In this in-depth webinar from QLI, Erin Young, OTR/L discusses assistive technology and provides examples of the latest assistive devices that are accessible, affordable, and can easily be taken home by clients or patients to really impact the quality of their lives.

Speaker: Erin Young, OTR/L

Video Transcription


So I call this presentation Take Home Tech, because I’m hoping to demystify some aspects of assistive tech today and help you all to walk away with some ideas that are accessible, affordable, and can easily be taken home by your clients or patients to really impact the quality of their lives.

The Technology Trap


All right. So to start with, the technology trap. This is a real thing, right? Think about when Apple stores were launching the iTouch that came out years ago. People spent days waiting outside. And that product is now left in the dust after just a few short years. And guess what? The products we think are revolutionary today, we’re going to be laughing about five years from now.

When it comes to adaptive tech, everybody wants the best. But it isn’t that simple. We hear all the time from work comp case managers who approve payment for the latest device that a therapist recommended and family advocated for that now goes unused. It’s collecting dust in a closet somewhere. That’s because the best doesn’t just have to do with a price tag. It has to do with what’s the best fit for that person, at that stage, with those deficits, for their lifestyle.

If you guys weren’t aware, QLI is a nonprofit. And my reason for telling you this is that our therapists and staff are always looking for a way to save, because not everybody is funded by workers’ compensation. And we believe that not every worker’s compensation case should be a blank check to get to the top of the line without considering appropriateness and need.

So here at QLI, we’ve trained ourselves to consider those factors for every case, because worst case scenario, you have an expensive room decoration, but best case scenario, technology can really mean the difference between living independently in the home with supports and living in a facility for the rest of your life. And dignity and family impact aside, that can really add up to some serious cost savings.

Things to Consider When Deciding on Assistive Tech


So talking a little bit more about decision making, we all want to make great decisions, not just good ones, right? And as a therapist, I want to use my therapy time well and make really, really solid recommendations that I’m confident about when it comes to assistive tech. So here’s where I start.

Four questions that I think everybody should ask themselves when we’re thinking about a piece of assistive technology or trialing a piece of equipment is to start with number one, current tech.

Current Tech

What devices does that person already have in their possession? Ideally, we want to make use of the stuff that they already have. There are just really cool accessibility features now that are built into iPhones, Android phones, tablets, laptops, even desktop computers.

When we have tours come through QLI, I like to show off some of the built in features about iPhones that I think a lot of people don’t know about. So for example, I can enable a feature on my iPhone that allows me to use left and right head turns to control my phone. Isn’t that nuts? I can literally make a phone call, send a text message just by turning my head left and right. Nothing extra I had to pay for. It’s just a feature that’s in my phone. So that’s a big part of my role here and a big thing that I think we need to explore, is just what do you already have?

Comfort Level


The second thing I look at is comfort level. What was this person’s technology use like prior to their injury? This is just a good one for us to know, because we need to make sure that we’re taking the right approach with how we introduce technology to them. I had a gentleman who I worked with who told me his only goal was to get back to using his flip phone. And he was the type when he would leave his home, he would turn off his flip phone and leave it in his glove box. I had to start pretty slow with him and jump into this at a really, really basic level. Whereas recently, I worked with a gentleman who is the director of IT for his state. We were able to start at a totally different point, because his comfort level was quite a bit different.



The third thing I always ask myself is that regarding cognition. So what is their cognitive ability like? And the reason we ask about this one is because we need to know what their capacity is like to take in new information and learn how to apply it. So if I’m working with someone with significant cognitive impairments, I need to implement a specific airless learning routine to support them in using that device.



And then of course, cost, what is the cost benefits for the individual? So if the benefits of the device or the benefits of their independence because of the device outweigh the cost, we would consider this to be an option. But we definitely want to be mindful of this to avoid that technology trap that I just mentioned. And then we also consider cost that aren’t strictly monetary. So the benefit of someone using a device could be great. But if the cost is a significant deal of time and support, we have to decide if this is actually feasible, because the benefit of use might not outweigh the cost of the time and support required to use it.

Rehabilitation Technology


So rehab technology, this is a term that we use a lot, we hear a lot. What does it actually mean? This is a super broadly defined category and it includes low tech solutions as well as the latest gee wiz gadget. Our goal with rehab tech is to start in a more structured therapy setting once we identify a device that is good fit. But we also have to make sure that this is applicable to their real world settings, too.


I just think that this is such a fun area to work in right now, because it feels like we’re living in this space age with constant developments in technology. And while we don’t have floating cars yet, the possibilities are still just endlessly cool. But it can really be more than just cool. It can be the difference between living independently with a good quality of life or living in a facility at 35 years old. It can also equate to big cost savings on the back end, as some of this equipment can actually allow people to be more independent and therefore require less caregiver support.

Assistive Tech Trends Over Time


There have been some big trends over time and just some big shifts that we’ve seen with technology overall. I think a good one to mention first off is social stigma. In the past, rehab technology often had the connotation of a big, bulky, obvious device. I think a lot of times users didn’t want to use these things because it just made them look different. Now, we’re just seeing an increased prevalence in the general population with using compensatory tools like an Apple watch or an iPad. These devices are also becoming much more multidimensional. So they’re hitting all areas: physical, cognitive, linguistic. They’re just much more versatile than they used to be.


And then of course, accessibility, we’ve really seen a shift from medical grade to commercially available products, things you can find at Target or Amazon. Some of these devices that we use, they might not necessarily be targeted at the disability population, but they have great implications for use, especially when insurance doesn’t typically fund some of these things.


So just as there is a huge number of products out there, there are also a huge variety of access methods to match the right piece of equipment with that equipment user’s needs. We’re going to just go over a couple of the access methods that exist. And again, there are a ton out there across the whole spectrum. So we’ll talk about individuals who are cognitively doing well, but require physical assistance, all the way to individuals who are physically doing well, but benefit from cognitive assistance.

Eye Gaze Technology


So to start with, we’ll talk about eye gaze. And eye gaze is just what it sounds like. It’s the process of electronically calibrating the user’s eyes using some kind of external aid, an eye tracker or a camera. And that calibration process allows the user to interact with and control their device using only their eyes. Pretty cool.


Many of you have probably heard of Tobii Dynavox. I have a couple of products here that I really like by them that are eye controlled.

So to start with the PCEye Mini, I’ve got dollar signs here to indicate the price. And I’ll tell you the price of all of these, too. The PCEye Mini is going to be higher end in terms of the cost. It’s a USB eye tracker that can Mount to your Windows PC or laptop to allow eye gaze. So you don’t need a keyboard. You don’t need a mouse. Wherever your eyes move, that’s where the mouse moves.


With this device, there is a little panel on the side of your screen and it’ll have icons like keyboard, left click, double click, right click. So if I wanted to type something on the keyboard, I could look over at the keyboard icon, my on-screen keyboard would pop up, and then I can start looking at the individual keys that I want to type.


The ideal candidate for the PCEye Mini is someone who probably has pretty limited upper extremity motor functions, but good cognitive ability. Some pros and cons with this device, on the plus side, it’s easy to transport. It is the size of a pen. It’s going to work in all lighting conditions, too, which sometimes eye gaze devices are affected by. And it also comes with accessible software so that the eye trackers are compatible through the desktop no matter what app is being accessed. That’s really why this one is on the higher end for the price range, because it’s going to work with internet. It’s going to work with whatever app you’re using, anything that you’ve got on your computer.


On the cons side, right now, it’s only compatible with Windows. You also, like I mentioned, have to have really good cognitive ability to use this. It’s going to take a little bit of training. And then insurance typically only covers this device as it relates to communication. The price on this is about $1,200, and you can work with a local rep from Tobii to get a demo.


Another Tobii product that I think is really neat is the Toby EyeX. This one is actually a gaming eye tracker sensor bar that plugs into your computer. It was really aimed at game developers to bring immersive eye tracking features to their games. But I think we can think outside the box a little bit and look at applying this to our population.


On the downside with this one, right now, it’s only compatible with Windows 10 and it’s designed to interface only with certain applications, so mostly games. On the plus side, it’s portable. It is low cost. It costs only $99. And I think another cool feature is it’s validated to support Windows Hello. And Windows Hello, if you aren’t familiar with it, it allows you to have password free logins and use facial recognition to log into your computer.


I have asked a rep as well about just the EyeX’s ability to do basic web browsing and word processing, and I was told that it is able to do that. So if your user is just wanting it for pretty basic stuff, this could be a great low cost option.


The OptiKey is still under the category of eye gaze, but is a little bit different. It’s an open source assistive on screen keyboard, which runs on Windows. It’s designed to be used with a low cost eye tracking device, like that Toby EyeX I mentioned, to provide hands-free keyboard, mouse, and speech control.


Ideal candidate, again, is going to be someone that’s got probably motor and speech limitations. I can’t really find a whole lot of cons for this software, because a huge plus is that it’s free. This is open source. You can go download it pretty low risk.


I have one video that I wanted to show you guys, too. This is within this category, but also going into our next one. So I’m going to show you a video of a device called the GlassOuse, and we’ll talk about this a little bit on the next one. So I wanted to show it to you ahead of time.


So the GlassOuse is actually a device that you… is deleting them. So this is just another example of how, with even limited physical mobility, you can still fully access your computer.


All right. We’ll go back to the screen.


Okay. So some things to think about when it comes to some of these eye gaze access methods, they are fatiguing oftentimes when you’re solely relying on your eyes to control something. If someone has vision impairment, something like an eye turn, strabismus, any abnormal movement, this might not be the best choice. And then something you should just consider is, are you wanting to use this method for communication or just accessing the web? Because there are some systems that are better for communication versus just basic web access.


I also have a little bit of information here on new developments. So I wanted to mention EyeTribe. They have actually been around for a little bit. They are a startup company out of Copenhagen, and they have developed some pretty inexpensive eye trackers. So I think it’s just been interesting to follow, because Oculus actually acquired them recently. And we’re also seeing Samsung, Google, and SensoMotoric Institute, they have all acquired eye control companies within recent years. All have also expressed an interest in the healthcare industry. So I think we’re going to see quite a bit more eye tracking in this industry.

Head Control Technology


Okay. So here’s that GlassOuse that I just showed you in that video and want to hit on this one a little bit more, because it’s one of my absolute favorite devices to use here at QLI.

So the GlassOuse, as you saw, is a pair of glasses that the user wears, and they’re able to pair it to their computer via Bluetooth to have a wireless mouse alternative. That blue plate that you see there with a little arm going up to the glasses, that’s what allows the user to use the mouse. They bite that plate and it clicks on the mouse.


They came out with a new version now that you can use without the bite plate. So you can just dwell on whatever the user is looking at and it’ll click on it. They also have a foot plate, a foot switch. So if the person might not have arm use, but they have good foot movement, they can step on that to click. It also has a puff switch. So if you blow air close to that little switch, it’ll click. So nice to see them continuing to develop that and come out with more options.


And just head control devices overall, they’re going to be really similar to eye gaze. It’s just, if you have someone with some of those visual impairments I mentioned, this might be a little bit of a better direction to steer them potentially.


So the other low cost option that we have there is the SmyleMouse. I included this one partially just because it makes me laugh. It’s a hands-free, touch-free, voice-free computer control device designed to help individuals be more independent users of their computers or tablets. So they can control the mouse pointer, click, drag, even right click items with their smile. So if you do a full smile or move your mouth in certain directions, that is how you control the SmyleMouse.


The downside is that it only works on devices running Microsoft 7 or above. It’s not as accurate as some of the items at the top of the list that I’m going to talk about here in a minute. But on the plus side, it works well with all applications and you can get a free trial on their website.


This one, the software license cost is about $500 per device per user. So it’s more of a one time fee to just use the software.


A couple of other really popular head control items that I wanted to mention, the SmartNav and the TrackerPro are ones that many people are likely familiar with. They basically use either a reflective dot that the user puts on their head, their hat, their glasses, and that reflective dot sends instructions to the computer to move the mouse cursor via software and an infrared camera that tracks the dot.


So both of these are going to be high cost. The SmartNav is $499. And the TrackerPro, I think, is even more. That one’s, yes, 995. The only real difference here is that the TrackerPro comes with accessible software built in. And with the SmartNav, you would have to get the software. These are again going to be good for people who have minimal upper extremity movement, but they do, once again, have to have a decent cognitive ability to be able to use these.


And I don’t like the having to use the reflective dot as much, just because it’s something that you can lose. It can fall off. The person that’s using it is going to have to have someone set that up for them.


So that’s where that GlassOuse is nice, because it just pairs via Bluetooth, and then the SmyleMouse being nice, too, because it just requires the camera built into your computer.


The one right in the middle there, the Sesame Enable, this is a really cool product. I’ve got a video here of one of my residents using it that I’ll show you.


All right. We’ll get that video going. Cool. Let us know if you’re having any trouble seeing these videos, too. So the Sesame Enable is what you’re watching right now in this video. It is gesture control for your Android phone. Basically, wherever you move your head, a cursor moves on the screen. You can click using dwell. You can use a switch. And it now has voice access, too, to answer or dismiss or hang up phone calls with voice, which is great.


Ideal candidate is somebody like my gentleman here who has good head control, good cognitive ability, but pretty minimal upper extremity usage. So right now, it’s started by calibrating to his head and his available movement. And now, wherever he is moving his head, it’s clicking on those targets on the screen.


The things that are a little bit tougher about this program, the Sesame Enable, is that right now it’s subscription based. So you can find it in the Google Play store, and it’s a subscription of $20 a month. The other downside is that right now it’s Android only.


But on the plus side, it doesn’t require any extra hardware and it uses the camera in your phone or tablet to register the head movement, so you don’t need an extra camera. So right now, whenever he is clicking on that button, two different options come up. I’m a little far away right now from the screen, but basically, on the right, there’s a purple finger that comes up. If he clicks that, it’ll do a mouse click. And if he clicks on the one on the left, it’ll let him exit.


Okay. So the other really nice thing about Sesame Enable is you can do a week long trial for free. Highly recommend that you just give it a shot if you have somebody that matches the ideal candidate description I gave you to use this one.


Things you need to consider when you’re using head control devices is just, like I mentioned, the need for assistance with the setup. If they’re going to be somebody that’s living on their own, maybe you want to use something that doesn’t require any caregiver support to set up. If they’re going to have someone there, then maybe you don’t worry about that quite as much.


Okay. Moving on.

Mouth Control Technology


So into our next category, we’re going to talk about mouth controlled options. That is, again, just what it sounds like. The mouse is mounted in a position where the user can control it using their mouth or lips to control the physical mouse.


So the picture that you’re seeing up here is the Jouse3. The IntegraMouse and the Jouse3 are pretty similar devices. And they’re also going to be on the highest end in terms of cost. Both are mouth controlled computer mouses that can be used as either a joystick, they can be set to keyboard mode. And just the light movements of the lips on that mouthpiece that you see will move the mouse across the screen. They also have sip and puff control. So if you either sip air in through the straw or puff air into it, that can allow for mouse clicks.


Once again, both of these top two devices are going to be really good for individuals that have pretty limited upper extremity movement. The cost on the IntegraMouse is about $2,500, and the Jouse is about $1,400.


Just to be honest, I don’t have either of these here just for that reason. The cost is pretty steep to justify. So what I use here is the QuadJoy, and I also really like the TetraMouse. The QuadJoy is really similar as the IntegraMouse and the Jouse. It just plugs in via USB. If you’re using a Windows computer with it, you can do some programming. If you’re using a Mac, it still works, but you really can’t adjust as many of the parameters like the mouse speed or how you do mouse clicks.


The QuadJoy is just over $1,300, and I do have a video here of me using the QuadJoy to show you.


Okay. So the QuadJoy is just mounted to the table here, and it’s got an adjustable arm so you can position at the right height. So I am moving really minimally just with my mouth on that straw. And I am puffing air into the straw to type, which I highly recommend you all go visit, into the web browser. So pretty cool. Don’t have to use arms at all. If I had a vision impairment that caused a lot of unnecessary or extra eye movement, I could still use something like this if I had good control of my head and my mouth.


Okay. So some considerations here, just thinking again that the user might need assistance for setup if it has to be adjusted to the right height. And if they do have ataxia or maybe some extra movement throughout their shoulders and their heads, that could affect their ability to use this mouse.


In the mouth controlled area, there’s a couple things I just wanted to let you guys know that are coming out and fun to keep an eye on. So TetraMouse is one of many 3D printed devices that we’re starting to see. TetraMouse is really the same as the others, but it is only $349 for the device and $100 for the mounting equipment. Doesn’t have sip and puff. You just use two eight-way joysticks to click and hold and scroll. I really like it. I think that their customer service is fantastic.


The only downside is that these 3D printed materials can be breakable. So going along with the 3D printed route, we’re seeing some more DIY 3D printed options out there. MakerBot, they had a competition a few years back. MakerBot is a 3D printing giant. And this competition was a challenge to develop 3D printed designs of assistive tech for people with disabilities. The winner was a mouth controlled mouse that can be 3D printed and assembled for under $20. Huge, huge, huge deal.


So we partnered with a local university here in Omaha and had them print this for us since we do not yet have a 3D printer here. And now, our next step will be to assemble it and recruit one of their engineering students to help us with the wiring of it. But this is a really big deal. And I think we’re just seeing a lot more of these DIY options pop up on websites like Thingiverse. There’s a lot of just free open source, 3D printed designs aimed at our population.

Direct Selection


Okay. So switching gears here a little bit, direct selection is just as the name implies. You press something and your selection is made. Everyday example of direct selection is a light switch. You flip the switch, the light turns on or off. So direct selection can refer to a selection method that can be helpful to compensate for physical, cognitive, and communication deficits. We’re going to talk about direct selection in each of those three categories.

Devices for Physical Deficits


To start with, let’s go over some devices that can help individuals with physical difficulty accessing their device.


The Handizap is a pretty neat little product. This was designed by a gentleman who has a C5 spinal cord injury, and it’s to help those with limited hand function in using modern electronic devices. It can be used to access phones, appliances, keyboards, remotes, wheelchairs, and so on. So it has an expandable ring that allows it to be adjusted from a size three to a size 15, has a little stylus tip on the end, and costs 30 bucks. You can find it on their website.


My only problem I’ve had with these is they sometimes spin on the user’s hands. So then I have just used a little bit of Thermoplast to make a buddy splint for it so it stays in the set position.


The Limitless Stylus is a great one, because a frequent problem with how we use styluses and something like a universal cuff is that they might actually block the screen because the user’s hand is in the way. So these are really optimized for users with limited hand function, crafted to fit the contours of their hand, and it does not block the view of the screen. That tip that you see there goes right over their index finger, and then the straps go over the back of their hand and their wrist. So you get a full view of the screen. This one’s $45.


The Caduceous Stylus with the SALT tip is designed to accommodate a variety of disabilities, including wrist and hand impairments. But it can also be used as a mouth stick. I like this one because the shaft of it is bendable. So it can be custom fitted for gripping or attaching if you’ve got someone that’s got a joint contracture or maybe just doesn’t have the ability to grasp. And this is a way that they really don’t even have to. It can just wrap right around their wrist, like you see in that picture. This one is $22, and we’ve got a link there for their website as well.


I’m so hoping to get my hands on this TubusOne one of these days. It is a little bit different. The user holds the mouthpiece that you see in their mouth, and they just have to gently puff into that mouthpiece. And in the end, there is that little soft silver woven fibers that you see shooting out of there. That hits the touch screen. It’s really gentle, but it’s still strong enough to register a touch, which can sometimes be a challenge when you’re using a stylus. This one has just been a little bit trickier to come by, because I think that the creator is in Sweden and they still have not gotten FDA approval to sell this in the United States.


This is my all time favorite direct selection device to use. I absolutely love this thing. It’s a Blue2Switch. You can get it from I use this on an almost daily basis here. So this provides single or dual switch access via Bluetooth connection. And the nice thing is it works with Apple and with Windows. We don’t always see that. A lot of times, like I mentioned earlier, devices might only be compatible with Windows and Android devices.


So basically, how this works is you can program the white button that you see there or the orange button to do a specific function on your phone. I’ve got a video of this one to show you, too, to better explain it. Let me pull that up here.


Okay. So here is an example of me using switch control on my iPhone by hitting these white and orange switches. I have the white switch set to move between the different icons so I can scroll from left to right, and then the orange one actually selects the action. So I’m going to show that one more time. So what I…


Oh, sorry, guys. I just realized I was muted for that. So I was just explaining that I can use the white button to open Internet Explorer, and then I use the orange button to make my selection. A cool thing that you can do with this is when I clicked on the screen for Team QLI, it offers me different options. So I can scroll, I can swipe left or right, I can exit altogether. So you can really have full access to your devices using this Blue2Switch.


And another thing I like about the Blue2Switch is it does have two external switch jacks. So you can actually plug two more switches into this. So for example, how I often set it up is I’ll have the white button do move to next item on my screen, I’ll have the orange button select, and then I might have a blue switch plugged in that does move to previous item. I might have a red switch plugged in that lets me go back to my home button. So just a pretty versatile piece of equipment. This is $185 and just well worth the price. It’s a great piece of equipment. We have a couple of them here.


Mouse Emulation is also a form of direct selection. So smartphones, tablets, and computers are now a fixture in most of our daily lives. Their capabilities reached so far beyond just making phone calls and surfing the web and sending emails, though. So for our folks that have significant physical disabilities, using their devices can be really challenging, because these technologies are designed for interaction using the fingers to do stuff like I just mentioned, click, tap, swipe, type. So obviously, this design places people with impaired upper extremities at a rather large disadvantage.


So if one of the aforementioned devices isn’t a great option for them, the technology now exists to allow integration of smartphones, tablets, and computers with the drive control system on a power wheelchair. For example, if I am working with someone that uses a joystick to drive or even an alternative drive control like a head array, they can use that drive control to access their device.


In the past, you had to pay for a separate module to pair your device to your power wheelchair via Bluetooth. But now, these power chairs are all having Bluetooth built in. And it’s nice that our residents don’t have to come up with the money to pay for that. It’s just part of the deal with the chair.


I also just have Android versus Apple written down here, too. Just generally speaking, Androids have a much more direct method of access when they’re paired to a power wheelchair. A mouse simply shows up on the phone, and the user can control the mouse with their drive control.


While the access method is a lot easier, pairing Android devices can get tricky, because the features and capabilities differ between models of phones. And in some cases, differences even exist on the same model between wireless carriers.


So then Apple devices, they are going to perform in a much more consistent manner. The video I just showed you of me using switch control is available on every iPhone, on every MacBook, regardless of the wireless carrier or the model. But access to Apple’s devices can really only be achieved using that switch control method I just showed you. There’s really not another option. So as I showed in the video with switch control, the drive control system, so their joystick, will operate like an array of switches, or you could actually use a switch like the Blue2Switch I showed you. And then the user just navigates the phone one row at a time, one icon at a time. It’s pretty tedious. In some cases, it’s also a little bit too complex for the user to get the hang of.

Devices for Communication Deficits


So let’s go over some devices that can also aid individuals with communication deficits. I’m going to go through this pretty fast, because I’m not a speech therapist. And if you do have questions, I’m happy to direct them towards one of our speech therapists here at QLI. Our speech therapists use Proloquo2go quite a bit. This is an AAC app for iOS, so Apple operating system. It is about $250. And it’ll have core words on the main page, like you see here on the picture on the screen. And then there’s fringe folders on the side so you can add more specific vocabulary.


We like that it’s customizable, it’s easy to edit, and you can use your own pictures. So rather than having some of the cartoonish looking ones that you see on the screen, we can actually take pictures of the user’s own devices, their own room, their therapists, their family members, to make it a little bit more suitable for adults.


The TalkTablet is pretty similar. It’s another AAC app. This one is only $79.99. However, I think the setup is a little bit easier than Proloquo2go, and the customer support is fantastic. It’s also available on Android, so it’s not just iOS like the Proloquo is.


And then we have Text to Speech on here. There are so many free options in the Google Play store and the App Store. We do a lot of just the free ones. There’s some really good customizable ones out there. They have apps that are free that address aphasia, and they allow you to really present choices. So maybe you’re just working with someone on stating their preferences. You could just have one of these free apps and just put the folder of lunch, for example, and put a couple different items so that they can still voice their choice.

Devices for Cognitive Deficits


Then getting into the cognitive side of things, we use devices here to aid individuals with cognitive deficits in memory and organization. And some of our go-tos are just the things that are already built into your devices, the Calendar app, the Notes app, the Reminders app. We use those routinely here. We can make sure and get someone in the routine of adding appointments to their schedule if they have a medical appointment, for example. We have residents make to-do list. We have them take notes at the end of each therapy so that they can use it as a memory aid and also just keeping notes of important conversations.


Here are a few specific apps that we use for cognitive compensation. These are favorites of our speech therapists here. And the first one is Google Keep. This one is just available under your Google drive. The picture at the top left is the Google Keep one. It looks like just a bunch of sticky notes on your screen. It’s super fast and reliable. The reminders can be integrated into your device. You can pin various boards and sizes to the app screen.


So I really like that, because if there’s one note that’s more important than the other, you can make it bigger. You can make the font bigger. You can pin it to first on your list. Kind of helps you prioritize. The only downside of this one is it currently doesn’t have a desktop application available.


One Note is the one on the right side in the middle. One Note is like having a giant five subject notebook. So you’ve got the tabs at the top, and you can organize content that way. I like that you can use this with numerous devices. It can sync between your computer and your phone. The notes are searchable, which is also a big plus. The only real downside is if you wanted to clip any content from the internet and add it to a note, it is not yet capable of doing that.


And then at the bottom we have Trello. Trello is free. It was developed as a project management application. You can also access it via numerous devices, if the user has numerous devices. I like that you can share this. So the client could share it with their spouse or their parent. You can make numerous lists and boards, like you see on the image there at the bottom left, and the boards are really easy to customize.


So now getting into smart home technology, this is one of my favorite things to work on here at QLI. And we are seeing it come up more and more often. So we’re going to talk a little bit about all things Amazon Echo and Google Home.


So the Amazon Echo, I was reading an article somewhat recently, and I can’t remember the source of it. So take this with a grain of salt. But they said that 60% of Americans now have an Amazon device in their home. Pretty amazing. This has just made a huge impact in only five years. It launched in November of 2014.


So with smart home tech in general, with Amazon Echo and the Google Home, they are made to make our lives more convenient, obviously. But they can really make a huge, huge difference in terms of some of our patients’ independence in their homes and being able to be left alone and still be able to contact someone if they need assistance.


So to start with, the Amazon Echo, they have a variety of different products now. The one that you see on your screen is the Dot. It’s about the size of a hockey puck. I think you can get it now for just $30. It’s going to be their lowest cost Amazon device. They also have the Amazon Echo that’s got a hub built into it. So if you’re using something like Philips Hue light bulbs or something that requires an in between device, so the hub would be something that can talk to those light bulbs. They now make Amazon Echos that have hubs built in, which is a huge plus, because then you don’t have to have another piece of equipment to set up.


One that I really like is the Amazon Show. This is one that’s got a seven inch video display on it. And I like this because it really works like a little tablet in a lot of ways. They used to have YouTube available on it, but I think that YouTube is actually owned by Google. So they quickly rescinded that. We always see changes happening when these comes out.


So with the Amazon Echo, if you don’t know, it connects to your wireless network. It is a speaker that is … Well, their main speaker is just about seven inches tall, has a really good microphone system for far field listening. And it is always listening when you give it a wake word, such as Alexa, Echo, or computer. Those are our three options right now. It can give you the weather. It can you give you news from a variety of sources, plays music through Amazon Prime, Google Play, Apple Music, integrates really well with the Google calendar. We use that a lot here. So a user might just say, Alexa, what’s on my schedule at 10:00 AM?” and be able to quickly get that information. And then as I mentioned, it also works with other smart home devices, like the Phillips Hue light bulbs, Belkin WEMO switches, automatic car adapters, SmartThings, Insteon, and Wink.


It can control lights, thermostats, outlets, really anything that can be operated with a switch. You can use the little smart outlets. Amazon also makes their own smart outlets now. And I always tell people if there’s one thing that you get, I would get one of these cheap little $20 or $30 smart outlets. It can just pair to the echo via Bluetooth, and you can plug a lamp into it, a fan, whatever it might be, and can pair to the Echo so that you can have voice controlled access of that device, or you can control it through the app on the smartphone.


So people always ask me, “Would you pick Amazon Echo or would you go the Google Home route? I personally think that Amazon Echo is best for my population who’s wanting to control smart home equipment specifically. It’s a little bit better at controlling smart lights, thermostats, and door locks than the Google Home.


It also integrates really well with Amazon products like the Fire TV Cube. It lets you order directly from Amazon just using your voice. You can also do some pretty crazy things like order from Domino’s using your voice, get an Uber, things like that.


So what is Amazon not so good at? It is not as good at answering everyday questions like, “What movies came out recently?” It also, and this is kind of a biggie, at least right now, it is not an available language on the Echo. Spanish is not an available language to have it set as. I think you can do German and Chinese, but you can’t do Spanish. So when I’ve had individuals who are Spanish speaking, I’ve steered them more towards the Google Home.


Something that I recently learned about the Amazon Echo is that it’s actually really good at recognizing AAC and synthetic voices. So if you have someone that is using a Tobii Dynavox or some speech production device, the Echo is capable of understanding that synthetic voice to then control smart home technology or to answer a question.


Just a weird quirk, too, they also came out with a whisper mode recently. So you can whisper to Alexa and she’ll whisper back. Why you would want to use that, I’m not totally sure, but it is there.


Okay. So Google Home, Google Home didn’t come out until quite a while after the Amazon Echo. Like the Echo, it integrates with Amazon really nicely. It can also control your Chromecast TV. You can use Google search. You can access your Google calendar, Gmail.


I will say that setting it up is quite a bit easier than setting up an Echo. And it is really good at answering more complex questions. So for example, if I ask, “What team does LeBron James play for?” I can then follow up with, “What’s his Jersey number?,” and it’ll have the context and be able to answer that question. Whereas with Amazon, you can’t ask those kinds of follow up questions.


But then on the downside, like I mentioned, it just can’t control as many smart home devices, nor does it do so as efficiently.

Home Technology on the Horizon


This is always my favorite slide, because I feel like we’re always changing things here. What are some things to look out for with assistive tech? What is on the horizon and in our not so distant future? So some things that I’ve been keeping an eye on, working on a little bit here at QLI, virtual reality has been a really big one. We are using the Oculus Rift and pairing with a local university to develop an exoskeleton that can be worn on the hand and paired with the Oculus Rift. So just seeing that they’ve got some great technology out there for gaming, and could we use that even though it’s not intended for our individuals? Could we use that within the rehab population?


I’ve also seen quite a bit about using virtual reality in telerehab. There have been a couple of recent articles in the International Journal of Telerehabilitation that have talked about their use of VR.


Robotics with E-Stim, that’s something that we are trying to incorporate right now, so just always thinking about, “How can we get more repetitions? How can we make our therapy more innovative, more engaging?” So doing things like pairing something like the Oculus Rift while someone’s on the FES bike, for example.


Brain-computer interfacing has been around forever. I think we just continue making progress in that area. But that being said, we’re still a little ways off from being able to just have a thought and have that control a device.


And then as I mentioned, adaptive gaming, that’s been a big area that we’ve been looking at lately. You guys might have heard that Microsoft and Xbox launched the adaptive controller. It’s been within the last year now. Previously, adaptive gaming had come at a pretty high cost to the user. You could get a custom controller made for $400, $500. This adaptive controller is $90. It works with the Xbox One system, and a variety of different switches can be used to control the controller’s functions, rather than having to physically hold that Xbox controller. So if you have someone that doesn’t have the ability to hit all the buttons on the Xbox controller, they could use a combination of the Xbox controller’s buttons, but then they could also use a head switch or a foot switch or anything that they’ve got. We can try to maximize that movement so that they can still engage in the things that they enjoy.


And I think that’s just the big takeaway with assistive technology overall. There are so many possibilities right now. There are things changing on a daily basis. It’s hard to keep up with. But all of these different things that we’ve talked about today, they can just make a huge difference, not only for the individual’s ability to be independent in their home with smart home technology, going back to school with some of these head control, eye control options, working, having gainful employment, but they can also just hugely impact that person’s quality of life. And I think that’s one of the most important things for us to keep at the forefront of our minds.


So thank you guys so much for joining.


Categories: Assistive Technology, Uncategorized