Innovations for Supporting Communication: Opportunities and Challenges for People with Complex Communication Needs.

Individuals with complex communication needs have benefited greatly from technological innovations over the past two decades, as well as from social movements that have shifted focus from disability to functioning and participation in society. Three strands of technological innovation are reviewed in this paper: (1) innovations in the tools that have become available, specifically tablet technologies; (2) innovations in access methods (eye gaze technologies and brain-computer interfaces); and (3) innovations in output, specifically speech technologies. The opportunities these innovations offer are explored, as are some of the challenges that they imply, not only for individuals with complex communication needs, but also for families, professionals, and researchers.

A novel EOG-based wireless rapid communication device for people with motor neuron diseases.

In this study, a new electrooculography (EOG) based system that provides efficient communication for people suffered from motor neuron diseases is presented. The system consists of two distinct devices. The first device operates as a main unit that is activated by the subject's eye movements. This unit is capable of transmitting 10 different command/state messages. These messages enable subject to choose his/her situation such as "I'm fine", "I feel bad", "I'm hungry" and "I'm thirsty". Commands such as "Come", "Go". The number of messages can be increased. The main unit acquires the EOG signal from the subject. Newly developed analogue and digital signal conditioning interprets the eye movements as specific messages and transmits them to the second unit (receiver) using radio frequency transmitter. The messages related to the subject's demands and situation can be heard from both main and receiver unit speakers. The wireless receiver unit is capable of notifying the patient's command by auditory and visual indicators. The realised device was tested by 2 healthy and 2 ALS patients and confirmed to be successful with 100% performance for sending correct messages.

Hearing loss and disability exit: Measurement issues and coping strategies.

Hearing loss is one of the most common conditions related to aging, and previous descriptive evidence links it to early exit from the labor market. These studies are usually based on self-reported hearing difficulties, which are potentially endogenous to labor supply. We use unique representative data collected in the spring of 2005 through in-home interviews. The data contains self-reported functional and clinically-measured hearing ability for a representative sample of the Danish population aged 50-64. We estimate the causal effect of hearing loss on early retirement via disability benefits, taking into account the endogeneity of functional hearing. Our identification strategy involves the simultaneous estimation of labor supply, functional hearing, and coping strategies (i.e. accessing assistive devices at work or informing one's employer about the problem). We use hearing aids as an instrument for functional hearing. Our main empirical findings are that endogeneity bias is more severe for men than women and that functional hearing problems significantly increase the likelihood of receiving disability benefits for both men and women. However, relative to the baseline the effect is larger for men (47% vs. 20%, respectively). Availability of assistive devices in the workplace decreases the likelihood of receiving disability benefits, whereas informing an employer about hearing problems increases this likelihood.

iPads, mobile technologies, and communication applications: a survey of family wants, needs, and preferences.

Families of children with communication disabilities were surveyed to explore wants and preferences relative to mobile media technology, including iPads, as a form of augmentative and alternative communication (AAC). The families surveyed reported wanting information and support from professionals, including speech language pathologists (SLPs), who are knowledgeable about AAC. These families wanted devices to meet their children's individual needs and reported that ease of use and affordability were the most influential characteristics in the purchase of mobile media devices and communication applications. SLPs who understand family decision making can utilize collaborative clinical decision making that respects families' wants and needs, while also focusing on device feature matching and family education.

Structure and practices of the video relay service program; telecommunications relay services and speech-to-speech services for individuals with hearing and speech disabilities. Final rule.

In this document, the Commission adopts further measures to improve the structure, efficiency, and quality of the video relay service (VRS) program, reducing the inefficiencies in the program, as well as reducing the risk of waste, fraud, and abuse, and ensuring that the program makes full use of advances in commercially-available technology. These measures involve a fundamental restructuring of the program to support innovation and competition, drive down ratepayer and provider costs, eliminate incentives for waste that have burdened the Telecommunications Relay Services (TRS) Fund in the past, and further protect consumers. The Commission adopts several measures in order to: ensure that VRS users can easily select their provider of choice by promoting the development of interoperability and portability standards; enable consumers to use off-the-shelf devices and deploying a VRS application to work with these devices; create a centralized TRS User Registration Database to ensure VRS user eligibility; encourage competition and innovation in VRS call handling services; spur research and development on VRS services by entering into a Memorandum of Understanding with the National Science Foundation; and pilot a National Outreach Program to educate the general public about relay services. In this document, the Commission also adopts new VRS compensation rates that move these rates toward actual costs over the next four years which will better approximate the actual, reasonable costs of providing VRS, and will reduce the costs of operating the program. The Commission takes these steps to ensure the integrity of the TRS Fund while providing stability and certainty to providers.

The Domesday dataset: linked open data in disability studies.

Augmentative and alternative communication (AAC) devices provide the ability for many people with disabilities to make themselves understood. For the large proportion of users with an intellectual disability, these devices may be their only means of communication. Estimates of the number of AAC devices in use are vague and lack transparency. This prevents researchers from answering key questions like 'How many people per 1000 are using electronic AAC?' and 'On average, how much money would fund a person's AAC use for 12 months?'. This work presents the 'Domesday dataset', which allows researchers to answer research, policy, and prevalence questions on the landscape of AAC use within the United Kingdom. This dataset was constructed by making several hundred Freedom of Information requests. These requests asked public bodies who purchase AAC devices in the United Kingdom to supply details of every AAC purchase since 2006 including make, model, and year of purchase.

Non-electronic communication aids for people with complex communication needs.

Non-electronic communication aids provide one form of augmentative and alternative communication (AAC) for people with complex communication needs. The aim here was to explore non-electronic communication aids as one AAC option and research challenges. This aim was addressed by reviewing funding for the provision of AAC systems, data from an Australian pilot project providing non-electronic communication aids, an audit of aided AAC published studies (2000-2009), and discussion of the review literature. Combined, these sources indicate that although there is great demand for non-electronic communication aids, funding schemes, both in Australia and internationally, have focused on electronic communication aids. Such funding has usually failed to meet the total device costs and has not provided for adequate speech-language pathology support. Data from the pilot indicated the demand for non-electronic communication aids, and patterns suggest potential factors that govern the types selected. Despite the high demand for non-electronic aids, the research literature has tended to focus on electronic communication aids, including within intervention studies and addressing design features and long-term outcomes. Concerns about ensuring that AAC systems are chosen according to the assessed needs of individuals are discussed within the context of limitations in outcomes research and appropriate outcome measures.

Frequency of purchase and associated costs of assistive technology for Washington State Medicaid program enrollees with spina bifida by age.

BACKGROUND: Assistive technology (AT) is one strategy to mitigate or eliminate barriers to independence for individuals with disabilities, including those with spina bifida (SB). However, little is known about current use and costs of AT for people with SB, including the cost burden to medical insurance payees. OBJECTIVE: The aim of this study was to evaluate frequency of AT purchases and their associated costs for individuals with SB covered by the Washington State Medicaid program. Additionally, we sought to compare Medicaid reimbursement for AT to the overall Medicaid reimbursement for all medical care for these individuals. METHODS: Data included all electronic claims and eligibility records of persons covered by the Medicaid program over a 4-year period (2001-2004) who had at least one service with a coded diagnosis of SB. Procedure codes were reviewed and grouped into the following AT categories: manual wheelchairs, powered wheelchairs, wheelchair cushions and seats, wheelchair accessories and repairs, wheelchair rental, ambulatory aids, orthotic and prosthetic devices, positioning aids, bathroom equipment, beds and bed accessories, and communication and hearing aids. Age group analyses were conducted after dividing patients into 3 age groups (0-15, 16-25, and 26+). Further subgroup analyses were done for individuals with dual or capitated medical coverage compared with those who had fee-for-service Medicaid-only coverage. RESULTS: A total of 984 individuals with at least one diagnosis of SB during the 4-year study period were identified. On average, approximately one third of individuals made claims for some type of AT per year; the majority of these AT claims (87%) were for mobility-related AT. Average annual Medicaid cost of AT was $494 per enrollee and AT accounted for 3.3% of all Medicaid costs for these individuals. AT-related costs were highest for those aged 0-15 years and lowest for those aged 16-25 years. Persons with only fee-for-service Medicaid coverage had more than twice the annualized Medicaid AT-related expenditures compared to those with additional coverage or who were covered under a Medicaid capitation plan. CONCLUSIONS: Medicaid reimbursement for AT, as classified in this study, is a relatively low percentage of overall medical costs for individuals with SB. Because of the small percentage of non-mobility-related AT paid for in this study, we believe there may be a substantial unmet need for AT in this population and/or that individuals with SB may have significant AT-related out-of-pocket expenses. Given its large potential impact and relatively low cost burden to Medicaid, AT is a "good buy" and coverage for AT should be expanded.

A survey of augmentative and alternative communication service provision in Hong Kong.

A survey was conducted to understand the service provisions for augmentative and alternative communication (AAC) in Hong Kong. The response rates of special pre-school training centers and special schools were 59% and 71%, respectively. The response rate of adult settings was 18%. Results indicated that a higher proportion of students identified as having complex communication needs had access to AAC service provision in schools for children with intellectual and physical disabilities than those in special pre-school training centres and other types of special schools. Generalization of AAC service beyond the classroom setting remains problematic. Seventy-two percent of the respondents were dissatisfied with the training in AAC that they received during their basic professional preparation. More advocacy work is needed to increase awareness and knowledge of AAC use in Hong Kong.

Reliability of speech generating devices: a 5-year review.

Individuals who use augmentative and alternative communication (AAC) depend on technology to meet their daily needs and form relationships. Speech generating devices (SGDs) are integral components of communication systems. Reliability of SGDs is critical for effective use in everyday life. This study examined the reliability of new SGDs and found that mean time to first failure was 42.7 (SD = 41.2) weeks and at least 40% required repairs within the first year of use. The components that most frequently broke down were touch screens, wiring, main boards, batteries, memory cards, and AC adaptors. The costs of repairing SGDs were analyzed. The clinical implications of device breakdown are identified for key stakeholders, including clients, families, service providers, funding agencies, and manufacturers.

Would people pay for text messaging health reminders?

The aim of this study is to determine the time and financial limitations that people would accept for using a telehealth service consisting of wireless text messaging reminders to improve adherence to a recommended healthy regimen. An empirical study based on a 1-month trial of a prototype system that studied adherence to a specified healthy behaviour was conducted. Fifty-one participants received daily cell phone text messaging reminders on taking one vitamin C pill daily for preventive reasons. At the end of the trial they answered a survey regarding their willingness to pay for and to stay with such a service, if offered. If usage were free, only 45% of the participants would continue to use it for a long indefinite period of time. If the usage were for a fee, 29% of the participants would use the service just a few weeks; 28% would use it an indefinite period of time if they could see its usefulness and if the cost were reasonable. The median amount indicated by the participants as a reasonable monthly fee for such a service was $5. Although the study did not evaluate perceived usefulness to use the telehealth service explicitly, a benefit perception proved to condition participant willingness to use the service and to pay for it, if necessary. If people perceive usefulness, they want to use the service, even for a fee. A free service would not be used if it is not perceived as beneficial.

Enhancing AAC connections with the world.

The availability of new technologies has changed how we control devices, exchange information, and communicate with others. Significant barriers, however, have prevented many individuals who use augmentative and alternative communication (AAC) from accessing the technology and computer-based activities available in today's "Information Society." In this paper we discuss the benefits and challenges to increased interoperability between AAC and mainstream technologies. We outline suggested roles and activities for six stakeholder groups: (a) individuals who use AAC, (b) individuals who assist in selecting and supporting use of AAC devices, (c) AAC researchers, (d) AAC device manufacturers, (e) mainstream application developers and technology manufacturers, and (f) public policy makers. We also provide suggestions for future research, public policy, and technical development.

Practical low-cost visual communication using binary images for deaf sign language.

Deaf sign language transmitted by video requires a temporal resolution of 8 to 10 frames/s for effective communication. Conventional videoconferencing applications, when operated over low bandwidth telephone lines, provide very low temporal resolution of pictures, of the order of less than a frame per second, resulting in jerky movement of objects. This paper presents a practical solution for sign language communication, offering adequate temporal resolution of images using moving binary sketches or cartoons, implemented on standard personal computer hardware with low-cost cameras and communicating over telephone lines. To extract cartoon points an efficient feature extraction algorithm adaptive to the global statistics of the image is proposed. To improve the subjective quality of the binary images, irreversible preprocessing techniques, such as isolated point removal and predictive filtering, are used. A simple, efficient and fast recursive temporal prefiltering scheme, using histograms of successive frames, reduces the additive and multiplicative noise from low-cost cameras. An efficient three-dimensional (3-D) compression scheme codes the binary sketches. Subjective tests performed on the system confirm that it can be used for sign language communication over telephone lines.

Controlling mouse pointer position using an infrared head-operated joystick.

This paper describes the motivation for and the design considerations of a low-cost head-operated joystick. The paper briefly summarizes the requirements of head-operated mouse pointer control for people with disabilities before discussing a set of technological approaches that can be used to satisfy these requirements. The paper focuses on the design of a head-operated joystick that uses infrared light emitting diodes (LED's) and photodetectors to determine head position, which is subsequently converted into signals that emulate a Microsoft mouse. There are two significant findings. The first is that, while nonideal device characteristics might appear to make the joystick difficult to use, users naturally compensate for nonlinearities, in a transparent manner, because of visual feedback of mouse pointer position. The second finding, from relatively informal, independent trials, indicates that disabled users prefer a head-operated device that has the characteristics of a joystick (a relative pointing device) to those of a mouse (an absolute pointing device).

Issues in augmentative and alternative communication in child psychiatry.

This article provided an introduction to AAC systems for children and adolescents with severe spoken-language disorders. Over the last decade, significant advances have been made in assessment and intervention approaches. For children with severe spoken communication disabilities, the AAC assessment is an ongoing process that includes information about the child's communication development, the child's environments, and the child's physical abilities. Children with severe disabilities who use AAC systems can demonstrate communication achievements far beyond traditional expectations. Recommended assessment and intervention practices are continuing to develop and the future is certainly optimistic for children with severe spoken-language disorders who may use AAC to communicate.

Communication aids for the speech impaired. Cost and quality-of-life outcomes of assessment programs provided by specialist Communication Aids Centers in the United Kingdom.

An evaluation was conducted of the approaches, costs, and quality-of-life outcomes associated with communication aid assessment programs for the speech-impaired provided by specialist Communication Aids Centres (CACs) in the United Kingdom. The average costs of CAC assessment programs was 410 pounds per client, which is not excessive. There was evidence of moderate quality-of-life benefits from clients' use of the recommended aids.

From alarm systems to smart houses.

The percentage of senior citizens in the Netherlands will rise in coming years. The expected percentage for the year 2010 of persons over age 65 in the total population is 15%. More persons over age 65 than ever before will continue to live in their own environment. Emergency response systems (ERS) can support independent living. The most common type of organization distributing ERS is a small, partly subsidized local alarm organization run by a social welfare office for the elderly. Government subsidy has been reduced in recent years which has motivated small organizations to join together into larger regional organizations in order to get a more solid financial base. On the other hand new semi-commercial and commercial organizations have come into being. These developments are part of the growing importance of home care, leading to more medical applications of ERS. User satisfaction with ERS is high. Portable triggers can enhance the effectiveness of the system. However, many users do not wear the portable trigger when feeling well. Future technical developments will result in multifunctionality of ERS-devices. In the long term the hardware of today will be integrated in a multimedia home terminal replacing the telephone. The portable trigger will remain the only specific hardware at home for ERS.