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Improving Independence with Daily Activities Using Assistive Technology” – Session Notes

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3D printed assistive writing device
source: randyrue/thingiverse

In November, the American Parkinson Disease Association’s (APDA’s) Minnesota chapter hosted a session on adaptive technologies, with occupational therapist Matthew White.  Mr. White discussed different device’s, such as electronics (computer, mouse, stylus, TV access, home environment control, phone access, cell phone access), daily activity helpers (cognitive aids, item tracker, medication reminders, daily living tasks, inclusive products (made with accessibility in mind)), digital assistants, academic and vocational skills, and fall detection.  Mr. White also recommended some do-it-yourself options.

For more resources on staying independent, please see this Stanford Parkinson’s Community Outreach webpage.

For a recording of this session, please see the APDA Minnesota YouTube webpage here.

See my notes below of the November 4th session. 

Regards, 

– Joëlle Kuehn

“ Improving Independence with Daily Activities Using Assistive Technology” – Session Notes

Speaker:  Matthew White, OTR/L, occupational therapist, Courage Kenny Rehabilitation Institute, Minneapolis, Minnesota 

Session Host:  APDA Minnesota Chapter

Session Date:  November 4, 2021

Summary by:  Joëlle Kuehn, Stanford Parkinson’s Community Outreach 

 Assistive technology (AT):

  • Any piece of equipment/software that helps a person in different aspects of life such as school, work, or home activities
  • Can be very low-tech (i.e. built-up handle on a feeding utensil used by someone with arthritis), or high tech (i.e person who controls computer entirely using eye gaze because of paralysis from ALS)

Mobile devices and computer access:

Stylus:

  • Often people with limited mobility in their fingers may need to use an adapted stylus
    • Some may need a head or mouth stick stylus when shoulder and arm motion is significantly impaired:
    • Ex. Faraday Caduceus stylus:
      • Can be wrapped around the hand requiring limited, if any, grasping ability
      • DIY versions: using industrial twist tie and off the shelf stylus (wrap around hand)
  • App – Jabberwocky:
    • Android only
    • Allows complete control of Android phone or tablet and uses head movement to move the mouse:
      • Tapping by winking 
      • Holding wink allows scrolling and swipe gestures
      • Opening and closing mouth can be assigned as gestures
      • Free! 
  • GlassOuse:
    • Bluetooth mouse worn like glasses
    • Moving head moves the mouse
    • Clicking or tapping done by biting or blowing on a sound switch near the mouse
    • ~$600
  • Voice Control features:
    • Basic navigation
    • Doesn’t need WiFi or cell data to work
    • Can customize commands and vocabulary
    • Free 
    • Apple Version: Dictation
    • Android version: Voice Access
  • Siri Shortcuts / Google Action Blocks:
    • Can perform customized multi-step actions with limited taps
    • Useful for those with limited dexterity, low vision, or needing a simple interface because of decreased cognition
    • Common reason: place large icon/picture of person for you to call, such as a loved one
  • Bluetooth wheelchair joystick:
    • If using a wheelchair
    • Some wheelchairs have a bluetooth mouse already built in
    • Different versions available (R-Net, Curtis, MK6i, ATOM), allow you to switch your joystick from wheelchair controls to a bluetooth mouse

Mounting equipment:

  • Mounting equipment to hold device to the chair:
    • Ex. Ram mount
    • ModularHose
    • iDevice friction knob:
      • Has a universal mount system
      • Can use on any surface
    • Levo G2 Deluxe stand:
      • Popular to hold a tablet
      • Can angle tablet in any position, even overhead while in bed 

Mouse:

  • Mouse options with computers:
    • RollerMouse red:
      • Roll fingers on a roller bar
      • Requires no gripping or squeezing
      • Can also get an arm rest
      • $265 for mouse, $165 for arm rest
    • Kensington Expert Mouse:
      • Trackball
      • Can be used with limited arm and hand movement by using the side of the hand to roll the ball, or knuckles to click
      • Buttons are customizable
      • $90
    • Both have advantage when tremors are present because the hand is typically lifted off of the roller bar or trackball before completing the clicking
  • Hands-free mousing: mouth and chin operated:
    • Mouth:
      • Puffing for clicking, mouth moving as mouse moves
      • Integramouse.com, $2500
      • Quadjoy.com, $1200
    • Chin:
      • BJOY chin mouse, $480
  • Hands-free mousing:
    • HeadMouse Nano:
      • Camera tracks head movement from a reflective sticker placed on glasses or forehead
      • $1,000
    • Smyle Mouse:
      • Uses a webcam to track your head movement 
      • Clicking is performed through gestures such as smiling
      • $500
    • Mac’s head pointer:
      • Apple computer’s accessibility option uses either the built in or connected camera
      • Tracks head motion to move the cursor
      • Clicking performed by facial expressions
      • Feature is built into Mac OS for computers    
  • Mouse for people with tremors/motor control:
    • ADmouse:
      • Uses directional buttons
      • Built in keyguard to prevent hitting other buttons
      • $300
    • SteadyMouse:
      • Software that filters out tremors
      • Compatible with any type of mouse
      • $43

Keyboard: 

  • Hand:
    • Typing aids:
      • Requires little to no grasp but still allows person to type one key at a time
      • Most have rubber tips
      • Hands can be palm down or in neutral position
  • Larger keyboard:
    • Chester Creek Vision Board 2
      • Designed for low vision users
      • Added benefit for larger keys for increased typing accuracy 
  • Speech recognition software:
    • Make sure to use a high quality microphone
  • Keyguards:
    • For tremors
    • Plastic sits on top of the keyboard, has openings for each key, makes each key recessed which reduces the change of unintentional keystrokes
    • $40-85
  • Filter Keys:
    • Windows feature
    • Can customize how keyboard responds to your typing
    • Ex. using “slow keys” will help if you accidentally hit the same key multiple times
    • Can help with unintentional keystrokes
  • One-handed keyboard:
    • BeeRaider:
      • Compact but with large keys
      • Keys located based on frequency of occurrence
      • $150
    • Tipy:
      • Unique in that it can be used with right or left
      • Integrated mouse
      • $300

Technology to help control home environment:

  • Voice controlled virtual assistants:
    • Several options out there
    • Alexa is just one option
    • Can control lights, tv, door locks, HVAC (heating, ventilation, air conditioning)
  • FLIC:
    • If can’t use voice to activate Alexa
      • Not loud or clear enough 
    • Button that can trigger an Alexa command
    • One button can perform 3 unique actions
      • Ex. Pressing and holding down can lock the door
  • Button pusher:
    • SwitchBot:
      • Can be useful if don’t have the dexterity to reach a button
      • Small battery operated device that can press physical buttons, making “dumb” devices “smart”
      • Ex. for coffee pots, computer power buttons, light switches, speaker phone button
      • Can use as app activated, or voice activated (like Alexa)
  • Commercially available environmental controls:
    • Ex. AutonoME residential, Grid Pad, EnvirON app
    • Input via touch screen or switch access
    • Pair with tablet or cellphone
    • Can control TV, light, social media, YouTube
    • $850-9k depending on model, more expensive than off the shelf devices

Phone access:

  • Hands free: Analog (Non-cellphone):
    • Serene RCx-100:
      • Answer by saying hello or whistling
      • Officially discontinued but still found online
      • $400-500
    • ATS Voice Activated:
      • Place, answer, end call with voice only
      • Requires minimal background noise
      • $250
  • Larger buttons:
    • Future Call Phone:
      • Large button
      • Picture buttons with people’s faces ford decreased memory
      • One-button quick falling
      • Hands free speakerphone
      • Amplification if a person is hearing impaired

Cell phone access:

  • Jitterbug Smart3:
    • Simplified smartphone
    • List-based menu
    • Voice typing, video chatting
    • $150 with monthly plan
  • Jitterbug Flip2:
    • Simple flip phone with larger physical buttons
    • Built-in voice calling and texting
    • $100 with monthly plan          
  • RAZ memory phone:
    • Very simple interface
    • Only make calls by tapping on the pictures (up to 24 contacts)
    • Designed for person with decreased cognition / dementia
  • Easy mobile app (android only):
    • If want to continue using own phone
    • Simplify home screen to increase ease of making or receiving phone calls
    • Enlarged buttons to help with tremors or poor dexterity
  • GrandPad:
    • Not a phone, but a simplified tablet with easy-to-use features including phone calls, emails, photos, music, news and games
    • Requires subscription (700-960)
    • Friends and family can use an app on their phone to share pictures and make calls to the GrandPad

TV access:

  • Large buttons on remote control:
    • Tek Pal
    • Tek Partner
    • Switch activated devices
    • PUCK2 – IR blaster (infrared blaster that works like a remote) connected to a phone via bluetooth using phone or digital assistant like Alexa

Cognitive aids:

  • MotivAider:
    • Vibrates to remind you to think of the “one thing” you need to do at different time intervals
    • Easy to set up
    • Can be worn like a pager
    • $65 (but also have an app version)
  • Re-vibe Connect:
    • Gentle vibration used as a “tap on the shoulder” to remind you to stay on task
    • Worn on the wrist like a watch but also has visual prompting on the screen
    • $220, includes 1 year subscription fee
  • Invisible Clock II:
    • Can be worn like a pager
    • Set up to 12 alarms
    • Provides either vibrate or audible alert
    • $40
  • CanPlan app:
    • Uses pictures as visual reminders
    • Tasks can be scheduled or use the to do list
    • Tasks are broken down using pictures:
      • Option to use text and have an audio description
    • iOS compatible only
    • Free
    • Similar apps:
      • ToDoist
      • Trello
      • Any.Do
      • Cozi
      • Pictello
      • Qcard

Item tracker:

  • Apple AirTag:
    • Small coin like tracker item
    • If in bluetooth range can use Find My app
    • Built in speaker
    • Battery replaced annually
    • Works iOS only
  • Tile:
    • Similar
    • Works on iOS and Android

Digital assistants:

Can assist with:

  • To-do list
  • Shopping lists
  • Reminders
  • Calendar
  • Setting an alarm
  • Timer
  • Orientation (date/time)
  • Calculations
  • Spelling
  • Location (requires bluetooth tags)        
  • Remembering specific things:
    • “Alexa, remember my wife’s birthday is August 27th, 1981”
    • “Alexa, when is my wife’s birthday?”

Medication reminders/adherence:

  • Voice alerts
  • Reminders
  • Only allow you to take right pill at the right time
  • Some will text or call caregivers if a dose is missed
  • Some options:
    • Medminder.com
    • Dosehealth.com
    • Reminder-rosie.com
    • Med-E-Lert

Academic/vocational skills:

  • Note Taking:
    • LiveScribe:
      • Smartpen
      • Records audio that is synced to what is written, built in audio while taking notes
      • Synchronizes note with audio recording, eliminates having to search through entire audio recording
      • Useful even for those with poor dexterity and can’t capture everything in a meeting/classroom
    • AudioNote, Notability:
      • App for mobile device
      • Records while note taking
      • Synchronizes note with audio recording, eliminates having to search through entire audio recording
    • Otter AI:
      • Real-time transcription app
      • Records conversation and puts into text
      • Good for taking notes
      • Free & paid versions depending on usage 
    • Google Live Transcribe app:
      • Android only
      • Text-to-speech
      • Option to save transcription for 3 days:
        • Or cut and paste into a note format of your choice
      • Requires data
      • Free            
    • Seeing AI:
      • Microsoft app
      • iOS only
      • Hover over text and it will read it out loud
      • Free
    • Claro ScanPen:
      • Using app, take picture and highlight the text, text is spoken automatically
      • iOS and Android
      • Free trial and paid version ($10)
  • Adapted writing utensils:
    • Special pens, special grips on pens
    • Help with limited grasp or arthritis   
    • Weight varies, so can be customized based on need
    • Good for people with tremors

Daily living tasks:

  • Nail clipping:
    • Clip Different:
      • One-handed nail clipper
      • Rotate finger and empty drawer when done
      • Rechargeable battery
      • Very safe
      • $150 
      • Adult and child version
  • Utensils:
    • Liftware – Steady:
      • Attachments are dishwasher safe
      • Motorized utensil that stabilizes distal tremors up to 70%
      • Rechargeable battery
      • $200 for kit, optional fork and spork attachments ($35 each) 
    • Liftware – Level:
      • Motorized utensil that uses sensors to keep the utensil level
      • Rechargeable battery
      • $200 kit + optional $35 fork attachment
    • S’UP spoon:
      • For liquid foods (soup, cereal)
      • Useful with limited mobility and tremors
      • Scoop holds food until brought to the mouth and tipped up to empty contents
      • $20
    • Obi Robotic Feeding System:
      • Hands-free robotic feeding system
      • Allows individuals with limited mobility to feed themselves up to 4 different types of food
      • Using 2 switches allows choosing food from desired bowls while accessing only 1 switch means taking 3 bites from each bowl at a time
      • Rechargeable battery lasts 3.5 – 5 hours
      • $6k
    • HandSteady Mug:
      • Unique handle which rotates to keep mug level
      • For reduced wrist/elbow/neck range of motion
      • Also good for people with essential tremor
      • Microwave and dishwasher safe
      • $20
    • Universal built-up handle:
      • Silicon material makes it grippier compared to foam
      • Can stick forks, pens, toothbrushes etc in the slot and it will provide more grip
      • Can use a slot or X side for larger utensils
      • Dishwasher safe
      • $20 for 4 pack

Dressing – adaptive clothing:

  • Many brands have adaptive clothing
  • Target, Kohls, Zappos, Adaptive Clothing Showroom, Tommy Hilfiger, Silverts, JCPenny
  • Buttons:
    • Magna-Ready:
      • Magnetic adaptor button kit:
        • Convert buttons to magnet enclosures
      • Retrofit to a button
      • No-sew option
      • $35 for 9 buttons
  • Adaptive shoes:
    • Nike Go Flyease (coming soon):
      • Hands free
      • No bending designs
      • Just step into shoes
      • Other version called Flyease Glide (already available)
    • Other brands with adaptive shoes:
      • Kizik
      • Quikiks
      • Zeba
    • If you wear a brace:
      • Easy UP shoe:
        • Designed for person wearing an AFO
        • Large back opening with BOA tightening knob (requires twisting)
      • Billy footwear:
        • Large front opening with zipper enclosure

Inclusive products:

  • Degree deodorant:
    • One-handed design
    • Magnetic closure
    • Large grip
  • Gillette Treo disposable razor:
    • Designed for caregivers
    • For a person who desires a shave with a real razor rather than an electric
    • Built-in shave gel, built-in safety comb to prevent nicks and cuts
    • Clog free design
    • Ergonomic handle
  • Alexa care hub:
    • Free but only provides passive monitoring
    • Designed to help a family member look after aging parent remotely
    • Can view high-level summary of recent interactions with parent’s Alexa
    • Easy access to Drop In, an intercom system between two users
    • Enables emergency (not 911) contact calling and notification when parent says “Alexa, call for help”
  • Ask My Buddy:
    • Personal alert network
    • Uses Amazon Echo or Google Home/Nest
    • Free service where you can use home voice assistant to call for help
    • By saying “Alexa, ask my buddy to send help”, it initiates a voice call, text message, and email to each of your predetermined contacts to check in on you

Fall detection:

  • Fall detection on Apple Watch:
    • Triggers 911 call when a hard fall is detected
    • Watch first gives you ability to cancel
    • If you don’t cancel, it will automatically call emergency services
    • After call, will send out a message to your emergency contacts, saying the watch detected a hard fall and emergency services were contacted
    • Available on Apple 4 watch and later versions
  • SkyAngel911:
    • Key fob and watch versions
    • 1 button to press to speak with 911 using 2 way speaker:
      • Automatically calls 911 but you can also talk directly with them
    • Automatic fall detection and calling 911 with a built in GPS for location
    • Cellular-based, works indoors and outdoors
    • Waterproof
    • No monthly fees

DIY options:

  • Sugro:
    • Rubber-like compounds (silicon rubber) to build-up objects and make them grippier
    • Can mold for 30 minutes, cures for 24 hours
    • Sticks permanently to many materials – glass, ceramics, metal, wood, most plastics and fabric
    • Tolerates wide range of temperature (-58 to 350ºF)
    • Non toxic, but it isn’t FDA approved yet, so don’t use for items that come in contact with food or your mouth 
  • InstaMorph:
    • Moldable plastic
    • Splinting material, but in granular form
    • Easy to work with
      • Melt in a cup of hot water and shape into desired form
      • Have 1 minute or so of working/molding time before it cool down and you can’t adjust the form anymore
    • Slippier than Sugru
    • Can drill it, and add colors
  • Grip tape:
    • Adding friction to a surface leads to less overall grip needed to hold onto something
    • Grip tape is an easy solution
    • Cat Tongue Non-Abrasive Grip Tape:
      • Apply to any item for increased grip
      • Is an alternative to Dycem, which is smooth and prone to collecting dust
      • Allergy free (latex free)
      • Waterproof (great for items in the shower)
    • Dycem Super Grip Comfort Tape:
      • Self-adhesive with layer of padding to make handles to walkers and canes more comfortable
  • One Wrap Velcro:
    • Velcro that sticks to itself, often used to wrap cords together because it sticks to itself
    • Can make easy loop handles for cups 
  • 3-D printing:
    • First a “model” is created using CAD software
    • Digital file converted into G-code by slicer program
    • 3D printer uses G-Code to lay down successive thin layers of plastic to create the 3D object
    • Different types of plastic with different flexibilities and other different properties
    • Simple description: heating up plastic and laying down in layers to create an object
    • Thousands of accessibility items available to download and print from online resources
    • Online resource option: thingiverse.com
    • Ex. one-handed fingernail clipper (attaches to normal nail clipper), stores flat:
    • Ex. snap on soda can handle (useful for limited grasp):
    • Ex. utensil holder (useful for limited grasp):
    • Why choose 3D printed:
      • If have access to a 3D printer, sometimes it’s quicker to print an item than to order it
      • Commercial option may not have all the features you need, you could modify as needed
    • If you don’t have a 3D printer:
      • There are many online websites that will print it and ship it to you:
        • Printathing.com
        • Shapeways.com
        • Makexyz.com
      • Local library may have one
      • Maybe connect with local high-school STEM class and provide them with a problem to solve and see what kind of solution they come up with
      • Makersmakingchange.com:
        • Connect with volunteers who may be able to print out items for you

Wearable technology focused on reducing tremors:

  • Steadiwear:
    • Gloves that reduce the effects of tremors
    • Claims up to 80% tremor reductions
    • Weight is under 1 pound
    • Battery free
    • $650
  • HandiThings – hand weight:
    • Unique open palm weighted hand glove with elastic finger loops to make it easier to use your hand for activities
    • Multiple sizes and weights to help reduce tremors during activities
    • $20-40
  • HandiThings – arm weight:
    • Arm weight worn around the forearm to reduce tremors
    • Variety of sizes
    • $20-40
  • Readi-Steadi:
    • Custom weighted orthotic designed by an occupational therapist to manage mild to severe hand tremors
    • Weighs less than one pound, applying sensory cues based on person’s unique tremor pattern
    • Requires order from a doctor, and working with a therapist to get the correct fit
    • $600 (most insurance companies cover the cost of the orthotic), requires a $150 assessment consultation fee
  • Steady-Rest:
    • Splint designed to mitigate tremors for feeding and writing
    • Works by stabilizing the wrist
    • $30 (available in left/right)

Resources:

  • Handout of assistive technologies for tremors:
  • All 50 US states have a federally funded assistive technology program focused just on helping citizens receive assistive technology demonstrations and device loans

Question and Answer:

Question: Does insurance cover any of these assistive devices?

Answer: Typically medical insurance does not cover a lot of these items. Things that are covered are usually durable medical equipment, such as walkers, canes, wheelchairs. Self-care items such a shoe horn or other things that help you get dressed are typically not covered. 

Question: If someone is living with PD, are there fundamentals that you would recommend for someone to consider having in their home?

Answer: It depends on your needs. I recommend connecting with your physician to get a referral to an occupational therapist who can evaluate those activities to find the best fit for your needs. 

Question: Are there any stores where people can buy assistive devices, rather than going online, so they can try them on?

Answer: It depends on where you go. Home Depot or Menards have some, they just don’t market it that way but it is there. Online has a lot more availability. Maxiaids.com has a lot of devices and is useful. A lot of the products are available on Amazon as well.

Question: Do you have any recommendations for brushing teeth or flossing with tremors?

Answer: For grasping, Sonicare is what we recommend. A universal cuff can help with grasping. A weighted open-palm glove is good for the tremor aspect. There are also some inserts to put into your mouth that supposedly brush your teeth.

Question: My employer set me up with nuanced or dragon-speak voice control on a windows computer, and it works very well. The employer wants to know if there is something for an Apple iMac that is better than their built-in software?

Answer:  Apple’s built-in feature causes really good control. What’s built into it is excellent. Nuanced and dragon can be used and can be better fits for different programs.

Question: What can help with cooking?

Answer: There are electric can openers, and devices to open a pull tab can, hold the pot and pan onto the stove top so it doesn’t slide around as much. There are ways and methods to adapt to take something out of the oven so you don’t burn yourself. I recommend getting an occupational therapist evaluation.

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