Augmented Communications Network for SCI Community Living Center

Implementation Home

Idea

Communication network for 30 residents of a VA Spinal Cord Impairment Community Living Center, accommodating disabilities ranging from up to eyeblink only. Provides communication including internet access, single/multiparty telephony, mail and instant messaging with a secure server. Augmented Communication interfaces include voice recognition, head control, and eye-gaze control. This will enhance communication among residents, and give all residents access to telecommunications and cyberspace.

Click the Documents link to read documentation and metrics for this Innovation.

Click the Overview link to read the Innovator's original proposal.

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Lead Innovator: Dr. Jeffrey Harrow, Physician, Tampa VAMC.

VHA ISSUE BRIEF

Issue Title: VHA Innovation Program Good News Story: Innovation #100, Augmented Communications Network (ACN) for Spinal Cord Injury (SCI) Community Living Center (CLC). James A. Haley Medical Center, Tampa, Florida.

Date of Report: October 27, 2011

Brief Statement of Program Issues and Status:

The Innovation prototype demonstrated the feasibility of augmenting a communications network to accommodate SCI residents in the CLC using customized software allowing access to the Internet, email, movies and music.

Background:

This Project designed and demonstrated the use of an Augmented Communications Network (ACN) comprised of Augmentative and Alternative Communication (AAC) hardware and software as needed for three levels of patients to control their mobile stations:

  • Level 1: Paraplegics with reliable motor control of head and arms. Communication and presence tracking is facilitated by a portable communication device which can be operated by touch (or voice) and can be carried around the campus on Resident wheelchairs.
  • Level 2: Quadriplegics with normal speech and reliable motor control of head, but without upper extremity function. Communication and presence tracking is facilitated by a touch-screen operated either by a head-controlled cursor with the use of a head-tracking device (or voice-control) or by a caregiver’s touch of the screen.
  • Level 3: Quadriplegics without speech and head control, but with reliable motor control of eyes only (generally those diagnosed with amyotrophic lateral sclerosis (ALS)). Communication and presence tracking is facilitated by an eye-controlled communication system using facial recognition software and a camera which allows the resident to select communication words and phrases by using the motion of their eyes.

The ACN provides networked communication between CLC residents, staff, phones outside the CLC and Internet sources. It includes access to telephone, email, instant message (IM), message board, checking “presence” and to access the Internet by customizing individual mobile stations to match the disability of the user. Disabled users with vastly different communication needs are able to control their stations and access Internet, email and over 600 videos stored on the server using customized software requiring a low degree of computer literacy.

An additional goal of this project was to demonstrate low-cost solutions whenever possible, both to reduce cost to the VA and users who have to buy these items on their own.

Actions, Progress, and Resolutions to Date:

The prototype demonstrated model tablets tailored to the individual’s disability, using affordable software and hardware. A Windows 7 environment was required instead of a tablet based on Google’s Android OS or Apple’s IOS because the augmentative software selected or developed are run as programs and not applications. The model tablet included five augmentative programs that were used depending on the needs of the individual: Windows 7 Voice Recognition (included in Windows 7), Dwell Click, Tilvus, Button Builder and Groucho Switch. Dwell Click allows persons who can move a mouse, but not press a button to simulate all modes of button pressing (left, right, double click and click-drag) by dwelling in one position. The Tilvus™ Assistive Interface enables full computer control using only a single, momentary contact switch controlled in various ways. Tilvus uses innovative “Coaster Cursor" allowing direction of the cursor to anywhere on the screen using only a single switch. Additionally, menus choices are selected by scanning, i.e., choices are cycled through and highlighted, then selected by switch activation. Button Builder was used to design screens to make it easy for persons with limited manual skills or limited computer skills to perform common functions, including environmental controls. Non-augmentative programs provided to improve communication at a low cost include OpenOffice.org 3, Skype, Facebook, Gmail, antivirus, instant messaging and video chat.

Access to movies was one feature requested by the residents. The recreational therapy department has a collection of over 2,000 DVDs. We purchased a DVD-ripping program after receiving legal review and loaded up the server with a small selection of content viewable by any client station using the network. Residents owning desktop computers accessed the network with the purchase of a USB Wireless-N adapter for as little as $XX.

The most challenging task was addressing patients with ALS lacking control of head motion or arms. There are commercial devices that use eye-gaze tracking for those in an intermediate stage of the disease. Some patients eventually lose the ability to do eye gaze tracking, but still have enough muscle control to activate a switch, either by raising their eyebrows or looking in a particular direction. Several devices using physical contact such as a strain gage do not, in general, work well. NeuroSwitch utilizes electrodes placed over the forehead to detect eyebrow motion implemented on an Apple computer. In order to have a switch for the Windows programs, and fulfill the goal of low-cost solutions, we conceived of detecting eyebrow position optically, using a facial-feature software application called faceAPI (available for a $XXX license per user). Groucho Switch was developed by the contractor, ASG, and represents not only a ground-breaking innovation, but a potential patent. We have completed an Invention Disclosure Form for the University of South Florida Division of Patents and Licensing, which by contract handles all intellectual property developed at the Haley.

Available eye-gaze tracking systems, where the camera is located out in front of the patient, have a major drawback: they lose their calibration when the patient is moved or turned, which precludes using advanced beds with automated turning to reduce the risk of bedsores. VisionKey™ uses a frame for glasses, allowing one of the eyes to be monitored by optical technology located in the frame, while the user sees an image presented by a viewer that is in front of one eye. The other eye is free to see the environment. This system performs letter selection by eye-gaze tracking, or if the person lacks full control, can be used as a switch if the person can look in a configurable direction. This system has been used as keyboard input into an individual station and as a switch input for Tilvus.

Indicate if Applicable: place an “X” next to the response reflecting facility action

  • Institutional Disclosure _X__YES; _____NO; _____N/A
  • Clinical Disclosure __X__YES; _____NO; _____N/A

Recommendation:

  1. The Tampa VAMC and University of South Florida should pursue their standard process for assessing an invention disclosure for its potential to generate more money than it costs to apply for the patent.
  2. The Tampa VAMC should gain more experience with the system. Institutional Review Board approval from the Social-Behavioral Board will probably be required to collect user feedback.
  3. Connecting with the VA Guest Internet was delayed for months due to regulations. The Tampa Regional Counsel learned of plans to make the VA Guest Internet an enterprise-wide feature and to adopt a set national of regulations about privacy and user behavior. We recommend that this be done, with input and lessons learned from stakeholders who have already set up a Guest Internet in their facility.

Contact for Further Information: Chuck Brown, Director of Innovation Program (10P7I) at 727-667-1259.

VHA OIA Innovation Awardees

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