Adaptive Use Data Form | DEEP LISTENING INSTITUTE

Date:

Institution or Individual:

Name of facilitator:

Student Name:

Age:

Range of Motion:

Postural Control:

Voluntary Movement:

Endurance:

Head Control:

Seating and Posturing Needs:

Cognition, Ability to follow directions, Motivation:

Educational/Vocational Background info:

Sensory (i.e. auditory,visual) status:

Current use of assistive technologies and devices:

Was the student using the software alone or in collaboration with other musicians/students?:

Was this software useful as a creative tool? In what ways?:

Was this software useful as a theraputic tool? In what ways?:

What was the general reaction of the student?:

What aspects of the software were easiest for the student to use and understand?:

What aspects were most difficult to use or understand?:

Did the student react differently to different instrument modes?:

Are there specific features you would like to see developed further or added?:

Are there changes to the interface that would assist use of the software?:

Did you have any difficulty using the software?:

Other Comments: