Wednesday, November 13, 2013

Filmaker with Motor Neuron Disease uses Eye Gaze to continue to make films

Via Daily Mail: http://www.dailymail.co.uk/news/article-2494162/The-doctors-told-let-Simon-die-Instead-tried-baby--ended-twins--The-inspirational-film-maker-refused-accept-death-sentence-Motor-Neurone-Disease.html

'The doctors told us to let Simon die. Instead we tried for a baby... and ended up with twins!': The inspirational film-maker who refused to accept the 'death sentence' of Motor Neurone Disease


Simon Fitzmaurice was diagnosed with Motor Neurone Disease in 2008

  • He eventually ended up on a ventilator and was told to 'agree' to die
  • But instead he and his wife decided to have more children
  • Meanwhile, Simon has been able to continue with his work making films
By Jenny Friel

Ruth Fitzmaurice watched as the consultant, a man they had never met before, entered the hospital room and made his way towards her husband’s bed.
Simon, a talented filmmaker and the father of three small boys, lay there with a tube going down his throat, pushing air into his lungs, allowing him to breathe but preventing him from being able to talk.
They listened as the medic spelled out in no uncertain terms what he expected them to do.
Life: Simon Fitmaurice lives at home with his wife Ruth, and breathes with the help of a ventilator device
Life: Simon Fitmaurice lives at home with his wife Ruth, and breathes with the help of a ventilator device

‘He basically announced that this was the end of the road,’ explains Ruth. ‘That was it, they had done all they could - that he had phoned Simon’s own consultant in Beaumont Hospital who agreed that ventilation for Motor Neurone Disease (MND) is not advocated in Ireland.’
The consultant continued, telling Simon that it was now time for him to make ‘the hard choice’ - to agree to come off the ventilator.
In other words, to allow himself to die. He told them that he knew of only two cases of home ventilation in Ireland... but both patients were extremely wealthy.
Ruth stood in the corner of the room, clutching on to her mother-in-law, Florence. ‘We were in total shock. I knew he could be heading that way but I didn’t think he was at that point already,’ she says.
‘We just cried, holding on to each other.’
 
That Simon had even been put on mechanical ventilation when he was admitted to the Intensive Care Unit with respiratory failure, according to the Fitzmaurices, appears to have been a fluke.
‘We think they probably did it and then said: “Uh oh, what have we done here?”’ says Ruth. ‘And they were stuck with him in the ICU.’
Despite the consultant’s stark and very clear recommendation, Simon refused to grant permission to take him off the machine that was keeping him alive.
‘Simon’s family very much think for themselves, and Simon in particular is a very strong character,’ smiles Ruth. ‘He wouldn’t be fazed by being told what to do by a doctor, he would question things and say: “Hang on a second.”
‘The consultant told us if he stayed on the ventilator that he wouldn’t get out of the hospital. With MND [a degenerative condition that destroys the cells that control voluntary muscles and can affect speaking, walking, breathing, swallowing and general movement] it’s like, “where do you think this is going? You’re only going to get worse. Why would you choose to ventilate?” So that’s when we decided to fight.’
Communication: Simon can use his eyes to direct a laser device, allowing him to speech via a machine
Communication: Simon can use his eyes to direct a laser device, allowing him to speech via a machine

It took four long months, dozens of meetings and exhausting rounds of tense negotiations but finally a home care plan was put in place and Simon returned to his home in Greystones, Co. Wicklow in March 2011.

By this stage the disease - which RTÉ broadcaster Colm Murray passed away from this summer - had left him in a wheelchair, with limited movement and requiring 24-hour nursing care.

But shortly after arriving home the couple made another decision that this time even had many of those closest to them scratching their heads.
Simon and Ruth, who had three young children, decided to have another baby.

‘Everyone thought we were a bit mad,’ laughs Ruth. ‘But we felt in the face of death and with everything that had happened, well, kids are the ultimate opposite of all that, they’re life-affirming.’
Before: Simon and Ruth on their wedding day in 2004
Before: Simon and Ruth on their wedding day in 2004

Their lives were certainly affirmed when 20 weeks into Ruth’s pregnancy they discovered she was expecting twins. Their youngest son and daughter, Hunter and Sadie, were born in April 2012.
Daily life for the Fitzmaurices is now consumed with taking care of their five children: Jack, eight, Raife, six, Arden, four, and the toddler twins. There is also Simon’s condition, which has left him only able to move his eyes.

A machine allows him to breathe and he is fed through a peg tube.  But his mind, as always, continues to work constantly. A writer from the age of 14, he became a multi-award- winning film-maker and his short film, The Sound Of People, was shown at the prestigious Sundance Film Festival in the US just months before his diagnosis in the summer of 2008.
Despite his illness, the 39-year-old has completed the script for My Name Is Emily, which he explains is a feature length movie ‘about a 16-year-old girl and her quest to free her father from a psychiatric institution, helped by the boy who loves her’.
He began writing it with his hands and finished it typing with his eyes, using a high-tech laser eye device that is connected to an on-screen keyboard.

The movie has already received substantial funding from the Irish Film Board and is set to begin filming in early 2014. Simon, from his wheelchair and using the eye device to communicate with his crew, will be the director.
This week he, his family and the film production team launched an online crowd funding campaign, which they hope will raise €200,000.
This money will help pay for, among other things, specialised equipment and a longer shoot, which will allow Simon to work shorter days.
It is an extraordinary challenge that they have set themselves. But one, Ruth says, that is helping them keep their spirits up through some extraordinarily difficult times.
She also believes Simon’s writing talent has only got better since the onset of MND: he has recently finished the first draft of a book.
‘It has been quite startling to watch,’ she says. ‘Everything he says now is pretty much profound. It’s all condensed into this amazing creativity.’
At their comfortable home in Wicklow, the love between Ruth and Simon is clear to see. She turns to him regularly throughout the interview, checking facts and dates, waiting patiently for him to answer via his laser eye device.
The words Simon types in are spoken out loud through the computer’s voice, which is male with an American accent. It took some getting used to, but the family has learned to accept it and are even quite fond of it now.
Family: This photograph shows Simon and Ruth with their eldest two childrenm Raife and Jack
Family: This photograph shows Simon and Ruth with their eldest two childrenm Raife and Jack

Dozens of family photos line the walls of the hallway and kitchen. Many are recent, showing the twins as small babies in the arms of various family members.
Others are older, from before Simon was diagnosed. They show an extremely handsome, dark-haired man with bright blue eyes and a broad smile.
One wedding photo in the hallway is particularly lovely. ‘Ah yes,’ grins Ruth. ‘We call that one the money shot.’
The couple first met when in college. ‘But Simon always had a girlfriend,’ says Ruth. ‘Then a few years later I was at a bus stop outside work. He walked by with his parents and stopped to say hello. I gave him my phone number but he didn’t ring me.’
‘She was out of my league,’ interrupts Simon.
‘I bumped into him again on the way to work, we began emailing and that was that,’ says Ruth, 38, who was working for Today FM at the time.
The couple were married in 2004 and shortly afterwards moved to a cottage in the north-east of
the country.
‘We lived in a cottage in the middle of nowhere,’ says Ruth. ‘We ditched in the day jobs, me to do my writing, Simon to do his films, to have children and a big garden. It was all going great - and then Simon got MND.’
‘I ruined it,’ says Simon. ‘It wasn’t your fault,’ smiles Ruth gently. ‘You didn’t ask to get MND.’
Ruth was pregnant with their third son when Simon travelled to the Sundance Festival over Christmas 2007 to show his acclaimed short film. While there, he noticed he had a pain in his foot.
‘There was nothing before that,’ says Ruth. ‘If anything, he was the kind of guy, when everyone else was struck down with a cold or something, he would be fine, full of energy. He lived life to the max: that was Simon, always.
‘His career was just starting out, the festival was a real wow moment, it was really going somewhere and he won these awards, then it all happened at once, it was crazy.
‘When he came home with his sore foot I had the typical wifey reaction; “Oh you’re being a hypochondriac. It’s probably the clutch in your car, it’s quite stiff, or the fancy trainers that you’re wearing that aren’t very practical.”
‘I didn’t think much of it; we were very busy at the time, we had two little boys and another on the way. My dad is a GP and he sent him to a neurologist when it got a little worse, when he was limping with it.’

Earlier days: Simon, right, films in the Himalayas
Earlier days: Simon, right, films in the Himalayas

In June 2008, the test results all finally came back.
‘I was around four months pregnant,’ says Ruth. ‘My dad drove us up that day, he was possibly waiting for bad news. I remember I was in the waiting room, Simon had gone into the doctor on his own.
'My dad had come in with mud all over his shoes and I was giggling at him dropping clumps all over the carpet.
‘I was kind of in my own world, then Simon came out and he said: “You better come in here.”
‘We went in and the doctor told us he had MND. Like anyone else, I’d heard of Stephen Hawking (the theoretical physicist was diagnosed with MND when he was 21, given two years to live but is now 71) but I didn’t really know anything more than that about it.’
‘My neurologist said I had three to four years to live,’ explains Simon. ‘That was five years ago. The prognosis does not include being on a ventilator.
‘Most people with MND die with respiratory failure. A ventilator enables me to breathe, because my muscles lack the strength to do so.’ Over the next two years, Simon lost the use of  his legs and arms.
In the meantime, the family moved to Greystones, where Simon grew up and where his family still lives.
‘The progression either starts in your limbs or your voice and your lungs,’ explains Ruth. ‘Simon’s was limb onset, his legs and arms went first. Then once your diaphragm goes you can’t breathe any more. That’s usually the end of the road for most people because in Ireland they don’t advocate ventilation.’
In 2010 Simon developed pneumonia. Exhausted and unable to breathe, his family brought him to their closest hospital, where he went into respiratory failure. For some reason it was decided to intubate him and put him on a ventilator.
'The consultant, however, later advised him to come off the machine, which came as a huge shock.
‘We thought we were really far from respiratory failure because Simon was still talking,’ says Ruth. ‘In my head I thought the progression would be that he would lose his voice first and then his breathing would go.’
Simon’s will to live was, and is still, great. He refused to follow the consultant’s advice.
‘In fairness to the hospital, once they realised we weren’t going to turn the ventilator off, they began to help us put together a home plan with the HSE,’ says Ruth.
‘The HSE have been absolutely great,’ says Simon.
‘Yes, once they committed to the package they have been great,’ says Ruth. ‘We have a nurse 24 hours, one during the day and a night nurse who sits in the study.
‘We have a night monitor hooked up so they’re listening in all night as we sleep, which is obviously a strange way for a couple to live but you do adapt. We have a carer for about nine hours a day because it takes two people to get him up and all of that.
'I’ve no idea how much it costs. The HSE provide some of it, we provide some and our health insurance provides some. It’s a huge operation to keep him going.’
Ruth is also keen to point out that ventilation is not for every MND patient. ‘’It’s a very personal choice,’ she says. ‘Simon chose the ventilation; not everyone would.
‘For some people, respiratory failure is the end point of what they want or put up with.
‘Simon will probably never reach that point, he just loves being alive and wants to be with us, and that’s his choice.’
Coming home from the hospital with all the equipment, Ruth admits, was a nerve-wracking prospect.
‘We were scared; it’s like bringing the hospital home with you,’ she says. ‘But when you saw him in the ICU, with no window, it was breaking him.’
Over the next year, they got used to the new regime of having 24-hour nursing care in their home and the birth of the twins, who were conceived naturally.
‘Yes,’ laughs Ruth. ‘As Simon’s dad has said, Simon’s equipment still works!
‘The kids keep us in the moment all the time when this is going on around us,’ she adds. ‘It gives us a focus and a motivation.’
Simon interrupts at this point, saying simply in his American accented computer voice: ‘Best decision ever.’
‘For both our families,’ agrees Ruth. ‘When you’re in the hospital everyone goes into this mode of death approaching, everyone is carrying it. Suddenly these babies came along, this life-affirming thing happened. Everyone was bowled over by it and it became this beacon of hope.’
So while there have been some huge positives, what have been the hardest things about Simon’s condition that Ruth has experienced?
‘Losing his voice, although we’ve got used to the American accent now,’ she says. ‘And the food, I found that very hard. Simon has a peg tube now and he doesn’t eat. We were big foodies, a lot of our relationship was based around dinner and going out to eat together.’
But the family has adapted to their new way of life. ‘MND is a part of me now,’ says Simon. ‘It impacts every part of my life and the lives of my family. You live with MND, you don’t fight it. You create a new normality and you build a life.
‘The biggest challenge over the last five years is that MND constantly changes the condition of your life.
You are building a normality on shifting sands. So adapting becomes part of your existence.
‘In the first years, it is mourning each loss - not adapting. But we have got better at living this life. Allowing room to enjoy, to be happy.’
His relationship with each of his children has also had to change as he grew weaker. Some, like the eldest Jack, remember how he was before, while the younger ones have never known him to be any different.
‘Simon is really good at adapting,’ says Ruth. ‘As each new little person comes along, it gets harder to connect with them. With the others he had more facial movement, he could interact with them.
‘But he still found a way. Sadie will sit on his lap and he puts on this lovely guitar music and puts up photos on his computer screen.
She sits there quite happily and will chat to his face and give him a kiss. He finds a way in, he never gives up on that.’
As for any present prognosis, Ruth says they have learned to do without one.
‘We don’t look too far into the future,’ she explains. ‘Of course, sometimes you can’t help it, but in general I find it pointless. We live very much in the now.
‘I’ve just had so many times when the doctors have said: “This is the end of the road,” and it hasn’t been. There have been so many times that you begin to not believe in statistics. This is what it is, just let’s go with it.’
‘Everyone dies,’ adds Simon. ‘Stephen Hawking and my friend Tim (who also has MND) are 70.’
‘Simon is at what you would term end stage now,’ says Ruth. ‘The only thing left that really move are his eyes - and whether or not his eyes will be affected is debatable.
‘And there’s always a danger of chest infection with the ventilator. There’s been a few bad chest infections and we thought he wasn’t going to make it through, but he has.’
The day after we meet, at the launch of his funding campaign Simon tells again how, for as long as he can, he will cling on to the life he has been given.
‘I want to live,’ he says. ‘Ruth and my five children are my life. I worry all the time about the effects of my MND on them... I don’t know the extent of the cost, I simply know it’s worth it. I’m in love with this life and it’s worth every hardship to me.’
Contributions to the campaign raising funds to help Simon direct his film can be made at indiegogo.com/projects/my-name-is-emily.
For further information about Simon and to view his previous work, visit mynameisemilythefilm.com


Read more: http://www.dailymail.co.uk/news/article-2494162/The-doctors-told-let-Simon-die-Instead-tried-baby--ended-twins--The-inspirational-film-maker-refused-accept-death-sentence-Motor-Neurone-Disease.html#ixzz2kXHdZRoQ

Tuesday, November 12, 2013

Brain-Computer Interfaces Unlock the World for People with Paralysis

Via http://alsn.mda.org/article/brain-computer-interfaces-unlock-world-people-paralysis

by Catherine G. Wolf, Ph.D. on Wed, 2013-11-06 09:35
 
The author, who has ALS, explains what's new in BCI technology
Brain-computer interface systems (BCIs) — all of which are still experimental and not yet commercially available — allow users who have lost the ability to move or communicate to do so by focusing attention on specific signals from a computer. The system then translates this attention into action, such as choosing a letter or word, controlling a thermostat, or moving a limb or wheelchair.
Article Highlights:
  • Cathy Wolf of Katonah, N.Y., has had ALS for 18 years and has lost nearly all voluntary movement, including speaking ability.
  • Wolf has been testing brain-computer interface (BCI) systems and assisting with their development since 2006.
  • BCIs that are well along in development either sense brain activity through the scalp or through electrodes implanted into the motor cortex of the brain. They show promise in restoring a user's ability to communicate and perform various actions.
Brain-Computer Interfaces (BCIs) enable a person with no voluntary movement to communicate, surf the Web, write emails, and even move a wheelchair. For people with advanced ALS, spinal cord injuries, stroke or other neuromuscular conditions, BCIs promise to give them back the world.
There are no commercially available BCIs yet. But pilot studies in users’ homes are in progress to find out how to make these systems easy to use for both the user and the caregiver.

A user-interface expert
 
I have had ALS for 18 years. In that time, I’ve lost the ability to move my arms and legs, eat by mouth, speak and even breathe. I do have some movement in my face. But ALS is unpredictable. I might lose the small movement of my eyebrows and mouth in the next six months or the next year.
Wearing an electrode cap containing conductive gel in the electrode spaces, Cathy Wolf operates her computer by paying attention to single characters or function shortcuts on the monitor.
I have been participating in the Wadsworth Center’s development of BCIs since 2006 (the center is part of the New York State Department of Health). I serve as a user and also the user-interface expert because of my long history in human-computer interaction at the IBM Thomas J. Watson Research Center.

I am not yet dependent on the BCI. For now, I am using an infrared switch which I activate by raising my eyebrows to select letters and words from an onscreen scanning keyboard. This method is currently faster than the BCI. I participate in the research both for myself and others with movement disorders.

Wadsworth BCI picks up brain waves through the scalp
The Wadsworth BCI is based on electroencephalogram (EEG) signals picked up from the surface of my scalp. I wear an eight-channel electrode cap with electrode gel on my scalp. The signals are sent to an amplifier and then to a computer.

When I started my participation with the Wadsworth Center, the only application available was typing and then hearing back what I had typed in text-to-speech, the mechanical voice in which computers speak.

Since then, many improvements and applications have been added.
 
P300: The 'a-ha' response
 
On a large screen, I look at a matrix of quickly flashing letters and symbols that flash in a quasi-random, but known, order. My task is to count the number of times the symbol I want flashes. The computer is looking for a component of brain waves called P300. The P300 response is often called the “a-ha” response because it occurs about 300 milliseconds after someone sees something significant. The computer uses an algorithm to pick the symbol with the highest P300 amplitude.
 
Word prediction
 
One improvement in the Wadsworth BCI system is word prediction. Word prediction is based on the frequency of the next letter, given the preceding letter. For example, if I type “w,” the words “when, was, with, we, who” would be listed. If the desired word is on the list, I pick it, instead of typing the entire word. There is also next-word prediction based on the previous word. These changes increase speed and accuracy.

The Wadsworth researchers also experimented with different flashing patterns. One had seven different colors for the symbols in the matrix, and I was instructed to name the colors of the desired symbol. In an independent study with seven people who had ALS, the use of color seemed to increase accuracy.

Email
 
Another, and more important, BCI application was email. I can email anyone, and there is a feature for remembering recent email addresses. I often email members of the project with suggestions about the user interface, and other suggestions.

Rich site summaries
 
There is also a Web application based on RSS (rich site summary) feeds. I can read The New York Times, ALS news, and even listen to music on Pandora.com. There is a YouTube application in which you type a subject matter, like the Beatles or cats, and you get a list of YouTube videos on the subject. There’s also a picture viewer application.

My recommendation: Caregiver alerts
 
I noticed that when I am using BCI, my caregivers sometimes occupy themselves with other things. I suggested adding the ability to call my caregiver or announce a problem with the ventilator. These messages are repeated until someone comes to turn them off. The messages can be customized.
My recommendation: Adding mouse 'emulation'
 
For all the BCI-specific applications, there are always several that were not included. So at the Users’ Forum at the Fifth International Brain-Computer Interface Meeting in June 2013, in which I was a remote participant, I said my ideal BCI would work with any computer or Internet application, just as my scanning keyboard and switch can be used. This would require adding mouse emulation [imitation] to the Wadsworth BCI, but some BCIs already have the ability to move the mouse.
BCIs in the pipeline
 
At the same meeting, in the session called “BCIs for Users with Impairments,” a variety of modalities was presented:
  • Auditory binary choice (two choices) BCI: The user is asked a yes/no question while in one ear “yes” is repeated and in the other ear “no” is repeated. Randomly, “yep” replaces “yes” and “nope” replaces “no.” The user answers the question by either counting the number of yeps or nopes.
  • Visual binary choice BCI used with the eyes closed: The user is fitted with special glasses which contain LEDs flickering at different frequencies in each eye. The LEDs can be seen with the eyes closed. The user answers a yes/no question by attending to the appropriate eye.
  • Visual BCI that uses eye blink in addition to EEG: Eye blink is detected by a different brain response.  
Although these were laboratory experiments, not for home use, I am sure the goal is to move them out of the lab. Thus, if you have movement disabilities, there is likely to be a BCI in the works that meets your personal needs!

The iBrain may monitor sleep but can't steal thoughts
 
Then there is the NeuroVigil’s iBrain, a one-channel dry electrode mounted on a headband that picks up EEG. The only application listed on the company’s website is in-home sleep monitoring, but the iBrain has been recently touted as “hacking” into the mind of Stephen Hawking and another person with ALS, Augie Nieto (co-chair of MDA’s ALS Division).

The iBrain was used to pick up brain waves when they thought of moving their left or right hands. Curious about the iBrain, I sent email twice to NeuroVigil. I got no response.

The word “hacking” connotes unauthorized access. When applied to the mind, it implies unauthorized access to one’s thoughts.

I don’t know whether the iBrain could function as a BCI. But I want to reassure everyone that the iBrain or any BCI cannot read your thoughts. BCIs require conscious effort to work. Counting how many times a symbol flashes is hard work. There is no way these systems could steal your thoughts.
As to whether the iBrain could function as a BCI, I suggest you wait for studies in peer-reviewed journals, and not be swayed by demonstrations.

BrainGate: An implanted BCI
 
Another approach to BCIs is illustrated by the BrainGate Neural Interface System. In such systems, explained neurologist Leigh Hochberg, a sensor is implanted on the surface of the motor cortex of the brain, in an area about 4 millimeters by 4 millimeters.

Once the sensor is implanted, the user imagines moving a limb, often the arm or hand. The sensor transmits the electrical signal to a decoder (one or more computers and software) that turns the brain signals into a useful form for an external device. The external device may be a computer with a cursor, a prosthetic device, a robotic arm or a device that controls the environment [such as the temperature in the room]. The recording is done intracranially [inside the skull] and is called electrocorticography (ECoG).

“My personal goal — shared by our BrainGate team — is to develop systems that provide a person with advanced ALS, or locked-in syndrome from brainstem stroke, or traumatic brain injury or other disorders, with 24-hour-a-day continuous point-and-click control over a computer cursor, enabling that person to communicate readily and to use any software on any computer that could be controlled with a point-and-click,” said Hochberg.

Implanted devices are potentially more natural for performing complex actions, especially when recording from several brain locations. One goal is to eventually use implanted intracranial devices like the BrainGate to bridge the nonfunctional motor neurons in people with conditions such as advanced ALS, brainstem stroke or spinal cord injuries, allowing them to move their own limbs.
The field is in its infancy, Hochberg noted. Still, there have been impressive advances. Three test users with quadriplegia were able to use the BrainGate to operate either a prosthetic arm or a three-dimensional robotic arm to reach and grasp. One tester used the BrainGate system for more than five years. After five years, the signals from the array were still useful to control external devices, though not as robust as the first year. This is significant because it shows that the BrainGate could provide use over a “clinically valuable time period,” Hochberg said.

Interestingly, implanted ECoG systems may make the noninvasive EEG systems more accurate. At the recent BCI meeting, a paper was presented about the successful use of ECoG to predict EEG in six people.

Although the goal of intracranial systems like the BrainGate is to seamlessly turn thoughts into movement, there is no danger that private thoughts could be stolen. Such systems reside in the motor cortex, not the area where complex thoughts and planning take place.

While some people may prefer the convenience of implanted systems, others are concerned about the risks.

Restoring abilities
 
The advances in both EEG and ECoG systems can now give people with no movement the ability to speak, the most human ability, and for me the most important.

Already, in pilot projects, they are enabling paralyzed people to use computers and control the environment. It is my hope that such systems will soon be available to all who need them.
For an in-depth look at the state of BCI science, see a summary of the Fifth International Brain Computer Interface Meeting sessions, with links to research articles.

Cathy Wolf, 66, earned a doctorate in psychology from Brown University in Providence, R.I., after which she began work in the field of human-computer interaction. At the IBM Thomas J. Watson Research Center in Yorktown Heights, N.Y., she worked on speech and handwriting recognition and natural conversational interfaces, registering nearly a dozen patents.

In fall 1997, Wolf learned she had developed ALS. Since then, management of the disease has included a tracheostomy, a ventilator and a feeding tube. Unable to speak, Wolf communicates with her husband Joel and the rest of the world using a WiViK onscreen keyboard; E-triloquist speech program software; and a SCATIR switch that works through detection of a reflected beam of light and which she operates with her eyebrows.

In addition to writing for the MDA/ALS Newsmagazine and American Academy of Neurology’s magazine Neurology Now, Wolf is an amateur poet and has published two poems in peer-reviewed journals. She was profiled in the January 2007 issue of the MDA/ALS Newsmagazine.

Monday, November 4, 2013

An iPad Is Not an Augmentative and Alternative Communication (AAC) Device-Unless It Is!

Speak for Yourself

 
Speak for Yourself AAC Language App, Changing the world, one voice at a time
 
When we write or say something about the iPad and AAC, we inevitably have someone respond that, “The iPad is not for everyone.” (Obviously. Nothing is for EVERYONE.)  “An iPad is NOT a communication device,” is another popular statement.  We’ve seen and heard this (or some derivative of it) quite a few times recently.  We disagree, so we thought it would save time if we posted our reasons here.

It was more common to hear this type of resistance when the iDevices were first introduced to the market. As a matter of fact, years ago, when the iPod was first released, we deterred people from using it as a communication device. There were, and to some extent still are, a variety of reasons we didn’t think it was sufficient for someone to rely on for his/her communication needs. To date, we still have not met anyone who is using it effectively to say anything and everything they want to say. If you know someone or if you ARE someone, who uses the iPod for spontaneous, generative AAC, we would love to hear from you!

Nonetheless, my gift request for Christmas that year… An iPod with a communication app.

Our school didn’t purchase it because they didn’t feel it was appropriate for communication.  However, I wanted it so that I could talk intelligently about it because we were being asked about it almost daily.  I didn’t feel comfortable saying, “It’s not appropriate for communication” and cutting off the conversation. People were stopping us in the hallways of schools, excited to talk about AAC. I wanted to engage in those conversations.  We also didn’t want to miss an opportunity to recommend a lower-cost, consumer device that may be appropriate for someone.  So I got it for Christmas, and by the end of the break, I had tried sample sentences, made modifications to vocabulary, and challenged myself to make it effective and “easy” for students.  At that time, my best efforts to make the iPod into an efficient, clinically sound communication device were unsuccessful.
Here are a few of the reasons:

1. The screen size
The screen size was too small to have sufficient vocabulary unless the student was required to navigate a large number of pages. If students were required to navigate a large number of pages, their communication rate would be significantly slower.

2. Lack of available language systems
There were not enough app options to trial with students. The only option was a page-based system that did not keep motor planning consistent and had limited core vocabulary.

3. No amplification
The speakers of the iPod could be heard in a small, quiet setting, if you were in close proximity to the speaker. That scenario was not realistic in life and not a viable option for students who need to have a loud, strong voice. External speakers were available on the market, but it wasn’t the most feasible solution to get an iPod for portability and then have a child in a situation where he has to carry a separate speaker with him to be heard. The iPod cases with speakers did not have enough amplification.

We asked the major device companies if they were going to make an app because if the language system was stronger, maybe we could problem solve for the students who were not able to get the expensive devices. The device companies said “No”. We turned away from the iPod and used it as a reinforcer for students as we worked to build language on their communication devices. We looked over our shoulder and continued to monitor the release of apps, hoping that one would follow clinically-sound AAC principles.

When news of the iPad hit the market, we whirled around, eyebrows raised.  We saw possibility in the hardware for our ambulatory students for several reasons,.  Here are the reasons we like the iPad or iPad mini as a communication device for students who are physically able to access it:

The 10-inch capacitated screen  (or almost 8-inch screen on the mini)
The screen is larger than most traditional device screens for ambulatory students. The capacitated screen means that students who had difficulty with press and release can access the iPad screen with a light touch.

The technology is familiar and accessible to the general public
Parents and therapists don’t have to learn an entirely unfamiliar device. Many of them have experience with iPhones and iPods, so we don’t have to explain that they have to hit the home button to exit the app, how to turn it on and off, or how to charge it. They know how to tap the screen with the right amount of pressure and easily use the iPad gestures to swipe back to the settings when necessary.  Even our youngest preschool students are navigating the gestures on the iPod and their parent’s iPhone.

Since the technology is accessible to the general public, students are not without their voices for long if something goes wrong with their iPad.
Protection plans can be purchased for roughly $80, and when the home button on my iPad stopped working, I walked into an Apple Store (a little panicked) and walked out with a new iPad that was synced with iTunes and identical to the broken one.

The response from some of you may be that “Device companies provide support.”

Service used to be a benefit of purchasing a traditional device, but much of the phone support that is needed is for funding and hardware issues.  That type of support is not necessary for the iPad, and functional support for apps is available online.

Some may also say,  “Device companies send loaners or ‘expedite’ repairs.”

This is true, but someone has to accept financial responsibility for a loaner, if it’s an option. We have a difficult time trying to convince parents to accept financial responsibility for a $7500-$17,000 device that is going to be in school all day and out of their hands. We also have a difficult time convincing districts to accept financial responsibility for a device that is going to be at home and out of their hands all night. When a loaner isn’t an option, for whatever reason, we have waited as long as three months for an “expedited repair” on a device.
Three months is a very long time.

The iPad weighs less than traditional devices
At the time that it was released, the iPad was two to six pounds lighter in weight than the devices that students were carrying throughout their day. If you think that’s not a huge difference, think of a thirty pound three-year-old who is carrying 10% of his body weight everywhere he goes. If you weigh 120 pounds, that would mean carrying an additional 12 pounds everywhere you go. That doesn’t even factor in low muscle tone, balance difficulties, or sensory issues intensified by a strap around a student’s shoulder/neck and across her body.  A few pounds make a big difference.

The iAdapter provides amplification
When the iAdapter was released, it provided amplification, and while the iPad  was not intended to be a communication device, all of our hardware objections were resolved. There was even a cover to discourage access to the home button and prevent students from exiting the communication app.  (Since then, Guided Access has been added to the iPad settings, which provides a software solution to exiting the communication app).

The iPad is affordable
We had students whose insurance had denied a traditional communication device, several times.  The districts refused to purchase the devices because they were “not in the budget.”  We had children sitting in classrooms who did everything right. They learned to use a device during a successful trial. They took ownership of the device and carried it throughout their school day. Their behaviors decreased.  Vocabulary and language expanded, but when the trial ended, they had…nothing. They are the students who haunted us. We watched the bright, interactive light in their eyes dim as time passed. The districts said, “We can give them an iPad. Make it work.”  Districts were willing to give an iPad to a nonverbal child, if the parent was willing to purchase the app (or vice versa). The districts were also willing to pay for support to reprogram and implement the iPad as a communication device.  In some cases, parents were willing to purchase the iPad, app, and case, if the district would support it in school.
AAC was changing…as we sat in meetings and explained language development. It was changing…as we sat quietly in corners of classrooms, reprogramming apps to decrease page navigation, keep motor planning consistent (as best we could), and give students access to core and fringe vocabulary.  We waited less and less patiently for someone to release an app with a language system that would allow students to communicate quickly and effectively, and start as basic as we needed but grow to a large vocabulary. We waited until finally we said, “What are we waiting for?” and started to create Speak for Yourself.

There are a variety of AAC language options available for the iPad
Of course we think that Speak for Yourself is the most efficient, clinically-sound AAC app available to encourage language development and help to promote spontaneous, generative communication. However, there are over 300 AAC apps on the market. So, if you disagree, you can find whatever you think is “better” in the form of an app. If you have a child who is successfully using a device, all of the major device companies have apps. If you have children using mid tech plastic devices, there are apps from those companies.
In response to those who say, “The iPad is an entertainment device and was not intended to be a communication device.”
Or
“The iPad is not for everyone.”
Or
“The child already sees it as entertainment, and cannot use it for communication.”

Apple makes improvements to support a variety of accessibility accommodations.

Maybe Apple wasn’t thinking of people with disabilities when it created the iPad, but if you look under “accessibility” in the iPad settings, the options have increased with each new version of iOS. Voice over was one of the first accommodations, and it allows people with visual impairment to know what they are touching on the screen by reading it to them. Guided Access, which allows the iPad to be “locked” into an app by disabling the home button was added in iOS 6. Switch access, including the ability to use the iPad itself as a switch (by touching anywhere on the screen to make a selection during scanning) or head movements was added in iOS 7.  Could eye gaze access be in the future? (We sure hope so!). It’s not for everyone, but the iPad hardware can meet a lot of individual’s needs, and Apple seems to expand that reach with each release.

As far as the iPad being created as an entertainment device, where is the benefit of keeping it in that box?  We use inventions all of the time in new and creative ways. I don’t make my daughter ride her bike down curbs because the sidewalk cut outs were “intended” for wheelchairs (Thanks to Robin Parker of the PrAACtical AAC blog for this analogy).

Eye gaze technology was originally used in the military and marketing. It would be ludicrous for us to say, “It wasn’t intended to help people who can’t talk or move effectively, so we shouldn’t use it for that.”  How many beautiful voices would be lost if we weren’t open to new ideas and possibilities? How many will never be heard if we refuse to consider viable options?

Many of our miracles today are in our technology. Robotics are allowing people to move prosthetic limbsBrain scanning computers are attempting to allow communication by thought to help people who are “locked-in.”  So when someone says that an iPad is not a communication device, that is just not true.  When it is, it allows parents to know their child better.  It gives students and adults who are nonverbal or limited verbally the ability to have a voice, rather than hoping that someone correctly guesses their needs, wants, feelings, and pain.  Sometimes it allows a child to express her thoughts or play peek a boo, and in those times, an iPad is most definitely a communication device.
Evie (2 1/2 years old) using Speak for Yourself.
Evie (2 1/2 years old) using Speak for Yourself.

Wednesday, October 23, 2013

Are you ready for wearable tech? It's coming

Article by: BRIAN GAAR , Austin American-Statesman         

  • Updated: October 22, 2013 - 5:41 PM
Now that capital is flowing into the sector, products are in the pipeline.

The digital domain is creeping off our desktops and onto our bodies, from music players that match your tunes to your heartbeat to mood sweaters that change color depending on your emotional state.
There are even fitness bracelets, anklets and necklaces to track your calorie burning.
 
At Chaotic Moon Studios, an Austin, Texas, mobile software firm, developers and engineers are working on a competitive product to Google’s upcoming Google Glass — eyewear that can log onto the Internet. And they’re designing other wearable projects for several other customers, from applications to full-blown products.
 
Chaotic Moon co-founder William “Whurley” Hurley said wearable technology will have as much of an impact as the smartphone revolution did a few years ago.
 
“I think we’re about to enter a whole new phase in the next 12 months, 16 months probably on the outside,” Hurley said. “There’s going to be a whole new phase. It’s just like when the iPhone came out and there was this mad gold rush. It’s gonna be the same thing.”
 
Another Austin mobile developer, Mutual Mobile, is working on Google Glass applications for a variety of clients. They include doctors who might use the glasses to pull up patient information, and warehouse employees who could use them to look at real-time inventory or scan bar codes.
“People are starting to get into it,” said Sam Gaddis, the company’s chief marketing officer.
Gaddis says connected devices of all types are the future — because sensors that can measure a variety of data are becoming so cheap.
 
Mutual Mobile has hosted “hackathons” to encourage its developers to see what they can invent.
After one recent event, its developers created a football with a sensor that can detect the quality of the throw, and a boxing game that measures how much you’ve hit the target.
Adding sensors to everyday objects “is just adding this new layer of data that didn’t exist before,” Gaddis said.
 
Experts say that wearables are the next big thing in tech.
 
“Everyone agrees the race is just beginning, and I think we’re going to see some very, very big leaps in just the next year,” tech entrepreneur Manish Chandra said at a wearable technology conference and fashion show in San Francisco that was buzzing with hundreds of developers, engineers and designers.
 
Wearable technologies have long been a sideshow to mainstream laptop and smartphones, but this year Google’s glasses and rumors of Apple’s iWatch are popularizing the field. Analysts forecast swift growth. Last year the market for wearable technology — from hearing aids to wristband pedometers — totaled almost $9 billion. That should climb to $30 billion by 2018, said analyst Shane Walker at IHS Global Insights.
 
Hurley said Google’s public relations campaign for its glasses sparked an influx of venture capital into wearables.
 
“And that’s what’s been missing for the last 20 years in this area, is people actually funding these projects,” he said. “So now we’re getting all these clients because there’s all this injection of funding.”
 
Other areas like gaming will also be affected, thanks to products like the Oculus Rift, a virtual reality headset that enables 3-D gaming.
 
At Austin’s recent Captivate tech conference, Robin Arnott was showing off a program he’d created for the Rift. After users strap on the headset, the program uses their vocal tones to display a series of tunneling images, creating fantastical visual effects.
Arnott called it a “meditation experience” that he hopes to release with the device in another year or so.
 
“It’s like you chase yourself down the rabbit hole,” he said of the program.
Arnott described devices like Google’s glasses, which overlay the Internet on top of the real world as “augmented reality.”
 
Wearables “extend your abilities as a human, just as your phone does,” he said.
“I really feel like this is an extra organ,” he said, grabbing his smartphone.
 
As wearable technologies proliferate, humans will need to adapt, said Georgia Institute of Technology professor Thad Starner. He advises Google on its glasses, which are lightweight frames equipped with a hidden camera and tiny display that responds to voice commands. Starner has worn his for several years.
 
“We’re talking about paradigm-changing devices,” said Starner. “Capabilities that people haven’t thought of before.”
 
He said that, unlike computers and tablets that people engage with, wearable computers are designed to be in the background, secondary to the wearer’s attention. “It seems like a paradox, but when you pull the technology closer to your body, there’s a seamless interaction, it’s more an extension of yourself,” he said.
 
But there are sure to be cultural and social issues. Google Glass — and some emerging competitors — have raised concerns of people who don’t want to be surreptitiously videoed or photographed. And what about interacting?
 
In a newly released survey from Cornerstone OnDemand, 42 percent of workers said they would not be willing to strap on wearable tech for their jobs, with older and more traditional employees more reluctant than their counterparts. The survey polled 1,029 Americans age 18 and over in August, and had a 3.1 percent margin of error.
 
And then there’s an issue of bandwidth, said Ritch Blasi, a consultant with Comunicano who researches the wearable technology market. At this point, there simply isn’t enough network service to support universal and constant wireless use, he said. But that, too, will catch up.
“It almost makes you think everyone is going to turn into a cyborg,” he said, referring to a fictional, prosthetic-laden high-tech comic-book superhero.
 
And will they? “When you look at the world and everything people are doing?” Blasi said. “I think the answer to that is yes.”
 

Monday, October 21, 2013

ALS Association Public Policy Department Presents a Webinar--the Affordable Care Act: What You Need to Know

Affordable Care Act: What You Need to Know
Date:   Thursday, October 24, 2013
Time:   12:00pm, EDT; 11:00 am, CDT; 9:00 am, PDT

Webinar Details:
  1. Go to: https://alsa.webex.com/alsa/j.php?ED=194269917&UID=482766607&PW=NZTA3MmViNjVi&RT=MiMxMQ%3D%3D
  2. If requested, enter your name and email address.
  3. If a password is required, enter the meeting password: ALSpolicy1
  4. Click "Join".
  5. Follow the instructions for audio that appear on your screen.

To join the audio conference only
To receive a call back, provide your phone number when you join the meeting, or call the number below and enter the access code.

Call-in toll-free number (US/Canada): 1-877-668-4490

Call-in toll number (US/Canada): 1-408-792-6300

Toll-free dialing restrictions: http://www.webex.com/pdf/tollfree_restrictions.pdf

Access code: 821 783 200

Tuesday, October 8, 2013

Eye-Tracking Technology Lets Web Users Browse Hands-Free

 

(photo credit: iStockphoto)

By Brian Honigman

Eye-tracking technology has been around for years, most notably in use for eye-tracking software and heat mapping for website conversion optimization, but it’s never really entered the mainstream market, until now.

Tobii Technology has developed technology that allows the full control of a laptop just by the gaze of the user’s eyes.

Tobii has been a player in the eye-tracking and gaze interaction industry since 2001. In the early days, sight technology was cumbersome, preventing a user from moving when using eye-tracking software. The company eventually overcame that obstacle and has continued to innovate on the idea of remote eye-tracking in different use cases.

“It was the first true remote experience, the first eye tracker that you could actually move and walk away from,” said John Elvesjö, executive vice president and founder of Tobii, explaining the breakthrough.

It was a powerful development for many markets, especially for disabled individuals without the use of their hands, who could now use a computer in a much more effective way.

The technology has continued to evolve. For instance, the software can now gauge how well a user is paying attention and remembering online advertising, Elvesjö said.

“We can take a look at the accumulated gaze time or attention that you’re getting [on an online ad], which can also be determined by other metrics, like how long before they actually looked at your message for the first time,” he said. “Also, if a person looked at the ad, looked away and then looked back in a specific period of time, which is what we would refer to as a declaration of interest. It’s a way for us to judge some of the key characteristics of an online ad.”

The mass market use of Tobii’s technology aims to allow computer users to browse the web simply by directing their gaze using a Tobii integrated laptop or a standalone module added to your PC.
For instance, if they are scrolling through a website and their eyes focus at a specific place of the page then scrolling will stop to allow them time to read and interact with the content. The technology can also help conserve power — if any monitor isn’t being looked at, the technology will dim the screen until it is in use again.

According to Mashable, this technology, called REX, is still being developed, but once released, will be available through the USB port of any Windows-based PC. Tobii plans to also provide this technology for Apple AAPL -1.04% products in the future.

Elvesjö stressed that they aren’t eliminating the need for a keyboard but want to improve the experience of browsing, gaming, and using software like the Microsoft MSFT -1.35% Suite. He said it will also help those with special needs and empower marketers to better understand the interaction with their online ads.

“We want to increase the bandwidth between the human and the machine,” Elvesjö said. “Literally making the machine more intelligent to make interaction faster and easier.”

Assistive Technology Podcast: How iOS7 and the iPhone 5 Impact People With Disabilities

 

By On September 29, 2013 · Leave a Comment · In Announcements

assistive technology update

BridgingApps is a weekly contributor to a podcast called the “Assistive Technology Update“.  This podcast takes a look at Assistive Technology—the clever devices designed to help people who have difficulties with vision, mobility, hearing or other special needs. Recently BridgingApps co-founder Sami Rahman contributed to the podcast with a segment on how the iOS7 and iPhone 5 updates impact people with disabilities. To listen click on the link below:

Assistive Technology Update: How will iOS7 and the iPhone5 impact people with disabilities who use assistive technology?