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Kathy Ireland Issue Feb/Mar 2011


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    $4.99 KATHY IRELAND FEB/MAR 20110 70989 35509 5

    0 2

    $4.99 ISSUE 02-11



  • MANAGING EDITORGillian Friedman, MD



    HUMOR WRITERSJeff CharleboisGeorge Covington, JDGene Feldman, JD

    EDITORSDahvi FischerRenne Gardner Regina HallMolly MackinJosh PateDavid RadcliffDenise Riccobon, RNJane Wollman RusoffMaya Sabatello, PhD, JD Romney Snyder

    HEALTH EDITORSMoses deGraft-Johnson, MDLarry Goldstein, MD

    CONTRIBUTING WRITERSAshley FiolekGale Kamen, PhDLaurance Johnston, PhDAndrea KardonskyDeborah Max Myles Mellor - Crossword PuzzlePaula Pearlman, JD Allen RuckerKristen McCarthy ThomasBetsy Valnes

    WEB EDITORSStan HoskinsMary Shafizadeh

    GRAPHIC ART/ILLUSTRATIONScott JohnsonMelissa Murphy - Medical Illustration Anna Blagovidova

    PHOTOGRAPHYNancy VillereCrushPhotoStudios.com


    The views expressed in this issue maynot be those of ABILITY MagazineLibrary of Congress Washington D.C. ISSN 1062-5321

    Copyright 2011 ABILITY Magazine


    MARKETING/PROMOTIONSStan HoskinsAndrew Spielberg


    [email protected]

    NON-PROFITSABILITY Awareness/Fuller CenterHabitat for Humanity




    ity G


    6 HUMOR Love Hurts

    8 ASHLEYS COLUMN Back in the Saddle

    10 SEAN FORBES Can You Hear Me Now?

    14 GUNSHOT WOUNDS Bullet Points


    18 BLIND FISHING BOAT New Fishermen Take the Bait

    22 YAHOO Expanding the Digital Highway

    32 REHABILITATION Hitting New Strides

    38 TERRI CHENEY A Plea for Innocence

    42 KATHY IRELAND A Model Businesswoman

    50 HEART TRANSPLANT An Uncommon Cardiac Connection

    54 LEIGH BRILL Excerpt From A Dog Named Slugger




    ABILITY Magazine is published bimonthly by C.R. Cooper, 8941 Atlanta Ave. HB, CA 92646(ISSN 1062-5321) All Rights Reserved.

    Subscriptions: $29.70 per 1 year (6 issues). Periodicals postage rates at Irvine, CA and at additional mailing offices.POSTMASTER: Send address changes to ABILITY Magazine, Attention Subscriptions Manager,

    PO Box 10878, Costa Mesa, CA 92627; Volume 2011 Kathy Ireland Feb/Mar

    Printed in U.S.A.





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    Terri Cheney p. 38

    Sean Forbes p. 10

    Rehabilitation p. 32

    Ashley Fiolek p. 8

    Kathy Ireland interview p. 42


  • The ABILITY Build programoutreaches to volunteerswith disabilities to helpbuild accessible homes forlow income families. We arecurrently seeking corpora-tions, organizations andchurches to sponsor morehomes. This award-winningprogram builds homes andawareness, changing thelives of everyone involved.


    [email protected] abilityawareness.org


    Finding that right somebody is hard. Some wouldsay its impossible. Im with that some. The twosexes are just so different. For instance, wheneverI wore one of my brothers shirts, he never cared. But,boy, youd think the world were ending if my sistercaught me wearing one of her skirts.

    Even the charges on our credit cards reveal a world ofdifference. An itemized bill for a girl might list shoes,spas, and hair stylists. A mans? Hooters, Roids sportsbar and Home Depot. At least women have somethingto show for their purchases. All men have are somehangovers and a monkey wrench.

    Even with all our differences, for whatever reason, menand women tend to seek each other out. We go out, ban-ter, small talk, tease, flirt, kiss and fight. Our hope is tofind that special someone with whom to spend a life-time. Or at least a couple of nights.

    Ive been married twice. The first time was when I wassix years old. It only lasted a month. It was a bitterbreak up. My little five-year-old ex got the house inthe tree, full custody of my stuffed animals and halfmy toys. Eventually, the tree house was struck bylightning and the stuffed animals found their way toGoodwill. I still keep in touch with the puffy panda.

    I vowed Id never get married again. I was wrong.Time, unfortunately, heals all wounds. My second mar-riage lasted seven years. I guess you could say I livedthrough The Great Depression. The day after thedivorce was final, my wife and I became friends. I knowI had faults. From the beginning of the marriage I start-ed sleeping around: on the couch, in the garage, in thedoghouse. It just depended how pissed off she was.

    The other day I stopped by to see my ex-wife. I broughther some flowers: the little ones with the yellow petalsand the beige arsenic powder speckled on them. When Igot to her place, she was standing there holding her cat.My God, did that thing smell. She was hissing at me,her hair was all natty and she had fleas. Honestly, Idont how the cat could stand being around her.

    Not that I was husband of the year. I would always forgetlittle things like taking out the trash, putting the toilet seatup or down, birthdays and anniversaries, coming home atnight. I think if I ever get married again Ill wed onChristmas Day. Whenever my wife says I forgot ouranniversary Ill say, No, I didnt! Remember that presentyou opened this morning? If I can find a girl who wasborn on December 25th, Ill be covered on all fronts.

    And men, heres another thing to keep in mind whenyou start dating: the first present you get your lovershould be something simple. Like a pencil. Its best tokeep her expectations low. I once dated a girl for fiveyears, and on our fifth anniversary I got her a box kite.Had I gotten her that kite in the first year, I might belooking at buying her a pair of shoes on the fifth year.Go cheap early.

    As in any relationship, there is a time to love and a timeto fight. Fighting happens quite a bit in a marriage. Ivealways thought a priest should never end a marriage cer-emony with, I now pronounce you husband and wife,but rather with, Lets get ready to rumble!

    The eventual break-up of my marriage wasnt my fault,though. My wife actually ran off with my best friend. Tothis day, Ive never been able to thank him enough.Whenever your best friend dates your wife, I dont carewho you are, it puts a crimp in the relationship. Youspend half the day feeling sorry for him. Ive alwaysfound that marriage is the quickest way to a divorce.

    I live in a condo, and Ive been seeing this girl for aboutthree months now who lives in the apartment across thestreet. But thats just cause I have a pair of binoculars.What can I say? I enjoy window shopping.

    Its tough getting back out into the dating world. Iverecently had some crazy dates. I put up an ad on an on-line dating service. I was up-front, honest and truthful.I said I wanted an old-fashioned girl who would stay athome and cook and clean for me. I got one interestedresponse. It was from my mom. Maybe it was my pro-file picture of Tony Curtis that caught her eye.

    I always wanted to find a girl just like my mom, but at thispoint Im willing to settle for any girl whos not my mom.

    The last girl I went out with was not very bright.When I met her at the restaurant she was wearing bigwooden shoes. I asked her why she was wearing themand she replied, I thought you said we was going

    H U M O R T H E R A P Y


    Dutch tonight. Then, when we were looking at ourmenus, I asked her if she wanted to share something.She said, Okay, when I was ten I French kissed mybabysitter. I told her I meant share something off themenu. Eventually, when the food came, she just staredat her meal for twenty minutes. I asked her what shewas waiting for. She said she was just watching whatshe eats.

    Sometime during the dinner she got up and went to thebathroom. As women are prone to do, she took herpurse with her. Now, ladies, how do you think thatmakes us guys feel, sitting there, with nothing to rum-mage through?

    I like women of all shapes and sizes. I went out with achubby Oriental chick named Sue Wee. She was kindof shaped like Dodger Stadium, but thats just a ball-park figure. She was a really nice person, and it didntmatter that she had reverse anorexia. There was justmore to love. Much more.

    As our relationship progressed, Sue threw out thatdreadful question: Do you think Im getting fat? Ididnt want to make her feel bad, so I softly strokedher hair and said, No honey, youve always been fat.She told me she had recently lost twenty pounds and Imade the mistake of gently responding, Look behindyou and youll find it. (I thought women liked hon-esty in a man.) All in all, I did feel something for her.It was like magic every time I saw her. Magic was theonly way I could explain how she got her butt intothose jeans.

    I once dated a really skinny girl. Ill never forget thefirst time I held her. She felt so good between my fin-gers. I was playful, swinging her like a five iron.Sometime during the relationship we became engagedand she wore my ring. On her wrist. We eventuallybroke up and I heard she moved to Colorado tobecome a ski pole.

    Another time, I went out with this lively Italian bella.This girl had beautiful, dark shiny hair. Unfortunatelyit was on her upper lip. Maybe Im picky, but I onlylike a handlebar on a bike. Then I found out she waseasy like Sunday morning. Her nickname was firesale, because her pants were always half off. I hate toadmit it, but I think that was a big reason why we last-ed so long.

    I dont like people who cling to me, invade my space,and never leave me alone. Thats why I refuse to sleepwith myself. Im too needy. I like attention. I can havepeople talk about me all night long. Really. Im rivetedby the conversation, and sickened, too.

    My dating life went through a dry spell for a while. Iactually hired a maid just so I could tell my friends Ihave a girl over the house at least once a week. I was so

    hard up for some companionship that I took my livingroom lamp out to dinner: a cheap date, but she wasextremely bright. The night went badly. I tried every-thing from compliments to sweet talk, but no matterwhat I said to the sexy lighting stand, I couldnt turn iton. I got frustrated so I started drinking. Then I becamedrunk and ended up wearing her lampshade for half thenight. Incidentally, the lamp thought I looked great inthe dark.

    Some time ago, I went out with a very sweet visuallyimpaired person. Yeah, I guess you could say it was ablind date. I took her to a nice romantic restaurant and,as we were leaving McDonalds, I began to drive herhome. (Luckily, I was the one who drove.) Anyway,when we were in the car I felt this heaving, breathingand nibbling in my ear. So I turned to kiss her and it washer seeing-eye dog. I decided to drop the girl off and goout dancing with the dog. A week later the dog dumpedme. Two weeks later I went to the doctor and got somebad news: the bitch had given me fleas.

    Sometimes Ill go fishing in a bar, trying to reel in aneasy catfish. One time I saw this quiet, homely girl inthe corner, sipping on a glass of wine. I got up mynerve, went over to her and said, Excuse me, are youfree this evening? She smiled, and the next thing youknow, we went back to her place. She had lied to me.She wasnt free that night: she was $300 an hour.

    I tried dating an older woman, but we only had onething in common. She was looking for a rich man tosupport her and I was trying to figure out if her hus-band had died and left her any money. In the end, wedidnt work out. Its tough to carry on a conversationwhen one of us is rambling on about senior discountson pharmaceutical medications and the other is tryingto describe a Family Guy episode.

    I know Im not great-looking. Im not good-looking.Im not even okay-looking. Im just looking for some-one who can tolerate me. Tolerance is a noble and rarequality. I would just like to find a woman who will(wink, wink) you know (wink, wink) go out in publicwith me.

    Look, you never know whom life is going to throw yourway. Its easy to get lost trying to find someone. I knowwhat women like: theyd like for me to leave em alone.Finding the right person is a painstaking process. Beforeyou settle down with someone, make sure that person isa friend, a lover, and a beautiful person.

    So do what ya gotta do. And then tell me how to do it.

    by Jeff Charlebois


    Ham on a Roll


    How did you celebrate the new year? I welcomed2011 by having the metal plate taken out of mycollarbone. This time when I went to the hospi-tal I didnt have to stay the night, and the surgery waspretty quick. I always seem to have bad reactions toanesthesia, and this visit was no exception. I got reallydizzy and threw up a bunch of times. I even had to getspecial medicine from the doctors. Im just glad its allover.

    Anyway, now Im back on track. Last week, I got thegreen light to start riding and training again! I have anon the bike photo shoot next week, so its importantthat I get back in the habit. My season of racing doesntofficially start until May but now is the time for me todo all of my pre-race work.

    This is the time of year when my family and I sit downand try to plan out my racing season. Sometimes it canbe stressful to put a plan down on paper and make newcommitments for the upcoming year, but its somethingthat needs to be done. I am very lucky that my familyand my closest friends all help me out.

    This year there will be eight rounds of racing for femalecompetitors and, of course, Ill be competing at XGames again. Everything seems kind of far off rightnow but I know the season is approaching quickly.

    The mens supercross season has already started, and Iwas lucky enough to go out to California to watch thefirst round of their racing season. Its an exciting time,and it was a lot of fun to see everyone again. Ill be atanother supercross race next weekend and plan to signsome autographs for my fans. Im definitely lookingforward to being there!

    In other news, one of my sponsors, Purple Communica-tions, teamed up with Red Bull to pay a visit to my oldhigh school. Red Bull made a captioned copy of a showI did for Fuel TV called First Hand. Janna, from Pur-ple, worked with Red Bull to get the DVD and then con-tacted the Florida School for the Deaf and Blind(FSDB) to set up a time for me to drop by.

    I was really nervous about going back to my old school.I hadnt been back since 2005! I started to wonder whatthe new students would be like, and I wasnt sure howmy old teachers would react to me. I was pretty shywhen I went to FSDB but I am a different person now,and I wanted to walk in to the auditorium with confi-dence! I teased my mom that I would walk onto thestage and curtsy. She dared me to do it!

    Janna played the First Hand DVD and then intro-duced me. I walked slowly onto the stage and did a bigcurtsy and waved hello to everyone. I looked down atmy mom and saw her laughing. I showed the studentsmy racing gear and my X Games medals, and then Iopened the floor up to questions. The students had somereally good ones!

    After the movie and questions I went out into the lobbyfor pictures and autographs. I also brought copies of mybook and signed them. While meeting all of the stu-dents, I had a chance to see all of my old teachers. Itwas such a wonderful feeling! They all were very proudof me and I told them I was thankful for the educationthey helped give me.

    One of my favorite teachers, Katie, said, I remembersitting down to do your Individual Education Program(IEP) and asking you what you wanted to do when youleft FSDB, and you always said, I want to be a profes-sional motocross racer! We laughed and wrote it downon the IEP but we never thought it would happen! Andnow today you are a professional motocross racer! Itfelt so great when she said that.


    My little brother, KickerAshley signs, Good to go!


  • 10 ABILITY

  • ABILITY 11

    As a successful songwriter, an accomplished per-cussionist, and the co-founder of Deaf Profes-sional Arts Network (DPAN), Sean Forbes expe-riences music in a way most of us can only imagine. Inan interview with ABILITYs Molly Mackin, Forbes dis-cussed his unique career and how his deafness promptshim to tackle the world of music in a way few haveheard it before.

    Molly Mackin: I understand you recently got married. Congratulations!

    Sean Forbes: Thank you. Yes, I got married in October.I have a deaf wife who loves music because I shared itwith her.

    Mackin: Tell me a little bit about your music. How didyou get your start in such a challenging industry?

    Forbes: Music is something Ive wanted to do my entirelife. I was always around music, growing up. My par-ents played it during car trips, and we had all kinds ofdrums and guitars and other instruments in our base-ment. At an early age, my brothers and I decided wewanted to develop careers in the music business. Im theonly deaf one in the family, and also the only one who,as an adult, actively pursued music as a career.

    Mackin: Oh, really? Impressive.

    Forbes: I know. Crazy. (laughs)

    Mackin: How long have you been deaf?

    Forbes: I became deaf at a couple of months old. I had ahigh fever and, although it was never officially diag-nosed, its believed I became deaf as a result of spinalmeningitis. I like to tell people that I became deafbecause I was playing music too loud. (laughs)

    Mackin: So youve essentially been deaf your whole life.How do you then translate something like rhythm?

    Forbes: Rhythm is something that is born inside of you.When I was very young, my parents noticed I couldmake a rhythm that was consistent, like a beats-per-minute, essentially. When I was five, my parents boughtme a drum set because they noticed my propensity forrhythm. I think its something that comes from inside.

    Every time I listen to a new song, or even an old song Iknow, I always try to follow the different rhythms thathappen throughout it. Bass and drums are pretty simplefor me to follow, but sometimes Ill be in a situation inwhich Ill have a different point of reference when Imlistening to something, and Ill be able to pick up theguitar or the piano line, and follow that rhythm.

    For me, following melody is what is pretty hard. Iusually ask my family, or people with whom I work,

    about the melody when Im listening to or writing a song.Hows this melody going? Theyll show it to me by imi-tating the music. My brothers always shared new musicwith me as we grew up. If there was a song by MtleyCre, they would act like Mtley Cre and demonstrate it.

    Mackin: Sort of like live-captioning.

    Forbes: Yeah (laughs). I was fortunate to grow up in atime when MTV was popular. When I watched it, Idnot always be watching the video; instead, I wouldfocus on how the different musicians played their instru-ments, because it was something I wanted to do. Ithought Mtley Cre was so cool, so I would watch howTommy Lee played the drums, and how Nikki Sixxplayed the bass. Mick Mars was off in his own world,and Vince Neil was, too. (laughs)

    Mackin: So when you say your family would imitate themusic for you, would they dance? Would they play theair-drums?

    Forbes: Yeah, air-guitar, air drums. At the time, I thinkMTV didnt have closed-captioning. Im such a goodlip reader, though, that when I wanted to listen to a newsong, we would turn on the television and my brotherswould stand there and lip-sync the words for me.

    There were so many things, growing up, that enabledme to participate in music. Every time we would go ona family vacation, my mom would play all the oldiesfrom the 60sthe Beatles, the Eagles, the RollingStonesand would drive and sing along. I would readmy moms lips to follow what was happening in thesong, and Id put the side of my leg against the speakerso I could feel the rhythm and keep the beat.

    I also made my mom turn up the music. Im surprisedmy whole family isnt deaf from all those long carrides. I was very fortunate, growing up, to be in a fami-ly that wanted me to experience the music that wassuch a huge part of their lives.

    Mackin: In your song Im Deaf, you have some reallygreat verses, and they all rhyme. Rhyming has a lot todo with the sounds of words. How does that work whenyoure writing?

    Forbes: Ive been writing songs since I was a kid, and Igrew up reading poetry and lyrics. I would often go onBob Dylans website and just read the lyrics. Over time,just by looking at how any rapper rhymes words and fitssyllables into verse, I got to a point at which meter andrhyme schemes became very natural for me. I honestlybelieve that came by reading. We all have narrators inour heads.

    Mackin: A lot of words are read one way and said amuch different way, especially in the English language.

  • 12 ABILITY

    Forbes: I know a lot ofrappers who bend wordsand make them rhyme.Im Deaf came out ofme so quickly I didntreally have time to studythe process. I had writtena lot of variations of thatsong, and then I got witha producer and the songjust came out.

    I dont like beating upsongs. Sometimes Ill be

    working on something and it comes out in less than 30minutes. Sometimes its not coming out and I put itaside, and I come back to it or I dont.

    Mackin: Do you write any poetry?

    Forbes: Ive written a lot of poetry. Ive been lagging onit lately, though. I write a lot of lyrics, and sometimesthey look like poetry, and other times they look likesongs. To me, theres not always a big difference. Some-times I just write a poem on the spot. Recently, Ivebeen writing a lot of music without music, right off thetop of my head. Ill come up with a simple drum trackand write a song around it, which is usually like writingpoetry. Sometimes its the music that drives the lyrics,sometimes the lyrics come first. When I read poetry, Ican usually envision music in it.

    Mackin: How do you write a melody?

    Forbes: The same way I get people to imitate musiciansfor me. Ill be writing a song, and at a certain point Illask a producer, How does the melody to this song go?,and hell sing the different pitches for me, which giveme an idea about the changes of the song. Then Illwrite a lyric to it. There are a lot of people in this orga-nization at whom I can throw things, and sometimeseven my dad will give me ideas. But I write all mylyrics myself.

    Mackin: I noticed while watching a video of you per-forming that you have a really nice flow. Have youever done slam poetry?

    Forbes: (laughs) Thank you. Ive never done slam poet-ry before, but I have a lot of friends who do it. Ive donefreestyle rapping with friends. Im really used to work-ing with and writing music, and slam poetry is a littledifferent in the way in which things are structured. Ithink its a really cool art form.

    Mackin: Is music common in the deaf community?

    Forbes: Yeah! There are a lot of deaf people who loveplaying music in their cars while driving. Mostly theyplay music thats dominated by drums and bass, like rap

    music and techno, because they can feel the pulse.

    There have been people in the past who have questionedmy career. They ask, Why do deaf people need music?Weve lived our entire lives without music, so why doyou want to bring music to the deaf community? Butthere are so many people who own iPods, iPads, andiPhones. Of course the deaf kids are going to want allthose cool things and to follow the same trends. I had anaudition a few weeks ago, and I asked the kids to comeready with a song. These girls came in and wanted tosing Justin Bieber. Obviously these kids are getting theirtastes from television and from schoolmates, as well asfrom the trends and fads theyre hearing friends follow.

    When I was in high school, my tastes were influencedby my hockey teammates and by my brothers and otherpeople my age who werent deaf or hard-of-hearing,even though most people werent as into music as I was.When I went to college, I started to realize a lot of deafand hard-of-hearing people love music. I attendedRochester Institute of Technology and lived in an all-deaf dorm. Id walk down the hall and hear EminemsCleaning Out My Closet, or some Jay-Z song.

    Not only that, but I met a couple of deaf people whoplayed musical instruments. Id pick up a guitar and startplaying, and they would be like, You play the guitar?Then I would go to someone elses room and pick up abass and do the same thing. It was interesting to see howmany people loved music, even though not everyone hadgrown up with the same background I did.

    I grew up reading rock and roll history books. I kneweverything about all the old groups. So when I started tosee that all these deaf people love music, I felt like I hadto do something. I had to do something about givingmusic to the deaf community. I was always signingsongs to my friendsmostly to girls, because it was agood way to get them to notice me.

    Mackin: I read somewhere about you and Eminemworking together. Is that right?

    Forbes: When I first started working here, he was a bigsupporter of what I was doing. I showed him a video ofme signing one of his songs. When he saw that, helooked at me like, Deaf people like music? He wasreally surprised to see there was a deaf community thatloved his stuff. Most people think deaf, and theythink, Oh I cant share my music with them. Theyrenot going to understand what Im saying. But a lot ofdeaf people relate with what Eminem expresses in hismusic: they struggle, they feel frustrated, they get pissedoff. I relate to him in a different way. He was a whitekid trying to get into rap music, whereas Im a deaf kidtrying to get into the music business, in general. I mean,its a struggle. I know he definitely connects with whatIm doing.


  • ABILITY 13

  • 14 ABILITY


    It may be the title of your favorite Rage Against theMachine song, but its also a grim reality in oursociety. Although the murder rate in many of ourmajor cities has recently been on the decline, theUnited States still leads the world in civilian gun vio-lence. Even some of our nations smaller citieslike itscapitol, Washington, DChave held the title of Mur-der Capitol of the World by boasting the highest annualnumber of murders per capita.

    The upside to these circumstances is that, in times ofrelative peace, our military surgeons in training can visitmajor trauma centers to receive experience in treatingpenetrating trauma (gunshot and knife wounds); itsthe sort of life-saving experience these doctors cannototherwise obtain when there is no battlefield.

    In contrast to penetrating trauma, blunt trauma refersto more common injuries like those incurred in motorvehicle accidents and falls from heights. The distinctmechanical nature of these types of injuries requires thatthey receive different methods of treatment. Most severetrauma calls for the expertise of specially trained sur-geons who can find and control internal bleeding andresuscitate patients who suffer from blood loss.

    Gunshot wounds (GSW) to the head have lately beenprevalent in the media, following the shooting of Ari-zona Congresswoman Gabriel Giffords, members of herstaff, and constituents. No less disturbing was the recentschool shooting in Los Angeles in which a female

    student was struck in the head by a bullet fired, appar-ently by accident, from a gun carried in another studen-ts backpack.

    As I listened to the media report on these two incidents,it occurred to me that most people have limited or nounderstanding of the treatment and conditions of thosewhose brains have been injured by handgun projectiles.My training as a neurosurgeon in Washington, DC andmy work in Oakland, California in major inner citytrauma centers has given me the opportunity to treatmore than my fair share of penetrating head injuries. Letme do my best to shed some light on the repercussionsof cranial gunshot wounds.

    Several things make GSWs to the head different from,say, the damage done by striking ones head on a wind-shield at 75 miles per hour. In the latter case, the damag-ing energy transmitted through the head is distributedthroughout the brain. In cases of GSWs, however, cavi-tation is created as a bullet passes through the brain.

    Cavitation denotes the large column of damaging energythat surrounds the course of a much smaller missile as ittravels at a high velocity through solid matter. Almostall GSWs that cross the brain from the entry point to theopposite side of the head end in death. Naturally, high-velocity military grade weapons are even more devastat-ing than the handguns that pollute our city streets. Evena grazing injury from an M16 can emit enough forcethrough the brain to cause death.

    Since the presence of a resting bullet in the brain seldomcauses harm, removing the bullet is not a recommendedsurgical treatmentin fact, such a procedure may resultin more damage. The same holds true for most GSWcases throughout the body. This is why a number ofgunshot victims continue to walk around with bulletslodged inside of them.

    It is recommended, in cases of GSWs to the head, thatthe entry and exit points simply be debrided (cleanedup) and closed (sewn up). Bone fragments should beremoved if near the surface and easily accessible, andthe dense covering of the brain (called the dura mater)should be repaired to keep spinal fluid from leaking.Any aid beyond this will not help the brain recover.

    The similarity between penetrating and blunt brain trau-ma lies in the fact that destroyed brain cells cannotregenerate. While stunned brain cells can recoverfunction, there is no way to predict how much a personcan improve after an injury. It generally takes three tosix months for a GSW patient to reach maximumimprovement. Few treatments are available for braininjury and most of them have little effect on outcome.

    Because nothing can be done to aid brain cellsdestroyed by the initial injury, modern treatment focusesinstead on salvaging those cells that hold the potential to

  • ABILITY 15

    recover. One of the reasons the brain is particu-larly sensitive to the effects of trauma is becauseit is confined within a rigid box: the skull. Alltissues swell when they are injured, but the skullleaves the brain no room to swell. As a result,pressure rises inside the head and makes it moredifficult for blood to reach the brain.

    In light of this fact, the focus of acute braininjury treatment is on reducing swelling orintracranial pressure while maintaining enoughblood supply to meet the demands of the brainshealing tissue. A number of medical treatmentsare applied to achieve these ends. First, thepatients ventilator rate is increased to lower car-bon dioxide (CO2) in the blood stream anddecrease the volume of blood vessels in thebrain. This must be done carefully to avoidrestriction of blood flow. Intravenous solutionsof a drug called mannitol or highly concentratedsalt solutions are also used to reduce swelling.

    As in the case of Ms. Giffords, the patient mightalso be placed in a medical comadeep gener-al anesthesiafor several days. While asleep,the brain requires less oxygen and nutrients, andis thus less vulnerable if blood flow is inade-quate. In dire situations of brain swelling, one orboth halves of the skull can be temporarilyremoved to allow the brain more room to swell.Typically, about one week after injury, swellingresolves on its own.

    Its worth noting that some glaring absencesoccurred in the media reports about Giffordscondition. It is what the doctors were not sayingthat concerned those of us in the know. Thebullet reportedly struck Giffords in the left tem-ple and exited on the same side of her head, nearthe forehead. The good news here is that the bul-let did not cross through the center of the brainhad it done so, the injury would likely have beenfatal. However, the left temporal and frontalregions of the brain not only control movementon the right side of the body, but also, in most ofus, the ability to speak and understand speech.As of yet, the media has not fully disclosed thetrue gravity of Ms. Giffords injuries.

    Ms. Gifford was recently moved to a rehabilita-tion facility, and its reported she will receiveintensive therapy from speech, occupational, andphysical therapists. Their goals will be to facili-tate the recovery of use of Giffords right armand leg, as well as her ability to speak and under-stand speech. Our thoughts are with her andthose injured or killed in the incident, as well aswith their families and loved ones.

    by Thomas Chappell, MD


  • 16 ABILITY

    toward wireless communications using Sprints 4Gtechnologies. This will take customers into the futureallowing for barrier-free access to the telephone. SprintRelay is proud to present: Sprint Mobile Video RelayService (Sprint Mobile VRS). Sprint Mobile VRS is afree Android app, currently available on the SamsungEpic 4G, for deaf and hard of hearing individuals toconnect with qualified video interpreters who relay theirphone calls. The Sprint Mobile VRS app also supportsSpanish VRS and the ability to video chat with anyvideophone. In addition to this, users will receive videomail on any missed calls. The companys flexible mes-saging services expands its theme of inclusion evenfurther, allowing customers with deafness or speech-related disabilities a customizable text messaging ser-vice via their Sprint PCS phones.

    Like many of the most successful businesses, Sprint rec-ognizes that its prosperity rests in its ability to appeal to adiverse spread of consumers, an awareness that is expert-ly reflected in the broad accessibility of their services.Recently named by Forbes as one of 2010s Top 20Most Responsible Companies for advanced policies ondiversity, Sprint has held a 100% rating on the HumanRights Campaign Corporate Equality Index for five con-secutive years. This is a company that not only under-stands the value of communication, but also of thosewho seek to be heard, seen, and understood.


    s part of an ongoing effort to celebrate and pro-mote businesses that work to make the world asafer, more efficient, and more welcoming place

    for people of all walks of life, ABILITY is pleased toprofile the latest recipient of its Best Practices Award.This issue, the editors applaud Sprint Nextel Corpora-tion for its innovative implementation of Video RelayService (VRS) and for its spirit of inclusion, both in theworkplace and in the consumer marketplace.

    l SPRINT l

    Since the 1970s, Sprint has maintained its position as adominant and forward-thinking force in the world oftelecommunications, a business marked by entrepre-neurial vigor and pin-drop clarity of message. In thelate 1990s, Sprint developed the only nationwide per-sonal communications service (PCS) in the UnitedStates. In 2005, the company bought Nextel, furtherstrengthening its role in the ways in which we connectand communicate.

    In more recent years, the technology giant has shown nosigns of shrinking, and has in fact applied its considerableinfluence and ingenuity to improving the ease of commu-nication for people with disabilitiesparticularly for the24 million Americans who are deaf or hard-of-hearing.

    Thanks to CapTela closed-captioned telephonedeveloped by Ultratec and provided by Sprintphoneconversations need no longer be a challenge or annoy-ance for the deaf or hard-of-hearing. With the aid of thisinnovative new technology, users can read captions on abuilt-in screen while in conversation. This advancementallows for a more natural, emotionally accurate dialoguebetween participants by eliminating or reducing theneed for a third-party translator.

    Additionally, with the evolution of the 4G network,Sprint Relay is shifting its developmental resources


  • ABILITY 17

  • 18 ABILITY

    f all of the many facets ofLawrence Euteneierscareerlobbyist, inventor,lecturer, dragon boat racer,fishermanthe term match-

    maker seems the most appro-priate description of the man.

    But Euteneier is a unique sort ofmatchmaker. His work is done on

    the water. He catches fish.

    Euteneier is the founder of Blind Fishing Boat, a servicethat matches sighted fishermen with fishermen withvisual impairments and allows both to enjoy the experi-ence of hitting the water with someone else who loves tofish. Upon the launch of his service five years ago,Euteneier received positive feedback from many in thedisability community, and found major support fromsighted fishermen who were eager to help others.

    Euteneier views his program as one with benefits forfishermen and fisherwomen of all experiences andbackgrounds. Its more like a dating service than anact of charity, Euteneier said. If a partnership worksout, maybe the two become exclusive, but theres noshame in being a player and going fishing with different people.

    Ive tried a lot ofsports over the years,and there is nothing

    that compares to fishing, in terms of

    built-in accessibility.


  • of sports over the years, Euteneier said, and there isnothing that compares to fishing, in terms of built-inaccessibility. You dont need bobbers to fish, and tyingyour own hooks is really quite simple. Fishing is mostlyabout the art of feeling the bite, and who better than todetect subtle differences with his hands than someonewithout sight?

    Euteneier, who has fished his entire life, says he has noreservations about going after some big and formidablecatch. Ive caught monster northern pike under the mid-night sun in Canadas Arctic, ancient white sturgeon inthe Fraser River, and bull shark off Floridas coast,Euteneier said. I even spent my summers working as acod fisher off Cape Breton Island. When wed pull alarge number of cod, itd be up to me to drive the doryback to the harbor while the captain and his son cleanedand washed the fish at the back of the boat. The captainfigured it was safer for me to drive than to handle therazor sharp knives.

    ABILITY 19

    Blind since age eight, Euteneier has a resume more sim-ilar to that of a senator than to that of a fisherman. TheCanadian innovator was instrumental in developingWeb-4-All, the worlds first computer capable of man-aging personal assistive technology based on an individ-uals preferences. For his tireless work in the field ofaccessibility, Euteneier received Canadas prestigiousFederal Public Servant Achievement of ExcellenceAward in 2003, the First Lady of Taiwan Award in2004, and the Meritorious Service Medal in 2006.

    Euteneier also served as Canadas Access TechnologyAdvisor from 1997 to 2000, and has documented innova-tions for people with disabilities throughout Sweden andCanada. In his free time, he participates as a member ofa competitive dragon boat team comprised of peoplewith visual impairments, and competes annually in a carrace to raise money for the training of guide dogs.

    Despite his busy schedule and varied interests, Euteneiermaintains that fishing is his truest love. Ive tried a lot

    Lawrence Euteneier (left) displays a ten-poundwalleye caught in Lake Ontario.

  • 20 ABILITY

    Euteneiers experience as a master fisherman hasrewarded him with a deep well of cherished memories,and he hopes that Blind Fishing Boat allows other fish-ermen to develop unforgettable experiences of theirown. He began the initiative with the specific goal ofproviding opportunities for people with visual impair-ments to fish and meet others in the sport. The venturearranges recreational outings as well as competitions forfishermen. Euteneier also maintains a blog that providestips for fishermen and information about the sport.

    The biggest concern I hear from other people withoutsight who fish is that they have trouble finding fishingbuddies, Euteneier said. No one will say no to yourface if you ask him or her to take you fishing, but you maynever run into that person again. Many people are eithertoo busy or maybe feel they dont have enough informationto fish safely with someone who is without sight.

    Despite the obvious differences between fishermen withand without sight, Euteneier emphasizes that all peopleinterested in the sport share a common bond. Everyonewants to fish with someone who fishes at his or her ownlevel, or better, Euteneier said. Everyone, sighted ornot, wants to enjoy the day on the water and maybelearn a few things. Many sighted people believe, wrong-ly, that fishing with someone without sight is going toinvolve a lot of time and attention.

    Euteneier says this common misconception hasinspired him to challenge fishermen with visualimpairments to get better, to gain more knowledgeabout the sport, and to show off their skills. He callsfor people with visual impairments to build a strongreputation of competence as fishermen, and encouragesfishermen without visual impairments to recognizethose with visual impairments are their equals at thesport and, in some cases, can be superior.

    As the landscape of this popular sport continues towiden, Euteneier works to spread his inclusive messageby writing, competitive fishing, attending exhibitionsand leading seminars on the topic of fishing. His effortsto advance the technology of accessible fishing havehelped the field develop into a worldwide initiative.Despite his efforts, Euteneier recognizes that technolog-ical advances dont often happen overnight. For manypeople with disabilities, Euteneier says, technologicalevolution can feel a bit like a rollercoaster.

    At first computers could speak everything under the oldDOS system, Euteneier said. Then, when Apple Mac-intoshes and Windows came out, everyone without sightwho was making a living by way of a computer suffereda setback. Windows and Macs were eventually made tospeak, but most of the new applications coming online inthe workplace today have not been built to functionproperly with screen readers. So its been a downhill ridefor the past five years, with barriers in the form of elec-tronic applications that are designed to streamline work-flow and eliminate paperwork.

    Euteneier points out that many of these lurches andsetbacks in the world of technology parallel the chal-lenges faced by fishermen throughout history. Forcenturies, fishermen living along Newfoundlandscoast navigated their dories without electronic aids,under extreme low visibility conditions caused byfog, Euteneier said. They obviously made it back totheir home ports often enough to keep them going out.They navigated using their senses of feel, smell, andsound. They made use of the feel of the differentwaves as the depth below the boat grew shallower, thesound of the surf breaking on shore, the smell ofspruce trees and chimney smoke as they approachedland. Its possible for anyone to develop these skills.

    Euteneier (right), with guide Thomas Smith, holds asix-foot white sturgeon caught in the Fraser River, inBritish Columbia.

  • ABILITY 21

    Euteneier usese a similar set of observational skills tonavigate his own boat. Hes aided by the fact that boat-ing and fishing tech-nologies haveadvanced over thecenturies: depth find-ers, directionaldevices, radars, andof course visibilityassistants all play apart in todaysangling experience.But Eutenieir sayssuch devices havenot yet been ade-quately adapted forpeople with visualimpairments.

    There is a stronginterest, world-wide, amongpeople withvision loss inaccess tomarine elec-tronics, Euteneier said.People with sight have been operating boatsfor centuries while blind at night or in situa-tions in which theres low visibility. In fact, theability to navigate while blind remains arequirement for securing certain classes of cap-tain certifications. When on the water, sightedpeople can only see about 15 miles before the hori-zon dips. This means setting a course, monitoringprogress, scanning for hazards both underwater andbeyond the horizon translate into working underconditions in which seeing what lies ahead isntalways possible.

    With the help of his Blind Fishing Boat initiative,Euteneier is intent on reframing the notion of what isor is not possible on the water. In 2010, Blind FishingBoat went to 17 fishing competitions, earning first placeat one and ranking among the top five at four others.Through a series of seminars, Euteneier has brought theinitiatives message of personal empowerment to morethan 460 people with vision loss or impairment. Hespersonally taught 16 people how to fish, or how toimprove their fishing skills. Hes worked to get the storyof Blind Fishing Boats published and promoted to thou-sands of people who may otherwise have never knownthat the sport of fishing is a possibility for them.

    In the end, Euteneier emphasizes that those possibili-tiespossibilities for fishermen with visual impair-mentsare exactly the same as the possibilities of peo-ple without visual impairments. The common goal forall fisherman, Euteneier said, is hooking the big oneand telling an even bigger story.

    The most exciting part of fishing is the moment the fishbites, Euteneier said. Whether youre fishing for sun-fish or sharks, theres nothing like feeling that first con-tact. Reeling that fish in, and being able to feel it in yourhands and smell it, and to know you are taking part in aritual that goes back to the beginning of time, leaves onefeeling fulfilled in a way that is truly unique.

    by Josh Pate


    Euteneier fishes from the firstfishing boat capable of beingoperated independently by aperson with vision loss.

    Euteneier and his MIRA guide dog pose witha 24 inch rainbow trout caught during the2010 America Cup International Fly FishingTournament in Colorado.

  • 22 ABILITY

    In the ever-expanding arenas of home computing,business technology and Internet navigation, accessto information is today more critical than ever.ABILITYs Chet Cooper and Liz Angeles sat down withYahoos accessibility experts Alan Brightman and Vic-tor Tsaran to discuss how the technology pioneer ischanging the way people with disabilities connect withthe world.

    Liz Angeles: What does accessibility mean, in respect tothe work you do at Yahoo?

    Victor Tsaran: In a general sense, accessibility refers tothe ability of people to access things. In the context ofdisabilities, however, accessibility means people withdisabilities should be able to effectively accomplishwhatever they need in their daily lives, whether thatentails turning on a light or going on the Internet or dial-ing a phone number. At Yahoo, our primary focus is tomake the Internet a better place, particularly in respectto the Yahoo! Network. We want our network to beaccessible, usable and friendly for people who use assis-tive technologies.

    Alan Brightman: Roughly half a billion people come tothe Yahoo! Network every month, and many of thosepeople live with disabilities. We dont know exactlywhom, because we dont need to ask, and those labelsdont make any difference anyway. All we care aboutare those users who have particular needsmaybe theywant information on this or that, but they dont use acomputer or see the screen the same way most peopledo. We dont believe any of that should make any differ-ence to productivity. Yahoo wants you to be able tocome and use the same mainstream product everyoneelse does, so its up to us to design a mainstream prod-uct thats as usable by everyone as possible. Once wevedone that, weve created a better-designed system. Ifthere are curb cuts on the sidewalk, thats a better-designed sidewalk for lots of people, not just for peoplein wheelchairs. Were essentially trying to build bettersidewalks across the Internet.

    Angeles: I know someone who has macular degeneration,

    and uses a computer screen with big letters on its dis-play. How is Yahoo helping someone like her?

    Tsaran: Our task as a web company is to make sure thatour websites will adapt to whatever it is that your friendneeds to accomplish and be adjustable towards her tech-nology. We make sure our websites will listen to her adap-tive technology and work with it efficiently. Thats theway accessibility should work. The site should be interac-tive, obviously, but should also allow users to adjust con-tent in order to be able to interact with that content.

    Brightman: The other thing we try to do is grab the lapelsof people with macular degeneration who assume theycant use a computer and let them know that they can.There are all kinds of ways to get online, to use a comput-er, to change your life in huge ways. But unfortunatelytoo many rehabilitation professionals or medical doctorsare unaware of that fact. A big part of what we try to doat Yahoo is evangelize for Internet access. Most peoplegain disabilities later in life. When that happens, some ofthe independence they used to have feels like its slippingaway. We want to enable people to say, I can do itmyself again, whatever that skill happens to be. It mightbe shopping, banking, socializing. You used to do it fineby yourself, and now you still can. You might just have todo it in a different way than before.

    Angeles: How does the work you do at Yahoo differ fromwhats being done at other online networks?

    Brightman: Well, accessibility on the Internet is not reallysomething about which to be competitive, because every-one should want to make their platforms accessible in dif-ferent ways. But at Yahoo, we try to differentiate our-selves by virtue of our contentwhether that be socialcontent, or finding out how to buy a car, or finding outhow your sports team performed last night.

    Tsaran: Theres a big networking component at Yahoo.Online searching is just one part of what people do onan everyday basis, but Yahoo provides a way for peopleto share information: we give them a piece of contentand then they can share that content with other people.

  • ABILITY 25

    Disability plays into this schema really well, becausewe want to make sure people of all abilities can accessany content that interests them. If you cant access thecontent, then you cant do anything with it, right? But ifthe content is accessible in a way in which people canget to it with their assistive technology, they can takeadvantage of that content in the same way as peoplemight who dont use assistive technology.

    Brightman: Theres a fair amount of e-commerce thatgoes on across the network. If I decide to open my ownstore and I make the doorways too narrow for wheel-chairs to get into, or if I put stuff too high up on theshelves, suddenly Ive put myself in the sales preven-tion business. So in respect to Yahoo, Im not doing allof this accessibility stuff just because Im a nice guy.Im doing it because we want everyone to make maxi-mum use of the products we offer. If Im building astore for e-commerce, I want as many people to be ableto get in that store as possible. If I dont have what mycustomers might need once theyre in my store, fine.But at least they have the opportunity, like everyoneelse, to do the shopping.

    Angeles: So if someone is, say, using the Yahoo! Person-als or Instant Messenger, or is building an e-commercesite, in what ways is Yahoo making that easier for them?

    Tsaran: We make sure all modes of interaction, whetherthrough keyboard or a mouse point-and-click input, willwork fluidly with all of our websites. So, specifically,lets say you use Yahoo! Messenger because you wantto chat with someone. You should be able to type a mes-sage and read a message even if you dont or cant use amouse. If youre using Yahoo! Search and you dont usea mouse, you should be able to find the edit fieldthrough keyboard use alone. And then, when searchsuggestions come up by way of our search engine, youshould be able to read those search suggestions withouthaving to click the mouse.

    Brightman: And we make sure all Yahoo tools for siteconstruction have accessibility built right into them, sothat every site can adopt that accessibility. We dontwant accessibility just to be a special thing at Yahooalone, we want it to be another performance criteria bywhich the quality of a site can be measured. And as wecontinue to create tools that are accessible, we makesure our engineers know about various kinds of disabili-ties, so our engineers can then test against those yard-sticks for accessibility. That way well always knowweve built the best website possiblea website morepeople can use.

    Angeles: Youre suggesting Yahoo is essentially trying tobuild a model for other companies to follow?

    Brightman: In some sense, yes. I think anyone whosbeen in a leadership position in terms of accessibilitywants to share that knowledge, because if the tide

    rises, all ships rise. Weve done some pretty tremen-dous things, difficult things, in the field of accessibili-ty, and the last thing wed want to do is keep ourknowledge some kind of a secret. Its online. Its avail-able to everybody. We cant make sure you dont seeit. So everything we do, in some sense, has to be amodel by definition, because its already out there assoon as its developed.

    Angeles: Whats your opinion about user-friendly tech-nologies like the iPad or iPhone?

    Tsaran: When the iPhone 3GS came out, it came withbuilt-in accessibility. It has a built-in screen radar forblind people. It has a built-in screen magnifier for peo-ple with limited vision. It has closed-caption support forpeople with hearing impairment. So its a device thatcomes with accessibility support tools built in. AtYahoo, we dont create any hardware. Our job is to putYahoo applications on the iPhone or, if people are view-ing our websites on their iPhones, to ensure our web-sites work with any assistive technology built into theiPhone. And from what I understand, the same assistivetechnology on the iPhone is going to be available on theiPad, so that means the Yahoo websites will work withthose tools as well.

    Brightman: The iPad is basically like a Macintosh com-puter, but its a new platform. Around the worldandYahoo is an incredibly international company, so werevery aware of thismost peoples first experience withthe Internet is by way of a cell phone, not by way of apersonal computer. With this in mind, we have to makesure that, no matter what your model of cell phone, nomatter what provider, everything we offer is accessibleto everyone. We are working to cross-platform theworld, essentially.

    Angeles: But with all this cross-platforming and websitelinking, do you also track your users and what theyredoing? Are you tracking the kinds of things they like?

    Brightman: There is no website of this magnitude thatwouldnt do that. What Yahoo wants to do, since weregoing to keep everything free to you by running adver-tisements, anyway, is provide you with the advertise-ments that are appropriate for you, that are actually use-ful to you. The only way we can know what might bepertinent to you is to ask the questions, Where haveyou been before? What kind of places have you visited?What do you like? Recently, since people are so wor-ried about the kinds of information a company likeYahoo might collect, weve begun to say somethingalong the lines of, Here is our guess at the advertisingcategories that might interest you. Take a look at oursuggestions, and if you dont like them, you can changethem. So were essentially getting our advertisers tostart targeting a profile instead of a person.

    No one loves advertising, but if youre going to get it,

  • 26 ABILITY

    anyway, you might as well get ads that could potentiallybe useful to you. Every website collects information.The real issue is how to respect a persons privacy whenthats being done.

    Angeles: For people who are blind or who have low-vision, how do pop-up ads translate to reach them?

    Tsaran: One way is through the use of text ads,because text ads can be read just like any other ads. Oradvertisements can be spoken to you audibly.

    Angeles: Can you then communicate verbally and say,Skip ad?

    Tsaran: We use an assistive technology shortcut key toskip over the ad block. We make sure that that blockis skippable.

    The reason people dont like ads is because, for themost part, ads are graphical. Text ads are easier to avoidand graphical ads arent accessible for people withvision impairment. But I think if we made graphical adsmore accessible, perhaps people would say, You knowwhat? Ads are okay. As long as I know whats in the ad,I can decide what to do with it. I can read it or skip it.

    Angeles: What are some goals for Yahoo that havent yetbeen accomplished?

    Tsaran: A big dream of ours is to ensure that whenpeople use mobile phones, they go to Yahoo and findthat were the friendliest network out there. This is thebig dream. There is a lot of innovation that goes intothe field of disability accessibility itself, and werealways working to make the most of that. How do you

    make dynamic content accessible? How do youdevelop interactive websites that expand things onthe page or that enhance parts of the page and arecontinually updating? Were now in a new era ofdynamic interaction that has never before existed, sowe need to be able to guide our users effectively andexplain to them how best to interact with this newinterface. Its a whole new world.

    Brightman: My goal would be that whenever there areconversations happening at high levels anywhere aboutweb accessibility or about users with disabilities,someone in that conversation is saying, Where isYahoo? What is Yahoos view on that?

    Yahoo has so many users that if we just impact a smallpercentage of those users, thats still a very formidablenumber of people. In light of this, we are playing anever-increasing role in things like the Federal Commu-nications Commissions recent broadband plan foraccessibility and the United Nations human rights con-vention on the rights of people with disabilities. Letsmake Yahoo more and more a part of these conversa-tions so that, to the best of everyones abilities, theseissues are handled well.

    Chet Cooper: What is Yahoo doing with the conventionfor human rights?

    Brightman: Well, were evangelizing like crazy theimportance of full accessibility and rights for peoplewith disabilities. It was really important, even symboli-cally, for the United States to become a signatory to thattreaty, but where Id love for us to play more of a role isin underdeveloped countries, where the rights of peoplewith disabilities are consistently trampled.

    One of our biggest stories has been the success of theYahoo Accessibility Lab. We opened it a little over twoyears ago, and just about every executive has beenthrough it, not to mention all sorts of product teams anddevelopers. They wonder about our work with disabili-ty accessibility, you know? In a sense, its like, Well,who are these folks with disabilities, anyway? Whydoes Yahoo care? Is this a philanthropic thing? And ofcourse it isnt. So we kind of give our visitors a littlecontext.

    For example, we put our engineers through some dis-ability-based simulations at which they will inevitablyfail. We have people attempt to write their names on-screen after being paralyzed from the neck down.Half of them will try to do it with their noses. Theyllgo through this wonderfully frustrating, really enlight-ening experience. Then theyll work alongside Victoron some accessible devices by which a person with adisability can better access the Internet. So these peoplewalk out of the lab after about an hour and tell ustheyll never see the world, particularly their ownworkstation, the same way again.


    to b

    y: N




    - Cru






    Alan Brightman, PhD

  • ABILITY 27

    The beauty of the lab is that it hasbecome a very dynamic, popularplace to invite other companies andthinkers. Google has been in our lab,Netflix has been in our lab, Mozillahas been in our lab and, most recent-ly, a group of about a dozen nine-year-old Girl Scouts was in our lab.Sons and daughters of Yahooemployees will often ask if they andsome of their classmates can comecheck it out. We love that. Most kidshavent yet learned what things aretaboo. They notice disabilities andare curious, and we want our engi-neers to notice.

    A year ago we opened our second lab,this time in India, because so muchdevelopment is going on now in thatpart of the world. Its interesting tosee how these kinds of efforts havereally gotten into the DNA of thecompany. Disability accessibility isno longer a special thing that Victorand Alan do. Its what we all do. Andthats really where we wanted to be.

    Cooper: Ive talked to Adobe manytimes and have asked them, Whydont you default everything as acces-sible in your products? Why does auser have to go through a certainmenu item and then go down and select something tomake the program more accessible? Ive never quitegotten a good answer.

    Brightman: Oh, its getting better, believe me. I washaving dinner with some Adobe people last night, andtheyre well aware of all the criticisms that are leveledagainst Adobes products in that arena.

    Tsaran: To their credit, Adobe has done some prettyinnovative things. It made PDF documents accessibleand really advanced the accessibility of Flash media,which is big on the Internet. When it comes to technolo-gy, its not so easy to just flip a switch and make some-thing accessible. I can only say that Adobe is tryinghard given the resources it has. The best we can do isappreciate the positive stuff Adobe does and be lessconcerned with the negative things.

    Brightman: If you can maximize accessibility in yoursite, that site rises in the search lists. If I have a videowith closed captioning in it, that captioning doesnt justhave to be for people who are deaf. It is also there asmetadata, so I can use it to search video. If all of myimages have text, its beneficial for everyone, and sud-denly people are saying, Hey, this accessibility stuffhas got a nice advantage for search engines.

    Tsaran: Increased accessibility benefits everyone. If youwant to make your website run faster, you can usecleaner coding standards, and that will make the sitemore accessible. You want your site to be more search-able? Make your code closer to accessibility standards.So accessibility is pretty much in everything we do, andit makes sense from many anglesperformance, usabil-ity, access, and so forth.

    Brightman: One of the big misconceptions about web-site design is the idea that, if we have to add in accessi-bility functions, the website itself will be more expen-sive to produce and maintain. Thats just not true at all,particularly if youre building a product from scratch. Ifyou start out with accessibility as part of the design, thataccessibility is just another part of what you would nor-mally do to build any website. The misconception is thatthe implementation of those functions is going to bemore expensive, but the only case in which that wouldbe true is if were dealing with some really advanced,hard-core site that pre-exists, and somehow we have toadd accessibility onto the site after the fact. Thats alousy way to design stuff, but sometimes its inevitable.

    Another common misconception among web designers isthat if they have to make a website accessible, those alter-ations will ruin the aesthetic of the site. But thats ridicu-lous. A lot of tools already exist in your computer that

  • 28 ABILITY

    you might never use. Theyre actually built into yourcomputer, whether youre a Mac or a PC user, and if youneed them, youll invoke them. If not, youll never noticethem. None of them ruins the aesthetic.

    Tsaran: The important thing here is the element ofchoice. Theres never going to be one design thatsgoing to make everyone happy. So what we aim to do isoffer people more choices. If you go to the Yahoo homepage, a link on the right side reads, Page Options. Ifyou pull that menu down, itll give you the opportunityto change the colors of your page. Thats just a littlething, but its one more way to say to the user, If youdont like our colors, you can change them to the onesyou do like, and well give you a couple of choices thatour designers have put together.

    Brightman: I would say that in the last two to threeyears, there hasnt been a new How to Build a Web-site book that hasnt included accessibility. So the topicis definitely out there. If youre taking web curriculumcourses and they dont have accessibility as part of thecourse, its a bad course. If I went to architecture schooland tried to graduate today without knowing aboutaccessible architecture, Id flunk. You cannot imaginesomebody submitting an architectural plan that wasntaccessible, and thats the place we want to get to incomputer usage as well. We want to get to the pointwhere its inconceivable that you would build a websitethat doesnt have accessibility, not only as a part of it,but also as not a big deal. Its just there. Its not thespecial class anymore. Its a good mainstream product.

    Cooper: What kinds of advancements are being made inonline video content and accessibility?

    Brightman: Thats a huge issue, actually. Roughly two-thirds of the video content online is user-generatedvideos. Unlike the one-third that was previously broad-cast and had to have captions by law, this user-generatedstuff goes online and doesnt have to have captions.

    In a nutshell, I worry about the deaf teenager whoshows up at school one morning and finds all of hisfriends are talking about a YouTube video they watchedthe night beforea video he couldnt hear and that was-nt captioned. So immediately this kid is feeling furtherand further behind his peer group. There have been dif-ferent efforts underway to try to make machines figureout what it is that people in these videos are saying.

    Were still so far away from doing transcribing in a reli-able way and, to me, thats one of the last huge accessi-bility problems online. As the Internet expands, theresonly going to be more and more multimedia, more andmore video, and I think deaf folks are going to have aharder and harder time of it if we dont make someadvancements soon.

    Angeles: Captioning is pretty tricky. I used to be a

    court reporter, and it took me a long time to train to doreal-time transcriptions. We have so many homonymsand different word usages in the English language.

    Brightman: Exactly. Internationalization is another formof accessibility, in a way. If I make something thatsreally terrific, but only people in the United States cantake advantage of it, then its not accessible to the rest ofthe world. Internationalization in many ways hasbecome increasingly more automaticprograms andinnovations are rolled out to everyone, across theworld, on day one. And accessibility for people withdisabilities is getting there.

    Angeles: Yaa-hooo!

    Brightman: I like that! We can use that. Give me anaudio file of that! [laughter]

    Tsaran: In the accessibility industry we focus a lot onhow to code and how to make a website compliant. Butwhat we too often forget about is the people aspect ofdisability. Making stuff accessible means asking thequestion, Can I actually use it? Forget about whatcode is there. The real question we ask ourselves atYahoo is, can people actually use and enjoy the stuffwe create? And once they can use it, what can they dowith it? Were really about involving people, lettingthem become part of the network and have fun.

    Brightman: Not that long ago, it was determined fourbillion images had been uploaded to Flickr. Can youimagine getting those in an envelope from your drugstore? Here are your pictures. Four billion. Theresnot a number in the whole Internet scheme that isntmind-blowing. The number of users, the number of min-utes spent online, every number that has anything to dowith the web is completely astonishing to me.

    Cooper: I interviewed Dean Kamen, the developer of theSegway. I asked him if any adaptations could be made tothe Segway to allow it to be operated by someone who isblind, and he said it should be possible. There are somany products that can be adapted for people with dis-abilities.

    Brightman: Right. I know there are people right nowwho look at things as basic as the cane and say, Is thatthe best we can do today? Theres a lot going ona lotof creativity and invention.

    Cooper: With Global Positioning Satellites, it seemslikely that cars will eventually have technology thatwould make steering unnecessary. The car would knowat any give time where it is in relation to others.

    Brightman: Oh, I dont think Ill be on the road at thattime. [laughter]


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  • 32 ABILITY

    In addition to being fertile soil for big-screen thrills,the field of robotics is playing an increasingly cru-cial role in modern medical rehabilitation. ABILITYsChet Cooper and Dr. Thomas Chappell recently spoketo W. Zev Rymer, MD, at the Rehabilitation Institute ofChicago. As the Institutes lead researcher, Rymerworks closely with Northwestern University facultyfrom the departments of engineering and neuroscience,along with professors of medicine, to spearhead techno-logical innovations in rehabilitative medical treatment.

    At any given time, the Rehabilitation Institute of Chica-go houses 20 to 25 spinal cord injury patients andreceives patients who have undergone acute care inemergency hospitals throughout the Midwest. The Insti-tute is one of 14 model centers for the early treatmentof spinal cord injury patients throughout the country.Dr. Rymer has worked at the Institute since 1989.

    Chet Cooper: Is it something of a challenge for a centerlike this to juggle research and treatment?

    W. Zev Rymer: It can be. The early days are especiallydifficult for people with acute spinal cord injuries, andits not necessarily an opportune time for research,except on things that improve the early outcomes. Thosethings tend to be done by neurosurgery, rather than byrehabilitation.

    Often we wont see a person with a spinal cord injuryuntil maybe four to six weeks after his initial incident.Considering the course of events after spinal cordinjuries, thats still a very difficult time for the injuredperson and his family. A lot of our early interventionsare specially focused on the patients adaptation to newlife needs, getting him thinking about being at home andin the workplace. Many of our research projects tend to

    The Lokomat in action

  • ABILITY 33

    focus on later in the course of events, often not untilnearly the end of treatment at the rehabilitation center,or even beyond. For example, if someone has had multi-ple fractures or a chest injury, that might delay doingresearch on mobility recovery.

    A lot of what we do here is based on outpatient testing,and sometimes it doesnt even begin until many, manymonths after care. I say all of this because there issome notion we may have a greater effect with ourexperimental treatments if we intervened earlier.

    Cooper: Can you discuss some of the work going on withrobotic interventions in the world of spinal cord injuries?

    Rymer: We have a number of projects focusing onspinal cord injury care, in general, and specifically withrespect to the application of robotics. George Hornby,who is a neuroscientist and a physical therapy professor,directs one of our labs that specializes in spinal cordinjury research. Hes interested in methods of improvinglocomotion in patients who have had incomplete spinalcord injuries: patients fortunate enough not to have suf-fered total destruction of the spinal cord from whichthere can be no recovery of function.

    George has been testing robotic trainers of differentkinds. The main one weve been using is called theLokomat, which has been in the United States since2001 and is now quite well-known.

    Cooper: How does the Lokomat work?

    Rymer: It was designed and developed in Zurich, inwhats called a paraplegia hospital. The RehabilitationInstitute of Chicago was one of the first places to haveone, and we were among its earlier adopters in NorthAmerica.

    The idea behind the robotic trainer is that it uses whatscalled an exoskeleton: metal limbs attached to the legsof a person with a spinal cord injury. The person is sus-pended above a treadmill with counterweights that off-set the need for weight bearing. This is an importantfeature, especially early on, when many people who suf-fer incomplete spinal cord injuries cant bear their ownweight. The Lokomat takes the persons limbs throughprogrammed walking movements over the treadmill.

    Meanwhile, the Lokomat also collects data about whatshappening during this walking exercise so we can mea-sure things like distance, duration, number of steps, andamount of weight borne by the patient. We can also pollthe electrical activity of the different muscles and evenmeasure metabolic factors, like oxygen consumption,during this process.

    The Lokomat allows us to provide better feedback aboutdifferent features of movement, especially as a person isrecovering and developing the ability for voluntary con-

    trol. What weve seen in people who are exposed toLokomat training over a period of several weeks tomonths is progressive recovery of their walking ability.

    Cooper: So this is better than working with therapists?

    Rymer: In some respects, yes. Manual therapy doeshave the advantage of allowing a therapist to adjust thelevel of assistance to optimize intensity of the effort theinjured person generates. That kind of pushes theinjured person to be continuously active and to approachthe limits of his strength and endurance.

    The downside of the manual method, however, is that itrequires a large number of therapists. A 45 minute train-ing session, for somebody whos got weakness in bothlegs, requires two therapists on each side. And one ther-apist can last maybe 10 minutes. The effort required bythe therapists to move the patients leg is exhausting,especially if the persons limbs are spastic. Spasticity isincreased stiffness that develops in muscles that havelost input from nerves, such as that which occurs in thelegs after spinal cord injury.

    In the end, finding the expense and logistics for fourtherapists to work on one patient during a 45 minutetraining session is impractical. Manual therapy is atleast comparable to the robot, but the robot can do on itsown what is required of four therapists. Thus the robothas compelling practical advantages. Moreover, there isa safety benefit to therapists because the manual methodoften causes back injuries, since it requires they lie nextto the treadmill and move the patients limbs.

    Cooper: So there are pluses and minuses to bothapproaches.

    Rymer: The problems with the machine are now beingaddressed. One of those problems was that the machinedidnt know exactly what a person was trying to dowithin it. Even though it has force and motion sensors,the Lokomat was initially programmed in such a waythat it would replicate the movement task independentlyof what the person was trying to do.

    In contrast, a therapist can sense when somebody is try-ing to walk on his own, and can assist as needed. Sowhat the new control algorithms for this robotic systemdo is provide more sensible control that provides helponly when its needed. Its a strategy thats beingreferred to as corroborative control. I think thats amuch more promising strategy, overall.

    Cooper: Are there any other hurdles for the Lokomat?

    Rymer: The other constraints of the standard Lokomatare cost and technical complexity. The device costs,depending on how its set up, somewhere between$250,000 and $350,000. A lot of places are not able tospend that kind of money on therapeutic devices for

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    rehabilitation. And indeed, in most hospitals that havethe machine, it has not been funded as a capital equip-ment item. Its usually funded as a donation or a giftfrom a philanthropic source of some kind. In addition,the service contract for maintenance of the device costs$12,000 to $15,000 a year. Most facilities cant afford that.

    Also, while the Lokomat is sophisticated, it turns outhuman ambulation, walking, is much more complex.The machine is able only to assist with movement of thelegs forward and backward, but walking involvesswinging the legs out, moving the pelvis side to side,and rotating the body. Nor does the Lokomat help withother vital components of ambulation, such as the abili-ty to maintain posture and balance.

    Nonetheless, I believe its still very helpful, and I thinkin early stages of spinal cord injury, in particular, itsbeen especially valuable. I think the group in Zurich thatdesigned it deserves a lot of credit.

    Cooper: What other devices are being tested?

    Rymer: We have a device called a KineAssist, designedby a Northwestern University start-up called KineaDe-sign. KineAssist wasnt intended to pick up where theLokomat leaves off, but operationally thats what itdoes. It carries a person safely as he walks over ground,and it has a frame that supports a person in a harness,allowing him to move his legs freely. The advantage ofthe KineAssist is that it allows for motion of pelvis andbody axis and trunk. This actually allows a person towalk up and down slopes, to climb steps, to sit or standlots of things that are important for daily living. So theKineAssist is the next step in the retraining of walking.

    Cooper: What patients does it primarily benefit?

    Rymer: Its mainly been used in the early period follow-ing a stroke. Its not yet a commercial device, but I thinkit should prove useful in spinal cord injury cases. Itbrings one special benefit: safety. When people withspinal cord injuries begin to walk, theyre very unstableand need therapists on both sides to support them. That,in turn, limits the freedom of the patient to test the limitsof his performance. This machine adds complete safetyso people cannot fall. If they slip, the KineAssist allowsthem, essentially, to roll forwards and remain suspendedin the harness.

    We have several other projects here, linked broadly towalking via robotic systems. One of the big hazards ofspinal cord injury is loss of bone mass. Though its notpossible to completely prevent that from happening,weve found we may be able to slow down or even stopit before theres been too much loss of bone density.Because of this, bone fractures are a big problem forpeople dealing with spinal cord injuries.

    By using progressive weight-bearing, as we do in the

    Lokomat, we may be able to assist in preservation ofbone mass, if not outright restoration of bone mass thatsbeen lost. We have a study running here, funded by theDepartment of Defense, on restoration of bone massafter spinal cord injury. Our lead investigator, a derma-tologist named Tom Schnitzer, has been using walkingstudiescoupled with different hormonal and drug treat-mentsto improve bone health after spinal cord injury.

    Thomas Chappell: Thats pretty crucial, isnt it? Theproblems of bone mass reduction, muscle atrophy, down-regulation of the vascular systemall life-changingissues. Is there a way to light additional fire under someof these developments, to get them out to people sooner?

    Rymer: The best solutionin terms of preservation ofbone mass, vasculature, muscle, and skinis not likelyto be robotic. It may amount to standing or sitting with avibrating foot plate which stimulates iron preservation,coupled with biophosphonates and some of these anti-osteoporosis drugs. I dont think there are enough robotsto be widely available to everybody with a spinal cordinjury who might need them. I wish I could say that itsall going to happen more quickly, but the Lokomat iscomplicated and expensive. With only 300 of thesethings existing, worldwide, theyre only being appliedto a tiny, tiny fraction of all of the people who mightneed them.

    We keep hearing that mass production methods arelowering costs, but with respect to rehabilitation tech-nology, in general, that hasnt happened. We dont havethe scale of production, we dont have the uniformity ofneed. So that principle might be true of medicine, ingeneral, but in the rehab world, it just hasnt worked.

    Over the 15 years in which the Lokomat has been inplace, its price has stayed steady or dropped, slightly.Everythings still too expensive. I think as health carecost issues escalate, these sorts of expensive devices aregoing to be harder and harder to fund. The onus is on usto come up with things that are essentially as effectiveas the more expensive options. Maybe they wont be asflexible in terms of providing many functions, but theyshould provide appropriate functions in a targeted man-ner. They can be designed and constructed more simply.

    Cooper: Are there any projects youre particularlyexcited about that are still in the early stages?

    Were doing some pilot work on a system called Armeo,for restoration of upper-limb function in people withquadriplegia. It supports the weight of the upper extremi-ty and allows people to use residual function to trainthemselves to do voluntary tasks while interacting with aseries of computer games designed to improve typicaldaily activities. Its a bit more interesting than a lot oftherapy routines, and were hopeful that intensive prac-tice will help both strengthen muscles and improve vol-untary coordination in people with spinal cord injury.

  • ABILITY 35

    Cooper: It works as a form of biofeedback?

    Rymer: Indirectly. Biofeedback usually means that theresa biological signal being given that somebodys beingasked to increase. In contrast, this is a game that says,Can I move? Can I do a task? Can I move kitchen uten-sils around? Can I play other kinds of games? These aregames, not unlike kids games, but theyre targeting func-tions that are relevant and useful for somebody who hasimpairment of upper-limb and hand function.

    We have a lab here dedicated to restoration of handfunction, specifically. Stroke survivors cant extend thewrist or open the hand, so there are a lot of devicesbeing developed to help them do those things. Most ofthe work weve done has been in the stroke arena. Wehave a big stroke robotics center thats uniquelyfocused on stroke. Stroke survivors are a more homo-geneous population with which to work, but all thethings weve learned from stroke robotics are also like-ly to be relevant to management of people with spinalcord injuries.

    There are other robotic devices weve started to workon testing, designed for complete spinal cord injury.One of them is a device called ReWalk, developed by acompany called Argo. We have not yet used the systemhere, although we hope to. This device was designed inIsrael, by a paratrooper who had sustained a spinal cordinjury. Originally he was just using it for himself. Its avery lightweight, powered exoskeleton that can be car-

    ried. It works quite nicely for people who dont have alot of spasticity and who have incomplete spinal cordinjuries. You have to use crutches for upper extremitycontrol and balance, but the machineas you tilt for-ward, to begin walkingallows the motors to bend thehip and knee, one side at a time, to produce relativelynatural motion.

    I saw the machine in action in New York, about sixmonths ago. A trained user, an Israeli soldier who sus-tained an injury in an accident, walked the streets ofManhattan with us for about an hour. He was able to goup and down stairs and do all kinds of things. Hesexceptional. Hes relatively lightweight, very strong andagile, well-trained, has good upper extremity and trunkcontrol. I dont know if one could necessarily expect thatlevel of performance from other users, but I thought themachine was excellent.

    Chappell: How did he balance?

    Rymer: He used crutches for balance, but the devicesmotors are powered by a battery pack that sits on hisback. About 15 pounds or so.

    Cooper: Theres a pretty good YouTube video for theproduct.

    Rymer: Yeah. Its been on ABC and Good Morning,America. Ive been trying to get the developers to workwith me to test it in people with incomplete spinal cord

    A rehabilitation session using the KineAssist

  • 36 ABILITY

    injury. Im hopeful that we can do that. There are poten-tial liability issues: someones going to fall in theReWalk device, at some point. I think its going to be atough road to make this a commercial product. But itsgood engineering: top-notch, well-designed, light-weight, very effective. Ive been talking to the inventorof this for nearly 10 years, and for a while I wasnt con-vinced it was ready for primetime. Now I think it is. Itsan elegant product. I think the whole idea of using theseportable exoskeletons to help people walk is going tobecome the center of attention in the field of rehabilita-tion in the next 10 years.

    The final piece of the robot story is an interesting one,but I dont know if its going to apply to the world ofspinal cord injury. Honda Motorcar Company hasdesigned the DiGORO robot systems. I dont know ifyouve seen them on the Internet?

    Cooper: Yes, I think so.

    Rymer: They actually were designed for use by frailpeople: a way for people to enhance their stamina and towalk greater distances. The Honda machine was origi-nally designed for the Japanese elderly, but Honda start-ed a study with us to see if we can use it in a differentpopulation, including spinal cord injury patients. Itskind of like the ReWalk, but its smaller and lighter andless powerful. The Honda device would be used toextend walking ability for somebody with very mildimpairment, whereas ReWalk is designed for those withsevere injuries.

    Weve tested the Honda device with some spinal cord-injured people, and their walking did improve a little bit.There seems to be a range of robotic systems evolving.Some of them might find a market and long-term roles intherapy and management. Others, Im not sure. Forexample, the Lokomat is expensive and complex, and it

    works quite well, but I think it will remain primarily inlarge hospitals and academic centers.

    For a long time, rehabilitation science wasnt really a pro-ductive field, but its highly productive now. As we getinto stem cells and other therapies that will potentiallymake radical changes in recovery from spinal cord injury,I think there will be more and more room for translationalwork*which is exactly the kind of work that we do.


    *Note from Dr. Chappell: Translational work refers to a relatively newconcept in medical science. For most of the history of modern medicine,scientific researchers (PhDs) and their work were mostly separatedfrom MDs and the treatment of patients. Historically, there was evensome animosity between the two camps, mostly because doctors tendto get paid better than scientists. My graduate school professor, a PhD,knew I intended to go to medical school. He used to tease me by say-ing, Before we PhDs came along all you MDs could do was wave mon-key skulls at your patients! Yet, somehow, we have managed toadvance medicine based on scientific endeavor. In many ways, howev-er, the process is arduous. In recent years, scientists, and doctors inter-ested in research, have more closely collaborated, even to the extentthat it is no longer uncommon for people to hold both an MD and a PhD.Research involving close collaboration between laboratory or basic sci-ence research and actual treatment of patients is called translationalresearch to connote proficient translation of information from scientificresearch into better treatment of disease.

    Hand rehabilitation using the j-Glove