Assistive Technology and Neuro-Diversity (Cognitive Impairment) Customizing Assistive Technology for Persons Who Are Neuro- Diverse Assistive Technology (AT) has broadened choice and expanded independence for many people with disabilities. People who are Neuro-Diverse (who have brain injury, unusual brain chemistry, dementia, and other non-typical brain function) can also use AT to gain control over their lives. The key, as is the case with all AT supports, is to carefully match the support to the person by using the person's knowledge of themselves and the person's goals as the context for support. the focus is on the person, not the device. What is Assistive Technology? (AT) From the AT Act: "The term `assistive technology device' means any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities." "The term `assistive technology service' means any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device. Such term includes-- (A) the evaluation of the assistive technology needs of an individual with a disability, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the
Transcript
Assistive Technology and Neuro-Diversity (Cognitive Impairment)
Customizing Assistive Technology for Persons Who Are Neuro-Diverse
Assistive Technology (AT) has broadened choice andexpanded independence for many people withdisabilities. People who are Neuro-Diverse (who havebrain injury, unusual brain chemistry, dementia, andother non-typical brain function) can also use AT togain control over their lives. The key, as is the casewith all AT supports, is to carefully match the support
to the person by using the person's knowledge of themselves and theperson's goals as the context for support. the focus is on the person, not thedevice.
What is Assistive Technology? (AT)
From the AT Act:
"The term `assistive technology device' means any item, piece ofequipment, or product system, whether acquired commercially,modified, or customized, that is used to increase, maintain, orimprove functional capabilities of individuals with disabilities."
"The term `assistive technology service' means any service thatdirectly assists an individual with a disability in the selection,acquisition, or use of an assistive technology device. Such termincludes--
(A) the evaluation of the assistive technology needs ofan individual with a disability, including a functionalevaluation of the impact of the provision of appropriateassistive technology and appropriate services to the
individual in the customary environment of theindividual;(B) services consisting of purchasing, leasing, orotherwise providing for the acquisition of assistivetechnology devices by individuals with disabilities;
(C) services consisting of selecting,designing, fitting, customizing,adapting, applying, maintaining,repairing, or replacing assistivetechnology devices;(D) coordination and use ofnecessary therapies, interventions,or services with assistivetechnology devices, such astherapies, interventions, orservices associated with educationand rehabilitation plans and
programs;(E) training or technical assistance for an individual withdisabilities, or, where appropriate, the family members,guardians, advocates, or authorized representatives ofsuch an individual; and(F) training or technical assistance for professionals(including individuals providing education andrehabilitation services), employers, or other individualswho provide services to, employ, or are otherwisesubstantially involved in the major life functions ofindividuals with disabilities."
I would add that obtaining an AT device should be a no problem experience-cheap, simple to use, and including all warranties, training, andmaintenance.
What You Will Learn
1. A basic understanding of AT, exposure to some typical devices, waysof funding AT devices, and AT resources.
2. How AT supports independence for neuro-diverse informationprocessing.
3. A framework for thinking about how to match a person's uniquenessto a device.
4. How all of us use AT to support our own independence.
Who Is Neuro-Diverse?
Some people who do not have typical central nervous systems have claimedthe name of "neuro-diverse", to reduce the impact that medicalization ofdisability hason theirlives, and tovalue theiruniquenessas individualhumanbeings.
How theCNSProcesses
Information
Most of what the brain does is non-conscious. The CNS recognizes patternsand responds to them so quickly that we are not aware of what has beengoing on, but only see the results. For example, as you sit and read thishandout, your non-conscious brain has prepared actions for you that you cando from where you are, in case you decide to do them. For example, if aglass of water is within reach, your brain will have already prepared themovements necessary for you to take a drink. Because of this non-consciouspre-planning, our decisions and choices over what to do seem effortless.
The conscious brain is much slower and less effortless. Basically, we are onlyconscious of things that last longer than about 3 tenths of a second. It isalso very difficult for us to remain conscious of slow activities that takelonger than a few seconds to show movement. But our conscious brainallows us to use intention to change the likelihood that we will act in acertain way.
The overall purpose of our CNS is to anticipate the world around us, to guessaccurately what will happen next. This purpose is the most importantorganizer of what we do. When our brain changes in its chemistry orfunction, these differences change what and how we anticipate, how weguess what will happen.
Neuro-Typical and Neuro-Diverse
Most of us use our CNS in the typical way that human beings normallydevelop neurological capabilities. To the extent that we do what is commonin neurological development, we are Neuro-Typicals. To some extent, all ofus have acquired differences from the typical in the way
our brain works. Some people have lots of differences in the way their brainswork, and they call them selves Neuro-Diverse to label those differences in apersonally valuing way. The differences often result in some combination ofless information processing in some areas and more information processingin others. While this presentation focuses on ways to boost the effectivenessof information processing, it is a fact that all use of AT requires theintegration of strengths into the support.
Examples of Neuro-Diversity
1. Learning Disability: There are a wide variety of informationprocessing issues that are described as Learning Disabilities. They aretypically identified in school, hence the label. They often involvedifficulties in ignoring certain kinds of information, stably perceivingcertain kinds of information, combining different kinds of information,or storing certain kinds of information. Examples include:
i. Auditory Processing-has trouble understanding languageagainst background noise, among other things
ii. Reading Problems-a wide variety of visual, visual tracking,phonetic, visual-auditory translation and other processingproblems.
iii. Right Hemisphere processing-Problems in social learning,including jokes, understanding how they appear to others,interpreting other people's social cues.
iv. Attentional Problems-though not like other kinds of learningdisabilities, attentional problems have been lumped in with LD.
2. Dementia: Although memory problems are the signature difficulty ofdementia in most people's mind, almost any kind of informationprocessing problem can occur. The striking problem with dementia isthe progression of it. People with dementia can and do changedramatically in very short times.
3. Substance Abuse and State Dependent Meaning: Although SA isoften thought of as a moral problem. both chronic use and withdrawalare, in the first place, brain problems. More than this obviousconclusion, SA and withdrawal alter the meaning that the abuserattributes to the world. State Dependent Meaning is a concept thathelps us to understand this process of change in meaning thatabusers experience. Imagine a laboratory rat given a small dose ofsleeping medication, just enough to make the rat a little sedated.While the rat is affected by the drug, you teach the rat the differencebetween a triangle and a square.
When the effect of the drug wears off, the rat will no longerremember the difference between the triangle and the square. If yougive the rat the same dose of the same drug a couple of months later,the rat will suddenly remmber the difference between the square andthe triangle. The memory is dependent on the chemical state of thebrain at the time that the learning occurred.
Another example: A boy begins heavy drinking at age 12. Hecontinues to drink until his 30's when he quits and joins an AA group.He goes to his first AA meeting and finds that he is very anxiousabout talking to women, even being tongue tied. Because he did hisadolescent social learning while drunk, he lost some of that learningwhen he quit drinking. The learning was tied to the chemical statedcreated by the alcohol. It would take a while to relearn social comfortand confidence in his new chemical state.
4. Mental Illness: Severe mental illness symptoms are state dependentphenomena of the brain. Individuals with sevee mental illness try toadjust and alter the symptoms through their behavior. That is, likeanyone else with a neuro-diverse or a neuro-typical brain, they try toadapt their experience of life to their goals and dreams.
5. Traumatic and Acquired Brain Injury: As you might expect, braininjury can affect literally every aspect of human experience andbehavior. Regardless of the source of a brain injury, there is acommon problem where well learned and automatic behaviors arefragmented or distorted. Any behavior which we repeat becomes moreand more automatic over time. In another way of understanding,behavior becomes more non-conscious as it is repeated. When theautomatic parts of behavior are disrupted, the person has noconscious idea of why they can no longer do the action. They can'taccess and use the non-conscious parts of the behavior. In order torelearn the behavior, a way for the person to succeed at the purposeof the behavior has to be found.
6. Autism: Although our society has become more aware of autism andthe spectrum of autism experience, most people do not realize thatthe community of people with autism is the source of the concept ofNeuro-Diversity. It is common for persons with autism to havedifficulty managin certain sensory information, to have trouble withescalating anxiety, and to have narrow, but sometimes surprisinglyskillful, development.
In all of these examples, and many others, AT can help support and modifythe person's control over their lives and their environment.
AT and Independence
As I have said earlier, the use of AT is in supporting the lives and dreams ofpersons who are Neuro-Diverse. During the development of the moderndisability rights movement, three have been two major threads in theconcept of independence, that developed on the basis of different historicalexperiences by the members of different communities:
The Independent Living Model
The Independent Living Model grew out of the experience of persons withsevere physical and sometimes cognitive disabilities. Its current publicexpression are Centers for Independent Living that help people finds ways tolive independently in the community of their choice. The institutional focus ofthis community has been nursing homes, and the community's definition ofindependence and support is based on the restrictions and barriers thatnursing homes create for autonomy. The best statement of the IL Model is:
National Council on Independent Living:Ten Principles on Independent Living
1. Civil Rights – equal rights and opportunities for all, no segregation bydisability type or stereotype.
2. Consumerism – a person ("consumer" or "customer") using or buying aservice or product decides what is best for him/herself.
3. De-institutionalization – no person should be institutionalized (formallyby a building program or family) on the basis of disability.
4. De-medicalization – individuals with disabilities are not "sick" asprescribed by the assumptions of the medical model and do not require helpfrom certified medical professionals for daily living.
5. Self-help – people learn and grow from discussing their needs, concernsand issues with people who have had similar experiences; "professionals"are not the source of help.
6. Advocacy – systemic, systematic, long-term, and community-widechange activities are needed to ensure that people with disabilities benefitfrom all that society has to offer.
7. Barrier-removal – in order for civil rights, consumerism,deinstitutionalization, de-medicalization and self-help to occur, architectural,communication and attitudinal barriers must be removed.
8. Consumer Control – the organizations best suited to support and assistindividuals with disabilities are governed, managed, staffed and operated byindividuals with disabilities.
9. Peer Role Models – leadership for independent living and disabilityrights is vested in individuals with disabilities (not parents, service providersor other representatives).
10. Cross-disability – activities designed to achieve the first five principlesmust be cross disability in approach, meaning that the work to be done mustbe carried out by people with different types of disabilities for the benefit ofall persons with disabilities.
The Recovery Model
The Recovery Model of Independence grew out of the experience of personswith severe mental illness. The Model's current public expression includes awide variety of clubhouses, drop-in centers, and support programs entirelyopeated and governed by persons with severe mental illness. Theinstitutional focus of the Recovery Community has been involuntarycommitment and loss of rights in state mental hospitals and local hospital in-patient units. The Recovery Model grows out of this loss of autonomy. Thebest expression of the principles of the Recovery Community is:
The 10 Fundamental Components of Recovery
Self-Direction: Consumers lead, control, exercise choice over, anddetermine their own path of recovery by optimizing autonomy,independence, and control of resources to achieve a self-determined life. Bydefinition, the recovery process must be self-directed by the individual, whodefines his or her own life goals and designs a unique path towards thosegoals.
Individualized and Person-Centered: There are multiple pathways torecovery based on an individual’s unique strengths and resiliencies as well ashis or her needs, preferences, experiences (including past trauma), andcultural background in all of its diverse representations.
Empowerment: Consumers have the authority to choose from a range ofoptions and to participate in all decisions—including the allocation ofresources—that will affect their lives, and are educated and supported in sodoing. They have the ability to join with other consumers to collectively andeffectively speak for themselves about their needs, wants, desires, andaspirations. Through empowerment, an individual gains control of his or herown destiny and influences the organizational and societal structures in hisor her life.
Holistic: Recovery encompasses an individual’s whole life, including mind,body, spirit, and community. Recovery embraces all aspects of life, includinghousing, employment, education, mental health and healthcare treatmentand services, complementary and naturalistic services, addictions treatment,spirituality, creativity, social networks, community participation, and familysupports as determined by the person. Families, providers, organizations,systems, communities, and society play crucial roles in creating andmaintaining meaningful opportunities for consumer access to these supports.
Non-Linear: Recovery is not a step-by-step process but one based oncontinual growth, occasional setbacks, and learning from experience.Recovery begins with an initial stage of awareness in which a personrecognizes that positive change is possible. This awareness enables theconsumer to move on to fully engage in the work of recovery.
Strengths-Based: Recovery focuses on valuing and building on the multiplecapacities, resiliencies, talents, coping abilities, and inherent worth ofindividuals. By building on these strengths, consumers leave stymied liferoles behind and engage in new life roles (e.g., partner, caregiver, friend,student, employee). The process of recovery moves forward throughinteraction with others in supportive, trust-based relationships.
Peer Support: Mutual support—including the sharing of experientialknowledge and skills and social learning—plays an invaluable role in
recovery. Consumers encourage and engage other consumers in recoveryand provide each other with a sense of belonging, supportive relationships,valued roles, and community.
Respect: Community, systems, and societal acceptance and appreciation ofconsumers —including protecting their rights and eliminating discriminationand stigma—are crucial in achieving recovery. Self-acceptance and regainingbelief in one’s self are particularly vital. Respect ensures the inclusion andfull participation of consumers in all aspects of their lives.
Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may requiregreat courage. Consumers must strive to understand and give meaning totheir experiences and identify coping strategies and healing processes topromote their own wellness.
Hope: Recovery provides the essential and motivating message of a betterfuture— that people can and do overcome the barriers and obstacles thatconfront them. Hope is internalized; but can be fostered by peers, families,friends, providers, and others. Hope is the catalyst of the recovery process.Mental health recovery not only benefits individuals with mental healthdisabilities by focusing on their abilities to live, work, learn, and fullyparticipate in our society, but also enriches the texture of Americancommunity life. America reaps the benefits of the contributions individualswith mental disabilities can make, ultimately becoming a stronger andhealthier Nation.
Both the Independent Living Movement and the Recovery Movement wereborn out of a sense of injustice, on the one hand, and possibility, on theother, by people who had been marginalized and stigmatized by global socialstereotypes. But the historically separate development of the twomovements has led to different cultures of social and personalempowerment, and these differences have made it more difficult than itneed be for the two movements to effectively collaborate. AT is one of theareas which is very important to both communities.
Matching a Person and a Device
There are 30,000 devices currently labeled as AT, and that inventory doesn'tinclude all the personal inventions of individuals and their caregivers. Thereis no lack of possible devices. The hard part is to match the informationprocessing profile of a person to any device at all in a way that improvespersonal control and choice. While we are going to review ways to matchunder functional areas like memory, there are also some basic principles toremember regardless of what you are trying to do:
1. Try to understand how the person wants to accomplish their goal. Thiswill provide you with a rough model of the way information will beprocessed, and will make it much easier to filter the huge number ofpossibilities out there.
2. Choose the simplest, cheapest, and nearest solution.3. Include warranties, maintenance, and training in your planning.4. Always, always, always, try out the device before buying.5. Be able to offer face to face support after the purchase.
Convergence
There is a general trend in technology called "convergence", in whichtechnological capabilities are concentrated more and more in single devices.If the devices that are targets of convergence are accessible, then peoplewith disabilities can get fewer devices, maybe even just one ideally, and willbe able to use the device to control other devices that they need forindependence. This process could dramatically reduce costs, learning curves,maintenance, and so on.
The current prototype of the convergent device is the iPad, and it is clearthat many more similar devices will be coming out soon. At roughly $500, itis worth asking how much of a person's AT supports can be covered by sucha convergent device.
Faster, Better, Cheaper
Google is working on a computer operating system (OS) called Chrome thatthey expect to begin releasing late this year. It would be used with astandard set of components for a netbook-like computer. Because thecomponents are standard, and the OS uses online applications (the so-called"cloud"), the computer will boot in 2 seconds and will cost roughly half whatthe cheapest netbooks cost now (roughly $150-$200). At this point, this kindof computer (with a touch-screen) becomes the convergent device withstandard accessibility software. More information about the OS is availalbleat http://www.chromium.org/chromium-os.
Generally Usable Cues
Cues can be used to trigger behavior. They can be used on their own or aspart of an integrated AT support system. The most common classes of cuesupports include:
• Lists (including checklists)◦ Shopping List◦ Directions◦ Steps to complete a task
• Visual Cues◦ Color warning◦ Posted reminder◦ Photo
• Auditory Cues◦ Word or phrase prompt◦ Alarm◦ Orienting sound
• Tactile (touch) cues◦ Orienting cue to allow more effective auditory or
visual cue◦ Guiding touch◦ Orient to safety support
All of these can be done without any special device. We have all used theseto support our decision making, our daily life, our independence. We cantake our experience into consideration when we are supporting someoneelse.
Memory
Reminders and Lists
The key to supporting people with mild to moderate memory problems is theuse of lists and cues. The earlier discussion outlined the broad way in whichhumans use lists and cues, and any of these techniques can be used to helpa person remember something. You may remember a film called "Memento",in which the main character had a severe memory loss, and used notes,photos, and tattoos to help him find the killer of his wife. The remindersobviously have to have meaning to the person being reminded, and, thus,must be customized to some extent.
Recall
Early memory problems often show as difficulties recalling rather than a lossof a memory. Our central nervous system has many ways to findinformation, but we often settle into a single standard way to get at certaininformation. When that way breaks down, we may find it difficult to switch.Trying to trigger the retrieval by using another sense (even smell) or earlieror later information may trigger the memory. Also, recording a meaningfulitem so that it can be used to recall the entire memory is a common anduseful way to support people.
1. Placing photos on a phone so that the person can call someone bypressing the face.
2. List of things to check before leaving the house placed at eye level onthe inside of the door.
3. Taking pictures (camera on a cell phone, or around the neck) during aday of activities and then going over them that evening.
4. Skull and Crossbones sticker on things or appliances the personshouldn't touch.
5. Use checklist that is actually checked to assure completion ofimportant steps
Typical Devices
• Medication devices: There are many, many devices for remindingpeople to take medication. They range from a few bucks to severalhundred dollars. On the simple end are plastic containers that havelabels for days of the week and time of day. You can typically pre-loadthem for a full week, and for 4-5 times per day. On the expensive endare devices that ring a bell when its time to take medications and onlyallow that particular dosage to be accessed. Some will transmit asignal or a text message to someone if the medication isn't takenwithin a certain time period. There are many in-between devices aswell, and it is worth your while to pick a device that genuinely fits theindividual's situation.
• Picture Phone: There are a variety of such phones and a couple ofdifferent kinds are pictured in this handout. These devices are handyfor anyone in an emergency. It is far easier when your hands areshaking to hit a large button that will dial 911 automatically than it isto hit little numbers. Also, smartphone often offer a feature of havinga picture with contacts, and a simpler auto-dial mechanism when youhit the contact picture.
• Digital recorder around the neck: There are numerous digitalrecorders at all price points. In addition, most smartphones have avoice recorder and memo player that can do the same things as thesesingle purpose devices.
• Cell Phone App to find car in parking lot of mall: Smartphone appsare, in many ways, the AT of the future. One of the car finder apps isthe best selling app for Android phones (The developer is getting$13,000 a month from a $2.00 app). Spoken Turn by Turn directionsdriven by the GPS device in the phone make following directionseasier. There will be more such capabilities, such as GPS directionswithin buildings, and even houses. Really, it's only a matter ofconnecting a need with a developer. Though I don't believe it existsyet, such an AT development effort would make a great non-profitventure.
• Water level alarm for bath tub: Another device that might have appealto many people, especially driven, busy ones. There are many devicesthat do this kind of signaling, and there are automatic ones thatattach to the tub or faucet. Also, more and more tubs are comingequipped with level shut-off devices.
Attention
Attention is a function that results from integrating all of the monitoringskills we have and the orienting capabilities of our senses. At the basic end,think of a light flashing off to one side of your head, or a sudden sound. Youwill automatically turn toward the stimulus.
Type
Attention functions on a continuum from very broad in scope, like thereaction to a sudden and new stimulus in the environment, to very narrow,when you are deeply involved in a television mystery, for example. Peoplevary in terms of their "temperament" for attention, from a person who has
severe Attention Deficit Disorder to a person with autism who can focus onchanging lights for hours. In general, anxiety can both destroy attention andfocus it on one single object or person or event.
Fatigue
In the brain, there is only a certain amount of attention, just as there is onlya certainly amount of energy generally, and when you run out of attention,you are in a state of fatigue. In order to restore your attention, you mustrest. You can't work through brain fatigue.
It is common after brain injury to experience functionalfatigue when the parts of the brain that are damagedare used for too long. "Too long" can be 10 seconds ifthe area responsible for the function is severelydamaged. Once fatigue sets in, further efforts in thatarea will produce emotional symptoms that escalate and can produce loss ofcontrol.
Some Scenarios
1. Remove visual distraction in a room, including pictures, busywallpaper, and close curtains.
2. Run a white noise generator at night to support sleep. Simply Noise isa web site where you can produce white noise to prevent distractions.Go to http://simplynoise.com/ to use.
3. Remove or cover mirrors, deaden echoes with carpet or wall hangings
4. When using a computer, simplify desktop, and reduce lights in room,to improve focus on screen. The image is from DarkRoom which fillsyour computer screen with a simple word processor. Goto http://they.misled.us/dark-room to download.
Typical Devices
• Alarm reminders. there are zillions of these devices. Choose one thatis convenient and easy to use.
• Hand-held, computerized, sequence of task step pictures. The picturebelow is a step in a recipe. These kinds of apps will proliferate overthe next few years for smart phones. There will be ones for manyhobbies, complete with step pictures and videos.
• Recorded Reminders: This version is a smart phone app. Others arementioned elsewhere in this handout. It records messages tied to areminder time.
• Checklist (no more than 7-9 checks). Checklists are a generally usefultool for following steps. There is a current craze about them becausethe The Checklist Manifesto, a book you can check outat http://amzn.to/d07Xke.
• Social Supervision (the teacher presence effect on attention): Thepresence of another human being automatically improves task focus.Often, the attention and information processing abilities of marriedcouples become automated and intertwined over time. If one spousedies, information procesing deteriorates as well, and not just becauseof grief. It also declines because the well practiced ways of gettingthrough the day no longer work.
Orientation
Orientation in humans is a complex process of grasping the meaning ofcontext. It isn't simply knowing where you are, but also knowing how yourelated to the objects and people in your immediate environment, andknowing how your context will help or hinder you in getting where you wantto go (both geographically and socially). Our brains use internal monitoringto constantly update our understanding of our internal and external context.Problems in Orientation often arise from failure of these monitoring skills.
But problems can also arise because a person becomes anxious. In the film"On Golden Pond", Henry Fonda suffers disorientation and anxiety whiletrying to walk a path in the woods. He looks around himself and does not
recognize where he is, and becomes very anxious, which increases his senseof disorientation.
In reality, we don't useevery sensory detail ofthe environment to movefrom one place toanother. We use specificpoints along the path totell if we are going in theright direction. In otherwords, we don't follow avideotape whentravelling, we noteintersection road signs.Once you believe thatyou have a problem, youcan begin to judge yourorientation on parts ofthe trip that you neverreally paid attention to. This triggers anxiety which in turn further disorientsyou.
Location and Orientation
Where we are is equal to a set of GPS coordinates. Our Orientation has to dowith how we interpret our location, and that is based on identifiable cues inthe world and personal knowledge. Often, as in walking a path we havenever taken befoe in the woods, our orientation is to cues we can't see andthe route we used to get where we are now.
Following Directions
Directions are never a perfect replica of the journey we are to take. Instead,they are highlights that for one reason or another are easy to sense. Wefollow directions by moving from one highlight to the next. If we getconfused we don't figure our our absolute position (or at least we didn't untilGPS devices became so common). Instead we retrace our steps and look fora recognizable highlight to re-orient our selves.
Confusion (Disorientation)
Confusion is difficulty in interpreting the cues in theimmediate environment. It can be an unawareness ofcues or a misinterpretation of them. Most people withdementia, for example, are confused about where theyare, but the place they believe they are is a realenough kind of place. Although such confusion is calledconfabulation (we are making up our location), we allconfabulate. It is just that we use more cues in doingso. A person with dementia uses very few cues tofigure out where they are, and then assumes what would be true if theywere right.
Anxiety has a powerful effect on confusion and disorientation. In fact,anxiety can create a sense of disorientation even when there is no failure torecognize or interpret cues.
Some Scenarios
1. Using pictures to label rooms in a house: Labels are easy to print offthe internet. You can use both text and picture together as well. For aperson's room, you can use a printed photo.
2. Putting transparent acrylic doors on cabinets: The picture below ispretty classy, but transparent acrylic works as well.
3. Using a turn by turn GPS device: With the advent of GPS in cellphones, a wide variety of possibilities can be included in any smartphone. The picture below contains two versions of turn by turndirections in an Android smart phone.
Typical Devices
• GPS devices: There are many GPS devices besides smart phones. Thedevice below is intended to be used at the spot you want to return to.It records your trip and can tell you whether you are getting closer toyour final destination.
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• Use of curtains or carpets to deaden sounds: Sound deadening is acommercially viable enterprise, so there are many different versionsand types on the internet. Watch those installation costs!
• Transparent shower curtains in a well lit bathroom: There are somechoices here as well. This one seemed like the best of both worlds,but there are other designs.
• Motion detectors that, for example, turn lights on and off. There arealso a wide variety of motion detector sysems, varying in complexity,from ones that turn on lights outside when a dog goes by, to onesthat speak a specific recorded message when movement occurs. Theycan also be used in the house with different messages or actions whentriggered.
• Universal remote for entertainment devices: A lot of these as well.This one has big buttons and can sit on a table and not move.
Personal Safety
Personal safety is at the core of personal independence. However. it is moreimportant to personal freedom to choose how safety will be addressed inone's life than it is to be "made" safe by segregation or restriction. The focushere, as in all use of AT, is personal choice.
Bathroom
Bathrooms can be dangerous because of hot water and slippery surfaces.There is also the possibility of eating non-food substances:
• Label shampoos, lotions and other non-food items, preferably withboth a picture of their use and their name.
• Get unscented items.• Use a color indicator of hot water in the tub or shower, such as a color
changing mat.• Use a water wand to prevent water from over-flowing• Put grab bars at various locations throughout the bathroom• Remove throw rugs from slippery floors
• Consider outdoor carpet in the bathroom• Rubber mats that stick to surfaces• brushes with soap in them for washing• Shower chair• Shower head on hose
Kitchen
Kitchens have heated surfaces and foods, glass objects, hot water, knives,and other hazards.
• Eliminate glass objects or replace with corning ware• Use toaster ovens or microwaves instead of stoves• Label cabinets• Replace cabinet doors with transparent acrylic ones• Make sure a smoke alarm/CO alarm is in the kitchen near the stove• Plenty of hot pads, including gloves• Use lazy-susan instead of passing large bowls or plates• Use sturdy dining table with 4 legs instead of center based support• Dishwasher instead of hand washing• Phone in kitchen
Home
Shadow common daily activities and look for risky behavior and hazards.
• A Personal Emergency Response System (PERS) is a necessary tool.People who have a system are only 10% as likely to end up in anursing home as people without.
• NO THROW RUGS!• Smoke/CO alarms through out the house• Rubber treads on stair steps• Heavy duty stair rails• Cell phone on person• Use computer video for daily contact (i.e., Skype)• Lower or raise bed so person can comfortably sit with feet on floor• TV watching chair should have organizer right next to it and should
have a device to assist getting up
Outside
Chores are a common source of injury.
• Barter for chores with person's strengths• Electric rather than gas lawn and garden appliances
• Cell phone on person• No Ladders!• Hire snow removal or barter• Have PERS on person
Some Scenarios
1. Have lights turn on automatically when it is dark or the person movesfrom room to room, or goes outside. The picture is from the Heliossystem that will turn lights on and off as the person moves in and outof rooms, as well as other environmental control tasks.
2. Use web cam to check on person each morning (be respectful ofprivacy!) The picture is from a webcam called "Watching Paint Dry".
It has accompanying Music. There are webcams everywhere thesedays. Check out the current weather in Lansing by webcamat http://www.instacam.com/showcam.asp?id=LNSMG&size=S
3. Build relationships with neighbors: If neighbors know you they'llwatch out for you. Try a backyard barbecue as a friend starter.
4. Have dog for companionship and protection. The more the merrier. Aneighbor can walk.
Typical Devices
• PERS: There are many types. If you push the button, it signalssomeone or a busiess to check on you. Some allow you to transmitspeech as well.
• Ablelink style communication, alarm system" Ablelink creates softwarethat allows for many of the functional supports described in variousparts of this handout to be done on a desktop or handheld computeror smart phone. The software is expensive and you have to have thedevice, but the software is quite remarkable. Go to
http://www.ablelinktech.com/ for more information.
• Door opening alarms: There are an awful lot of door alarms. I wouldlook for price points and convenience.
• Water control devices: Pictured here is a water level control devicebuilt into the bathtub. There are wands that attach to faucets, and ahost of other devices.
• Temperature indicators: Here is a cute one that has a digital readout.There are many types of these, some that change color.
• Fall detection sensors: There are many types of these. This particularone is for the iPhone. Because smart phones contain accelerometersand GPS devices, they can be remarkably good at detecting falls. The
future of fall detection.
Mood and Symptom Management
Sleep
Sleep is the single most important variable in mood,symptoms of mental disabilities, energy level, andgeneral quality of life. Time and effort invested inassuring high quality sleep is never wasted and willreduce the number of interventions that need to bemade in other parts of the person's life.
• Stop caffeine• Daily exercise• Use night light• Use noise generator (i.e., fan)• Establish routine of relaxation for several hours before bed• Learn meditation• Nightly massage• Reading, or listening to, books• Music or automatic TV turnoff• Establish medication taking times in view of their effect on sleep
Stress
Stress is different than variety. Good living requiresvariety in stimulation and activities. A person shouldtypically be alert and ready to do an activity if theopportunity comes up. If heart rate is rising, shakinghands, anxiety, the person is under stress. If "couchpotato" syndrome, person is trying to recover fromstress.
• See ideas for Sleep• Plan daily activities• Rehearse stressful, but necessary, activities• Establish routine with small variations• Have several "fun" activities every day• Break up log trips into smaller chunks• Do some exercise after stressful experience
Depression/Agitation
Changes in your basic energy and activity level arenormal up to a point. Sometimes, though, the volumeis too high or low for long periods. Medication shouldbe examined, but avoid use of anti-psychotics foragitation. The use of these drugs is dangerous in olderpeople, and is typically done because it is easy. But, these drugs literallyremove meaning from life, and make it more difficult to appreciate positiveand negative experiences. Look for another way.
• Exercise is good for both depression and agitation. Exercise can be awalk together
• Routine is necessary to maintaining energy at a usable level• Examine experiences of depression and agitation for triggers. Once
you understand a trigger, you can manage it. While the cause may bebiochemical, the actual level can be changed by surprising things.
• Believe someone when they say that something raises or lowers theiractivity level.
Hallucinations
Demystify hallucinations. Everyonehas them eventually, many peoplewhen they were children. Tell theperson that hallucinations are notdangerous. The anxiety thathallucinations often trigger both inthe person have them and peoplearound that person cause moredisorientation and loss of the senseof control than the hallucination.There is an International Society ofPeople who hear voices, and put upwith stigma and discrimination as aresult.
• Use sensory interference, as desribed under Attention• Ask the person to check with you when they think they might be
hallucinating• Exercise will work• Sit and drink tea and talk• Wait for the intensity of the hallucinations to drop off, and do
something else in the meantime
Some Scenarios
1. Combine music and meditation
2. Eat regularly to avoid blood sugar issues
3. Avoid alcohol, caffeine, drugs
4. Stop daily activities at least 2 hours before typical sleep time, andshift to low energy. Hi-Ho, Hi-Ho, it's off to sleep we go!!
Typical Devices
• iPod: and the many, many other devices that can play music,newscasts, videos, short movies and long ones-You name it.Whatever works for you.
• Smartphone: The newer smartphones can do all of the iPod things,and I expect to see more and more relaxation apps in the nearfuture.
• Exercise machine: Exercise is necessary, necessary, necessary. Justadjust the approach to the person's functional abilities. Ask a PT or anOT for advice.
• Reminder for short meditation/breathing exercise every hour: Anydevice will do as long as it can handle a number of alarms. Some willtell you what to do. You can 3 of one kind of activity, 4 of another,and so on.
Integrating AT Supports
Planning AT for the Whole of Life
Over time, you will build up ways that AT fits into a person's life. As you dothis, you will find that having many devices for many different purposesdoesn't work. It becomes time for the person and you to look at broadersolutions. Also, each experience of support and independence teaches it'sown personal lessons about what works and what doesn't. Record thelessons.
• Ablelink Video-Use of technology to support a number of processingproblems at once See link for more info" Living the Smart Life DVDhttp://bit.ly/9RSeNU
• Computer control over home environment: You can hookup anythingelectric to a common control system and change everything at onceinstead of going around the house trying to change individual items.There are sensors for everything, and they can all be linked to yourcomputer.
• Remote control over computer: A relatively simple way to make useof a computer in a person's home is to use G-Bridge to connect yourcomputer with theirs, and use wireless web cams to monitor doors orareas where a fall might occur. There are also systems that tie GPS tothe internet so that you can track a person's movements if they havethe device on their belt or around their neck.
Future of Health Related Support
Sensors and remote telecommunications will change the way we receivemedical services over time. Sooner or later, we will all be wearing sensorsthat detect and record our health status as we go through daily activities.Video chat at high definition will allow those sensors to trigger an alarm andinstead of immediately running to the hospital, we might have a visual examby Internet. As these technological tools become part of health care, we willalso use them for other purposes, like social interaction, monitoring whilerespecting privacy, game playing, planning activities and events, and so on.For example, see this article on belt-worn health sensors at http://bit.ly/c09Fuu.
Beyond This Presentation
Resources
Nationally, there are a huge variety of resources around AT, so many in fact,that it is daunting to find what you are looking for. The Resources listedbelow focus on those that are generally useful.
The Job Accommodation Network: Find the site at http://askjan.org/.JAN originally developed to help employers figure out what accommodations
to use to support employees with disabilities. the network has focused a lotof energy on AT, and is generally helpful with developing an AT strategy.
ABLEDATA: Find the site at http://www.abledata.com/. The ultimatedirectory of devices, Abledata now contains over 19,000 device descriptions.When you want to see the variety of options available.
Michigan Loan Funds: Find the Siteat http://www.michiganloanfunds.org/. Operated by United Cerebral Palsy ofMichigan, the loan funds offer lower interest rates, and more flexible termsfor devices that increase personal independence for persons with disabilities,including children. There is no bottom limit on loans, and the top is$30,000.
Michigan Disability Rights Coalition AT Project: Find siteat http://www.copower.org/At/index.htm. MDRC has operated the MichiganAT project since 1997, and the Project includes many more activities than Ican discuss today. You should visit and get a better grasp of the localprojects, newsletters, and resources that the AT Project has created andmaintains.
AT Xchange: Find the site at http://www.atxchange.org/v3/home.php. ATXis a "classifieds" web site for used AT equipment, some free, some at lowcost. Once you create an account, you can trade, buy, or sell.
Michigan Protection and Advocacy Service AT Project: Find the siteat http://www.mpas.org/AdvocacyServices.asp?TOPIC=10922. MPAS helpswith information and advocacy around AT rights issues, and is a partner ofMDRC in our AT Act activities.
UCP Upper Peninsula AT Center: Find this site at http://www.ucp.org/ucp_localsrv.cfm/87/8293/8305/1104. The Center provides AT solutions forthe entire Upper Peninsula of Michigan, and UCP and the Center are partnersin our AT Act Activities.
National Assistive Technology Technical Assistance Project: Find the site athttp://www.resnaprojects.org/nattap/RESNA.html. A list of all State ATprojects and all their activities. A good resource when you can't find an
RESNA: Find the site at http://resna.org/. A resource for professionalinformation nationally. Find an assessment professional or learn how to builda career in Assistive Technology.
Aging In Place At Home: Find the site at http://www.aipathome.com/. Agood starting point for making any home livable by a person of any age who
has a disability, and the first step to staying out of a nursing home.
Family Center for Technology and Disability: Find the siteat http://www.fctd.info/. Information and resources for school and homesupport of independence by children with disabilities.
BlogsNorman Learned at http://normlearned.blogspot.com/LTC Reform at http://ltcreform.blogspot.com/The Recovering Life at http://therecoveringlife.blogspot.com/
Making Up the Mind: How the Brain Creates Our Mental World byChris Firth at http://bit.ly/ccH9gx
Chris Firth has written a superb and dryly amusing description of how ourbrains make the world we experience and in which we live. The new imagingtechnique of functional MRI has allowed neuropsychologists to see the braindoing stuff in real time, and what these experiments reveal is startling and"brain-changing".
Universal Design for Learning (UDL) Videos from The National Center forUDL at http://bit.ly/bvFAZ0
UDL isn't just for schools anymore. The basics of UDL are useful in any ATactivity, allowing easier brain process for everyone. Worth a look, and thevideos are easy to watch.
The Illustrated Guide to Assistive Technology and Devices by SuzanneRobitaille at http://bit.ly/bvFAZ0
At the price ($14.00 on Amazon), the best and most accessible introductionto AT and decision making I've seen. Worth keeping around, as well, since itis a good reference.
Universal Design for the Home by Wendy A. Jordan at http://bit.ly/8Y8J4H
The best way to solve a problem is to never have one. This book needs aDIY person, but has many ideas for making it easier to live in the home youhave. Stuffed with ideas.
From our Veterans Home Care program, a one stop site for devices brokenout by general cognitive support purpose. A good place to check befoe goinginto Abledata's massive directory.
Last Thoughts
"To the cognition of the brain must be added the experience of the soul."-Arnold Bennett
“When you take a person with dementia and you put them in a car anddrive them for four hours to come for an appointment, they're not really attheir best when you assess them."
-Andrew Kirk
"Nothing About Us without Us."-Many authors and versions
"A true friend knows your weaknesses but shows you your strengths."-William Arthur Ward
"Disability is an art. It’s an ingenious way to live.”-Neil Marcus
"I have heard there are troubles of more than one kind. Some come fromahead and some come from behind. But I've bought a big bat. I'm all readyyou see. Now my troubles are going to have troubles with me!"
Assistive Technology and Neuro-Diversity by Norm DeLisle is licensed underaCreative Commons Attribution-Noncommercial-Share Alike 3.0 United StatesLicense.
