MIT Assistive Technology Design

This semester I, an occupational therapy student, alongside a group of MIT engineering students, got together to help our client Stacy overcome her reading barriers. Stacy is currently a third year Harvard Medical student, who was diagnosed with dyslexia this past year.

Often times when we hear that someone is a “Harvard” student, we assume that they are without flaws, up on a pedestal with no need for additional support in almost all aspects of life. However, my experience with Stacy has opened my eyes to the vulnerability of us as human beings. Stacy is an intelligent, hardworking individual, and with great aspirations to help patients attain a life without sickness. But what would it feel like to be a doctor without the ability to read clearly and or understand material? These were some of the growing concerns Stacy had shared with me during our first meeting.

Her questions set the tone for our team and served as the foundation to create a web-extension that best fit Stacy’s needs. Our team met every Saturday morning and worked to see things from her perspective to ensure that the end product would be customized to her needs.

The process of understanding a disability from a second hand point of view has been a difficult and grueling process. With weekly meetings and trials, we continuously recorded feedback and adjusted the web extension according to the response from Stacey. When we felt that our prototype would be stellar, we realized that there were many adjustments that needed to be made along the way. However, as the semester draws to an end, I feel that our team has come to realize the importance in understanding how different professionals can come together to create a patient driven product that can help individuals of all needs.

Many times as an OT I have felt that other professions have constantly overlooked the abilities and know-hows of an occupational therapist. However, this experience has helped me realize that just as the human body, we all come with different skill sets that are invaluable when working as a team. Metaphorically, the engineers were the hands, as they created the web-extension from scratch. Our client, Stacy, was the heart, as she was the purpose, and the meaning behind the motivation to create this assistive device. And I, the OT, served as the mind, to understand the point of view of the engineers and to advocate for Stacy to ensure that her opinions were heard and met. It has been truly an amazing experience and honor to collaborate with such a diverse team.

Sincerely,

Irene Joo

This semester, three mechanical engineering students from MIT and I, an occupational therapy student from BU, are responsible for creating a dogcart for our client who has osteopetrosis, in which her bones harden and become denser that causes her to fatigue easily. Our client currently uses the Playmarket Go 3 Shopping Trolley Cart (image below) and explained that it has been hurting her hands, hence the reason for wanting a dog cart. She ideally wants this device for grocery shopping as well as for daily outings. Our client wants it to go onto the T and buses, and to be used on the street regardless of the weather and terrain. Also, she wants it to go able to easily go through security checks. She is currently training her Black Mouth Cur service dog, Orenda, whom she only had for three weeks. The first prototype was inspired by current dog carts available on the market. This prototype took into consideration some of her requests. It included two long arms extending from the cart to Orenda. It also included a large enough space for our client’s groceries. In addition, two large, 20” wheels were included to be able to go over curbs. After trialing the prototype, the mechanical engineer students realized that the arms were too long and could be shortened and the width of the cart could be halved. They also realized that Orenda’s harness is too big for her and  is lacking two rigid attachment points necessary to attach Orenda to the cart. For the second prototype, we are considering having a three-wheeled cart that is similar to her current cart for easier and efficient maneuverability. We are also considering a cart with a large handle that our client could potentially use to physically pull the cart when needed. We sent our client an email to ask her questions regarding our current ideas for the second prototype. By asking for her input, we will be able to design a dog cart that is best suitable for our client and her needs.

Image of Playmarket Go 3 Shopping Trolley Cart

(http://www.sierratradingpost.com/playmarket-go-3-shopping-trolley-cart~p~8486m/)

Image of sample dog cart available

(http://www.blueskyberners.com/images/100_2973.jpg)

Image of 1^st prototype with Orenda

Image of 1^st prototype without Orenda

[Link if video doesn’t work]

Poor Cassidy the kitten was recently found in the woods. He was emaciated, only weighing about a pound at nine weeks, and had a very serious infection. He was also missing his two back legs, which are very important for a cat’s survival. He was lucky though, and was taken in by the owner of the site Tiny Kittens, a site that streams live videos of rescue kittens to raise money for kittens in need. The owner of the site went to social media for help and asked if anyone could donate a little set of wheels for him. Two high school students at Walnut Grove High saw little Cassidy and decided that they could help. They designed a wheelchair, made it using a 3D printer, and sent it for Cassidy to use. Handicapped Pets Canada also heard of Cassidy’s plight and fitted little Cassidy for his own tiny, customized wheelchair. Handicapped Pets Canada is keeping up with Cassidy and will fit him for his own Walkin’ Wheels (Handicapped Pets Canada’s flagship product) or even a pair of little prosthetics!

With 3D printing technology really taking off, the process of quickly customizing assistive technology is becoming easier and easier.  This is going to lead to more ingenuity in the assistive technology field and the ability to easily help other injured critters like little Cassidy. As ease and availability continue to increase, hopefully all kittens with issues like Cassidy will retrieve proper care and live happy, healthy lives.

Cassidy out of his wheelchair.

As we continue to develop and finalize our custom made solutions to our respective clients, it is important to be aware of the sustainability of these devices. How can we create something that will support them in the long run? Self-efficacy could be one principle to foster sustainability.

According to Bandura (1977), self-efficacy is the belief that one can perform adequately in a particular situation. It reflects confidence in the ability to exert control over one’s experiences. If our clients are confident in their ability to use their assistive technology, we can expect sustainability and attainment in the face of obstacles and aversive experiences. Albert Bandura’s self-efficacy theory demonstrate four key mechanisms to improve self-efficacy.

1) Performance Accomplishments: Success raises mastery expectations; repeated failures lower them. After strong self-efficacy expectations are developed through repeated successes, the negative impact of occasional failures is likely to be reduced.

2) Vicarious Experience: Seeing other people perform activities without adverse consequences generates expectations in observers that they will improve if they intensify and persist in their efforts.

3) Verbal Persuasion: People can be socially persuaded that they possess the capabilities to master difficult situations.

4) Emotional Arousal: Diminishing emotional arousal (i.e. anxiety, stress) can reduce avoidant behavior.

If we allow our clients to: have success in using their AT; see someone model AT without any bad implications; know they have the talent, skill, and knowledge to use the AT; and feel safe and comfortable, we can ensure success and sustainability for our clients.

Reference: Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215.

Just today, the MIT Tech Review published an article on current research at the University of Nevada aimed at making fitness more accessible to the blind community. Professor Eelke Folmer has created a prototype drone system that replaces the need for a sighted guide for blind runners.

Reading the article, I was excited most by the following excerpt:

“Most of the accessibility research [for the blind] focuses more on things like screen readers and making the Web more accessible,” Folmer says. “The community of blind people still has major problems pertaining to health, socialization, and quality of life. It would be more helpful for this demographic if we research how technology can improve these issues.”

As an athlete and fitness freak myself, I take for granted my ability to exercise. This article made me realize that and also how little I hear of assistive technology for this purpose.

There are many incredible athletes with impressive accomplishments despite their disabilities. Marla Runyan, for example, came to speak to my track team last year and inspired us all with her crazy feats and stories.

However, what about your average joe person who happens to have a disability which makes taking care of their health and fitness difficult? What can we do to lower that barrier? The rate of obesity is much higher (50% as opposed to 33%) in the disabled population, and I think one of the most important things we can do to improve that as a society is to make exercise more readily available to all abilities. Exercise is empowering. To be able to run around a track as a blind person, without needing a sighted guide, is an exciting advancement.

The more I learn and have seen about the assistive technology field, the more I am shocked at its historical development. From a technological perspective, the disparity between the complexity of what is being researched, and the simplicity of the issues that people still face on a daily basis, is absurd. I fear that developers have gotten so caught up in what new flashy things can be done that they ignore problems that may be simple to fix.

As only one example of this, the wheelchair was invented in the late 1700s and has hardly changed since! With issues as simple as storage still troubling millions of people every day, it is riddled with imperfections which make life in a wheelchair even more difficult than it would otherwise have to be. And yet, despite this, millions of dollars are going into development of incredibly complex exoskeleton-like systems which will no doubt be inaccessible to all but the highest class of people with disabilities. With this class as an example of how important a technological solution can be even on a low budget, I am confident that if that same funding went into solving the more pressing, but less flashy issues, they could be easily resolved.

One of the few researchers working with these goals in mind is MIT’s own professor Amos Winter. Winter has been developing many new assistive technologies, all aimed for the developing world. It is precisely this low budget requirement that the developing world clientele necessitates which has forced Winter to create simple, elegant, mechanical solutions to the most pressing issues that the user’s face. These solutions are brilliant in their simplicity and truly make you wonder why they hadn’t been done before. I believe Winter’s work exemplifies need based engineering in its greatest form.

Last week I came across an interesting post on Reddit that outlined a DIY caller ID for the visually impaired.  The caller ID system was created by a Reddit user for their mother because commercial alternatives did not adequately fit the needs of the mother.  This is often also the case for clients working with PPAT – there are commercial solutions to many challenges caused by disabilities, but they often do not fit the unique situation of the individual user precisely.

Screenshot of the caller ID for the visually impaired Reddit post. Link to post

The post struck me because I realized that there are likely tens of thousands of individuals with disabilities, relatives, and friends who have taken on the development of simple, custom assistive technologies.  Additionally, with the ubiquity of cheap electronic devices like smartphones, tablet computers, and accessible microcontrollers like Arduinos, countless assistive technologies can be developed quickly and cheaply by anybody with a bit of programming knowledge.  Not everyone has the programming background necessary, though.

The availability of electronics has led to a massive network of hobbyists who do have programming experience (including myself and many of my friends) who create often mundane and largely useless devices just for fun and to satisfy curiosity.  Many of these hobbyists take the time to thoroughly document their efforts on online forums like Instructables.

I’m curious if a system, probably a website, could be an effective way of broadcasting ideas for simple assistive technologies from those who need them to a broad audience of hobbyists who are looking for an interesting project to spend a weekend working on.  Thought would need to be put into the logistics of such a website: would it just be a place where hobbyists could post code and instructions for making an assistive technology, or would it go further in pairing individuals with hobbyists.

A forum of this kind serves two purposes.  First, it disseminates the types of assistive technologies that have the potential to drastically improve an individual’s quality of life.  Second, it serves as a repository for assistive technologies that have already been developed, reducing the duplication of work to solve the same or similar problems.

Interacting with my client, Kurt, has given me a new understanding of the psychological challenges faced by people with disabilities, which can sometimes be more difficult to cope with than physical challenges. Kurt was once the head chef of a restaurant in Chicago. After working there for many years, he began to lose his eyesight and eventually had to quit his job. It was shocking to hear how he transitioned from being a well-known and respected chef to a “non-entity” who no longer felt relevant in society. It surprised me to discover that his friends and acquaintances began to treat him differently after he lost his sight.

Our client Kurt with his guide dog Zoar

I experienced this difference in social interactions myself during the wheelchair lab. I noticed that more strangers would smile at me, ask how I was doing, and open doors for me. While these strangers were clearly well-intentioned, it felt degrading that others assumed I required help or special attention. Their words and actions emphasized the fact that I was different from them, constructing a clear rift between abled and disabled people. Assuming that a person with a disability needs assistance robs them of their independence and leaves them feeling helpless. To avoid these interactions, I felt pressured to constantly be occupied and moving; if I ever stopped briefly to catch my breath, people assumed I was lost or needed help.

Listening to Kurt’s challenges and experiencing this difference in social interactions myself made me realize the importance of our language, tone, and actions. Rather than trying to be helpful by offering assistance to a person with a disability, it goes a long way to first ask if they would like help. Preserving people’s independence and decision-making power is critical to making everyone feel like an equal being, regardless of their abilities.

Image Source

“This is my chance to leave them behind.”

According to recent research, this thought crosses the mind of many people in Southeast Asia during natural disasters. Takepart.com reports:

 “People with disabilities are four times more likely to die during a natural disaster than people without disabilities.”

Oftentimes, people with disabilities are seen as sources of shame for a family. Families seen them as the consequence for sins in a past life or of the mother during pregnancy. This oftentimes leads to the discrimination of the entire family and caretakers see a natural disaster as the perfect opportunity to rid themselves of their burden.

Even if a person with a disability is able to make it to a relief center on their own, there is no guarantee to safety. Un.org reports:

“People with disabilities are many times even turned away from shelters and refugees camps due to a perception that they need “complex medical” services.”

Basically, if a typhoon hits, people with disabilities are on their own. Societal reform could save the lives of so many. Citizens of these countries need a change in mentality to give people with the disabilities a chance for survival. Mass distribution of information about the causes of since-birth disabilities, inclusive policy change at refugee centers, and simply larger compassion for those with disabilities could lead to great strides towards safety for this community.

Speed reading was very much in fashion one-tenth of a generation before me. I remember seeing the signs for speed reading cram schools (There are some weird cram schools in Korea.) dotting the building facades. The fad was dying down by the time I was learning to read and as far as I know, and no one in my generation learned to speed-read anymore.

Then when I was in seventh grade, I saw this kid. We were supposed to read Hobbit and discuss it in class. I found it weird because he was confidently getting everything wrong. At the end of the class, the teacher pulled him aside and asked, “Did you learn to speed read?” He nodded, and then the teacher said he shouldn’t speed-read materials for discussion.

I remembered this episode because I could only find articles that concluded that speed reading is not suitable for quality reading where the material is new and more difficult. They say that even if we overcome the speed at which we take in textual data by eliminating subvocalization (phenomenon where we are reading out loud in our mind.) and increasing peripheral vision so that we read in more words at a time, the bottleneck would be the speed at which we process the information.

I decided to write about this very tangentially related topic because I wanted to learn more about what have people done with speed reading that has been or could be adapted for the dyslexic population. It is hard to find quality scientific review articles for laymen who is not a cognitive scientist that are not pop science. I want to learn more about how textual learning happens and how it can be improved. Which modules within the brain wired differently that results in dyslexia?

Reference:

http://www.theatlantic.com/health/archive/2014/03/is-speed-reading-possible/284326/

http://lifehacker.com/the-truth-about-speed-reading-1542508398