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What Criteria Is Necessary To Create An Ideal Placement For A Switch Site?

Michelle Lange, OTR/L, ABDA, ATP/SMS

November 1, 2018

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Question

What criteria is necessary to create an ideal placement for a switch site?

Answer

An ideal switch site is going to use as small a movement as possible. That movement should be isolated and volitional with controlled switch activation. They may need to use sustained pressure if that is required for a power wheelchair, as well as a controlled release. The six features that create an ideal switch site are as follows:

  • small movement
  • isolated movement
  • volitional movement
  • controlled activation
  • sustained pressure
  • controlled release

There is a hierarchy of potential switch sites:

  • Hands
  • Head
  • Mouth
  • Fee
  • Lower Extremities
  • Upper Extremities
  • Mind

The hands are the most common placement for many of our clients. 

Another question I often hear when talking about switch access is that sometimes the client is able to access switches in several areas. As you are looking at potential switch sites, you might think there are a couple different places this client can activate a switch. How do I choose which one is best? Again, go back to our switch assessment and look at those features of an ideal switch site. We want a movement that is small, accurate, has good speed, with sustained pressure if required for power mobility, consistent, and has a timed release (for safety). As you look at these potential switch sites, make sure that you are choosing the one that has those features to the most extent. That will be your optimal switch site. 

If a client is scanning on a communication device, some clients use two switches for scanning. If that is the case, you are going to choose the two most efficient switch sites for the client. If the client is using several switches for power mobility, such as one switch for forward, one switch for left, one switch for right, you are going to choose the strongest site for forward because that is the switch the client is going to use most frequently. 


michelle lange

Michelle Lange, OTR/L, ABDA, ATP/SMS

Michelle Lange is an occupational therapist with over 35 years of experience and has been in private practice, Access to Independence, for over 15 years. She is a well-respected lecturer, both nationally and internationally, and has authored numerous texts, chapters, and articles. She is the co-editor of Seating and Wheeled Mobility: a clinical resource guide. She is the former NRRTS Continuing Education Curriculum Coordinator and Clinical Editor of NRRTS Directions magazine. Michelle is a RESNA Fellow and member of the Clinician Task Force. Michelle is a RESNA-certified ATP and SMS.


Related Courses

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Power wheelchairs do far more than drive – the driving method can be used to navigate and control other features including Reverse, Speeds, Power Seating, or an Interfaced Assistive Technology device (i.e. a communication device). Power Wheelchairs can send Bluetooth signals to control devices such as tablets and smartphones. Finally, new SMART technologies are making power wheelchairs safer and more efficient for everyone.

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Master skills to implement in your practice immediately with continued Master Class. This three-hour master class addresses the complex needs of children with multiple disabilities in the early intervention setting, including successful transition to school. A multi-disciplinary approach to augmentative-alternative communication (AAC) and interventions are addressed and case studies are included.

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