Everybody is an individual. It is quite a concept to contemplate, that on a planet of nearly seven billion people no two individuals are exactly the same. So, when the unthinkable happens and one of that seven billion sustains a brain injury it would be, I suggest, fair to say the needs of that individual will be truly unique.
Working as an Assistive Technologist for the past 26 years I have learned that supporting an individual with an acquired brain injury is in part a complex tapestry made up of input from numerous professions and disciplines and factors including (but by no means limited to) the impact of the injury, personal and family goals, personal characteristics, immediate environment, all of which influence the development of a bespoke, person centred approach that can meet the needs of the individual as they recover, rehabilitate, and adapt to their new lives.
In many instances that approach will include the provision and use of Assistive Technology. Assistive Technology as defined by the Word Health Organisation (WHO)
Assistive technology enables people to live healthy, productive, independent, and dignified lives, and to participate in education, the labour market and civic life. Assistive technology reduces the need for formal health and support services, long-term care, and the work of caregivers.
In the case of a brain injury and depending on when an individual was injured, Assistive technology can be used to restore function, to enable a child to participate in activities that they were able to before their injury, or help a child to develop function, use appropriate assistive technologies to learn how to do the things they wish and need to do as they grow up.
Assistive Technology can be used in numerous ways for numerous reasons. The assistive technology spectrum can be used to help individuals with physical sensory or cognitive impairments (in the case of a brain injury it can often be all three) enabling them to overcome the challenges they face post injury.
Common applications of Assistive Technology in the realms of brain injury can include:
Augmentative and Alternative Communication (AAC) technologies. Electronic and software based devices can give a voice to a child who has lost the capacity to speak or who wishes to learn how to speak.
Environmental Control Technologies (ECT) can help a child to interact with their immediate home environment (open windows, turn on lights operate their TV etc.) even if they do not have the physical capacity to do so.
Walking aids, manual wheelchairs, and powered wheelchairs can restore or bestow independent mobility.
Today there are myriad Assistive Technologies available designed to enable a child to independently access ICT, a computer, smartphone, or tablet device, with many of the accessibility tools built into the devices’ operating systems.
Access tools including switches, specialist keyboards, mice and pointing devices including eye tracking technologies can enable even the most physically and cognitively challenged child to interact with technology at home and in the classroom.
Specialist software can help a child type more efficiently to complete class-based activities or homework, it is possible for a child to speak directly to a computer and through voice recognition technology to have their words appear on screen.
Assistive Technologies can also be used to open up the world of gaming and social media to children who are otherwise unable to participate in these activities. As we all know all work and no play…
Other software packages and apps can help a child with a severe cognitive impairment develop cause and effect and turn taking skills and to develop numeracy and literacy skills.
More recently, apps and programmes have been developed to help young people with challenges they may face with their memory or their management of emotions and moods, especially when transitioning, for example between schools, to college and possibly employment.
These are just a few examples of assistive technologies available currently and the list of products and solutions is growing by the day.
A full understanding of the range of Assistive Technologies currently available and in the pipeline is far beyond the capacity of this article (and the author, most probably).
Perhaps it would better to give an example of a practical application of Assistive Technology for a specific issue and a specific child.
Ruby (not her real name) was injured when she was struck by a car. She sustained numerous physical injuries and a traumatic brain injury.
Following her recovery and a period of rehabilitation, Ruby wished to return to the family home to live with her parents and brother.
In this instance I was asked to assess Ruby as her old family home did not meet her needs and she was moving into a new home. It was her and her families’ desire that Ruby’s home was to be as accessible as possible.
Ruby is unable to stand and walk, she has little movement in her right arm and hand and her left hand and arm is stiff and difficult to move. Ruby has a mild cognitive impairment, and she finds to difficult to speak and be heard.
What we decided was to source and install technologies that worked in combination with the existing Assistive Technologies already being used by Ruby.
Ruby has a powered wheelchair to help her move around independently. Ruby is able to drive her powered wheelchair with her left hand, she can steer her wheelchair, adjust her seat height and backrest position using her wheelchair joystick.
Ruby has access to a tablet with a rugged case in the event that it is dropped. Her tablet is equipped with apps that assist Ruby, including one which she can use to talk when people are unable to understand her.
When considering how she would interact with and control her home environment We needed to ensure that Ruby’s existing technology and the skills she had already put so much effort into acquiring were not lost. As is often the case one size does not fit all and in the Assistive Technology world one supplier cannot fully meet the needs of a diverse population with equally diverse needs.
What we settled on was a hybrid system that allowed Ruby to use her wheelchair and tablet as controllers and using them she was able to open and close her doors to turn on her lights and to control her home entertainment equipment.
In addition, we decided to investigate if Ruby’s speech was potentially clear enough for her to benefit from using her voice (as smart speakers can offer cost effective and easy to use solutions) to control her environment. Ruby was provided with a Google home smart speaker and the technology was linked to her environmental control.
Ruby was found to be able operate the speaker with some success, but her speech was sometimes too slow and indistinct to operate the device and it was not considered to be a reliable alternative to her existing controls.
However, all is not lost as Ruby is now exploring two potential solutions to help her overcome the challenges she faces. Solution one is an app that uses artificial intelligence to translate what Ruby says and then output a voice command that a standard smart speaker can understand.
The second is a newly developed smart speaker that can learn to accommodate differences in the user’s speech including the volume and the rate at which words are spoken.
Ruby and her family are still on their journey to enable Ruby to live as independent life as she is able to, but we can say for this particular individual it is certain that Assistive Technology will play a part in helping Ruby to achieve her goals.
Written by Paul Doyle – Assistive Technologist – click here to find out more about Paul’s work.