July 2020 [Cohort 9] Assistive Technologies for Special Needs Students
Autism
Deafness
Emotional Disturbance
Multiple Disabilities
Hearing Impairment
Other Health Impairments
Speech or Language Impairments
Traumatic Brain Injuries
Specific Learning Disabilities
High Incidence
In 2020, it was reported that 1 in 54 children in the U.S. are diagnosed with autism. (Austism Speaks, 2020)
What is Autism?
Oxford Languages Definition
a developmental disorder of variable severity that is characterized by difficulty in social interaction and communication and by restricted or repetitive patterns of thought and behavior.
Assistive Technologies
What?
Assistive technology (AT) are varying methods of technology used to improve the functioning capabilities of people with disabilities. (ATiA, 2020)
Statistics and facts
Source: (Austism Speaks, 2020)
Boys are four times more likely to be diagnosed with autism than girls.
Most children were still being diagnosed after age 4, though autism can be reliably diagnosed as early as age 2.
31% of children with ASD have an intellectual disability
Autism affects all ethnic and socioeconomic groups.
Minority groups tend to be diagnosed later and less often.
Early intervention provides the best opportunity to support healthy development and deliver benefits across the lifespan.
Autism costs an average estimate of $60,000 a year through childhood
Nearly half of 25-year-olds with autism have never held a paying job.
Why?
AT is used to enhance communication for people with autism, regardless of the severity and speech ability. (Austism Speaks, 2020)
Note: Children with autism typically process visual information easier than alternative methods. Therefore, most AT used for children with autism are focused on delivering information through their strongest processing area. (NASET, N.D.)
"Low" Technology
"Mid" Technology
"High" Technology
Schedules
Object schedules
Visual schedule
Rules and signs
Big Mac
Talk Pad
Voice in the Box
This device can be programmed with simple 1-4 step directions. The child is motivated to hit the buttons and thus complete the sequence of steps. This is particularly beneficial for kids with autism as they often struggle to follow the steps of a sequence to complete their "job"
This piece of equipment is a great motivational device to focus on turn-taking activities. It is used to promote social skills. For example, children will take turns pushing the Big Mack button to respond to prerecorded questions or routines.
This device can help the child to focus his attention during large group listening activities. These activities tend to be very difficult for children with autism.
For example, when the teacher is reading a book aloud to the class, numerous lines from a book can be visually represented with a corresponding recorded message on the buttons. The child can "assist" in "reading" the story by pushing the appropriate buttons for the story
Video taping
Computers
Children with autism are often highly interested, motivated and thus attentive to videos due to their "predictability". Video taping can serve as an excellent tool with which to teach numerous skills to children with autism.
Language comprehension skills
Social skills
Expressive language skills
Self help skills
Emotions
Academics
Research on the use of computers with autistic children have revealed the following.
Increase in focused attention
Increase in overall attention span
Increase in in-seat behavior
Increase in fine motor skills
Increase in generalization skills
Decrease in agitation
Decrease in self-stimulatory behaviors
Decrease in perseverative responses
Adaptive hardware
In order to access the computer, some children with autism might require that the standard computer be adapted with certain devices such as the following
Touch window
Big Keys and Big Keys Plus
Intellikeys
Trackballs
Intellectual Disability
Visual Impairment
Source for Low, Mid, and High AT: (NASET N.D.)
Orthopedic Impairments
What is "Orthopedic Impairment?"
According to the Individuals With Disabilities Education Act (IDEA), an orthopedic impairment is defined as a bone-, joint-, or muscle-related disability that is so severe that it negatively affects a child’s educational performance (IDEA, 2004).
Causes of Orthopedic Impairment
click to edit
Children might either be born with or acquire problems with their joints, bones or muscles.
click to edit
Genetic abnormality (e.g., the absence of a member, clubfoot)
Disease (poliomyelitis, bone tuberculosis)
Injury
Birth trauma
Amputation
Burns
Fractures
Cerebral palsy
click to edit
click to edit
WHAT
This category covers difficulty with speech and language. A common example is stuttering. Also, trouble pronouncing words or making sounds with the voice. It also covers language problems that make it hard for kids to understand words or express themselves.
HIGH INCIDENCE
click to edit
About 8% of kids have speech language difficulties. It is the most common childhood disability, affecting approximately 1:12 children.
click to edit
click to edit
click to edit
IDEAS FOR CLASSROOM MODIFICATION
click to edit
Speech Language Pathologists are trained to identify language-based learning disabilities and implement techniques to help students continue to learn with their peers. It is very important to identify language problems early on in a child's education.
click to edit
click to edit
A person with orthopedic impairment may have:
click to edit
Musculoskeletal disorders
Neuromotor impairment
Degenerative diseases
Orthopedic problems can be the result of:
deformities
Orthopedic issues may be ones from birth such as:
muscular dystrophy
or joint deformities.
click to edit
diseases
click to edit
injuries
Orthopedic problems vary - children may experience trouble using their hands, arms, or legs. Some of these children will make use of assistive devices and technologies in order to function as independently as they can.
help students with various levels of severity of orthopedic impairment. These devices enable access to the educational curriculum and may include one or more of the following:
surgeries/injuries
osteogenesis imperfect
Loss of bone or muscle tissue, or include the amputation of a limb.
Broken bones and burns may also lead to damage to either muscles or bones.
can result in:
click to edit
click to edit
click to edit
Children may experience trouble using their hands, arms, or legs.
Some of these children will make use of assistive devices and technologies in order to function as independently as they can.
ASSISTIVE TECHNOLOGIES
Classroom Modifications and Accommodations
Assistive Technology Devices
People with orthopedic impairments usually need physical accommodations in school, and at home. They have legal rights to this support under the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973.
click to edit
speech recognition software
alternative keyboards and mice
augmentative and alternative
communication devices
word prediction software
screen reading software
academic software for
students with disabilities
Due to the unique nature of orthopedic impairments, additional specialists might need to become involved in the development and implementation of appropriate educational programming for the student.
click to edit
What Are Other Health Impairments?
Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment
(IDEA,2020)
High Incidence
click to edit
Attention Deficit Hyperactivity Disorder (ADHD)
Tourettes Syndrome
click to edit
Epilepsy
Assistive Technologies
Definition: ADHD is not a behavior disorder. ADHD is not a mental illness. ADHD is not a specific learning disability. ADHD is, instead, a developmental impairment of the brain’s self-management system
Audiobook services like audible. Listen to someone read books to them on a small tablet can help them to be active while listening to the readings
Speech recognition software Allows students to express themselves quickly and efficiently
Reminder devices such as a vibrating watch. Students can receive simple reminders to refocus on their classwork.
Talking Calculators Helps them to hear numbers as they work out problems before submitting a final amswer
click to edit
Definition: A nervous system disorder involving repetitive movements or unwanted sounds.
Assistive Technologies
click to edit
Pre-recording class presentations on video To help lower stress for these students, they can make a video at home of themselves where anxiety is lower
Speech-to-text software Valuable for these students because they will be able to say aloud what they want to type and software creates a document for them
Recording Devices By recording the lecture instead of trying to write them down, a student will be able to listen to the information later
Reader software Software designed to read written text out loud
Definition: A disorder in which nerve cell activity in the brain is disturbed, causing seizures.
Assistive Technologies and strategies
Inform the class about epilepsy. Emphasize that epilepsy is not a disease and that it is not contagious
Modified monitors that are flicker free and audio adjusted where the screen fades out instead of blinking off
Strategies Repetition of material, Redirection, Memory learning, strategies Extra time on assignments, Non-timed assessments
Diabetes
Productivity and organization tools Digital organizers, timers, calendars and spreadsheets to help them keep track of what they need to do
Definition: A group of diseases that result in too much sugar in the blood (high blood glucose).
Assistive Technologies
click to edit
Visual aids Students with diabetes often experience ongoing visual problems
Portable magnifiers
Software magnification for computer use
Electronic prompting aids
Personal digital assistance
Glucose Monitor
Alarm watch reminder
What is a traumatic brain injury?
The National Institute for Neurological Disorders and Strokes (2020) defines a Traumatic Brain Injury as an injury which is acquired from a sudden trauma and results in damage to the brain. It normally occurs when the head is hit suddenly and violently. The resulting injuries can range from mild to severe.
How common is a traumatic brain injury?
Of all the acquired disabilities in childhood, sever brain injury is the most common (Michaud, Duhaime, & Batshaw, 1993).
Results of a traumatic brain injury
A mild traumatic brain injury can result in a change of consciousness or mental state. The majority of incidents are mild and are usually referred to as concussions.
A more serve implication can result in memory loss or a long period of unconsciousness.
837,000 cases were identified in children in 2014 .
Difficulties expressing language
Lower physical strength and agility
Teachers struggling to communicate
Problems with word retrieval
Balance problems
Impairments in memory
What symptoms should you look for in your students?
Fatigue
Poor coordination
Sleep disruption
Anger
Inappropriate social behavior
Dizziness
Headaches
What are the causes?
How should students receive differentiation for a severe brain injury?
ABC (Antecendent-Behavior-Consequence) assessment to analyst each moment of unwanted behaviour
Controlled noise and activity levels
A formalised assessment of cognitive skills to assess what extra help is needed
Dividing work levels into smaller sections
Strong co-ordination between hospital, therapists school and families
Designated space to rest and take time out
Predictable and consistent routine in the classroom
What assistive technologies can be used to support a student?
A walking device such as crutches or a wheelchair to help movement between classes
A calendar or notebook to help keep them organized and to help planning
Magnifying glass or glasses to help their vision such as looking at the board
A grip attached to their pen to help with writing
Frustration, anger and discouragement
High Incident: “a severe orthopedic impairment that adversely affects a child’s educational performance.” (IDEA, )
click to edit
click to edit
-Allow student time to express themselves.
-Do not interrupt a slow speaker.
-Be a good model and speak directly to student.
-Reduce unnecessary classroom noise.
-Provide student with written information on topics being covered prior to discussion.
-Private location for testing.
-Pre-teach words and ideas.
-Teach one concept at a time.
-Use visual cues.
-Provide hands on experiences.
Low technology ideas: Use dry erase boards, binders, folders, images and graphic organizers.
Communication tools and text-speech-tools such as Dragon voice recognition software. Apps for helping students with letter and word pronunciation. ClaroSpeak. QuestionIt. Articulation Station. Proloquo200. There are also digital creation tools that help kids write and share stories. Cast UDL Book Builder. My Story School eBook Maker. GoAnimate for Schools.
Assistive Devices/Strategies
Deaf-Blindness
Low Incidence
a rare, challenging, and demanding condition (Caporusso, 2014)
a rare, challenging, and demanding condition (Caporusso, 2014)
What
combination of hearing and visual impairments
Assistive Technologies
click to edit
there is poor assistive technology for deaf-blind people (Trizio, 2014).
Tractor Suit: delivers touch cues on the torso
Hey yaa: wearable, 2 waist belts, using vibrotactile cues
Braille to Go: a standard Android smartphone with a Braille display
Cochlear Implant
V-Braille: Braille Characters in a haptic form on a standard mobile phone
Identity Cane: indicates a person has a vision impairment
Long Cane: detects obstacles and surface changes
click to edit
click to edit
Awareness in participation of physical education classes
Note-taking assistance
extended time to complete assignments
Teacher awareness of student’s condition and its affect (such as tiring easily)
Adequate awareness of the student's medical condition and its affect on the student
Securing assistive technology and suitable augmentative communication and other assistive devices
Instruction focused on impairments in, and the improvement/development of gross and fine motor skills
Seating arrangements to develop useful posture and movements, and larger tables
Low Tech
Mid Tech
High Tech
What
combination of hearing and visual impairments
What? As defined by IDEA: an impairment in hearing, whether permanent or fluctuating, that adversely affects a child's educational performance but is not included under the definition of "deafness."
click to edit
Educational Challenges
A hearing loss below 90 decibels is classified as a hearing impairment. Though some students may suffer from permanent hearing loss, many younger students may have temporary hearing loss due to colds and ear infections. Whether permanent or temporary, this can affect language development and access to the curriculum.
Teaching Hearing Impaired Students
participating in classroom discussions
taking notes (while listening to teacher)
watching videos
presenting oral reports
grammar, spelling, and vocabulary
Classroom Adaptations
area rugs, heavy curtains, tennis balls on the bottom of chair legs-all can reduce extra noise.
Assistive Devices/Technology
Turn off/ eliminate equipment that makes background noise (ie projectors, fans)
Flashing fire alarm
arrange desks/students in a circle so impaired hearer can see all peers faces.
Communication Accommodations
Obtain student's attention before speaking
do not speak when your back is to the student
clearly enunciate speech, speak slower, and repeat/rephrase when necessary
use a talking stick or some other method (hand raising) so the student knows what peer is speaking so they can face the speaker.
check frequently for understaning
to ehance lip readers conditions: avoid hands in front of face, keep facial hair well groomed, do not chew gum
reduce visual distractions
for lip readers : avoid backlighting, so speakers faces are not in a shadow
Assistive Listening Devices-devices that help amplify the sound
personal hearing devices (hearing aid, cochlear implant)
use closed captioning while viewing videos
use facial expressions, body language and gestures to help convey message
explicitly teach idioms and explain jokes or sarcasm, and pre-teach new, specific vocabulary
microphone for speaker/s (pass to all peers when they talk)
Test Taking/Curriculum Modifications
allow test to be taken in a quiet room
Have a person read them the test, rather than using a digital or computer generated voice- this allows for speech intonation/inflections, speech to be slowed, and can be repeated to ensure understanding
allow extra time for test taking, as hearing loss can effect one's ability to process information, including written information
Physical Therapists
Additional Therapists
Occupational Therapists
Speech-Language Pathologists
Adapted Physical Education Teachers
Classroom Accommodations
-Make an inclusive environment to respect people's differences.
-Allow a service animal to accompany the student.
-Let the student have a preferable seat.
-Ask the student about any concerns.
-Allow the student to use an interpreter.
-Give extra time for tests.
What?
Specific learning disorder (often referred to as learning disorder or learning disability) is a neurodevelopmental disorder that begins during school-age, although may not be recognized until adulthood. Learning disabilities refers to ongoing problems in one of three areas, reading, writing and math, which are foundational to one’s ability to learn (American Psychiatric Association, & Penesetti, D., Nov. 2018).
Com Touch: increases remote voice communication with the use of touch
WHAT IS IT? >> According to the IDEA Act (Revised May 2017), Emotional Disturbance is defined as showing one or more of the below characteristics during a marked length of time and to a degree has an effect of a child’s educational performance:
‣ an inability to learn (excluding intellectual, sensory, or health factors)
‣ inability to build or maintain relationships with peers and teachers
‣ Inappropriate behavior or feelings relevant to the current situation
a pervasive mood of unhappiness or depression
‣ developing physical symptoms/fears associated with personal or school problems
Examples of disabilities classified as Emotional Disorders (Center for Parent Information & Resources, 2017):
Anxiety Disorder Generalized, PTSD, Obsessive Compulsive, Panic
Bipolar Disorder Depressive, Manic
Conduct Disorders Oppositional Defiant, Intermittent Explosive
Psychotic Disorders Schizophrenia, Dissociative Identity, Schizoaffective
Eating Disorder Anorexia, Bulimia, Pica, Over Eating
DIAGNOSTIC TOOLS & ASSISTANCE
Diagnostic and Benchmark Assessment Tools Social-Emotional Assets and Resilience Scale, Social Skills Improvement System Rating Scales, Behavioral and Emotional Rating Scale (Denham, 2016)
Physician Prescribed Medication: Mood Stabilizers, Antipsychotics, SSRIs, Benzodiazapines (Anxiety Disorders: Parents’ Medication Guide, 2020)
Psycho, Cognitive & Behavioral Therapies and Counseling
ASSISTIVE TECHNOLOGY IN THE CLASSROOM
Text-To-Speech Software - Can Help Students relieve stress by being read to (especially if they have co-morbid disorders such as dyslexia) (Lynch, 2018)
Voice Recognition Software - Can help students take notes without feeling the stress of physically writing (also helpful for students with co-morbid dysgraphia
Reminder Devices - such as vibrating or flashing light alarms or other sensory-engaging tools (stress balls, fidget spinners) that can help ground students and remind them to pay attention.
The TALKLIGHT App - helps teachers monitor classroom noise levels and modulate their own voices, which can help create a calmer environment for the students with emotional disorders
Motor crashes 20%
Other 21%
Struck my objects 19%
Falls 24%
Assault 11%
Suicide 1%
As a cohort, we believe it has low incidence in the classroom
means concomitant impairments (such as intellectual disability-blindness or intellectual disability-orthopedic impairment)
click to edit
Enviornmental considerations:
Are there multiple ways of presenting content?
Are multiple means of showing what the student knows supported?
Are multiple approaches to student engagement accepted?
Are there areas without visual clutter?
How flexible is the classroom schedule?
How much adult support is in the room?
Medical considerations
click to edit
Does the child recieve medications that might affect their learning and engagement?
Implementing assistive for seating and positioning in the case of severe physical challenges
Most common forms
SpLD is an umbrella term used to cover a range of frequently co-occurring difficulties (The Dyslexia Association, 2020).
Dyslexia
Dyspraxia or Developmental Coordination Disorder (DCD)
Dyscalculia
Dysgraphia
Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD or AD(H)D)
Variability of abilities in times of day: Teachers will need to examine what happens prior to an optimal learning conditon. What variables promote the best learning outcome for the student? Did they just get off a long bus ride? After lunch? Change in their seating positions?
What Is It? Individuals With Disabilities Education Act (IDEA) defines visual impairment as "impairment in vision that, even with correction, adversely affects a child’s educational performance. The term includes both partial sight and blindness" (IDEA, 2004).
Use Sensory Learning Tools
High Incidence
According to the National Institute of Health (2019), research shows that 8 to 10 percent of American children under 18 years of age have some type of learning disability.
Ideas for classroom adaptations
Bean bags
Maipulatives like animals, fruits, or other toys
Flashcards for matching
Music and songs about colors and numbers
Art supplies such as crayons, markers, paints
Low incidence in the classroom
Inclusion
Inclusion means putting students with disabilities into the general classroom.
click to edit
Most Common Forms Include (Willings, n.d.):
Intellectual Disabilities
Achromatopsia: the inability to differentiate colors
The focus on instruction should be on the student
Myopia: extreme nearsightedness
Astigmatism: the inability of an eye to focus sharply, causing extreme blurriness
retinitis pigmentosa: progressive retinal degeneration that is hereditary and can lead to blindness
References:
Psychiatry.org. 2020. What Is Intellectual Disability?. [online] Available at: https://www.psychiatry.org/patients-families/intellectual-disability/what-is-intellectual-disability [Accessed 8 August 2020].
Inc, C. and Technology, A., 2020. How Assistive Technology Helps People With Intellectual Disabilities Achieve Independence – Createability Inc. [online] Createabilityinc.com. Available at: http://createabilityinc.com/2020/05/27/how-assistive-technology-helps-people-with-intellectual-disabilities-achieve-independence/ [Accessed 9 August 2020].
What is "intellectual disability"?
Focus on multiple intelligence
Adaptive curriculum
Request classroom accomodations
Intellectual disability1 involves problems with general mental abilities that affect functioning in two areas:
intellectual functioning (such as learning, problem solving, judgement)
adaptive functioning (activities of daily life such as communication and independent living)
Intellectual disability affects about one percent of the population, and of those about 85 percent have mild intellectual disability. Males are more likely than females to be diagnosed with intellectual disability.
(What Is Intellectual Disability?, 2020)
According to the World Health Organization (WHO), around 18.9 million children who are 15 years old and under are visually impaired worldwide (Vishnuprasad et al., 2010).
Consult with teachers about making simple changes to the classroom that will aid your child in their learning. The right accommodation depends on the specific learning disability that your child has.
Create an IEP (Individualized Education Plan
School administrators and teachers can create a roadmap for dealing with your child's needs and how the school will fulfill those requirements
INNOVATIVE ASSISTIVE TECHNOLOGIES (University of Illinois Library, 2020)
TEACHING STRATEGIES (Henkler, 2020)
Find a specialist
Look for a specialist with ongoing professional education in learning disabilities as well as your child’s required subject area — whether that’s reading, writing, math, or a combination of those.
JAWS Screen Reader
Kurzweil Education
Refreshable Braille Displays
Audiobooks
Have visually impaired students sit away from bright, harsh lights if they experience light sensitivity. Have visually impaired students also closer to the blackboard/near the front of the classroom
Write on the board with large letters and contrasting colors (e.g. black ink on a white board)
Always give instructions to students orally
Give detailed explanations, from presentations and lectures to diagrams.
When testing students, ensure that visually impaired students are given enough support so they can do their best on the test. Use big text, braille, a recording of the questions, etc.
click to edit
JAWS stands for Job Access With Speech. It is a screen reader that provides braille and text-to-speech output.
Text-to-speech software that enables visually impaired students to access computers functions and also hear what is displayed as text on their computer screens.
Audiobooks are recordings of book readings
Children with visual impairments can listen to audiobooks instead of reading books for class assignments
A refreshable braille display raises and lowers pins in braille cells, based on the text on a computer screen. As the student moves the computer's cursor around, the pins will raise and lower depending on what is displayed on the computer screen
Provide visually impaired students with a voice recording of the lectures/lessons and/or handouts with your notes in big, large print
Low Incidence
What?
Low Incidence
click to edit
Non-tech Accomodations
Assistive Technologies
The IDEA Act (last modified May 2018) describes deafness as a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child’s educational performance.
According to the Center for Parent Information and Resources (CPIR), children are usually only considered deaf if their hearing loss exceeds 90 decibels (2015)
"Profound deafness occurs in 4-11 per 10,000 children" (CPIR, 2015), so from 0.04% to 0.11%
Hearing loss can be caused by either genetic or environmental factors.
Environmental causes include loud noises, ear infections, a build-up of fluid, and others. (CPIR, 2015)
(Special Education Guide, 2020)
Hearing Loop System-(induction Loop System)- connects teachers' microphone directly to the students hearing aid via a wire
FM systems-similar to the hearing loop system- uses a radio signal to transmit sound from the microphone to the hearing aid- no wire is necessary.
ASR- Automatic Speech Recognition- software that transcribes speech to text- ( to use with a computer at student's seat)
click to edit
A note-taker - can be recruited from the other students
A sign language interpreter
Enable captions on videos shown in class and online lectures
Telecommunications (National Deaf Center, 2019)
Text-to-speech software or devices for note-taking or communication
modify written and reading assignments- (shorten length, adjust evaluation criteria, alter phonics assignments)
"With or without amplification" means that even a hearing aid is not enough to allow the child to succeed in the classroom. (Deafness, n.d.)
pre teach vocabulary
American Sign Language Interpreter or supplemental lessons to learn ASL
use a peer notetaker- so student can concentrate on watching/listening to the speaker- and/or provide a written outline of the lesson as well as notes for the lesson
utilize visual aids when possible in a lesson - ie posters, flash cards, graphic organizers, charts, or any visual item that helps illustrate the concept of the lesson
Arranging seating in a circle so the student can read every student's lips, and the teacher standing where the student can read theirs
Extra speech and language training with a specialist for the student
Extra training in sign language and nonverbal communication for the teacher
Relias
Assistive Listening Devices to amplify sound (National Deaf Center, 2019)
Hearing Loop Systems: a system installed in the classroom that provides wires so that the teacher's microphone can be linked directly to the student's hearing aid or cochlear implant
FM/DM systems that transmit the signal wirelessly from the teacher's microphone, and the student can tune a receiver device to pick up the signal and connect it to their hearing aid or cochlear implant
Relias has developed “6 Building Blocks for Empowering People with IDD” which provides an organized roadmap to decision-making for both the care provider and the consumer with IDD. (Inc and Technology, 2020)
click to edit
Personal devices
Hearing Aids
Cochlear Implants - surgically implanted in the inner ear
Videophones
Smartphones
Low Incident
Text telephone
(Verbit, 2020). (Bright Hub, 2020) (Accommodations for Students With Hearing Loss, 2020)
Visible fire alarms (e.g. flashing lights)
an old but still used system, functionally similar to modern text messaging
a subscriber based system available only to deaf people but able to connect to others, run through the FCC
can be used like a videophone, text telephone, or in many other ways
In-class or take-home tablets or laptops, with assistive apps/programs installed
Assure student is looking at your face before speaking
More visual and kinesthetic-directed teaching
click to edit
(Special Education Guide, 2020)
(Bright Hub, 2020). (Accommodations for Students with Hearing Loss, 2020)
(Accommodations for Students with Hearing Loss, 2020). (Bright Hub, 2020)
(Bright Hub, 2020)