WATA Bulletin: SPRING 2000
Contents:
- Preschool children with developmental delays: motorized toy cars facilitate movement and social participation
- Legislative & Policy Update
- Calendar of Events
Preschool children with developmental delays: motorized toy cars facilitate movement and social participation
Jean Deitz, PhD, OTR, FAOTA; and Yvonne Swinth, Ph.D., OTR
Who are those happy children on preschool playgrounds driving sporty cars with roll bars? Are they the same children who used to passively watch the activities of their peers, seldom, if ever, having the opportunity to join in the play?
Two young children with complex developmental delays participated in a study we designed to explore the effects of a power mobility toy on child-initiated movement, social participation, and affect during recess or gym class. The two children, both 5 years old, had severe neuromotor impairments, speech impairments and substantial limitations in functional skills. Although neither child was being considered for power mobility, both learned to drive the toy car and both increased their self-initiation of movement. Their play appeared to be more developmentally appropriate when they were using the toy car, compared to when they were not using it.
The car used in the study was a "BOSS," a battery-operated, ride-on toy car made by Hedstrom (now available only through Innovative Products, Inc.- see below). Digital electronic controls, adjustable speed controls and a remote control device were supplied by Innovative Products, Inc. (830 48th St., Grand Forks, ND 58201 http://www.iphope.com/). We found that the digital electronic controls were important because they reduced jerking when the car was started, a feature that was important for both children, in view of their spasticity and startle responses. Likewise, we found the adjustable speed controls to be invaluable because they allowed the adults to set a maximum speed that was appropriate to the setting and the skill level of the child. For example, in the early stages of training and in indoor environments, the maximum speed was set at a low- to mid-range level. On the outdoor playground with open space and uneven terrain, the highest speed setting (a fast walking speed) was used. This seemed compatible with the speeds traveled by playmates on tricycles.
The remote control device allowed the adult supervising the child to use an override switch to control the car when necessary for safety. We tried the remote control occasionally during the early phases of training in the clinic and then outdoors, especially with one of the children who often tried to "spread his wings" and travel to remote parts of the playground.
We found use of the remote control to be confusing to the children. A hand-over-hand approach on the steering wheel, combined with verbal cues, was more effective in helping them learn independent and safe mobility skills and to follow playground rules. No situations arose that we couldn't handle without the remote control. As with children riding tricycles, it was easy to walk or jog after a child and redirect his or her travel. Therefore, we don't recommend purchasing the remote control unless the person supervising the child has limited movement capabilities.
The toy car used in this study has many positive characteristics. It can enable mobility play for children who otherwise are unable to participate independently in playground and gym activities. Further, it looks like a toy, is appealing to other children, and is appropriate for use in preschool or early elementary school environments.
It was easy and inexpensive to use high density foam to create customized seating devices to meet the unique needs of individual children. We cut the foam with an electric carving knife. Others have attached car seats to the toy cars to provide supported sitting.
The low cost of the toy car (approximately $3,800) compared to most power mobility devices is a plus, especially in situations where family members and other care providers are trying to determine whether a child can benefit from power mobility.
The car also has some negative attributes. First, it is loud: teachers and other staff members commented that it was disruptive indoors. Second, it is challenged by rough surfaces and inclines. Third, because the toy car has a fairly large turning radius, it is impractical for use in most classrooms and other small or crowded spaces. Fourth, it is a toy: breakdowns are frequent, but solvable. Fifth, the joystick that comes with the car has limited movement from the center position, and one of the children had difficulty using it. As an alternative, we recommend using a proportional joystick similar to those on pediatric power wheelchairs.
Toy cars can enhance mobility play and enable self-initiated movement for children with limited and inefficient movement capabilities. However, as with children who have recently learned to creep or walk, parents and other care providers need to monitor the children's movements and ensure that the environment is safe.
For references and more information, contact WATA at watap@u.washington.edu or 800-841-8345.
Note: Jean Deitz is a professor of in the Department of Rehabilitation Medicine at the University of Washington, Seattle. Yvonne Swinth is an assistant professor in the School of Occupational Therapy at the University of Puget Sound, Seattle.
Legislative and Policy Update
Sherrie. Brown, J.D., Ed.D., UW Research Assistant Professor, Educational Leadership and Policy Studies
The Washington Legislature went into special session March 10 to finish work on budgetary decisions complicated by Initiative 695, which eliminated the motor vehicle excise tax, leaving the state with $1.1 billion less than anticipated. Typically there would have been only relatively minor revisions to last year's two-year budget. (A Superior Court ruling that I-695 is unconstitutional has been appealed and will be heard in the state Supreme Court June 29.)
For current supplemental budget proposals, visit the Washington State Office of Financial Management website at www.ofm.wa.gov/budget.htm. To contact legislators, call the Legislative Hotline at 800-562-6000 or TDD 800-635-9993.
Washington Assistive Technology Alliance tracks state bills of interest to AT users and will issue a final legislative wrap-up once the legislature has adjourned. If you have questions, call Sherrie Brown at 206-685-1261.
Bills signed by Governor Locke
Patient Bill of Rights (2SB6199) requires health carriers to: 1) protect consumer health information; 2) offer to disclose information regarding covered benefits, drug formularies, exclusions, reductions and limitations to covered benefits prior to selling policies; 3) provide access to primary and appropriate specialty care providers; 4) maintain a documented utilization review program description and make clinical protocols available; 5) establish a grievance process and retain records of grievances for three years; 6) provide for independent review of health care decisions once internal appeals are exhausted; and 7) designate a Medical Director who is a medical doctor. Patients are allowed to sue for harm proximately caused by the failure of the insurer to follow accepted standards of care for health care providers.
Insurance Market Fix (2SSB6067) is the legislature's attempt to address the individual insurance market problems. However, consumer groups have expressed some reservations: Some eight percent of individuals with serious health problems will be screened into more expensive health plans, those with pre-existing conditions will have to wait nine months for coverage, and policies can be canceled even if policy holders have paid regular premiums. (See http://depts.washington.edu/ssweb.)
C.A.R.E. for Caregivers (SHB2454) establishes a program for family and other unpaid caregivers of adults with functional disabilities, offering information and referral services, respite care and supplemental services.
Long-Term Training (SSB6502) requires that (effective March 2002) caregivers in long-term care settings obtain basic and/or specialty training within 120 days of employment or diagnosis. It establishes a steering committee to advise on rules relating to training needs which would offer AT advocates an opportunity to address the importance of AT training for caregivers serving individuals with functional limitations.
DD Endowment Trust Fund (SB6233) modifies and clarifies the fund established with a $5 million appropriation last year. It provides for a definition of developmental disabilities and clarifies that individual trust accounts will be set up within the endowment trust fund.
Rehabilitation Council (HB2853) requires that a majority of the voting members of the Rehabilitation Council for the Department of Services for the Blind meet the number and diversity requirements of federal law.
Businesses Owned by Persons with Disabilities (SJM8015) requires the Office of Minority and Women's Business Enterprises to certify businesses owned and controlled by disabled persons as a subcategory of minority business enterprises for purposes of public contracting.
Barriers to Employment (2SHB 2364) did not make it out of the Senate in time. However, the Senate budget and the Governor’s latest budget include funds to implement it. It would allow workers with disabilities to retain Medicaid coverage when they find a job and would direct DSHS to explore the feasibility of designating one or more employment networks to service social security recipients with disabilities. The bill is necessary to implement the federal "ticket to work" act in Washington State.
Medicaid Access (2SB6167) passed the Senate unanimously but died in the House. However, the Senate Budget includes funding to implement this bill. It would allow DSHS to ignore asset limits for families renewing their Medicaid eligibility every six months, to streamline the renewal process and reduce administrative costs. It would require DSHS to convene a working group that includes stakeholders and recipients of public assistance to establish basic customer service performance measures and goals.
BILLS THAT DID NOT PASS
L&I and Early Intervention (SB5631) would have required the Department of Labor & Industries and self-insurers to pay up to $5,000 for early intervention services for injured workers, including costs of job modification, workstation improvements and personal accommodation devices.
Vision/Hearing Screening (SB6463) would have authorized school districts to provide vision and hearing screening to preschool age children.
Special Education (HJM 4020) asked Congress to approve legislation that would require review of special education paperwork and to consider providing parents of special education children a voice in determining the most appropriate type of paperwork to help their child achieve educational goals.
Basic Health Plan (3S5848) aimed to improve access to the Basic Health Plan in rural counties by allowing the Health Care Authority to offer non-capitated BHP plans and/or self-insure the BHP where necessary to meet access needs.
RESOURCES
General Disability Issues: Contact Toby Olson at the Governor’s Committee on Disability Issues & Employment. 1-800-949-4232/1-360-438-3168.
Special Education Issues: Contact the Washington State Special Education Coalition Parent Coordinator, Donna Obermeyer, at 360-705-2113, email obe2donna@home.com or by mail at 4537 Juli Ct. S.E., Olympia, WA 98501. The website is www.ussec.org/
Developmental Disability Issues: Community Advocacy Coalition sponsors weekly briefings every Wednesday at 10:00 am in House Hearing Room E, and sends out weekly updates. Contact Janet Adams at the Community Advocacy Coalition in Olympia at 360-357-5596 or email her at arcwa@earthlink.net.
Health & Social Policy: Nancy Amidei at the UW School of Social Work publishes a weekly update on legislative action on health and public welfare issues at http://depts.washington.edu/sswweb (click on POLICY WATCH 2000). To request email updates, contact her at amidei@u.washington.edu.
Children’s Issues: To receive Children's Alliance Legislative Alerts, contact Paul Barry at (206) 324-0340 or paul@childrensalliance.org. The Alliance also sponsors weekly briefings in Olympia at 11:00 a.m. on Thursdays, House Hearing Room E.
For more detailed Updates on both state and federal policy issues, please check WATA's website at http://wata.org and follow the link called Policy.
Calendar of Events
Introduction To Assistive Technology: Summer Institute, June 19-23, 2000, Seattle
The Summer Institute will provide participants with a comprehensive introduction to the field of assistive technology (AT). Through lectures, demonstrations of AT devices, case studies and hands-on experiences with AT, we will focus on an interdisciplinary approach to the selection, implementation and use of technology to meet the educational, vocational, transitional and independent living needs of individuals (adults and children) with disabilities. Participants will increase their understanding of the advantages and limitations of technology; improve their assessment, intervention and advocacy skills; learn to formulate and follow functional assessment strategies; and increase their knowledge of electronic information technology for accessing resources and networking. For more information call 800-841-8345 or visit http://uwctds.washington.edu.
RESNA 2000 Annual Conference, June 28-July 2, 2000, Orlando, FL
RESNA 2000, sponsored by the Rehabilitation Engineering and Assistive Technology Society of North America, will bring together people who use, develop, manufacture and deliver these technologies. It will provide an informative, thought-provoking educational forum with a diversity of presentations, including instructional courses, scientific and interactive poster papers, concurrent sessions, computer tech and environmental control systems labs. For more information call 703-524-6686, email info@resna.org, or visit http://www.resna.org.
New Millennium: Research to Practice (Call for Papers)
The 11th World Congress of the International Association for the Scientific Study of Intellectual Disabilities (IASSID) will be held Aug. 1-6, 2000 in the Washington State Convention and Trade Center in Seattle. Scientists, educators, care providers, support groups, advocates and persons with disabilities and their families from around the world are encouraged to attend. For more information visit http://www.waisman.wisc.edu/iassid/.
For calendar Updates, visit the Web at http://wata.org/calendar.htm
Your feedback is welcome. If you have comments, or mailing list additions or changes, please contact:
WATA Bulletin
Box 357920
Seattle WA 98195-7920
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e-mail: uwctds@u.washington.edu
The WATA Bulletin is supported by grant H224A3006 from the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, to the Division of Vocational Rehabilitation, Olympia, WA.