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Ask HN: Assistive Devices for recently quadriplegic dad

158 points by throwawaysci ↗ HN
In a most unfortunate incident, my dad slipped in our house and received a severe spinal cord injury (c5 to c7). This has rendered him quadriplegic. He is currently stable and is in in-house rehab. He was very active and was a part time professor. He also had a one or two consulting assignments.

He would like to use his laptop/ipad/phone. After some research I found some companies like TeclaShield that sell switches/ bluetooth interfaces and such.

Does anyone have any experience in this area? Your help or advice will be really appreciated.

36 comments

[ 3.1 ms ] story [ 79.3 ms ] thread
johnnyg
I'm sorry I don't, but my thoughts are with you and I think its great you are advocating for and supporting your father.
nikki-9696
Sorry to hear. You might find a lot more useful advice on Reddit, if you haven't already posted there.
jeremyt
Dragon naturally speaking + Sennheiser ME-3 microphone should be at the top of your list
mindcrime
A company I used to work for did a project once, deploying a lot of home automation for someone with mobility issues. It's been a few years ago, and the tech has probably changed a lot since then, but they used OpenRemote[1] heavily as part of the project. It might be worth looking into.

[1]: http://www.openremote.com/

aerovistae
I created a Chrome extension called Hands Free for Chrome which allows near-total control of the browser with your voice.

It occasionally has to be reset by hand if the voice recognition locks up, which is the only barrier. But I'm fairly certain it's the best option available for people in your father's situation.

https://chrome.google.com/webstore/detail/hands-free-for-chr...

tyingq
I see it's got really great reviews, but the user count seems low given how useful it appears to be.

Is it just new, or maybe an unintentionally well kept secret?

aerovistae
Unintentionally well kept secret. I have no idea. There's a similar one with a weaker feature set (imo) which has 10k+ users-- there's obviously no shortage of demand. I haven't got a clue as to why it's so unsuccessful.
tyingq
Hmm. I have no need for such a tool, but kudos for putting in the work on a free tool for people that do. And open source too...nice.
tinus_hn
There was a talk by a C4 paraplegic at WWDC this year that shows his setup.
j_s
Perhaps https://developer.apple.com/videos/play/wwdc2017/110/ ?

Convenience for You is Independence for Me

Why design apps with accessibility? Meet Todd Stabelfeldt, founder of C4 Consulting, who has lived with quadriplegia since the age of 8. Over his decades-long struggle for increased independence in both his personal and professional lives, Todd has become a noted expert in technologies for persons with disabilities, which he has found can offer not only a level of autonomy but also empowerment and dignity to the mobility impaired. Leading by example, Todd runs a successful business but his real passion lies elsewhere. Hear how apps designed well with accessibility in mind have changed his life as a husband, father and as owner of the “Quadthedral“, his family's HomeKit-enabled smart home.

--

Unfortunately http://asciiwwdc.com/ hasn't been updated with a searchable transcript for 2017. I'm having trouble viewing the video in a browser on my PC; the download links are under "Resources".

Voltbishop
I'd recommend the two products:

1. http://www.quha.com/products-2/accessories/quha-pufo/

It's a bluetooth device that allows controlling the mouse cursor with body movement (head or finger etc) It's cheaper. Coupled with a free dwell clicking software, should work!

2. Eye tracker - there are a lot of options, visit reddit.com/r/eyetracking that and reddit.com/r/ALS and ask them for advice. These devices let you control a PC with your eyes are especially designed for people who have ALS. The ones that work really well cost money, but most insurance companies cover them in full. Avoid Tobii, they are not reliable and are more marketing than anything. Mygaze,LC Technologies, Eyetech digital, smi vision. These are all companies you can trust. All should offer free trail periods and should have a rep who can come and visit your dad to do an evaluation. If they don't offer at minimum 2 week trail, they're not a trusted company. Secondly you can contact your local cities AT clinic they have donated equipment for situations like this.

I hope this helps!

onlydnaq
You could take a look at tobii [1]. They make some interesting products where they combine eye tracking, speech analysis and other stuff to create user interfaces for people with specific needs.

[1] https://www.tobiidynavox.com/en-US/tobii-dynavox-pceye-plus/

Voltbishop
Tobii is horrible for people with disabilities. Their reps are driven by making money, their devices dry your eyes out because of the amount of IR they put on your eye balls. And they don't offer extended support. And forget trying to run these devices if you have glasses or any eye condition!
jonnycowboy
Sad to hear, I demoed a system with a Tobii sensor and it performed very well (even with my glasses). We were wondering about the effect of the constant IR blasts (are they continuous or pulsing?), thanks for the input.
Voltbishop
Bring a old cell phone that's sensitive to IR light and place it in front of a tobii system. You'll see they're pulsing at a high frequency something like 30 lights at a >60 refresh rate per second, to the point you can actually see the light on the users face (using sensitive camera). Not all eye tracking companies put this much light on your eye's, but Tobii seems to be cutting corners - to make up for short coming in image processing. It's a brute force method to eye tracking.

The sensation you get after running a tobii is feeling like you've been up past midnight staring at a bright screen. Most people don't get that it's the eye tracker that makes you feel this way. Some of the other more respected companies take the amount of IR light placed on your eye balls seriously and try to drastically reduce it.

Talk to Tobii about it and they'll just bury it and say "there are no none health risks, or regulations about having that much IR light on your eye". Basically no one has set a threshold for how much IR light should be on a person's eye thus it isn't a problem "we should worry about".

j_s
Jouse3 $1500 mouth mouse/joystick seems tried & true. http://www.compusult.net/assistive-technology/our-at-product...

Source: https://www.twitch.tv/nohandsken quadriplegic streamer who plays Diablo/Path of Exile, Heroes of the Storm, World of Warcraft, etc. (I encourage Amazon Prime subscribers to give him ~$2.50 every 30 days via their free Twitch sub! https://help.twitch.tv/customer/portal/articles/2574674-how-... )

slightly related/helpful discussion: https://github.com/melling/ErgonomicNotes

apostacy_steak
My father contracted Guillain-Barre - a fast oncoming neurological disorder that left him quadriplegic. I did a bunch of research a couple of years ago to help him out.

First, if your dad can still move his head you can use Apple's assistive tech to "tab" through the items on the screen with a turn one way, and "clicking" on an item by turning his face the other.

Second, MS Windows' voice control is actually really decent. You can browse, search, send emails, etc. all with your voice. It takes some training (both for the user and the machine) but my dad has gotten pretty quick with his.

Lastly, there's a bunch of eye trackers out there now, and you can use them for a lot of things. I setup CameraMouse (http://www.cameramouse.org/) for when voice wasn't quite cutting it (or my dad got tired of talking.)

Unfortunately, there's no perfect solution, and all require time to adjust.

WheelsAtLarge
It's not a laptop but an Amazon Echo is excellent for Music, Audible books and Podcasts. Hard to beat how well the immediate voice recognition works. Home automation works but it's a try and see if it works for you type of situation. It's worth investigating for your needs. Also it's relatively inexpensive. I should add that home automation needs additional hardware and costs. But you can buy an on/off plug for a bit under $30.00.
house9-2
If he still has good movement of his neck:

- Smartnav (if Mac you need to buy via 3rd party, but includes the software)

Fairly expensive, there are other variants that cost less/more, some gaming devices like TrackIr might work as well? Possible that health insurance would pay for these types of devices?

I personally use Smartnav about 50% of the time I am programming, along with Dragon/Voicecode due to RSI issues.

Smartnav + Dragon might be enough for using laptop/desktop, not so much for mobile devices. If he actually programs I would recommend voicecode.

All of these technologies have a massive learning curve.

You might want to checkout the voicecode forum and slack channel, I know there are some quadriplegic programmers in that community who would have better insight than I.

- http://www.naturalpoint.com/smartnav/

- http://voicecode.io/

- http://discuss.voicecode.io/

- https://voicecode.slack.com/

gtsteve
I'm sorry to hear that. That's very bad luck indeed.

I remember hearing about this project some time ago: https://github.com/OptiKey/OptiKey

It might be helpful as it's an open-source project and if extra features are needed you might be able to add them yourself if you are a programmer.

I mentally bookmarked it because I felt it would be a good "make the world a better place" type project to contribute to if I ever had some spare time.

base2john
Sorry to hear about your family's situation, but hopefully he's able to get back to work soon.

Tecla is great you should give it a try. Depending on his comfort and ability a head tracking mouse from Orin is pricey but works really well with a laptop/desktop setup. Dragon Naturally speaking is useful too.

Also he should make an appointment with a local assistive technology practitioner soon to get a run down of all the options, both low and high tech. You can find these ATP folks at most all rehab hospitals.

Good luck

kinova
There is this robotics arm that helps gaining autonomy. There are options that allow the user to use his tongue, head or breath to control the arm. It interfaces easily to the wheelchair controls.

www.kinovarobotics.com

m0ngr31
A little while back, I had a quadriplegic man reach out to me and thank me for a skill I wrote for Alexa to control a Kodi box. It allowed him to watch what movies and shows he wanted without constantly asking for help.

https://github.com/m0ngr31/kodi-alexa

I'm truly sorry about your dad. That's a scary situation for him to be thrust into.

Mz
I was passingly acquainted with two quadriplegics from my corporate job. They were both employees of the company.

Quadriplegic just means all four limbs are impaired. The degree of impairment can vary substantially. One of these men had use of his arms, but did not have full use of his hands. He drove himself to work, had a full time job, wife and kid. He broke his neck in a pool accident in his teens. He used a manual wheelchair. He was able to use a manual wheelchair because he had use of his arms. He chose it over an automatic wheelchair to get in regular exercise.

The other was substantially more impaired. He broke his neck in a riding accident later in life. He had been a brilliant surgeon. He used an automated wheelchair. I think he had partial use of one arm and maybe a couple of fingers, which allowed him to navigate a smartphone with that hand. He came in once a week for a few hours to review surgical reports for the company. When ordinary claims processors (like I was) could not figure out if the surgery was covered and their boss with more training couldn't either, we printed off the entire file and hand delivered the paper version to this man on Friday afternoon. I had one claim go to him and hand walked my papers to the meeting.

I also attended an educational talk given by the two of them. This is how I know how they each broke their neck and other details.

Since your father was a consultant, he may be able to return to doing consulting work at some point in the future. The specialized knowledge in his head does not stop being valuable just because of his physical limitations. I am mentioning this because new quadriplegics are often suicidal. They feel that life is simply over. It's not. He was a professor and consultant, like this former surgeon, his knowledge and expertise still has value. Even though the former surgeon could no longer work as a surgeon, his knowledge of surgery was valuable and he had a unique very part time job at a world class company.

Depending on the exact details of your father's limitations, he may also benefit from the use of ordinary things like smart phones with apps. There are also a lot of non-tech assistive devices, like chairs to help them shower and spoons that can be strapped to their hand so they can feed themselves if they have arm movement but limited hand control.

Best.

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j_s
Please follow-up to report what works best for your father! So many of these Ask HN's have a great list of options, but no follow-up to report what worked best for your particular situation.

Thanks for bringing this request here to allow the community the chance to contribute!

jonnycowboy
I work for a company that makes robot arms for assistive purposes (Kinova) so I have some insight to share.

1st a voice setup with Alexa or similar can really help.

With regards to phone use, some of our users have an attachment to put the phone close to their head and use their nose to "click/select" (they can move their head).

Eye tracking technology is really impressive these days (can be as fast as using a mouse). I've recently demoed a system with a Tobii sensor (https://www.tobii.com/) that was hooked up to a laptop, very impressive when combined with appropriate software (it handles scrolling, keyboard shortcuts, etc in a custom interface). I'm not sure with regards to phone/tablet use how well they integrate.

Ping me on Linkedin if you'd like to talk more.

jbannick
Contact Barrie Ellis World expert on motion impairment assistive technology. Barrie.ellis@oneswitch.org.uk
htatbr
I worked with quads as a college grad student. I also worked with HIV patients in US Peace Corps. You really need to watch for sepsis. Watch out for catheter infections. https://www.indiegogo.com/projects/the-connected-catheter-by... I would not allow any quad to use a catheter more than a short time. Spinal singularity will fail by increasing infections. A new DNA tech may change this. https://nanoporetech.com/products/smidgion https://www.youtube.com/watch?v=OK5nNSwt3MA https://www.cs.columbia.edu/2016/dna-sequencing-in-classroom...

Sepsis now dominates the hospital ICU. It is what kills most AIDS patients too. Antibiotic resistance is driving costs. The ICU is now 40% of US hospital budgets. This is bankrupting state and federal budgets. This is why medicare, medicaid, obamacare are bankrupting US Govt (Fed and State) budgets. In 2013 health dominated state budgets.

State spending on health care now exceeds education spending. Look at NM's past budgets. http://www.usgovernmentspending.com/compare_state_spending_2...

​ Today 1/4 of US VA and Indian Health patients are diabetic. US Defense Dept. funding must now compete with Medicare. Today 40% of hospital costs are for growing ICU's and chronic disease. 1/2 of US Medicare cost = chronic disease from diabetes.

NM ICU's are dominated by chronic disease. http://www.amazon.com/Where-Night-Is-Day-Politics/dp/0801451...

40% of US hospital budgets now pay ICU/chronic disease costs. This cost is going up annually. http://money.cnn.com/video/technology/2013/07/24/fortune-tra...

Can MinION help pre ICU patients better control diet and sepsis infection. http://www.bloomberg.com/news/articles/2015-06-03/deadly-inf... A complete bacterial genome with MinION http://www.nature.com/nmeth/journal/v12/n8/abs/nmeth.3444.ht...

Minion can find septic bacteria fast. https://genomemedicine.biomedcentral.com/articles/10.1186/s1...

henry.brown@state.nm.us