Friday, September 27, 2013

Electronic Eye Gaze Communication Options for People with ALS

There are various types of electronic eye gaze options for people with ALS. These systems rely on eye movement to “activate” a letter on a computer screen in order for the letter to be typed. In order for the system to work reliably, the person with ALS needs to have upper and lower and lateral eye movements. This article will describe the various options for eye gaze technology including insurance funded devices and DIY (Do It Yourself) devices.

Insurance funded systems

For more sophisticated computer access there are several “eye gaze” computer systems on the market. These high priced specialty computers rely strictly on eye movement for activation. This type of machine is only used by people that have little or no muscle movement left on their bodies. The basic premise is that a CCTV camera is placed below a computer monitor. The camera tracks your retina movement. Special software is loaded into the computer and allows the user to have full access by simply moving their eyes around the screen.

Insurance will only fund an eye gaze system if the speech therapist writing the report can document no other forms of access will work with the client. Most insurance companies (including Medicare and some private insurance providers) will fund 80% of the cost of this device. However, following Medicare guidelines, people enrolled in hospice or living at an assisted living facility are NOT eligible for communication devices. This often leads to frustration for many PALS since they now need the eye gaze systems but can’t get them funded. There are now other options on the market which are described later in this document.

Producers of eye gaze systems are:

DynaVox (www.dyanvoxsys.com)

Eye On (www.eyetech.com)

LC Technologies (www.eyegaze.com)

Prentke Romich Company, (www.prentrom.com)

Tobii (www.tobii.com)

Other Eyegaze Options (most are not fundable via insurance but it never hurts to ask)

The Eye Tribe $99.00 (http://theeyetribe.com) Not yet available—company taking pre-orders. Expected shipment date December 2013.

The Eye Tribe software enables eye control on mobile devices, allowing handsfree navigation of websites and apps; incl. eye activated login, enhanced gaming experiences and cloudbased user engagement analytics. The Eye Tribe intends to become the leading provider of eye control technology for mass market consumer devices by licensing the technology to manufacturers.

It all started seven years ago where the four founders meet at the IT University of Copenhagen. The ambition was to make eye tracking available for everyone at an affordable price. Within a couple of years they were renowned as the world leading research group in low cost eye tracking. After finishing their PhD’s the four founders bought the IP from the University and formed The Eye Tribe company during their participation in the European StartupBootcamp accelerator program in 2011. The team now includes 16 full time employees, building eye tracking software and applications for mobile devices. The Eye Tribe received seed funding of USD 1 million from private European investors in 2012 and is also leading a USD 4.4 Million government funded project to develop eye control for mobile devices.

The EyeWriter Project (a Do It Yourself Kit—the blueprints are free and cost of materials is about $100.00. http://www.eyewriter.org)

Members of Free Art and Technology (FAT), OpenFrameworks, the Graffiti Research Lab, and The Ebeling Group communities have teamed-up with a legendary LA graffiti writer, publisher and activist, named TEMPTONE. Tempt1 was diagnosed with ALS in 2003, a disease which has left him almost completely physically paralyzed… except for his eyes. This international team is working together to create a low-cost, open source eye-tracking system that will allow ALS patients to draw using just their eyes. The long-term goal is to create a professional/social network of software developers, hardware hackers, urban projection artists and ALS patients from around the world who are using local materials and open source research to creatively connect and make eye art.

PCEye by Tobii $3,900.00 . (http://www.tobii.com/pceye)

The Tobii PCEye Go is a peripheral eye tracker that enhances computer accessibility with the speed, power and accuracy of gaze interaction. The device replaces the standard mouse, allowing you to navigate and control a desktop or laptop computer using only your eyes. You place this device on your EXISTING computer so no other hardrive is required. The PCEye Go runs on standard Windows computers and tablets, allowing you to work with any application that is normally controlled by a standard computer mouse or through touch. Surf the web, connect with friends online, play games, Skype, use environmental controls to turn on the lights or TV and even make spreadsheets and documents by using your eyes.

The PC Eye can also be used on any WINDOWS TABLET and will turn that tablet into an eye gaze system.

VT2Mini by Eye Tech Ditigal Systems (https://www.eyetechds.com/vt2-mini.shtml)

With the simplicity of a single USB interface, the VT2 mini offers compactness and the largest head motion box for reliable and accurate data collection. Easily swapped between laptops, tablets or desktop computers, we include the QuickCAPTURE gaze analysis software and QuickLINK API to allow researchers and developers access to valuable metrics such as gaze position, dwell times, blink rates, pupil size, and much more.

Vision Key (http://www.eyecan.ca) $4,000

VisionKey is the latest in eye controlled communication and enables users with severe physical disabilities to type and talk with their eyes. Lightweight and head mounted, VisionKey gives users communication independence and control in their lives by simply "looking". The system also gives them each a voice by enabling them to control a speech synthesizer in the VisionKey unit or on the computer. Now users can write letters, play games, surf the net and listen to multi-media sound just by moving their eyes. VisionKey combines a viewer mounted on a pair of standard frames with a small control unit. An eye tracker and a microcomputer measure the position of the eye and when a selection is made, it appears on the control unit LCD and on the computer. Users look at a specific word, letter or character on the chart in front of their eye and "type" by holding their gaze until a selection is confirmed by a green highlight and a beep.

The research into electronic eye gaze devices continues to develop at an amazing speed. As new technology emerges, additions will be made to this list.

Should you have any questions about eye gaze technology or any assistive technology for people with ALS, please feel free to contact me at abrownlee@alsa-national.org.

Alisa Brownlee, ATP

September 2013

Hands Free Access to the iPad via Switch Activation

Apple's new operating system, the iOS7 enables users to access their iPhone, iTouch, and iPad without having to use their hands to touch the screen. The new operating system allows switch access to Apple's line of tablets. If you have questions about switch access to the iPad, I am happy to help--email me at abrownlee@alsa-national.org

In order to use the iPad with a switch you will need:

1. iPad (or iPhone, iTouch) with iOS7

2. Bluetooth Switch or Bluetooth Switch Interface

Optional: Mounting (to secure the iPad to a wheelchair, table, etc...) Mounting options available at www.rjcooper or www.blueskydesigns.com

What is a switch?

A switch controls an electronic device--it sends a current to the machine to do something. For example, a joystick on a power wheelchair is a switch--when activated, it sends a current to the driving mechanism to go forward, back, left, right. A switch does the same thing with a communication device--sends a current to the electronic device to do something. In this case, the switch makes the iPad scan--row, row, row, column, column, column until it comes to the icon you want then the users hits the switch.

Switches are at the core of access technology. What can appear to some as simply a "button" can —properly selected and installed—open worlds of access to communication devices, environmental controls, computer software, and mobile devices. (source: Ablenet)

Switches come in a variety of shapes and sizes. The type of switch that a user needs depends on what muscle movement they have to activate the switch. The iPad relies on a Bluetooth interface to use a switch with the device. This means the user has to be utilizing a Bluetooth switch or have a Bluetooth switch interface.

Bluetooth switches are available at:

AbleNet

http://www.ablenetinc.com/Assistive-Technology/iPad-iPhone-and-iPod-Accessories-Apps/Blue2%E2%84%A2-Bluetooth%C2%AE-Switch

RJ Cooper

http://www.rjcooper.com/bluetooth-switch-interface/index.html

Inclusive TLC

http://inclusivetlc.com/Products/ViewProduct.aspx?psid=364&gpid=353

After choosing the appropriate switch, you now need to sync it to the iPad. The following information is from Spectronics.

Switching it up in iOS 7

Via http://www.spectronicsinoz.com/blog/apps-and-mobile-learning/accessibility-and-access/switching-it-up-in-ios-7 by by

Charlene Cullen September 27, 2013

Wednesday, August 7, 2013

Banking on your voice: Machine stores speech for patient's future use

http://www.sunherald.com/2013/08/07/4854978/banking-on-your-voice-machine.html
By ELIZABETH DE ARMAS — The Miami Herald

MIAMI — Carole Shearn isn't quite sure when she will lose the ability to speak, but she is sure of one thing: Her voice will still be heard, even when the words can no longer be spoken from her lips.
The 70-year-old West Palm Beach, Fla., resident was diagnosed with ALS, also known as Lou Gehrig's disease, last October. Her form of ALS weakens the throat muscles first.

The progressive disease has no cure, but at the University of Miami Miller School of Medicine's Department of Otolaryngology, Shearn is the first patient to take part in voice banking - a program where patients who will eventually lose their voice due to diseases such as Parkinson's, ALS and cancer - can record key words, phrases and personalized messages to communicate when speaking is no longer an option.

Shearn uses Tobii Assistive Technology, a speech-generating device, which stores her recordings into categories. She can then use a mouse, touch the screen or even use her eyes to retrieve the sound files.

In case of an emergency, Shearn has even programmed a message saying "get help immediately" and "call 911." Tobii, which is compatible with Bluetooth technology, will call for her.
"Truthfully, I was so amazed when I found out about the Tobii," she said. "It makes me feel good that I can personalize my messages to whomever. It is my lifeline."

ALS is a neurodegenerative disease that attacks the motor neurons. As the disease progresses, these neurons begin to degenerate and stop sending messages to muscles. Eventually, individuals diagnosed with the disease lose the ability to move their legs, arms and body.

According to the National Institute of Neurological Disorders and Stroke, 20,000 to 30,000 people are living with ALS in the United States. The average lifespan for a person with ALS is three to five years.

Because ALS patients lose strength and movement in their limbs, Tobii has a built-in eye tracker. Shearn can sit in front of the device - without moving any part of her body but her eyes - and still communicate effectively.

Jocelyn Odlum, a speech pathologist at the University of Miami, met Shearn at an ALS support group in West Palm Beach and then began seeing her at the clinic. After evaluating Shearn, she got her started on voice banking. Shearn has been recording her voice every day for the past two months.
"Carole is an inspiration," Odlum said. "She took this disease and is doing everything she possibly can to be prepared."

Odlum says that once individuals are diagnosed with ALS, they should see a speech pathologist immediately so they can be introduced to these devices and helped. "Unfortunately by the time people come to see me they have no voice," she said.

Shearn has recorded basic phrases such as "Hello. My name is Carole," and "How was work?" But, she also has recorded some of her other favorite phrases: "What's up buttercup?," "What's new, super glue?," and "You snooze. You lose."

When Shearn was initially diagnosed, she had no idea what ALS was. She also didn't know that the disease had no cure. "That was very hard to hear," she said.

"I had tears in my eyes of course and I asked how long I would have to live and my doctor said he didn't know, three to five years, so we left the office on that," she said.
Shearn's daughter, Jennifer Wagner, had been suspicious of early symptoms she had been noticing: slurred speech and choking spells, even when she wasn't eating. She researched her mother's symptoms and learned about ALS.

"It was very daunting and difficult to read," she said. "I had a pretty good idea of what the disease was and what it was going to entail, and I didn't want my mom to go through that."

Although Shearn can still drive and walk without any assistance, Wagner drives her mother from West Palm Beach to the university. She also started an open Facebook page called Carole's Crusade, where people can become more aware about the disease and follow her mother's progression.

"I know that I cannot cure the disease so my main goal is to bring attention to it," she said.

For Shearn, keeping a positive mindset has helped her cope with the disease, but she acknowledges she is not as hopeful and optimistic as she was eight months ago because she notices herself "getting a little worse."

"I was certain I was going to live past 90," she said. "I would still like to." But if she doesn't, Shearn says she feels she has done everything she has wanted to do - traveled to Rome, Alaska, Paris, England, Italy, Spain and the tip of Africa, been surrounded by good people, and had a successful 36-year teaching career.

"My life has always been about people so I don't crave a lot of outside influence," she said. "Our family is small, but we are tight. That has always been everything to me. I feel my life has been blessed."

Read more here: http://www.sunherald.com/2013/08/07/4854978/banking-on-your-voice-machine.html#storylink=cpy

Tuesday, August 6, 2013

Pupil response may help brain-damaged patients communicate

Via: Los Angeles Times
http://www.latimes.com/news/science/la-sci-retina-20130806,0,4412651.story
by Melissa Pandika

August 5, 2013, 8:02 p.m.

A study suggests that, even if someone can't blink at will, their eyes can indicate a response to a question.

People with brain damage that has left them mute and motionless may be able to communicate with a system that measures the size of their pupils, a new study has found.

Individuals suffering from "locked-in syndrome" have lost motor control but remain aware and alert. The rare condition usually results when damage occurs to the brainstem, which controls motor function. Stroke, traumatic brain injury and amyotrophic lateral sclerosis (also known as Lou Gehrig's disease) can cause locked-in syndrome.

Many locked-in syndrome patients communicate with an alphabet chart, blinking to indicate their choices as a caretaker points to each letter. Others use devices that measure eye movement patterns representing "yes" or "no." Completely locked-in patients who aren't able to move their eyes at will may be able to use systems that translate brain activity into speech, although these often require surgical implantation and special training.

A new system called the EyeSeeCam measures changes in pupil size that happen involuntarily — even in people who lack motor control — and decodes them into yes or no responses, potentially offering an easier alternative for locked-in syndrome patients, including completely locked-in individuals.

In the 1960s, researchers discovered that pupil size can be used to measure mental effort: The bigger a person's pupils, the harder his or her brain is working. Neuroscientists used these findings to develop the EyeSeeCam, which takes advantage of how people's pupils dilate when they try to solve math problems.

Since this happens automatically, patients don't need to be trained to use the EyeSeeCam, said Wolfgang Einhauser, a neurophysicist at Philipp University of Marburg in Germany who helped develop the device. It's also relatively inexpensive, consisting of just a camera and laptop.

In a trial described Monday in the journal Current Biology, Einhauser and his colleagues asked patients 15 simple questions, such as "Are you 20 years old?" After each question, the computer presented the patient with yes or no options while showing a math problem onscreen.
Patients solved only the problem associated with their response, and the mental effort caused their pupils to dilate. An infrared camera mounted to a headpiece measured their pupil size over time and sent the information to a laptop. A software program immediately translated the measurements into responses based on when they peaked.

When the researchers tested the EyeSeeCam on six healthy individuals, it decoded their pupil sizes into accurate answers almost every time. The researchers saw similar results in three out of seven locked-in syndrome patients, almost all of whom could manage small head movements. With some slight adjustments, it correctly translated the pupil dilations of two additional patients more than 70% of the time.

"We found that quite remarkable," Einhauser said.

Only one out of four patients with more severe locked-in syndrome — marked by more widespread brain damage — finished the trial, and his answers were no more accurate than guessing.
The researchers also tested the EyeSeeCam on a minimally conscious patient with severely impaired cognitive ability. Although he couldn't answer the questions independently, he was able to solve math problems if the researchers pointed at them. The system translated these responses with more than 80% accuracy, suggesting that it could also serve as a diagnostic tool to assess a patient's state of consciousness, the researchers wrote.

Within the next two years, the researchers hope to finish fine-tuning the EyeSeeCam so that it works better for severe locked-in syndrome cases, Einhauser said. They also plan to make the device less cumbersome. It will eventually resemble a small webcam that can be hooked up to a laptop.

Although completely locked-in patients stand to benefit most from the EyeSeeCam, the trial participants still had control over their eye movements, said Niels Birbaumer, a neurophysicist at the University of Tuebingen in Germany who was not involved in the study. As a result, "we have no idea whether pupil size" accurately reflects yes or no responses, he said.

Mark Delargy, a physician at Ireland's National Rehabilitation Hospital, agreed. Although the study controlled for lighting changes and other environmental factors that can affect pupil size, internal variables, such as emotional state, are more difficult to control. Anxiety and pain can cause the pupils to dilate, for example.

But identifying these emotions in locked-in patients is tricky. "They won't tell you any new information," said Delargy, who was not part of the study. "You have to devise a question to enable them to tell you."

The EyeSeeCam's success in the minimally conscious participant has made the researchers confident that pupil dilation can serve as a means of communication, Einhauser said. Now that they've "provided the proof of principle," testing the system on completely locked-in patients is "definitely on the agenda," he said.

Even if pupil size does accurately reflect yes or no responses, the study tested only the EyeSeeCam, so it's undetermined whether it offers an advantage over existing systems, Birbaumer said.
Still, the device "has potential," Delargy said. "This is one of the greatest hopes for rehabilitation of locked-in patients and for the opportunity to give a voice to people who have lost it."
melissa.pandika@latimes.com

Wednesday, July 31, 2013

Revolutionary new neck support collars for patients with Motor Neuron Disease

A revolutionary new device to replace ‘hated’ neck support collars for Motor Neurone Disease (MND) patients has been developed.

Imagine being unable to support your own head, unable to speak properly or eat without assistance. That is the reality for patients with MND; enabling the continuation of the most basic aspects of living such as being able to maintain eye contact with other people can dramatically improve quality of life.

From left to right, Heath Reed, Principal Industrial Designer on the Head-Up Project, Jane Evans, Regional Care Advisor for the Motor Neurone Disease Association, Moya Briggs and her husband John Briggs - examining the new collar at the recent Design4Health Exhibition at Sheffield Hallam University.

Moya Briggs, 67, who was diagnosed with the less aggressive form of MND four years ago, chose to take part in a unique patient-led project, called ‘Head-Up’ to create a more suitable collar for patients with MND.

Moya said: “I hate the current collar I have to wear, absolutely hate it. When I’m wearing it I feel like an Egyptian mummy, all choked around my neck. For it to give me enough support I’ve got to have it really tight and when it’s tight I feel like I’m choking in it. It makes me feel as if I’m only partly communicating with the world.

“I hate the look of my current collar too and I cover it with a scarf. The fact that this new collar is inconspicuous and comfortable will make all the difference.”

The award-winning ‘Head-Up’ project is funded by the National Institute for Health Research (NIHR) Invention for Innovation (i4i) Programme. It is a collaboration between Sheffield Teaching Hospitals NHS Foundation Trust, the University of Sheffield and Sheffield Hallam University. The team was brought together and provided with early funding by the NIHR Devices for Dignity Healthcare Technology Co-operative (D4D HTC).

The collar came from a complete rethinking of existing collars as it sits low on the patient’s neck and offers support along the contours of the neck muscles, making it much easier for patients to carry out everyday tasks such as eating and communicating. The new collar will be undergoing a comprehensive evaluation later this year.

The involvement of patients and the public in research has been strongly promoted by NIHR, and is at the heart of D4D’s culture. Moya and other MND patients have played an extensive part in the design workshops for the new collar.

She said: “The whole device is very inconspicuous and provides so much more support. The snood itself feels like a second skin. It was wonderful for me because the muscles at the back of my neck usually feel the strain but I could instantly feel the relief in my neck.”

“I think it’s going to be a great relief to a lot of people. Every time I go out I will be wearing it and I need it for when I’m on the computer or if I’ve got to sit at the table or do anything for a long period of time.”

D4D, which is hosted by Sheffield Teaching Hospital NHS Foundation Trust, brought together an extensive multidisciplinary team including designers and engineers from Sheffield Hallam University’s Lab4Living, clinicians, clinical neurologists, MND nurse specialists, occupational therapists, physiotherapists and medical engineering experts from the University of Sheffield and Sheffield Teaching Hospitals.

This group was supported by MND patients and carers through the Motor Neurone Disease Association. D4D is also leading the regulatory compliance, evaluation and commercialisation work to put the collar as quickly and effectively as possible into the hands of patients.

Moya said: “I think the role that initiatives such as the NIHR D4D HTC play is very important. They can add an extra dimension – bringing forward products which integrate modern materials and help make people feel more part of the community and less obviously disabled.”

The project was led by Dr Christopher McDermott, who is a Consultant Neurologist and a Co-Director at the Sheffield MND care centre and also supported by the Motor Neurone Disease Association (MNDA).

Source: http://www.sth.nhs.uk/

Sunday, July 28, 2013

Write to Talk Apps

Via http://community.advanceweb.com/blogs/sp_6/archive/2013/07/23/write-to-talk.aspx

Published July 23, 2013 11:31 AM by Megan Sutton

Handwriting comes more naturally than typing for many adults and is likely to be better preserved after neurological injury or disease. For those who have lost their ability to speak, a voice-output app may be the best way to be heard. However, nearly all voice-output communication apps require the user to type in a message, leaving those without keyboarding skills in the lurch. Two AAC apps offer writers a chance to hear their words by converting handwriting to text, then text to speech.

HandySpeech (universal iOS app for $29.99) excels at recognizing print, script and mixed case writing and outputting it in high-quality artificial speech. Voices can be male or female in US or UK English accents; 11 other languages are available for in-app purchase of $2.99 each. The app requires an Internet connection (wifi or 3G) for speech output, though if none is available, the user can work around the problem by selecting the text and making use of the device's text-to-speech function.

There are many settings to help the app better recognize handwriting, including the ability to exclude letter shapes that are rarely or never used. Users can type directly into the app if desired, as well as paste text from other apps. A great feature of this relatively low-cost AAC app is the ability to store phrases for quick communication. Unfortunately, the only way to save phrases is to type them in through the settings, excluding the handwriting user from the process of storing messages.

Handwriting-to-speech is one of many features included in the full-service AAC app Predictable (universal iOS app for $159.99). While Predictable lacks the variety of settings to improve handwriting recognition, it offers the ability to use the voice when the device is not connected to the Internet. You can also easily output your message to email, Facebook, Twitter and SMS, or add it to the stored phrases list. Unfortunately, this app's useful word prediction feature does not work when using handwriting input. It is also difficult to insert spaces between words when combining handwritten phrases.
For an app that turns handwriting to text without the voice output, please look back at my previous post on MyScript Memo.

posted by Megan Sutton

Monday, July 8, 2013

Graduate Student's Proposal for Google Glass is Accepted by Google

A doctoral candidate in Penn State’s College of Education is working to make a new technology into a tool to assist people with disabilities. Sam Sennott applied to the recent Google Glass project, which was offering Google’s hands-free, wearable computer to researchers and consumers as a part of the company’s research and development.

Sennott said he was eager to apply for the new technology when he heard about it in 2012. He submitted his 50-word entry in February, and Google contacted him about a month later to invite him to join the program. He said he anticipates receiving his Glass this summer.

“The overarching goal is to use Google Glass as an accessibility tool for people with a wide range of physical, communication and cognitive disabilities,” said Sennott.

There are three primary areas that Sennott identifies as possibilities for this project.

“First, will be helping people who struggle to speak by working with Glass as an augmentative communication tool,” said Sennott. “Second, will be to develop a range of assistive technology solutions. Third, will be looking at how parents, teachers and other related service providers can use Glass to enhance their work with students.”

Hacking things together to make them work is what special educators do on a daily basis, according to Sennott, so coming up with a new way to use Glass was natural.

“It is in my DNA to make solutions work out of whatever materials are available and to seek out new tools to get the job done for the students and families we serve,” said Sennott. “For me, all it takes is being with the individuals I serve and the ideas start flowing. I am committed to harnessing the power of innovative new consumer technologies to make a difference.”

This is not the first time Sennott has adapted a new technology to be used as an accessibility tool. He was able to collaborate on creating a popular technology for iPhone, iPod touch and iPad.
“I co-created the original Proloquo2Go,” said Sennott, “the iOS software that helps people who have difficulty speaking due to disabilities such as autism, cerebral palsy and developmental disabilities.”
Sennott anticipates that the assistive technology community will support this project.

“The assistive technology community is incredible,” said Sennott. “They mobilize quickly and are really generous with lending a hand to share about important new developments in the field.”
Sennott, who will be joining the faculty of Portland State University this fall, said he plans on using Google Glass as a part of his research in his new position, but he is cautious about his predictions for this project.

“My hope is that it provides tools that are powerful, discrete and always nearby,” said Sennott.