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Summary | I. Telephone Communication | II. Computer and Internet Access | III. Environmental Controls | IV. Independence SummaryMainstream wireless technology is expanding peoples' ability to communicate and work from any location without the constraint of a telephone cable or modem wire. Current and future wireless technology holds great promise for improving the lives of people with communication disabilities. To maximize the benefit of wireless technology to people who use Augmentative and Alternative Communication (AAC) devices, all mainstream capabilities should be built into or added on to AAC devices. Customer and manufacturer-focused research in the area of wireless communication capabilities indicates that significant improvements can be made to AAC devices in the area of wireless communication capabilities that will dramatically increase the capabilities and independence of the people who use these devices. The areas that require improvement are: [ Top of Page ] Telephone CommunicationsCell phones are part of wide area networks primarily supporting voice communication. As a person roams about, the communication link to their cell phone is transparently handed off from one base station (or group of base stations) to another. From the perspective of the cell phone user, it appears that they have a single, unbroken communication link. Cell phones that are able to access and utilize Internet resources have recently become available in the marketplace [1]. It is expected that in the future, cell phones adhering to the so-called 3G (3rd Generation) wireless cell phone standard will provide high quality voice communication and full Internet access (e.g. email, streaming audio and video, web browsing, file transfers etc). [2] Future AAC devices should integrate mobile phone capabilities directly into the device. As an interim step, AAC devices should be capable of being connected to existing mobile phones. Assistive Technology, developer of the Gemini, has incorporated a phone adapter into the hardware of the product. The phone feature controls must be able to be able to be operated by users with a variety of physical limitations. Description of the ProblemThe telephone is a critical communication link for all people. People with communications disorders who use augmentative and alternative communication (AAC) devices are currently have limited access to telephone communication. The most common method of using an AAC device with a telephone is to hold the handset next to the AAC device. This method is very cumbersome and inefficient. The sound quality for the AAC consumer's communication partner is extremely poor. There is also a severe loss in conversation continuity caused by the need to reposition the handset or speakerphone during the conversation. Some AAC devices have a phone port that the user must plug into. This type of system creates the need for third party intervention as well as the need for tethering. These limitations create the need for many people who use AAC devices to get assistance from a third party when making a telephone call. Two commonly used strategies are for the assistant to deliver a pre-determined message and for the assistant to act as an interpreter over the phone. Again, both of these methods are inefficient and severely restrict a person's ability to communicate over the telephone. Technology RequirementsCellular and digital mobile phones hold great promise for expanding the capabilities of people who use AAC devices. These phones wireless capabilities eliminate the need for the user to be "tethered" to phone line. This feature alone is of great benefit to people who are use wheelchairs. Cellular phones increase a person's security by proving a link to family, friends, or emergency services. Other improvements are needed to make these phones fully accessible to people with communication disabilities. The most pressing requirement is for the AAC device to operate as a cell phone. In the future, the AAC device should have the phone integrated into the hardware of the device. A near-term solution would be to allow the AAC device to interface with an "off-the-shelf" cell phone via an audio jack. With both an integrated cell phone and an add-on, it is critical that the AAC device user be able to control the functions of the phone in the same manner that he operates his AAC device in person-to-person conversations. The selection methods are discussed in detail in other sections of these proceedings but include; direct selection using a finger or head pointer, scanning using a switch, and numerous other methods. In addition to the standard audio communication, cell phones for use with AAC devices should have the ability to communicate with other cell phones through text messaging. This feature is becoming popular among mainstream digital phones. The text message service allows known as SMS (Short Message Service) allows messages of up to 160 characters to be sent between two digital phones or between an internet connected PC and a digital phone. [3] SMS equipped AAC devices or an AAC device equipped with an interface to an SMS equipped phone would be extremely useful to people who use these devices. This technology would improve private communication in group settings (i.e. noisy environments). In addition to the features described above, telephones for use with AAC devices also:
References
[ Top of Page ] Computer and Internet AccessThe personal computer (PC) and Internet access may be the greatest inventions ever for people with communication disabilities. Wireless standard should provide equal access to all the computers in the environment otherwise the person is still segregated from co-workers and may not have access to the best or most appropriate PC's/equipment. Wireless capabilities reduce the cost and "bother" of worksite accommodation. These tools allow people to break out of their physical limitations and increase work, educational, and recreational opportunities. Internet access enables remote education and employment, networking, information exchange, recreation, community involvement, etc. Personal computers allow for a new level of independence for all people. This is especially true for people with a range of physical disabilities. Description of the ProblemWhile personal computers and the Internet have opened up significant opportunities for people with communication disabilities, they still possess significant limitations. The primary limitation is the existence of bulky and inefficient cables and wires. These "hard wire" connections create a situation where the user is tethered to either the wall or a desktop personal computer. There have been some attempts to make PCs wireless with IRda and other connections but up until recently these connections have been slow and require a line-of sight connection with primary receiver or a repeater. New wireless technology such as WiFi (IEEE 802.11) and Bluetooth promise to expand wireless access to the Internet and computer peripherals (printers, scanners, displays, etc.). These two wireless standards have not yet gained universal acceptance but universities, libraries and some AAC manufacturers have begun to install them. Words+ products are PC based and support WiFi cards. Assistive Technology produces the Gemini that supports WiFi wireless LAN access. Technology RequirementsWireless computer network technology may be the next big breakthrough for people who use AAC devices. Wireless networks will eliminate the need for the user to be tethered to a desktop personal computer or a wall outlet. The ability to stay connected to the Internet while moving around will be a great benefit to people who use wheelchairs. It will be especially beneficial to people with communication disabilities that may use their computer as their primary communication tool. To fully take advantage of the emerging wireless networks, AAC devices should be compatible with this technology. There are two obvious solutions to this problem. First, the AAC device can have all the functions and features of a personal computer including networking and communication capabilities. Second, the AAC device can function as a "keyboard emulator" with a wireless link to a Personal Computer (PC) base station and utilize the PC's networking and communication capabilities. This second option may be preferable in the short run since very restrictive Medicare policies prohibit reimbursement for an AAC device that functions as a PC. While these policies greatly benefit companies that manufacture dedicated AAC devices, they greatly constrain the integration of AAC functions in ubiquitous PCs. Either option will significantly enhance a person who uses these devices ability to take advantage of mainstream wireless and Internet technologies. Consumers have identified a number of features that a wireless connection between AAC and a PC should possess. An improved AAC wireless link will incorporate the features listed below to meet the needs expressed by AAC stakeholders (Consumers, Manufacturers, and Researchers): Must allow the AAC device to synchronize automatically and wirelessly with the companion device (PC or other computer). Must be a universal protocol that enables the AAC user to access multiple PC's, public systems (e.g. library or other public computers), and computer peripherals (printers, scanners, etc.) with the AAC device as input device. In other words; the AAC user will be able to approach different private and public computers and log onto that computer with their AAC device.
While technology currently exists or is in development that performs many of these functions, there are a number of barriers to integrating them into AAC devices. The primary barrier is cost. This includes both development costs to the manufacturers and final costs to the consumers. As discussed in the marketing section of these proceedings, manufacturers of dedicated AAC devices are extremely small compared to mainstream computer-based product manufacturers. As a result, AAC manufacturers do not have a large research and development budget that they can for the primary development of wireless technology. It is critical to the successful integration of wireless technology into AAC devices that development kits and software are affordable for manufacturers. It is also important that the wireless standard is established before AAC manufacturers begin their development process. Small manufacturers fear a scenario where they choose the wrong protocol and their devices do not interface universally with companion devices (computers, etc.). The ultimate cost to consumers must also be considered when evaluating any new wireless technology for AAC devices. These devices are generally funded by reimbursement agencies (insurance, charity, or government). The Medicare reimbursement schedule is extremely complicated and is based on the functional features of the device. The maximum Medicare reimbursement for an AAC device is currently $6,475. [1] This amount is well within the current price range of laptops that actually have more computing power than AAC devices. The challenge is to develop the specialized hardware and software needed by this population and including a wireless link without pricing the devices above current levels, and to revise Medicare policies to approve PC-based AAC devices for reimbursement. References
[ Top of Page ] Environmental ControlsPeople who use Augmentative and Alternative Communication (AAC) devices have a wide range of physical conditions. A large portion of this population suffers from conditions that may impair or limit muscle control. This population would benefit greatly from a system that allows their AAC device to control their environment. Description of the ProblemEnvironmental controls have become such a part of everyday life that people have begun to take them for granted. The most commonly used environmental control is the television remote control. Other environmental controls such as garage door openers, thermostat temperature controls, and light and ceiling fan remote controls have become relatively common in high-end houses. In addition, ECU's could be used for door entrances, door intercoms, opening and closing blinds, etc. Attempts have been made to incorporate some environmental controls into AAC devices but their use is limited. This may be due to a number of factors including cost, lack of a standard system, or a lack or information on available technology. Mainstream technology such as X-10 has been developed that can perform environmental control and monitoring functions. X-10 is a power line carrier protocol that allows compatible devices throughout the home to communicate with each other via the existing 110V wiring in the house. Using X-10 it is possible to control lights and virtually any other electrical device from anywhere in the house with no additional wiring. [1] X-10 provides the user with an on-off function. Some AAC devices however have programmable and universal IR ports, by which the AAC user can control their environment (i.e. TV, radio, VCR, ECU). IR remote gives access to device functions not just on/off. Drawbacks of IR systems include the devices proprietary IR access codes where some IR receivers will only work with matched remote controls from manufacturers. Technology RequirementsMost AAC devices use embedded Windows-based operating systems. The operating system is modified to meet the performance specifications of the AAC device hardware and the language processing software. The most pressing need is for technology that will link the AAC device operating system to an environmental control unit. This link must be wireless and it must also be adaptable to a variety of input systems. The diversity of physical conditions that affect people who use AAC devices necessitates a system that can be modified by the user, personal assistant, or clinician. This adaptation to user needs is the critical link that will make mainstream environmental control technology assessable to people with a wide range of disabilities. Another key aspect of environmental controls that is important to people who use AAC devices is the ability for the device to "automatically" control the target device (light, stereo, thermostat, etc.). To perform this function, there must be a two-way wireless link between the AAC device and the device or system being controlled. The ideal system will "sense" the user presence or motion. For example when an AAC user moves into the living room the thermostat will adjust and the lights will turn on. This type of wireless link will also have applications in public services. An example of this is a system where the pedestrian crossing signal at an intersection will "sense" the approach and presence of a person with an AAC device and change the light to allow that person to cross. This type of system will eliminate the need to press the crosswalk button (a task that many people with motor impairments are unable to perform). An environmental control unit must have the capability to be programmed with the user's "profile". The profile will store personal information about the AAC user and their specific environmental control needs. Using the example listed above of a crossing signal; the "profile" would wirelessly "tell" the crossing signal that the AAC user need 30 seconds to safely cross the street. The "profile" would wirelessly transmit the specific needs of the AAC user to any environmental control that is "need" dependent. Consumers have identified a number of features for a wireless environmental control unit that can be operated through an AAC device. An improved AAC wireless link will incorporate the features listed below to meet the needs expressed by AAC stakeholders (Consumers, Manufacturers, and Researchers):
References
[ Top of Page ] IndependenceNew and improved wireless technology can open significant opportunities for people with disabilities. Many of these technology opportunities are discussed in the other sections of these proceedings. People who use AAC devices have other issues that can be addressed by linking new or improved wireless technology to their AAC device. Description of the ProblemWireless environmental controls address many home environment issues that concern people who use AAC devices. There are other independence related issues that cannot be solved by improved environmental controls units. When a person who uses an AAC device is outside the home there are many obstacles to total independence. While many people are able to overcome these obstacles, there are many ways that improved technology can make overcoming these obstacles easier. Automobile manufacturers have learned the value on integrating positioning and navigation systems into automobiles. Acura, General Motors, and Saab sell vehicles in the United States that are equipped with the OnStarT. OnStarT is a navigation and service system that combines the functions of a satellite global positioning system (GPS) with a cellular phone[1]. The OnStarT system has a safety feature that automatically notifies a dispatcher if an "unusual event" such as activation of an airbag occurs. The dispatcher contacts the driver to see if he needs assistance. If he does or there is no answer then the dispatcher contacts local emergency services and they send the appropriate aid to vehicles location. A system similar to OnStarT would be extremely useful to people who use AAC devices. Technology RequirementsA system similar to OnStarT holds great promise for enhancing the independence of people who use AAC devices. When used in combination with a mobility aid (wheelchair or scooter), it should provide location information to the person using the device. It should also provide navigation information (i.e. directions to the intended destination). It must also have a safety notification feature that contacts someone when an "unusual event" occurs (e.g. a wheelchair tips over or battery exhausts charge). This should work similar to the automobile based system. A system that integrates the features of a cellular phone and a GPS could also perform other tasks. These tasks include "proximity activation" of environmental controls. An example of this "proximity activation" would be a system (GPS triggered) that notified an environmental control unit (ECU) in the house as the person approached. The ECU would open the door, activate lights and provide related services for safety and convenience. This is just one example of how an integrated communication and navigation system will be able to increase the independence of people who use AAC devices. The OnStarT demonstrates that the technology exists to provide independence assistance to people who use Augmentative and Alternative Communication devices. The challenge is integrating this technology into AAC products. The most obvious obstacle to overcoming this challenge is cost. A system like OnStarT adds approximately 2000 dollars to the price of an automobile and that price is for a mass market product. The service charge for operating this system is between 199 and 399 dollars depending on the service options. Such costs are out of the range of most AAC users and the cost of such niche market products would be much higher. It is unlikely that reimbursement agencies will pay this price for this service. As this system and possibly other competing systems become more widely used, the cost should decrease. References
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