Partnering for change (P4C) in Sweden- a study protocol of a collaborative school-based service delivery model to create inclusive learning environments.

BACKGROUND: Inclusive learning environments are considered as crucial for children's engagement with learning and participation in school. Partnering for change (P4C) is a collaborative school-based service delivery model where services are provided at three levels of intensity based on children's needs (class, group-, individual interventions). Interventions in P4C are provided universally to support all children with learning, not only children with special education needs (SEN), and as such are expected to be health-promoting. AIM: The aim of the study is to evaluate the effectiveness and cost-effectiveness of P4C as well as school staff members' and children's experiences after P4C. METHODS: In a parallel, non-randomised controlled intervention design, 400 children, aged 6-12 years, and their teachers, will be recruited to either intervention classes, working according to the P4C, or to control classes (allocation ratio 1:1). Data will be collected at baseline, post-intervention (4 months), and 11 months follow-up post baseline. The primary outcome is children's engagement with learning in school. Secondary outcomes include for example children's health-related quality of life and wellbeing, occupational performance in school, attendance, and special educational needs. The difference-in-differences method using regression modelling will be applied to evaluate any potential changes following P4C. Focus group interviews focusing on children, and professionals' experiences will be performed after P4C. A health economic evaluation of P4C will be performed, both in the short term (post intervention) and the long term (11-month follow-up). This study will provide knowledge about the effectiveness of P4C on children's engagement with learning, mental health, and wellbeing, when creating inclusive learning environments using a combination of class-, group- and individual-level interventions. TRIAL REGISTRATION NUMBER: NCT05435937.

The psychosocial impact of eye-gaze assistive technology on everyday life of children and adults.

PURPOSE: This study investigates the psychosocial impact of eye-gaze assistive technology (EGAT) in both children and adults with long-term experience using eye-gaze assistive technology in everyday life, as well as the psychosocial impact as related to duration of use. METHODS: In this descriptive comparative study, 34 adult and 27 child EGAT users participated in a structured individual interview using the Psychosocial Impact of Assistive Devices Scale (PIADS). RESULTS: The participants' age ranged from 5-74 years, 50% were female and 52% had been diagnosed with cerebral palsy. The EGAT had a positive psychosocial impact on competence, adaptability, and self-esteem among adult and child users. Competence was the only subscale with a higher value for adults (p = 0.038), compared to children. The items with the highest impact for the psychosocial aspects were quality of life, ability to participate, and self-esteem. The adults had longer duration of use than children, but for high-, medium-, and low-duration users, the device showed a positive psychosocial impact. CONCLUSIONS: Participants considered EGAT to have high positive impacts for participation and quality of life. The study adds new knowledge in that high positive psychosocial impact may be found even among low-duration users of EGAT, which is important to consider for service providers.

The Impact of Eye-gaze Controlled Computer on Communication and Functional Independence in Children and Young People with Complex Needs - A Multicenter Intervention Study.

INTRODUCTION: Children and young people with complex needs (severe motor impairments and without speech) have few opportunities to use alternative devices for communication. Eye-gaze controlled computers (EGCCs) might provide individuals with complex needs increased opportunities for communication and participation in society. OBJECTIVE: To investigate the impact of EGCCs on communication, functional independence and participation in activities in children and young people with complex needs. METHODS: A multicenter intervention study during seven months, measuring outcomes with or without EGCC at four time points, was conducted in Sweden, Dubai, and in USA. Seventeen participants (aged 3-26 years, diagnosis e.g. cerebral palsy, Rett syndrome) were provided with EGCC and services from an Assistive Technology center to implement EGCC in school and/or at home. RESULTS: Participants significantly increased their expressive communication skills and functional independence with EGCC compared to baseline. All but one (16 of 17) increased their activity repertoire and computer use with EGCC. With EGCC, participation in computer activities averaged 4.1 performed activities (e.g. communication, play), with a duration of 70 minutes/day and a frequency of 76% of days. DISCUSSION: The study strengthened the research evidence that EGCC can be an effective intervention in daily life for children and young people with complex needs. Communication and independence, common goals of intervention, were shown to be relevant EGCC outcomes.

Communicative Interaction with and without Eye-Gaze Technology between Children and Youths with Complex Needs and Their Communication Partners.

Use of eye-gaze assistive technology (EGAT) provides children/youths with severe motor and speech impairments communication opportunities by using eyes to control a communication interface on a computer. However, knowledge about how using EGAT contributes to communication and influences dyadic interaction remains limited. AIM: By video-coding dyadic interaction sequences, this study investigates the impacts of employing EGAT, compared to the Non-EGAT condition on the dyadic communicative interaction. METHOD: Participants were six dyads with children/youths aged 4-19 years having severe physical disabilities and complex communication needs. A total of 12 film clips of dyadic communication activities with and without EGAT in natural contexts were included. Based on a systematic coding scheme, dyadic communication behaviors were coded to determine the interactional structure and communicative functions. Data were analyzed using a three-tiered method combining group and individual analysis. RESULTS: When using EGAT, children/youths increased initiations in communicative interactions and tended to provide more information, while communication partners made fewer communicative turns, initiations, and requests compared to the Non-EGAT condition. Communication activities, eye-control skills, and communication abilities could influence dyadic interaction. CONCLUSION: Use of EGAT shows potential to support communicative interaction by increasing children's initiations and intelligibility, and facilitating symmetrical communication between dyads.

Usability of Eye-Gaze Controlled Computers in Sweden: A Total Population Survey.

Eye-gaze technology allows individuals with severe physical disabilities and complex communication needs to control a computer or other devices with eye-gaze, thereby enabling them to communicate and participate in society. To date, most research on eye-gaze controlled devices related to persons with disabilities has focused on a single diagnosis in either adults or children and has included only a few participants. This current study utilized a total population survey to identify the prevalence and perceived usability of eye-gaze technology among adults and children in Sweden. Participants were 171 eye-gaze technology users with severe physical and communication impairments, ranging between 4 and 81 years. Cerebral palsy was the most common diagnosis. Daily usage was found in 63%, while 33% had weekly, and 4% had less frequent usage. Adults, compared with children, reported using their computers more frequently (65%/38%; p < 0.01), and for the activities they needed to perform (59%/31%; p < 0.01) and were more satisfied with services, indicating that service providers should prioritize and develop more effective services for children and their parents.

Hope and Technology: Other-Oriented Hope Related to Eye Gaze Technology for Children with Severe Disabilities.

Introducing advanced assistive technology such as eye gaze controlled computers can improve a person's quality of life and awaken hope for a child's future inclusion and opportunities in society. This article explores the meanings of parents' and teachers' other-oriented hope related to eye gaze technology for children with severe disabilities. A secondary analysis of six parents' and five teachers' interview transcripts was conducted in accordance with a phenomenological-hermeneutic research method. The eye gaze controlled computer creates new imaginations of a brighter future for the child, but also becomes a source for motivation and action in the present. The other-oriented hope occurs not just in the future; it is already there in the present and opens up new alternatives and possibilities to overcome the difficulties the child is encountering today. Both the present situation and the hope for the future influence each other, and both affect the motivation for using the technology. This emphasises the importance of clinicians giving people opportunities to express how they see the future and how technology could realise this hope.

Gaze-Based Assistive Technology - Use in Everyday Life for Individuals with Impairments.

This session focuses on the latest developments of gaze-based assistive technology (AT) and the impact of gaze-based AT interventions in the home and at school. In particular, for play, communication, assessments and early intervention. The discussion focuses on how research findings can advance future developments.

The Benefits of Gaze-Based Assistive Technology in Daily Activities for Children with Disabilities.

This article reports research findings on how gaze-based assistive technology contributed to performance of daily activities for a group of children with severe physical impairments and without speech.

Gaze-Based Assistive Technology for a Toddler with Tetraplegia and Without Speech.

This is a case study exploring gaze-based AT as early intervention, for a ten-month-old non-verbal child with severe physical impairments. Data was collected repeatedly over time through questionnaires, videos clips, and field observations until the child was three years old.

Gaze-based assistive technology used in daily life by children with severe physical impairments - parents' experiences.

OBJECTIVE: To describe and explore parents' experiences when their children with severe physical impairments receive gaze-based assistive technology (gaze-based assistive technology (AT)) for use in daily life. METHODS: Semi-structured interviews were conducted twice, with one year in between, with parents of eight children with cerebral palsy that used gaze-based AT in their daily activities. To understand the parents' experiences, hermeneutical interpretations were used during data analysis. RESULTS: The findings demonstrate that for parents, children's gaze-based AT usage meant that children demonstrated agency, provided them with opportunities to show personality and competencies, and gave children possibilities to develop. Overall, children's gaze-based AT provides hope for a better future for their children with severe physical impairments; a future in which the children can develop and gain influence in life. CONCLUSION: Gaze-based AT provides children with new opportunities to perform activities and take initiatives to communicate, giving parents hope about the children's future.

Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study.

OBJECTIVE: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention. METHODS: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities. RESULTS: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high. DISCUSSION: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Eye gaze performance for children with severe physical impairments using gaze-based assistive technology-A longitudinal study.

Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1-15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9-11 months, and after 15-20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15-20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

Improving computer usage for students with physical disabilities through a collaborative approach: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the effect of an assistive technology (AT) intervention to improve the use of available computers as assistive technology in educational tasks for students with physical disabilities during an ongoing school year. METHODS: Fifteen students (aged 12-18) with physical disabilities, included in mainstream classrooms in Sweden, and their teachers took part in the intervention. Pre-, post-, and follow-up data were collected with Goal Attainment Scaling (GAS), a computer usage diary, and with the Psychosocial Impact of Assistive Devices Scale (PIADS). Teachers' opinions of goal setting were collected at follow-up. RESULTS: The intervention improved the goal-related computer usage in educational tasks and teachers reported they would use goal setting again when appropriate. At baseline, students reported a positive impact from computer usage with no differences over time regarding the PIADS subscales independence, adaptability, or self-esteem. DISCUSSION: The AT intervention showed a positive effect on computer usage as AT in mainstream schools. Some additional support to teachers is recommended as not all students improved in all goal-related computer usage. A clinical implication is that students' computer usage can be improved and collaboratively established computer-based strategies can be carried out by teachers in mainstream schools.