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?
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
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,”
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.
Using technology to help preserve independence
With the creation of the Luscii remote monitoring platform, people with ongoing care needs can avoid the necessity for regular medical appointments, while clinicians can ensure they’re being looked after from afar. NR Times speaks to its founder Professor Daan Dohmen about Luscii’s role in the future of healthcare
From his early experience of working part-time in a nursing home came a realisation that patients could and should play a more active role in their care and health.
“For me, that was a really important step in my vision to use technology to help regain people’s independence,” says Professor Dr Daan Dohmen.
“The nursing home had all good intentions but took away the independence of people living there – they put them in the shower, they did everything.
“There was one day that I took an 82-year-old lady from the nursing home to a grocery store one block away. We weren’t supposed to do that as there was a store in the nursing home, but I said ‘Let’s go together’ and took her there in a wheelchair.
“She said to me ‘Daan, this was the nicest thing to happen to me in ten years’ – and that made me think even more about how we can use technology to provide freedom to people who may not have that.”
And from that realisation has grown Luscii, a platform which enables home monitoring for patients, allowing clinicians to keep check from afar without the need for them to come in to hospital.
Founded in the Netherlands, it is now used in seven countries across Europe and Africa, including in the NHS, Luscii – named in tribute to Florence Nightingale, derived from the Latin ‘luscinia’ – is enabling a new digital approach to healthcare.
Powered by its Clinical Engine, the use of AI supports and alerts healthcare providers when intervention may be needed, and contact can be made immediately via message or video connection.
Clinicians can monitor patients remotely via a dashboard, using Luscii’s concept of virtual wards to correlate data and alerts for multiple patients, and then responding with intervention whenever required.
“For managers of Trusts and CCGs, they understand this can help increase capacity and help with waiting lists, but it is even more important from the patients’ perspective in unlocking the power for them to use the tools independently,” says Daan.
“And for doctors and nurses, who we call our ‘medical developers’, they can build their own digital pathway with e-learning modules and algorithms for their patients.”
With the launch of Luscii in a pre-COVID-19 era, in 2018, the events of the past year have seen the platform take on an even more fundamental role in healthcare.
“COVID really pushed the concept of digital,” says Daan.
“We’d seen a lot of doctors and nurses who were quite anxious about digital health, thinking is it clinically relevant, will it lead to ‘cold care’? Often if a patient said they wanted to try digital apps, the doctor would say ‘That’s nice, but I don’t think it’s for you’.
“The past year has forced clinicians to try digital means, and suddenly they are finding out that this can be beneficial in certain situations.
“Through our virtual wards, we were able to support the early discharge and triage of COVID patients – sometimes it was 11 days earlier when patients could go home.”
And its response to COVID, which saw it develop the Corona Check app – which enabled hundreds of thousands of people to submit health data daily from their homes, allowing healthcare providers to determine who may have COVID-19 and who needed most immediate care – has been acknowledged with the Prix Galien Excellence COVID-19 MedTech Award.
“We got out the digital Lego box and built a COVID app – we now have 20million registrations on that platform,” he says.
Born out of his previous business FocusCura, a healthtech which uses smart tools to promote the autonomy of vulnerable people, Luscii continues to grow, particularly in light of the new-found digital adoption within healthcare.
Now in seven countries – five of which came in during COVID – with its native Netherlands and the UK being some of the earlier adopters. Currently, it is used in more than half of all Dutch hospitals and was pioneered in the NHS by the All Together Better alliance in Sunderland, supporting elderly patients with chronic illnesses at home.
And it was among elderly people, inspired by his experience of the nursing home, that Luscii’s potential was initially realised.
“A lot of elderly people with chronic diseases had to go to hospital all the time, they often had to arrange for a family member to take them there, then they would get to hospital only for ten minutes later to be back outside as they were fine and able to leave. The rest of the week they’d be too tired to do anything,” says Daan.
“We came up with the idea of how to support people with chronic illnesses to have remote check-ups. This was at a time when iPads had just launched and video calls were happening. But what started as a project got bigger and bigger so we had to split off independently.”
And from its origins in supporting elderly people, the roll-out is now including a much wider area of healthcare, as its role in COVID has helped to demonstrate.
“Once we have virtual wards, people can understand how they could be used in other areas,” says Daan,
“It’s a personal dream of mine that doctors create these programmes and share between them. Through collaboration, it becomes bigger than a product – it is a movement.”
Going forward, with the potential for digital healthcare continuing to be realised, the ongoing international roll-out is set to continue for Luscii.
“We are now in seven countries worldwide, four of which we haven’t been to physically, the roll-out has all been done virtually,” says Daan.
“We have shown we can scale quickly so we can support more patients in more areas.”
Rehab tech business wins further recognition for innovation
Rehabilitation technology developed by Fourier Intelligence has won yet more recognition for its globally-significant innovation.
The ExoMotus M4, a lower limb exoskeleton, was awarded the Shanghai Design 100+ accolade.
The exoskeleton, a gait and body weight system, is the first and only product of its kind on the market with its own body weight supporting system.
The ExoMotus M4 will be launched into the Chinese market at the Shanghai GReAT 2021 annual summit at the end of July, and is expected to be unveiled in the international market in early 2022.
The latest recognition comes only shortly after Fourier Intelligence won four awards at the China International Medical Equipment (CMEF) Spring Expo, with two being given to its newly-revamped ArmMotusTM M2 Pro device.
The Shanghai Design 100+ awards recognise and promote the influence of designers in Shanghai, and covers innovation from over 30 industries.
Over 2.45million public online votes were cast in determining the winners, which were also determined through industry voices and key expert votes.
The ExoMotus M4 lower limb rehabilitation robot was acknowledged for its ergonomic and user-friendly design, which can achieve gait functional training and multiple mode evaluations.
The gait mechanical leg can provide the user with precise sensory input in the early stage of rehabilitation through repetitive walking and inhibit the formation of an abnormal gait pattern or learned non-use.
Early gait training on the ground enhances plantar activation and biofeedback, and dynamic balance and symmetrical weight-bearing assessments can be performed before and after training, which provides a quantitative reference for measuring the outcome and progress of gait training with this futuristic assistive technology.
In addition to having multiple training modes and adjustable parameters, having the additional balance assessment and training modules are the three main characteristics of this lower limb rehabilitation robot that is designed to empower gait training. Through this feature, users can have personalised rehabilitation training.
Fourier Intelligence is recognised globally for its innovative and intelligent solutions that are based on independent research and development of core rehabilitation robot technology, providing medical institutions and patients with the world’s leading comprehensive advanced rehabilitation solutions.
At present, the company has strategic partnerships with nearly 20 universities and research institutes around the world to jointly develop progressive rehabilitation technologies and promote the application of rehabilitation robotics at the international level.
Some of these partner institutions include the Shirley Ryan Ability Lab in Chicago, KITE Research Institute at the Toronto Rehabilitation Institute – University Health Network, ETH Zürich in Switzerland, National Healthcare Group in Singapore, and the University of Melbourne.
Fourier Intelligence has over 1,000 installations in hospitals and institutions with a global presence in more than 50 countries and regions around the world.
‘Eye tracking technologies are vital life links for ALS patients’
Eye tracking technology is proving to be a lifeline for people living with ALS, delivering vital communication assistance which helps to break isolation. Here, leading healthtech influencer and ambassador for health innovation Gil Bashe discusses the power of such intervention
The moment the flood of ice-cold water poured over my head, there was shock and silence; seconds afterward, my senses returned. I blurted out: “That’s cold!” Family nearby laughed, the moment passed, and the video of my ALS Ice Bucket Challenge was shared online. Mission accomplished, or so one might think.
My state of frozen speechlessness was over in a moment, but for people diagnosed with ALS (amyotrophic lateral sclerosis also known as Lou Gehrig’s disease), that state doesn’t just last for a moment. It’s an ongoing, harsh and frightening reality that makes life more difficult and can actually shorten it.
LOSS OF SPEECH SIGNALS LOSS OF CONNECTION
Verbal and physical communication connects us. It is essential to life. But impaired speech (dysarthria) is among the first symptoms evident with ALS. As the disease advances, degradation of the nerves that control lip, jaw, tongue and vocal cord movement causes reduction in muscle stimulation. Unused muscles grow weaker and weaker, to the point where 80 to 95 per cent of people with ALS cannot fulfill their communication needs using their voices alone. In time, most become silent, unable to speak at all, and it’s this loss that isolates ALS patients perhaps more than any other aspect of the disease.
New clinical research points to promising investigational therapies that may slow the progress of ALS. This is important, but patients struggling now lack the luxury of time. While they wait, there are other innovations that can make their lives better and ease their isolation, especially health tech that assists essential communication. But these technologies only work if patients can get access to them.
EYE-TRACKING TECHNOLOGY OFFERS PEOPLE WITH ALS THE ABILITY TO COMMUNICATE
Advancements in precision eye-tracking can enable many with ALS to tap into lifestyle-assistive technology options. As leg, arm and lip muscles become weaker, eye-tracking tech enables users with ALS and other neurodegenerative conditions to engage in daily tasks, including wheelchair operation, home automation and augmentative and alternative communication (AAC) with family, friends and health providers.
One thing to keep in mind: for ALS patients, preserving communication is an essential part of care. If patients can’t communicate with those around them – especially family, caregivers and doctors – they are lost. The ability to communicate and be understood improves and may lengthen life. Austin Nieto recounted how obtaining an AAC device broke through his father Augie’s crippling isolation.
“With my dad’s mind unaffected, he basically became locked in his body, unable to communicate his thoughts, feelings, and basic needs,” shared Nieto. “My father was given a life expectancy of two to three years at the time of his diagnosis, and we are blessed that this year will be his sixteenth year with us since that day. I honestly believe this is a result of his EyeTech eye-tracking communication device.”
Today’s AAC technology is easy to navigate, and the clinical “magic” is driven by the marriage of medicine and software. EyeTech technology uses machine learning and artificial intelligence to translate a user’s gaze into action, enhancing conversation and ability. While the technology’s control panel is a familiar, user-friendly tablet, its operating system draws from constant human interaction, cloud-based secure data and camera calibration. The more a user makes it part of their real-world situations, the faster the technology adapts to provide an intuitive and natural connection between users and those around them. EyeTech founder and chief science officer Robert Chappell says:
“Eye-tracking is uniquely capable of enriching lives and delivering a higher quality of life to people needing to access AAC technologies. Focusing on how the technology can be a facilitator of connection and not an arduous barrier for people with neurologic conditions is what is making innovators drive toward new software and software updates geared to advance the AAC and medical fields – it’s all about accessibility for people in need – accessible of use and reimbursement.”
ALS DIAGNOSIS SHOULD TRIGGER RAPID PAYER APPROVALS FOR SUPPORTIVE CARE
Accessibility is the rub. The urgent need to support or restore communication makes getting authorization for AAC devices among the most frustrating challenges people with ALS and their families face. Payers too often treat requests for communication technology as secondary to care. This is wrong: with ALS, communication IS care.
The process is far from straightforward. People with ALS must first be evaluated by a speech language pathologist or other health professional to validate need based on cognition, speech quality and access ability. Then, device requests are sent to an AAC device manufacturer who must navigate the Medicare, Medicaid or private payer maze for reimbursement. Finally, the person with ALS must train to use the technology that will break their isolation and allow them to communicate again. Then they wait for approval to gain access. As their minutes and days tick away, they live in disease-imposed silence.
Service organizations like the Paralyzed Veterans of America (PVA) help U.S. veterans, who are twice as likely to develop ALS, navigate the Byzantine approval process. Others have to find their own path forward. Medicare often covers 80 per cent of device costs every five years, but ALS patients without supplemental Medicaid or private insurance need to pay out-of-pocket for copays. The average cost of a speech-generating device is $15,000, so people already devastated by ALS and the potential of being trapped in a silent world face the additional hurdles of income loss and mounting medical debt.
COMMUNICATION IS A LIFE LINK
For most with ALS, this is an unnecessary hardship, imposed by a system that appears to lack the humanity required to meet their most basic needs. Communication for people with ALS isn’t just a “nice- to-have” – it is an essential life link. While caregivers, providers and AAC innovators struggle through the approval and payment process and its roadblocks, people with ALS and other neurological conditions watch precious days, often weeks, slip by.
Eye-tracking AAC technologies are proven; they support and sustain lives. There is little doubt of their ability to break the isolation of ALS patients and support those who live with other disabilities and neurological diseases like Parkinson’s and Alzheimer’s. The health system is fragmented with people with health urgencies needing to navigate its complexities. The technology works and makes a life-sustaining impact. What will it take for the payer and approval system to heed the patient’s urgent call to action?
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