So first and foremost, thank you all for joining us this evening for our National Grand Rounds event, which is titled assistive technologies for the consumer showcasing the latest technologies for consumer accessibility. This evening, our faculty is James Gardner, and we also have Sunil Subharwal who will be moderating for us. And we're going to run through just a few quick housekeeping slides, before we get started. So, first and foremost, just so you know, this product and activity will be recorded and it will be made available on our academies online learning portal. This should be done within the next week or two so please feel free to keep a lookout for that. For the best attendee experience during this activity, please mute your microphone when you're not speaking. You're also invited and encouraged to keep your camera on and to select hide non video participants. So this will ensure that speakers are prominent on your screen. If you have a question please feel free to use the raise your hand feature. You're also welcome to unmute yourself or use that chat feature. Please just be aware that time may not permit us to panel and for the panel to field every question, but we do have 15 minutes at the end of the presentation which will allow for us to answer any questions you may have. Okay, and then just a little bit about our zoom features here, we have our mute and unmute our video feature. And then our chat feature here to ask any questions. And feel free to submit any reactions this way. Okay, and then this evening's agenda so we're going to go through introductions, and then we'll have about 40 to 45 minutes for our presentation in a 15 minute q amp a. And before we pass off introductions just want to make you aware of next month's National Grand Rounds event, which is titled how to integrate MSK into other areas of physiatry stroke and stroke rehabilitation. So with that, I'm going to pass it over to Sunil. Great. So it gives me great pleasure to welcome and introduce Dr. James Gardner. I've actually actually having heard James before. I know we're in for a treat so I'm really looking forward to it. James Gardner is an occupational therapist at the University of Utah hospitals in the Department of Rehabilitation and is a certified assistive technology professional or ATP. He was hired there to develop an assistive technology program to meet the technology needs of patients across this rehab spectrum in that healthcare system. James is currently the manager of patient technology at the Craig H. Nielsen Rehabilitation Hospital where he ensures that patients have access to their technology and their environment during the hospital stay. He also helps patients transition the technology at home so they can continue accessing the world through technology in a way that meet their needs and abilities. So his really his vision, and I think the spread of the word, is to make the world a better place. presentation is to spread efforts to improve access and increase independence for people with all abilities. So I really like that last part, people with all abilities, because I think it's a key point, having heard him before. Of course, the primary goal is to educate ourselves and our patients so that, you know, they can access technology to overcome any physical impairments or other impairments that they have to optimize accessibility. But I think a silver lining is that I think we'll also pick up tips on how we can use technology to make our own lives a little easier and more efficient. So with that, I'm going to pass it on to James. Awesome. Thank you very much. And thank you everyone for attending tonight. So hopefully this will be a helpful review of some of the technology that you have or you're probably either watching on or holding in your hand a phone that has all the technology that we're going to show you today. And so that's, I think it's going to mean that you can be able to, like he said, like use in your day to life and hopefully also recommend to patients if it is, if it is as they need it. So hopefully everyone can see my screen. We're going to just jump in first here to the PowerPoint and then I'll be coming in and out of a PowerPoint and sharing some actual how to access these things. I'm going to be using an iPad for today's demonstration and for today's presentation. So kind of already saw, heard about what I do. I kind of work in all the different areas of rehab, both acute inpatient outpatient and in the community. I've been doing this for over 10 years now. And you can kind of see there all the different kind of areas that I work in both the computer or tablet phone access, mounting video gaming and virtual reality access entertainment, which includes music, television and movies and all the different things that people want to access that way. Social participation, lots of social participation these days is done all virtually and online. And so giving people access back to that is important. Home and room automation. You'll be seeing some, some material about how we can use this technology to access environment as well. I help with wheelchair evals and with speech evals as well for people who cannot communicate with their voice. And then I also work with outdoor recreation access and development of technology with outdoor recreation equipment. And then of course we have a, we have a development teams here at Craig H. Nelson Rehab Hospital that helped to develop new technology that's innovative and hopefully giving more access to patients. So we'll keep on going if I can. So today we're going to be looking at high impact solutions that are built into your devices or have some low cost things that you can add on. But most of the things I'm going to be showing today will be right in the device that you're, that you already have or that the patient already has. We're going to look at those main access options including eye gaze and head access, head control, voice control and showing you some really quick demos of how those work. Give you some critique about how it's used in the clinic and with patient care here in the hospital. Some pros and cons of all of them. And then I'll share a case study at the end so you can kind of see it in action with a patient. So in the past accessibility was reliant on these third party devices and they are expensive. There's a high learning curve for these devices and often needed, you need to take out a loan to get them. And oftentimes because they were like just made like one-off equipment, they often had low production value. And so they would break, so they're expensive and weren't very reliable. And so we began starting to implement these accessibility features about 10 years ago, about the time I started, there was this idea like putting this, these features inside the devices, inside a phone, inside a tablet or computer. But at first they were really limited in what they could do. And they still relied on third party devices to be really successfully used. And so not fully accessible. But now with companies like Google and Apple, Windows, they've all began to implement this technology right into their devices so that you don't have to buy a lot of different things to get it to be able to work for anybody of any ability. And so we're going to be looking at those today. The nice thing is that this is something that they're also continuing to develop and they're getting feedback and making them better and which is exciting to see that they're not just kind of sticking with one thing and keeping it that way, but they've actually found ways to improve all of these options as well. And really like the point of this is that we want to provide full access, not just partial access or some limited access, but want to give someone the ability to fully control their technology and then fully control that part of their life as much as possible. And so being able to go back to work, go back to school or other occupations and able to really do that efficiently and not have to feel like they are a liability for a company, but really feel like they can offer all the good things that they are able to offer. And so I'll be showing all these different accessibility features individually, but where it becomes really impactful is when we can put them in combination and where they use multiple of them together. And I'll be talking about that as well. So as we talk about in today's presentation, I'll be talking a lot about Apple. I'm actually, I own a Google phone, so I'm not an Apple only person, but I'm going to focus in on Apple because that is often what patients have. It's the most used phone in America. So we're going to talk about Apple. But with that said, all of the features that I'm showing you on Apple are also available in Google and on Windows devices. In fact, sometimes some things Google came first at. And so like it just is, they kind of like all have kind of piggybacked on each other and created this system that kind of works almost universally where it's similar in all the different devices. So, but we're going to look at Apple today. I'm going to show you how to access it in Apple devices. And then we'll, but just know in the back of your mind, if someone has a Google phone or a Samsung, whatever it is, Android, Windows, this is also available for them as well. And so Apple accessibility has come a long way. When they first opened, when they first started, they had just had a switch control and they have all these different features. Now I'm going to go ahead and hop out of the presentation and come over. Hopefully you can see this as well on my, the iPad that's showing up on the screen. So if you come into settings and you go to accessibility, you'll see here that there is a whole list of options for accessibility. And you're going from a vision. So they have people, people who are, who are blind and have low vision, they can use some resources on the iPad to help them understand what's happening on the screen and navigate the screen that way. My area of expertise is in the physical and motor adaptations. I work with most, most of the people with spinal cord injury. And so oftentimes they lose function of their hands or some level of the upper extremity and they can't use the phone or computer like they normally would. So lots of my work is done in the physical and motor. And today's lecture is going to be focusing more on the physical and motor accessibility features. But there are also hearing features that you, you'll see as well, that can be used for people that have hearing deficits. And then you can add in other things on top of the iPad to give it eye gaze options, which we'll show, and then some augmented communication as well. You can add some apps that allow people to communicate just with some cheap or cheap apps that you can download on your, on your device. The nice thing also that I'll talk about today is I'm showing you an iPad, but the same features are on the Mac books, the iMac, the iPhone, every device that Apple makes has the exact same features and it runs pretty much the exact same way. So you can really translate this information over to any device in the Apple ecosystem. So we're going to, I'm going to keep it on this half screen for now. So, cause I think it's helpful to be able to go back and forth between the iPad and the presentation. But voice control, voice control, it tends to be the very first access method that people can use. Obviously there are some people who are on vents or who have limited voice access, a little voice ability, especially right after an injury, but most people can get to where the point where they can use their voice. And so this is, tends to be the most popular and the most used access method that I, that I show patients. And it's also the one that's become the farthest in the last few years of being really helpful and usable for our patients. And when I, when I think of voice control on an, on an iPhone or an Apple device, you think of Siri first, right? And that is what often people think of, but really this is, Siri is very shallow as far as what it can do in like accessibility of a device. And so we really are moving more towards this idea of voice control, where you can actually click on buttons and swipe and scroll and do all the things that you need to do on a device. Not, not just like make a call or send a text message, things like that. As you can see, voice control, the voice control is built into the accessibility tab. It's right here. And then you have a lot of different options that you can do with, with voice control. You can do a dictation. So type paragraphs and papers and do all the things you need to do for emails, things like that. You can do gestures as far as scroll and zoom, tap all the different things you need to do on a device. And then you can also do device functions, like turn up volume, take a screenshot, things like that, where you might be able to, might be limited. Otherwise, when you can't, can't touch a lot of buttons on this side. The nice thing is that this is, this is customizable and it can be combined with other methods at the same time. So I'll be showing you later on some mouse functions, but you can use the mouse and the voice simultaneously to have a really full and efficient access for patients. We're going to show just a quick video. This is from Apple. You kind of get the idea of what it's capable of in a really brief way. And then I'll do a little hands-on demo as well. Wake up. The dictation microphone icon. Voice control is a breakthrough feature that gives you full control of your devices, comma, with just your voice, period. It's a whole new way to do everything you love, period. Like this. Correct love. A list of numbered options. 16. The word is replaced by a red heart. Open photos. Ian sits in a wheelchair in front of an iMac. Scroll up. Show numbers. 13. A man with a bike. Click share. Share options. Three. Messages. Next field. Ian composes a message. Let's ride this one today. Thumbs up emoji. Click send. Open maps. Show grid. Long press. It's 20. Mark location on the Pacific Coast Scenic Byway. Open app switcher. Four. Tap share. Tap Tim. Tap send. Now Ian rides his motorized wheelchair across a pedestrian bridge over a blue river. Later he uses a sip and puff controller to ride along a forest trail. Tim bikes up next to him. Hey, good to see you. Open music. Turn up the volume. Tim and Ian, look out the window. OK, so I like that video because it kind of shows a really quick and easy view of all the different features that is capable of with voice control. So let me just click off of this. There we go. It really is a powerful tool that patients can use. And really, and it's the nice thing that it's not a huge learning curve and everything works together, right? And so you can see it works pretty quickly and people can access everything they need to pretty efficiently. So let me go ahead and pull up my iPad again. It kind of lost its connection for a second. But what I was mentioning before is that where voice control really becomes powerful is in the customization of it. And so because oftentimes, we're limited in what we can do with just our voice by itself. And so let's see. James, your voice volume got a little lower than it was earlier. I don't know if you adjusted it. Let's see. I might be. Oh, it's good now. Oh, it's OK. OK. So this customization of commands is what really is powerful. As you can see here on my iPad, I can do simple things like open up music. So tap 44. Tap 44. Oh, changed. There's photos. Go home. Tap one. Tap 34. You can see you can just open up, swipe right. Swipe right. Swipe left. Do all the things like that. So those are the basic commands. But when you can get into this customizing part of things, you can really do things that are a little bit more intense. And so you come up in here. You go to Accessibility. You go to Voice Control. And then you can here go to Customize Commands. And you can make custom commands. So let's say you're playing Pokemon Go. Pokemon Go is one of those things you have to have a lot of different gestures and things to do. So it's not. And it doesn't work with the button pressing. And so it takes a little bit more effort to do that. And so to be able to get it to you, you have to make these custom commands, which are things like you would do something like this, like just throw a ball. And then you could label that catch it. And then at that point, you can come into your game. And imagine someone with no hand function that wants to play that game. You could say something like, open Pokemon Go. And then they get into the game. There's a sound for you. I'm going to turn that down so you don't have to have the Pokemon music going for you. But you can see here, there's all the different things you can catch. So you can say, show grid, show grid, tap 15, show grid, 15, tap four, missed it, show grid, tap four, show grid, 15, tap four, catch it. So that's all without hand function. So I'm not touching the screen. You can do everything with your voice. Catch it. Catch it. Oh, it doesn't want to be caught. But you can see there, it really does give full access. Once you create these gestures, and so you can do everything in games, even that move around an app, you can do everything with your voice, really giving that full access that is necessary. So using those customized commands is good. So you can also add vocabulary. So if there's names that are difficult for the voice dictation to spell, you can put in all your own names in there. And that way, you can have things like, Craig H. Nelson Rehabilitation Hospital, or my full name, or whatever you're doing, APMR, it'll know what you're trying to say and then type that out for you. So it really makes dictation a little bit more helpful as well. As far as what you can do, you can actually show confirmations, which is already, you saw some things popping up. Like when I say something, it shows me what it heard. You can also show hints. If you don't know what to say, it'll give you suggestions. The overlay is what you see here, the numbers on the iPad that will pop up here. That way, you can say tap, then it'll say a number, and then it goes there without having to know all the button names are. And then it has this ability to only pop up those options whenever you're looking at the device. And so it does not up all the time. So if that bothers them to you, you don't have to be showing it all the time. So it's helpful that way. So let me go ahead and come back to the presentation here. Other things, so like I mentioned before, other devices have the same control options. In Android, it's something called voice access. You can also use Google Home for some home automation features. And then in Windows, it's also called voice access as well. So if you're looking for this in other devices, you're going to search for voice access and your accessibility features on each of those devices. Switch Control is another kind of the granddaddy of all the switch of all of the accessibility options. It's been around the longest. Basically, what it is, you can press a button and it makes an action happen on the screen or in a room or whatever it is. It just is one button. That button can be as simple as the red button you see there. It can be also a sip and puff or a facial gesture as well. On the iPad, you can make it so if you make a funny face or you make an O formation with your mouth, it will make a click then. So you can really use the camera on the device or the screen on the device to really make any kind of these switches or like inputs, right? So we just need an input that can trigger an action on the device. There are a lot of different ways to do this and to move the cursor around the screen that is available on most devices. And so you can really adapt it to each patient and their ability. And so I'm going to show a video in a second that shows the different ways that it can be used. But this is kind of a screenshot here of kind of what it looks like when you have it going on your device. You can see a menu and all the different things you can do with just one button press. So if a person comes in, they don't have a voice and they don't have head movement, but they have just the ability to maybe even like sip on a straw a little bit or create a twitch on their face, they can then control their phone and control everything that they need to as far as the device goes. And so some things you can do, obviously with the device, you can add different types of switches, both sound switches, you can make a noise to make a happen. You can do a blink switches. You can do all the different types of motor switches as well. And then with that, you can do all the different options, both you can change the timing and how quick the meetings move around the screen and how easily they can be used. It's kind of easier to see this probably in the video. So I'm gonna show a video of it being used on an iPhone that you can kind of see what's happening there. Oh, before I do, this is a sip and puff device that we developed here at NRH that is wireless so that this can be put in on any patient that has any kind of ability to provide a sip or a puff action with their mouth. They can attach it there and it's wireless and it connects directly to the iPad switch control system. So it's kind of a nice way to access for our patients without a lot of wires or cables. But here is the video of it in action. So you can kind of see what it looks like. So you can see there's this like scrolling highlighted box that's moving around the screen. In this case, it's automatically moving. So he's just pressing the button whenever that box hits the button that he wants to press. And so he's trying to get to a certain area in the screen. It's moving around the screen, highlighting the different buttons of the phone. He's tapping the button whenever he wants. And then you can also long press and give you this menu which gives you a little bit more options like scrolling or the home button. You can really move around the screen. And this is what they call the gliding cursor. And so what it does is it kind of acts like a target. So you hit where you wanna go first time and then you hit it again where you want it to stop vertically. And then it's, he wants to get to the four. So he's gonna hit it again once it gets to the button four. And then horizontal cursor is gonna come up and down on the screen. And when it gets to the four for him on this time, he kicks it again. And then again, he will tap it and he'll get and actually click on that point. And this is really helpful for things that require a little bit more fine tuning and a little bit less time. And this example, you're seeing switch control used with lots of different switches. And so you can actually, he does it with his tongue. He can, you can actually, instead of the cursor moving automatically, it moves as he tells it to go up or down. So it makes it a little bit quicker. He also can use the joystick for his, on his wheelchair to control the switch control interface. You'll see that in a second. And that's probably the fastest way for him to be able to do it. And so he can move that joystick around. Yeah, of course. Creates. You can also sort of turn the volume down. It creates a, it creates a way for them to access their phone that way. So let's see. I'll do the next, next slide. And the next slide. There we go. And let me just quickly pop out. I'm gonna show you, I have some time. Yeah. I'm gonna show you where to access that on the device. And so you back in the accessibility features, you're gonna see switch control. I lost my connection here. Let me talk back on here. You can see. You can, that way I can share this with you. And so if you have your own device, you can also look at it on your device as well. So here underneath accessibility, there's switch control. You'll have to turn it on if you want it to work, but here you can, here's where you can add switches. You can see here, there's different ways that you can do that. You can add a new switch. And here you can see a sound. And so you can say these different laws or oohs or pops, and that will become a new click. Or with a camera, you can do left or right head movement. And you can add an external switch as well. That's where you add switches. And then you can make recipes, kind of like with the customization thing, with voice control, you can do certain things with certain amounts of switch actions. And then you can see here, there's a lot of different actions that you can adjust and make the switch control more accustomed to the patient or to whoever's using it. So that is kind of where you can access switch control for yourself. Okay, so next one is mouse control. And it's kind of funny to talk about mouse control on devices, because you think that it would be pretty straightforward, but actually iPads and iPhones didn't allow mouse control up until about a year and a half, two years ago. But now they have implemented a mouse cursor option for mobile devices, which is really helpful for our patients that want to be able to use a mouse on a mobile device. And so this is something that you can plug in either through the USB-C port on the iPad, or you can do a Bluetooth mouse and then have a full mouse access for controlling the device. I find that this is most powerful when it's combined with voice control. So you can move a mouse on the screen and then use your voice to dictate. It makes it so you can really have an efficient access for going to work or doing kind of school tasks and things like that. There is a way to customize some of these functions as well, but most people just use it straightforward. The question is like, what kind of mouse could someone with little hand function use, right? So we kept kind of think outside the box of like, it can't be maybe your regular mouse you'd work with your PC on, right? And so, or even a track pad may not be usable. And so we had to think outside the box of what they can use. And so, I'm gonna skip that for now, maybe not. And so we can find a ways to find options that they can actually use their head to control, right? So we're just gonna go ahead because I think, yeah, less than time. And this is where most of my patients end up falling and needing. And so the one I use most is called the glass house. It is something that you wear on your face or there's new ones that can be kind of worn on a hat. So it's not so a front in your face, but it really is just basically a mouse on your head. And so it turns all your head movement into a cursor action on the screen. The KUHA Zono is the same exact thing. It's just a little bit more expensive. And then the Noki Logic is something that is actually in development. It's gonna be something that's worn in the ear that has some really cool technology built into it as well, but it's not actually available right now for purchase, but it's something that I'm looking forward to trying and something to look forward to in the future. But really this ends up being for someone without hand function, really the best and fastest way for someone to reuse a computer or a phone. And so, then the other option, if you don't have all these devices or don't have the money to spend on the glass house or the KUHA Zono, you can actually do, there is the ability to use head control on the iPad itself. It's built in the switch control settings, which doesn't make a lot of sense, but you can use the front facing camera in your iPad and then it tracks your head movement and facial gestures and creates a mouse there. So you can see here in head tracking, you click on that. And then once that's going, you can then use these smiles and eye blinks and things like that to create mouse clicks and be able to use the device just with your head using just what's on the iPad itself. And so that's helpful. You don't have to buy anything at all and you can have a pretty good head tracking option. The one drawback of using head tracking on the iPad is that you have to be in front of the iPad. It has to see your face. It can't be mounted to the left, really. It's got to have a good look at your face. And so it becomes more of like it takes over your vision. And so that's the one drawback of using the head tracking ability that's built into the iPad itself. But there are some great options for head control. So this is, I don't know if you can, can you see my video? Someone can say that they can or not. Can you see my face on there at all? Or is it just my screen? I can see your face. Okay, perfect. So you can see, you can see I'm wearing, this is the Glass House device right here. And you can see on the iPad, now I'm moving my head around and I have the, I use this bite switch, right? And you can use sip and puff. You can use different switches to use it, but I'm going to just put this in my mouth and click on a few things. You can see how it works. As you can tell, like just a few things that I did there, like you can get a pretty efficient access. Like you can click around a screen and you can do all those things pretty easily and have a very fast, efficient access to any device, which is the goal, right? We wanna have, give people the option that not only like, can they use the device, but use it quickly and have be successful in whatever they want to do. We're gonna keep moving forward because we have a lot of time. Eye control is the kind of the last, is the last one we're talking about today. There is some built-in eye control to show you. Most of the time though, we end up relying on third-party devices for eye control. That's really like fully accessible, right? And so Tobii is probably the number one device maker in eye gaze, and they have an iPad version now that you can use. You can have an iPad and put it in this case and it makes it an eye gaze device. Skyl is another option. You can see it's a little bit more expensive. It's not necessarily gonna be a cheap option, but for some patients, it's gonna be the only way that they can access their device really well. It also, the pro of using eye gaze is that it can be more private, right? So voice control can be a little bit noisy if you're in a work environment or at a school environment, not be able to use your voice. So head control and eye gaze control can be a little bit more private and be more discreet way of control. This is a video showing how it's being used. The eye gaze can be used in our hospital rooms. This is using our room controls that we have developed here at Creative Nursing Rehab Hospital. You can see, I'm just using my eyes to move the cursor around the screen. I'm clicking on different controls and I'm able to open the blinds and turn on the lights. And eventually you'll see control the TV with just my eye gaze. So, and it works well for it works well for some cases it's not the best option if they had head control I probably would push them over to head control it's cheaper and it's also a little bit faster, because you can add a little bit more access options like by controls and things like that to make it more, more fast for them but that is something is an option that they can use which it can be helpful. There is an app called Hawkeye that you can download it's free on the on the iPad that uses the front facing face ID camera so you have to have the iPad that has a face ID camera, but you can then control it does have some eye gaze options, and it but you have to be within the app you can't leave the app. So we're not quite there yet but I do see that in the future that this is something that should be and could be implemented just like everything else you saw today, built into the iPad or the iPhone itself and having eye gaze as a control option so I'm hoping that in the next couple years we'll see that become a little bit more accessible, because if it does, it makes those 3000 $10,000 devices a little bit more usable for more accessible for consumers. One thing that I'll just add here for our Google users is that there is this option called Sesame enable it as a company that won an award for the development and they tried to do a business out of it didn't work well but they were kind enough to allow people to keep this to download for free now, you can use the front facing camera of your device as a head tracking cursor for the, for the phone, it doesn't work on iPhone right now, but it is a little bit easier to use than the head track control that's built into the iPad it has a lot more like cool features built into it that makes it more efficient so for someone who needs a free head gay head tracking option, and has an Android phone this is the one something I would recommend to try. As far as, okay so this is kind of where I love where I get into what I really love, and so the person I'm going to talk about today we're going to call him Ryan. He came to me as a three quarter three C3 spinal cord injury I actually met him the day after his injury because someone called me and said this guy in acute wants to be able to access his iPad. And so that's the kind of person he was he wanted to have independence he want to have access immediately and not wait around and so met him there. He was very highly active before his injury he loved to ski and he worked for a finance firm very tech savvy, his goals were to get better get back to work and get online immediately and without any delay and so that's kind of what was what we're going for. But he really be able to do that he needs to be able to multitask multitask be able to use the phone and computer same time he's on a call with clients. He can't just be trying to get just the computer he's got to be able to talk to and answer phone calls and then access their information on there on the, on the, on the computer. So that becomes really difficult how do we do that has to be efficient right so it's got to be quick can't they not because they're not going to be able to wait around and wait for him to be able to move around and change access methods and try to click around with the switch control so it had to be a little bit faster and easier for him to use and he's got to be able to dictate emails, send texts, make documents quickly, all those things have to be done. And so for him what we did is we actually put in four different access access methods and so we use the glass house first computer mouse control we use Windows Speech Recognition or Windows Voice Access now for computer control so he had his computer here, and then he had his phone mounted right next to him. And that was where and on this phone we had his wheelchair actually we had has the wheelchair can be used to control the phone. So he had his wheelchair you joystick using to control the phone and then he uses Siri dictation the voice control built in software to be able to send texts and do all things on his phone. And so with those four access methods he was able to go back to work full time he worked 25 hours a week, or the C3 spinal cord injury, and he was really successful in doing it and so I'm going to these are just some quick, I this these videos are a little bit older and so the grainy but I really feel like they really show what you're going to see is him doing some mock work, you'll see him controlling the phone with his wheelchair you'll see him going to the computer accessing Gmail, and doing all the different things that he needs to do for work. My glass house assistive device makes it so easy to use my computer and phone at the same time. Check it out. So here's this glass house clicking on me watching the news, I go to my, my music. And of course I get a phone call right here he's using this wheelchair with switch control. Hello. Yeah, you want me to email it to you. Okay. So same time he's talking he's accessing his computer with this glass house, and getting online and getting all the information that he needs there. The next video is going to be showing him dictating a little bit. My glass house assistive device makes it so easy to use my computer and phone at the same time. Check it out. I can be watching the news, I go to my, my music, oh I did the wrong one, the wrong video that's okay. I'll have to like, let's see this forward, let's try, let's see this one. Once you get your systems together, you realize some things are faster with speech recognition, some things are faster with the glass house device. Hey buddy, comma, I'm sending over that video you wanted for your presentation. Just like that. There you go. So you can see like he was able to do all these complex activities with no hand function whatsoever, hardly any head function as well but some limited head function as well but he was able to get back to that activity fully and I think that is kind of what I like want to end with as far as accessibility side is that really, like I mentioned before like this technology and I apologize for going so fast. There's a lot to talk about could probably give us in two hours as well. But really giving and thinking about how we can provide access it's not just about maybe like someone like just answering a phone call but really is taking back your life for some of these people and, and then not not in this and like taking back things that are meaningful for you and taking back your, your friends and your family and your work, all those things that you feel like you would lose from a devastating injury. You can gain back at least at some level maybe not fully and maybe not the same way that you would want to but it does give you back those things and I think that's the power of this is that by using these accessibility features and combination and finding ways to give really good access we can provide patients with a really full and meaningful ways of taking back their life. I wanted to just show you how this this technology can translate in other areas as well not just in the computer for work and school but also in the community and on the ski mountain. And so we at the Craig Edgerton Hospital Craig Edgerton Rehab Hospital has developed a couple of different options for allowing these people that have limited upper extremity function to have access to recreation. One of them is a Tetra ski it's a device that was developed here in house and a lot and it really allows for downhill sip and puff skiing independently without anybody really helping them or do anything on they can go and really access their So that's actually Brian the one that was in the video before that's him up on the mountain. And you'll see him in a second. He's going to be using a sip and puff device. He's in a sip and puff device to control some actuators on the ski itself. And he's going down the mountain on zone the guy in the back is an emergency break, but he's not controlling the device at all. So Brian is able to go and do all these things on our own on his on his own and so that's that is an example of how the sip and puff controls that we use for our computer access are also used for the ski is the same sip and puff that we developed here that can be used in this way that really helps him take back not only his work but this is what he loved to do he loved to ski and so giving that back to him was huge. And just making him feel like he had that ability to take risks and have fun and do all the things, even with limited opportunity function. Next one is a video, this called the tetra sale. So this is a patient who is in a skill their facility, and has been there for almost 20 years now he's he's on a ventilator, and he's using our sip and puff device to control a ski, I mean a cell that we developed that's motorized and fully independently, changing the sales direction and moving around the lake on his own so thinking about sitting in a scanner facility for 20 years to be able to use the technology to get back on a lake, and to be independent and to have these, these life meaningful life experiences. It's powerful thing that what technology can provide. So, and then I'm also going to show you in the last two minutes, something that we've really that's kind of my, my own personal projects, as that we developed, we built the creation of some hospital we developed fully automated hospital so we made the rooms and all all 75 beds in the hospital fully accessible for any patient at any level of functioning so if a person can sip on a sip on a straw I can mention they can control everything in their environment in a hospital room and I feel like what it does is it gives patients the view from the very beginning like I can do this. This is possible. I have, I have potential to be independent and to do things beyond maybe what other people could think I could do. And what I even know, even my, even, even themselves may not think they can do and so here's an here's a video just showing a quick idea of all the different access options that we developed, and we gave to people you this is with voice control and I think also the head controls, I control all the things. Let's watch cable. Please turn off the clock. Turn off the TV. Please open the door. Thank you. Hi, can you open the blind. So we've even have the ability now also to take that accessibility outside the room as well. So you saw the door opening, you can also, we've also developed a way, and it's the first in the world really in the hospital setting at least, that allows us to have voice control of an elevator. And it gives the people, they can leave their floor, go down to the cafeteria, go to the garden outside and do it all independently without having to have anybody kind of do things for them. So they're gonna show that really quick. Mac, open the door. Mac, take me to the first floor. Okay, so you can kind of see like, that is kind of like the ideal of how we can really implement this technology, not only with using the devices, but also thinking about how to open up the world outside their house or their room and thinking about how we can really give access with this technology to the entire space and the world around them, which is in the community around them, which is exciting. And that's something I wanna help to promote and to pass on and to gather other hospitals and other facilities to really think about how we can provide access to everyone, right? Like not just some, but really think about access for all. I really wanna really quick say thank you to the team at the Craig H. Nelson Rehabilitation Hospital. They obviously support me a hundred percent and everything we do here is a team effort. And then also everyone asks me like, how do you get this to work? Like, how do you do this? Well, the first thing I say is contact the IT department and have them contact with ours because it really was they're like seeing our vision and allowing our vision to grow that allowed this to happen. And now they've even dedicated, continue to dedicate three full-time developers that continue to work on developing new ways to use the technology that's in the hospital. And I could share a whole presentation about that as well, but it's exciting to be able to be a part of that. And I wanted to say thank you to those people. And so with that, I know that was very quick and very like fast paced, cause I wanted to get through as much as I could in 45 minutes, but I will just kind of put this here. And then you, there are some QR codes here that you can get on. One is the Trails Adaptive. So those ones with the skiing and the sailing, the group that does that is Trails Adaptive. And so if you wanna follow that progress, we're working on getting to be a Paralympic sport. We have skis in all over Europe and all over the country now and people that train people how to use them. And so we're really trying to push to get this to be a worldwide sport. So it'll be the first real sporting event for people with quadriplegia or tetraplegia that would be able to have full competition, which is exciting. And then this is our hospitals Instagram, which you can follow all of the different smart hospital and there are the updates with us there. My contact info is on the left bottom. And then if you ever wanna come and take a tour of our facility, you can request one and we're happy to do it. We really want to share and promote this technology and push it out to the rest of the country and world. And so we're happy to do a tour and to give that opportunity for anyone to come see it that wants to. So with that, that's all I have to say. I'm here, now I'm ready for questions. And I think that there's gonna be a moderator that's gonna help give those to me and I'll do that now. So I'm gonna close, at least stop this full presentation. I'm gonna leave this up so people who wanted the QR codes can still grab them, but I'm ready for questions if there are any. James, I don't know if you can see the chat, but lots of thank yous and great talk and lots of appreciation. So we still have about five minutes or a little longer than that for questions, if anyone has any. I know I'm going to try this on my iPhone as soon as I get home. Yeah, that is the fun thing is that most people have these devices with them and they can use, I use voice control all the time, especially when I'm driving, things I need to do hands-free and I want to do, I can really have full access that way. But yeah, so something you can just use on your phone and try it out. And then you can show your patients when you're ready. Nice way to take pictures when both your hands are occupied. Exactly right, yep. Great, well, I know there's a lot of thank yous. Do you have any other last boils of wisdom to share with us? No, I mean, obviously, like I said, there's a lot more that I could share and then details I could share, but I feel like my goal was to just give you a vision of what's out there and then let you, like you were mentioning, explore on your own and really think about how you can utilize this in your own practice, what patients maybe don't even think about that they could use this and really benefit from it. Oftentimes, we just don't often think about it and don't know that it's there. I had a patient just come in yesterday that had, it's an 11-year-old with CT spinal cord injury and the caregivers weren't aware of the options that were there available for them. That was right on the phone that she already had. And so came in and all of a sudden she's texting her friends and she's looking at her TikTok and she's calling people and taking videos and vlogging all of her experiences. And so really did like within like a 15-minute session, open up a whole new area of the world for this patient. So like, I think that is what the, there's a lot of meaning that can, meaningfulness that can be found here, even if it seems small and maybe unimportant in the grand scheme of things. And there's obviously lots of medical things that need to be taken care of, but independence and access are going to be vital for helping them mentally cope, I think with the difficult situations that people come into, so. So Paul had a question about how will AI interface with this technology? So, yes. So like there's a different answer to that question, but AI into our smart room stuff is already in development. Like we're starting to think about how the room can react to the patient's sleeping patterns. If people with brain injury need to be woken up at certain times and have sensory stimulated, sensory limited at certain times, the room can actually provide that. So really thinking about how camera, we're using camera technology and our real-time locations technology, having their room start to really think ahead for the patient and how it can be helpful for the patient's healing as well, not just environmental control. But for AI, I think that is something that is going to be really helpful where lots of times the biggest hindrances are just getting through some of the menial tasks of it all. And so if you can tell a device to say, hey, can you email my boss or whatever, and tell them that I'm gonna be late for the meeting, whatever it is, like it'll do all of that within with just one command versus now it would take open Gmail, boss's email, and so there are some things that Siri could do with that, but to have a really like fully featured and written out email where AI could do all that for us, I think that's gonna be a beneficial thing for the AI can help kind of make some of those smaller tasks easier for people with disability, right? And so utilizing all those kind of fun things you've seen chat GPT do, think about like for someone that has a hard time typing and has a hard time writing longer paragraphs that they can really get out thoughts quickly and then edit those and make them theirs like that is where I think it could be a really beneficial thing for our patients and people that have upper extremity deficits. So I'm excited to see kind of where that will go and how we can utilize that more in accessibility. Yeah, good question. It's definitely on our minds. If any other questions, you can put them in the chat or just unmute yourself or your video and pick up if anyone has any questions. I don't think you lost anyone in the audience. So James, thank you so much. Now, I guess I have a question. Is there, there was a lot of information and it was really good. Is there like a place you could go back as a reference to refresh yourself or what are the kind of resources you could go to? Yes, so obviously like Apple has, Apple and everyone has like tutorials and FAQs that you can go to. YouTube, of course, you can learn anything on YouTube. And if you just put it in there and you wanna learn how to access and how to actually do all the different setting changes, you can get on there, get on YouTube. My number one recommendation is what I've already shared is that you get up, open your phone, open the accessibility tab and just start messing with it and trying it out. That's how I have learned most of what I've done with the help of experts online. There are some online resources that kind of go over a lot of different of the access methods that you can add on and buy. And I'm happy to share that some of those links, I can sort of get some of those links to you and maybe you can share it with, I can share it with the, I don't have to share with this group or not, but there are some online resources that do have like a little bit more of a breadth of like what's out there than more than what I just showed. I just kind of showed you kind of what I have used the most and there are other devices out there that may be beneficial or maybe even cost-effective for some of other people, so. Well, thank you so much. Really good. Yeah, you are so welcome. Thank you everyone for spending your evening listening to me talk.

assistive technologies

consumer accessibility

James Gardner

voice control

switch control

head control

mouse control

eye gaze

disabilities