Defense Date


Graduation Date

Summer 1-1-2017


Immediate Access

Submission Type


Degree Name



Instructional Technology (EdDIT)


School of Education

Committee Chair

Ara J. Schmitt

Committee Member

Elizabeth McCallum

Committee Member

Joseph Kush


Alternating Treatments Design; Assistive Technology; Motor Dysfunction; Speech-to-Text; Traumatic Brain Injury; Written Expression


Traumatic Brain Injury outcomes vary by individual due to age at the onset of injury, the location of the injury, and the degree to which the deficits appear to be pronounced, among other factors. As an acquired injury to the brain, the neurophysiological consequences are not homogenous; they are as varied as the individuals who experience them. Persistent impairment in executive functions of attention, initiation, planning, organizing, and memory are likely to be present in children with moderate to severe TBIs. Issues with sensory and motor skills, language, auditory or visual sensation changes, and variations in emotional behavior may also be present. Germane to this study, motor dysfunction is a common long-term sequelae of TBI that manifests in academic difficulties. Borrowing from the learning disability literature, children with motor dysfunction are likely to have transcription deficits, or deficits related to the fine-motor production of written language.

This study aimed to compare the effects of handwriting with an assistive technology accommodation on the writing performance of three middle school students with TBIs and writing difficulties. The study utilized an alternating treatments design (ATD), comparing the effects of handwriting responses to story prompts to the use of speech-to-text AT to record participant responses. Speech-to-text technology, like Dragon Naturally Speaking converts spoken language into a print format on a computer screen with a high degree of accuracy. In theory, because less effort is spent on transcription, there is a reduction in cognitive load, enabling more time to be spent on generation skills, such as idea development, selecting more complex words that might be otherwise difficult to spell, and grammar.

Overall, all three participants showed marked improvement with the application of speech-to-text AT. The results indicate a positive pattern for the AT as an accommodation with these children that have had mild-to-moderate TBIs as compared to their written output without the AT accommodation.

The findings of this study are robust. Through visual analysis of the results, it is evident that the speech-to-text dictation condition was far superior to the handwriting condition (HW) with an effect size that ranged + 3.4 to + 8.8 across participants indicating a large treatment effect size. Perhaps more impressive, was 100 percent non-overlap of data between the two conditions across participants and dependent variables.

The application of speech-to-text AT resulted in significantly improved performance across writing indicators in these students with a history of TBIs. Speech-to-Text AT may prove to be an excellent accommodation for children with TBI and fine motor skill deficits. The conclusions drawn from the results of this study indicate the Speech-to-Text AT was more effective than a handwriting condition for all three participants. By providing this AT, these students each improved in the quality, construction, and duration of their written expression as evidenced in the significant gains in TWW, WSC, and CWS.