AT and People with Mental Retardation:Improving Tools and the AT Access Infrastructure

Beth Mineo Mollica, PhD CCC-SLPDelaware Assistive Technology Initiative

Cathy Bodine, PhD CCC-SLPColorado Assistive Technology Project

An Underserved Population

Barriers to AT Technology design Misperceptions regarding benefit

Caregivers Persons with disabilities Service providers

Provider knowledge, skills & capacity Policy & funding issues

Universal Designs

DISHDRAWER This style

dishwasher doubles  as kitchen cabinetry making storage and cleaning of up to 4 paces settings accessible in one location.

Universal Designs

TALKING MICROWAVE OVEN

This standard microwave has been modified with a voice to help guide a person during operation.

Assistive Technologies for Independence

PILL ALARM

This product has two chambers and two timers to remind persons to take medications at the proper time.

Assistive Technologies for Independence

Assistive Technologies for Independence

With Voyager, any program on the computer can be placed on the desktop as a button to simplify program startup.

Assistive Technologies for Independence

PocketCoach

Assistive Technologies for Independence

Visual Assistant Picture-based handheld computer trainer for individuals to learn new tasks.

Money Coach

Web Trek: A Specialized Web Browser Providing

Independent Access to the Internet to Individuals with Mental

Retardation Project Summary: Two-year SBIR funded by NIDRR to develop a web browser, picture-based search engine, and email application to enhance Internet access for individuals with mental retardation.

Project Outcomes: Prototype web browser used by individuals with mental retardation to more independently access the web and search for and save sites of interest.

Current Status: Phase II SBIR Currently Funded by NIDRR. Will result in the completed Web Trek browser and email application in 2001.

Related AT Projects for Individuals with Mental Retardation

Assistive Technologies for Independence

Augmentative/Alternative Communication (AAC)

New Horizons in Technology

PixWriter

High Tech: Recorders and Pagers

Delaware’s ExperiencePrecipitating Factor:

QA visit to community residence –

AT available but not used

Two studies examined the causes

Ongoing efforts to improve AT access and use

Study #1Representative sample of Division of

Mental Retardation caseload (N=50)AT needs screened 80% referred for

further evaluation Evaluation driven by screening results Consumer, family, & provider involvement Up to 4 disciplines involved Average cost of evaluation = $360

Study #1 ResultsProjected cost for addressing needs =

$2,300 per person (n=34)Costs averaged across entire sample =

$1,550 per personEstimates included devices and

services to meet immediate needs only

Study #1 Results68% of study population had an

immediate need for AT devices and services

Areas of AT Need

55%

9%

20%

9%2%

5%

Communication

Literacy

Mobility

Self-Care

Sensory

Vocational

Study #2Study #1 participants followed for 15

months to: examine the extent to which their needs

were met identify elements that either facilitated or

hampered AT access

Study #2 Results

74% of those who needed AT had at least some of their device/service needs met

91% continued to have unmet needs

Study #2 ResultsContrary to popular belief, lack of

funding resources was not the primary barrier.

Confusion about how to access that funding was the problem.

Study #2 Results

Funding Sources

6%

15%

22%

6%

28%

15%

4%4%

Personal/Family Funds

Medicaid

Private Insurance

Medicare/Medicaid

School

Equipment LendingLibraries

Stockley Center

Special Populations

Study #2 ResultsThose residing in the state institution

(Stockley Center) enjoyed much better AT access than those living in the community because of Stockley’s investment in: staff development (skill & attitudes) an equipment inventory the development of policies/procedures

streamlining AT access

Study #2 Results

Those with a successful AT outcome had the benefit of an advocate concerned with timely and appropriate acquisition of devices/services.

Study #2 Conclusion

Delaware’s MR/DD system would benefit from an AT access infrastructure with:

qualified providers technology availability coordination responsive and consistent policies and

practices enabling attitudes

Building Infrastructure

Shared vision Awareness and training Long overdue “consideration” of AT

needs Funding and policy Promising partnerships

Shared vision

May begin as coercion…. Key stakeholders

Awareness and training

Delaware case manager training Colorado knowledge transfer initiative

AT Curriculum

12 modules spanning 3 monthsFamiliarization with broad spectrum of

AT, home mods, & vehicle mods Key considerations Funding & policy issues

Active and experiential learningMentored case management

Curriculum Modules

• Overview• Identifying AT Needs• Positioning & Mobility I• Positioning & Mobility II• Augmentative and

Alternative Communication (AAC) Overview

• Language Facilitation through AAC

• Tools for Sensory Enhancement

• AT for Learning, Working & Playing

• Home Modifications• Low & High Tech Tools

for Activities of Daily Living

• Accessing AT: Funding & Policy Perspectives

• Summative Experience

Building Infrastructure

Long overdue “consideration” of AT needs

AT “Screening” Tool

Addresses wide range of domainsMechanism for systematic consideration

of ATCatalyst for team deliberationsDocumentation of functioningHelpful in transition planning

Priority Area

Activities Independent/Adequate

Partially Independent

Dependent Not Applicable

No AT

W/ AT

No AT

W/ AT

No AT

W/ AT

ENVIRONMENTAL CONSIDERATIONS

Personal Transportation

gets in and out safely

uses vehicle safety mechanism (e.g., harness, seat belt, tie-down system, carseat)

places/stores mobility device in vehicle

drives

Comments/Concerns:

Priority Area

Activities Independent/Adequate

Partially Independent

Dependent Not Applicable

No AT

W/ AT

No AT

W/ AT

No AT

W/ AT

Positioning & Mobility

sits

is mobile in bed

transfers

stands

stands for prolonged periods

walks on flat surface

walks on uneven surface

walks on incline/stairs

is mobile in wheelchair

changes position as needed

Funding and policy

Policy clarification Advocacy for more responsive policies

Policy Clarification

Process – who, what, when, & how

Funding streams – what, for whom, under what circumstances

Payment cascade

Gaps in Support Remain

Private insurance more limited than Medicaid

DE MR/DD waiver made more restrictive

Natural families lack supportMedicaid doesn’t cover key areas of AT

- Home mods, vehicle mods, sensory aids, ECUs

Comprehensive Resource GuideContents

Guide to Funding Resources Guide to Service Providers

Format Very large notebook Website with search capabilities

Promising partnerships

Developmental Disabilities CouncilsState Developmental Disabilities agenciesCenters for Medicare and Medicaid Services (CMS)Advocacy Organizations

Mobility for All: Mobility for All:

Jim SullivanCo-Director, Cognitive Levers Project

Center for LifeLong Learning and Designjames.sullivan@colorado.edu

Alexander RepenningCEO and PresidentAgentSheets, Inc.

alexander@agentsheets.com

Low Tech AT for Cognition

E-Z Pocket Highligher tape Sticky notes Pocket notebook Templates

High Tech: Recorders and Pagers

High Tech: Recorders and Pagers

Types of Assistive Technology

LiteracyWord prediction Intellikeys Talking Word Processors

Math / Time Talking Watch / Clock Talking Calculators

Transportation GPS Systems

Word Prediction

Concept Development

Multi-Sensory Output

Using Symbols

PixWriter

Intellikeys Keyboard

Money Coach

PixWriter

Types of Assistive Technology

Communication ChatPC Chat Box Cheap Talk

                         

Other Uses of Assistive Technology Monitoring

Motion sensors

Mercury switches

Universal Designs

TALKING MICROWAVE OVEN

This standard microwave has been modified with a voice to help guide a person during operation.

The convergence of new technologies

Technologies that adapt to Personalized needs Are sensitive to the environment Are sensitive to the persons role in the environment Will support the Safety, Social and Medical needs of

individuals

The Convergence Aims at Awareness

The key is “awareness” to person, location, context, etc. and the ability to act-react-interact based

on that awareness

Sensors and Actuators

There is much in the news about micro and nano technology, about MEMS Even implanting these in the body

These devices take technology similar to building ‘chips’ and make a combination of electrical and mechanical devices

Research projects in Affective wearable computing Affective Jewelry and Accessories: Wearable jewelry

with embedded sensors for sensing physiological changes associated with emotions.

Expression Glasses: A wearable device which allows any viewer to visualize the confusion and interest levels of the wearer.

The Galvactivator: A wearable device which maps your skin conductivity to a glowing red LED.

Frustration Detection: using physiological signals of skin conductivity and blood-volume pressure.

Communication

We are familiar with many of the new wireless communication technologies Cell Phones GPS systems

Now on our wrists

Wireless Ethernet Systems The Internet (wired and wireless)

Computation

We are seeing new computing platforms PDA – with many attachments Tablet computers Cheap super-computers supporting

advanced graphics systems Computational Dust Embedded Systems in clothing

Goal of New Computation Models

Anywhere, Anytime, Anyone, Anything

What you want/need, the way you want/need it and when you want/need it

Agent based technologies Personalization Portals/Portlets Data Fusion Data Mining Decision Support Collaboration support Privacy Distributed…..Computing,

Storage, Data, Communication Embedded system, computation

where you need it and no more than you need

Emerging Mobile & Wearable

Subscriber Identification Module (SIM)

Old approach: Old approach: “fit the user into the system”“fit the user into the system”

“Here is your map ….

You live here …

Your destination is here …

Your bus will have this label…

When you see this landmark, remember to pull the cable on the bus so the driver knows you will get off at the next stop.

This is where you will get off…

Don’t forget your backpack!

OK, now let’s talk about the schedule …. do you know how to read a clock? … “

New approach: design a system to “fit the userNew approach: design a system to “fit the user””

other things I can do

things I have to remembermy bus

my drawing of my house

my mom works here

Simulated person

Real-time tracked busses

Speech recognition

Smart Phone – Carry Anywhere Assistant

Smart Phone Smart Home

At Home

Why Cell Phones?

People are accustomed to using phones – it is one of their most important technology devices

Most portable and mobile device Better chances for acceptability as compared to

other computing devices Smart Phone evolution:

Voice Computer and IP data network on board Platform standardization enabling third party

application developers

Smart Phones

Back-lit & Contrasting colors

Larger fontsBack-litAudio-feedback

Code reader(Smart ID,RFID,…)

Wider Phone Keypad

Full-dayBack Battery

WiderVerticalKeySpacing

Wider Screen

WiderHorizontalKeySpacing

Smart Phone – Carry Anywhere Assistant

Smart Phone

… and Away

Grocery Stores

On the road

Restaurants

Doctor Office

Parking Lots. . . . . .Other Smart Spaces

Wireless Networks

Satellite

Macro-CellMicro-Cell

Urban

In-Building

Pico-Cell

Global

Suburban

dik ©In-Room(BlueTooth)

Check locks on doors and

windows

Other Services

Automatically refill prescription

Check iflaundry is done

Call in a nurse

Call in for help and

Assistance

Monitorof kitchen:oven and

stove on/off; temp.

Turn on/offlights (and

visually inspect)

other rooms.

Sense and see visitors/strangers

at front door

Order grocerieswith dietary restrictions

MIT – Intelligent Room: The basis for the next generation Smart House

Dynamic, Context-Aware Speech Recognition

Head and Arm Position Tracking for Gesture Understanding

A Help System for the Intelligent Room Information Retrieval and Personal

Information Management in the Intelligent Room

Honeywell PartnershipLeverage of Smart Home technology: The Leverage of Smart Home technology: The Independent LifeStyle Assistant (ILSA) Independent LifeStyle Assistant (ILSA) ProgramProgramPlans for future collaboration on joint Plans for future collaboration on joint applications that uses Smart Phones and applications that uses Smart Phones and ILSAILSATesting in the homes of elders beginning Testing in the homes of elders beginning October, 2002 (next month).October, 2002 (next month).

Vision Computation

will be freely available everywhere  Computation will enter the human world, handling our goals and

needs. 

We will not need to carry personalized devices around with us.  Instead, "anonymous" devices, either handheld or embedded in the

environment, will bring computation to us, no matter where we are or in what circumstances. 

These devices will personalize themselves in our presence by finding whatever information and software we need. 

We will not need to type or click, nor to learn computer jargon.  Instead, we will communicate naturally, using speech, vision, and

phrases that describe our intent, leaving it to the computer to locate appropriate resources and carry out our intent.

Future Generations of Assistive Technology (AT) devices should

Provide and utilize ease of personalization knowledge of location knowledge of context

Extend the safety and medical possibilities of today’s systems

Next Generation of “AT” Be useful for a wide range of individuals

Across the ability spectrum Large market base Cheaper prices An integrating/community building common

toolset In short, approximate the Standard of Care

that we have in the best Human-based caregiver and support systems!

Opportunities and Challenges

The convergence of technologies is not uniform Much work remains to be done before

commercially viable Care in development and deployment in the

CD community is required Assessment Financial Support Development of Infrastructure, Training Integration with existing support community

Opportunities and Challenges

Just because we have the technology does not mean we should use it!In some cases there is no problemIn others the supporting science is not availableIn all cases we must acknowledge the social

and family settings and our understanding of the requirements at a human level

– Often as much art as science– Key for final success

We are at the beginning of

The next technological explosion inSensors and actuatorsCommunicationComputation

An Integrated Understanding of Cognitive Science, NeuroscienceLearning Science, Genetics

Our Challenge and Hope for Really Making a Difference in Peoples Lives

Depends upon a broad integration of expertise within a living context, not a laboratory

This will challenge us to Work together Expand our appreciation of different fields Understand and respect the contributions made by

everyone Place the individual with a (cognitive) disability at the core

of our activities

Don’t forget to fill out your conferenceEvaluation form.

Thanks for coming!