Children with severe multiple disabilities face many barriers to active participation in their learning programs, and assistive technology plays a significant role in eliminating some of the barriers. Appropriate high, low and no tech tools and equipment are recommended for each child, as needed, to facilitate the child’s efficient, active participation in his learning plan. Use of the assistive technology is monitored and reviewed frequently, to ensure continued appropriateness and effectiveness. TEAMability views assistive technology as a process that evolves and changes over time, as the child grows and develops over time. In other words, for TEAMability, assistive technology is a large resource of various tools, equipment, and strategies that, when appropriately applied, allow the student to actively participate and progress in his learning plan and life’s activities.

With completion of the Transdisciplinary Functional Abilities Evaluation, implementation of the learning plan can begin. Using information from the collaborative team evaluation as the basis for the learning plan, TEAMability looks at what the child can do presently, what he is ready to learn and what strategies and materials are appropriate for teaching these skills.  At the TEAMability Learning Center, we are outfitted with state of the art equipment that allows us to probe comprehensively for preferences. We have multiple enhanced learning environments in which a child can explore, discover, and learn. We offer unparalleled opportunities for whole body movement experiences. The TLC provides an optimal environment for children, parents, teachers, and caregivers to learn strategies and techniques that can be applied in natural everyday settings. In a school setting, the team meets to prioritize needs and to write developmental goals. Functional objectives are developed and practiced in meaningful, real-life contexts. The result is a cohesive, transdisciplinary IEP that integrates all developmental skills and provides intense focus on a few salient objectives. In a home setting, we prioritize goals and integrate each goal into a functional set of activities that are family friendly. TEAMability then uses modeling and role release techniques to train families, teachers, and caregivers in implementation skills and techniques so that they are able to effectively carry out the learning plan.

 TEAMability believes that instruction must begin at the child’s current level of functioning and must provide frequent opportunities for practice in natural settings.

These natural settings must be custom learning spaces, each designed specifically to meet the learning needs of an individual child. For learning to occur, the environments of the child with severe combined disabilities must be engineered to provide powerful opportunities for interaction in a variety of settings. Control and power must originate with the child. These custom learning spaces must:

• identify and utilize the child’s natural preferences and motivators

• allow the child to affect his environment

• employ naturally occurring stimuli

• allow the child opportunity and time to communicate

• provide opportunities for Active Learning™
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TEAMability customizes home and classroom environments for optimal learning by collaboratively crafting:

• learning media

• optimal sensory environments (lighting, sound, temperature)

• opportunities to explore, experiment, and discover through movement

• placement and use of communication system

• positioning options

To determine what the proper positioning might be for a child, TEAMability begins by asking the question: What task must the child perform? The positioning serves as a tool, as a means to an end, and that end is FUNCTION. In other words, TEAMability uses positive positioning not only for comfort, pressure relief and skeletal alignment, but also to:

• Stimulate social interaction

• Provide opportunities for observing and visually attending the environment

• Improve eye alignment and tracking

• Facilitate active head movement and independent control of head position

• Encourage task readiness and active participation.

• Facilitate upper extremity or lower extremity movement and to coordinate that movement with vision

• Provide foundation for processing more than one channel of sensory information

• Promote swallowing and management of oral secretions

The team approach is essential to make daily activities, including feeding, learning opportunities for the child with severe combined disabilities The natural ability to suck, bite, chew and swallow safely and efficiently is often compromised in persons who live with severe combined disabilities. Depending upon the types of motor, sensory and cognitive deficits present, parents and caregivers  face the daily challenge of feeding a son or daughter who may require a combination of unique food processing, special positioning, coaxing, adapted equipment and/or longer mealtime sessions.  Therapeutic intervention teaches parents how to use oral-motor techniques and tools every time they feed their child. This often results in improved oral-motor skill development, including enhanced lip, tongue and cheek coordination leading to safer swallowing, faster feeding and increased food intake.
Due to motoric, sensory, cognitive and behavioral factors, self-feeding is not possible for some children with severe combined disabilities.

It is TEAMability’s goal to enhance the feeding experience by imbedding it within a broader learning framework.   When parents and caregivers learn how to use oral motor techniques as a part of a consistent feeding activity routine, children not only develop eating skills but also have the opportunity to learn to predict and anticipate the steps of their mealtime. Feeding activity routines give the child frequent learning sessions that encourage him to build memory of the steps, sequence and pace of his meals, allowing him to more actively participate in and communicate during each breakfast, snack, lunch and dinnertime. 

TEAMability knows that children with severe combined disabilities learn best in structured, consistent environments which provide frequent opportunities to practice skills in natural settings. This is best carried out through the use of activity routines, predictable sequences of actions that make up a skill. These routines incorporate appropriate visual, tactile, and auditory prompts and permit active participation at the child’s current level of functioning.  

Consistent implementation of activity routines results in the anticipation and prediction of the steps in a skill, increased ability to participate and communication of preferences.
Activity routines may be created and utilized to teach skills such as feeding (see Feeding section), toileting, toothbrushing and other ADL (activities of daily living) chores; vocational tasks such as can crushing, paper shredding, etc.; or during recreational or play activities. The activity routine is designed to give the severely disabled the chance to do what they are independently capable of within the activity precisely because that is what is most meaningful to their minds and bodies. 

TEAMability’s transdisciplinary approach to persons with severe combined disabilities is essential to ensure that all aspects of a person’s abilities and needs are considered in the development of a customized activity routine.  Parents, teachers and caregivers are shown how to implement the routines consistently for maximum benefit to the child they teach.  The “hand-over-hand” strategy of physically guiding a child’s hand to move, touch, grasp or “hold” toys and other materials is strongly discouraged.   When a child’s physical movement is not seen immediately, adults think that without hand-over-hand “help”, that child cannot get the benefit of the experience independently.  When given proximity of materials and time, a child will often begin to show independent discovery and exploration of toys and other objects.  Normally developing children learn naturally when they independently interact with their environment.  Severely disabled children are no different.  Except for speed and quality of movement, their learning happens in the same way.   During active self-driven movement, the child with severe combined disabilities best learns what she likes, wants more of, how to move to touch it and remembers its position relative to herself. 

Active movement, or self-initiated mobility, is essential for development of self-awareness, spatial awareness, cognition, body image, and visual motor perception. Through movement, a child can learn about himself, about his body, and about the things that are separate from him.  Active movement is also a means for choice making and demonstrating preferences. Ultimately, some form of active movement is the vehicle for learning cause and effect. Those individuals who have severe combined disabilities quite often have little to no ability to move actively. Their existing disabilities are compounded by the inability to move actively and effectively.

TEAMability believes that providing these children a means of self-initiated mobility is an essential component of their learning program. Active movement is learning, and TEAMability uses a transdisciplinary approach to designing an effective program for self-initiated mobility. Some programs require simply a structured schedule and scripted routine, as already discussed, but other programs may require more complicated pieces of equipment, including a power wheelchair/seating system or a mobile standing device. All programs, to be effective, require the input and design of a transdisciplinary team working for that individual student.

Imagine the transdisciplinary teamwork required to enable a student with no functional vision, severe cerebral palsy, and mental retardation to access and maneuver a power wheelchair for a safe, whole body mobility experience. Imagine even further, the possibilities of using such a powerful tool as self-initiated mobility to teach cause and effect, to build self-esteem, to create anticipation, and to introduce a form of communication.

Children with severe, combined disabilities experience extreme differences in their abilities and methods of communication. Classified as non-verbal, they may express their feelings, wants, needs, and preferences in ways that are frequently overlooked, ignored or misinterpreted. Sometimes inappropriate and complex communication systems are introduced in an attempt to provide a means of expression.

TEAMability assesses when and how a child communicates, what means he uses to gain attention, and how he makes requests or demonstrates preferences. Preferences are identified and utilized in the construction of activities that promote intentional initiation of communication, a means of requesting more, and the ability to choose objects or activities. Communication systems and strategies are designed which utilize the child’s current communication behaviors and promote new abilities to communicate. These may include:

• Vocal, physical or switch supported means of requesting attention.

• Objects, tangible symbols, pictures, gestures, sign language or voice output systems for requesting, rejecting, or choice making.

• Object calendars for anticipating and predicting events in the daily schedule.

Parents and caregivers play a vital role in the process of creating, devising, and implementation of a communication system. Parents are dynamically involved in the team assessment, providing valuable information about their child’s ability to communicate discomfort, pleasure, and affection. Parents also contribute pertinent keys to the child’s likes, dislikes, and motivators.  In-home parent training occurs as parents are an integral part of each service session, contributing ideas as well as learning and practicing strategies and providing data on their child’s observed progress. Under the guidance of TEAMability (role modeling and role release techniques), parents learn and practice skills that will help their child communicate and participate as fully as possible in life’s activities. The basic parental need to be positive instruments within their children’s lives is affirmed and in turn, the parents feel more confident and capable of being effective advocates for their child in school and the community.

From home to school, children with severe combined disabilities receive instruction and services from many different people: teachers, paraprofessionals, occupational therapists, physical therapists, speech and language therapists, teachers of the vision/hearing impaired, adaptive physical education teachers, doctors, nutritionists and family members. Often, these individuals have little opportunity to communicate and collaborate.  This results in their perceiving the child only from their own perspective and does not address how all of the child’s abilities combine to determine his current level of overall functioning and his ability to learn.  Each service provider or caregiver is a piece of the puzzle in search of the big picture. 

TEAMability uses a transdisciplinary team model, wherein the responsibility for the learning process is shared collectively by all of the team members. Team members work directly with children, family, teachers and each other while assessing student function and developing and executing learning plans. Teachers, paraprofessionals and parents are the direct implementers of learning plans that are carried out in natural settings. The skills and knowledge of each team member are incorporated into the student’s daily program allowing frequent practice in meaningful, functional, preferred activities. Team members model techniques and strategies for family and teachers, cooperating and communicating to discover how the student learns.

The collaborative (same time, same place) feature of the transdisciplinary team results in the pieces of the puzzle fitting seamlessly together to reveal the big picture: a meaningful, individually designed learning plan which utilizes effective, appropriately implemented strategies carried out in natural contexts.