Assistive Technology in Practice: Devices that Support Function, Access, and Independence

Video Transcription

Steve Kirschke: Who’ve already joined and who are still joining. This is Steve Kirschke. I have Don Terry in the studio. Welcome, Don. Good

Don Terry: Morning.

Steve Kirschke: We got Laura remotely from Denver. Welcome, Laura. And we have Olivia Ollis. Olivia is our presenter today. She’s going to be talking about assistive technology. So this is always a highly requested topic. I think everyone’s interested to see what’s new and fresh out there, so we’re excited to hear what you have for us today. Before we do that, we’ll do a little bit of housekeeping, talk a little bit about QLI. Those of you who are familiar with QLI, thank you again for the partnership, and we really just appreciate the opportunity to work with you all. You might have to click. There you go. And those of you who are unfamiliar with QLI, we are based in Omaha, Nebraska. We are a post-acute and outpatient rehab program. We deal primarily with complex catastrophic neurological injuries. So you can see what our expertise is in below on that slide.

But the majority of the folks we serve have suffered a traumatic injury, a traumatic brain injury or spinal cord injury. So that’s kind of our bread and butter. In terms of today, just a little bit of housekeeping. Use the Q&A for any questions. You can pop them into the question and answer section within Zoom, as well as just a quick reminder on your CEUs. We just ask that you attend the majority of the session. There will be a poll question at the end. There’s only one poll question. If you feel like you missed it, just wait till the slide that says poll question. It’s a dead giveaway. As well as once you leave the webinar, you should be automatically prompted to fill out a job form. In doing so, once you submit that, your CEUs and your slides for the presentation, both will be sent to your email.

We do have individuals who sometimes miss this popup, whether it be you have them blocked or you just miss it, that’s okay. Just email Don or myself or Laura. We’ll get you set up. But with that, Olivia, I’ll kick it over to you.

Olivia Ollis: Great. Thank you so much for the introduction. Really excited to be here and talk about assistive technology today. I’m probably a little bit biased, but I think it’s one of the most fun areas of occupational therapy and can really make a big difference in somebody’s life. So I love to start out with QLI’s mission just because every session that we do and every intervention that we have, we try to tie it to our mission, just deliver life-changing rehabilitation and care, protect dignity, instill purpose and create hope and commit to excellence. I’ll let you read through the objectives, but overall, hoping that after today we’ll be able to describe various computer access solutions for return to work and return to school, discuss recreation from an assistive technology standpoint, go over voice activated environmental controls, and also apply client-centered approaches. I think sometimes assistive technology can feel a little bit intimidating, so hoping that this makes it a little bit more approachable for everybody.

The Importance of Assistive Technology

So the importance of assistive technology. Assistive technology is any device or piece of equipment that supports an individual. So like Steve was saying, we are working with people that have gone through a life-changing injury, so trying to give back pieces of autonomy and independence while also giving back pieces of life that they had before, but then promoting new hobbies, activities, and a new way of doing things.

Adaptive Gaming

The first thing I would love to go over is adaptive gaming. I feel like this is an area that’s really grown, and with our population especially, we have a lot of younger individuals. So this is a tie not only to socialization, recreation, and then connection.

Xbox Adaptive Controller

So the first piece of AT for gaming is the Xbox Adaptive Controller. I’m sure everyone has probably seen the Microsoft commercial from about 10 years ago. It was around Christmas time. You had a young kid and everybody in the neighborhood was really excited saying that he got the Xbox controller, and it was the first time that he was able to play a video game with his friends. And if that doesn’t make you want to buy one, I don’t know what does. A couple perks of the Xbox adaptive controller though. So you buy the white box and on the back of that it has a switch port for every control that’s on the standard controller. You also have a lot of flexibility within the Logitech adaptive switches, so that’s what you plug into the back. You’re able to have a lot of versatility in switch design, so you can use more gross motor movement patterns.

You can use fine motor skills. I’ve had individuals put them by their head, so they’re using their head for switches if they don’t have a lot of upper extremity function. It works great for individuals with hemiparalysis. I just had a resident recently, he was really into racing games and he had left-sided weakness, so we were able to put everything on his right side. He would use his right elbow for acceleration. He used his right foot for gas in reverse. We had different boost options, but his whole right side was decked out.

It made it a lot easier, and then he was able to actually play that with his kids and they were really excited. It was cool to see him with his sons. Xbox has also done a really wonderful job. Before, they didn’t have a joystick, and a lot of people that are avid gamers really like the 360. It’s a smooth control, so you can go any direction. We went out to Microsoft. We had the opportunity to meet with one of the inventors of the adaptive controller, and he had suggested at the time making our own. So we had purchased different parts and pieces to make an arcade joystick, and then you can actually plug that into the side of the Xbox. It reads a lot of different pieces of technology, which is cool, but now they have an adaptive joystick that you can use by itself and you can use it one-handed or you can also plug it into the adaptive controller and use a mount, so then you’re able to just use it as a joystick.

Xbox has also done a really cool job with the Copilot mode. Sometimes we have individuals that come through and from a cognitive perspective, they’re not able to game like they used to, or it might be a little bit overwhelming with all of the choices that they have, but they still want to be a part of it. With Copilot, they’re able to do their own controller, but then myself or a family member or a friend can use a controller and they’re playing together as one person. So sometimes maybe my resident’s the one shooting and I’m the one controlling the direction. Sometimes they have two different controls and I have the other three, but it’s a really cool way that they’re able to collaborate together. There’s also a lot of flexibility in the compatibility with it. So you are able to use the Xbox adaptive controller with PC gaming as well, which is really cool.

PC gaming world, there aren’t a ton of adaptive options. There are some mice that have buttons on the side, but it’s really hard though from a fine motor perspective. So I feel like this is very helpful to be able to use the switches. The only downside is the chord management. We use a lot of Velcro.

Steve Kirschke: I’m sure you’ve learned way more about gaming than you ever knew.

Olivia Ollis: Oh yeah. I am not a video gamer. My residents make fun of me because a lot of times I don’t know what the controls are, so I have to research that. I know how to adapt them, but I didn’t know stress until I played Halo with a group of guys. They were yelling. They’re like, “Watch out for the alien,” and I’m trying to go left and they’re like, “Oh, they’re left.” My heart rate was probably like 200. It was the most stressful session of my life. And then they’re like, “Same time next week.” I was like, “I don’t know if I’m cut out for that one.”

Steve Kirschke: Yeah. You might be talking about this, but I’m curious, what’s been your experience with Microsoft and what is that like? And if you’re going to hit it later, that’s okay too, but.

Olivia Ollis: No, this is a perfect time. I feel like Microsoft is a really great company for accessibility. I think the adaptive controller, just in talking with Bryce, he was one of the inventors that we got to meet, he just said there wasn’t a huge push in technology for accessibility yet, so they really opted to try to make gaming for everyone. But then I think starting with this, they were able to open up a lot of other doors and they started connecting with hospitals. They started connecting with individuals that had injuries or disabilities, and they said it was really eye-opening. They did say this is an area where they’re not making money, they’re actually losing money. But from a PR perspective, it’s a feel good area. They feel good about it and it gives people a lot more freedom, but I think that they did a really nice job not boxing it in.

We’ll go over PlayStation in a minute and it’s a really cool controller, but it’s just a lot more limited in what you can do with it as far as other devices where Microsoft has been a lot more open source.

Steve Kirschke: Cool.

PlayStation Adaptive Controller

Olivia Ollis: So leading into the PlayStation, this is the access controller. It just came out last year. I’ve had a lot of my younger individuals with SCIs really enjoy this if they have some function of both upper extremities. So when you purchase it, it comes with just one of them. There’s a lot of different button options. The nice thing is you don’t have to buy the switches separate. So for Xbox, you purchase the controller, which is about $99, and then you have to purchase the switches, which are another hundred. With the PlayStation, it is all in one. However, I found it beneficial for the majority of games to have two of the controllers, one for your right upper extremity and one for left upper extremity. But it does go back though just to what game you’re playing and how many controls you need. A couple of the highlights for this, they’re all magnetic, the little white buttons that are going around the circle, so you can pop those on and off.

They have convex and concave options, which is really nice. And then it comes with these little rubber buttons that are all labeled, and then you do all of the programming for it on the PlayStation application itself. So one of the cool things, I had an individual, he didn’t think that he’d be able to video game again, and he was very self-conscious about what his setup would look like. He didn’t love the Xbox one just because the buttons are very large, there were cords everywhere, and he’s like, “It looks weird. It looks different.” We spent a lot of time going over why appearance isn’t super important, but it was really important to him though that it was something small. He could fit it in his bag. He could go take it to his friend’s dorm room when he went back to college, and this was a really great fit for him.

A couple of nice things, he had multiple different profiles. So he had a right upper extremity profile for Madden, a left upper extremity profile for Madden. He had the same setup, but switched a couple controls out for 2K basketball, if anybody else didn’t know. Another area that I learned, but you can just select those profiles so you don’t have to go and reprogram them every time, you just have to switch out those buttons. And then it comes with a joystick. So the joystick’s included on both. You can switch the topper out really easy. The magnetic pieces for the joystick, most of my individuals are able to switch those out themselves. They range from really tiny to a little bit bigger. It comes with three options.

One of my favorite parts is that you can dual assign a button. So something I didn’t realize that you do a lot in gaming is pressing two buttons at once. And if you imagine having an upper extremity deficit, that can be really difficult to coordinate the movement. So if it’s something where I have to hit L1 and A at the same time, I can dual assign one of the buttons for that. So there’s a lot of customization. It does, unfortunately, it only works for the PS5. So if you have a PS4, it won’t work. I haven’t been able to get it to work with an adapter to work with any other device. So if you have a PS5, it’s great, but it’s not as flexible as the Xbox.

Steve Kirschke: So you’re saying the Xbox, the newest model versus the oldest model, they’re interchangeable and this one’s not so much? I

Olivia Ollis: Think the Xbox starts with Xbox 360 is the oldest that you can use it for, but you can play up or down, and then PlayStation will only work for the PS5. Got it.

Nintendo Switch Adaptation Options

Nintendo Switch. Unfortunately, there aren’t a ton of adaptation options. However, I feel like it’s really popular, especially since the Nintendo Switch two came out. You’re able now, which is a newer feature, you can remap the buttons. They’re still going to be labeled how they come out of the factory, but if I wanted X to be A or B to be X, I can switch those around within the app. There is an adapter that we found. It’s on Amazon. It’s fairly cheap. And using that, I’ve been able to pair the Xbox adaptive controller with the Nintendo Switch. I don’t know if Nintendo would love that option, but it works. And then we also have been trying our hand at some 3D printing.

There are some great resources online. So if you have an individual that’s using one upper extremity for gaming, we’re able to print for one hand and you can kind of see how it’s sandwiched in. So that’s for your right hand and then you can switch it in reverse for left upper extremity. It costs less than a dollar to print those, which is really nice.

Hoping that they might come out with their own adaptive controller eventually, but I haven’t heard any rumors of that yet. I will say the Nintendo Switch, I talk about grading activities a lot in occupational therapy and it translates really well for gaming also. Nintendo Switch, a lot of the games are like Mario Kart where it’s a little bit more simple. We’ve had really good luck with you can set it so that you’re not driving off the road, you can set it so that you stay on the course the whole time. We can downgrade some of the controls so you’re not using all of the special features. I think that’s the same across any game. You can do that for Xbox or PlayStation, but just knowing where to start your individual with a video game. It can be difficult or challenging when you’re used to playing video games at a higher level and then after your injury, it’s really difficult either from a cognitive or a motor standpoint.

So sometimes grading it helps, and you start simple, and then you keep building your way up until you get to the desired game. I think those are our big ones for gaming.

Return to Work and School Devices

So transitioning over to return to work and school. I think this can be such a huge part of somebody’s identity. One of the first things that you’re asked when you introduce yourself, if you’re in a school setting, what year are you? What grade are you? If you’re an adult and a professional, people love to know what you do for work. And a lot of our individuals just for independence and to instill purpose, they want to go back to school or work, so how are we finding the right devices that work for them? So we have quite a few different ones. We have input devices, head tracking, eye gaze, voice control, and note taking.

Input Devices (Adaptive Mouse Options)

We start with input devices. We look a lot at adaptive mouse options. Microsoft, again, they just came out close to two years ago, two and a half years ago with a lot of adaptive mice and they’re super affordable. They’re around $30. So using the adaptive hub, you’re able to connect that to your computer with Bluetooth or with a USB-C, and then you can pick. You only have to buy one mouse and then you can get different toppers for each mouse and you can actually 3D print those. They made them open source. So if you have access to a printer, you can be printing the toppers for less than a dollar a piece. So it’s a pretty small investment and there’s a lot of different options. I will say some of them, they’re smaller, so they’re very light. So a lot of times I’m using Velcro or Dycem to help keep those down just from an ease of access standpoint.

But I have noticed though a lot of my individuals that use them, they like them because it’s a sleek design. It doesn’t look super accessible in nature, so a lot of people don’t bat an eye at it. I found that’s a really big thing with assistive technology. A lot of my adults don’t want things that are bright and primary colors and that are drawing a lot of attention. They just want something that works well and matches what they already have.

Steve Kirschke: You seem to have mentioned that a couple times. Is that something you’ve been surprised by in terms of just aesthetics compared to just functionality?

Olivia Ollis: We do have a lot of younger individuals, but they’re all adults and they don’t want something big and bright. A lot of my guys that I’m working with right now are returning to college or going to college for the first time, and they already went through this life-changing injury, so maybe they’re using a wheelchair for the first time and now they’re going with individuals their age. They’re in a wheelchair that looks different. And then they’re pulling out all this adaptive equipment and it’s just drawing a lot of attention when really they just want to go to class and they want to be a normal college student. I had, which he just discharged, but an individual, he does a lot of lecturing. He works for the government. He also teaches at a college. He’s like, “I don’t want people to be focused on the device that I’m using.

I want them to be focused on what I’m doing with them or what I’m lecturing on.” And I think when we think of technology, we all want the new and sleek design. We want the cool phone. We want the nice sleek looking laptop. So I don’t think our accessories should be any different, and I’ve just noticed a lot with AT, there’s a lot of primary colors. Just aesthetics aren’t first and foremost. It’s mostly function, which is really important, but it’s nice that companies though are starting to make more modern designs.

One of the other adaptive mouse options that I found to be super helpful is the Kensington Expert Mouse. It’s nice because it has four large buttons, so you can use more of a gross motor skill and you can pre-program those. So you can switch around where your left click is, where your right click is. I can make one of them so they copy, one to paste, but there’s a lot of programming involved. And then the top, it looks like a pool ball. I lost a bet. It’s not the same size as a pool. They’re not interchangeable, but it’s a really smooth 360 and you don’t have to use any fine motor skills for it. All of these two, when you’re using them, you can just change the mouse settings within the computer. You don’t actually have to change your scroll speed or your mouse speed separately, which is really nice and it makes it super easy to teach somebody how to use.

And then the last big option, if somebody’s using a physical mouse, is using your power wheelchair joystick as a mouse. It’s super easy to connect with Bluetooth. Again, you can change the settings that are already in your computer. It’s nice because you can use it on a laptop, a desktop, you can use it on your phone. You can have multiple different inputs. Some people can even use it for their TV. The only downfall is you’re not able to readjust your chair while you’re using it. You can change your tilt so you can still do pressure reliefs, but you’re not able to drive it. You have to flip out of that menu option and go to a separate mouse option. I feel like it’s not quite as efficient as some of the others. However, it’s a lot less fatiguing, and if your individual’s already able to drive their joystick, then you know that they will be successful with the mouse.

Steve Kirschke: Is it plugged in?

Don Terry: We do have a question submitted. Are these devices available to the public or…

Olivia Ollis: Yes

Don Terry: Just folks with. Okay.

Olivia Ollis: Yep. You can order any of these online. Amazon has the Kensington mouse. You can get all of the Microsoft adaptation mouse options. Those are all available on Microsoft’s website. A lot of these two aren’t really. The Microsoft ones are targeted for accessibility. The Kensington one was originally made more for just proper ergonomics. So if anybody just wants a cool mouse, you can totally just go buy one. And it’s nice too, because since they aren’t super expensive and a lot of times these are hard to get covered or hard to find grants for, so your out-of-pocket payment isn’t quite as outstanding as some of the others, makes it more obtainable.

Head Tracking

Sorry. Next, we’ll move on to head tracking. So if you have an individual that lacks upper extremity function, head tracking can be a really great option. I listed my three favorites that I found so far. My first one is the Cato. It’s by Autonomous Living Solutions. It’s still in beta testing. We are lucky enough. I met them at a conference and we’ve been beta testing here and we’ve actually had a lot of success with it. It’s really flexible in programming so the end user can fully customize it to their desired settings. Right now I have somebody using it on our long-term care. He has pretty good cervical range, but he’s not able to do really far stretching that’s quite fatiguing for him. So we have a quick movement. We’ll actually jump the cursor all the way over to the right or the left. It’s a little bit harder to program.

It doesn’t look as user-friendly on the interface side, but once you have it programmed, then you’re set. I guess to program it, you would need somebody assisting you with that part unless you already have a head tracking device that you’re using to program it. So you do have to have somebody initially help set it up.

Don Terry: Somebody as in an IT person or just a family member or a friend or somebody who knows a little bit about computers?

Olivia Ollis: Probably somebody that knows a little bit about computers. They do have instruction manuals that they’re putting out online. It took me a few practice rounds and their company actually helped me set them up. Once I did it twice, it’s pretty easy. But the first couple times I think because there’s so many options with customization, it’s not just a quick and easy scroll bar. You have to know what they’re all labeled as, and right now it still looks pretty program heavy. So it’s X-axis, Y-axis. There’s a lot of labels where some of it’s just trial and error. I was

Steve Kirschke: Going to say, it sounds like some troubleshooting just to get parameters set and the sensitivity or I’m making stuff up at this point, but.

Olivia Ollis: Yeah, it’s a lot more work, I would say, upfront. It comes just out of the box with some basic user functions. Once though you want to start customizing, it can be a little bit programming heavy. The really nice thing though is they’re estimating that the price point for this will be around $200, which isn’t cheap by any means, but in comparison to the other head tracking options that I’m going to show you, it’s significantly lower in price. The Zono is, I would say, probably the biggest competitor for that once it comes to market. So the Zono is an earpiece. I feel like it looks really sleek. You have a lot of adjustments that you can make in the settings, but it looks really user-friendly. When you download it, there’s an app, you can scroll the settings, it’s easy to look at. There’s a lot of ease of access where family can be helpful, friends can be helpful, where you might not need someone that knows as much about computers.

The really cool thing about both of these are too, you can use it with your phone, you can use it with an iPad or tablet, or you can use it with a laptop or desktop, and then you can. There’s different options. So you can use dwell time where you hover over something for a desired amount of time and then it’s going to automatically click and that’s customizable or we can pair it with switches. With the Cato and the Zono, I’ve paired them both with an arrow switch, which is just a Bluetooth button. So somebody might be able to do a big press for a left switch and then they’ll use head tracking for everything else. But I think the flexibility though, just knowing that you can pair it with different objects or different switches and options is really helpful.

Steve Kirschke: So just this might be a little bit of an off topic, but I think it’ll make sense. Practically, in addition to let’s just say at QLI in someone’s day, practically you’re meeting with our residents to set these things up and that’s kind of alongside their other therapies and in addition to, correct?

Olivia Ollis: Yes.

Steve Kirschke: I’m guessing there’s some setup and then there’s the functional use that they might be using in some of our other therapies such as speech therapy where they might be looking for a job and things like that, right?

Olivia Ollis: Absolutely.

Steve Kirschke: Practically, there’s just a lot of troubleshooting and figuring out the right device and setting it up, and then the user portion of it.

Steve Kirschke: That’s kind of how it looks?

Olivia Ollis: Yeah. So I’m fortunate enough I get to meet every resident that comes on campus. I do an assessment with each individual, and then if it’s somebody that does need assistive technology, there’s a little bit of trial and error at first, just figuring out which device works best for you. And maybe they are able to use a mouse, but it’s really fatiguing though, so they can only use it for an hour a day. It’s not super functional at this point, so then maybe it’s time to start looking at some head tracking options. Once we find what device we want to use and I feel like I have the settings in a pretty good spot and the individual’s able to do a little bit of troubleshooting or direct somebody else and the mouse is moving too fast, I need to lower it and here’s how we do it, I will send instructions to all the teams, that way they know how to do it, and then I try to make myself pretty available too.

I don’t want the individual to be so frustrated with the device that they don’t want to use it anymore, but the more repetition that we get though, the better. And then it’s a lot easier if we’re able to get those repetitions in while we’re here. I’m so fortunate that the rest of the clinical team and the residential team are all really excited to learn about these, so I can do some co-treats and join in, and then they’re able to be helpful too, so it’s a little bit less intimidating for my resident, but then they’re getting those repetitions. Maybe it’s using their phone in the evenings or maybe it’s checking their schedule throughout the day to know what therapy they have next.

Don Terry: Gotcha.

Olivia Ollis: So that’s been really helpful.

Don Terry: Couple questions coming in. For the head tracking devices, are those compatible with platforms like iOS, WIN, and Chromebook?

Olivia Ollis: Yeah. The Cato and the Zono, I feel like they both work really, really great with iOS. There’s a lot of customization you can do. Apple just has a really great accessibility settings area where it’s already programmed in your phone and they’re designed to work alongside those. With Android, we’ll talk about that a little bit more later when we talk about voice control, but Android, you’re having to download separate apps for each accessibility feature where Apple, it comes with the device. So just a little bit more work on the back end to get the same result, but they do both work though across all platforms.

Don Terry: For age appropriateness, is there a limit on the low end? How soon can kids start using some of these devices?

Olivia Ollis: I’m honestly not as well versed in pediatrics. I work with an adult population. I think just off the top of my head, a couple things I would think of would be, are they intentional with their movements? Are they able to go to their desired location? And maybe that’s putting an iPad. I don’t have this in the PowerPoint, but something I use a lot with my individuals that may have cognitive deficits after an injury is putting an iPad in assistive access mode. It simplifies your entire phone or your entire iPad, so then you can pick how many apps are on a screen. It makes them a lot larger so you have bigger targets to choose from. It’s less visual clutter. So maybe starting with something like that and then slowly adding more apps or you go in and out of assistive access.

Steve Kirschke: Do you feel like that would be appropriate for Don Terry?

Don Terry: On the tech savviest have, let’s limit the opportunities.

Olivia Ollis: It’s appropriate for everybody.

Katie knows how to do it, but I haven’t seen anything with an age limit. I think as long as they can be intentional with movements and with what the desired outcome is, I wouldn’t see an issue with it, but I’m also. I don’t specialize in pediatrics, so I’d be interested to know if anybody decides to try it. Perfect. The last tracking option, this one’s been around for a while. It’s the Glasshouse glasses. I feel like this, at least at QLI, has gotten a little bit less popular now that there are some smaller sleeker options, but you wear them like glasses. They also have a headband and a baseball cap option, but it tracks. I feel like it looks a little bit more sci-fi. I have some individuals that love it. I had a guy that was. He wanted people to know that he was using high-tech stuff.

He compared himself to Iron Man, but then I’ve had other people that are like, “I don’t want something on my face all day.” So it really just depends, but there’s a ton of different switch options, which is really cool. So the bite switch is the most popular that I found and that comes with it, but you can also do a proximity switch, so you can just hover over so you don’t actually have to click on anything. They have some that you can strap to a specific muscle group, so if maybe you’re able to. You have some use of bicep or wrist flexors, you can strap it there and that can trigger a click as well. I haven’t found as many individuals reaching towards this option, but I do It’s a good one just to know about and have in your back pocket because it could be a great fit for somebody.

Eye Gaze

Our next pretty high tech option is eye gaze. I try to reserve this one if the rest of them are not working. So if we’re not able to use head tracking, maybe I just don’t have enough cervical range or it’s really fatiguing, I’m not able to use voice, I can’t use a combination of voice with mouse with head tracking, then I’m going to go to iGaze. This is for a couple different reasons. EyeGaze is really expensive. It’s really finicky. There’s a lot of programming. You have to have it in really good locations. You have to have a really great setup. It works great when you have it perfect. So a few options are the Iris Bond Heru. I was able to try all this a few months ago. It’s significantly cheaper than the Toby options. However, I found it’s not quite as precise as the Toby options and you have to have a really good setup as far as not having a glare on the screen.

You can’t have the room too dark, but it can’t be too bright. But it can though work with iOS and Windows, which is nice. And then it’s an attachment that you purchase to go with your device. And there’s a lot of different case options. The Toby Dynavox I feel like is the one that everybody thinks of when they think of iGaze. It’s Windows based. You can use it for your phone. So you don’t use it with your phone, but you can make the device itself your phone. So you can tie it to your phone plans, you can make calls, send text messages, you can scroll through Facebook, Instagram, any of those apps. You can browse the web. There’s a lot of different AAC app options that you can put on here and a lot of customization options similar to what I was saying with the assistive access for the iPad.

I can change the grid size. I can add more. I can take some away. I can make the keyboard larger, smaller. And then the TD Pilot, that one is really cool. They partnered with Apple and Apple doesn’t love partnering with people. So I think that was kind of a cool opportunity that they took. So it works with an iPad, which is nice for Apple users because it looks familiar. You don’t have to switch over to Android. A couple downsides though, you cannot connect it to a phone number. You can tie it to your Apple ID so you can communicate Apple device to Apple device. Otherwise you would have to use a third party app like WhatsApp or GroupMe for sending messages. But you are able to also pair that with a lot of the Apple settings. So it’s all within the settings, so a little bit more user-friendly for configuration.

A couple tricky things about iGaze though, aside from having the perfect setup, it tracks pupils. So one of my individuals that I’ve been trialing it with, he has really small pupils and he has fairly poor ocular motor function. So it’s really hard for him to move his eyes all the way to the left, all the way to the right to be able to use the entire screen. He also has transition glasses. So the lenses, when you look up or you’re looking down, it distorts what your pupil looks like just a little bit, which I hadn’t thought about until I was talking to some of the reps and they were like, “Oh, he has transition lenses.” So there’s a lot of just little factors that you don’t think about. And iRespond had suggested for their users that have glasses to have either a really slim wire frame or the clear glasses.

That way it’s not interacting with the pupil tracking because if you have a darker frame, it actually doesn’t work as well. So just some considerations to think about. It can be a really great solution. It just has to be the right individual for it.

Voice Control Solutions

We’ll slide over to voice control solutions. I feel like this is one of the most popular things that I use, not only on my SCI side, but also on my TBI or stroke side too. We found if you think about aphasia, there’s expressive receptive, but sometimes it’s also hard just being able to read text or being able to type. It’s not as efficient, so voice to text can really help. So a few of the options. We have Apple, Android, and then your third party options. So Apple is nice. It’s iOS compatible only. It’s available in Apple settings. You don’t have to do anything special to start it. You can use Siri to turn it on and off so the individual can do it completely independently. They don’t need somebody to help them get it set up initially. It will label your screen with numbers or you can use a grid.

So instead of having to say, “Hey Siri, open messages. Hey Siri, go home,” you’re able just to give it direct commands. You can also tell it to go to sleep or wake up so that it starts or stops listening. So if I’m having a full conversation, my phone’s not keeping track of everything and typing it into a big text box. I can switch modes to command mode, dictation mode. And the nice thing about Apple Voice Control is it’s really consistent from phone to iPad to laptop. It’s the exact same commands for everything, so you’re not having to learn separate commands or separate ways to say things. And it’s pretty loose speech. You’re able to use very conversational tones with it and it listens well.

On the other side of that, if you have an Android phone, there are voice control options too. You have to download it from the Play Store. And I feel like it works really well with the phone itself. Working with other apps, if they were designed initially for an Android phone, it works well. Sometimes though, if it was designed more on an iOS platform, the Android one does not work quite as well. You need someone to initially set it up just because you’d have to navigate to the Play Store and download it. But once it is downloaded, it has a lot of the same features as Apple where you can have it start and stop listening. You can still show all of the numbers, you can still pull up your grid, you can scroll, swipe. So really helpful. And then Android voice control is similar to what we use on the PC, but not quite the same.

So some of the commands are a little bit different, which can be kind of confusing for individuals.

Dragon is a third party software. You can purchase it for Windows or PC. It does not work for Apple. It’s nice because you can have several devices that you use it for. It’s a little bit more on the expensive side. It’s a $700 one-time purchase. Once you have it, you have it. Or you can do more of a membership base where you’re paying each month or each year. So it just depends on how long you think you need it for, if you’re going to have that device for a long time, what you want to download it to. Something interesting though is Microsoft actually purchased Dragon, so they’re not making any more upgrades to it. If there’s a bug, I was told that they will fix it. However, what you see is what you get now. The cool thing though is that now that Microsoft purchased it, they have their own voice access within settings on PC devices.

So similar to Apple, you can just go to your settings, turn on voice access, and the commands are nearly identical to Dragon. The only couple of areas that I found that Dragon is outperforming voice access still is Excel spreadsheets and PowerPoint. Microsoft has been really great though. I gave them that feedback and they said that they would work on it because they’re continually looking for feedback. But if you have an individual that can’t afford Dragon or maybe their employer isn’t willing to purchase that, voice access can do nearly all of the same things. And you still are able to navigate Excel and PowerPoint, it’s just not quite as smooth as Dragon. Otherwise though, they’re nearly identical.

I have a lot of users too that will use this part-time. So maybe on a day that they’re more fatigued or if they don’t have their mouse handy or they’re using it more for a dictation piece where they’re still using maybe the head tracking for most of the navigation, but then they’re using this for dictation or they’re doing a combination of the two. So they’re opening up all of their apps using voice control, but then within there they’re using their power chair to navigate the cells in Excel. So I think there’s just a lot of layering that can happen. So it’s really important to have different options, your option A, B, and C. So on a really good day, maybe they’re using a mouse. On a day where they’re more tired or they need to be more efficient, they’re using head tracking. So I think that’s important to take into account too is what are you using it for on this day?

How are you feeling on this day? And do we feel like this is going to be an option for every day or is this an option for some days?

Don Terry: That’s a really good point for moving forward as well. They might find that I need a backup now and maybe I need to use that in the future more permanently.

Olivia Ollis: Yeah. I think too, something that we found are just in meetings, a lot of individuals don’t want to use voice control because that can be disruptive or in a lecture. So they don’t want to say, open my notes app, start dictation where all of that’s being transcribed. It might be a little bit easier and less disruptive if they’re using head tracking to navigate within a setting with a lot of people and then they’re using voice control when they’re navigating more by themselves or in an area where they don’t have to be as quiet. And voice control isn’t going to work as well if I’m in a really busy area, if I’m studying at a coffee shop. It’s going to be hard because it’s picking up on everyone. I found that it helps a lot to have a nice microphone, but again, that’s more to set up.

So if you’re going to study or you’re going to work in a more busy area, it might be better to use a head tracking or a mouse option, whereas when you’re at home, maybe that’s the time where you’re pulling out your voice control solutions.

Don Terry: Question just submitted. Are there recommendations for someone who likes to use social media apps like Facebook or the other ones?

Olivia Ollis: Just recommend…

Steve Kirschke: MySpace.

Olivia Ollis: I’ve never had a MySpace. I think again, it just depends on the user. If you’re using voice control, you can, like Apple for instance, if you pull up Instagram, I could say open Instagram, show numbers. I could go to my profile if I wanted to add a picture and I can use number six. Then it’s going to navigate to that screen. I can scroll down, I can stop, I can swipe left, I can swipe right. I had an individual, he was using it for Tinder. Interesting application, but he’s like, “This is great. I can swipe right and left now.” I was like, “All right. It’s like my mom doesn’t have to help me.” So there’s just a lot of different options and I think just knowing that they just want to use their phone however is possible. But if you’re using though head tracking, it still works great with all of those solutions.

You can scroll up, scroll down. Voice I feel like is a little bit faster within social media, but if you’re editing a picture, head tracking or a mouse might be better. It just depends on what you’re looking for. So I think just knowing your individual and knowing what they need or what they want.

AI Tools

So talking about return to work and return to school, AI tools has been a really big area of growth. So looking at a couple different options, if you’re returning to school, you might need a different solution than returning to work. Different goals, different purposes, different material that you’re uploading. A couple of my favorite for return to school are Geneo and Jamworks. They’re both designed for the education setting. They’re both, I feel like, really comparable to each other. On Geneo and Jamworks both, you’re able to do transcriptions. So I can choose if it’s an online setting. So maybe I’m taking an online class or maybe I’m in person. I can differentiate which one that way knows which microphones to use. I can upload PowerPoints so that I am transcribing on a certain slide. So it’s going right with what your professor or your instructor’s saying. And then at the end of it, I get a full transcription.

I can go back and listen to it, but it will also give me a summary if I ask for it. It can quiz me on the material. Jamworks is cool. It has a live Q&A area, so I can go and ask it a question. So if I’m doing homework alongside of it and I’m looking for a certain information, I can search what is the definition of photosynthesis? And it’s going to go back and it’s going to find that information from the slide for me. I can also go through on both of those apps and I can flag information. So this would’ve been great, honestly, when I was in school. They were both designed more for individuals with ADD or ADHD, and then they started seeing the application for other individuals that need accessibility for different reasons. But if you think about when you’re taking notes, maybe you’re highlighting or you’re starring things, that can be really difficult if you don’t have function of your upper extremities.

Or from a cognitive standpoint, if it’s a lot to focus on where I’m trying to listen, I’m also trying to take notes, that can be a lot and kind of overwhelming, so I can just hit a flag button and it’s just going to flag it and highlight it. I could type in a quick note like test or ask question. I can hit a question mark instead, so it makes it really quick and efficient. So it takes some of that workload off so you can really focus on the material that’s being read. This a big thing too. When I was in college, I volunteered as a student note taker, but whoever was getting my notes was relying on that I wanted the same information that they wanted, that I wasn’t going to miss a slide, that I wasn’t rushed, that my handwriting was legible. So this is a great option just to have more autonomy and independence with it.

You don’t have to ask anyone to get their notes. You don’t have to ask for any assistance. So it’s something that they’re able to pull up by themself and it makes it a lot easier to organize.

Otter AI is a really cool one that I feel like more universities are starting to use it also, but it works great though in a professional setting if you’re returning to work. There’s different, oh goodness, options. So you can have one that has less features, one that has more features, so you can pay for those different tiers, but it also does transcription summaries. I can use it with Zoom. I can use it on phone calls. It will summarize all of that for me. And then it has an AI component also though to help pick and select important information. And I feel like all three of these have been really reliable. A lot of times your employer or the school or university will provide these. So sometimes it’s just knowing which one does this university provide for students.

Environmental Controls

And the last area that I’d like to cover are environmental controls. And I think this is an area where we see that there’s just such a spectrum of what you can pay for and how much money you want to spend or you’re able to spend. So the biggest areas I feel like people really want when I talk to them in assessments or we’re talking about what is it going to look like when you go home, if they’re going to be home alone for any amount of time, safety as far as can I get out of the house if I need to, control of lights, control of windows and thermostat. So just enough that you’re comfortable in your environment. No one wants to sit in a dark room because they don’t want to call somebody to come over to help turn on their lights or the sun’s peering in and it’s putting a terrible glare on the TV so they can’t really watch their movies, but should I call somebody to come over to help me with that?

Should I just wait a few hours until the sun moves? So I feel like those are the biggest ones that people really want. And then anything on top of that as far as smart appliances, those are just kind of added bonuses. So those are kind of the big areas that we’ll cover today. You’re able to do a full smart home environment. When you do that though, you’re paying for them to set it up like tech support. You’re paying money every month, that way they can come and provide service if needed, but then also that way you can use the app and then you have to pay the initial fee for all the devices. So I feel like this is a hard area that not many are able to obtain. So that’s when we start looking at individual options. So lighting controls, we could do smart plugs.

So it just plugs into your outlet, anything that you can turn on and if you unplug it and you plug it in, it stays on, that’s going to work with a smart plug. So you’re just turning the smart plug on and off. They range in price from 15 to $25, really easy solution, super quick to implement. You can do smart bulbs. So if you want more control over the dimness or the brightness of a bulb, you can switch all those Bluetooth capable, and then you can also switch out for smart switches if you know how to do that or if you have somebody that’s able to do a little bit of rewiring for you. And again, the pricing just really varies on what you’re looking for there and you can use app or voice. For curtain and shade controls, found those are actually really expensive if you get nice shades, but I have a lot of individuals that’ll opt for curtains instead.

So they’ll leave the blinds open and then you can put on an attachment that’ll push your curtains open and closed and that just connects with Bluetooth as well. And then door operators, a little bit more on the pricey side. However, you are able to pair a lot of them with Alexa so you can make them voice controlled, you can pair it with an app, or if you want to spend a little bit less, you can do a switch instead where you’re just hitting a big button. Something too that I found, which I didn’t think about when I first started recommending door operators, if you have someone that’s living alone, but then they have a caregiver coming in the morning, we pair this a lot with a door locking mechanism. So the lock will have a pin and then they can assign that to caregivers. Or if they don’t know who the caregiver coming in is from bed, they’re able to use their phone, maybe use a ring doorbell, look and see who’s there.

I can unlock the door from bed and then I can also open the door from bed. Or if I’m like, “Ooh, they should not be coming in, that way I’m not having to leave my door unlocked all the time.” But then we always just think about too, if you’re at home and there’s an emergency, that can sometimes be the difference between needing 24-hour care, can I exit my home if needed and needing drop-in support is can I leave my home if there’s a fire?

So those are big ones to look at. A couple other environmental controls I feel like are big. TV controls just from an entertainment standpoint. I just had a resident, he was really worried. He’s like, “Well, I just watch this one channel all the time because I don’t want to hit my call light for somebody to come in and change the channel for me. They have more important things to do.” So just giving somebody that autonomy and independence back over what they’re watching and not feeling like they need to call for support. The Fire TV Cube is the best option that I found for voice control. You’re able to pair it with cable also, so it’ll read your TV. You can change inputs, you can navigate through Netflix or any other streaming app, but you can also navigate cable. You can also download an app so you can use voice control on your phone.

And then if you’re using the FireCube, that can replace an Echo Dot so you could still turn on your lamps and everything in that room with it. Roku has the same functions as a Fire Stick. It’s app controlled and then you can use the app on your phone with voice, but you cannot actually voice control the TV with a Roku. Apple TV, you can use voice and app. If you’re using voice, you’re using your phone with voice, but it is integrated to work with that really well where you’re not having to use all the numbers that you would have to do on Roku. You can use more passive language where you could say play or pause. It’s quite a bit more expensive though than a Roku and a little bit more expensive than a FireCube. And then climate control is kind of the last one to look at.

Smart thermostats, they’re really easy to install. And again, there’s a spectrum of how much control you want or what brand you want, but you can get them for around $70 to control your entire home. I think about all the times that I’ve laid in bed where I’m like, oh, I’m really hot. I’m going to go turn down my thermostat. If I have to do a transfer, maybe I’m not able to transfer myself, I would just be laying in bed uncomfortable all evening. So just little pieces of technology to give back autonomy and independence I feel like is huge. All right, that’s kind of a quick overview of a lot of different assistive tech options.

Poll Question and Q&A

Steve Kirschke: Great. I will launch the poll question. This is one of the things you need to do for your CEUs, and then we have at least one question that we can have Olivia answer. All right, so there’s the poll question. One question, when it comes to recommendations, I’ll even throw assessments in. About how many hours do you feel like you see people need to get up to speed, to assess their needs and then have them ready to go from a tech perspective? I’m sure that that’s really dependent on the injury, where they’re going, a lot of different things. But I think the nature of the question is if our audience is planning in terms of life care plans and cost for that, do you have any recommendations that you could talk about?

Olivia Ollis: Yeah, it does vary a lot. I have some individuals, especially my residents that are on the younger side, that tech has been a huge part of their life since they were born. They catch on really quickly, some of the stuff they’ve already been using, so it’s a lot easier to implement. And then I have other individuals that use their phone for calling only, so then they’re just now learning how to use Siri, so that can be a little bit tricky. So it is really dependent. I would say on average, if I have an individual and we’re working on some of these goals for Assistive Tech, I’m meeting with them for about an hour to an hour and a half a week, sometimes separate days. So it might be three 30-minute sessions or an hour session and a 30-minute session. A really important area too that I found is training their support system, that way they’re also comfortable using it.

So if I have someone that where maybe it’s a little bit hard to retain information, their wife might be a really big component of their care plan, so we’re pulling her into sessions also, or maybe a parent, that way they also know how to set up the tech. It can be really stressful if you rely on this and you’re in your home and maybe your lights aren’t working now. So just knowing, all right, my lights aren’t working, so now I can’t use them with voice. How do I figure out what the problem is and how do I find the best person to support this? So there’s a lot of decision making. I do give a lot of handouts to our individuals go home with a discharge binder. So it has basic information, “This is how you set up a new device. Here are some common areas.

If this happens or if this isn’t working, I should go to X, Y, Z.” So a lot of our sessions in the beginning, the bulk of it’s learning how to use it, but then towards the tail end of their stay, it’s more just how do I support it? How do I set this up? How do I make sure that it stays working? And if it’s not working, what are my resources? So it does vary, but I would say around an hour to an hour and a half weekly.

Steve Kirschke: Great. There’s a specific question around return to school, specifically high school or college. Any suggestions on math options for an individual with a spinal cord injury?

Olivia Ollis: Jamworks actually would be the one that I recommend for math. If you are reading off an equation or the instructor is, it’ll pick up on that equation and it can annotate it for you. It’ll transcribe it. So instead of writing out derivatives or whatever they’re doing in math class, that was not my strong suit, but it’ll actually write it out for them though. That way they’re not having to go back later where it’s written word for word. It’s actually going to show the equation and it can also help show steps of solving the equation. So that would be the one that I looked at first.

Steve Kirschke: Okay. Any details on how to access PC Voice using Windows 10? And if it’s too hard to answer, we could maybe connect you with this person after. So I don’t exactly know what goes into that.

Olivia Ollis: I wonder connect after. It should be in settings, but if it’s not working well, I can maybe help troubleshoot that.

Steve Kirschke: Okay. And then any resources on finding someone like you in different areas of the country? Is there a forum? Are there groups of people that you interface with? Is there a database, something like that?

Olivia Ollis: I feel like from a professional level, if you’re looking for colleagues to share ideas with, there’s some Facebook groups for assistive technology that are really great. Also, I have just reached out to other OTs and AT specialists at Craig or at Shirley Ryan so we can idea share Shepherd Center. I think if you’re looking though more for support for an individual or a client that needs these devices, every state has an assistive tech program, so I would start by searching there. So like Nebraska ATP or Iowa ATP, and I think that would be a really great starting point.

Steve Kirschke: Yeah, I think the general, my take is you referenced some other centers of excellence for the individuals we’re working with. I think a center of excellence is going to probably have a leg up in this regard compared to maybe a different program that doesn’t specialize in these sorts of diagnoses because what we’re talking about obviously is really specialized. There’s a lot of expertise that you’ve either learned formally, and then I think you’ve referenced a lot of things you’ve learned on the fly through troubleshooting, and I don’t think there’s a replacement for that, right?

Olivia Ollis: No, and technology’s constantly changing and it’s hard to keep up with all the new updates, so it’s really great to have others that share your same passion where if I find something cool, I might send it to the Craig team or if somebody at Shepherd finds something cool, they’ll send it to me. So it’s kind of a small community. Conferences have been really helpful too, just from learning and growing. And then I’m always happy too. I love problem solving and looking at things, or if anybody has ideas to share with me, I’m always open to that as well.

Steve Kirschke: Yeah, there’s a specific question on do we offer services for folks who are not residents? I think this is definitely something that we have entertained in the past. It’s really more just a phone call to our admissions team or me and Don, and we can facilitate that. And some of it could be dependent on really what’s needed, the time investment, but we’re open to getting creative with providing these services. There’s a couple more. We got time for a couple more. Any advice or AT technology you would recommend for a student who’s hard to understand but gets frustrated with how long an AAC device takes to verbally say something?

Olivia Ollis: Yeah, I think this is a great opportunity too, to partner with the speech language pathologist. I do that a lot where I’m hoping more from the access standpoint, but my speech counterpart is helping from which AAC app makes the most sense. I think some of the top things I look at if a device isn’t being used or it’s not being used efficiently, is my screen too crowded? Are my settings right to where I am being accurate with whether it’s eye gaze or maybe it’s head tracking, making sure those settings are in a really good spot where it’s efficient and not frustrating. Sometimes you can set it so that it’ll jump to the closest object. So if I’m using head tracking and I get close to it, it’s just going to jump to the one that’s closest, and that can be super helpful with accuracy if it’s hard to stay on an area for a certain amount of time.

I would start with checking settings, and then if that’s not helping, I would collaborate with the speech therapist and just see if there’s anything from the app that’s, again, maybe it’s visual clutter, maybe less words would be better, or maybe it needs to be more specific or just the organization in general. Sometimes there’s different categories, so maybe going back and saying, “Okay, when I ask this question, normally it’s under this category, do we need to move that somewhere else?”

Steve Kirschke: Just real quick before we go to the last question, could you just advance your screen so people can get ahold of you or know who you are? Maybe I just missed it. Last thing, could you speak to the learning curve if there is one related to a native Siri user who wants to use a full Apple voice?

Olivia Ollis: Honestly, I feel like the learning curve is pretty minor. You don’t have to use Siri to get its attention. It’s always listening. So when you turn on voice control, you’ll see a little blue button in the top left of your screen. If it’s blue, then it’s listening, so you’re able just to give it commands. I think the biggest learning curve that I found are individuals that were using Siri only. They have the habit of saying Siri for everything, so then it’s getting the wrong part of the phone to listen. So that’s the biggest part. Otherwise, it’s really natural speech and just knowing is it listening or is it not listening? So if it’s gray, it’s not. So you just have to wake it up. It’ll also walk you through a tutorial and settings on how to use it, so I’d encourage you just to play with it.

I sat on my hands for an hour and just scrolled through social media and used my phone like normal to learn it.

Steve Kirschke: Cool. Well, it is 10 o’clock. Olivia, amazing information. I’m always blown away.

Assistive Technology, Brain Injury Rehabilitation, Webinar