Low Tech vs. High Tech

What is the difference between low tech and high tech in regards to Assistive Technology?

First, it is important to understand what is assistive technology to begin with.  To paraphrase many definitions that are available, assistive technology is the use of a device to assist with improving the function of the user.  For example, a pair of glasses can be considered assistive technology as they assist with vision.  A walker can be considered assistive technology as it helps with walking or ambulation.  There are also different levels of assistive technology, and this can be broken down into low and high tech devices.
 

Low technology does not require a power source.  Sometimes this can be the easiest and most practical of solutions in assistive technology.  Low tech devices are items that facilitate independence in an area as does high tech devices.  Examples of low tech are a cane for assistance with walking, a pencil grip for children with grasp issues, or even glasses to assist an individual with seeing their environment.  

Even if an individual can benefit from high tech assistive technology, it is always important that they have a low tech "backup".  Technology can fail, batteries die, and emergencies can happen.  In these cases, an individual will continue to meet their needs using their low tech device.  Also, low tech devices might be all a user needs.  High tech is not indicated for everyone.

Before we discuss high tech devices, there is another classification that many individuals use, mid tech.  The difference between mid tech  and low or high tech  is that mid tech has a battery source.  Typically, they have limited capability but do have a power source.  This can include communication devices that can be pre-programmed with single pre-saved phrases or simple remotes that can control an individual's lights.  

 Again, mid tech can also be an appropriate option for individuals.  They are simple devices that can facilitate independence for the user.

High Technology:

Users of high technology are typically individuals with significant functional impairments.  This can includes folks with spinal cord injuries, Lou Gehrig's disease, or muscular dystrophy.  Examples of high tech devices are:

• Communication devices with alternative access methods such as eye gaze
• Stand alone environmental control units, with alternative access, that can control multiple devices in the user's environment
• Computer workstations with alternative software and hardware for access, such as a head mouse or dwell click software 

These devices can assist a person with the most minimal of movement to independently communicate or control their computer.  

Funding can be a challenge for these devices and they can be quite costly.  Communication devices (or AAC devices) can often be partially covered by insurance companies.  A qualified professional can assist with the selecting the appropriate device for the user's needs and goals, as well as obtaining funding for best device choice.

What have your experiences with these forms of assistive technology?

Direct vs. Indirection Selection?

Selection Options for Device Use:

When evaluating an assistive technology device,  the selection method is one of the most important aspects of the evaluation.  The if the appropriate type of selection method is not being utilized then the user cannot be as efficient and might become frustrated with the device use. These selection methods can be used with computer access, communication devices (AAC or SGD), and environmental control units.

Direct Selection:  Direct selection simply is just what it sounds like; you press a switch and your "selection" is made.  An everyday example of direct selection is a light switch; you "flip" the switch and the light turns on or off.  Other examples of direct selection is the left or right buttons on the mouse, dwell click software, or touch screen use/access for computer skills.  Direct selection can be a very quick form of access for the appropriate individual.  If it is not appropriate, then the individual might spend an extended amount of time to fix errors or be unable to effectively access the device at all.  Direct Selection does not need to be performed with a hand but any body part or technical device in order to make a selection.

Indirect Selection or Scanning:  Indirect selection is also known as scanning which is an indirect way of accessing a device.    

The user will access a switch which will begin intermdiate steps or scanning in order to make a choice.  There are several different types of scanning.  Either one or two switches can be used with scanning; these switches are mounted or positioned at the body part with the best strength or that will not create fatigue with use over time.  

The most common form of scanning or indirect selection is linear scanning.  With linear scanning, the user accesses their switch which begins the scan.  This scanning moves row by row.  When the scan gets to the line with the letter or choice that the user wants, they access the switch again; this begins a column scan.  Once the scan gets to the desired choice, the user accesses their switch again and the desired action happens.  This could be a pre-saved phrase for communication or a letter for typing with an on screen keyboard.

Inverse Scanning is performed with the user holds their switch down to being the scan.  The user holds their switch down until the desired choice is highlighted and lets go to have their choice made.

Group Scanning:  With group scanning, the user accesses their switch and groups are highlighted.  As the group with the desired choice is highlighted, the user accesses their switch.  It then will narrow the choices with a linear scan.

Item by Item Scanning:  The user accesses their switch to move the highlight or cursor in order to make a choice.  This method requires multiple switch access "hits" in order to get to the desired choice.

Other, individuals are concerned that scanning is slower than direct selection.  Points to consider are if the individual is unable to perform direct selection without making a considerable amount of mistakes, indirect selection will be more efficient and less fatiguing.  

Indirect selection is appropriate for an individual with limited movement.  For example, if the user has only one area of movement such as one finger, scanning would be an appropriate access method for access of the computer or a communication device.

Positioning is very important for scanning use.  The switch must be mounted to the area with the best strength so that the user will not become fatigued over time.  Switches can be mounted to any surface such as a wheelchair, tabletop, or bedrail.

Considerations with scanning is that it requires a higher cognitive load.  The user must be able to anticipate the scan and understand the cause and effect of indirect selection.

There are many features that can be modified with scanning.  These include:

• The rate of the speed of the scan
• The type of scan
• The type of feedback
• Audio
• Click sounds
• Reading the scan choices out loud
• Visual
• Highlight color
• Magnification of the scan
• One or two switches

When evaluating an assistive technology device, the type of selection is one of the most important parts of the evaluation and consideration of particular devices.  It is important to remember that the most appropriate access method might not be established within the first session; it can take time to figure out the best method as well as the modifications required to make this method the most appropriate.

Switch Use

What is a switch?


Switches are used with all forms of assistive technology.  The easiest way to think about a switch is a device that can start or stop a device.  The most common type of switch is activate with some kind of touch, creating the contact of two surfaces or switches to work with an assistive technology device.

What kind of switches are there?


There are literally hundreds (if not thousands) of switches available for assistive technology access.  Switches are meant to be accessed by the available body part or motion that is strongest for the user.  This area of access needs to be consistent and not create fatigue with extended use.  The area of access can also vary dependent on the position of the individual.  For example, a person might use their finger for switch access when in their wheelchair and a sip and puff switch for when they are in their bed.


When evaluating what is the best switch site, it is recommended to evaluate distal to proximal.  This means, start with the hands or fingers.  If this is not an appropriate site, what can be done as we move up?  Are gross movements easier than fine movements?  If the individual cannot use their arms, what other areas are appropriate?  


Addition considerations for switch use is the amount of force required to press the switch (if it is a tactile switch).  When looking at the "specs" of the switch, you can find the amount of force in ounces or pounds for access.  This is very important for an individual with limited movement or a harder switch user that needs a more durable switch.

How can a switch be mounted for access?


There are many ways that a switch can be mounted.  Switches can be mounted to a wheelchair, tabletop, or any other surface for best access.  If appropriate, Velcro can be instrumental in attaching a switch for access.  


If additional mounting options are required, a simple tabletop mount might be appropriate.

Removable mounts can be used that would attach the switch to a wheelchair, tabletop, or any other surface.  These mounts can be purchased with varying arm lengths and plate sizes.

More permanent mounting can be done in wheelchair components such as in the headrest.  Conductive fabric and clothing can be used to create novel switches, making it a part of clothing.


What if the user cannot "hit" a switch?


There are switch options for an individual with limited or lack of movement that would be required in order to touch a switch.


Sip and puff:  A sip and puff switch is a great option for users with limited movement or issues with significant fatigue when attempting to touch a switch. Through the actions of sipping and puffing, the user can control their assistive 
technology device.

Proximity:  A proximity switch is activated when the user gets closer to the switch.  Dependent on the switch chosen, the range of how close the individual the user has to get to the switch to activate it can vary.  This switch can be mounted pointing at any area for the user.

EMG switch:  An EMG switch is also known as a muscle twitch switch.  A muscle twitch sensor is placed on a muscle that can be used consistently without pain or fatigue.  When the user contracts the muscle, it activates the assistive technology service. 


Sound switch:  This is a switch option that has been around for sometime.  The Clapper is an example of a sound switch.  When the individual makes a sound, it activates the device such as a communication device.  There are very sensitive sounds switches available allowing for changes in the sensitivity, how loud or soft the sounds needs for access.  


To conclude, the importance of switches and their positioning is very important. If the individual is not setup with the best switch for the strongest access site the user will not be efficient or conserve their energy.  Through a full evaluation, an appropriate recommendation can be made not only for the device but for the appropriate access method. 

Cell Phone Adaptability

Often, when people think about cell phone accessibility, they think that if the phone has voice activation or recognition features, then its accessible.  Unfortunately, often a small button is required to initiate these voice features.  What is the user to do if they cannot access this button?


Switch Accessibility:

Through various hardware options, a switch can be added to a bluetooth for access.

The picture above shows an example of a switch adapted bluetooth.  Any ability switch can be plugged into the switch port.  The user would then access the switch (with the strongest area of their body) to answer a call, hang up a call, or dial (using the voice commands).  This eliminates the need to hit the small bluetooth button for voice command use.  It can also work fairly well with the Siri features of the iPhone 4S, for writing text messages and emails.

Voice Activation:

There are options with hardware that will enable full voice activation, without the requirement of pressing buttons.  

Through the use of voice commands, the user can dial and answer calls.  This device is a speakerphone which would limit the privacy for the user but still can enable independence.  The original intent for this device was for hands free calling when in a car but it can be adaptable for many individuals.

The thing to remember about all voice activated devices that they can never be 100% accurate.  These are devices, not people.  They cannot interpret what the user means if they say the wrong word or name.  Furthermore, if there is background noise it can affect the accuracy of the device.  

These devices can be very important to facilitate independence for individuals with varying disabilities.

Telephones telephones telephones

Telephones are a necessity to our daily life but a piece of technology that is not accessible for all users.  Not only is the telephone a requirement for for keeping in touch with friends and family but it is important for home safety.  If you cannot access your telephone, how can you call for help.  Here are some of the options, although there are more available on the market dependent on your needs.


Call your telephone company.  The company that is providing your service might have options for phones without any or a limited additional cost.  These services might include accessibility for the death or hard of hearing population, or for individuals with minimal physical impairments.  


Scanning Telephone:  The use of a phone that has a scanning feature can be very beneficial for a user with limited mobility.  The telephone featured below has a remote control that allows for any ability switch to be plugged into it.  There are 20 preset numbers that can be pre-programming.  When the user presses the switch, the scanning through the 20 preset numbers begin.  The speed of the scan can be adjusted for the user.  Once the scan gets to the desired number, the user presses the switch again and it dials out.  To answer or hang up, the user only needs to hit the switch.  Not only can this be accessed by a physical switch but by an air switch as well.  If the user cannot use their hands, the physical switch can be mounted by their head or the air switch might be appropriate.  

Voice Amplification:  If an individual has issues with the volume of their voice, using a telephone can be very challenging.  The people that they are speaking with might be unable to hear or understand them, asking them to constantly repeating themselves, requiring more energy for telephone use.  A nice solution might be using a telephone that amplifies the speaker.  There are many options that amplify the incoming person for a hand of hearing individual but limited for amplifying the outgoing for low volume.  There are some "inline" amplification options that connect between the phone and the wall.  There are also telephones that amplify through the handset, pictured below.

Computer Based:  A computer could be used for telephone needs.  There are certain websites that can be accessed for free that connect to an operator.  You enter the number to dial, the operator dials it, and then speaks for you.  The user would type what they want said, the operator speaks it and then types back the response.  This is great for someone who is deaf or hard of hearing, or for an individual with limited or no upper extremity use that is accessing their computer through adapted means.  

Picture Based Dialing:  For individuals with cognitive issues or have issues with remembering or recognizing numbers, picture based dialing can be helpful.  These types of phones allow the user to program preset numbers with the pictures of who they are dialing onto.  The individual only has to press the picture to dial the desired individual.  The amplification phone above has this feature has does many other phones.

Keep in mind that these telephones are options but not the only options for making telephone calls.  Cell phone adaptations are to be addressed in an upcoming blog post.