Literature Review

Accessing Art: Assistive Technology And
Students with Physical Disabilities
A Literature Review by Melissa Enderle

Introduction
With the implementation of federal laws and advances in medicine, more and more children with physical disabilities are being educated in the regular public school setting. Children who previously would have been in hospitals or institutions are now attending school. There is also a shift in education from self-included classrooms towards inclusion, even with students whose physical disabilities are more severe. Regular education teachers and some special education teachers are finding students with more severe physical disabilities in their classroom. Likewise, the art teacher is also faced with adapting the curriculum for this population. Today’s art teachers are being expected to provide rich experiences for the physically disabled, sometimes in classes with thirty or more students. However, many art teachers are personally and professionally unprepared for meeting the challenge of integrating the child with special needs into the art classroom.

Because of their motor impairments and the demands of mainstreaming in academic courses, students with physical disabilities often have fewer opportunities than their able-bodied peers. Assistive technology has bridged the gap somewhat, giving some the chance to communicate, hold a device, or participate in activities similar to those by typical children. The significant advances in computer technology have opened opportunities for even the most physically disabled child.

For the child who is unable to successfully make meaningful marks on an art paper, the computer may provide an avenue for creative expression that the child is so desperately seeking. How then, can students with physical disabilities when using computers and related assistive technology, independently access the art experience? This paper hopes to address this question, providing art teachers some approachable, successful tools to use with their students with physical disabilities.

Definition of Terms

Assistive Technology

Federal laws such as the 1994 Amendment IDEA, known as the "Tech Act" define an assistive technology device as:

"Any item, piece of equipment, or product system, whether acquired commercially, off-the-shelf, modified or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities." Such technologies help people with disabilities to perform functions that may otherwise be difficult or impossible. . Assistive technology runs the range from inexpensive "low-tech" solutions to "high-tech" solutions. Assistive technology may involve adapting a computer with a specialized method for the user to operate the computer, or it may utilize special software to perform tasks (LAB Resources, 1999).

Physically Disabled

Wisconsin Department of Instruction defines physically disabled as a

"Severe physical defect such as an infection of the joints or bones, disturbance of the neuromuscular mechanisms, congenital deformities, cardiac conditions, or spastic and other acquired deformities" (1990, p. 21-22). Some students who are physically disabled have varying degrees of paralysis, caused by congenital disorders (such as spina bifida), accidents, or infection (such as muscular dystrophy and arthritis). The student may have difficulty in physical movements such as walking, eye-hand coordination and fine or gross motor control. Pain and fatigue is common.

Students who have cerebral palsy have a variety of disorders that result from damage to the brain before or during birth or in the first few years of life. Individuals with cerebral palsy may display some of the following symptoms to varying degrees: jerky voluntary movements, continual involuntary muscle movement, limp muscles, or extremely stiff muscles.

Computers and Related Assistive Technology Rationale

Computers and Students with Disabilities

The benefits of computers in the classroom have been documented by numerous studies, including several at the Macomb College of Education and Human Resources (Hutinger, 1998). Particularly significant are the findings related to computer utilization by students with disabilities.

Computer applications serve as tools for children with severe disabilities, enabling them to accomplish tasks that they would have been unable to do without the technology (Hutinger, 1996). For the first time, a child with a physical disability may have the opportunity to feel and demonstrate a sense of control over his/her environment (Peterson, [personal conversation] June 30, 1999, Frame, 1991, Hutinger 1996, Potter 1997). As a child successfully uses computer applications and becomes increasingly competent, feelings of self-confidence and self-esteem result when the child gains a sense of autonomy. Social interaction often increases with cooperation occurring both on the computer and during other experiences such as play (Hutinger, 1994, 1996). Communication between students is increased when using the computer. For example, one child may ask another "how did you do that" when working on a program. For those students who are nonverbal, the computer’s speech output capabilities provides a voice to communicate or stimulate communication (1996).

On the computer, learning becomes an interactive process, with the child actively communicating with the computer and program to learn a concept. The computer gives immediate feedback, resulting in a personalized dialogue between the user and the program and higher levels of motivation (Stevens, 1991). The computer is forgiving and consummately patient, allowing the child with a disability to work at his or her own pace in a more non-threatening environment (Taylor, 1991). Adds Pam Westhoff, "The computer, serving as an extension of our own intelligence, can help us realize our potential (1991).

Computers in the Art Room and Students with Disabilities

The art room poses a new set of circumstances for the child with a disability. While art tasks might be used in other domains of the school such as reaching a specific therapeutic objective, it has been found (Hutinger, 1998) that students with disabilities are given little time for exploring materials and child-initiated art activities. Children with disabilities can be more effectively included in the arts curriculum when we adapt conventional equipment to suit their needs, combining art with technology (Kiendl, et. al 1997). In the art classroom, the student is asked to express him/her self through the art process. According to Moyer, "the arts empower, teach oneself about individual potential, overcome self doubt, and assist in the building in the rich lexicon of experience which is required to build positive self image" (1991, p. 2-3).

However, expressing oneself can be complicated by a physical disability. A study by Kellogg on scribbling found that children with disabilities often display a delay in creating scribbles, because they have difficulty in manipulating conventional art supplies (Kiendl, et. al 1997). Studies by Rosner have found that assistive technology devices improve access to art materials and provide not only the opportunity to scribble, but to grow and develop through art. These assistive devices, in turn, can allow for more freedom through the use of imagination and the creative process (1982). According to an art teacher (Lake, 1998),

"This freedom gives many of my students, both normal and with disabilities, a new playing field on which to create. And I have not had a student who wasn't willing to keep trying when they began this new media." Charles Frame adds that assistive technology and the computer may enable people with disabilities to discover gifts not previously tapped, empowering them to express and experience their talents for the first time (1991). By exposing young children to computer-related art and giving them the tools and knowledge by which to create on the computer, the groundwork has been laid for a possible career in one of the most rapidly growing fields; computer graphics and animation (Peterson, [personal conversation] June 30, 1999, Roland, 1994).

The computer as an art tool has some unique characteristics especially desirable for individuals with physical disabilities. Whereas an unintentional mark on a marker drawing is generally permanent and may mar the desired image, a "mistake" in a computer art program can be easily eradicated. The computer "eraser" cannot put a hole in the paper; undo's allow an image to instantaneously return to its previous form, no matter how drastically it was just changed. Julie Treviranus (1994), computer technology teacher, comments that the computer allows students to adjust perceptual errors (such as adjusting shapes in initial sketches) by selecting faulty areas with the lasso tool and moving them. Gradually, they learn to master control over their techniques without the penalizing consequences of most traditional mediums. In addition, the computer-generated art image can be saved and manipulated endlessly, allowing for exploration and experimentation. Tasks that are laborious and tedious for a disabled art student can be reduced or sometimes even eliminated, instead allowing more time for the creative art process (Peterson, [personal conversation] June 30, 1999). The ability to print multiple copies of the final image is both a motivating and affirming process.

The interactive nature of computer arts programs has also resulted in growth for students with disabilities that transfer over to other areas of development. Retention of software application use and transference of knowledge to other programs was much greater than what was expected of the studied preschoolers with mild to moderate disabilities. Likewise, when coupled with computer art programs, these students were able to retain the ability and knowledge to use alternative input devices — two full years after initial use (Hutinger, 1996). Frequent use of exploratory computer software improved on-task behavior, eye-hand coordination, symbol recognition and group interaction (1997).

"Using high technology such as computer graphics software and appropriate peripherals reflects a useful adaptation for children with severe physical disabilities and equalizing their opportunity to participate in inclusion activities" (Hutinger, 1998 p. 31).

Successful Examples of Assistive Technology in Art

Although the integration of assistive technology into the art curriculum is rather uncommon and therefore not studied by many, there are a few programs that have been successfully implemented and researched. Often begun as exploratory programs, several have developed into comprehensive annual events. Training for current and future teachers, therapists, and parents is an outgrowth of the program.

One such program is the Young Artists Workshop (YAW). Begun in 1985, YAW sought to explore new ways to meet the needs of children with physical and/or communication disorders. Starting with only twenty students, YAW has now evolved into an extensive year-round program that has served almost 1,800 children ages 3-21. In 1986, Charles Peterson, founder of YAW, began the Arts Access Through Assistive Computer Technology — the first known project of its kind to explore the use of computer and augmentative communication system technology - to access visual and performing arts for children who are non-vocal, physically disabled or those with multiple disabilities. In this program, popular art programs were made accessible for the physically disabled through their communication devices or alternative keyboards. The impact: an ever-growing number of young people who were no longer denied access to the arts because of their disabilities (Foley, 1991). In addition, YAW has initiated undergraduate and graduate education courses in adaptive education, teacher certification in adaptive education, and a new Master of Science Degree Program in Adaptive Education and Assistive Technology.

In nearby Green Bay, Wisconsin, experimental work in access to the arts through assistive technology was being conducted. Charles Frame began the project after responding to a twelve-year-old boy (with severe physical and communicative disabilities) that there was no way for him to use a painting program. Disturbed that the physically disabled and non-speaking students such as the twelve-year-old boy were often excluded from traditional art and music classes, Charles Frame was determined to turn these youngsters into active participants (Frame, 1991). Setups were devised that allowed users of the augmentative communication devices TouchTalkers and LightTalkers to interface with Macintosh, IBM’s and Apple IIGS computers through an Adaptive Firmware Card and Trace-Transparent Access Module. The resulting overlays and setups were published and distributed.

The Macomb Projects at Western Illinois University has also looked into the area of art through computer-related assistive technology for children with disabilities. In a five-year study at three preschool sites and two birth-to-three sites, the growth in knowledge and abilities was measured. Items used included: switches, Touch Window, KeyLargo, Intellikeys, KidDraw graphics tablet and software such as KidPix, EA Kids Art Center and Hyperstudio. In every case, the children demonstrated a consistent increase in their skills over time, regardless of the differing ages, disabling conditions, or differences in their initial skill levels (Hutinger, 1998).

Assistive Technology Items Helpful in Computer-Related Art

Rationale

Contrary to the typical software program that uses the keyboard as the main input, most paint/draw programs make heavy use of the mouse. While the painting/drawing program may have some keyboard equivalents for operations normally performed by the mouse (such as z S for save), movement around the screen through the mouse is a necessity. Since a person with a physical disability doesn’t often have the fine motor control to manually manipulate a mouse, some other methods of controlling the mouse actions must be found (Frame, 1991). More information regarding the described assistive technology devices may be found in the book by Anson.

Devices

Direct Drawing Tools

The TouchWindow (Edmark Corporation) and the KidDraw (KidBoard Company) are two tools that can be used intuitively by children. Both have a pen-like stylus that assists the child in drawing more accurately. The TouchWindow can be used either attached to the screen or on the lap, and can be activated by a finger or hand, in place of the stylus. The KidDraw, a child’s version of a graphic tablet, provides a more naturalistic drawing experience with pressure sensitivity.

Alternative Keyboards

Alternatives to the standard keyboard such as IntelliKeys (IntelliTools Corporation) and DiscoverBoard (Don Johnston Company) can be used in place of a keyboard, mouse or both. Alternative keyboards are customizable, programmable, and can thus accommodate a wide range of users with disabilities. Students may use either pre-made overlays to accompany programs such as KidPix or they may use overlays custom-designed to fit their needs. Pressure sensitivity, key size, and speech output can be adjusted on the DiscoverBoard.

Trackballs and Joysticks

Prior to trying other devices, a child who is having some difficulties in using the pre-supplied mouse should be given the opportunity to try other mice, including ones that are smaller or different in shape. Trackballs are quite popular with individuals with disabilities for several reasons: they are more stable, require less desk space, accept a range of movement degrees, come in extremely large or small sizes, and have programmable button capabilities including latching. The latching feature helps adapt for simultaneous button/mouse movement, enabling even the one-fingered user to successfully use the drag function in painting programs. Joysticks may be familiar with students who play video games or use a power wheelchair. Some joysticks allow for movement in 360° while others only move up, down, left and right.

Switches

For the user who can perform only a single motor action reliably such as turning the head to the right, switches can provide independent control for the first time. Coupled with the powerful Discover:Kenx technology, the switches can systematically go through tools or menus in any software, utilizing either ready-made programming or custom-designed scanning arrays.

Voice Recognition, Electronic Pointing Systems

Although improving, voice recognition software and hardware still isn’t at the point of accuracy where it can be a reliable hands-free alternative to the mouse for the physically disabled user. Voice recognition systems do have the capability (although cognitively draining or unacceptably inaccurate) to input data, navigate through the computer and execute standard commands.

Electronic pointing systems such as the Head Mouse and the Head Master can give the user with good head control a completely hands-free operation of the computer. The Head Master, a headset device with ultrasound, tracks movement of the head and translates that movement to the cursor on the screen. The Head mouse uses reflection with an infrared source to track head position. Both devices produce extremely natural movement of the mouse pointer and allow for complete control of the pointer, making it an excellent option for the individual who requires a mouse emulator (1997).

Low Tech Adaptations for the Computer to Access Art

Some of the best adaptations are simple in design, cost and technology. A pointing or typing aid, commonly worn on the head, held in the mouth or hand, or strapped to the chin, can allow a student with severe physical disabilities to use a keyboard (standard or alternate), touch screen or trackball. Keyboards (standard or alternate) can be placed on an easel or slant board, velcro can keep hardware stable, and the keyboard can be protected with a moisture guard. Keyguards cut down on extra keystrokes, while software modifications can help accomplish tasks the deactivation of the automatic keystroke repeat feature. An adjustable table will get the monitor at eye level and the keyboard or input device within easy reach. Drag (to slow down a mouse) can be accomplished by turning over the mousepad; to slow down a trackball, sticky back felt can be added in the ball’s well (Ensign, 1992).

Considerations for Choosing and Implementing Assistive Technology in the Art Room

Finding the best assistive device involves some trial and error. In order to assist in finding the most appropriate device, several considerations should be taken:

Consider what the child can do and how they can access the computer.
What are the learning objectives and how does the technology relate to achieving them?
Will the device help make the task more efficient and less taxing?
Will the child use the device?

Proper support is another factor for consideration (Hutinger, 1998, Robinson, 1996). Training should be provided for teachers, therapists and parents on ways to integrate the use of assistive technology in naturally occurring activities or environments (Moyer, 1991, Lesar, 1998, Hobinson, 1996). Follow-up support needs to be given in order to help maintain the device, provide assurance to concerned individuals, and assist in any programming that might need to be done with the device. Consideration for such factors will raise the probability that the chosen assistive technology devices will be integrated into the class projects and objectives (Lesar, 1998).

Implications, Avenues to Explore

Art is one subject in school in which all children have the opportunity to speak and express themselves using the powerful mode of visual communication. With a "little imagination from concerned educators, the visual arts can be used to reach across disability barriers and reopen vital avenues of communication with others" (Peterson, 1989, p. 3). The idea is "to place ability over disability in expanding capability" (Taylor, 1991, p. II-3-3). Computers and related assistive technology can help ensure that all children, including children with physical disabilities, have that same chance to make those personally meaningful marks in a dignified, empowering and independent manner. It is our responsibility as educators to help challenge preconceived notions of physical disabilities and provide all students equal opportunity to learn, achieve and experience success. For some, experiences in art on the computer may lead to computer-related art careers, thereby helping to overcome a 30 percent employment rate for the disabled U.S. population (Lyman and Mather, 1998).

Asserts Craig Roland (1994, p. 2), "Whatever technologies are brought to bear on the arts learning process, children must learn to use the tools they have available to them to think, to imagine, to create, to take on the impossible, to play with ideas, to explore, and to feel what it means to be human". Computers and related assistive technology can be a positive addition to the art room. In order to make its implementation and integration into the art room a positive one for all involved, proper education, training and support is needed. A non-threatening approach with practical utilization strategies would increase the likelihood of acceptance and support by art teachers. In order to make the implementation a reality, I have proposed to do several things in a practical project available to art teachers. Art educators would be introduced to some of the assistive technology devices that would be of benefit. Videos or pictures could be shown to help art teachers see physically challenged children using the technology in the art room. Ready-made layouts and setups for popular art software would be included so art teachers would be able to provide ready access for some students. For additional support, a network of individuals or agencies knowledgeable in computers or assistive technology would be included.

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