Switch Assessment

Michelle Lange, OTR, 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, ABDA, ATP/SMS

Michelle is an occupational therapist with over 30 years of experience and has been in private practice, Access to Independence, for over 10 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, editor of Fundamentals in Assistive Technology, 4th ed., 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 certified ATP, certified SMS and is a Senior Disability Analyst of the ABDA. 

 


Related Courses

Series: Power Mobility and Training in the School
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Video

Presenter

Michelle Lange, OTR, ABDA, ATP/SMS
Course: #2166Level: Intermediate3 Hours
  'very informative and I like the suggestions she gave for grading activities to form safe and appropriate use of the power chair in the student's functional environment over time'   Read Reviews
Please note: This course series is comprised of the following individual recordings: #2107, #2127 and #2165.

Power wheelchairs can offer independent mobility to many people with physical disabilities, including young children. But how do we determine if a client is ready for a power wheelchair? And if they are not yet ready, how to we develop mobility skills? This series will present strategies to both determine and develop readiness, present evaluation strategies including related factors such as transport, accessibility and transfers and present a variety of mobility training strategies.

Mounting Assistive Technology to Wheelchairs
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Michelle Lange, OTR, ABDA, ATP/SMS
Course: #2216Level: Introductory1 Hour
  'Specific and practical information'   Read Reviews
This webinar will provide an overview of mounting systems used to secure speech generating devices, notebooks and tablets to wheelchair frames. These systems mount a device for visual regard, access, safety from theft and protection from falling. We will review system components and mounting guidelines.

Power Wheelchairs: An Overview of Advanced Features
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
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Michelle Lange, OTR, ABDA, ATP/SMS
Course: #2217Level: Advanced2 Hours
  'Great practical examples of each technology'   Read Reviews
Power wheelchairs do far more than drive. This webinar will review advanced features including infrared transmission used to control devices in the environment through the driving method; mouse emulation used to control computers, tablets and speech generating devices through the driving method; interfacing external assistive technology devices to the power wheelchair electronics and more.

Overview of Computer and Tablet Access
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
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Course: #2317Level: Introductory1 Hour
  'The heirarchy is a great tool'   Read Reviews
This course will present a hierarchy of computer and tablet access options for clients unable to use a standard access. Access assessment requires analysis of physical access, vision, cognition and functional applications. Alternative keyboards and mice will be presented, as well as other alternative access options.

Tablet applications
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Video

Presenter

Michelle Lange, OTR, ABDA, ATP/SMS
Course: #2318Level: Introductory1 Hour
  'great explanations and examples!'   Read Reviews
Tablets are a hot item and are being used more and more with clients who have physical, verbal or cognitive limitations. New Apps are coming out all the time, but this course will present some that are being used with clients who have autism, are non-verbal, or have cognitive limitations. These Apps can increase participation, education, communication, recreation and independence.