Development and Provision of Technical Aid for the Persons with Severe Physical Disabilities
Takuro HATAKEYAMA
8th ISPO World Congress in Melbourne, Australia
Scientific Session
(INTERNATIONAL SOCIETY FOR PROSTHETICS AND ORTHOTICS)
1995.3.3(This is an oral paper without slides)
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Dr.Platts, thank you very much for your kind introduction. I am very pleased and honored to be here, today.
As Dr.Platts mentioned, I am engaged in the Division of Rehabilitation Engineering of Yokohama Rehabilitation Center.May I have the first slide, please.
Yokohama is located in almost the middle of Japan where a 30-minute-drive by car takes you to central Tokyo. Yokohama is the second largest city in Japan with the population of 3,300,000.
The city is known as an old port town which had started to engage in foreign trade 130 years ago. I understand Melbourne is one of Yokohama's sister ports.This is Yokohama Rehabilitation Center where I work.
The center was founded in 1987 as a core facility for community-oriented rehabilitation system for the disabled people in Yokohama, which aims to optimize the living status of disabled clients.One of the characteristics of our center is home-visiting rehabilitation program involving multiple specialists.
Our rehabilitation engineering service has been developed in close relationship to this home-visiting program. This is because we, the engineers need to see clients at their home in order to develop and provide appropriate assistive devices.The visiting-team consists of a physician, a physical therapist or an occupational therapist, a social worker, and a rehabilitation engineer. A speech pathologist and a nurse are also available upon request.
This slide shows our home-visit. The client's wife and our staff are discussing to find the best way of access to the road from his house on the hill.
The Division of Rehabilitation Engineering of Yokohama Rehabilitation Center consists of nine engineers, who expertise mechanical engineering, electronic engineering, or architecture.
The division has five areas of concentration. They are; 1)housing, 2)mobility, 3)seating, 4)communication and environmental control, and 5)recreation and sports.
Approximately 600 cases are taken care of in the division per year.Based on my clinical experience for over 20 years, I am going to talk about development and provision of technical aids related to communication and environmental control.
People with severe disabilities often have difficulties in interacting with people and their environment.
It is frequently seen that utilization of assistive devices enable disabled people to minimize these difficulties.Communication devices are usually provided for those with cervical cord injury, cerebral palsy, progressive muscular dystrophy, and Amyotrophic Lateral Sclerosis known as ALS.
Of these ALS patients especially have serious communication problem in their terminal stage since their residual physical function is very limited and gradually declines.Let me explain the issues by showing you some of the assistive devices which we have developed for the past several years.
One of the important points of developing technical aids is to determine the most appropriate control devices.
The slide shows some of the commonly used control devices.
The point is that you need to determine how the user can generate any movement most consistently with the least effort.
The left above is a puff & sip switch developed for a C4 level quadriplegic user.
The right above is a balloon switch for a C3 level quadriplegic user. When he slightly pushes the balloon with his head, the switch is turned on.
The left below is a tongue switch for a user with a traumatic brain injury.
The right below is a finger tip switch for an ALS user.
As you noticed, these control devices are not necessarily the application of highly sophisticated technology.
The prerequisites of control devices are the certainty of input and the appropriate utilization of users' residual function.The left above shows an environmental control system consisted of an input device, a display, a controller, and standard equipments which can be added to this system through the controller.
The right above shows one of our users operating the system.
The middle below shows the utilization of a puff & sip input device.
Through the system a user can control many electric appliances such as a light, a powered bed, a TV, an air conditioner, a telephone, an intercom, and an auto-lock.
While the user is alone, he talks to a visitor through the intercom, and if necessary, let him or her in by unlocking the door.The access to a telephone is vital for severe physical disabled people to keep in touch with their friends and community.
The left above shows an telephone designed for disabled or elderly people. It looks like a standard telephone, but the dial buttons are depressed so that cerebral palsied people with finger tremor or those who use toes can easily dial.
As the right below shows, this telephone can be operated by single-switch control. While the bell ringing, the user can answer by pushing the switch once. To make a call, the auto-scanning of telephone numbers begins with one push of the switch.One of the advantages of the computer-based device is its multifunction capability. The adapted input devices enable the PC can run other applications.
The slide shows a user with high level quadriplegia runs a PC by manipulating an keyboard and mouse emulator named a KB mouse. This input device, a digitizing pad operated by a mouth stick and a puff & sip switch functions in the same manner as standard mouse operation.
The KB mouse allows him to enjoy drawing just like he used to do as a hobby. His skill of computer graphic had gradually improved and his drawings have been used as covers for a journal.The same input device enables a young man with progressive muscular dystrophy to communicate with numbers of people through a PC network systems. Although he stays in bed all day long, he can communicate with his friends and get any information whenever he wants.
The next is a reading aid designed for a client with severe physical disabilities.
The left above shows a computer-based filing system which display was modified so that a laid user could easily see.
This was designed as a mouse operating system. Since my client can not use a mouse due to limited hand function, I developed a single-switch interface which can control the system in the same way as mouse operation.I also created another single-switch interface which can operate the system by changing the combination of number and duration of touching.
This reading aid allows the person with muscular dystrophy to enjoy reading without any assistance. The only problem of this system is the cost. It is still quite expensive for a personal use.Interacting only with people is not sufficient to enrich the life of disabled people because we also engage in various activities by interacting with our surroundings or environment. As I mentioned before, this person draws computer graphics as a semi professional artist. So, he wanted to take pictures of his drawing subjects such as wild flowers or birds living in the nature. To respond his request, I developed a puff & sip control device for a single-lens reflex camera in a collaboration with a camera manufacturer. Besides focus and shutter control, this alternative device allows him to change the angle of the camera placed on a tripod in vertical and horizontal planes.
This is an automatic, electric easel designed for a professional artist with progressive muscular dystrophy. Controlling the easel with a joystick, he can move his canvas vertically or horizontally. After using this easel, he became capable of drawing a bigger picture once again and to keep holding his private exhibition in Tokyo which is the souse of his energy to live.Next, let me summarize the usefulness of technical aids to improve the quality of life of disabled people by describing a day of an ALS user.
Mr. Tsushima has been using a respirator for 5 years, and his residual hand function is to generate slight movement of his right index-finger.
Every morning, he wakes up at 6:30. His wife is still asleep due to rather heavy routine care taking for him.
He turns on the environmental control system by touching the finger tip switch. Then, to watch a 30-minute news show, he turns on the TV and selects the channel by touching the switch several times. When the news show is over, he turns off the TV and changes to a PC to write a story by using a soft ware application of word processor. He stores the story and turns off the PC. Then, he turns on the TV again to watch a morning show. At around 7:30, his wife comes into his room saying "God morning!".Some of you might think it is much easier to ask an attendant to control these appliances. What I want to emphasize here is that direct manipulation of these appliances makes him realize that he can still handle a part of his life independently. This is essential for him to sustain the quality of his life because it makes him feel alive and this feeling is the souse of his energy.
After having operated the word processor for several months, he completed the story about his battle to ALS. Unfortunately his physical function has been declined and he can no longer move his index finger. So, I provided another input device utilizing his eyebrow movement. He still keeps his life style by managing some of his daily activities independently.
Finally, I am going to explain four considerations which I think important in developing and providing technical aids for people with severe physical disabilities.
The first point is a precise identification of the user's needs. It is common that users can not specify their exact needs. In this case, some of the staff should reinforce them to describe what they desire. In case the user can not fully identify any, the clues are often found in the users' occupation, roles in their family, hobbies and future dreams. Next, the staff integrate all information obtained, and clarify the users' needs and available services.The second point is the respect for a user's self determination.
In the process of development and provision of technical aids, any final decision should be made by the user. To ease this self determining, we have to provide options as many as possible. Encouraging self determination usually improve the users' independence.The third point is an appropriate selection of the level of technology utilized for the device. The highly advanced technology is not necessarily the best choice. The selection has to be done through the careful assessment of the user's physical, perceptual and cognitive functions. We also need to know too much support by assistive devices may cause the user to lose his or her feeling of being alive (motivation of living). To minimize this disadvantage, any interface should be designed by utilizing the residual function appropriately.
Finally, to improve the quality of assistive devices, the most advanced technology that are developed in various fields need to be applied.
To accomplish this application, extensive collaboration has to take place with other researchers in universities, private companies and foreign institutes.May we have the lights on, please.
To maximize the independent living standard of disabled people, I will continue to develop and provide technical aids in Yokohama Rehabilitation Center.
Finally, I would like to thank Dr. Platts again, and I also thank the Board of Directors for inviting me to participate in this conference. May I also thank each of you in the audience.
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