An IBM training manual from 1991 reads: “For people without disabilities, technology makes things easier. For people with disabilities, technology makes things possible.”

But for a long time, much of the technology widely used by people with disabilities was distinct from the sleek gadgetry of the mainstream.

Occupational therapist Keith Norman says: “It used to be that the only technology we would prescribe for people with disabilities would look odd. Other people would wonder ‘why has that person got that device?’

“But now, if someone’s using an iPad, no one even notices. We very much support the use of mainstream technology for clients for this reason; it gives them a sense of being able to do what everyone else is doing.”

Norman represents Steve Wiseman Associates, which finds ways of getting technology working for people with disabilities.

As he and company founder Steve Wiseman are explaining at a UK neuro-rehab event, slick consumer devices are playing an evermore important role in serious injury rehabilitation.

Like never before, mainstream technology is opening up new possibilities for people with brain and spinal injuries. And, with a few expert modifications – or even just a YouTube tutorial – its capabilities can be extended even further.

Wiseman says: “It’s about stretching what the technology is designed to do. With an Amazon Echo smart speaker, for example, how can you tell Alexa to play the Rolling Stones if you can’t speak?

Steve Wiseman

There are communication devices which can be programmed to say things Alexa understands. Also, eye gaze technology can be used to select a cell on a screen, that will then speak to Alexa.

“A lot of what is now called mainstream technology is actually quite cutting edge. Another example is Philips Hue lighting. Each bulb has a Wi-Fi chip that can be controlled by another device wirelessly. This could be a handheld controller or eye gaze, but it could also be directly controlled through Alexa.”

Nadia’s story shows just how transformative mainstream technology can be with her own will power and some expert intervention. She became paralysed from the neck down, except for some finger movement, after a neurological injury caused by infection. Cognitively and verbally she remains very adept, however.

Norman says: “There were a number of things she wanted to achieve; to send emails, engage with her friends on social media and to play music in her room. She is also a massive Netflix fan. These presented some interesting challenges.”

Nadia already had an Amazon smart speaker and Google’s equivalent, the Home Hub. “We also brought in the Harmony Hub, a device which enables you to download the codes from various remote controls. It can then be controlled via commands to the smart speaker to operate the TV.”

Nadia also trialled Chromecast, a dongle which allows anything being watched on a phone to be streamed simultaneously on TV. But perhaps her most empowering technology tool was the dictation and speech recognition software Dragon NaturallySpeaking. Via a laptop, this gave her the ability to use Netflix and social media and to send and read emails.

As well as dictating speech, the programme can be used to control computer functions and navigate apps. It takes perseverance to master, with an array of commands to learn, but Nadia got to grips with it quickly. Choosing what to watch involved several steps including “press page down” to scroll through programmes, “click link” to highlight all the links on the page and “choose x” to pick the desired programme.

“She’s now able to manage many of her own affairs,” says Wiseman. “The key to success with Nadia was that she had very clear goals and was very motivated, as were the people around her.”

For six-year-old Sophie, meanwhile, technology provided a gradual increase in independence. She was in a road traffic collision at just 20 months old and suffered orthopaedic injuries and a severe traumatic brain injury.

Today she is a wheelchair user and, although able to vocalise sounds, has no speech. She also has complex epilepsy and limited trunk, head and limb control.

Wiseman says: “First we introduced eye gaze, which enables the moving of a cursor around a screen using eyes only.”

Video footage shows Sophie directing a sparkling trail across a screen by moving her eyes.

“Once you get more advanced there are various ways of clicking on something you have selected, such as dwelling on the item.

“It is specialist but is becoming mainstream, particularly among gamers. This is great because, while the eye gaze unit on Sophie’s computer cost around £1500, gaming ones are available for £140 and they do most of what the specialist eye gaze unit does.”

Having seen eye gaze in action, Sophie’s parents were keen to build on her progress to give her more independence.

“They wanted her to be able to control her bedroom lights so we used the Philips Hue system. We enabled her to control the lights from a computer; when she looked at a colour on the screen, the light would change to that colour.

“A decision was also made in conjunction with the speech and language therapist to make the system say ‘turn on the green light’, for example, to reinforce it. So, she’s looking at the colour, hearing the command and seeing the light change.”

Alexa was also ushered into Sophie’s world, giving her more control over the environment around her. The smart speaker was paired up with a Philips Hue Go – a chargeable, portable light resembling a soup bowl in shape and able to change colours, flash and even provide a strobe effect.

On Sophie’s computer screen, different cells activated by eye gaze triggered audio recordings from her mum. As well as instructions to Alexa to control the light, Sophie could “play some funky music”.

The computer, Alexa and the light combined to let Sophie enjoy the music she loves in her own bedroom, as any other little girl would. “The beauty of this system is that Sophie’s cousins and other family members can join in.

They can talk to Alexa without using the eye gaze and the whole thing is participatory. “Of course, this is a multidisciplinary process. All of this requires input from other members of the team. For example, Sophie had issues with head control so the physio was very involved [with the eye gaze setup], as well as the speech and language therapist in terms of what the computer should say for a particular cell.”

Sophie’s case underlines mainstream tech’s ability to mitigate profound challenges. But, as Wiseman explained, simplicity is

Keith Norman

often the key to solving problems, rather than relying on the very latest innovation.

For instance, a disabled child once needed easy access to an iPad to entertain him on a long flight. Norman’s solution involved a camera tripod and the occupational therapist’s close ally, the Velcro strap. Another assignment saw Wiseman and co put a dancing Peppa Pig robot under the knife. Pressing its nose to activate sound and movement proved too tricky for a young client.

They rewired it to a big red button which gave the child the same reward for her effort as an able bodied child. In fact, such wired-in controls are useful for many client tasks and can be adapted for various devices.

A client unable to move a mouse or touch a screen, could potentially manage a joystick. Failing that, buttons or switches could possibly be harnessed.

Wiseman says: “On Netflix, for example, instead of saying ‘number two’ to choose a programme with Dragon, you could use a switch to select it. Every time you hit a switch, you get what you want.

“We find that most of these mouse emulation methods work best with the Windows operating system.

“Also, Windows computers have USB ports, unlike tablets and some Apple laptops, and you usually still have to be able to plug something in to make things work.”

As the interconnectivity of everyday devices improves, wires and ports may become less important in the future – assuming the ‘internet of things’ revolution is as rapid as experts predict. For now, there is plenty more existing mainstream technology for Wiseman and Norman to tap into for their clients.

The gaming world offers particularly rich pickings, both as entertainment and in the pursuit of greater independence.

“Games have an element of purpose and can motivate you to do something that could develop skills that translate elsewhere,” says Norman.

“They can develop concentration, anticipation, timing, turn taking, problem solving and motor control. Also, they are highly motivating.”

Titles benefitting his clients currently include Hill Climb Racing, a simple-but- addictive driving game where players must go as far as they can without flipping their car over. It is built around two controls – ‘brake’ and ‘gas’ – and is therefore ripe for tweaking by the technology experts.

Eye gaze, basic switches and other user- friendly control methods are well suited to such games where the number of possible inputs is limited. Older players yearning for something slower paced but equally addictive, may enjoy certain golf titles, says Norman.

“Again, various modifications can be made using relatively cheap and robust technology to control variables like swing power and direction.

“It’s important to match the right game to the right person, considering their physical, mental, cognitive and attention skills,”
he says.

NR Times attended Steve Wiseman Associates’ talk at an event for neuro- rehabilitation professionals hosted by Irwin Mitchell Solicitors in Newcastle.

Legal view, with Fran Mayes, Lead Partner for Personal Injury in the Irwin Mitchell Newcastle office

Recent years have brought rapid improvements in the capabilities of mainstream technology, which is available at a much lower cost than previously.

Mainstream technology is also becoming increasingly accessible to people with disabilities.

This enables clients to become more engaged with technology and, because these devices and platforms are used by their friends and loved ones and not distinctly specialist to their disabilities, they may feel more motivated to use them; and in turn feel the many benefits of that.

An overriding message from technology experts in the field is ‘the earlier the better’ in terms of engaging in technology to improve the individual’s outlook, quality of life and opportunities.

From a legal perspective in the aftermath of an acquired brain injury, this means ensuring funding is available at the earliest possible stage to make sure a comprehensive multidisciplinary team (MDT) can be put in place.

Crucially, the MDT should be backed up by a specialist in technology who can advise on the equipment needed to support progress.

Overall, these specialists have an important role to play in assisting rehabilitation professionals within the MDT as they work towards maximising the opportunities available to the client, their outlook and their quality of life.

As we have heard from Steve and Keith, mainstream technology certainly has the power to achieve all of these goals, especially when expert intervention is applied to simplify and speed up processes and controls.

With mainstream technology continuing to advance at lightning speed, its influence on the recovery journeys of severely injured clients looks certain to grow in coming years.