Motor difficulties: Solutions through collaboration, lateral thinking and technology By Andrew Downie Paper presented at the Children's Hospital Education Research Institute 2010 Conference 2 Solutions through collaboration, lateral thinking and technology Contents 1. Introduction ....................................................................................................... 1 2. Personal background ........................................................................................ 1 3. Adaptive technology definition .......................................................................... 2 4. Staying abreast of developments...................................................................... 2 5. A personal solution with wider implications ....................................................... 3 6. A collaboration case study ................................................................................ 4 7. Miniguide – from concept to product ................................................................. 4 8. Benefits of building in accessibility .................................................................... 5 9. Brain waves ...................................................................................................... 7 10. Conclusion..................................................................................................... 7 1. Introduction Because many of you will already have extensive knowledge of equipment specifically intended for use by people who have physical disabilities, I will not dwell on such products. That said, they will not go unheralded. Instead, I will focus on the importance of collaboration and lateral thinking in this wide-ranging discussion. Physical disability, even without coexistent issues, represents a huge diversity of both nature and severity. While technology has the potential to provide those of us who have significant disabilities with huge benefits in areas of vocation, recreation and general quality of life, it is not, of itself, the solution. During this presentation, I will tease out some of the issues surrounding effective selection and utilisation of equipment by and for individuals. By way of anecdotes, case studies and references, I hope to illustrate how collaboration and lateral thinking can be just as important when looking for solutions as catalogues of devices. That is in no way to suggest that technology should not be fully utilised. The contrary is in fact the case, my suggestion being that constant information gathering is an important component when looking at equipment options. 2. Personal background To put this presentation into context, I offer the following snippets. I work for the Centre for Learning Innovation, which is part of the NSW Department of Education & Training. My role is to provide adaptive technology information to Departmental students and staff who have disabilities. Very briefly, this involves: Conducting/organising workshops on various topics Providing information and/or suggestions on an individual basis via staff Producing product reviews and furnishing latest technology news on our Accessibility Blog at http://accessiblecli.wordpress.com Examining Departmental websites under development for any accessibility issues In that list, included is provision of information and/or suggestions. To clarify that point, one of the things I do not do is to specifically advise purchase of one product over another. Apart from being too far removed from the person and situation, I have a strong view that, wherever possible, the individual(s) who will use equipment should be actively involved in the decision making process. Ideally, this will include their familiarity with all options, allowing an informed decision. In very many cases, the process will also include formal assessment by a person(s) with relevant expertise. Here, however, I suspect I am preaching to the converted. Many years ago, I was hosting a small party. While collecting sausage rolls from the kitchen, I heard a guest in the lounge room comment, "He's the only bloke where you ask have you heard about this thing and he says yes, I have one". While confessing to being something of a technojunky, I submit two defences. Firstly, that was prior to marriage and family responsibilities and also prior to the explosion of gadgets that has occurred over recent years. Secondly, my emphasis was, and continues to be, on equipment that is useful rather than gimmicky. 2 Solutions through collaboration, lateral thinking and technology I am a psychologist both by training and inclination. My primary focus is therefore on positive outcomes for people in all facets of life that are important to them. When technology facilitates achievement of self fulfilment by people who have disabilities, I make no apologies for embracing it. 3. Adaptive technology definition While some argue for a subtle difference between "adaptive" and "assistive" technology, I use the terms interchangeably. I define adaptive technology as equipment, either purpose-built or modified, to meet needs of people who have disabilities. Examples of purpose-built equipment include electronic Braille displays, hearing aids and membranous keyboards. Equipment modified to meet needs of people who have disabilities includes computers with any of a host of specialised software, a public address system fitted with a loop for hearing aid users and adaptions to motor vehicles to allow people who have significant physical disabilities to drive. "Mainstream equipment" is that which was not designed specifically with people who have disabilities in mind. Some such products, however, have particular relevance. Examples include speech-to-text software, interactive whiteboards and optical character recognition programs. While, for selfish reasons, my knowledge of equipment relevant to people who have vision loss is stronger than that for other types of disability, I try to stay abreast of developments generally. As will be illustrated throughout this presentation, it is important not to restrict one's knowledge to purpose-built products. The rapid advances generally, and the marked convergence of resource areas over the past decade or so, mean that many broadly available products offer particular benefit to people who have disabilities. 4. Staying abreast of developments Back when my friend quipped that I bought every new product upon its release, it was relatively easy to keep up with significant technological advances. Firstly, product development was more drawn out, resulting in greater stability. Secondly, products were much easier to categorise. There was also not the sheer volume of tempting items being thrust towards consumers. I am not complaining about either the quantity of currently available options or the diversity. Keeping up with what is current is, however, a challenge. One of the dilemmas when reviewing a product is to gamble on its ongoing availability. In a previous position, I often evaluated notebook computers for student use. Too often, by the time funding became available, the model in question had become obsolete. Especially when considering a computer for its relevance to students who have disabilities, a revised model can sometimes bring as many pitfalls as benefits. Whether contemplating mainstream or adaptive equipment, it is therefore important to be aware not just of recent releases, but also of products under development. The extraordinary search facilities afforded by the internet are a wonderful resource. It is important, though that internet searches are conducted with some finesse in order to avoid disappointment and frustration. 3 Solutions through collaboration, lateral thinking and technology But trawling the internet alone is by no means sufficient. Joining relevant online lists etc can be a very effective way of sharing information. My only caution here is that there is only so much time in a day, making it important not to subscribe to so many sources that you are inundated. It is eminently possible to have too much, as well as too little, information. This is where collaboration can play a part. I have colleagues and friends who have similar interests. Rather than all of us reading the same information, we can act as filters for each other. And while the internet may sometimes seem to be all-pervasive, it is important not to forget personal and professional networks. Very often, discussing a situation with a colleague will yield valuable information. While the colleague may offer information and/or suggestions, do not under-estimate the importance of explaining the problem to someone. In my many years of crisis counselling, it was notable how often a person would explain a situation and, with little input from me, resolve the issue. When contemplating the use of technical prostheses, the process can be a little different in that acquiring relevant information can be a crucial ingredient. 5. A personal solution with wider implications One of my favourite computer tools is the free AutoHotkey scripting language for Windows from http://www.autohotkey.com. Among its many talents is the capacity to provide abbreviation expansion. This is where entering two or three characters can produce anything from a single word to many pages of text. Many of you will be aware of commercially available abbreviation expansion software. This can be a wonderful asset for people who cannot write quickly. There are examples specifically to aid those who have special needs and less sophisticated implementations in commonly available word processors and mobile phones. While the following example was not produced with someone who has a physical disability in mind, it does illustrate the potential benefit. I have long prided myself on speed and accuracy of my keyboarding. It may therefore seem strange that I should require the assistance of abbreviation expansion. My work involves writing some HTML code. Most people would make use of a powerful HTML editor in such situations. For my modest purposes, however, these tend to be overly complicated and highly visual in nature. The solution lay with AutoHotkey. My script, which started life several years ago, continues to grow as need and inspiration dictate. It allows very rapid insertion of anything from basic HTML tags to a complete HTML page, marked up and ready for content. In many situations, readily available options will suffice, but In others a tailor-made solution will be more effective. I was fortunate in this example that I had developed sufficient knowledge to provide my own solution. Importantly, that did not happen in a vacuum. Over the years, a number of mentors and situations were instrumental in my developing sufficient knowledge and skills. I make two comments about this. Firstly, there are often situations where I do not have requisite knowledge or skills. In those situations, I set about acquiring them or, more usually, finding someone who 4 Solutions through collaboration, lateral thinking and technology does. Secondly, the importance of developing and fostering networks cannot be under-stated. 6. A collaboration case study Several years ago, while undergoing rehabilitation following a brainstem haemorrhage, Lara enrolled in TAFE. At the time she had no speech and only very limited movement in one hand. Her teacher introduced her to word prediction software on a computer, together with a compact keyboard. The keyboard's small size was an asset. Unfortunately, though, the word prediction software commandeered the number keys. Numbers could be generated by holding down a function key, but Lara could only press one key at a time. The teacher contacted me and asked for suggestions. This was not a situation where listening alone would suffice. I employed my good friend, AutoHotkey. One of its features is that it can remap keyboard keys, mouse and joystick buttons. I wrote a script which, with a press of the scroll lock key, remapped suitable keys to number keys. Pleased by the result, student and teacher contemplated further refinements. While Lara had very quickly mastered Windows keyboard commands, access to the mouse would at times be helpful. Moving the physical mouse was out of the question. Through its Accessibility panel, Windows offers MouseKeys, but this involves holding down or repeatedly pressing a key to achieve significant movement of the mouse pointer. I therefore wrote an AutoHotkey script that allowed mouse movement with minimal key presses. Pleasingly, due to improved movement, Lara no longer needs these facilities. Her situation demonstrates, though, how collaboration and some imagination can provide a solution for specific circumstances. If you want to read more about her life generally and about the issues confronting her following the haemorrhage, you can order a copy of her book, Lara's Gondola, by sending an email to email@example.com. 7. Miniguide – from concept to product Very often, it is not technology as such that provides a solution, but concepts about its application. The following anecdote describes a product that is primarily relevant to people who have little or no vision. Lateral thinking and sharing ideas, however, make it relevant to some people with both vision and physical disabilities. Something over a decade ago, through an email list based in the USA, I read about a man in Adelaide who was contemplating development of an electronic travel aid for blind people. Time does not permit even a summary of the checked history of these devices, but I will boast that I have used most of them. The man is Greg Phillips, who runs a small company called GDP Research. After swapping emails, Greg sent me a prototype of his product. His initial concept was that this small ultrasonic device may be useful for a stationary blind person to detect 5 Solutions through collaboration, lateral thinking and technology an approaching person. He was therefor somewhat dismayed when I reported that I had used it to travel between home and work. I suggested several alterations, which Greg implemented. Between us, we also came up with the Miniguide name. Greg had approached various blindness agencies around Australia, with no success. I put him in touch with the Guide Dog Association in NSW and they implemented a formal evaluation of the Miniguide. While I very much like audio input from electronic travel aids, most blind people prefer vibro-tactile feedback. Greg therefore developed a tactile Miniguide and, ultimately, one that can provide audio and/or vibro-tactile output. While it would be almost impossible to get accurate figures, The Miniguide is probably one of, if not the, most popular ETA to date. People with far greater technical resources have built less effective aids. The strength of Greg's approach is that he is open to feedback from people who use the equipment. Involvement of the Guide Dog Association means that the feedback is drawn from a broad cross section of potential users. This is very important in that people who are blind are a very heterogeneous group. This diversity includes people who, as well as having vision loss, also have other disabilities. Jeremy Hill is a resourceful orientation and mobility (O&M) instructor based in the Guide Dogs Coffs Harbour office. With Greg's technical assistance, he has adapted the Miniguide to meet needs of people who have various physical challenges. People who have had a stroke (or cerebral vascular accident) can develop hemianopia. For those not familiar with this confusing type of vision loss, it involves loss of vision in one half of the visual field in one or both eyes. A person who suffers a right sided stroke may develop left sided hemianopia. Jeremy uses a hook and loop strap to secure the Miniguide to the person's left arm. If the arm has no feeling, a small speaker is used instead of the vibro-tactile output. The Miniguide alerts the person to objects on the left which would otherwise be neglected with resultant collisions. It is hoped that the reinforcement given by the Miniguide will result in the user learning to look to the left. Even if this does not occur, at least collisions can be avoided. The Miniguide has also been helpful for people who have limited vision and use either a wheeled walker or wheelchair. The aid is attached to the front of the walker/chair and a lead runs to a separate vibration monitor near the user's hand. As the Miniguide does not report down steps, travel is limited to safe, familiar and flat areas. Jeremy reports, though, that it reduces incidents of wheel walker rage. That is, some of the frustration associated with a combination of poor sight and limited physical capacity is alleviated. It is especially useful for detecting glass doors and when encountering changed lighting conditions. 8. Benefits of building in accessibility This section is not intended to be a shameless endorsement of a particular product. What it does illustrate, though, is the potential of mainstream products to meet diverse needs when lateral thinking is employed. This includes facilities built into the product itself and further enhancement by creative thinkers. 6 Solutions through collaboration, lateral thinking and technology Contrary to my previous reputation for being in the vanguard of every new fad, I have only just joined the with-it set in the mobile phone arena. While I've used mobile phones for over a decade, until the recent delivery of my iPhone the only facilities available to me were sending and receiving calls. Demonstrating my lack of lateral thinking, when the first iPhone was released I muttered that a thing with a touch screen could not be used by someone with no vision. Apple responded (they didn't hear my mutterings) by building in a revolutionary screen reader with the release of the 3GS. Not only does this meet the needs of people who have little or no vision, but it is also highly relevant to many people who have visual perception problems. The phone also has features that make it highly relevant to people who have hearing loss and those with many types of physical disability. It is also worth noting that the product is highly attractive to the general population. Jamie Knight is a front end web developer from the UK. To deal with his autism, he uses his iPhone for three areas of life that he finds challenging: communication, organisation and management. When he has difficulty speaking, Jamie uses Proloquo2Go, a powerful augmentative communication app for the iPhone. It is available from the App Store (with an iTunes account) for approximately $240. One of the tools Jamie uses for organising his life, including running a business, is the calendar provided with the iPhone. As well as the entries usually put into a calendar, Jamie uses his to remind him to do such things as eat and lock doors. One issue he has is obsessive worrying over details. Being able to retrieve information from the phone, either directly or from the internet, helps to alleviate his anxiety. Ricky Buchanan's article about Jamie is available at http://atmac.org/autism-apple- iphone-macbook-life. David is quadriplegic. As a result, he has limited hand movement. By using a number of apps on his iPhone, he composes music. Having the various instruments at his fingertips is a real asset. That very light touch is required to play them is also highly beneficial. But is the iPhone perfect for everyone? In the 2010 May Ability News, Dr Graeme Smith comments: "It is brilliant for those with vision impairment, excellent for people with hearing impairment, very good for some with cognitive impairment... but a frustration for those with (very severe) physical disability, unless you are one of the few who can use a Pogo Stick or similar pointer. Standard access tools, like trackballs, joysticks, switches, special keyboards, head-mounted pointing devices and eye gaze systems are no use to you on the iPhone." Subsequent release of the iOS 4 software allows connection of a Bluetooth keyboard. This goes some way to improving physical access, but by no means addresses Dr Smith's concerns. At least at this time, an external keyboard does not replicate all controls on the phone. On the potentially useful voice dialling feature, he comments: "A great option and it works well... as long as you can hold down the physical Home button for a few seconds to activate the service." 7 Solutions through collaboration, lateral thinking and technology There is, then, an excellent opportunity for someone with requisite skills to correct these shortcomings. An iPhone app to make all controls accessible via the touch screen would be helpful. While likely to be more expensive, an external device that provides full control of the phone would be another valuable option. 9. Brain waves At the Human Computer Interaction Conference in 1997, researchers from the University of Technology Sydney (UTS) presented their work on the Mind Switch. In brief, subjects could activate a switch by closing their eyes. My very peripheral involvement in the project arose by asking whether the switch could be activated by a blind person. Several months later, testing in a UTS laboratory demonstrated that I did have a brain, but that opening or closing eyes did not affect amplitude of alpha waves, the trigger used to activate the switch. In July of this year, I visited Prof Hung Nguyen, Dean of the Faculty of Engineering and Information Technology at UTS. He described current research directed towards helping people who have severe physical disabilities. One aspect of the work involves enhancement of the Mind Switch concept, whereby various cognitive functions produce electrical impulses that can trigger a number of switches. An alternative approach is to use an accelerometer that measures head movement. Information yielded from either approach can be used to perform such tasks as accessing environmental controls and controlling a wheelchair. Laser or sophisticated camera systems allow a wheelchair to safely negotiate an environment, avoiding obstacles and even detecting stairs. As Prof Nguyen described these systems the same thought came to us both simultaneously. Not only do these technologies have applications for wheelchair control, but there is the potential for a sophisticated electronic travel aid for blind people. The ABC Catalyst program featured Prof Nguyen's work on 18 March 2010. A video, demonstrating the various technologies employed, is available from http://www.abc.net.au/catalyst/stories/2848661.htm. 10. Conclusion We are at a point in history when available technological options offer unprecedented opportunities for improving lives of people who have disabilities. This may be by building a device that meets specific needs, adapting an existing product or taking advantage of facilities built into a product intended for the broader market. It is a time when each check of a favourite website, blog, wiki or email list has the potential to deliver news of another potentially vital breakthrough. It is important that those of us charged with responsibility for delivering resources to people who have disabilities share and disseminate knowledge of new products and emerging technologies. What is also important is that we do not just wait passively for the next break-through technology. Tools that are already available should be fully exploited, sometimes in ways not even envisaged by their creators. Lateral thinking is so important when searching for solutions to problems faced by groups and individuals. This includes discussing issues and ideas with relevant others. While it helps to clarify the issues, it also opens the possibility of fresh ideas and new information. So, let us leave here with a commitment to improving opportunities for society generally and for those who 8 Solutions through collaboration, lateral thinking and technology have disabilities specifically. While embracing the potential of technology, may we all nurture perhaps the most important resource of all, human imagination and creativity.
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