Computer & Communication and Environmental Control
At this session, I would like to talk about the computer and Communication and Environmental control for the people with severe physical disability.
What do you call to mind by hearing the word "Communication"?
I call this picture to mind at first.
This is a person to person communication.At our home-visiting service, we used to use a character board.
But, if the client has a severe disability, it is too difficult to read the client's finger movement.This is a message board using in the daily living.
The client can efficiently communicate rather than a character board.
A key of using this communication method is a changing the various content board according as living scenes.This is a most simple communication aid.
If the client is hard of hearing, it is very useful.
A key of using this aid is the adjust your eye to the client's eye.This method is called "Eye Contact".
If the client can not move the part of the body except eye, this method is utilize.
You can see the client' eye movement through the transparent acrylic resin board.
On the surface of the board, you put thecharacters or pictures.
By reading the movement of the client's eye, you adjust the position of the board until the character or the picture, the client's eye and your eye is on the straight line.
For using this method, you need a lot of training.
Especially, in the case of ALS in the middle of the night, there is no way except this method.Untill here, I was talking about a person to person communication.
I think it is important about not only a person to person communication but also a person to the client's living environment, a person to social, nature and animals such like this picture.
If a client has severe physical disability, the switch for controlling an assistive aid is very important.
This picture shows a part of human body for the control switch.
For example, puffing and sipping, up and down the shoulder, touch by the hand, the finger, push by the elbow, the heel, the toe, the head and so on.
These are in practical use.
In the future, it will may utilize the eye movement, the voice recognition, and the brain waves.
But at the present time, we provide many practical control devices.
From now, I would like to show you a practical application of the control device.This is a puff and sip switch for the TV remote controller for the C4 level quadriplegic client.
He can not at all his body except above shoulder.
When the client puff into the cube at near his mouth, the TV power turns on.
When he sip, the TV channel will change.
This is a very simple aid.
Before he was provided this aid, he refused any rehabilitation program and services.
The reason was that he lacked the motivation to live.
But after I introduced this simple aid to him, he felt rejoicing that he can control something by himself and he become positively at everything.He is C3 level quadriplegic client.
I designed the balloon switch which he pushes softly by his head movement.
He is able to call the nurse by using this switch.
After using switch, his fever of unknown origin disappeared.
Maybe, the reason is the cause from a psychological unsuitable situation.He is the client with a brain contusion.
He is unable to move body except his tongue.
But there is a involuntary movement of his head.
Therefore we designed a tongue touch sensor with a fixed device at his chin.
He became to call his mother overtime when he want to listen to the classical music.This client is an Amyotrophic lateral sclerosis (known as ALS) patient.
At this picture, he is still able to move slightly his finger.
In every time, he can call his wife in his house.
Therefore both of he and his wife felt a sense of security in their mind.
I think it is very important in the care at the own home.We often use a string switch controlled by the thum of foot.
This is a piezoelectricity switch.
When this material bend slightly, the electricity was generated.For example, this picture shows an application as a headband switch.
If the client move her eyebrow up and down, this device work as a switch.This is a very simple and interesting communication tool which made by the client's idea.
A communication book was fixed near Joystick Control box of the electric wheel chair.
The user is able to manipulate the page of the book by his toe.
He changes the page according to the living scene.A certein person from US was using a dial plate communication device.
The dial plate was fixed on the foot plate of the his wheel chair.
He rotate this dial by his toe to communicate.
This device is a special made article.This is a most simple communication aid which is called "Dial Scan" or "Rotary Scan".
When the user input a signal, the pointer such as the minutes hand begins to rotate.
The user may stop the area which the user want to select the words or picture.
I think you will be able to make by yourself.Approximately 25 years ago, I made this communication aid for the mainly Cerebral Palsy.
It consist of a scanning board, a real voice recorder, a slide projector and a display.
This protype is the model of a existing communication aid in Japan.This is a handy type communication aid with voice output.
The voice is a synthetic sound by using the micro computer.This is a handy type communication aid which can be recorded the real voice.
You can use by both methods of the direct selection or the scanning method with one or two switches.At here, I would like to talk about the relation between the control device and a seating or positioning.
She is 30 years old.
Before, she was perfectly bedridden.
After she got the appropriate positioning chair, she could sit by herself and move freely her arm.
This picture shows a training scene to point the large target by her finger.
At the last, she could manipulate the normal keyboard with a keygard.
Especially in case of Cerebral Palsy, you should fully examine the seating or positioning before a examination of the control device.This picture shows that she is manipulating the keyboard with a headstick.
This is very nice method for her at this point.
But, this method may cause the serious problem in future.
That is the disease of cervical vertebra.
When the people with Cerebral Palsy will be more 40 years old, most of people have this problem.
Therefore the disease prevention is needed.
I think it is very important.This picture shows a positioning chair with a neck and head and shoulder support.
In Japan, recently, many people are interested in such a considerations.Well, I will go back to the subject of the communication aid.
This picture shows the ordinary display of the communication aid by utilizing the personal computer.
The user can select one character by auto scanning method that is vertical and horizontal combination.I would like to introduce a certain boy who has a neuro muscular disease and used an artificial respirator since 5 months.
At this picture, he is 8 years old.
I provided a special switch which was consisted of an optical fiber sensor.
This thin black cable is an optical fiber cable.
The top of the cable attach an ultra miniature sized prism.
He is unable to move his body except his eyes and his right thumb finger.
When he move his thumb finger slightly, the light from the prism was reflected with his thumb, and it become the switch signal for the communication aid.
When he begin to use this communication aid at first, he tried many times to activate the switch and after 15 minuets he begin to write the letter on the TV screen as following.
I am IKUO. I am 8 years old. My teacher' s lesson is not interesting for me. My teacher's face looks like a certain animal...
...
But I have a big question. Why does he has this power of expression?
Because he is unable to speak, write, and has no body movement.
There was a secret.The fact is...
One year ago, he and his teacher was made a communication rule which is suitable for his residual function.
This picture shows a speciall table of Japanese syllable for him.
For example, when his eye look straight forward and move his thumb one time, it means Japanese character "a".
Another example, when he move his eyes lift up and move his thumb one time, it means Japanese character "kA".
Every thing like that.
Since one years ago, he and his teacher trained to write a letter with this rule.
I was very much impression ed..
Here is no technology, But he is able to communicate fully.He is now a High school student in hospital
When he write a home work, he uses a communication aid
When he ask something to his family, he use this special rule.
Till now, he wrote 2 books and one of his hobbies is a communication to another person via a computer network.The access to a telephone is vital for severe physical disabled people to keep in touch with their friends and community.
This picture shows a telephone for the people with disability and elderly that we designed ten years ago.
After then, more thousand people is using this telephone.
The idea in this telephone...Each dial buttons are depressed so that cerebral palsied people with finger tremor or those who use toes can easily dial.
As this picture 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.This picture 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.
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 client is alone, he talks to a visitor through the intercom, and if necessary, let him or her in by unlocking the door.
Generally speaking, a purpose of utilization assistive aids is a decreasing the load for care.
This is fact.
But I think that is not enough.
The question is How does the person with severe physical disability to live?
First of the important matters is an increasing something can by oneself.
It will produce the energy to live in the client.
Next is an increasing sometime being alone.
This makes the client to be free from the family, and the family too.
Next is a finding one's part in home.
In most cases, the almost clients have lost sihgt of his or her part in home.
But, by using assistive aids they do the some job for the family.
For example, the client can take care of the house during the family absence by utilizing the telephone, intercom, and unlocking the door.
The last one is a keeping in touch with the society.
The client should be a member of the society.I would like to show you this well-known graph in the rehabilitation medical field.
The horizontal axis means the passage of time.
The unit of this axis is month or year.
The vertical axis means the psychological strength of reaction of the cervical cord injured patient.
If a person meet with an accident and his or her cervical vertebra was damaged, at first he or she will be at stage of shock.
If the person's damage is in C4 or C5 level, the person can not move one's body at all.
We call this stage as "Shock Stage".
After a few weeks or a few months, the patient will change over to the next stage.
We call this stage as "Denial Stage".
At this stage, the patient will not admit one's body situations.
It will be no long before the patient will change over to the next stage.
We call this stage as "Distress Anger Stage".
Most of the patient will say no to the families and the medical staffs about every things.
The question is How the patient will escape from this stage.
We have many experiences that the patient escaped from this no good stage by utilization of Assistive aid.
The patient will change over "Adaptation Stage" and "Recovery Stage".
The key is How should we give the patient this opportunity.That's all.
I would like to close this session.
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