Assistive technology

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Assistive technology (AT) is a generic term that includes assistive, adaptive, and rehabilitative devices for people with disabilities and includes the process used in selecting, locating, and using them.

The Technology-Related Assistance for Individuals with Disabilities Act of 1988 (US Public Law 100-407) states that it is "technology designed to be utilized in an assistive technology device or assistive technology service."

AT promotes greater independence by enabling people to perform tasks that they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to or changed methods of interacting with the technology needed to accomplish such tasks.

Likewise, disability advocates point out that technology is often created without regard to people with disabilities, creating unnecessary barriers to hundreds of millions of people.

Assistive technology and universal accessibility

Universally Accessible Street Cross at Evanston, Illinois

Universal (or broadened) accessibility, or universal design means greater usability, particularly for people with disabilities.

Universally accessible technology yields great rewards to the typical user as well; good accessible design is universal design. One example is the "curb cuts" (or dropped curbs) in the sidewalk at street crossings. While these curb cuts enable pedestrians with mobility impairments to cross the street, they also aid parents with carriages and strollers, shoppers with carts, and travellers and workers with pull-type bags.

As an example, the modern telephone is inaccessible to people who are deaf or hard of hearing. Combined with a text telephone (also known as a TDD Telecommunications device for the deaf and in the USA generally called a TTY[TeleTYpewriter]), which converts typed characters into tones that may be sent over the telephone line, a deaf person is able to communicate immediately at a distance. Together with "relay" services, in which an operator reads what the deaf person types and types what a hearing person says, the deaf person is then given access to everyone's telephone, not just those of people who possess text telephones. Many telephones now have volume controls, which are primarily intended for the benefit of people who are hard of hearing, but can be useful for all users at times and places where there is significant background noise. Some have larger keys well-spaced to facilitate accurate dialing.

Also, a person with a mobility impairment can have difficulty using calculators. Speech recognition software recognizes short commands and makes use of calculators easier.

People with learning disabilities like dyslexia or dysgraphia are using text-to-speech (TTS) software for reading and spelling programs for assistance in writing texts.

Computers with their peripheral devices, editing, spellchecking and speech synthesis software are becoming the core-stones of the assistive technologies coming for relief to the people with learning disabilities and to the people with visual impairments. The assisting spelling programs and voice facilities are bringing better and more convenient text reading and writing experience to the general public.

Toys which have been adapted to be used by children with disabilities may have advantages for non-disabled children as well. The Lekotek movement assists parents by lending assistive technology toys and expertise to families.

The following professionals may be certified by RESNA (RESNA.org) to serve the assistive technology needs of individuals: occupational therapists, physical therapists, speech language pathologists/audiologists, orthotists and prosthetists, educators, and a variety of other rehabilitation and health professionals.

Assistive technology products

Personal Emergency Response Systems

Personal Emergency Response Systems (PERS), or Telecare (UK term), are a particular sort of assistive technology that use electronic sensors connected to an alarm system to help caregivers manage risk and help vulnerable people stay independent at home longer. An example would be the systems being put in place for senior people such as fall detectors, thermometers (for hypothermia risk), flooding and unlit gas sensors (for people with mild dementia). Notably, these alerts can be customized to the particular person's risks. When the alert is triggered, a message is sent to a carer or contact centre who can respond appropriately.

Technology similar to PERS can also be used to act within a person's home rather than just to respond to a detected crisis. Using one of the examples above, gas sensors for people with dementia can be used to trigger a device that turns off the gas and tells someone what has happened.

Designing for people with dementia is a good example of how the design of the interface of a piece of AT is critical to its usefulness. People with dementia or any other identified user group must be involved in the design process to make sure that the design is accessible and usable. In the example above, a voice message could be used to remind the person with dementia to turn off the gas himself, but whose voice should be used, and what should the message say? Questions like these must be answered through user consultation, involvement and evaluation.

Accessible computer input

Sitting at a desk with a QWERTY keyboard and a mouse remains the dominant way of interacting with a personal computer. Some Assistive Technology reduces the strain of this way of work through ergonomic accessories with height-adjustable furniture, footrests, wrist rests, and arm supports to ensure correct posture. Keyguards fit over the keyboard to help prevent unintentional keypresses.

Alternatively, Assistive Technology may attempt to improve the ergonomics of the devices themselves:

• Ergonomic keyboards reduce the discomfort and strain of typing.
• Chorded keyboards have a handful of keys (one per digit per hand) to type by ‘chords’ which produce different letters and keys.
• Expanded keyboards with larger, more widely-spaced keys.
• Compact and miniature keyboards.
• Dvorak and other alternative layouts may offer more ergonomic layouts of the keys^{[citation needed]}. There are also variants of Dvorak in which the most common keys are located at either the left or right side of the keyboard.

Input devices may be modified to make them easier to see and understand:

• Keyboards with lowercase keys
• Keyboards with big keys.
• Keyboards with less and big keys, or multifunctional keys, such us the special keyboard PiTech, with only five big rounded keys, which is used with a special software for writting PiTech.
• Large print keyboard with high contrast colors (such as white on black, black on white, and black on ivory).
• Large print adhesive keyboard stickers in high contrast colors (such as white on black, black on white, and black on yellow).
• Embossed locator dots help find the ‘home’ keys, F and J, on the keyboard.
• Scroll wheels on mice remove the need to locate the scrolling interface on the computer screen.
• Footmouse - Foot-operated mouse.

More ambitiously, and quite crucially when keyboard or mouse prove unusable, AT can also replace the keyboard and mouse with alternative devices such as the LOMAK keyboard, trackballs, joysticks, graphics tablets, touchpads, touch screens, foot mice, a microphone with speech recognition software, sip-and-puff input, switch access, and vision-based input devices.

Software can also make input devices easier to use:

• Keyboard shortcuts and MouseKeys allow the user to substitute keyboarding for mouse actions. Macro recorders can greatly extend the range and sophistication of keyboard shortcuts.
• Sticky keys allows characters or commands to be typed without having to hold down a modifier key (Shift, Ctrl, Alt) while pressing a second key. Similarly, ClickLock is a Microsoft Windows feature that remembers a mouse button is down so that items can be highlighted or dragged without holding the mouse button down throughout.
• Customization of mouse or mouse alternatives' responsiveness to movement, double-clicking, and so forth.
• ToggleKeys is a feature of Microsoft Windows 95 onwards. A high sound is heard when the CAPS LOCK, SCROLL LOCK, or NUM LOCK key is switched on and a low sound is heard when any of those keys are switched off.
• Customization of pointer appearance, such as size, color and shape.
• Predictive text
• Spell checkers and grammar checkers

Durable Medical Equipment (DME)

• Seating products that assist people to sit comfortably and safely (seating systems, cushions, therapeutic seats).
• Standing products to support people with disabilities in the standing position while maintaining/improving their health (standing frame, standing wheelchair, active stander).
• Walking products to aid people with disabilities who are able to walk or stand with assistance (canes, crutches, walkers, gait trainers).
• Advanced technology walking products to aid people with disabilities, such as paraplegia or cerebral palsy, who would not at all able to walk or stand (exoskeletons).
• Wheeled mobility products that enable people with reduced mobility to move freely indoors and outdoors (wheelchairs/scooters)
• Vehicles modified with Height adjustable suspension, to allow wheelchair entry to the vehicle
• Robot-aided rehabilitation is a sensory-motor rehabilitation technique based on the use of robots and mechatronic devices

Learning difficulties

• Age-appropriate software
• Cause and effect software^[1]
• Hand-eye co-ordination skills software
• Diagnostic assessment software
• Mind mapping software
• Study skills software
• Symbol-based software^[2]
• Text-to-speech
• Touch typing software

Visual impairment

Choice of appropriate hardware and software will depend on the user's level of functional vision.

• RIAS (Remote Infrared Audible Signage) has the potential to help both low vision and the blind navigate outside and indoors.

Hardware

• Large monitors.
• Adjustable task lamp, using a fluorescent bulb, shines directly onto the paper and can be adjusted to suit.
• Copyholder holds printed material in near vertical position for easier reading and can be adjusted to suit.
• Closed circuit television (CCTV) or video magnifiers. Printed materials and objects are placed under a camera and the magnified image is displayed onto a screen.
• Modified cassette recorder. To record a lecture, own thoughts, ideas, notes etc.
• Desktop compact cassette dictation system. To allow audio cassette playback with the aid of a foot pedal.
• Fusers produce tactile materials, for example diagrams and maps, by applying heat to special swell paper.
• Scanner. A device used in conjunction with OCR software. The printed document is scanned and converted into electronic text, which can then be displayed on screen as recognisable text.
• Standalone reading aids integrate a scanner, optical character recognition (OCR) software, and speech software in a single machine. These function together without a separate PC.^[3]
• Refreshable Braille display. An electronic tactile device which is placed below the computer keyboard. A line of cells which correspond to Braille text move up and down to represent a line of text on the computer screen.
• Electronic Notetaker. A portable computer with a Braille or QWERTY keyboard and synthetic speech. Some models have an integrated Braille display.
• Braille embosser. Embosses Braille output from a computer by punching dots onto paper. It connects to a computer in the same way as a text printer.
• Perkins Brailler. To manually emboss Grade 1 or 2 Braille.

Software

• Customization of graphical user interfaces to alter the colors and size of desktops, short-cut icons, menu bars and scroll bars.
• Screen magnifiers
• Screen readers
• Self-voicing applications
• Optical character recognition. Converts the printed word into text, via a scanner.
• Braille translation. Converts the printed word into Braille, which can then be embossed via a Braille embosser.
• Text-to-speech and Speech-to-text
• Spell checkers and Grammar checkers

Augmentative and Alternative Communication (AAC)

Augmentative and alternative communication is a well defined specialty within AT. It involves ways of communication that either enhance or replace verbal language. When combined with Applied Behavior Analysis (ABA) teaching methods, AAC has improved communication skills in children with Autism. AAC devices vary widely with respect to their technological sophistication:

• Low-tech systems. Simple paper or object based systems, i.e. do not require a battery (e.g., Talking Mats, Dry Erase Boards, Clipboards, 3-Ring Binders, Manila File Folders, Photo Albums, Laminated PCS/Photographs, Highlight tape).
• Light-tech systems. Typically consisting of a digitized speech recorder with a touch-sensitive display pad and sometimes switch access. Lite-tech systems require a battery (e.g., Tape Recorder, Language Master, Overhead Projector, Timers, Calculators).
• High-tech systems. Computerized VOCAs that vary from single purpose appliance-like systems to multipurpose computer-based communication aids. Typically high-tech systems require training and ongoing support to operate the devices (e.g., Video Cameras, Computers and Adaptive Hardware, Complex Voice Output Devices).

Deafness and hearing loss

• Audiometer
• Fire alarm paging system
• Loop system (portable and fixed)
• Radio aids
• Telecommunications device for the deaf
• Teletext
• Video cassette recorders that can read and record subtitles (Closed Captioning).
• Vibrating fire alarm placed under pillow when asleep.
• Door bell lighting system.

Others

• Wakamaru provides companionship, reminds users to take medicine and calls for help if something is wrong.
• Telephone Reassurance: community based program that calls seniors at home ensuring their well-being.^[4]
• Cosmobot is part of a play therapy system designed to motivate children to participate in therapy.
• General User Interface for Disorders of Execution (GUIDE) is an interactive verbal prompting system that talks people with cognitive impairment through daily routine tasks.^[5]

See also

• Braille technology
• Computer accessibility
• Design for All
• Matching Person & Technology Model
• Occupational Therapy
• Robot-aided rehabilitation
• Web accessibility

References

1. ^ Bates, Roger; Jones, Melanie (2003). "Using Computer Software To Develop Switch Skills". 2003 [Technology and Persons with Disabilities] Conference Proceedings. http://www.csun.edu/cod/conf/2003/proceedings/6.htm. Retrieved 2007-02-08. 
2. ^ Hawes, Paul; Blenkhorn, Paul (2002). "Bridging the Gap between Aspiration and Capability for Aphasic and Brain Injured People". 2002 [Technology and Persons with Disabilities] Conference Proceedings. http://www.csun.edu/cod/conf/2002/proceedings/220.htm. Retrieved 2007-02-08. 
3. ^ "What is a reading aid – technology information sheet". Royal National Institute for the Blind. 2006-09-29. http://www.rnib.org.uk/xpedio/groups/public/documents/PublicWebsite/public_readingaidsinfosheet.hcsp. Retrieved 2007-02-08. 
4. ^ assistivetech.net: Telephone Reassurance. Accessed 2009-08-06.
5. ^ Brian O'Neill and Alex Gillespie: "Simulating naturalistic instruction: the case for a voice mediated interface for assistive technology for cognition", Journal of Assistive Technologies Volume 2, Issue 2 (June 2008): 22-31. Accessed 2009-08-06.

Further reading

• Behrmann, M. & Schaff, J.(2001). Assisting educators with assistive technology: Enabling children to achieve independence in living and learning. Children and Families 42(3), 24-28.

• Bishop, J. (2003). The Internet for educating individuals with social impairments. Journal of Computer Assisted Learning 19(4), 546-556. Available as a free download

• Cain, S. (2001). Accessing Technology - Using technology to support the learning and employment opportunities for visually impaired users. Royal National Institute for the Blind. ISBN 1-85878-517-0.

• Cook, A., & Hussey, S. (2002). Assistive Technologies - Principles and Practice, 2nd Edition. Mosby. ISBN 0-323-00643-4

• Edwards, A. D. N., (Ed.) (1995). Extra-Ordinary Human-Computer Interaction: Interfaces for Users with Disabilities. Cambridge Series on Human-Computer Interaction. New York, Cambridge University Press. (Also available as part of the CD-rom, Overcoming Barriers: Theory and Practice in Disability, Cambridge University Press, 1999).

• Franklin, K.S. (1991). Supported employment and assistive technology-A powerful partnership. In S.L. Griffin & W.G. Revell (Eds.), Rehabilitation counselor desktop guide to supported employment. Richmond, VA: Virginia Commonwealth University Rehabilitation Research and Training Center on Supported Employment.

• Van der Heijden, D. (2005). How Does Alternative Access to Computers Work?. Jun 26, 2007.

• Lahm, E., & Morrissette, S. (1994, April). Zap 'em with assistive technology. Paper presented at the annual meeting of The Council for Exceptional Children, Denver, CO.

• Lee, C. (1999). Learning disabilities and assistive technologies; an emerging way to touch the future. Amherst, MA: McGowan Publications.

• McKeown, S. (2000). Unlocking Potential - How ICT can support children with special needs. The Questions Publishing Company Ltd. ISBN 1-84190-041-9

• Nisbet, P. & Poon, P. (1998). Special Access Technology. The CALL Centre, University of Edinburgh. Available as a free download The CALL Centre. ISBN 1-898042-11-X

• Nisbet, P., Spooner, R., Arthur, E. & Whittaker P. (1999). Supportive Writing Technology. The CALL Centre, University of Edinburgh. Available as a free download The CALL Centre. ISBN 1-898042-13-6

• Rose, D. & Meyer, A. (2000). Universal design for individual differences. Educational Leadership, 58(3), 39-43.

• Orpwood, R. Design methodology for aids for the disabled. J Med Eng Technol. 1990 Jan-Feb;14(1):2-10. | PubMed ID: 2342081

• Scherer, M. J. (2005). Living in the State of Stuck: How Assistive Technology Impacts the Lives of People with Disabilities, Fourth Edition. Cambridge, MA: Brookline Books: ISBN 1-571-29098-2.

• Scherer, M.J. (2004). Connecting to Learn: Educational and Assistive Technology for People with Disabilities. Washington, DC: American Psychological Association (APA) Books: ISBN 1-557-98982-6.

• Scherer, M.J. (Ed.). (2002). Assistive Technology: Matching Device and Consumer for Successful Rehabilitation. Washington, DC: APA Books: ISBN 1-557-98840-4.

• Swann, J.I. (2007) Promoting independence and activity in older people Quay Books: ISBN 9781856423342

• Adlam, T. et al. The installation and support of internationally distributed equipment for people with dementia." IEEE transactions on information technology in biomedicine (1089-7771) yr:2004 vol:8 iss:3 pg:253-257 | download from IEEE (694k PDF)

• Poulson, David; Martin Ashby; Simon Richardson (eds.) (1996). userfit. A practical handbook on user-centred design for Assistive Technology. TIDE USER consortium.