Forum Proceedings

Market Needs | Current Technology | Needed Technology | Barriers to Achieving Needed Technology | References

The following is the raw data collected during the T²RERC's Stakeholder Forum. It reflects the comments and needs as expressed by the forum participants.

1. Needs (Unmet needs of consumers, clinicians, etc.)

• AAC devices need the ability to quickly access (i.e. file transfers, use of PC applications, etc.) any Personal Computer under multiple conditions. This includes the ability to be able to compose on AAC device and transfer file to PC for storage, printing, etc.
• A consumer at the forum uses five different computers at work. She currently can't access all of them. Each one must be set-up separately. This limits her productivity.
• AAC users need to be able to communicate with all public computers (e.g. library).
• Need wireless control of household items (e.g. doors, drapery openers and closers).
• Need communication link that functions more like TV remote control but is not directionally sensitive. It should have good range, the ability to turn TV and other appliances on and off. It should not need separate communication protocols for different devices.
• Need wireless controls to perform complex tasks - beyond simple ON/OFF functions.
• Need wireless communication that can communicate with devices (e.g. PC, TV, stereo.) throughout the environment. Need wireless access to Kiosks (e.g. ATMs, ect). This access must be secure for all functions (especially for financial and other sensitive transactions).
• Need to be able to customize wireless preference profiles to the user and their environment. (e.g. At 8PM at home, AAC device wirelessly communicates with the drapes to close and outdoor light to turn on.) · Need personalization of device based on profile of person. You call on the device functions when you need them to work at that moment. (e.g. Similar to profile on Yahoo, AOL or other internet portals).
• AAC device should be able to wirelessly control and start PC. The mechanical ON/OFF switch is not a good option.
• Need wireless Email access on the AAC device. Email received and edited on AAC device.
• Need improved software to allow computer to function as an AAC device.
• Most AAC users outside of their own house have no access to phones. AAC users need cellular phones and/or internet based phone capabilities through their AAC devices.
• There is a need for wireless phone access and wireless data transmission through a PC.
• Need communication capabilities indoors and outdoors.
• Need wireless control of outside environment. (e.g. Traffic signals and crosswalks that can receive input from AAC devices).
• Need system that can interact with environment in multiple rooms.
• AAC should recognize when it should activate (different types of doors) /proximity detection. Need wireless communication to signal proximity (e.g. University of Long Beach has a water fountain that "turns on" as people get close, elevators, car doors, .)
• Need wireless communication link to PC to be much more reliable than current systems. (e.g. One user wanted to compose with AAC software on their device and upload text for storage and printing on their PC. The communication link failed 90% of the time - so they composed on PC with pencil and keyboard strokes.)
• Need wireless link to set up quickly and transparently. (People cannot take the time to troubleshoot a device that does not work.)
• Need wireless communication hardware to be aesthetically acceptable. Many devices are cumbersome and stigmatizing).
• Need wireless "way finding" or navigation aids to help locate ideal route and open doors when necessary.
• AAC device used as a keyboard emulator must have all functions (e.g."alt","del" keys and other "smart" keys such as a single key browser launcher).
• When wireless communication is involved, privacy must be respected especially when not under user control. User must be able to determine who has access to their information.
• Consumers are concerned that people will have access to their communication without the consumer's knowledge/approval. Consumers privacy must be respected by everyone (even by well meaning clinicians/care givers)
• Need to be able to have phone conversation "privately" (one user has to use speaker phone, increases volume on his device). Need wireless ear level receiver (headset) (Sound signal from AAC device). AAC device would produce "voice" with speech synthesizer.

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2. State-of-the-Practice (current technology, strengths, weaknesses, etc.)

• A consumer has an AAC device that can operate TV and computer. It has the capability to transfer files and data from AAC device to the computer via IrDA(Infrared).
• Most Environmental Control Units (ECUs) currently use IrDA.
• Older versions of AAC devices had the processing functions in a PC (ie. an AAC emulator program) and the input functions with user via a keyboard. This did not work well because it tethered the user to the PC.
• Currently available AAC devices are compatible with older PC operating systems (Windows 98 and earlier). Some cannot communicate with newer PC's operating system A system is needed that works with all current and future PC's operating systems.
• It is difficult for consumers to make cable connection to PC. Cables are difficult to access and require a high level of manual dexterity.
• When AAC device is used to access PC, it is sometimes difficult to view monitor content.
• If PC and AAC device are too close or not the right angle, IR communication may not work. The angle of approach with IR controlled items is an issue.
• Florescent lighting can interfere with IR communication.
• AAC device not only used in apartment but outside as well. IrDA communication does not work outside in sunlight.
• Some AAC devices are effective as controls. One consumer uses device for TV channel changing when husband has the remote control(the AAC device overrides the TV remote).
• Interference may be a problem. An AAC user accidentally opened an automatic garage door.
• Existing environmental control units (ECU) ("Ezra" - brand name mentioned) opens front doors, switch manually activated, person has to be near switch.
• AAC device has to be programmed, when you get a new VCR or any other device. Need wireless control that programs automatically or "recognizes" device.
• ECU's that perform simple switch functions (ON/OFF) work well. More complex functions do not work as well.
• Personal Digital Assistants (PDAs) (e.g.Palm Pilots) are available with wireless capabilities, Internet and email access and editing/word processing - everything users need on AAC device.
• Some AAC devices have IR connections(Both IrDA Data and IrDA Control). Other wireless connections are less common.
• Other wireless connections are available in a limited basis via WiFi (eg. Gemini manufactured by Assistive Technology Inc.)
• Ericsson initiated Bluetooth protocol in 1994. Bluetooth involves radio frequency connection and has range limitations (currently up to ten meters). Bluetooth is "like a piece of invisible wire and users need to have protocol to access to that wire." Bluetooth has range limitations (currently up to 10 meters) and bandwidth limitations.
• Other forms of wireless links between AAC device and computers may appropriate instead of (or in addition to) Bluetooth (e.g. 802.11/WiFi).
• Future versions of Bluetooth technology should have a 100 meter range.
• Body area networks are being developed. These computer systems interface directly with the body.(e.g. Fabric Area Network (FAN) ) and could have some applications in the area of AAC.
• Most AAC devices currently do not have printing capabilities Wireless access to printers is already available for mainstream technology (e.g. IrDA, RF, Bluetooth). It is just a matter of equipping the AAC devices with the correct interface.
• Some AAC devices have reliability issues. This could impede wireless integration if they are always "breaking down." (i.e. Adding new technology to a system that is already unreliable)
• Radio Frequency (RF) has potential but there may be security problems, proprietary problems, etc. There is no common standard for RF worldwide. AAC companies will be very cautious moving forward with this technology.
• Laser networks are being developed and may be future alternative to RF transmission. These systems also have limitations (e.g. line-of-sight limitations).
• IrDA is primarily used for data transfer between devices (e.g. PC and PDA). IrDA does not support voice transmissions.
• IrDA is short range (approximately 3 ft) and limited to line-of-sight(transmitter and receiver must align with-in 15 degrees).
• An AAC user reported that he had difficulties transmitting large amounts of data using the currently available IrDAwireless systems.
• Some AAC devices use IrDA to operate the television in the same way that a remote control does.
• Current IrDA has limited range (approximately 3 feet). A repeater can be used to increase this range but the repeater also requires line of sight.
• Radio signals(RF noise) does not interfere with IrDA functions.
• X-10 home automation (RF) products are available to turn on lights, television, etc. X-10 kits are available at a relatively low cost. One forum participant reported that he was able to purchase an introductory package for six dollars through the X-10 website. The package included transmitter, module, program and remote control.
• Using current PCMCIA technology (LAN card) / PC's can be set up to operate environmental controls wirelessly. There is a need for similar technology to allow AAC devices to have the same capability.
• Software available for some ECUs allow users to operate devices via an illustration of a remote control on the PC. A consumer states that this feature is easy to use.
• Professional care providers and therapists may not be trained or permitted (by contract) to install or program ECU for AAC users. There is a need for technological support for AAC users in setting up an ECU.
• Many AAC consumers have had negative experiences with current wireless PC connections (costly, difficult to set up, poor performance). These consumers may be reluctant to accept new wireless technologies.
• Current wireless technologies may work with a PC but "all" computers still must be turned on physically(i.e. You must push a button somewhere on the computer "box)
• For the consumers, the functions and performance of the technology are more important "type" of technology. In other words, consumers are more concerned about what the technology does and not how it does it. The "MedAlert" system was used as an example. This system was popularized by a television commercials featuring a woman who falls and says "I've fallen and can't get up". Consumers don't know how this system works but they do know that it performs a useful function. The AAC user should not be tethered to the computer. A wireless link between the AAC device and PC will allow the user to multi-task and expand their capabilities. · Infrared data transmission is extremely draining on batteries (e.g. The Pathfinder AAC device operates 8-10 hours on a "normal day but only 5-6 hours when using Infrared.). There is a need for a wireless connection between the AAC device and other applications that does not drain the power source. Without a "less draining" power source, AAC devices will need a improved power source (battery)
• AAC users must now hold the phone next to the speaker on the AAC device. This creates excess noise and unclear phone communication. There is a need for a direct connection between the AAC device and a phone (e.g. Output jack on an AAC device that can be connected to input jack on a telephone).
• Infrared transmissions (IrDA data and IrDA control) have been improving (e.g. data transfer rate is getting faster)
• A variety of Radio Frequency transmission (X-10, Bluetooth, WiFi, etc.) have become more available for mainstream products.
• Currently available cellular phones have the following features that may have AAC device applications:
• Phones can be dialed manually or through voice activation.
• Have an "instant messenger" or text message feature
• Can have GPS or other locating systems incorporated within them.
• Cellular networks are currently more available than LAN networks.
• Most AAC device software runs in Windows environment. Capabilities of current AAC device platforms (Windows/Windows CE) are not being fully used because of manufacturer-imposed limitations. (i.e. Certain Windows functions are disabled by AAC manufacturers)
• Physical access to power switches (ON/OFF and RESET buttons) is difficult and varies from PC to PC. This poses a unique barrier to AAC consumers.

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3. Needed Technology (refinements, innovations, etc.)

• Consumers must be able to remotely reset computer when it crashes from the AAC device. (It cannot be done now).
• A wireless protocol (e.g. Bluetooth, WiFi etc.) would be useful for wireless upload from medical monitoring devices. Nurses and other caregivers could transmit via wireless link information (e.g. blood pressure, EKG, etc.) to doctors for interpretation/diagnosis.
• AAC device must be customized to the user (e.g. person with cognitive disability would be able to access and operate complicated task such as transactions at an ATM)
• Unreliable AAC devices create unique problems for the users. Any new technology must not reduce reliability.
• The AAC device with wireless link should interact with other targeted devices (e.g. light signal, television, pc).
• The AAC wireless link must not or interfere inappropriately with other devices. Especially medical devices (e.g. respirators, pace makers)
• The AAC device wireless link will have universal applications and interoperability (e.g. it should transmit voice, data, and control signals)
• The wireless AAC technology will have the capability of proximity notification to other devices and visa versa (e.g. light signal detects user crossing street)
• The wireless technology will be universally operable by all levels of users (e.g. work with users at all ability and cognitive levels).
• The wireless AAC technology should not be affected by environmental factors (e.g. fluorescent lighting, sunlight, radio interference).
• The wireless AAC technology will be less visible than current products (e.g. wireless optical "head pointer")
• New devices must comply with Federal Government Medicaid rulings.
• The wireless AAC technology must have sufficient bandwidth to interface with the internet and download data quickly and efficiently.
• The accepted wireless standard must not significantly increase the cost of AAC devices.
• The wireless technology must be adaptable and interface with current technology and software.
• New wireless technology must not be extremely complicated to install or operate.
• Headsets that are wireless and multifunctional (i.e. work with phone, PC, etc.) would be extremely useful for AAC users.
• Eye tracking technology has good potential for AAC device input but the user must be at the proper angle to engage and disengage the system.
• Connection and communication between AAC device and PC needs to simplified and universal (e.g. backing up data is difficult because you have to set up protocol, connect to the pc, etc.)
• There is a need for AAC devices to synchronize communication protocol automatically and wirelessly (e.g. work with PC's at school and at home effortlessly).
• There is a need to standardize connection protocol between AAC devices and all types, models and versions of computers software and hardware. Currently users have to "learn" how to operate/adapt to the different computers (e.g. AAC users have to set their device to work with computer)
• There is a need for wireless recharging of the batteries/power source in AAC devices. [e.g. Electric toothbrushes on the market have wireless recharging -Sonicare Toothbrush (i.e. inductive charging)]
• There is a need for AAC devices to operate as a cell phones (e.g. either integrated within the device or with a jack that can plug into the device). This is a safety issue as well. (AAC user was stuck in the snow and tried to use a standard cell phone but dropped it and lost it)
• Cell phone use is free for emergency services. This service could be expanded for the AAC community to provide basic services.
• Many cell phones are small, difficult to dial, have to be mounted on AAC, etc. AAC users must have it integrated into their device to make it useable.
• There is a need for a software standard to allow AAC device to operate directly as a phone.
• Cell phone integration with AAC devices will allow direct text messaging with users of mainstream technology such as a PDA or text-equipped cell phone.
• Wireless AAC technology should have the following features:
  • Should incorporate a wireless telephone connection and communication either internally or through the internet.
  • Should incorporate wireless environmental control
  • Should incorporate a locating and positioning system (i.e. GPS)
  • Should allow remote operation of computers.
  • Should operate throughout the waking day -16 hours.
  • Should not drain the power source (battery)
  • Should be universal and self configuring so that any AAC device can used with any PC
  • Should be compatible with all hardware attachments and software applications (e.g. Windows CE, Mac OS, and Palm OS)
• AAC products need to have standard operating system in place to allow for a more universal interface with other devices.
• A wireless interface between AAC device and a cell phone (e.g. Bluetooth) may eliminate some of the current limitations.
• Some AAC users want Internet and computer access via cell phone, mobile internet is cost prohibitive and slow at present.
• AAC devices should allow the user to access their home computer and environmental controls remotely through the Internet. (e.g. They could log-in to their home PC and turn the air conditioning on before they get home).
• Direct Internet access through the AAC device is a service that some consumers desire. This eliminates the need for a separate PC.
• Any wireless communication link must be secure to protect the privacy of the user.

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4. Barriers (to obtaining technology, to developing technology, etc.)

• Incorporating Bluetooth hardware (e.g. chips) in AAC devices is perceived as cost prohibitive for manufacturers/developers in this industry. AAC manufacturers would only need small quantities. Producing small quantities of chips significantly increases the cost to purchaser.
• Other competing standard wireless technologies are being introduced along with Bluetooth (e.g. 802.11/WiFi). Companies are concerned about which alternative may end up as the accepted standard technology. They only want to invest in developing a technology that is ultimately widely accepted.
• Mainstream technology companies are sometimes slow to integrate accessibility features in their products. (It took Microsoft 6-10 years to make software (Windows, Office Suite) compatible with AAC software features such as sticky keys and emulators
• Security and privacy are concerns for AAC users when using wireless technology. This issue is not unique to the AAC community or to wireless technology.
• AAC developers and manufacturers have difficulty keeping pace with the emerging and changing technologies.
• As Bluetooth (or competing wireless standard) becomes available, older AAC devices and companion devices (e.g. PC) will require some type of "conversion kit" to make them compatible. Funding limitations will not allow users and reimbursement agency to replace old devices just to make them compatible.
• The relatively small size of the AT industry limits its purchasing power (of chip sets). Large volume manufacturers will have priority when ordering chip sets. This will continue to be a problem as long as chip set supply is limited.
• Limitations to coverage areas of mobile phones will effect system performance limitations. They may only operate within certain "cells" and may not work in buildings or outside of primary coverage area.
• Wireless phones are also prohibited in certain areas or buildings (e.g. hospitals, airplanes) · Cell phone charges and subscription costs may be a barrier to accessibility. If it is a part of the device will it be reimbursed by payment agencies?
• All cellular phones require a service provider. This may limit the availability and affordability of service. Wireless phone service is not available in some rural areas at this time.
• The phone and service must be digital to allow for text messaging.
• There is a question of whether inclusion of a cellular phone into an AAC device would change the regulatory requirements of the AAC device and the phone. (i.e. Would this make the cell phone a medical device?)
• AAC product manufacturers may not be exploiting the full capabilities of currently available (mainstream) technologies because they lack the resources to invest in full range of development kits.
• Some AAC manufacturers have expressed a hesitancy to share development information with mainstream software companies (e.g. Microsoft). Partnering as early and open as possible only way this will succeed.
• Barriers include a reluctance by some consumers and practitioners to accept new technology and a lack of knowledge on how to operate it.

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5. Carriers

• The formulation of a buying group or conglomeration of companies in the AT industry (e.g. an industry group such as CAMA or ATIA) would enable the industry to compete/purchase hardware (chips) in high enough quantities to reduce costs via volume discounts.
• Cooperative Bluetooth Special Interest Group (SIG) for Assistive Technology(AT) may help solve some of the development cost issues. An AT SIG would work in partnership other industry SIGs to share costs. With wireless integration standards in AT industry, manufacturers would have the ability to exchange innovations, ideas and technologies through the SIG.
• AT industry should collaborate with other industries (e.g. Geriatric, medical, and "mainstream consumer")to be competitive and offer innovative technology.
• The federal government has recently emphasized Universal Design and Assistive Technology(e.g. Freedom Initiative). They are funding research in these areas. Section 508 in the Rehabilitation Act will be tremendous impetus for mainstream manufacturers to partner with Assistive Technology manufacturers)
• As of June 21st (2001) all new procurements by government agencies (and government funded agencies) must adhere to accessibility provisions of Section 508. [1]
• Cellular phones and other forms of mobile communication are increasing in their capability to provide positioning and locating service. This may benefit AAC users, especially if cell phones are integrated into AAC devices.
• Wireless hardware prices will drop when large volume manufacturers (e.g. Toshiba, Panasonic, Ericsson) begin production and sale of standardized wireless compatible products.
• AAC developers and manufacturers can merge their efforts with research centers (e.g. universities) to develop (or choose) wireless standard for AAC devices and integrate this standard into the AAC devices.
• AAC developers and manufacturers will benefit when a universal wireless standard is finalized. Developers could adapt technology to AAC devices. Current AAC developers could integrate "off the shelf" wireless technology to AAC devices.
• Coverage areas of cellular or wireless phones are increasing with newer technologies.
• Mainstream products are increasingly using "AT-Type" applications (e.g. Voice recognition etc.).
• Internet connection through AAC device, solves cell phone problem. If the user can access an Internet based phone service (eg. "Net-to Phone") they will not need a separate cell phone.
• AAC users are "accustomed to" text type messaging.

References

1. FirstGov. "Section 508. The Road to Accessibility." [Online: http://www.section508.gov]

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