Assistive technology

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Hearing aid

Assistive technology or adaptive technology (AT) is an umbrella term that includes assistive, adaptive, and rehabilitative devices for people with disabilities and also includes the process used in selecting, locating, and using them. 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 changing methods of interacting with, the technology needed to accomplish such tasks.

Examples of Assistive technology include the curb cut in architecture, standing frames, text telephones, accessible keyboards, large print, Braille, and speech recognition software. Assistive technology or interventions are sometimes controversial or rejected, for example in the controversy over cochlear implants for children.

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 travelers and workers with pull-type bags.

Mobility impairment and wheelchairs

A typical modern battery powered chair.

A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing. Wheelchairs are used by people for whom walking is difficult or impossible due to illness (physiological or physical), injury, or disability. People with both sitting and walking disability often need to use a wheelbench.

Personal Emergency Response Systems

This voter with a manual dexterity disability is making choices on a touchscreen with a head dauber.

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 caregiver or contact center who can respond appropriately.

Accessible input devices for computers

This is a sip-and-puff device which allows a person with substantial disability to make selections and navigate computerized interfaces by controlling inhalations and exhalations.

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. Key guards fit over the keyboard to help prevent unintentional key presses.

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.^[1][2] 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 writing^[3]
• 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, such as eye trackers which allow the user to control the mouse with their eyes.

Accessibility software

In human-computer interaction, computer accessibility (also known as Accessible computing) refers to the accessibility of a computer system to all people, regardless of disability or severity of impairment. Examples include Web accessibility a set of guidelines ^[4] and two accessible^[5] web portals designed for people developing reading skills are peepo.com [1] — try typing a letter with your keyboard for more — and peepo.co.uk [2] with enhanced graphics, unique style controls and improved interactivity (requires an SVG supported browser).

Durable medical equipment (DME)

Durable medical equipment is a term of art used to describe any medical equipment used in the home to aid in a better quality of living. It is a benefit included in most insurances. In some cases certain Medicare benefits, that is, whether Medicare may pay for the item. The item is defined by Title XIX for Medicaid and includes iron lungs, oxygen tents, Nebulizers, CPAP, catheters, hospital beds, and wheelchairs^[6]

Assistive technology for visual impairment

Many people with serious visual impairments live independently, using a wide range of tools and techniques. Examples of assistive technology for visually impairment is include the Canadian currency tactile feature, which a system of raised dots in one corner, based on Braille cells but not standard Braille.^[7] For general computer use access technology such as screen readers, screen magnifiers and refreshable Braille displays has been widely taken up.

Hardware

• White canes
• Large monitors can be used with increased DPI for ease of electronic text reading.
• E-book readers, such as the Amazon Kindle and tablet computers, such as the iPad, which offer text-to-speech and adjustable font size features.
• Adjustable task lamp, using a fluorescent bulb, shines directly onto the paper and can be adjusted to suit.
• Bank note reader
• 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 recognizable 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.^[8]
• 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.
• Mountbatten Brailler. An electric braille writing machine.
• Eye Tracking. and Head Tracking Devices

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
• Real-time text for the deaf.

Augmentative and alternative communication (AAC)

An AAC user uses number coding on an eye gaze communication board

Augmentative and alternative communication (AAC) is an umbrella term that encompasses methods of communication for those with impairments or restrictions on the production or comprehension of spoken or written language.^[9] AAC systems are extremely diverse and depend on the capabilities of the user. They may be as basic as pictures on a board that the are used to request food, drink, or other care; or they can be advanced speech generating devices, based on speech synthesis, that are capable of storing hundreds of phrases and words.^[10]

Modern use of AAC began in the 1950s with systems for users who had lost the use of speech following surgical procedures.^[11] During the 1960s the use of manual sign language grew greatly, but it was not until the 1980s that AAC began to emerge as an area in its own right.^[11] AAC is now used for a wide variety of speech impairments. Studies show that AAC use does not impede the development of speech, and may even result in a modest increase in speech production.^[12]

A great diversity of diagnoses, including cerebral palsy, intellectual impairment, autism, and many others, cover varying degrees of communication impairment. AAC interventions are highly individualized, taking into account specific abilities of language comprehension, social-relational characteristics, learning strengths and weaknesses, and developmental patterns for specific types of intellectual disabilities.^[13] AAC can be used to aid both spoken and written language, and can supplement or replace speech and writing as necessary. AAC can be a permanent addition to a person's communication or a temporary aid.^[9] The systems used in AAC include gestures, hand signals, photographs, pictures, line drawings, words and letters,^[14] which can be used alone or in combination to communicate.^[15]

Aided AAC makes great use of symbols, particularly for non-literate users,^[14] as well as a large variety of input methods. The specific access method will depend on the skills and abilities of the user. Body parts, pointers, adapted mice, joysticks, or eye tracking^[16] could be used, whereas switch access scanning is often used for indirect selection.^[17] In many cases, rate enhancements methods may be used to speed up the generation of messages.^[14] Clearly, an evaluation of a user's abilities and requirements is necessary to match a user with the most appropriate AAC method, input approach, and vocabulary. This evaluation requires the input of family, particularly for early intervention. Respecting ethnicity and family beliefs are key to a family-centered and ethnically competent approach.^[18] Adult AAC users generally have satisfying relationships with family and friends and engage in pleasurable and interesting life activities.

Deafness and hearing loss

• 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.

Assistive Technology for Cognition

Assistive Technology for Cognition (ATC)^[19] is the use of technology (usually high tech) to augment and assistive cognitive processes such as attention, memory, self-regulation, navigation, emotion recognition and management, planning, and sequencing activity. Systematic reviews of the field have found that the number of ATC are growing rapidly, but have focused on memory and planning, that there is emerging evidence for efficacy, that a lot of scope exists to develop new ATC^[20]. Examples of ATC include:

• NeuroPage uses a pager system to prompt users about meetings. It was one of the earliest ATC to provide randomised control trial evidence of efficacy^[21]

• 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.^[22]
• 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.^[23]

Claims Since children with autism process visual information easier than auditory information, when utilizing assistive technology claims that any time we use these devices with these children, we're giving them information through their strongest processing area (visual). Therefore various types of technology from "low" tech to "high" tech, should be incorporated into every aspect of daily living in order to improve the functional capabilities of children with autism.

Benefits Regarding comprehension skills, increasing comprehension of tasks/activities/situations is essential in addressing skill areas such as organization, attending, self help, following directions, following rules and modifying behavior. As a result, the child becomes more independent. The following "low" tech visual support strategies can be created and used to benefit and assist the child in increasing his comprehension skills and thus decreasing the occurrence of challenging behaviors.

Consistent daily use of an individualized visual schedule will increase a child's organization skills and independent functioning throughout all aspects of his life and will ease transition through adulthood. There are numerous ways to present visual schedules for example an object schedule, 3-ring binder schedule, clipboard schedule, manila file folder schedules, and dry erase board schedules are all beneficial to increase a child's organization skills and independent functioning.

The use of a weekly/monthly calendar at both home and school can provide the child with important information regarding up-coming events/activities, rather than relying on auditory information. When the child asks when a particular event will occur, he can easily be referred to the visual calendar. Use of a visual calendar can also be helpful in assisting the child to understand when regularly scheduled events may not occur.

Outcomes In a pilot study, Researchers Lacava, Golan, Baron-Cohen, and Myles explored the use of assistive technology to teach emotion recognition to eight children with Autism and the results indicated that after intervention, participants improved on face and voice emotional recognition for basic and complex emotions that were in the software. As well as for complex voice emotional recognition for emotions not included in Mind Reading.

See also

• Braille technology
• Cognitive orthotics
• Design for All (in ICT)
• Matching Person & Technology Model
• OATS: Open Source Assistive Technology Software
• Occupational Therapy
• Web accessibility

Notes

1. ^ Chubon, R.A., Hester, M.R. (1988). "An enhanced standard computer keyboard system for single-finger and typing-stick typing". Journal of Rehabilitation Research and Development 25 (4): 17–24. PMID 2973523. 
2. ^ Anson, D., George, S., Galup, R., Shea, B., Vetter, R. (2001). "Efficiency of the Chubon versus the QWERTY keyboard". Assistive-Technology 13 (1): 40–5. doi:10.1080/10400435.2001.10132032. PMID 12212435. 
3. ^ PiTech
4. ^ http://www.learningdisabilities.org.uk/page.cfm?pagecode=ISSIWD
5. ^ http://www.learningdisabilities.org.uk/page.cfm?pagecode=ISSIWDAS
6. ^ 42 U.S.C. § 1395x(n)
7. ^ Accessibility features - Bank Notes - Bank of Canada
8. ^ "What is an electronic reading aid?". Royal National Institute of Blind People. 2009-12-01. http://www.rnib.org.uk/livingwithsightloss/Documents/What%20is%20an%20electronic%20reading%20aid.doc. Retrieved 2010-02-23. 
9. ^ ^{a b} ASHA (2005).
10. ^ Gilliam & Marquardt, pp. 356–359.
11. ^ ^{a b} Glennen & DeCoste.
12. ^ Schlosser & Wendt.
13. ^ Beukelman & Mirenda.
14. ^ ^{a b c} Mirenda.
15. ^ Beukelman & Mirenda, pp. 246-249.
16. ^ Mathy
17. ^ Jans & Clark.
18. ^ Perette et al. (2000).
19. ^ LoPresti, E.F., Mihailidis, A. & Kirsch, N. (2004). Assistive technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation, 14, 5-39.
20. ^ Gillespie, A., Best, C. & O'Neill, B. (2012). Cognitive function and assistive technology for cognition: A systematic review. Journal of the International Neuropsychological Society, 18, 1-19.
21. ^ Wilson, et al. (1997). Evaluation of NeuroPage: A new memory aid. Journal of Neurology, Neurosurgery and Psychiatry, 63, 113-115.
22. ^ assistivetech.net: Telephone Reassurance. Accessed 2009-08-06.
23. ^ Brian O'Neill, Kate Moran, Alex Gillespie (2010). "Scaffolding rehabilitation behaviour using a voice mediated assistive technology for cognition". Neuropsychological Rehabilitation 18: 1–19. http://lse.academia.edu/AlexGillespie/Papers/1347716/Scaffolding_rehabilitation_behaviour_using_a_voice-mediated_assistive_technology_for_cognition. 

References

• American Speech-Language-Hearing Association. (2005). "Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Position Statement". http://www.asha.org/docs/html/PS2005-00113.html. Retrieved 2009-01-23. 
• Gillam, Ronald Bradley; Marquardt, Thomas P.; Martin, Frederick N. (2000). Communication sciences and disorders: from science to clinical practice. Jones & Bartlett Learning. ISBN 9780769300405. 
• DeCoste, Denise C. (1997). "Chapter 10: Introduction to Augmentative and Alternative Communication Systems". In Glennen, Sharon; DeCoste, Denise C.. Handbook Of Augmentative And Alternative Communication. San Diego, CA: Singular Publishing Group. ISBN 1-56593-684-1. 
• Schlosser, R. W.; Wendt, O. (2008). "Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review". American Journal of Speech-Language Pathology 17 (3): 212–230. doi:10.1044/1058-0360(2008/021). PMID 18663107. 
• Beukelman, David R.; Mirenda, Pat (2005). Augmentative & alternative communication: supporting children & adults with complex communication needs (3rd ed.). Paul H. Brookes Publishing Company. ISBN 9781557666840. 
• Mirenda, P. (2003). "Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids". Language, Speech, & Hearing Services in Schools 34 (3): 203–216. doi:10.1044/0161-1461(2003/017). 
• Mathy; Yorkston, K.; Guttman (2000). "Augmentative Communication for Individuals with Amyotrophic Lateral Sclerosis". In Beukelman, D.; Yorkston, K.; Reichle, J.. Augmentative and Alternative Communication Disorders for Adults with Acquired Neurologic Disorders. Baltimore: P. H. Brookes Pub.. ISBN 978-1557664730. 
• Jans, Deborah; Clark, Sue (1998). "Chapter 6: High Technology Aids to Communication". In Wilson, Allan. Augmentative Communication in Practice: An Introduction. University of Edinburgh. ISBN 978-1898042150. http://www.callscotland.org.uk/Resources/Books/Augmentative-Communication-in-Practice/. 
• Parette, H. P.; Brotherson, M. J; Huer, M. B. (2000). "Giving families a voice in augmentative and alternative communication decision-making". Education and Training in Mental Retardation and Developmental Disabilities 35: 177–190. http://psycnet.apa.org/psycinfo/2001-17960-006. 

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): 24–8. 
• Bishop, J. (2003). "The Internet for educating individuals with social impairments". Journal of Computer Assisted Learning 19 (4): 546–556. doi:10.1046/j.0266-4909.2003.00057.x. http://www.jonathanbishop.com/publications/display.aspx?Item=9. 
• 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 ed.). 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. ISBN 0521434130.  (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. Rehabilitation counselor desktop guide to supported employment. Richmond, VA: Virginia Commonwealth University Rehabilitation Research and Training Center on Supported Employment. 
• Galvão Filho, T. (2009). Tecnologia Assistiva para uma Escola Inclusiva: apropriação, demandas e perspectivas. Tese (Doutorado em Educação) – Universidade Federal da Bahia, Salvador, 2009. (disponível em: <http://www.galvaofilho.net/tese.htm> )
• 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) (Free Download). Special Access Technology. The CALL Centre, University of Edinburgh. ISBN 1-898042-11-X. http://callcentre.education.ed.ac.uk/About_CALL/Publications_CAA/Books_CAB/SAT_CAC/sat_cac.html. 
• Nisbet, P., Spooner, R., Arthur, E., Whittaker P. (1999) (Free Download). Supportive Writing Technology. The CALL Centre, University of Edinburgh. ISBN 1-898042-13-6. http://callcentre.education.ed.ac.uk/About_CALL/Publications_CAA/Books_CAB/Supp_Writing_CAC/supp_writing_cac.html. 
• Rose, D., Meyer, A. (2000). "Universal design for individual differences". Educational Leadership 58 (3): 39–43. 
• Orpwood RD (Jan-Feb 1990). "Design methodology for aids for the disabled". J Med Eng Technol 14 (1): 2–10. doi:10.3109/03091909009028756. PMID 2342081. 
• Scherer, M. J. (2005). Living in the State of Stuck: How Assistive Technology Impacts the Lives of People with Disabilities (4th ed.). 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. (2004). "The installation and support of internationally distributed equipment for people with dementia" (PDF). IEEE Transactions on Information Technology in Biomedicine 8 (3): 253–7. doi:10.1109/TITB.2004.834393. PMID 15484430. http://ieeexplore.ieee.org/iel5/4233/29401/01331402.pdf. 
• Poulson, David; Martin Ashby; Simon Richardson (eds.) (1996). userfit. A practical handbook on user-centred design for Assistive Technology. TIDE USER consortium.