Assistive Technology and Neurodiversity
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Effectively using devices to support people with neurodiverse characteristics
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Assistive Technology and Neurodiversity
- 1. Tools for Independence Customizing Assistive Technology for Persons Who are Neurodiverse
- 63. Thank You!!! I Appreciate Your Interest
Notes de l'éditeur
- Assistive Technology (AT) has broadened choice and expanded independence for many people with disabilities. People who are Neuro-Diverse (who have brain injury, unusual brain chemistry, dementia, and other non-typical brain function) can also use AT to gain control over their lives. The key, as is the case with all AT supports, is to carefully match the support to the person by using the person's knowledge of themselves and the person's goals as the context for support. the focus is on the person, not the device.
- AT supports independence and choice for people with disabilities Focus on how a person processes information, not on the device Remember to include warranties, maintenance, and repair Always try out a device, so it doesn't end up in the closet We all use AT to help us negotiate our way through life
- From the AT Act: "The term `assistive technology device' means any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."
- Some Examples: Learning Disabilities There are a wide variety of information processing issues that are described as Learning Disabilities . They are typically identified in school, hence the label. They often involve difficulties in ignoring certain kinds of information, stably perceiving certain kinds of information, combining different kinds of information, or storing certain kinds of information. Dementia Although memory problems are the signature difficulty of dementia in most people's mind, almost any kind of information processing problem can occur. The striking problem with dementia is the progression of it. People with dementia can and do change dramatically in very short times. Substance Abuse Although SA is often thought of as a moral problem. both chronic use and withdrawal are, in the first place, brain problems. More than this obvious conclusion, SA and withdrawal alter the meaning that the abuser attributes to the world. State Dependent Meaning is a concept that helps us to understand this process of change in meaning that abusers experience. Imagine a laboratory rat given a small dose of sleeping medication, just enough to make the rat a little sedated. While the rat is affected by the drug, you teach the rat the difference between a triangle and a square. When the effect of the drug wears off, the rat will no longer remember the difference between the triangle and the square. If you give the rat the same dose of the same drug a couple of months later, the rat will suddenly remmber the difference between the square and the triangle. The memory is dependent on the chemical state of the brain at the time that the learning occurred. Mental Illness Severe mental illness symptoms are state dependent phenomena of the brain. Individuals with sevee mental illness try to adjust and alter the symptoms through their behavior. That is, like anyone else with a neuro-diverse or a neuro-typical brain, they try to adapt their experience of life to their goals and dreams. TBI As you might expect, brain injury can affect literally every aspect of human experience and behavior. Regardless of the source of a brain injury, there is a common problem where well learned and automatic behaviors are fragmented or distorted. Any behavior which we repeat becomes more and more automatic over time. Autism Although our society has become more aware of autism and the spectrum of autism experience, most people do not realize that the community of people with autism is the source of the concept of Neuro-Diversity. It is common for persons with autism to have difficulty managin certain sensory information, to have trouble with escalating anxiety, and to have narrow, but sometimes surprisingly skillful, development.
- IL Values: Civil Rights Consumerism De-Institutionalization De-Medicalization Self-Help Advocacy Barrier-Removal Consumer Control Peer Role Models Cross Disability Recovery Movement Values: Self-Direction Individualized and Person-Centered Empowerment Holistic Non-Linear Strengths-Based Peer Support Respect Responsibility Hope
- Try to understand how the person wants to accomplish their goal. Choose the simplest, cheapest, and nearest solution. Include warranties, maintenance, and training in your planning. Always, always, always, try out the device before buying. Be able to offer face to face support after the purchase.
- Use Cues to Trigger Behavior: Lists (including checklists) Shopping List Directions Steps to complete a task Visual Cues Color warning Posted reminder Photo Auditory Cues Word or phrase prompt Alarm Orienting sound Tactile (touch) cues Orienting cue to allow more effective auditory or visual cue Guiding touch Orient to safety support
- Placing photos on a phone so that the person can call someone by pressing the face. List of things to check before leaving the house placed at eye level on the inside of the door. Taking pictures (camera on a cell phone, or around the neck) during a day of activities and then going over them that evening. Skull and Crossbones sticker on things or appliances the person shouldn't touch. Use checklist that is actually checked to assure completion of important steps
- The key to supporting people with mild to moderate memory problems is the use of lists and cues. Early memory problems often show as difficulties recalling rather than a loss of a memory. Trying to trigger the retrieval by using another sense (even smell) or earlier or later information may trigger the memory.
- There are many, many devices for reminding people to take medication. They range from a few bucks to several hundred dollars. On the simple end are plastic containers that have labels for days of the week and time of day. You can typically pre-load them for a full week, and for 4-5 times per day. On the expensive end are devices that ring a bell when its time to take medications and only allow that particular dosage to be accessed. Some will transmit a signal or a text message to someone if the medication isn't taken within a certain time period. There are many in-between devices as well, and it is worth your while to pick a device that genuinely fits the individual's situation.
- There are a variety of such phones and a couple of different kinds are pictured in this handout. These devices are handy for anyone in an emergency. It is far easier when your hands are shaking to hit a large button that will dial 911 automatically than it is to hit little numbers. Also, smartphone often offer a feature of having a picture with contacts, and a simpler auto-dial mechanism when you hit the contact picture.
- There are numerous digital recorders at all price points. In addition, most smartphones have a voice recorder and memo player that can do the same things as these single purpose devices.
- Smartphone apps are, in many ways, the AT of the future. One of the car finder apps is the best selling app for Android phones (The developer is getting $13,000 a month from a $2.00 app). Spoken Turn by Turn directions driven by the GPS device in the phone make following directions easier.
- Another device that might have appeal to many people, especially driven, busy ones. There are many devices that do this kind of signaling, and there are automatic ones that attach to the tub or faucet. Also, more and more tubs are coming equipped with level shut-off devices.
- Remove visual distraction in a room, including pictures, busy wallpaper, and close curtains. Run a white noise generator at night to support sleep. Simply Noise is a web site where you can produce white noise to prevent distractions. Go to http://simplynoise.com/ to use. Remove or cover mirrors, deaden echoes with carpet or wall hangings When using a computer, simplify desktop, and reduce lights in room, to improve focus on screen. The image is from DarkRoom which fills your computer screen with a simple word processor. Go to http://they.misled.us/dark-room to download.
- Attention is a function that results from integrating all of the monitoring skills we have and the orienting capabilities of our senses. At the basic end, think of a light flashing off to one side of your head, or a sudden sound. You will automatically turn toward the stimulus. Attention functions on a continuum from very broad in scope, like the reaction to a sudden and new stimulus in the environment, to very narrow, when you are deeply involved in a television mystery, for example. People vary in terms of their "temperament" for attention, from a person who has severe Attention Deficit Disorder to a person with autism who can focus on changing lights for hours. In general, anxiety can both destroy attention and focus it on one single object or person or event. In the brain, there is only a certain amount of attention, just as there is only a certainly amount of energy generally, and when you run out of attention, you are in a state of fatigue. In order to restore your attention, you must rest. You can't work through brain fatigue.
- Alarm reminders: There are zillions of these devices. Choose one that is convenient and easy to use.
- Hand-held, computerized, sequence of task step pictures. The picture below is a step in a recipe. These kinds of apps will proliferate over the next few years for smart phones. There will be ones for many hobbies, complete with step pictures and videos.
- Recorded Reminders: This version is a smart phone app. Others are mentioned elsewhere in this handout. It records messages tied to a reminder time.
- Checklist (no more than 7-9 checks). Checklists are a generally useful tool for following steps. There is a current craze about them because the The Checklist Manifesto, a book you can check out at http://amzn.to/d07Xke .
- Social Supervision (the teacher presence effect on attention): The presence of another human being automatically improves task focus. Often, the attention and information processing abilities of married couples become automated and intertwined over time. If one spouse dies, information procesing deteriorates as well, and not just because of grief. It also declines because the well practiced ways of getting through the day no longer work.
- Using pictures to label rooms in a house: Labels are easy to print off the internet. You can use both text and picture together as well. For a person's room, you can use a printed photo. Putting transparent acrylic doors on cabinets: The picture below is pretty classy, but transparent acrylic works as well. Using a turn by turn GPS device: With the advent of GPS in cell phones, a wide variety of possibilities can be included in any smart phone. The picture contains two versions of turn by turn directions in an Android smart phone.
- Orientation in humans is a complex process of grasping the meaning of context. It isn't simply knowing where you are, but also knowing how you related to the objects and people in your immediate environment, and knowing how your context will help or hinder you in getting where you want to go (both geographically and socially). Our brains use internal monitoring to constantly update our understanding of our internal and external context. Problems in Orientation often arise from failure of these monitoring skills. irections are never a perfect replica of the journey we are to take. Instead, they are highlights that for one reason or another are easy to sense. We follow directions by moving from one highlight to the next. If we get confused we don't figure our our absolute position (or at least we didn't until GPS devices became so common). Instead we retrace our steps and look for a recognizable highlight to re-orient our selves. Anxiety has a powerful effect on confusion and disorientation. In fact, anxiety can create a sense of disorientation even when there is no failure to recognize or interpret cues.
- GPS devices: There are many GPS devices besides smart phones. The device below is intended to be used at the spot you want to return to. It records your trip and can tell you whether you are getting closer to your final destination.
- Use of curtains or carpets to deaden sounds: Sound deadening is a commercially viable enterprise, so there are many different versions and types on the internet. Watch those installation costs!
- Transparent shower curtains in a well lit bathroom: There are some choices here as well. This one seemed like the best of both worlds, but there are other designs.
- Motion detectors that, for example, turn lights on and off. There are also a wide variety of motion detector sysems, varying in complexity, from ones that turn on lights outside when a dog goes by, to ones that speak a specific recorded message when movement occurs. They can also be used in the house with different messages or actions when triggered.
- Universal remote for entertainment devices: A lot of these as well. This one has big buttons and can sit on a table and not move.
- Have lights turn on automatically when it is dark or the person moves from room to room, or goes outside. The picture is from the Helios system that will turn lights on and off as the person moves in and out of rooms, as well as other environmental control tasks. Use web cam to check on person each morning (be respectful of privacy!) The picture is from a webcam called "Watching Paint Dry". It has accompanying Music. There are webcams everywhere these days. Check out the current weather in Lansing by webcam at http://www.instacam.com/showcam.asp?id=LNSMG&size=S Build relationships with neighbors: If neighbors know you they'll watch out for you. Try a backyard barbecue as a friend starter. Have dog for companionship and protection. The more the merrier. A neighbor can walk.
- Personal safety is at the core of personal independence. However. it is more important to personal freedom to choose how safety will be addressed in one's life than it is to be "made" safe by segregation or restriction. The focus here, as in all use of AT, is personal choice. Bathrooms can be dangerous because of hot water and slippery surfaces. There is also the possibility of eating non-food substances. Kitchens have heated surfaces and foods, glass objects, hot water, knives, and other hazards. Shadow common daily activities and look for risky behavior and hazards. Chores are a common source of injury.
- PERS: There are many types. If you push the button, it signals someone or a busiess to check on you. Some allow you to transmit speech as well.
- Ablelink style communication, alarm system" Ablelink creates software that allows for many of the functional supports described in various parts of this handout to be done on a desktop or handheld computer or smart phone. The software is expensive and you have to have the device, but the software is quite remarkable. Go to http://www.ablelinktech.com/ for more information.
- Door opening alarms: There are an awful lot of door alarms. I would look for price points and convenience.
- Water control devices: Pictured here is a water level control device built into the bathtub. There are wands that attach to faucets, and a host of other devices.
- Temperature indicators: Here is a cute one that has a digital readout. There are many types of these, some that change color.
- Fall detection sensors: There are many types of these. This particular one is for the iPhone. Because smart phones contain accelerometers and GPS devices, they can be remarkably good at detecting falls. The future of fall detection.
- Combine music and meditation Eat regularly to avoid blood sugar issues Avoid alcohol, caffeine, drugs Stop daily activities at least 2 hours before typical sleep time, and shift to low energy. Hi-Ho, Hi-Ho, it's off to sleep we go!!
- Sleep is the single most important variable in mood, symptoms of mental disabilities, energy level, and general quality of life. Time and effort invested in assuring high quality sleep is never wasted and will reduce the number of interventions that need to be made in other parts of the person's life. Stress is different than variety. Good living requires variety in stimulation and activities. A person should typically be alert and ready to do an activity if the opportunity comes up. If heart rate is rising, shaking hands, anxiety, the person is under stress. If "couch potato" syndrome, person is trying to recover from stress. Changes in your basic energy and activity level are normal up to a point. Sometimes, though, the volume is too high or low for long periods. Medication should be examined, but avoid use of anti-psychotics for agitation. The use of these drugs is dangerous in older people, and is typically done because it is easy. But, these drugs literally remove meaning from life, and make it more difficult to appreciate positive and negative experiences. Look for another way. Demystify hallucinations. Everyone has them eventually, many people when they were children. Tell the person that hallucinations are not dangerous. The anxiety that hallucinations often trigger both in the person have them and people around that person cause more disorientation and loss of the sense of control than the hallucination. There is an International Society of People who hear voices, and put up with stigma and discrimination as a result.
- iPod: and the many, many other devices that can play music, newscasts, videos, short movies and long ones-You name it. Whatever works for you.
- Smartphone: The newer smartphones can do all of the iPod things, and I expect to see more and more relaxation apps in the near future.
- Exercise machine: Exercise is necessary, necessary, necessary. Just adjust the approach to the person's functional abilities. Ask a PT or an OT for advice.
- Reminder for short meditation/breathing exercise every hour: Any device will do as long as it can handle a number of alarms. Some will tell you what to do. You can 3 of one kind of activity, 4 of another, and so on.
- Over time, you will build up ways that AT fits into a person's life. As you do this, you will find that having many devices for many different purposes doesn't work. It becomes time for the person and you to look at broader solutions. Also, each experience of support and independence teaches it's own personal lessons about what works and what doesn't. Record the lessons.
- Ablelink video-Use of technology to support a number of processing problems at once.
- Computer control over home environment: You can hookup anything electric to a common control system and change everything at once instead of going around the house trying to change individual items. There are sensors for everything, and they can all be linked to your computer.
- Remote control over computer: A relatively simple way to make use of a computer in a person's home is to use G-Bridge to connect your computer with theirs, and use wireless web cams to monitor doors or areas where a fall might occur. There are also systems that tie GPS to the internet so that you can track a person's movements if they have the device on their belt or around their neck.
- Obviously, there is a great deal more to learn about AT than I could provide today. The rest of this presentation will point you toward that larger world of information and support.
- JAN originally developed to help employers figure out what accommodations to use to support employees with disabilities. the network has focused a lot of energy on AT, and is generally helpful with developing an AT strategy.
- The ultimate directory of devices, Abledata now contains over 19,000 device descriptions. When you want to see the variety of options available.
- Operated by United Cerebral Palsy of Michigan, the loan funds offer lower interest rates, and more flexible terms for devices that increase personal independence for persons with disabilities, including children. There is no bottom limit on loans, and the top is $30,000.
- MDRC has operated the Michigan AT project since 1997, and the Project includes many more activities than I can discuss today. You should visit and get a better grasp of the local projects, newsletters, and resources that the AT Project has created and maintains.
- ATX is a "classifieds" web site for used AT equipment, some free, some at low cost. Once you create an account, you can trade, buy, or sell.
- MPAS helps with information and advocacy around AT rights issues, and is a partner of MDRC in our AT Act activities.
- The Center provides AT solutions for the entire Upper Peninsula of Michigan, and UCP and the Center are partners in our AT Act Activities.
- A list of all State AT projects and all their activities. A good resource when you can't find an answer in Michigan.
- A resource for professional information nationally. Find an assessment professional or learn how to build a career in Assistive Technology.
- A good starting point for making any home livable by a person of any age who has a disability, and the first step to staying out of a nursing home.
- Information and resources for school and home support of independence by children with disabilities.
- I have served as Director of MDRC since 1997. Before that I worked in a wide variety of environments-schools, medical clinics, State Councils, substance abuse programs, and I worked for 13 years at Michigan Protection and Advocacy. I am married to Goddess Jill, and have a daughter, Loree, and a grandson, Nevin. We also have 3 dogs, Wrigley, Jersey, and Ferd.
- AT supports independence and choice for people with disabilities Focus on how a person processes information, not on the device Remember to include warranties, maintenance, and repair Always try out a device, so it doesn't end up in the closet We all use AT to help us negotiate our way through life
- Chris Firth has written a superb and dryly amusing description of how our brains make the world we experience and in which we live. The new imaging technique of functional MRI has allowed neuropsychologists to see the brain doing stuff in real time, and what these experiments reveal is startling and "brain-changing". UDL isn't just for schools anymore. The basics of UDL are useful in any AT activity, allowing easier brain process for everyone. Worth a look, and the videos are easy to watch. At the price ($14.00 on Amazon), the best and most accessible introduction to AT and decision making I've seen. Worth keeping around, as well, since it is a good reference. The best way to solve a problem is to never have one. This book needs a DIY person, but has many ideas for making it easier to live in the home you have. Stuffed with ideas. From our Veterans Home Care program, a one stop site for devices broken out by general cognitive support purpose. A good place to check befoe going into Abledata's massive directory.
- I am Norm DeLisle, the Director of Michigan Disability Rights Coalition. "With Liberty and Access for All" is our motto, and :Feisty and Non-Compliant" is our attitude. The funny looking square in the lower right is a QR code, like a barcode, only it can hold more info. If you have a smart phone, you can use a bar code scanner app and your phone's camera to find out what info is stored there. Social Networking (SN) is the general term for our communication with one another on the Internet. SN has exploded in popularity over the last few years, and it represents an important set of tools for our advocacy and our recovery.