Assistive Technology Access Alternatives: Be a "Switch Hitter"

Patty Hove, Chief Occupational Therapist
Kent County Assistive Technology Resource Center

How often do you use a switch in everyday life? To turn on the radio? Turn off a light? Do you use your hands? Due to the recent advance in technology, operating a switch is no longer reserved for the hands! Individuals who don't have good control of their hand movements can use other parts of their body to activate a switch. An occupational therapist (OT) helps determine the best placement of the switch and what type of switch should be used. The proper switch and switch placement makes a difference in function and comfort.

Upon completion of a comprehensive switch assessment, which involves obtaining a background history, goals of the individual, evaluation of motor and visual/motor skills, and trial use of switches, the OT determines what is the most reliable movement pattern (least amount of energy expended by the individual), makes recommendations for the placement of a switch or switches, and the type of switch that would be most effective. In addition, the quality and type of movement are important factors in choosing the best switch for an individual. Muscle tone may increase and adversely influence a movement. Other important considerations include:

• Will the switch be used for one function (i.e., turning a light on and off) or multiple functions (i.e., computer access, ECU operation, etc.)?
• Does the switch site encourage abnormal or primitive reflexive patterns?
• Are there multiple switch sites available for separate functions: mobility, communication, ECU (Environmental Control Unit) operation, toy activation, computer access, etc.?
• If the switch site is determined to be near the face, is it cosmetically pleasing, or does it obstruct the individual's face and inhibit communication? How?
• How many switches will be needed? Will they look fluid with an individual's tray or chair or become "monstrosities with multiple arms"?
• How often will the switch be used? Durability is an important feature.
• Will the switches be mounted? Who is responsible?
• Who is responsible for recommendations and is follow-up provided?
• Has a good team approach been utilized?
• What are the costs of the switches and mounting systems?

After a switch assessment, these individuals became more independent in various aspects of their lives:

• D. uses her right foot to push a rocker switch placed on the footplate of her wheelchair for powered mobility. Foot placement was the key to allowing D. to use powered mobility.
• G. uses his elbow to activate the switch for using his computer. He was wasting a lot of energy trying to use his hand to hit the switch time after time and, even then, accuracy was a problem.
• J. uses a switch placed above his knee to access his communication system. His knee was where his movements were most controlled, so a knee switch increased his rate of communication.
• J.W. uses his chin to turn on a joystick that operates (by infrared) his heating, air conditioning, and his electric door.
• K.W. uses a large flat durable switch at her foot to turn on the television because, when using a switch placed at her hand, she used all of her energy to focus on the switch and missed the action on the TV. Her foot switch clicks when she hits it so she doesn`t need to look at it to use it.

When looking at an individual's goals for independence, consider how a switch assessment can supplement traditional therapeutic evaluations. Your local Assistive Technology Resource Center has a switch assessment kit which offers an array of over 40 different switches, but be sure to consult with an occupational therapist about switch placement and the type of switch in order to save time and energy for you and the individual who will be using it.