MIT Assistive Technology Design

I find the view of people with disabilities in society as a very complex concept. PPAT is the second class I have taken that explores the different opinions groups of people have on disability and what it means to be a person with a disability in our modern world. The other class that delved into this exploration was bioethics. Before I entered into the bioethics class, I definitely viewed disability as a negative thing – as a problem that someone has that ideally should be fixed as soon as possible. After reading many papers in the bioethics class and even the initial papers in the PPAT class, it’s clear that not all people hold that same sentiment. Some people believe their disabilities are a part of who they are and they don’t wish to be changed, or for example they don’t want their child to receive a hearing aid at birth because they want their child to be primarily part of the deaf culture. Others just feel like being different is not better or worse. It is therefore also difficult sometimes to communicate about disability because you have to be careful to keep all these different perspectives in mind. I personally align more with the idea that for those who want, science and engineering should work to create “fixes” for disabilities – for example better hearing aids and vision enhancement – but I am now much more sensitive to understanding that many people don’t want to be viewed as needing “fixing,” and it’s more about providing people with disability a way to make their life easier than to inherently repair anything about them.

Blog by Riana Hoagland

This term I have learned about designing assistive technology in both PPAT and 2.009. My 2.009 team decided to pursue Mobilishield, a compact, automated cover for power wheelchair users to deploy in the rain, for our final product.

While reading the Universal Design File I could not help but see the principles outlined in the text parallel the thought process we have applied them to our work thus far in the design of Mobilishield.

Principle One: Equitable Use– Mobilishield’s size and mounting mechanism will allow it to be used with any power wheelchair using a rod clamping mechanism on the side of the chair.

Principle Two: Flexibility in Use– The switch that is used to deploy Mobilishield utilizes a bust modular architecture, meaning it is easy to interface a different switch with the main enclosure if the user prefers to deploy the device using a body part other than the finger.

Principle Three: Simple and Intuitive Use– In order to deploy and retract Mobilishield, only one press of a button is required.

Principle Four: Perceptible Information– The switch’s form factor will differentiate it from the other buttons found on power wheelchair control panels.

Principle Five: Tolerance for Error– Mobilishield will be mounted on the chair adjacent to the top of the headrest with the necessary clearance to ensure the canopy is deployed above the user’s head regardless of his or her height.

Principle Six: Low Physical Effort– We have designed the switch to activate the device to require less than 0.5 N of force to operate, minimizing user fatigue.

Principle Seven: Size and Space for Approach and Use– The switch can be placed in a custom location on each chair to ensure the user can reach it repeatedly.

These principles will continue to guide us as we work on Mobilishield this semester!

At the beginning of the course, we discussed models like CMOP and HAAT, which are used to better understand people with disabilities and their interactions with assistive technology.  While they seemed more like abstract concepts initially, I have developed a greater appreciation of these models now that I have started to apply them to my project because they help avoid the temptation of engineering in a vacuum.

Designing assistive technologies is not about solving a problem, but rather about helping a person.  No matter how ingenious a solution might be from a technical perspective, ultimately, if the user does not like the solution and cannot be convinced to use it, the solution needs work and should not be presented as the final product.  It is therefore important to understand the intended users and their needs and preferences.

For my project this semester, we are working to alleviate the inconvenience of using a traditional TV remote for a client with MS.  When we started, my partners and I immediately began exploring the design space and discussing solution tradeoffs from a technical perspective.  Then one day, our mentor shared with us some surprising news: our client was not even sure whether her problem of an inconvenient TV remote was “legitimate.”  Subsequent discussion helped convince her otherwise, but had we never talked with her about the importance of our project, no solution that we designed may have ever been that appealing.

We may have had a good understanding of the activity and the assistive technologies involved, but the understanding of our client was incomplete.  It was only through a more balanced understanding of all HAAT model components that has allowed us to pursue a more meaningful dialogue with our client that has greatly aided our design process.

Last week we had a guest lecture that was really interesting to me about the design of low cost wheelchairs that could be used in developing countries. I found the concept of disruptive technology fascinating in its ingenuity and also usefulness to people that could not afford current technology.

The talk got me interested in assistive technology in India; my parents are from there and I have visited plenty of times, but I have never really thought about the struggles that differently abled people may face in a country that historically has not been accepting of these differences.

Reading some of the articles that can be found online, it seems that one of the biggest challenges to AT in India is simply the fact that people with disabilities 1) don’t know that the technology exists and 2) are not properly trained in its use. Thus, it’s an interesting scenario wherein developing new, cheaper AT is great, but it’s not really doing much if people don’t know it exists in the first place.

Another point I stumbled upon is that the economics of AT are not financially attractive in India (or most places for that matter) but India specifically lacks the necessary policy to support its development. In the US we have a couple different established government programs to foster the acceptance of people with disabilities and also push for assistive technology development. India, on the other hand, is still slightly behind in this area. I would be really interested to see if you could find a class like PPAT at a school like IIT.

They say that you never know what an experience is like until you have experienced it yourself.  That could not be anymore true in the context of people with disabilities.  Two weeks ago, I was tasked with navigating around MIT in a wheelchair, and as someone who relies on his legs everyday to get to class, this experience could not be any more surreal.

As my brain began to comprehend that I could not use my legs, my other senses became significantly heightened.  Even the slightest bump in a sidewalk would freak me out.  Never had the sidewalks around MIT’s campus seemed so jagged and uneven.  On several occasions, my wheels got caught in the crevices, and I could not move, which was even more nerve-wracking considering that one such instance was in the middle of an intersection!

Ramps were a rather unexpected obstacle.  I had always assumed that ramps were a useful mechanism to make buildings more accessible to people with wheelchairs.  However, I did not fully appreciate the physical effort required to ascend these ramps.  The inclines were sometimes too steep, and I had no choice but to pull myself up awkwardly by the rail, which was even more exhausting for my already tired arms.

Although there were many frustrating physical obstacles, the shining point was the people.  Nobody seemed to treat me differently because of my wheelchair, and many were quick to assist when needed.  One even became quite distraught when she saw how much I was struggling.  Nevertheless, while MIT has such a supportive community for people with disabilities, my experience impressed upon me how much work is still needed before MIT is fully accessible to those with wheelchairs, and I hope my experience and that of others will impel greater action to mitigate this situation.

Creating Assistive Technology for Clients with Disabilities:

The Occupational Therapy Lens: Three Things to Keep in Mind 

Over the past few months, I have had the unique opportunity to collaborate with clients and engineering students to develop assistive technologies. During this experience, I have witnessed the different strengths that an interprofessional team brings to the design process. Below are three useful tips from the occupational therapy perspective.

By Gina Khalid, Occupational Therapy Student – MGH Institute of Health Professions

1. Ask questions and listen

When creating assistive technologies (AT) for your clients, chances are that you and your team have many questions. But what is the most effective way to ask good questions, while also allowing your clients to be heard? A common technique used in occupational therapy practice is motivational interviewing, often explained using the acronym “OARS”.

• Ask Open-ended questions that help your client talk and share, rather than answer “yes” or “no” (e.g., “what does a typical day look like for you?”)
• Make Affirmations by recognizing your client’s strengths
• Practice Reflective listening (e.g., “that seems difficult for you”)
• Summarize key elements of the conversation

2. Get your clients involved

Designing AT for your clients is an exciting and rewarding experience, and it should come as no surprise that your clients want to be a part of the process. Sometimes their enthusiasm may interrupt the fabrication process, but remember, your clients are the experts in their disability and their input regarding the AT is valuable. In the end, your clients are the ones using the AT firsthand, so get them involved and ideate together!

3. Consider the environment

It is really easy to overlook the environment and solely focus on the task at hand. Often, AT teams are so focused (rightly so) on prototype testing, materials selection, and software that the broader context can get lost. Although the client is a part of several environments (e.g., built, natural, social, and cultural), the physical environment is the most relevant to AT. Here are a few questions to consider:

• Where will the client primarily be using the AT device?
• Are there other spaces in which the client may potentially use the AT device?
• Will the AT device be able to adapt to different environmental conditions?
• How seamlessly can the AT device be transported between environments?

Integrating these simple tips into your AT design process will not only help build rapport with your clients, but will ensure that the AT you create makes a meaningful difference in the lives of your clients.

This semester, I learned how to use a combination of engineering and creativity skills to create a device to assist an individual with low vision. Throughout the past few months, our team has considered several very different approaches in which we could try to solve this problem and have iterated over some very different prototypes.

A couple of things that I’ve learned about problem solving and think are worth sharing:

1. Simple solutions are often very good solutions.

It’s not too uncommon to be more focussed on creating something impressive rather than something that simply gets the job done, especially here at MIT. When brainstorming, it’s good to note down whatever ideas come to mind, but to also stop sometimes and think about what the basis of problem is and how to address them.

2. Don’t get caught on one idea or in one direction; sometimes you need to consider other options.

This happened to me. Soon after being presented with the problem, I immediately thought of a potential solution, and became too attached to it. Only after we tested it and realized it didn’t give the most accurate results did I start considering going in a different direction. I would think that this is a common occurrence as well, people do get attached to their own ideas.

3. Draw inspiration from your surroundings.

This could be from everyday items around you, something you saw online, or from talking to your friends. I personally found that bouncing ideas off people completely uninvolved in the project often produced interesting ideas because these people often did not experience the problem presented in point #2. My main point is, if you constantly have this problem at the back of your head, you can find inspiration in many things.

Through PPAT I continue to understand the importance of collaboration with clients. Studying OT, we learn about client-centered practice theoretically, but it isn’t completely understood until you experience it empirically. Why should we make decisions jointly with clients, involve clients actively, and be egalitarian? What if I feel I know what is best for them?

I guess it’s all about promoting choice, freedom, and autonomy. As we demonstrate these values, the clients feel empowered, have opinions, and participate actively. We instill confidence in the clients and convey the idea that we view them as competent in their ability to direct and choose their own solution. When my team and I asked my client to freely speak his thoughts, it not only built rapport but also shed light on his talents. We saw how smart and creative he was. Surely, his ideas were very enlightening. As someone with the most knowledge of his own disability, he understood exactly what he needed and exactly what he wanted to have better access to reading his mails. Collaboration allowed him to open up, share his opinions, and suggest his own alternative solutions. Collaboration helped him become excited about meeting with us every week and confident that he also had something to share to the team.

On the flip side, I also see the cautions associated with this collaborative style. Overreliance on this style may not be received well by clients accustomed to, and who prefer to, view service providers as experts. According to Taylor (2008), clients inclined to participate in social or cultural networks with hierarchical role structures may not value collaboration and may be looking for structured instruction, advice, resources, and ongoing direction. Although my client now seems to not be in this population, it is important to know in the future that we should not misunderstand or misperceive less-engaged clients as being passive or even apathetic about finding their own solutions. These clients may be merely behaving within their own sociocultural comfort zones.

In conclusion, ultimately, I learned collaboration comes with understanding our clients’ preferences and allowing as much opportunity for them to shine.

Taylor, R. R. (2008). The intentional relationship: Occupational therapy and use of self. Philadelphia, PA: F. A. Davis Company.

It is surprising to me how few of the ideas that are being worked on in PPAT this semester currently exist as products on the market, especially when many of them have the potential to help a broad range of individuals. When looking closer at the variety of assistive technologies that currently exist, I was shocked to find that while over one billion people in the world live with some form of disability, the global market for assistive technologies is reported to be a mere $30 billion in 2015. When considering that assistive technologies are based on giving people the chance at an easier life, and access to them can make an enormous impact on a person’s future, it is horrifying to think of how small this technological market is in today’s economy. To put this in perspective relative to other global markets, the automotive market is estimated to have had an annual revenue of $9 trillion in 2015! That would make the assistive technology market, which could restore fundamental human capabilities to over a billion individuals, a mere 0.3% of the automotive market, while in many countries cars are considered to be a luxury! One possible reason for this is that reports show that the average income of people with disabilities in the US is significantly lower than that of the average US citizen. Unfortunately, it is not uncommon for people who are over represented in poverty to have their needs ignored. In order to bring the market of assistive technologies to a reasonable level, it is important to fight this sort of prejudice in the work place, and restoring to the disabled community the respect and attention that is deserved. It is only then that there can be created the market necessary to really help people around the world.

Graphs showing the inequality in pay for people with disabilities