Lateral Thinking Training Presentation by ljt17435


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									Motor difficulties: Solutions through
 collaboration, lateral thinking and


                Andrew Downie

            Paper presented at the

         Children's Hospital Education

              Research Institute

              2010 Conference
                       2 Solutions through collaboration, lateral thinking and technology

 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
       Examining Departmental websites under development for any accessibility

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 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

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

   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

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

   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

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

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

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

           "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

   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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