaminer and computer monitor and shifted his attention appropriately. During thePractice phase of the assessment, he entered his responses quickly. He looked fromthe questions on the screen to the expanded keyboard, scanning the board and thentargeting the appropriate squares with apparent ease. Each time a question appearedon the screen, the subject pulled his hand away from his lap quickly and attempted tolocate the matching item on the board.39This subject's body language and facial expression indicated that he wasmotivated by the computer and appeared to view the assessment with a competitivespirit. This subject was familiar with the computer. He appeared to understand themechanics of the task with no problems. During extended viewing times, he wasrestless and would wriggle in his seat and look around the room, his frustrationmounting. During prolonged time in which to respond, the subject would look to thecomputer monitor and check his work. One time he recognized an answer as incorrectand showed concern.Subject BSubject B was assessed in her own classroom but could not hear the speechfeedback from the computer because of the noise level. The assessment had to bedelayed until her classmates left for Physical Education. Once the session began, theonly distraction was occasional whispering by staff at the back of the room. This subjectcompleted both Photographs and Letters sections of the assessment. this tookapproximately 60 minutes. The assessment was given in the order set out in theoriginal design, however, it was noted that more practice time to master the mechanicsof the task may have facilitated better performance. She appeared eager to please andlooked to those present for reinforcement after each response. She often attempted toanswer questions before the screen presentation of items was completed. This wasespecially notable under standard time conditions. This subject was easily fatigued andanswered fewer questions at the end of the session. the subject had difficultynegotiating a motor movement in time to respond under standard time conditions.Twice she did not have time to respond at all and showed great concern. Later, shegave up. She appeared much more comfortable under prolonged time conditions. Thesubject had difficulty activating cells appropriately with her fist. It appeared that the sizeof the square on the overlay was too small. The expanded keyboard had to be tilted tofacilitate the subject's ability to make responses. The board was moved to various40positions while the subject attempted her responses in an attempt to reduce the numberof arm movements needed to respond and, thus, facilitate optimal performance. Givenprolonged time in which to respond, this subject looked to the computer monitor andchecked her work. This subject's attention drifted when the stimulus exposure time wasprolonged and she was required to wait before responding. This subject looked at thescreen presentation less often with auditory feedback. This behavior did not occurunder conditions with visual feedback only.Subject CThis subject's assessment took place with the subject's teacher, assistant, S.E.T.- B.C. Regional Coordinator and examiner in attendance. The assessment wasadministered in the usual order but the subject gave no response to questions understandard conditions. The assessment took approximately 30 minutes. Subject C waitedfor thirty minutes while research personnel arrived and the computer equipment was setup. Once it was time to begin the assessment, the subject appeared agitated. Whileinstructions were given the subject looked around the room and stared at the ceiling.Despite his frustrations, each time the subject hit a cell, he searched for an effecton the computer screen. Auditory feedback helped him to orient himself to the taskbeing presented on the monitor. His limbs and vocalizations quieted, and his body andgaze would orient toward the screen. At other times however, the auditory feedbackappeared to confuse him and encourage incorrect answers. He would press a cell andthe computer would provide the auditory feedback by labeling the item. The subjectwould hear the auditory presentation and hit the same cell again. Prolonged viewingtimes made him impatient even though he needed a prolonged time in which torespond. the subject had difficulty hitting the cells on the overlay which he had intended(his fist was too big for cell), and he often activated other cells unintentionally. To helpalleviate this problem, the board was continually moved to within the subjects range ofmovement. While the computer alleviated the problem of the subject's slow motor41response rates, misunderstanding of the task prevented him from demonstrating hisability. While the computer helped the subject orient himself to the task, it alsoappeared to confuse him. Practice at performing a task plays a large role in allowingstudents to show their true abilities and this practice is best done on the tool which is tobe used during the assessment process. Subject C only participated in thePhotographs level of the assessment.Subject DThis subject was tired and ill during the assessment. Owing to his condition, hismother stayed throughout the session. Also in attendance were the examiner, S.E.T. -B.C. Regional Coordinator, teacher and assistant. There were several other distractersthroughout this session. The door opened and closed four times as the itinerant supportteacher entered the room to check on "how things were going". In addition, those inattendance whispered in low tones while the assessment was in progress. At thesetimes, the subject looked away from what he was doing and it is likely that thesedistractions had an additional influence on the subject not performing at his best duringthe assessment.Procedural changes for this subject's session included increased practice time offthe computer and on the computer. The subject received three extra practice sessionson the computer at the Photographs (auditory plus visual feedback ) level of theassessment. During assessment, the subject had to be repositioned at the computer inorder to complete the session. In addition, the subject's responses had to be facilitatedby physically moving the expanded keyboard to areas where the subject could reach.This subject completed the Photographs level of the assessment only. The assessmentprocedure was changed. This subject did two sets (visual and auditory combined andvisual feedback only) under prolonged conditions. Prolonged conditions (auditory andvisual feedback) were applied first and prolonged (visual feedback only) conditions wereapplied next.42The subject's medical diagnoses is characterized by limb disfigurement and shortstature and he would squirm and wriggle in his chair during his struggle to reach thetargeted square. To facilitate ease of access, the subject was repositioned. Thesubject's assistant sat in a chair in front of the computer and the subject was placed onher lap. The expanded keyboard was placed in midline and tilted toward the subject toreduce the number of arm movements necessary to produce a response. Using thismethod the subject was able to target more cells and complete more answers withouthitting cells unintentionally.This subject used the auditory feedback portion of the assessment as a cue torespond. The auditory feedback was successful in orienting his attention to the screenand creating an opportunity for him to check his work. In one case, this subject showedconcern when he realized he had given an incorrect response. Prolonged responsetime enabled this subject to self check his work.Like other subjects, this subject lost interest in attending to the screen whenexposure time was too long. This may have partially contributed to the number ofincorrect responses.Subject EThis subject's assessment took place in a quiet room with few distractions. Whilemotivated at the prospect of using the computer, he did not appear comfortable withresearch staff. This may have had an influence on his performance during theassessment. Present were the S.E.T. - B. C. Regional Coordinator and examiner.Three procedural changes were made for this subject. This subject received extrapractice off of the computer. He was asked to identify various pictures on the board (bypointing). This was done to familiarize Subject E with the keyboard overlay. Hereceived extra practice on the computer as well. The first set - Photographs withauditory feedback was administered two times to help familiarize the subject with thetask. Next, the subject was given the Photographs set under prolonged conditions with43visual feedback only. Finally the subject was administered the Photographs level of theassessment under standard/visual feedback only conditions. Another proceduralchange was to reposition the board and monitor to allow the subject easier shift of gazebetween the two. This subject's session took approximately 60 minutes.This subject responded well to the computer's auditory feedback; alerting to thescreen presentation and then maintaining attention to the presentation by shifting hisgaze from one item to the next. This subject appeared to enjoy being able to "cause"things to appear on the screen and seemed to appreciate the fact that now everyonepresent could see him producing work.Under prolonged response time conditions, the subject was able to perform muchbetter than under standard time conditions. Under standard time conditions, this subjectshowed increased anxiety and less motor accuracy. This occurred with much lessfrequency under prolonged conditions. Ample time to respond allowed this subjectmore time to concentrate on his motor movements.This subject's motor impairment was characterized by slow, uneven anduncontrolled movements. Although the computer facilitated motor responses for thissubject, it was necessary to make other physical adaptations to reduce the demands ofthe task and facilitate optimal performance. While looking between keyboard andscreen, this subject had difficulty keeping his place. The distance between thekeyboard and monitor was reduced in order enable him to shift gaze easier.Subject FThis subject appeared comfortable despite the S.E.T. - B.C. RegionalCoordinator and examiner being new to her. The only interruption to her session was asmall 10 minute snack break needed owing to a metabolic disorder. Duringassessment, the subject was able to attend and understand instructions given her andrespond to the questions presented under both standard and prolonged conditions. Theassessment began by having the subject practice identifying squares on the expanded44keyboard by pointing to them while the computer was not on. Subject F was given twopractice sessions with both feedback conditions in order to acquaint her with themechanics of the task and the expanded keyboard layout. She completed bothPhotographs and Letters sections of the assessment. Her session lasted approximately60 minutes.This subject's cerebral palsy was characterized by slow and laboured armmovements. Although she could hold books and turn pages, she had difficulty withmore sophisticated fine motor tasks such as holding pencils or crayons and writing.Although she responded to all questions, answers were not always completed understandard conditions. Subject F lost her place when shifting gaze between keyboard andmonitor more frequently under standard conditions. Under prolonged conditions, thesubject lost her place less often and looked to the monitor to check her work more often.The Unicorn board allowed her to devote her attention to the skill of successfully shiftingher gaze from screen to board by removing complicated motor demands involved inproducing a response.During conditions without auditory feedback, the subject would look to theexaminer upon completion of an answer as if wanting feedback regarding her response.The auditory feedback assisted the subject in orienting her attention to the screen.Subject GThis subject appeared tired and according to his teacher, was not motivated bythe computer at any time. Despite these things, the subject was cooperative andattempted to respond to questions given him. Subject G was given extra practice at thePhotographs (prolonged - auditory plus visual feedback) level. He was given twopractice sessions. This subject's session was shortened owing to fatigue and wasapproximately 30 minutes long. Towards the end of the session, the subject'sperformance had to be facilitated by giving support to his arm and wrist and moving the45board to various locations which reduced the motor demands involved in producing aresponse.Subject G had great difficulty understanding the tasks and he hit cells randomly.He attempted to target and depress cells on the board, but his slow and labouredmovements caused his arm to drag and activate cells unintentionally. It became clearthat it was more reliable to monitor the subject's eye gaze to determine whether aresponse was intentional than to rely on the expanded keyboard providing a reliablealternative for motoric access. In this case, the best method of access to the computerwas not, in fact, the expanded keyboard. The board had to be physically moved towhere the subject could reach it. Although the subject tried several times to activate thecells on the board, the keyboard was not sensitive enough to register some of hisresponses. The squares were too small to accommodate his fist. He became frustratedat these times. To help him respond, once he had targeted a cell with his eyes, supportwas given at the wrist and pressure was applied to his hand to allow him to activate theintended cell. This procedure seemed to appease him.Subject HThis subject's assessment took place on a Friday afternoon in the learningassistance centre. His mother, S.E.T. - B.C. Regional Coordinator, examiner, teacherand teacher aide were present. At times the district support teacher entered the room toobserve but this did not appear to distract the subject. Once equipment was set up, thesubject was wheeled into the room. He immediately became excited. Subject H'smovements were quick, impulsive, uncontrolled and involved all four limbs. There weremany loud shrieks and vocalizations. When positioned at the computer, he glancedmomentarily at the screen then slapped the expanded keyboard wildly. Time was givenfor him to explore the board. The subject proceeded to hit each square in what seemedan attempt to see what would be spoken by the computer. He became very excited bythe "beep" and speech feedback and would attempt to hit the squares to make the46speech feedback repeat. All the subject's responses were recorded by the examinerbecause the computer caused the subject to become too excited and his subsequentmovements uncontrolled. At the suggestion of the school staff, the subject's wrist wasweighted down with a wrist band to facilitate more controlled movement. Support at theelbow was also given. When it became clear to the subject that instructions were aboutto be given, he quieted momentarily and appeared to listen.During the assessment, the subject would locate and attempt to hit the sameitems repeatedly. It was apparent that he did not understand the task. The subject wasextremely motivated by the computer - but unfamiliar with its use. Since no computerresults could be recorded and the excitement caused by the computer put the subject atsome medical risk, the session was ended early, lasting only 20 minutes.These subject profiles were intended to demonstrate some of the difficultiesthese children face during assessment.Difficulties which were faced by students during the computer based assessmentwere a lack of time to respond, complete responses, and check their work. They haddifficulty waiting an extended period of time before responding. When practice was notgiven, they sometimes became confused over the task to be done. Motor and physicalfatigue made it difficult for subjects to complete tasks. Limited time meant there werelimited opportunities to change incorrect answers. Often the subjects were not able tomake desires/needs (or confusion over the task) known to the examiner. In addition, insome cases the board was not sensitive enough to register subjects' responses and theoverlay or expanded keyboard was inappropriate for the subject's motor needs.Subjects sometimes had difficulty not activating other cells on the overlay and sessionswere often too long and tiring.The problems students faced during assessment were summarized here. Theseproblems are discussed in further detail in Chapter Four.47CHAPTER FOURDISCUSSION AND CONCLUSIONDiscussionWhile this study began as an exploration of the effects prolonged exposure andresponse times and enriched feedback might have on eliciting optimal performanceamong this population, it turned into a study of the variety of factors influencing optimalperformance. The original procedure underrated the difficulties inherent in assessingchildren whose disabilities limit their performance. Several themes emerged from thestudy. It is important to include a discussion of the factors which appeared to have aninfluence on students showing their optimal performance.This discussion will consist of a description of the discoveries which were madeas a result of the journey examiner and student took together through the process ofcomputer based assessment. Themes which emerged during the study are presentedand their implications discussed.One of the difficulties encountered were the rooms assigned for the assessment.While most subjects were able to carry out their assessment in a room that they hadbeen introduced to previously, most subjects had not frequented these locations. Thismay have unduly highlighted the significance of the assessment and caused subjectsundue pressure and anxiety.Subjects' unfamiliarity with the examiner and S.E.T. - B.C. staff that attendedsessions (as did various school and district staff and occasionally parents) could verywell have raised performance anxiety. These departures from the original design of thestudy, were not under the investigator's control. In one case, the subject's motherstayed throughout the session because the subject was ill. In another case, S.E.T. -B.C. staff were approached to deal with a technical problem. In some assessmentcircumstances there were numerous other distractions reducing the likelihood that thesubject's best performance was seen. In Subject D's session, two itinerant district staff48interrupted the session several times. In the sessions of Subjects A, B, C, and G,whispering between the S.E.T. - B.C. Regional Coordinator and school staff personfamiliar to the child went on while the subject was undergoing assessment. Conditions,to repeat, were not under the control of the examiner. For a better exploration into thebenefits of the computer during assessment, a more laboratory like situation isnecessary.While familiarity of the subject with the examiner was a concern, the familiarity ofthe examiner with the subject was also of special significance. It quickly becameapparent that there was a need for the examiner to be well acquainted with the subtle,nonverbal behaviors of the subjects in order to interpret their wants and needs. Ininstances where desires were expressed through facial expressions, vocalizations andgestures, alterations to the assessment could be made accordingly. However, lessuniversal expressive behaviors went unnoticed and school staff had to intervene as aresult of the examiner's unfamiliarity with the subject's repertoire of subtle cues. Thedifficulty in assessment of nonspeaking children is confirmed by Kraat (1984), whostated that students' nonverbal behavior is often misread or misinterpreted. It isimportant to ensure that assessment be administered so as not to bias and penalizechildren with impaired speaking ability. The results of assessment should not reflect thechild's impaired ability to speak. One way of ensuring more reliable results might be toensure familiarity of the examiner with the student being assessed. There are several,covert subskills needed to perform tasks in assessment. Receptive language skills areneeded in order to understand the task to be performed. Examiner familiarity with thesubjects' more subtle expressive cues would have enabled subjects to receiveinstructions more appropriate to their level of receptive language functioning. At times,the struggle to get messages across to the examiner, subjects' attention was divertedfrom the task at hand. This precluded subjects showing their best performance andoften lead to needless frustration for both examiner and subject. More importantly, it49may be that the subjects' understanding of the task to be performed was over or underestimated as a result of misinterpreting the subjects' nonverbal behaviors.Lack of familiarity with the task and the keyboard overlay played a significant rolein determining whether a subject's best performance was seen. Subjects broughtvarying abilities and backgrounds to the assessment. One subject understood themechanics of the task immediately while the remaining seven needed to practice.Others needed occasional prompts to remember what to do. In at least two cases, theuse of the expanded keyboard was confused with the function it was used for in theclassroom. One subject used the expanded keyboard in an attempt to label items whileanother used it as a communication device in order to express his wants and needs.The former subject became passive while the other began a tantrum. As subjectsbecame more familiar with the task, the number of correct answers increased. Theresults of Subject F demonstrate remarkably well the effects of practice.All subjects spent several seconds attempting to locate the items on the overlay.It quickly became apparent that lack of familiarity with the keyboard was an interveningfactor which put subjects at a disadvantage during assessment. Many mistakes whichwere made during assessment could have been due to the lack of familiarity with thekeyboard rather than the task itself. The data suggests that long response times mayhave been due to unfamiliarity with the keyboard. This concurs with the findings ofLillie, Hannum and Stuck (1989) in a study done with children who werenonhandicapped. They found that mistakes were made for reasons other than notknowing the correct response. As the assessment continued, there was a general trendfor response times to improve, suggesting that practice played a key role in acquaintingthe subject with the symbols on the keyboard overlay and their locations. Withoutpractice, the assessment became more of a test of the subject's ability to locate items inthe time given rather than an assessment of the subject's memory. Unfamiliarity withthe keyboard overlay caused slower response rates among all subjects and caused50frustration among Subjects C, and G, creating conditions which did not facilitate optimalperformance among subjects.In addition to the problem of lack of familiarity with the keyboard overlay, eachsubject brought different motor or "keyboarding" ability to the assessment situation.Subjects for whom motor ability was severely impaired appeared to benefit the mostfrom the expanded keyboard. The larger area in which to maneuver made it easier forthese subjects to negotiate a motoric response accurately. It was easier for theexaminer to interpret the unreliable motor movements of subjects because of the clearlydefined response areas on the overlay.However, the expanded keyboard did not meet the motor needs of all thesubjects. In at least two cases, subjects with severe motor impairments still haddifficulty in producing a response. In the cases of Subjects B, C, and G, inaccuracieswere noted because the size of the area displayed on the expanded keyboard was notlarge enough to accommodate the subject's fist or trembling movement. In some cases,subjects had difficulties producing responses which were outside of the subjects' rangeof motion. These subjects (B, C, G, and H) needed extra physical help from theexaminer in order to answer questions. It was necessary to move the board to variouslocations in front of these subjects to reduce the number of arm movements necessaryin producing a response. In the case of Subject B, the board was not sensitive enoughto register the light pressure the subject applied to it. Subject G needed support to thehand and wrist in order to prevent him from dragging his arm across the board andactivating several cells unintentionally. Accidental hits of the board increased infrequency as the assessment progressed. It is highly likely that this was due to motorfatigue.The ability of the Unicorn expanded keyboard to meet the needs of thesesubjects was very poor by the end of these assessment sessions. It is clear that theUnicorn expanded keyboard is not a cure for all. There is a need for the development ofa tool which will meet the fluctuating motor needs of this population. Assessment51sessions for subjects whose motor needs were not met by the use of the expandedkeyboard became assessments of the subject's patience and physical enduranceinstead of an assessment of their memory. Subject G's session was ended early for thisreason. An overlay with the appropriate sized cells in which to maneuver and displaysymbols in the areas of the board within the subjects' range of motion may havefacilitated better performance from them.Despite the problems with physical suppport to subjects and the shortcomingsdescribed, the computer did provide the examiner with an opportunity to observe andgive help to the subject during assessment. The computer had the ability to presentquestions quickly or slowly, give feedback, pause for a response and tabulate answers.This meant that the examiner could observe subjects and attend to possible problemswhich arose during assessment (as is illustrated above) without pausing or ending theassessment. This advantage has been noticed by others who studied nonhandicappedpeople (Fitch et. al. 1984; Hasselbring 1984; Walton 1985; Gardner 1985). Theyreported increased opportunities to observe students during assessment as aconcomitant of computer augmentation.There is little doubt that the response time given to subjects affectedisubjects'capacity to perform at their best. Even when the expanded keyboard proved to be anappropriate response mode for the subject, inadequate time to respond to a questionoften prohibited subjects from answering. It is not only the response mode whichcontributed to the subject's ability to respond, but also the time allowed to negotiate amotoric response. Although the Unicorn expanded keyboard suited the needs of mostsubjects, on several occasions subjects were not able to demonstrate their knowledgedue to the short amount of time in which they had to respond. Two subjects (B and C)made attempts to respond but were not able to activate any cells as a result of thelimited amount of time given in which to respond. When subjects were able to respond,limited time did not allow some subjects to complete their responses. This causedfrustration and anxiety to subjects. this frustration was probably exacerbated by the52presence of spectators. Later these subjects gave up and did not attempt to respond.Subjects' movements became more rigid and uncontrolled under conditions with limitedtime to respond. It is probable that motor fatigue was exacerbated by limited timeconditions. This is consistent with results obtained by Anastasi (1988), and Reavis(1990).Even so, there are disadvantages to long response times for some subjects.When response time was longer than the subject needed to negotiate a motoricresponse, subjects became distracted and bored. Their attention wandered. In onecase, the subject began to add extra items to his response making his answer incorrect.These factors appeared to contribute to less than optimal performance. Response timegiven to subjects must be gauged and provided with care. It appears necessary toadjust response time specifically to the motor needs of the individual to facilitate optimalperformance. For this reason, it will be important to develop software that respondsimmediately after the last depression of a key (or cell) by going on to the next question,or to have a human tester present that can monitor the assessment situation and makestimulus and response time adjustments as needed. In this assessment, the computercould not approach the ability of the "human" to be flexible and to make fineadjustments to the assessment procedure as needed.It is also necessary to adjust stimulus exposure time to suit the needs of thesubject. When stimulus exposure time was protracted (60 seconds), all subjectsbecame distracted. They wriggled in their seat, looked away from the computer screenand appeared bored. The extended period of time to wait coupled with distractions mayhave caused subjects to forget items which were presented reducing the likelihood thatbest performance was seen. When auditory feedback was not given, subjects' attentionwas not brought back to the task. Consequently, response time needed was longer.This suggests that response time given to subjects needs to be based partially upon theindividual's ability to maintain attention to the task. The computer technology that wasused was unable to instantaneously adjust response time to the subject and task.53The need for stimulus exposure and response time to be adjusted according tothe needs of the student illustrates the need for examiners to be intuitive and flexible.The computer equipment was not capable of making adjustments instantaneouslycausing less than optimal performance to be seen. However, it was possible for theexaminer to make some adjustments to the assessment procedure when needed.Auditory feedback had a remarkable influence on subjects' ability to perform well.It helped almost all subjects to orient to the task. Their attention was brought to thescreen and the questions anticipated as a result of the beep and speech feedback. Aseach item was announced by the computer, subjects' eye gaze simultaneously followedthe items being displayed on the screen. Most subjects' attention was maintainedthroughout the duration of the auditory feedback. Studies by Hinchley et al (1977)confirm that auditory feedback involves students more actively in the instructionalprocess. Iacono and Miller (1989) also say that the computer helps students withhandicaps to attend to the relevant stimuli in tasks.However, there were some exceptions. Subject B did not look at the screenwhen auditory feedback was given. Instead she tried to scan and locate the items onthe keyboard as they were announced. Although auditory feedback appeared to causeattention to be diverted from the screen, this behavior was likely a strategy to overcomea lack of familiarity with the keyboard overlay. Further familiarity with the keyboard mayhave enabled this subject to attend to the screen presentation and facilitate betterperformance. Subject C became confused as a result of the auditory feedback.Although this subject began the assessment understanding the task he was to perform,auditory feedback seemed to cause incorrect answers. This subject would respond toa question and the item would be labeled by the computer. Each time an item waslabeled, the subject attempted to locate this item on the overlay causing both the subjectand computer to generate the same item repeatedly. It appeared as though the subjectthought that the task was an auditory matching exercise. This problem would likely54have been remedied by providing a more stable understanding of the task throughincreased practice.The most remarkable impact auditory feedback had on the assessment processwas its ability to provide opportunities for the examiner to observe the responses of thesubjects. The "beep" feedback which occurred after each response enabled subjects todetermine if their answer had been registered by the computer. Traditionally,assessment has been difficult with this population because of involuntary motormovements, forcing the examiner to make interpretations about the student's intentions.Feedback helped the examiner to determine whether the subject had isolated the cellwhich was intended because it made subjects more aware of the response which theyhad produced. The resulting image on the screen made their work public knowledge.Both examiner and subject were able to acknowledge that a response had been made,what it was, and whether the answer was recognized as correct or incorrect by thesubject. In all cases, subjects looked to the screen as a result of the feedback whichthey heard from the computer. Three of these subjects (A,B, F) checked their work,recognized when answers were incorrect and showed some concern or a desire tochange these answers. The computer and its capacity to generate auditory feedbackenabled the examiner to make a more precise interpretation of subjects' responses andmake new discoveries about the subjects' awareness of the nature of the responseswhich were made.The importance of allowing subjects time to practice before embarking oncomputer assisted assessment cannot be underestimated. Practice appears to beneeded in order to understand the mechanics of the task to be performed, familiarizesubjects with the response mode, ( its sensitivity and beep feedback), and familiarizesubjects with feedback mechanisms (the computer monitor and audio output). Extrapractice time off of the computer was given to Subjects D and E in order to help thembecome familiar with the expanded keyboard overlay. Subject F received extra practiceon the computer. While all could locate some items faster, the number of items that55Subjects D and E remembered correctly remained the same given equal conditions.However, Subject F's performance was remarkably improved. This subject completedboth Photographs and Letters levels of the assessment. At the first and less abstractlevel, the subject needed prompts to look at the screen, scan the items on the board,remember items in the correct order and reproduce them. When the second and moreabstract level was introduced to her later, fewer prompts were needed and moreanswers were correct. Out of the five subjects completing tasks at the Photographslevel, three subjects' response times improved. This appears to indicate that practicehelped subjects to become more familiar with the overlay, helped familiarize them withthe mechanics of the task, and gave them time to practice their motor skills. In caseswhere response times did not improve, behaviors were noted that indicated motorfatigue may have been an influencing factor. These behaviors were especially apparentduring the assessment sessions of Subjects B, C, D and G. These subjects were alsonoted as being the more severely physically handicapped or were ill or tired at thebeginning of the session.The problem of motor fatigue was a common one throughout most subjects'assessments. For this reason, Subject G's session was shortened. Subject D'ssession ended early owing to illness. A snack break was given to Subject F owing to ametabolic disorder. In all cases, providing a short interval between sets seemed to helpthe subjects restore their energy and they returned to the assessment with renewedinterest. In the case of Subject D, the subject was repositioned to reduce the effortinvolved in producing a response. This seemed to help lessen motor fatigue also. Thissuggests that it is important to consider the medical conditions of the subjects amongthis population in order to provide them with an environment that will best facilitateoptimal performance.A large factor in determining whether subjects' best performances were seenappeared to be the suitability of the task. If tasks presented were too hard for thesubject, response times were slow, number of correct answers and number of items56remembered were low. Frustration and anxiety were seen. Subjects' movementsbecame more uncontrolled and subjects' muscle tone became more rigid. Thiscomplicated the subjects' ability to respond, and evoked more frustration and anxiety.To enable the participation of subjects who could not remember items in sequence, thetask was changed to allow memorization of the items in any order. Tasks needed to besimplified in this way for all subjects except Subjects A and F. Although tasks weresimplified as indicated, the software had been written to branch to the next question inresponse to the subject memorizing and reproducing items in the correct sequence.Simple memorization of items in any order was counted as incorrect by the computerand the computer would end the session instead of going on to the next question. (Theexaminer later counted the number of items remembered by the subjects which hadbeen tabulated by the computer). As a result of the software being written in this way,subjects had to wait on several occasions while the examiner manually adjusted theprogram to present the next question. These waiting periods lasted approximately 60 -90 seconds and had a partial influence on subjects' ability to maintain their attention tothe task. Accordinigly, it was likely that best performance was not seen. It is likely thathad the software allowed for the level of the task to be adjusted to the ability of thesubject, waiting periods and frustration would have been reduced for these subjects. Anenvironment which would have been more conducive to eliciting optimal performanceamong the subjects might have been created.In addition, it is evident that assessment on the computer is only as good as thesoftware alllows. While the function of the computer is to provide a more detailedassessment of the learner according to Brinker (1982), the computer cannot do its jobwell if the software does not meet good educational standards and is flexible. Stimulusexposure, response time, feedback and level of task difficulty must all be consideredwhen developing software for this population. No assessment mode, especially any thatentails computers, will revolutionalize assessment practices unless proper assessmentprinciples are respected.57The results illustrate the heterogeneity of this population. All subjectsapproached and responded to the computer based tasks presented to them differently.Problems arose for different reasons and were approached in different ways. To meetthe needs of students in a population such as this, there is a need for both examinerand computer to be highly flexible. The software used in this study was rudimentaryand did not incorporate the flexibility or human touch that the human assessor brings tothe assessment situation. Further, the computer was not able to make sensitiveadaptations to the assessment instantaneously while the examiner possessed thisability. The computer was unable to instantaneously adjust for stimulus exposure andresponse time or vary feedback and presentations. It was unable to adjust the level oftask difficulty. The computer was unable to apply these adjustments continually andwith sensitivity. There is a need for this flexibility in the assessment of any children -and especially with children with the special needs that handicaps present.In summary, specific elements of the computer based assessment whichappeared to facilitate better performance were an appropriate response mode,prolonged time to respond, practice and familiarity with the task and keyboard overlay,appropriate tasks, short assessment sessions, examiner - subject familiarity, auditoryfeedback and reduced motor fatigue and waiting periods.It is highly likely that a superior computer based environment would havefacilitated better performance among these subjects if exposure and response times,keyboard layout and feedback were adjusted specific to the needs of the subject and iftime to practice the task was given.ConclusionWhile this study was intended to pilot an assessment program and to explore thebenefits of computer - assisted assessment of non speaking children with multiplehandicaps - including conspicuous physical handicaps, the study suggested that manyfactors have to be taken into account when assessing students with severe disabilities.58Although the study set out to explore the benefits of prolonged exposure and responsetime and enriched feedback conditions, many unanticipated questions were unveiledwhich appeared to have a great influence on these students' ability to perform their best.The heterogeneity of the population and the factors which complicate students'performance were illustrated.In order to exploit the usefulness of the computer during the assessmentprocess, it is crucial that the computer be used with an attentive and nimble examinerpresent. The benefits of using the computer during assessment of this population areminimized for both examiner and student unless it is augmented with human tact,intelligence and responsiveness. While the computer is capable of generating andvarying feedback and can offer a response mode for students with physical andnonspeaking handicaps, its power depends on the examiner. The examiner's role mustbe perceived as one of equalizing opportunity for the child in order to facilitate the child'soptimal performance. To do this, examiners must know the needs of the children theyare assessing - regardless of the use of sophisticated computer equipment andsoftware. It is important for examiners to determine the kinds of presentation modesthat help students to demonstrate their abilities. Furthermore, since these fluctuate orvary, it is necessary for examiners to be present to monitor and change feedbackconditions when necessary. The sound and display should match children's' currentinterests and abilities in order to provide and maintain their motivation. This means theexaminer must also determine the appropriate response mode in order for the child toreach, manipulate, and respond to a stimulus. The computer environment must bestructured accordingly.While the computer and examiner are partners in the assessment process, thecomputer's role must be perceived as one of augmenting the role of the "human"present. The computer is capable of taking care of the chore of presenting tasks,scoring answers and enables the examiner to make in depth observations about howbest to take advantage of the computer's flexibility in presenting information, offering an59alternate response mode and providing an appropriate amount of time in which torespond.The ability to demonstrate knowledge has been a problem among children whoare physically handicapped and nonspeaking. Lack of ability to demonstrate knowledgehas influenced attitudes and caused low expectations. The computer is capable ofstructuring conditions which make students' responses more observable andidentifiable. It was the "beep" response that created opportunities for the examiner toobserve students' awareness of responses and recognition of incorrect responses.Student responses were displayed on the computer screen. Auditory feedback drewstudents' attention to the screen. They looked, searched for an effect and checked theiranswers. It was possible for both examiner and student to acknowledge that aresponse had been made, observe the resulting image on the screen and note if ananswer was correct or incorrect. If the computer is capable of making responses moreobservable and allowing for a more precise interpretation of student responses, then itshows promise for progress in the assessment of these children. However, in order forthe computer to remain useful, the examiner must recognize his/her role to be one ofyielding continual, astute and sensitive observations about student responses and thenature of the conditions which best facilitate optimal performance.This study revealed some intervening factors which appeared to have animportant influence on facilitating optimal performance. Care must be taken to monitorthe level of motor fatigue, give tasks at the appropriate level, provide practice at the taskto be performed, increase familiarity with the keyboard, create student - examinerfamiliarity and rapport, reduce waiting intervals, give short assessment sessions,provide students with an appropriate response mode and provide appropriate time toview and respond to questions. To ensure that the examiner can take these factors intoaccount, assessment sessions need to be distributed across a period time. Only anexaminer familiar with the student can read the nonverbal behaviors of the studentwhich may indicate fatigue, possible frustrations in communication, cognitive and motor60areas. It is also important to determine student skills which were evidenced but notcredited by the computer. Examiners run the risk of over or under estimating students'abilities unless assessment sessions are carried out over an appropriate amount of timeand the examiner is familiar with the student. Computers can augment the examiner'sresources. The examiner needs to be able to see both the possibilities and limitationsof the computer to create conditions which best facilitate the student's performance.Examiners should be well trained in making observations of students and makeprocedural variations which facilitate optimal performance from the student.The data suggested that the Unicorn expanded keyboard helped the majority ofchildren by meeting their limited response capacities. The Unicorn keyboard allowedsubjects with uncontrolled and spastic movements to be given an assessment.Although the computer with the Unicorn expanded keyboard effectively provided aresponse capacity for some students, it was noted that in some cases, the board lackedenough sensitivity to register student responses. There was no mechanism whichprevented students from accessing keys which they did not intend to activate. In orderto make the Unicorn board accessible to students with a wide variety of needs, thisassessment tool needs refinement. There may be several solutions to this problem.One solution may lie in refining the hardware. By creating a Unicorn board with theflexibility to provide keys with less sensitivity than others, it may be possible for thestudent with laboured movements to accidentally hit keys without activating them.This group of subjects was unique. The members of the group were moredifferent from one another than alike. A different claim is not likely to have beenproduced by a bigger sample. Both tool and approach need to be individualized -including the software which is used. Software needs to be developed which will allowfor the heterogeneity of this population. Assessment tools need to be flexible allowingconditions to be adjusted to suit the diverse and fluctuating needs of these children. Afeature which can be adjusted to suit the response rates of this population is needed toincrease opportunities for these students to complete answers and provide correct61answers. If an adjustable feature were included that matched the task and criterionlevel for success to student ability, then conditions might be created which enablestudents of varying abilities to respond. It is important to include a practice session inthe assessment process to ensure that students understand the "mechanics" involved inthe task and in producing a response. Software should be developed which can createopportunities for students to become familiar with the keyboard overlay, practice thetask, respond to questions, confirm their response, and change their response if needed(i.e. provide an erasure).The field of computer based assessment offers promise in overcoming some ofthe difficulties currently associated with the assessment of physically disabled students.The computer has the potential to enhance conditions which facilitate the demonstrationof students' abilities. The computer has the ability to provide flexible presentation andresponse modes. Part of the usefulness of computer based assessment rests in thecomputer's ability to provide examiners with increased opportunities for observation. Toexploit this quality, examiners need to be able to anticipate the advantages whichcomputer present while ensuring their limitations don't hamper the human powersexaminers possess.The computer did not match the ability of the examiner to be flexible and adapt orstructure the assessment environment to meet the needs of the students on a continualbasis. The intelligence of the computer was rigid and limited. It could not determinewhen to make fine adjustments or make sensitive observations about what kind ofadjustments were appropriate. It is clear that it is necessary to be flexible and adjust theassessment environment instantaneously and continually to facilitate optimalperformance among these children. Human intelligence is less rigid. It is more flexibleand sensitive. Although the computer and human may work as partners in theassessment process, their roles are not equal. The power of the computer rests withthe human. It is imperative that the examiner see the computer objectively so that the62computer's limitations do not also limit the powers and subsequent efficacy of thehuman assessor.Limitations of the StudySeveral variables were beyond control. Room size and time for the assessmentsession varied among the schools. A tightly controlled laboratory situation is needed inorder to explore the benefits of the computer with more validity. Also, familiarity with theexaminer was not possible and it is likely that this influenced the subjects' performance.The time subjects were able to spend with the computer based assessment tool waslimited and only a short time was available for observation of the subjects in theirclassrooms. The tool itself included only a small number of assessment items.Subjects also varied in the degree of experience they had with technology prior to thestudy.Limitations in funding and time severely constrained the number of times theassessment could be carried out with subjects. Accordingly, a thoroughly test of theeffects of practice upon the performance of subjects was not possible. The cost andtime involved in carrying out the study may discourage others from attempting to repleata similar study. The low incidence of youngsters like these in this study and theirdispersion is a major factor.study.Language competence was not addressed in this pilot project. Undoubtedly,language development would affect the results.The findings of the present study illustrate the difficulties of assessing childrenwith severe speech and motor handicaps. 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The Computer Based Cognitive Measure Form75Computer Based Cognitive MeasureObservation FormStudent's Name: Date of Birth:How does student showyes/no?Exposure Time Response Time Nonspeaking? yes^noWears glasses: Yes/No Best visual field: Right/LeftWears hearing aid: Yes/No Best hearing side: Right/LeftHandedness: R/Umixed On medication? Yes/NoWhich?Current mode of communication:PRIOR COMPUTER EXPERIENCE:Describe the environment in which the student spends the most time (classroom,learning assistance centre etc.) ^Does the student use a computer in the classroom? yes noFor how long?^mins./week.Does the student use a communication device?^yes noFor how long?^mins./week.What language functions does the student use? (requesting, clarifying, negatingaffirming, etc.).Does the student use a computer in the L.A.C.?^yes noFor how long^mins./week.Name computer hardware with which student is familiar (incl. communication devices):Does the student use:76conventional keyboard?^ yes^nomini keyboard?^ yes noUnicorn keyboard? yes^noother expanded keyboard?^yes noIf the student uses a computer, how is the keyboard positioned and how does thestudent use it? (left hand, in midline etc.).If the student uses a computer, how is the monitorpositioned?^Name the types of software with which the student is familiar. ^VISUAL PRESENTATIONLooks at examiner yes no max min visLooks at presentation on screen yes no max min visLooks around the room consistently yes no max min visSmiles in response to screen yes no max min visShifts gaze from examiner to screen yes no max min visFollows examiner's movements yes no max min visFollows adult's visual line of regard yes no max min visPoints/gestures to screenpresentation yes no max min vis.Points/gestures to screenpresentation and looks yes no max min visto adult for confirmation yes no max min visShifts gaze between itemson screen yes no max min visMaintains attention to screen yes no max min visPauses (may look away) fromvis and aud.vis.and aud.vis. and aud.vis. and audvis. and aud.vis. and aud.vis. and aud.vis and aud.vis. and aud.vis. and aud.vis. and aud.vis. and aud.77screen presentationStudent looks away fromscreen presentationSmiles, looks away from screen,laughs, expresses excitementwhen screen presentation appearsLooks back and forth betweenexpanded keyboard and screenShifts gaze between examinerand expanded keyboardLoses place while looking backand forth between expandedkeyboard and screenKeeps place while looking backand forth betweenexpanded keyboard and screen.Looks at hand while depressingcell on expanded keyboard.Turns away while depressing cellon the expanded keyboardSearches out an "effect" on thescreen after depressing cellyes no max min visyes no max min visyes no max min visyes no max min visyes no max min visyes no max min visyes no max min visyes no max min visyes no max min visyes no max min visvis. and aud.vis. and aud.vis. and aud.vis. and aud.vis. and aud.vis. and aud.vis and audvis.and aud.vis and audvis. and aud.Appears to use verbal mediation (may whisper to self)in response to presentations when the following number ofitems are presented:1 yes no max min vis vis and aud.2 yes no max min vis vis and aud.3^ yes no max min vis vis and aud784 ^yes^no^max min.... vis^vis. and audCheck one. Scans 2 ^ 3^4 ^photographs ^ line drawings letters^VISUAL AND AUDITORY PRESENTATIONAttends to examiner's voice^yes^no^max min vis. vis and aud.Ceases activity when spoken to^yes^no^max min vis^vis and aud.Turns head/eyes deliberatelytowards sound ofdigitized speech^yes^no^max min vis^vis and aud.Alerts and reacts to presentation ofwords.^ yes^no^max min vis^vis and audLooks to adult in response to wordspoken with digitized speech^yes^no^max min^vis vis and audMaintains attention to sound source yes^no^max min vis^vis and audPoints/gestures to sound source^yes^no^max min vis^vis and audPoints/gestures to sound sourceand looks to adult for confirmation yes^no^max min vis^vis and audLooks to sound source in anticipationof next word to be presented^yes^no^max min vis^vis and audPauses (may look away) fromspeech presentation^yes^no^max min vis^vis and audLooks, smiles, may show excitementat speech presentation^yes^no^max min vis^vis and audAppears to understand digitizedspeech presentation.^yes^no^max min vis^vis and aud.79Looks to the source of auditoryfeedback after having depresseda cell^ yes^no^max min vis^vis and aud.Looks back and forth betweenexpanded keyboard andsound source^ yes^no^max min vis^vis and audListens for "click" to know when torelease pressure fromthe expanded keyboard^yes^no^max min vis^vis and audSearches out an "effect" on the screenas a result of hearing the "beep" fromthe computer^ yes^no^max min vis^vis and aud.GENERALAppears to listen for feedback (beep) from Unicorn after depressingcell^ yes^no^max min vis^vis and audKnows to press Unicorn square again if no "beep"is heard.^yes^no^max min vis^vis and audBegins to respond before response time is up.often seldom^never^yes^no^max min vis^vis and audShows concern (grimaces, looks toexaminer, stops hitting keys) whenUnicorn beeps more than onceper hit^ yes^no^max min vis^vis and audShows self correcting behaviorin response to:digitized speech^beep from expanded keyboard^screen presentation.yes^no^max min vis^vis and aud80Student shows correction of errorwhen given visual presentation^yes^no^max min vis^vis and audStudent shows correction of errorwhen given visual andauditory presentation^yes^no^max min vis^vis and audStudent shows awareness of response s/he has madewhen given feedback about their responses through:expanded keyboard beep^digitized speech feedback screen presentationyes^no^max min vis^vis and audStudent adds extra items or changes previous response when response timeis longer than is needed to complete questionyes^no^max min vis^vis and audStudent may grimace/vocalize/make body movements, look at examiner/screenwhen response time runs outyes^no^max min vis^vis and audStudent looks to symbols on Unicorn as a cue to the right answer(eg.to jog recall memory).yes^no^max min vis^vis and audCheck one. Repeats (using expanded keyboard) the following number of words:2 ^3 ^ 4 ^Attempts question more than once yes^noContinues with question despite running out of time^yes^noSmiles, vocalizes, responds affirmativelywhen asked if s/he wants to continue^ yes^noSmiles, makes eye contact when told of computer assessment^yes^noLooks to screen in anticipation of next item/question^yes^noAttempts question despite suspicion of previous incorrect answer^yes^noStudent looks at the screen when told to^ yes^no81Student looks at Unicorn when told to^ yes^noStudent does not attempt question until afterscreen presentation is gone^ yes^noMOTOR MOVEMENTSExpanded keyboard is adapted using the following:Angled?^ yes^ noKeyguard? yes noPositioned to the right?^ yes^ noPositioned to the left? yes noUses right hand to press targeton expanded keyboard^ yes^ noUses left hand to press targeton expanded keyboard^ yes^ noUses both hands to press targeton expanded keyboard^ yes^ noLooks toward or aims to targeta square even though action maynot be completed^ yes^ noAppears to use eyes to directhead toward screen^ yes^ noLooks from screen presentationto hand^ yes^ noLooks from screen presentationto arm^ yes^ noAppears to "motor plan" next motormovement through scanning fornext item on overlay^ yes^ noLooks away before targetting next82"response square"on overlay^yes^ noRests quietly between questions yes noMovements from cell to cell become slower(after first one or two cells are pressed).^yes^ noStudent does not have hit cell morethan once for response^ yes^ noMovements slow when moving pastmidline on overlay^ yes^ noShows no sign of needing to shiftposition to view overlay^ yes^ noStudent activates cells other than thetarget cell in responding^ yes^ noComputer accepts last cell hit as response^yes noSUMMARY OF SCREENING FINDINGSStudent responds to:photographs ^ line drawings^ letters^Student responds most frequently to:photographs ^ line drawings^ letters^Under what conditions?^MAXIMUM EXPOSURE-MAXIMUM RESPONSE TIMEEstimated number of visual items that are remembered consistently:1^2^3^4MINIMUM EXPOSURE-MINIMUM RESPONSE TIMEEstimated number of visual items that are remembered consistently:1^2^3^4MAXIMUM EXPOSURE-MAXIMUM RESPONSE TIME83Estimated number of items that are remembered consistently when visual andauditory stimuli are paired:1 2^ 3^ 4^MINIMUM EXPOSURE-MINIMUM RESPONSE TIMEEstimated number of items that are remembered consistently when visual andauditory stimuli arepaired:1^ 2 ^ 3^ 4^VISUALMAXIMUM EXPOSURE -MAXIMUM RESPONSE TIMEAppears to understand that pictures represent objects.^yes^noRemembers last items only (when presented visually), yes^noRemembers first items only (when presented visually),^yes^noIdentifies (with consistency)Circle one.Tends to remember all items but in wrong order given visualpresentation of:^ yes^noNumber of distractors student appears able to handle. Circle one:1 2 3 4 5Mistakes symbols that look similar eg. LI.^ yes^noMINIMUM EXPOSURE-MINIMUM RESPONSE TIMEAppears to understand that pictures represent objects.^yes^noRemembers last items only (when presented visually), yes^noRemembers first items only (when presented visually),^yes^noIdentifies (with consistency)Circle one.Tends to remember all items but in wrong order given visualpresentation of:^ yes^noNumber of distractors student appears able to handle. Circle one:1 2 3 4 5Mistakes symbols that look similar eg. LI.^ yes^no84VISUAL AND AUDITORYMAXIMUM EXPOSURE-MAXIMUM RESPONSE TIMEMistakes words that sound similar eg. ball, doll,^ yes^noTends to remembers last items only (when presented by the computer)yes^noTends to remember first items only (when presented by the computer) yes^noCheck one. Identifies with consistency :photographs line drawings^ letters^Remembers all items (but in wrong order) given auditory presentation of:photographs ^ line drawings^ letters ^MINIMUM EXPOSURE-MINIMUM RESPONSE TIMEMistakes words that sound similar eg. ball, doll.^ yes^noTends to remembers last items only (when presented by the corriputer)yes^noTends to remember first items only (when presented by the computer) yes^noCheck one. Identifies with consistency :photographs line drawings^ letters^Remembers all items (but in wrong order) given auditory presentation of:photographs ^ line drawings^ letters ^MISCELLANEOUSWhat distractions werepresent?^Did the student appear to have difficulty following instructions (re test or otherwise)?yes^noWhat is the amount involved in producing a response for this student? (amount to beremembered, degree of movement available to him/her, degree of effort85involved)^How does the student respond when given too much exposuretime?^How does the student respond when given too little exposure time?^What other factors appear to be influencing theseresults?^_How does the student respond when given too much responsetime?^How does the student respond when given too little response time?^What other factors appear to be influencing theseresults?^How does the student respond when given auditory feedback from the computer forhis/her responses?How does the student respond when given visual feedback from the computer forhis/her responses?What other factors appear to be influencing theseresults?^How does the student respond to minimal practice time:in the Photograph Memorysection?^in the Photo Memory with Aud. Labelssection?^86in the Letterssection?^in the Letters with Labelssection?^How does the student respond to maximum practice time:in the Photograph Memorysection?^in the Photo Memory with Aud. Labelssection?^in the Letterssection?^in the Letters with Labelssection?^What other factors appear to be influencing theseresults?^How does the student respond when using other memorysoftware?^How does the student respond hen using other computersoftware?^Circle those that applyAlerts especially to musicAlerts especially to animationAlerts especially to software with purposeAlerts especially to colour87

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