at and people with mental retardation: i mproving tools and the at access infrastructure beth mineo...
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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 [email protected]
Alexander RepenningCEO and PresidentAgentSheets, Inc.
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!