University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 5-2004 Essential Elements for Assessment of Persons with Severe Neurological Impairments for Computer Access Using Assistive Technology Devices: A Delphi Study Brian Scott Hoppestad University of Tennessee - Knoxville Follow this and additional works at: https://trace.tennessee.edu/utk_graddiss Part of the Education Commons Recommended Citation Hoppestad, Brian Scott, "Essential Elements for Assessment of Persons with Severe Neurological Impairments for Computer Access Using Assistive Technology Devices: A Delphi Study. " PhD diss., University of Tennessee, 2004. https://trace.tennessee.edu/utk_graddiss/2267 This Dissertation is brought to you for free and open access by the Graduate School at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Brian Scott Hoppestad entitled "Essential Elements for Assessment of Persons with Severe Neurological Impairments for Computer Access Using Assistive Technology Devices: A Delphi Study." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the equirr ements for the degree of Doctor of Education, with a major in Instructional Technology and Educational Studies. Edward L. Counts, Major Professor We have read this dissertation and recommend its acceptance: John R. Ray, Michael C. Hannum, C. Glennon Rowell Accepted for the Council: Carolyn R. Hodges Vice Provost and Dean of the Graduate School (Original signatures are on file with official studentecor r ds.) To the Graduate Council: I am submitting herewith a dissertation written by Brian Scott Hoppestad entitled “Essential Elements for Assessment of Persons with Severe Neurological Impairments for Computer Access Using Assistive Technology Devices: A Delphi Study.” I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Doctor of Education, with a major in Instructional Technology and Educational Studies. Edward L. Counts Major Professor We have read this dissertation and recommend its acceptance: John R. Ray Michael C. Hannum C. Glennon Rowell Acceptance for the Council: Anne Mayhew Vice Chancellor and Dean of Graduate Studies (Original signatures are on file with official student records.) ESSENTIAL ELEMENTS FOR ASSESSMENT OF PERSONS WITH SEVERE NEUROLOGICAL IMPAIRMENTS FOR COMPUTER ACCESS USING ASSISTIVE TECHNOLOGY DEVICES: A DELPHI STUDY A Dissertation Presented for the Doctor of Education Degree The University of Tennessee, Knoxville Brian Scott Hoppestad May, 2004 Copyright © 2004 by Brian S. Hoppestad All Rights Reserved ii DEDICATION I dedicate this study to my wife Donna and my children Alex and Anna who have exhibited the utmost patience, and have sacrificed on innumerable occasions to allow me the time and vigor required to complete my studies. To my parents, Jean and Lamont, who have been staunchly supportive of me throughout all my educational endeavors. To my in-laws Marvin and Anne, who have graciously offered their assistance and support. In memory of Ruby Gray a remarkable person, a tremendous educator, and an inspiration to all. iii ACKNOWLEDGEMENTS I would like to acknowledge all of those persons without whom this study would not have been possible. Most notably, to my committee chair Dr. Counts whose guidance, patience, and diligence coordinating the various aspects of the study was of inestimable value. To my committee members Dr. John Ray, Dr. Michael Hannum, and Dr. Glennon C. Rowell for all of their invaluable assistance and advice for implementation and completion of the dissertation study. To Nancy Morlyn, Mary Sayre, Dr. Sharon Judge, and Nancy Wohl whose assistance with the pilot survey allowed development of a quality instrument for data collection. To my brother Dale, for his technical assistance in developing the survey form and for his help in organizing the data storage and retrieval. I would also like to acknowledge F.A. Davis Company for allowing permission to use several figures in the literature review for the study. iv ABSTRACT This study was undertaken with the intention of determining potential elements for inclusion in an assessment of persons with disabilities for access to computers utilizing assistive technology (AT). There is currently a lack of guidelines regarding areas that constitute a comprehensive and valid measure of a person’s need for AT devices to enable computer access, resulting in substandard services. A list of criteria for elements that should be incorporated into an instrument for determining AT for computer access was compiled from a literature review in the areas of neuroscience, rehabilitation, and education; and a Delphi study using an electronic survey form that was e-mailed to a panel of experts in the field of AT. The initial Delphi survey contained 22 categories (54 subcategories) and elicited 33 responses. The second round of the survey completed the Delphi process resulting in a consensus by the panel of experts for inclusion of 39 subcategories or elements that could be utilized in an assessment instrument. Only those areas rated as essential to the assessment process (very important or important by 80% of the respondents) were chosen as important criteria for an assessment instrument. Many of the non-selected elements were near significance, were studied in the literature, or were given favorable comments by the expert panelists. Other areas may be redundant or could be subsumed under another category. There are inherent obstacles to prescribing the proper AT device to assist disabled persons with computer access due to the complexity of their conditions. There are numerous technological devices to aid persons in accomplishing diverse tasks. This study reveals the complexity of the assessment process, especially in persons with severe disabilities associated with neurological v conditions. An assessment instrument should be broad ranging considering the multidimensional nature of AT prescription for computer access. Both intrinsic and extrinsic factors affect the provision of AT. vi TABLE OF CONTENTS Chapter Page I. INTRODUCTION AND GENERAL BACKGROUND INFORMATION..... 1 Introduction............................................................................................................. 1 Problem Statement.................................................................................................. 4 Purpose of the Study ............................................................................................... 5 Design of the Study................................................................................................. 7 Importance/Need of the Study ................................................................................ 9 Assumptions……………………………………………………………………...10 Limitations ............................................................................................................ 10 Delimitations......................................................................................................... 12 Definition of Terms............................................................................................... 13 Organization of the Study ..................................................................................... 18 II. LITERATURE REVIEW .................................................................................. 20 The Emerging Discipline of Assistive Technology...............................................20 Assistive Technology Overview............................................................... 20 Assistive Technology Legislation............................................................. 25 The Nervous System Structure Related to Assessment for Assistive Technology for Computer Access............................................................................................. 33 Nervous System Structure ........................................................................ 35 Cerebral Cortex......................................................................................... 39 Motor Control ....................................................................................................... 43 Motor Control Theories ............................................................................ 45 vii Components of Motor Control.................................................................. 48 Sensory Input Related to Motor Function to Use Technology ............................. 51 Cognition Related to Computer Access.................................................... 54 Conscious Awareness Associated with Accessing a Computer ............... 56 Postural Control to Allow Computer Access............................................ 58 Neurological Conditions Observed in Persons Requiring Assistive Technology Interventions for Computer Access ...................................................................... 60 Brain Injury............................................................................................... 60 Cerebral Palsy ..........................................................................................