Assistive Technology Goes Mobile

By Sarah Foley, M.S., CCC-SLP and Erin Muston-Firsch, M.S., OTR/L, Craig Hospital

 Technology is more than just a luxary at Craig. As technology becomes a greater part of the world at large, therapists at Craig are finding more and more ways to incorporate it into the acute rehabilitation process for those recovering from TBI. In the Assistive Technology Lab, for example, occupational and speech therapists consider technology a vital tool in the lives of those living with disabilities. Specifically, therapists have found that technology opens up opportunities post-injury for many patients, ranging from increasing engagement in therapeutic tasks to allowing the individual to return to a previous job.

Technology as a Treatment Modality

D (first initial used to protect the person’s privacy) sustained a severe TBI after a fall. Before his injury, this young man enjoyed playing games on both his computer and video game system. When he initially came to Craig, D was not able to move most of his body, communicate basic needs, or remember things from day to day – let alone play traditional video games. His treatment team also noticed severe left visual neglect, or difficulty looking at and attending to things on his left side. D’s initial treatment involved using a device that tracked his eye movements in order to play video games; not only was this a great way to work on scanning and attention on his left side, but it was also something that he really enjoyed and found motivating. D’s family commented that it was one of the first things he was really able to “do” as a part of his rehabilitation. As D progressed and began moving his arms, big button switches were used to play games, encouraging him to move and reach while still challenging his vision. Eventually, D began to gain more control of his hands and fingers, so he was further challenged with video game controllers to practice hand-eye coordination, reaction time, and problem-solving skills. D used technology therapeutically, as a treatment, to work on deficits from his TBI. As he progressed, his therapists were able to adjust the type of technology he could use and the games he could play to provide just the right level of challenge for him.

While we traditionally think of using assistive technology to make access easier, it can also be used to work on physical, cognitive, and even visual skills. There are a variety of options available, including use of eye tracking technology to work on vision and attention, big button switches to work on reach and coordination, mobile applications to provide visual and cognitive challenges, and computer and console-based video game controllers to work on dexterity and reaction/processing time. Virtual reality is an emerging technology with the potential to work on balance, motor skills, dexterity, and cognitive skills in an immersive environment. D’s story shows us that technology is a great treatment tool because of its widespread commercial availability and its inherent ability to motivate and engage users through interactive, competitive gameplay.

Technology to Address Language Deficits

M was a young man who sustained a TBI through electrocution. Upon arrival at Craig, he was unable to move most of his body. He was barely able to communicate “yes” or “no” through his head movements, much less signal any other basic needs. Through the use of technology, M learned how to use his eyes to operate special software on a computer. A camera attached to the computer could track his eye movement – by holding his gaze in a specific part of the screen, M was able to trigger the computer to say what he was thinking. When he was discharged, M was using his eyes to communicate anything and everything he wanted to say. In addition, this technology allowed him to text his friends, engageon Facebook, and surf the web independently.

Speech-generating devices such as these are some of the ways that Craig therapists use technology to assist people with communication. For those who can physically touch a screen, there are iPads and communication apps that can say selected words and phrases for the speaker. For others who have some gross motor movement, switches can be enabled to select a word or phrase as the computer/tablet scans through various options.

Technology to Address Cognitive Deficits

J was a woman in her 50s, actively involved in her family and community. Before her brain injury, J did much of the organization and planning for her family. Her stroke caused difficulties with her language skills – writing specifically – and she had trouble maintaining attention and performing typical life management. She was determined to be more independent with these things as she returned home.

J’s phone became her lifeline. She relied on it for remote communication with her many family members and as a cognitive tool to provide the structure she could no longer maintain herself. Her therapist worked with her to simplify her home screen so that she could more easily locate the apps she used most. She learned how to use voice input for texts and emails, making communication more efficient. She was taught to use her online calendar for visual organization of her days. Alerts were set up to remind her of upcoming tasks, and she used a separate medication app to guide her in filling her pill box each week. A simple emergency alert app provided her and her family with peace of mind if a medical emergency occurred when she was alone. With proper training to use these tools, J was able to return home with less supervision and increase her independence in performing daily tasks.

In addition to the tools mentioned above, individuals with brain injury can benefit from mobile technology at home. Use of call systems, similar to intercoms, allows families to check on their loved ones when in another room or location. Far-field recognition (such as the Amazon Echo or Google Home) can turn lights on and off using a single voice command. When motor movements are impaired, TV may be more easily accessed using an app on the individual’s phone.

Technology for Return to Work and School

Consider these scenarios:

1. N was a young man working at a fast-paced job that demanded efficient computer skills. After his TBI, his language skills were impaired and his left arm did not work at all.
2. T was in her junior year of high school when she sustained a TBI in a car accident. When it was time to return to school, she still had difficulty with multitasking (i.e., taking notes while listening to the teacher) and keeping up with the pace of the class.

What are these individuals to do? How are they to successfully reintegrate into their work and school environments?

As patients move toward the end of inpatient rehabilitation, they are often looking for tools to aid them in returning to work or school. For those likeN, who are using computers frequently but lacking the manual dexterity to access the keyboard or mouse, adaptive equipment can be provided to allow for this access. Speech recognition software, such as Dragon NaturallySpeaking, allows speakers to dictate into a microphone and see their words appear on the screen. Others may prefer to learn one-handed typing to increase their efficiency with only one functioning hand. Adaptive mice, such as trackballs and trackpads, can be used in lieu of standard mice to allow for easier movement, scrolling, and clicking. For those like T, who need to take notes during classes or meetings but lack the processing speed to keep up with the presenter’s pace, smart pens (i.e., LiveScribe) and notetaking software (i.e., Sonocent Audio Notetaker) are available. These technologies allow users to take brief notes as they take audio recordings of the presentation, and the notes are then timestamped with the audio to make subsequent review quick and easy.

Closing Thoughts

With so many devices and programs available, there is a lot to consider when selecting the right technology to support someone after a brain injury. Just as no two brain injuries are exactly alike, no two assistive technology solutions are exactly alike either. Consulting with assistive technology professionals can provide expert assessment, education, and training to identify the best use of technology for each individual’s needs. With the right tools and training in hand, many individuals with brain injury can experience increased confidence in their daily living. Whether used to communicate with others, assist with memory and organizational support, facilitate return to work and school, or provide a motivating therapeutic challenge, assistive technology is a powerful tool for independence.

For more information on the assistive technology being used at Craig, click here.

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This article originally appeared in Volume 11, Issue 2 of THE Challenge! published in 2017.