A plug-and-play brain-computer interface to operate commercial assistive technology

Abstract

Purpose: To determine if a brain-computer interface (BCI) could be used as a plug-and-play input device to operate commercial assistive technology (AT), and to quantify the performance impact of such operation. Method: Using a hardware device designed in our lab, participants (11 with amyotrophic lateral sclerosis, 22 controls) were asked to operate two devices using a BCI. Results were compared to traditional BCI operation by the same users. Performance was assessed using both accuracy and BCI utility, a throughput metric. 95% confidence bounds on performance differences were developed using a linear mixed model. Results: The observed differences in accuracy and throughput were small and not statistically significant. The confidence bounds indicate that if there is a performance impact of using a BCI to control an AT device, the impact could easily be overcome by the benefits of the AT device itself. Conclusions: BCI control of AT devices is possible, and the performance difference appears to be very small. BCI designers are encouraged to incorporate standard outputs into their design to enable future users to interface with familiar AT devices.

• Implications for Rehabilitation

• Brain-computer interface (BCI) control of assistive technology (AT) devices is possible.

• The performance impact of such control is low when BCIs are commercially available, AT providers can use a BCI as an input device to existing AT devices already in use by their clients.

     

Assistive technology as reading interventions for children with reading impairments with a one-year follow-up

Purpose: This pilot study investigated the possible transfer effect on reading ability in children with reading difficulties after a systematic intervention to train and compensate for reading deficiencies by using applications in smartphones and tablets. The effects of using assistive technology (AT) one year after the interventions were completely studied. School related motivation, independent learning and family relations were also considered.

Method: 35 pupils aged 10–12 years participated. They were assessed five times with reading tests. The participants, their parents and teachers were surveyed with questionnaires regarding their experience of using AT. The data from the assessments were analyzed with paired t-tests and Wilcoxon signed-rank tests. The data from the questionnaires were analyzed using content analysis.

Results: The paper shows that using AT can create transfer effects on reading ability one year after the interventions were finished. This means that reading impaired children may develop at the same rate as non-impaired readers. Also, increased school motivation and an increase in independent learning and family effects have been shown.

Conclusions: This paper provides implications in how to facilitate reading impaired pupils’ learning process and realizes the need to challenge the concept of reading to change to fit modern means of gaining information.

• Implications for rehabilitation

• Children with reading impairment could benefit from assistive technology in regards of their reading development process and increase their chances of not falling behind peers.

• Assistive technology as applications in smartphones and tablets may aid children with reading impairment to have an equal platform for learning in school as their peers without reading difficulties.

• Assistive technology could facilitate the information gaining process and subsequently increase motivation to learn and increase interest in reading activities.

• Assistive technology had wider effects on its users: stigmatizing situations when leaving the classroom for special education were avoided and positive effects on family life were noted.

     

Mobile devices and weak ties: a study of vision impairments and workplace access in Bangalore

Purpose: To explore ways in which social and economic interactions are changed by access to mobile telephony. Method: This is a mixed-methods study of mobile phone use among 52 urban professionals with vision impairments in Bangalore, India. Results: Interviews and survey results indicated that mobile devices, specifically those with adaptive technology software, play a vital role as multi-purpose devices that enable people with disabilities to navigate economically and socially in an environment where accessibility remains a significant challenge. Conclusions: We found that mobile devices play a central role in enabling and sustaining weak ties, but also that these weak ties have important gender-specific implications. We found that women have less access to weak ties than men, which impacts women’s access to assistive technology (AT). This has potential implications for women’s sense of safety and independence, both of which are strongly related to AT access.

• Implications for Rehabilitation

• Adaptive technologies increase individuals’ ability to keep in contact with casual connections or weak ties through phone calls or social media.

• Men tend to have stronger access to weak ties than women in India due to cultural impediments to independent access to public spaces.

• Weak ties are an important source of assistive technology (AT) due to the high rate of resale of used AT, typically through informal networks

     

The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya

Purpose: In this paper, the authors explore the use of mobile devices as assistive technology for students with visual impairments in resource-limited environments. This paper provides initial data and analysis from an ongoing project in Kenya using tablet devices to provide access to education and independence for university students with visual impairments in Kenya. Method: The project is a design-based research project in which we have developed and are refining a theoretically grounded intervention – a model for developing communities of practice to support the use of mobile technology as an assistive technology. We are collecting data to assess the efficacy and improve the model as well as inform the literature that has guided the design of the intervention. Results: In examining the impact of the use of mobile devices for the students with visual impairments, we found that the devices provide the students with (a) access to education, (b) the means to participate in everyday life and (c) the opportunity to create a community of practice. Conclusions: Findings from this project suggest that communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Implications for Rehabilitation

• The use of mobile devices as assistive technology in resource-limited environments provides students with visual impairments access to education and enhanced means to participate in everyday life.

• Communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Providing access to assistive technology early and consistently throughout students’ schooling builds both their skill and confidence and also demonstrates the capabilities of people with visual impairments to the larger society.

     

Exploring factors facilitating adults with spinal cord injury rejoining the workforce: a pilot study

Abstract

Background: Return-to-work (RTW) rates after spinal cord injury (SCI) in the USA are very low and are continuing to decline. Previous research has attempted to identify factors facilitating RTW; however, the phenomenon of RTW involves many personal factors and predicting RTW success remains difficult. Purpose: The purpose of this pilot study was to explore the factors facilitating adults with SCI rejoining the workforce in an urban area in order to identify items that may be emphasized in the rehabilitation process. Methods: The study was completed using qualitative methods. Four adults who had acquired a traumatic SCI in adulthood and were currently employed participated. Their experiences in RTW after injury were collected via semi-structured interviews and photography of assistive devices. Results: The most common facilitating factor was motivation, with family and rehabilitation professionals serving as extrinsic motivators. Other facilitators were resources and perceived benefits. Conclusions: Motivation and resources were important facilitators, including rehabilitation professional’s personal influence and therapies, and resource assistance from state agencies. The results indicate that practitioners can play an important role in influencing RTW, and resources from state agencies are helpful when individuals know how to access and utilize them.

• Implications for Rehabilitation

• Assistive technology supports successful return to work after SCI.

• Motivation strongly influences return to work after SCI and can be influenced by rehabilitation professionals, family and community members.

• Patients should be well informed about how to access assistance programs such as vocational rehabilitation.

     

Assistive technology access and service delivery in resource-limited environments: introduction to a special issue of Disability and Rehabilitation: Assistive Technology

This special issue addresses access to and service delivery of assistive technology (AT) in resource-limited environments (RLEs). Access to AT is complicated not simply by limited funds to purchase AT, but by larger ecosystem weaknesses in RLEs related to legislation and policy, supply, distribution, human resources, consumer demand and accessible design. We present eight diverse articles that address various aspects of the AT ecosystem. These articles represent a wide range of AT, many different countries and different research methods. Our goal is to highlight a topic that has received scant research investigation and limited investment in international development efforts, and offer an insight into how different countries and programs are promoting access to AT. We encourage researchers, funders and non-profit organizations to invest additional effort and resources in this area.     

Systems thinking for assistive technology: a commentary on the GREAT summit

Abstract

The area of assistive technology has a long history of technological ingenuity and innovation. In order to ensure that the benefits of assistive technology are equitably distributed across the population and life course, it is necessary to adopt a systemic approach to the area. We describe examples of systems thinking and non-systems thinking across 10?Ps. These Ps are People (or users, as the primary beneficiaries of assistive technology), Policy, Products, Personnel, Provision (as key strategic drivers at systems level); and Procurement, Place, Pace, Promotion and Partnership (as key situational factors for systems). Together these Ps should constitute a framework for an “open” system that can evolve and adapt, that empowers users, inter-connects key components and locates these in the reality of differing contexts. The adoption of a stronger systems thinking perspective within the assistive technology field should allow for more equitable, more resilient and more sustainable assistive technology across high, middle- and low-income contexts and countries.

• Implications for Rehabilitation

• The progress of assistive technology provison has been hampered by disconnected initiatives and activities and this needs to be corrected.

• Systems thinking is a way of thinking about the connections between things and how these are influenced by contextual and other factors.

• By encouraging the providers and users of assitive technology to think more systemically we can provide a more cohesive and resilient systems.

• The user experience is the central component of systems thinking in assistive technologies.

     

Exploring the functional impact of adaptive seating on the lives of individual children and their families: a collective case study

Purpose: This study examined parent-reported change in the functional performance of four school-aged children with wheeled mobility needs who had used a new adaptive seating system for 6 weeks.

Methods: The collective case study involved four mothers whose children, ages 6–9 years, received a new adaptive seating system for a manual wheelchair or stroller. Mothers completed the Family Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS) at the time their child received a new seating system, and then after 6 weeks of daily use. Other questionnaires, health records, and semi-structured interviews provided additional data about the seating interventions and their functional effects on individual children and their families.

Results: The FIATS-AS detected overall functional gain in one family, and both gains and losses in 2–7 dimensions for all families. Functional status and change scores showed consistency with measures of seating intervention satisfaction, global functional change, and home participation. Interview themes also suggested consistency with change scores, but provided a deeper understanding of important factors that influenced adaptive seating outcomes.

Conclusion: This study supports the need to explore further the complexity, temporality and meaningfulness of adaptive seating outcomes in individual children and their families.

• Implications for Rehabilitation

• Assistive technology practitioners need to adopt practical measurement strategies that consider the complexity, temporality, and meaningfulness of outcomes to make evidence-informed decisions about how to improve adaptive seating services and interventions.

• Health measurement scales that measure adaptive seating outcomes for service applications must have adequate levels of reliability and validity, as well as demonstrate responsive to important change over time for individual children and their families.

• Needs-specific measurement scales provide a promising avenue for understanding functional outcomes for individual children and youth who use adaptive seating systems.

     

The segway personal transporter as an alternative mobility device for people with disabilities: a pilot study

Sawatzky B, Denison I, Langrish S, Richardson S, Hiller K, Slobogean B. The Segway Personal Transporter as an alternative mobility device for people with disabilities: a pilot study.

Objectives

To determine the functional measures that best correlate with the skill levels of people with disabilities who operate a Segway Personal Transporter, and—using a qualitative analysis—to explore subjects’ experience with the Segway.

Design

A prospective study encompassing 3 training sessions with the Segway to correlate subjects’ functional ability (eg, cognition, balance, mobility, muscle strength) with their skill level on the device.

Setting

A provincial adult rehabilitation center.

Participants

Twenty-three subjects (age range, 19−65y) with a wide range of disabilities (eg, multiple sclerosis, spinal cord injury, amputation) who could walk at least 6m with or without assistance.

Interventions

Not applicable.

Main Outcome Measures

Segway Task Assessment, Berg Balance Scale, and Timed Up & Go test.

Results

No correlation was found because all participants successfully completed the final Segway Task Assessment, regardless of scores on functional assessments.

Conclusions

The Segway is a useful device for a broad range of populations with functional disabilities. Subjects found the Segway easy to use and were excited about its potential as an assistive device for use in their communities.     

Why the time is right for a radical paradigm shift in early powered mobility: the role of powered mobility technology devices,policy and stakeholders

This article explores the changing landscape of early pediatric powered mobility. We specifically focus on key indicators that suggest pediatric powered mobility technology (PMT) practice for very young children is poised for a radical paradigm shift. This shift will challenge the current purview of PMT design and function, how it is obtained, and its introduction to children and their families. We propose that this positive, yet radical shift is essential in achieving a standard of practice in which PMT provides for early exploration and participation for children with disabilities at an age concomitant with their non-disabled peers, and within socially inclusive environments. To sustain this new standard, we must acknowledge the significant disconnect that currently exists between clinical research supporting the use of PMT with very young children, and barriers to widespread device access, effective user-driven design and positive social perception of PMT. In this article, we discuss three areas that are particularly important for both shift and sustained change: the history and current availability of novel and conventional PMT devices, pediatric PMT policies and the role of children and families as primary stakeholders in PMT practices. Within each area, we suggest barriers, facilitators and future directions.

• Implications for Rehabilitation

• The time is right for reframing how powered mobility technology for very young children is conceived, designed, and implemented.

• In order for multiple innovative devices to survive in the powered mobility industry, it is important to continue to show the benefits of early powered mobility use for both traditional and non-traditional users, and also enact and enforce policy that promotes sustainable access and financial support for powered mobility technology.

• The experiences of children and families and the realities of everyday use of powered mobility technology must be brought to the forefront of a movement toward user-centered design.

• Advocacy efforts undertaken in partnership with families, clinicians, researchers, and disability communities are essential in recognizing mobility, and access to early powered mobility technology, as a human right.

     

BNCI systems as a potential assistive technology: ethical issues and participatory research in the BrainAble project

Abstract

Purpose: This paper highlights aspects related to current research and thinking about ethical issues in relation to Brain Computer Interface (BCI) and Brain-Neuronal Computer Interfaces (BNCI) research through the experience of one particular project, BrainAble, which is exploring and developing the potential of these technologies to enable people with complex disabilities to control computers. It describes how ethical practice has been developed both within the multidisciplinary research team and with participants. Results: The paper presents findings in which participants shared their views of the project prototypes, of the potential of BCI/BNCI systems as an assistive technology, and of their other possible applications. This draws attention to the importance of ethical practice in projects where high expectations of technologies, and representations of “ideal types” of disabled users may reinforce stereotypes or drown out participant “voices”. Conclusions: Ethical frameworks for research and development in emergent areas such as BCI/BNCI systems should be based on broad notions of a “duty of care” while being sufficiently flexible that researchers can adapt project procedures according to participant needs. They need to be frequently revisited, not only in the light of experience, but also to ensure they reflect new research findings and ever more complex and powerful technologies.

• Implications for Rehabilitation

• BCI/BNCI systems are not similar to existing switch-controlled or eye gaze systems. Users and those supporting them need to have their expectations carefully managed.

• BCI/BNCI are emergent technologies and side effects of long term use are not well understood: this demands an ongoing concern to ensure duty of care and maintenance of a “watching brief” regarding ethical issues.

• Practitioners need to be particularly careful when introducing BCI/BNCI systems to be sensitive to the meanings that are attached to them and how they may convey prognosis.

     

Validating a measure to assess factors that affect assistive technology use by students with disabilities in elementary and secondary education

Purpose/Aim: The purpose of this study was to measure the predictive validity, internal consistency and clinical utility of the Matching Assistive Technology to Child & Augmentative Communication Evaluation Simplified (MATCH-ACES) assessment. Methods: Twenty-three assistive technology team evaluators assessed 35 children using the MATCH-ACES assessment. This quasi-experimental study examined the internal consistency, predictive validity and clinical utility of the MATCH-ACES assessment. Results: The MATCH-ACES assessment predisposition scales had good internal consistency across all three scales. A significant relationship was found between (a) high student perseverance and need for assistive technology and (b) high teacher comfort and interest in technology use (p?=?(0).002). Conclusions: Study results indicate that the MATCH-ACES assessment has good internal consistency and validity. Predisposition characteristics of student and teacher combined can influence the level of assistive technology use; therefore, assistive technology teams should assess predisposition factors of the user when recommending assistive technology.

• Implications for Rehabilitation

• Educational and medical professionals should be educated on evidence-based assistive technology assessments.

• Personal experience and psychosocial factors can influence the outcome use of assistive technology.

• Assistive technology assessments must include an intervention plan for assistive technology service delivery to measure effective outcome use.