Assistive Technology and Neuro-Diversity (Cognitive Impairment)
Customizing Assistive Technology for Persons Who Are Neuro-
Assistive Technology (AT) has broadened choice and
expanded independence for many people with
disabilities. People who are Neuro-Diverse (who have
brain injury, unusual brain chemistry, dementia, and
other non-typical brain function) can also use AT to
gain control over their lives. The key, as is the case
with all AT supports, is to carefully match the support
to the person by using the person's knowledge of themselves and the
person's goals as the context for support. the focus is on the person, not the
What is Assistive Technology? (AT)
From the AT Act:
"The term `assistive technology device' means any item, piece of
equipment, or product system, whether acquired commercially,
modified, or customized, that is used to increase, maintain, or
improve functional capabilities of individuals with disabilities."
"The term `assistive technology service' means any service that
directly assists an individual with a disability in the selection,
acquisition, or use of an assistive technology device. Such term
(A) the evaluation of the assistive technology needs of
an individual with a disability, including a functional
evaluation of the impact of the provision of appropriate
assistive technology and appropriate services to the
individual in the customary environment of the
(B) services consisting of purchasing, leasing, or
otherwise providing for the acquisition of assistive
technology devices by individuals with disabilities;
(C) services consisting of selecting,
designing, fitting, customizing,
adapting, applying, maintaining,
repairing, or replacing assistive
(D) coordination and use of
necessary therapies, interventions,
or services with assistive
technology devices, such as
therapies, interventions, or
services associated with education
and rehabilitation plans and
(E) training or technical assistance for an individual with
disabilities, or, where appropriate, the family members,
guardians, advocates, or authorized representatives of
such an individual; and
(F) training or technical assistance for professionals
(including individuals providing education and
rehabilitation services), employers, or other individuals
who provide services to, employ, or are otherwise
substantially involved in the major life functions of
individuals with disabilities."
I would add that obtaining an AT device should be a no problem experience-
cheap, simple to use, and including all warranties, training, and
What You Will Learn
1. A basic understanding of AT, exposure to some typical devices, ways
of funding AT devices, and AT resources.
2. How AT supports independence for neuro-diverse information
3. A framework for thinking about how to match a person's uniqueness
to a device.
4. How all of us use AT to support our own independence.
Who Is Neuro-Diverse?
Some people who do not have typical central nervous systems have claimed
the name of "neuro-diverse", to reduce the impact that medicalization of
lives, and to
Most of what the brain does is non-conscious. The CNS recognizes patterns
and responds to them so quickly that we are not aware of what has been
going on, but only see the results. For example, as you sit and read this
handout, your non-conscious brain has prepared actions for you that you can
do from where you are, in case you decide to do them. For example, if a
glass of water is within reach, your brain will have already prepared the
movements necessary for you to take a drink. Because of this non-conscious
pre-planning, our decisions and choices over what to do seem effortless.
The conscious brain is much slower and less effortless. Basically, we are only
conscious of things that last longer than about 3 tenths of a second. It is
also very difficult for us to remain conscious of slow activities that take
longer than a few seconds to show movement. But our conscious brain
allows us to use intention to change the likelihood that we will act in a
The overall purpose of our CNS is to anticipate the world around us, to guess
accurately what will happen next. This purpose is the most important
organizer of what we do. When our brain changes in its chemistry or
function, these differences change what and how we anticipate, how we
guess what will happen.
Neuro-Typical and Neuro-Diverse
Most of us use our CNS in the typical way that human beings normally
develop neurological capabilities. To the extent that we do what is common
in neurological development, we are Neuro-Typicals. To some extent, all of
us have acquired differences from the typical in the way
our brain works. Some people have lots of differences in the way their brains
work, and they call them selves Neuro-Diverse to label those differences in a
personally valuing way. The differences often result in some combination of
less information processing in some areas and more information processing
in others. While this presentation focuses on ways to boost the effectiveness
of information processing, it is a fact that all use of AT requires the
integration of strengths into the support.
Examples of Neuro-Diversity
1. Learning Disability: There are a wide variety of information
processing issues that are described as Learning Disabilities. They are
typically identified in school, hence the label. They often involve
difficulties in ignoring certain kinds of information, stably perceiving
certain kinds of information, combining different kinds of information,
or storing certain kinds of information. Examples include:
i. Auditory Processing-has trouble understanding language
against background noise, among other things
ii. Reading Problems-a wide variety of visual, visual tracking,
phonetic, visual-auditory translation and other processing
iii. Right Hemisphere processing-Problems in social learning,
including jokes, understanding how they appear to others,
interpreting other people's social cues.
iv. Attentional Problems-though not like other kinds of learning
disabilities, attentional problems have been lumped in with LD.
2. Dementia: Although memory problems are the signature difficulty of
dementia in most people's mind, almost any kind of information
processing problem can occur. The striking problem with dementia is
the progression of it. People with dementia can and do change
dramatically in very short times.
3. Substance Abuse and State Dependent Meaning: Although SA is
often thought of as a moral problem. both chronic use and withdrawal
are, in the first place, brain problems. More than this obvious
conclusion, SA and withdrawal alter the meaning that the abuser
attributes to the world. State Dependent Meaning is a concept that
helps us to understand this process of change in meaning that
abusers experience. Imagine a laboratory rat given a small dose of
sleeping medication, just enough to make the rat a little sedated.
While the rat is affected by the drug, you teach the rat the difference
between a triangle and a square.
When the effect of the drug wears off, the rat will no longer
remember the difference between the triangle and the square. If you
give the rat the same dose of the same drug a couple of months later,
the rat will suddenly remmber the difference between the square and
the triangle. The memory is dependent on the chemical state of the
brain at the time that the learning occurred.
Another example: A boy begins heavy drinking at age 12. He
continues to drink until his 30's when he quits and joins an AA group.
He goes to his first AA meeting and finds that he is very anxious
about talking to women, even being tongue tied. Because he did his
adolescent social learning while drunk, he lost some of that learning
when he quit drinking. The learning was tied to the chemical stated
created by the alcohol. It would take a while to relearn social comfort
and confidence in his new chemical state.
4. Mental Illness: Severe mental illness symptoms are state dependent
phenomena of the brain. Individuals with sevee mental illness try to
adjust and alter the symptoms through their behavior. That is, like
anyone else with a neuro-diverse or a neuro-typical brain, they try to
adapt their experience of life to their goals and dreams.
5. Traumatic and Acquired Brain Injury: As you might expect, brain
injury can affect literally every aspect of human experience and
behavior. Regardless of the source of a brain injury, there is a
common problem where well learned and automatic behaviors are
fragmented or distorted. Any behavior which we repeat becomes more
and more automatic over time. In another way of understanding,
behavior becomes more non-conscious as it is repeated. When the
automatic parts of behavior are disrupted, the person has no
conscious idea of why they can no longer do the action. They can't
access and use the non-conscious parts of the behavior. In order to
relearn the behavior, a way for the person to succeed at the purpose
of the behavior has to be found.
6. Autism: Although our society has become more aware of autism and
the spectrum of autism experience, most people do not realize that
the community of people with autism is the source of the concept of
Neuro-Diversity. It is common for persons with autism to have
difficulty managin certain sensory information, to have trouble with
escalating anxiety, and to have narrow, but sometimes surprisingly
In all of these examples, and many others, AT can help support and modify
the person's control over their lives and their environment.
AT and Independence
As I have said earlier, the use of AT is in supporting the lives and dreams of
persons who are Neuro-Diverse. During the development of the modern
disability rights movement, three have been two major threads in the
concept of independence, that developed on the basis of different historical
experiences by the members of different communities:
The Independent Living Model
The Independent Living Model grew out of the experience of persons with
severe physical and sometimes cognitive disabilities. Its current public
expression are Centers for Independent Living that help people finds ways to
live independently in the community of their choice. The institutional focus of
this community has been nursing homes, and the community's definition of
independence and support is based on the restrictions and barriers that
nursing homes create for autonomy. The best statement of the IL Model is:
National Council on Independent Living:
Ten Principles on Independent Living
1. Civil Rights – equal rights and opportunities for all, no segregation by
disability type or stereotype.
2. Consumerism – a person ("consumer" or "customer") using or buying a
service or product decides what is best for him/herself.
3. De-institutionalization – no person should be institutionalized (formally
by a building program or family) on the basis of disability.
4. De-medicalization – individuals with disabilities are not "sick" as
prescribed by the assumptions of the medical model and do not require help
from certified medical professionals for daily living.
5. Self-help – people learn and grow from discussing their needs, concerns
and issues with people who have had similar experiences; "professionals"
are not the source of help.
6. Advocacy – systemic, systematic, long-term, and community-wide
change activities are needed to ensure that people with disabilities benefit
from all that society has to offer.
7. Barrier-removal – in order for civil rights, consumerism,
deinstitutionalization, de-medicalization and self-help to occur, architectural,
communication and attitudinal barriers must be removed.
8. Consumer Control – the organizations best suited to support and assist
individuals with disabilities are governed, managed, staffed and operated by
individuals with disabilities.
9. Peer Role Models – leadership for independent living and disability
rights is vested in individuals with disabilities (not parents, service providers
or other representatives).
10. Cross-disability – activities designed to achieve the first five principles
must be cross disability in approach, meaning that the work to be done must
be carried out by people with different types of disabilities for the benefit of
all persons with disabilities.
The Recovery Model
The Recovery Model of Independence grew out of the experience of persons
with severe mental illness. The Model's current public expression includes a
wide variety of clubhouses, drop-in centers, and support programs entirely
opeated and governed by persons with severe mental illness. The
institutional focus of the Recovery Community has been involuntary
commitment and loss of rights in state mental hospitals and local hospital in-
patient units. The Recovery Model grows out of this loss of autonomy. The
best expression of the principles of the Recovery Community is:
The 10 Fundamental Components of Recovery
Self-Direction: Consumers lead, control, exercise choice over, and
determine their own path of recovery by optimizing autonomy,
independence, and control of resources to achieve a self-determined life. By
definition, the recovery process must be self-directed by the individual, who
defines his or her own life goals and designs a unique path towards those
Individualized and Person-Centered: There are multiple pathways to
recovery based on an individual’s unique strengths and resiliencies as well as
his or her needs, preferences, experiences (including past trauma), and
cultural background in all of its diverse representations.
Empowerment: Consumers have the authority to choose from a range of
options and to participate in all decisions—including the allocation of
resources—that will affect their lives, and are educated and supported in so
doing. They have the ability to join with other consumers to collectively and
effectively speak for themselves about their needs, wants, desires, and
aspirations. Through empowerment, an individual gains control of his or her
own destiny and influences the organizational and societal structures in his
or her life.
Holistic: Recovery encompasses an individual’s whole life, including mind,
body, spirit, and community. Recovery embraces all aspects of life, including
housing, employment, education, mental health and healthcare treatment
and services, complementary and naturalistic services, addictions treatment,
spirituality, creativity, social networks, community participation, and family
supports as determined by the person. Families, providers, organizations,
systems, communities, and society play crucial roles in creating and
maintaining meaningful opportunities for consumer access to these supports.
Non-Linear: Recovery is not a step-by-step process but one based on
continual growth, occasional setbacks, and learning from experience.
Recovery begins with an initial stage of awareness in which a person
recognizes that positive change is possible. This awareness enables the
consumer to move on to fully engage in the work of recovery.
Strengths-Based: Recovery focuses on valuing and building on the multiple
capacities, resiliencies, talents, coping abilities, and inherent worth of
individuals. By building on these strengths, consumers leave stymied life
roles behind and engage in new life roles (e.g., partner, caregiver, friend,
student, employee). The process of recovery moves forward through
interaction with others in supportive, trust-based relationships.
Peer Support: Mutual support—including the sharing of experiential
knowledge and skills and social learning—plays an invaluable role in
recovery. Consumers encourage and engage other consumers in recovery
and provide each other with a sense of belonging, supportive relationships,
valued roles, and community.
Respect: Community, systems, and societal acceptance and appreciation of
consumers —including protecting their rights and eliminating discrimination
and stigma—are crucial in achieving recovery. Self-acceptance and regaining
belief in one’s self are particularly vital. Respect ensures the inclusion and
full participation of consumers in all aspects of their lives.
Responsibility: Consumers have a personal responsibility for their own self-
care and journeys of recovery. Taking steps towards their goals may require
great courage. Consumers must strive to understand and give meaning to
their experiences and identify coping strategies and healing processes to
promote their own wellness.
Hope: Recovery provides the essential and motivating message of a better
future— that people can and do overcome the barriers and obstacles that
confront them. Hope is internalized; but can be fostered by peers, families,
friends, providers, and others. Hope is the catalyst of the recovery process.
Mental health recovery not only benefits individuals with mental health
disabilities by focusing on their abilities to live, work, learn, and fully
participate in our society, but also enriches the texture of American
community life. America reaps the benefits of the contributions individuals
with mental disabilities can make, ultimately becoming a stronger and
Both the Independent Living Movement and the Recovery Movement were
born out of a sense of injustice, on the one hand, and possibility, on the
other, by people who had been marginalized and stigmatized by global social
stereotypes. But the historically separate development of the two
movements has led to different cultures of social and personal
empowerment, and these differences have made it more difficult than it
need be for the two movements to effectively collaborate. AT is one of the
areas which is very important to both communities.
Matching a Person and a Device
There are 30,000 devices currently labeled as AT, and that inventory doesn't
include all the personal inventions of individuals and their caregivers. There
is no lack of possible devices. The hard part is to match the information
processing profile of a person to any device at all in a way that improves
personal control and choice. While we are going to review ways to match
under functional areas like memory, there are also some basic principles to
remember regardless of what you are trying to do:
1. Try to understand how the person wants to accomplish their goal. This
will provide you with a rough model of the way information will be
processed, and will make it much easier to filter the huge number of
possibilities out there.
2. Choose the simplest, cheapest, and nearest solution.
3. Include warranties, maintenance, and training in your planning.
4. Always, always, always, try out the device before buying.
5. Be able to offer face to face support after the purchase.
There is a general trend in technology called "convergence", in which
technological capabilities are concentrated more and more in single devices.
If the devices that are targets of convergence are accessible, then people
with disabilities can get fewer devices, maybe even just one ideally, and will
be able to use the device to control other devices that they need for
independence. This process could dramatically reduce costs, learning curves,
maintenance, and so on.
The current prototype of the convergent device is the iPad, and it is clear
that many more similar devices will be coming out soon. At roughly $500, it
is worth asking how much of a person's AT supports can be covered by such
a convergent device.
Faster, Better, Cheaper
Google is working on a computer operating system (OS) called Chrome that
they expect to begin releasing late this year. It would be used with a
standard set of components for a netbook-like computer. Because the
components are standard, and the OS uses online applications (the so-called
"cloud"), the computer will boot in 2 seconds and will cost roughly half what
the cheapest netbooks cost now (roughly $150-$200). At this point, this kind
of computer (with a touch-screen) becomes the convergent device with
standard accessibility software. More information about the OS is availalble
Generally Usable Cues
Cues can be used to trigger behavior. They can be used on their own or as
part of an integrated AT support system. The most common classes of cue
• Lists (including checklists)
◦ Shopping List
◦ Steps to complete a task
• Visual Cues
◦ Color warning
◦ Posted reminder
• Auditory Cues
◦ Word or phrase prompt
◦ Orienting sound
• Tactile (touch) cues
◦ Orienting cue to allow more effective auditory or
◦ Guiding touch
◦ Orient to safety support
All of these can be done without any special device. We have all used these
to support our decision making, our daily life, our independence. We can
take our experience into consideration when we are supporting someone
Reminders and Lists
The key to supporting people with mild to moderate memory problems is the
use of lists and cues. The earlier discussion outlined the broad way in which
humans use lists and cues, and any of these techniques can be used to help
a person remember something. You may remember a film called "Memento",
in which the main character had a severe memory loss, and used notes,
photos, and tattoos to help him find the killer of his wife. The reminders
obviously have to have meaning to the person being reminded, and, thus,
must be customized to some extent.
Early memory problems often show as difficulties recalling rather than a loss
of a memory. Our central nervous system has many ways to find
information, but we often settle into a single standard way to get at certain
information. When that way breaks down, we may find it difficult to switch.
Trying to trigger the retrieval by using another sense (even smell) or earlier
or later information may trigger the memory. Also, recording a meaningful
item so that it can be used to recall the entire memory is a common and
useful way to support people.
1. Placing photos on a phone so that the person can call someone by
pressing the face.
2. List of things to check before leaving the house placed at eye level on
the inside of the door.
3. Taking pictures (camera on a cell phone, or around the neck) during a
day of activities and then going over them that evening.
4. Skull and Crossbones sticker on things or appliances the person
5. Use checklist that is actually checked to assure completion of
• Medication devices: There are many, many devices for reminding
people to take medication. They range from a few bucks to several
hundred dollars. On the simple end are plastic containers that have
labels for days of the week and time of day. You can typically pre-load
them for a full week, and for 4-5 times per day. On the expensive end
are devices that ring a bell when its time to take medications and only
allow that particular dosage to be accessed. Some will transmit a
signal or a text message to someone if the medication isn't taken
within a certain time period. There are many in-between devices as
well, and it is worth your while to pick a device that genuinely fits the
• Picture Phone: There are a variety of such phones and a couple of
different kinds are pictured in this handout. These devices are handy
for anyone in an emergency. It is far easier when your hands are
shaking to hit a large button that will dial 911 automatically than it is
to hit little numbers. Also, smartphone often offer a feature of having
a picture with contacts, and a simpler auto-dial mechanism when you
hit the contact picture.
• Digital recorder around the neck: There are numerous digital
recorders at all price points. In addition, most smartphones have a
voice recorder and memo player that can do the same things as these
single purpose devices.
• Cell Phone App to find car in parking lot of mall: Smartphone apps
are, in many ways, the AT of the future. One of the car finder apps is
the best selling app for Android phones (The developer is getting
$13,000 a month from a $2.00 app). Spoken Turn by Turn directions
driven by the GPS device in the phone make following directions
easier. There will be more such capabilities, such as GPS directions
within buildings, and even houses. Really, it's only a matter of
connecting a need with a developer. Though I don't believe it exists
yet, such an AT development effort would make a great non-profit
• Water level alarm for bath tub: Another device that might have appeal
to many people, especially driven, busy ones. There are many devices
that do this kind of signaling, and there are automatic ones that
attach to the tub or faucet. Also, more and more tubs are coming
equipped with level shut-off devices.
Attention is a function that results from integrating all of the monitoring
skills we have and the orienting capabilities of our senses. At the basic end,
think of a light flashing off to one side of your head, or a sudden sound. You
will automatically turn toward the stimulus.
Attention functions on a continuum from very broad in scope, like the
reaction to a sudden and new stimulus in the environment, to very narrow,
when you are deeply involved in a television mystery, for example. People
vary in terms of their "temperament" for attention, from a person who has
severe Attention Deficit Disorder to a person with autism who can focus on
changing lights for hours. In general, anxiety can both destroy attention and
focus it on one single object or person or event.
In the brain, there is only a certain amount of attention, just as there is only
a certainly amount of energy generally, and when you run out of attention,
you are in a state of fatigue. In order to restore your attention, you must
rest. You can't work through brain fatigue.
It is common after brain injury to experience functional
fatigue when the parts of the brain that are damaged
are used for too long. "Too long" can be 10 seconds if
the area responsible for the function is severely
damaged. Once fatigue sets in, further efforts in that
area will produce emotional symptoms that escalate and can produce loss of
1. Remove visual distraction in a room, including pictures, busy
wallpaper, and close curtains.
2. Run a white noise generator at night to support sleep. Simply Noise is
a web site where you can produce white noise to prevent distractions.
Go to http://simplynoise.com/ to use.
3. Remove or cover mirrors, deaden echoes with carpet or wall hangings
4. When using a computer, simplify desktop, and reduce lights in room,
to improve focus on screen. The image is from DarkRoom which fills
your computer screen with a simple word processor. Go
to http://they.misled.us/dark-room to download.
• Alarm reminders. there are zillions of these devices. Choose one that
is convenient and easy to use.
• Hand-held, computerized, sequence of task step pictures. The picture
below is a step in a recipe. These kinds of apps will proliferate over
the next few years for smart phones. There will be ones for many
hobbies, complete with step pictures and videos.
• Recorded Reminders: This version is a smart phone app. Others are
mentioned elsewhere in this handout. It records messages tied to a
• Checklist (no more than 7-9 checks). Checklists are a generally useful
tool for following steps. There is a current craze about them because
the The Checklist Manifesto, a book you can check out
• Social Supervision (the teacher presence effect on attention): The
presence of another human being automatically improves task focus.
Often, the attention and information processing abilities of married
couples become automated and intertwined over time. If one spouse
dies, information procesing deteriorates as well, and not just because
of grief. It also declines because the well practiced ways of getting
through the day no longer work.
Orientation in humans is a complex process of grasping the meaning of
context. It isn't simply knowing where you are, but also knowing how you
related to the objects and people in your immediate environment, and
knowing how your context will help or hinder you in getting where you want
to go (both geographically and socially). Our brains use internal monitoring
to constantly update our understanding of our internal and external context.
Problems in Orientation often arise from failure of these monitoring skills.
But problems can also arise because a person becomes anxious. In the film
"On Golden Pond", Henry Fonda suffers disorientation and anxiety while
trying to walk a path in the woods. He looks around himself and does not
recognize where he is, and becomes very anxious, which increases his sense
In reality, we don't use
every sensory detail of
the environment to move
from one place to
another. We use specific
points along the path to
tell if we are going in the
right direction. In other
words, we don't follow a
travelling, we note
intersection road signs.
Once you believe that
you have a problem, you
can begin to judge your
orientation on parts of
the trip that you never
really paid attention to. This triggers anxiety which in turn further disorients
Location and Orientation
Where we are is equal to a set of GPS coordinates. Our Orientation has to do
with how we interpret our location, and that is based on identifiable cues in
the world and personal knowledge. Often, as in walking a path we have
never taken befoe in the woods, our orientation is to cues we can't see and
the route we used to get where we are now.
Directions are never a perfect replica of the journey we are to take. Instead,
they are highlights that for one reason or another are easy to sense. We
follow directions by moving from one highlight to the next. If we get
confused we don't figure our our absolute position (or at least we didn't until
GPS devices became so common). Instead we retrace our steps and look for
a recognizable highlight to re-orient our selves.
Confusion is difficulty in interpreting the cues in the
immediate environment. It can be an unawareness of
cues or a misinterpretation of them. Most people with
dementia, for example, are confused about where they
are, but the place they believe they are is a real
enough kind of place. Although such confusion is called
confabulation (we are making up our location), we all
confabulate. It is just that we use more cues in doing
so. A person with dementia uses very few cues to
figure out where they are, and then assumes what would be true if they
Anxiety has a powerful effect on confusion and disorientation. In fact,
anxiety can create a sense of disorientation even when there is no failure to
recognize or interpret cues.
1. Using pictures to label rooms in a house: Labels are easy to print off
the internet. You can use both text and picture together as well. For a
person's room, you can use a printed photo.
2. Putting transparent acrylic doors on cabinets: The picture below is
pretty classy, but transparent acrylic works as well.
3. Using a turn by turn GPS device: With the advent of GPS in cell
phones, a wide variety of possibilities can be included in any smart
phone. The picture below contains two versions of turn by turn
directions in an Android smart phone.
• GPS devices: There are many GPS devices besides smart phones. The
device below is intended to be used at the spot you want to return to.
It records your trip and can tell you whether you are getting closer to
your final destination.
• Use of curtains or carpets to deaden sounds: Sound deadening is a
commercially viable enterprise, so there are many different versions
and types on the internet. Watch those installation costs!
• Transparent shower curtains in a well lit bathroom: There are some
choices here as well. This one seemed like the best of both worlds,
but there are other designs.
• Motion detectors that, for example, turn lights on and off. There are
also a wide variety of motion detector sysems, varying in complexity,
from ones that turn on lights outside when a dog goes by, to ones
that speak a specific recorded message when movement occurs. They
can also be used in the house with different messages or actions when
• Universal remote for entertainment devices: A lot of these as well.
This one has big buttons and can sit on a table and not move.
Personal safety is at the core of personal independence. However. it is more
important to personal freedom to choose how safety will be addressed in
one's life than it is to be "made" safe by segregation or restriction. The focus
here, as in all use of AT, is personal choice.
Bathrooms can be dangerous because of hot water and slippery surfaces.
There is also the possibility of eating non-food substances:
• Label shampoos, lotions and other non-food items, preferably with
both a picture of their use and their name.
• Get unscented items.
• Use a color indicator of hot water in the tub or shower, such as a color
• Use a water wand to prevent water from over-flowing
• Put grab bars at various locations throughout the bathroom
• Remove throw rugs from slippery floors
• Consider outdoor carpet in the bathroom
• Rubber mats that stick to surfaces
• brushes with soap in them for washing
• Shower chair
• Shower head on hose
Kitchens have heated surfaces and foods, glass objects, hot water, knives,
and other hazards.
• Eliminate glass objects or replace with corning ware
• Use toaster ovens or microwaves instead of stoves
• Label cabinets
• Replace cabinet doors with transparent acrylic ones
• Make sure a smoke alarm/CO alarm is in the kitchen near the stove
• Plenty of hot pads, including gloves
• Use lazy-susan instead of passing large bowls or plates
• Use sturdy dining table with 4 legs instead of center based support
• Dishwasher instead of hand washing
• Phone in kitchen
Shadow common daily activities and look for risky behavior and hazards.
• A Personal Emergency Response System (PERS) is a necessary tool.
People who have a system are only 10% as likely to end up in a
nursing home as people without.
• NO THROW RUGS!
• Smoke/CO alarms through out the house
• Rubber treads on stair steps
• Heavy duty stair rails
• Cell phone on person
• Use computer video for daily contact (i.e., Skype)
• Lower or raise bed so person can comfortably sit with feet on floor
• TV watching chair should have organizer right next to it and should
have a device to assist getting up
Chores are a common source of injury.
• Barter for chores with person's strengths
• Electric rather than gas lawn and garden appliances
• Cell phone on person
• No Ladders!
• Hire snow removal or barter
• Have PERS on person
1. Have lights turn on automatically when it is dark or the person moves
from room to room, or goes outside. The picture is from the Helios
system that will turn lights on and off as the person moves in and out
of rooms, as well as other environmental control tasks.
2. Use web cam to check on person each morning (be respectful of
privacy!) The picture is from a webcam called "Watching Paint Dry".
It has accompanying Music. There are webcams everywhere these
days. Check out the current weather in Lansing by webcam
3. Build relationships with neighbors: If neighbors know you they'll
watch out for you. Try a backyard barbecue as a friend starter.
4. Have dog for companionship and protection. The more the merrier. A
neighbor can walk.
• PERS: There are many types. If you push the button, it signals
someone or a busiess to check on you. Some allow you to transmit
speech as well.
• Ablelink style communication, alarm system" Ablelink creates software
that allows for many of the functional supports described in various
parts of this handout to be done on a desktop or handheld computer
or smart phone. The software is expensive and you have to have the
device, but the software is quite remarkable. Go to
http://www.ablelinktech.com/ for more information.
• Door opening alarms: There are an awful lot of door alarms. I would
look for price points and convenience.
• Water control devices: Pictured here is a water level control device
built into the bathtub. There are wands that attach to faucets, and a
host of other devices.
• Temperature indicators: Here is a cute one that has a digital readout.
There are many types of these, some that change color.
• Fall detection sensors: There are many types of these. This particular
one is for the iPhone. Because smart phones contain accelerometers
and GPS devices, they can be remarkably good at detecting falls. The
Mood and Symptom Management
Sleep is the single most important variable in mood,
symptoms of mental disabilities, energy level, and
general quality of life. Time and effort invested in
assuring high quality sleep is never wasted and will
reduce the number of interventions that need to be
made in other parts of the person's life.
• Stop caffeine
• Daily exercise
• Use night light
• Use noise generator (i.e., fan)
• Establish routine of relaxation for several hours before bed
• Learn meditation
• Nightly massage
• Reading, or listening to, books
• Music or automatic TV turnoff
• Establish medication taking times in view of their effect on sleep
Stress is different than variety. Good living requires
variety in stimulation and activities. A person should
typically be alert and ready to do an activity if the
opportunity comes up. If heart rate is rising, shaking
hands, anxiety, the person is under stress. If "couch
potato" syndrome, person is trying to recover from
• See ideas for Sleep
• Plan daily activities
• Rehearse stressful, but necessary, activities
• Establish routine with small variations
• Have several "fun" activities every day
• Break up log trips into smaller chunks
• Do some exercise after stressful experience
Changes in your basic energy and activity level are
normal up to a point. Sometimes, though, the volume
is too high or low for long periods. Medication should
be examined, but avoid use of anti-psychotics for
agitation. The use of these drugs is dangerous in older
people, and is typically done because it is easy. But, these drugs literally
remove meaning from life, and make it more difficult to appreciate positive
and negative experiences. Look for another way.
• Exercise is good for both depression and agitation. Exercise can be a
• Routine is necessary to maintaining energy at a usable level
• Examine experiences of depression and agitation for triggers. Once
you understand a trigger, you can manage it. While the cause may be
biochemical, the actual level can be changed by surprising things.
• Believe someone when they say that something raises or lowers their
Demystify hallucinations. Everyone
has them eventually, many people
when they were children. Tell the
person that hallucinations are not
dangerous. The anxiety that
hallucinations often trigger both in
the person have them and people
around that person cause more
disorientation and loss of the sense
of control than the hallucination.
There is an International Society of
People who hear voices, and put up
with stigma and discrimination as a
• Use sensory interference, as desribed under Attention
• Ask the person to check with you when they think they might be
• Exercise will work
• Sit and drink tea and talk
• Wait for the intensity of the hallucinations to drop off, and do
something else in the meantime
1. Combine music and meditation
2. Eat regularly to avoid blood sugar issues
4. Stop daily activities at least 2 hours before typical sleep time, and
shift to low energy. Hi-Ho, Hi-Ho, it's off to sleep we go!!
• iPod: and the many, many other devices that can play music,
newscasts, videos, short movies and long ones-You name it.
Whatever works for you.
• Smartphone: The newer smartphones can do all of the iPod things,
and I expect to see more and more relaxation apps in the near
• Exercise machine: Exercise is necessary, necessary, necessary. Just
adjust the approach to the person's functional abilities. Ask a PT or an
OT for advice.
• Reminder for short meditation/breathing exercise every hour: Any
device will do as long as it can handle a number of alarms. Some will
tell you what to do. You can 3 of one kind of activity, 4 of another,
and so on.
Integrating AT Supports
Planning AT for the Whole of Life
Over time, you will build up ways that AT fits into a person's life. As you do
this, you will find that having many devices for many different purposes
doesn't work. It becomes time for the person and you to look at broader
solutions. Also, each experience of support and independence teaches it's
own personal lessons about what works and what doesn't. Record the
• Ablelink Video-Use of technology to support a number of processing
problems at once See link for more info" Living the Smart Life DVD
• Computer control over home environment: You can hookup anything
electric to a common control system and change everything at once
instead of going around the house trying to change individual items.
There are sensors for everything, and they can all be linked to your
• Remote control over computer: A relatively simple way to make use
of a computer in a person's home is to use G-Bridge to connect your
computer with theirs, and use wireless web cams to monitor doors or
areas where a fall might occur. There are also systems that tie GPS to
the internet so that you can track a person's movements if they have
the device on their belt or around their neck.
Future of Health Related Support
Sensors and remote telecommunications will change the way we receive
medical services over time. Sooner or later, we will all be wearing sensors
that detect and record our health status as we go through daily activities.
Video chat at high definition will allow those sensors to trigger an alarm and
instead of immediately running to the hospital, we might have a visual exam
by Internet. As these technological tools become part of health care, we will
also use them for other purposes, like social interaction, monitoring while
respecting privacy, game playing, planning activities and events, and so on.
For example, see this article on belt-worn health sensors at http://bit.ly/
Beyond This Presentation
Nationally, there are a huge variety of resources around AT, so many in fact,
that it is daunting to find what you are looking for. The Resources listed
below focus on those that are generally useful.
The Job Accommodation Network: Find the site at http://askjan.org/.
JAN originally developed to help employers figure out what accommodations
to use to support employees with disabilities. the network has focused a lot
of energy on AT, and is generally helpful with developing an AT strategy.
ABLEDATA: Find the site at http://www.abledata.com/. The ultimate
directory of devices, Abledata now contains over 19,000 device descriptions.
When you want to see the variety of options available.
Michigan Loan Funds: Find the Site
at http://www.michiganloanfunds.org/. Operated by United Cerebral Palsy of
Michigan, the loan funds offer lower interest rates, and more flexible terms
for devices that increase personal independence for persons with disabilities,
including children. There is no bottom limit on loans, and the top is
Michigan Disability Rights Coalition AT Project: Find site
at http://www.copower.org/At/index.htm. MDRC has operated the Michigan
AT project since 1997, and the Project includes many more activities than I
can discuss today. You should visit and get a better grasp of the local
projects, newsletters, and resources that the AT Project has created and
AT Xchange: Find the site at http://www.atxchange.org/v3/home.php. ATX
is a "classifieds" web site for used AT equipment, some free, some at low
cost. Once you create an account, you can trade, buy, or sell.
Michigan Protection and Advocacy Service AT Project: Find the site
at http://www.mpas.org/AdvocacyServices.asp?TOPIC=10922. MPAS helps
with information and advocacy around AT rights issues, and is a partner of
MDRC in our AT Act activities.
UCP Upper Peninsula AT Center: Find this site at http://www.ucp.org/
ucp_localsrv.cfm/87/8293/8305/1104. The Center provides AT solutions for
the entire Upper Peninsula of Michigan, and UCP and the Center are partners
in our AT Act Activities.
National Assistive Technology Technical Assistance Project: Find the site at
http://www.resnaprojects.org/nattap/RESNA.html. A list of all State AT
projects and all their activities. A good resource when you can't find an
answer in Michigan.
RESNA: Find the site at http://resna.org/. A resource for professional
information nationally. Find an assessment professional or learn how to build
a career in Assistive Technology.
Aging In Place At Home: Find the site at http://www.aipathome.com/. A
good starting point for making any home livable by a person of any age who
has a disability, and the first step to staying out of a nursing home.
Family Center for Technology and Disability: Find the site
at http://www.fctd.info/. Information and resources for school and home
support of independence by children with disabilities.
Your Presenter's Personal Information
Name Norm DeLisle
Position Director, MDRC
Norman Learned at http://normlearned.blogspot.com/
Blogs LTC Reform at http://ltcreform.blogspot.com/
The Recovering Life at http://therecoveringlife.blogspot.com/
MDRC FB http://www.facebook.com/pages/Michigan-Disability-Rights-
Web page http://www.copower.org/
1. AT supports independence and choice for
people with disabilities
2. Focus on how a person processes
information, not on the device
3. Remember to include warranties,
maintenance, and repair
4. Always try out a device, so it doesn't end
up in the closet
5. We all use AT to help us negotiate our
way through life
Making Up the Mind: How the Brain Creates Our Mental World by
Chris Firth at http://bit.ly/ccH9gx
Chris Firth has written a superb and dryly amusing description of how our
brains make the world we experience and in which we live. The new imaging
technique of functional MRI has allowed neuropsychologists to see the brain
doing stuff in real time, and what these experiments reveal is startling and
Universal Design for Learning (UDL) Videos from The National Center for
UDL at http://bit.ly/bvFAZ0
UDL isn't just for schools anymore. The basics of UDL are useful in any AT
activity, allowing easier brain process for everyone. Worth a look, and the
videos are easy to watch.
The Illustrated Guide to Assistive Technology and Devices by Suzanne
Robitaille at http://bit.ly/bvFAZ0
At the price ($14.00 on Amazon), the best and most accessible introduction
to AT and decision making I've seen. Worth keeping around, as well, since it
is a good reference.
Universal Design for the Home by Wendy A. Jordan at http://bit.ly/
The best way to solve a problem is to never have one. This book needs a
DIY person, but has many ideas for making it easier to live in the home you
have. Stuffed with ideas.
Tricare's Computer/Electronic Accommodations Program
From our Veterans Home Care program, a one stop site for devices broken
out by general cognitive support purpose. A good place to check befoe going
into Abledata's massive directory.
"To the cognition of the brain must be added the experience of the soul."