
Ask HN: Assistive Devices for recently quadriplegic dad - throwawaysci
In a most unfortunate incident, my dad slipped in our house and received a severe spinal cord injury (c5 to c7). This has rendered him quadriplegic. He is currently stable and is in in-house rehab. He was very active and was a part time professor. He also had a one or two consulting assignments.<p>He would like to use his laptop&#x2F;ipad&#x2F;phone. After some research I found some companies like TeclaShield that sell switches&#x2F; bluetooth interfaces and such.<p>Does anyone have any experience in this area? Your help or advice will be really appreciated.
======
Voltbishop
I'd recommend the two products:

1\. [http://www.quha.com/products-2/accessories/quha-
pufo/](http://www.quha.com/products-2/accessories/quha-pufo/)

It's a bluetooth device that allows controlling the mouse cursor with body
movement (head or finger etc) It's cheaper. Coupled with a free dwell clicking
software, should work!

2\. Eye tracker - there are a lot of options, visit reddit.com/r/eyetracking
that and reddit.com/r/ALS and ask them for advice. These devices let you
control a PC with your eyes are especially designed for people who have ALS.
The ones that work really well cost money, but most insurance companies cover
them in full. Avoid Tobii, they are not reliable and are more marketing than
anything. Mygaze,LC Technologies, Eyetech digital, smi vision. These are all
companies you can trust. All should offer free trail periods and should have a
rep who can come and visit your dad to do an evaluation. If they don't offer
at minimum 2 week trail, they're not a trusted company. Secondly you can
contact your local cities AT clinic they have donated equipment for situations
like this.

I hope this helps!

------
Mz
I was passingly acquainted with two quadriplegics from my corporate job. They
were both employees of the company.

Quadriplegic just means all four limbs are impaired. The degree of impairment
can vary substantially. One of these men had use of his arms, but did not have
full use of his hands. He drove himself to work, had a full time job, wife and
kid. He broke his neck in a pool accident in his teens. He used a manual
wheelchair. He was able to use a manual wheelchair because he had use of his
arms. He chose it over an automatic wheelchair to get in regular exercise.

The other was substantially more impaired. He broke his neck in a riding
accident later in life. He had been a brilliant surgeon. He used an automated
wheelchair. I think he had partial use of one arm and maybe a couple of
fingers, which allowed him to navigate a smartphone with that hand. He came in
once a week for a few hours to review surgical reports for the company. When
ordinary claims processors (like I was) could not figure out if the surgery
was covered and their boss with more training couldn't either, we printed off
the entire file and hand delivered the paper version to this man on Friday
afternoon. I had one claim go to him and hand walked my papers to the meeting.

I also attended an educational talk given by the two of them. This is how I
know how they each broke their neck and other details.

Since your father was a consultant, he may be able to return to doing
consulting work at some point in the future. The specialized knowledge in his
head does not stop being valuable just because of his physical limitations. I
am mentioning this because new quadriplegics are often suicidal. They feel
that life is simply over. It's not. He was a professor and consultant, like
this former surgeon, his knowledge and expertise still has value. Even though
the former surgeon could no longer work as a surgeon, his knowledge of surgery
was valuable and he had a unique very part time job at a world class company.

Depending on the exact details of your father's limitations, he may also
benefit from the use of ordinary things like smart phones with apps. There are
also a lot of non-tech assistive devices, like chairs to help them shower and
spoons that can be strapped to their hand so they can feed themselves if they
have arm movement but limited hand control.

Best.

------
aerovistae
I created a Chrome extension called Hands Free for Chrome which allows near-
total control of the browser with your voice.

It occasionally has to be reset by hand if the voice recognition locks up,
which is the only barrier. But I'm fairly certain it's the best option
available for people in your father's situation.

[https://chrome.google.com/webstore/detail/hands-free-for-
chr...](https://chrome.google.com/webstore/detail/hands-free-for-
chrome/ddgmnkioeodkdacpjblmihodjgmebnld)

~~~
tyingq
I see it's got really great reviews, but the user count seems low given how
useful it appears to be.

Is it just new, or maybe an unintentionally well kept secret?

~~~
aerovistae
Unintentionally well kept secret. I have no idea. There's a similar one with a
weaker feature set (imo) which has 10k+ users-- there's obviously no shortage
of demand. I haven't got a clue as to why it's so unsuccessful.

~~~
tyingq
Hmm. I have no need for such a tool, but kudos for putting in the work on a
free tool for people that do. And open source too...nice.

------
apostacy_steak
My father contracted Guillain-Barre - a fast oncoming neurological disorder
that left him quadriplegic. I did a bunch of research a couple of years ago to
help him out.

First, if your dad can still move his head you can use Apple's assistive tech
to "tab" through the items on the screen with a turn one way, and "clicking"
on an item by turning his face the other.

Second, MS Windows' voice control is actually really decent. You can browse,
search, send emails, etc. all with your voice. It takes some training (both
for the user and the machine) but my dad has gotten pretty quick with his.

Lastly, there's a bunch of eye trackers out there now, and you can use them
for a lot of things. I setup CameraMouse
([http://www.cameramouse.org/](http://www.cameramouse.org/)) for when voice
wasn't quite cutting it (or my dad got tired of talking.)

Unfortunately, there's no perfect solution, and all require time to adjust.

------
j_s
Jouse3 $1500 mouth mouse/joystick seems tried & true.
[http://www.compusult.net/assistive-technology/our-at-
product...](http://www.compusult.net/assistive-technology/our-at-
products/jouse3)

Source: [https://www.twitch.tv/nohandsken](https://www.twitch.tv/nohandsken)
quadriplegic streamer who plays Diablo/Path of Exile, Heroes of the Storm,
World of Warcraft, etc. (I encourage Amazon Prime subscribers to give him
~$2.50 every 30 days via their free Twitch sub!
[https://help.twitch.tv/customer/portal/articles/2574674-how-...](https://help.twitch.tv/customer/portal/articles/2574674-how-
to-use-twitch-prime-free-subscriptions) )

slightly related/helpful discussion:
[https://github.com/melling/ErgonomicNotes](https://github.com/melling/ErgonomicNotes)

------
gtsteve
I'm sorry to hear that. That's very bad luck indeed.

I remember hearing about this project some time ago:
[https://github.com/OptiKey/OptiKey](https://github.com/OptiKey/OptiKey)

It might be helpful as it's an open-source project and if extra features are
needed you might be able to add them yourself if you are a programmer.

I mentally bookmarked it because I felt it would be a good "make the world a
better place" type project to contribute to if I ever had some spare time.

------
WheelsAtLarge
It's not a laptop but an Amazon Echo is excellent for Music, Audible books and
Podcasts. Hard to beat how well the immediate voice recognition works. Home
automation works but it's a try and see if it works for you type of situation.
It's worth investigating for your needs. Also it's relatively inexpensive. I
should add that home automation needs additional hardware and costs. But you
can buy an on/off plug for a bit under $30.00.

------
j_s
Please follow-up to report what works best for your father! So many of these
Ask HN's have a great list of options, but no follow-up to report what worked
best for your particular situation.

Thanks for bringing this request here to allow the community the chance to
contribute!

------
johnnyg
I'm sorry I don't, but my thoughts are with you and I think its great you are
advocating for and supporting your father.

------
house9-2
If he still has good movement of his neck:

\- Smartnav (if Mac you need to buy via 3rd party, but includes the software)

Fairly expensive, there are other variants that cost less/more, some gaming
devices like TrackIr might work as well? Possible that health insurance would
pay for these types of devices?

I personally use Smartnav about 50% of the time I am programming, along with
Dragon/Voicecode due to RSI issues.

Smartnav + Dragon might be enough for using laptop/desktop, not so much for
mobile devices. If he actually programs I would recommend voicecode.

All of these technologies have a massive learning curve.

You might want to checkout the voicecode forum and slack channel, I know there
are some quadriplegic programmers in that community who would have better
insight than I.

\-
[http://www.naturalpoint.com/smartnav/](http://www.naturalpoint.com/smartnav/)

\- [http://voicecode.io/](http://voicecode.io/)

\- [http://discuss.voicecode.io/](http://discuss.voicecode.io/)

\- [https://voicecode.slack.com/](https://voicecode.slack.com/)

------
jonnycowboy
I work for a company that makes robot arms for assistive purposes (Kinova) so
I have some insight to share.

1st a voice setup with Alexa or similar can really help.

With regards to phone use, some of our users have an attachment to put the
phone close to their head and use their nose to "click/select" (they can move
their head).

Eye tracking technology is really impressive these days (can be as fast as
using a mouse). I've recently demoed a system with a Tobii sensor
([https://www.tobii.com/](https://www.tobii.com/)) that was hooked up to a
laptop, very impressive when combined with appropriate software (it handles
scrolling, keyboard shortcuts, etc in a custom interface). I'm not sure with
regards to phone/tablet use how well they integrate.

Ping me on Linkedin if you'd like to talk more.

------
jeremyt
Dragon naturally speaking + Sennheiser ME-3 microphone should be at the top of
your list

------
m0ngr31
A little while back, I had a quadriplegic man reach out to me and thank me for
a skill I wrote for Alexa to control a Kodi box. It allowed him to watch what
movies and shows he wanted without constantly asking for help.

[https://github.com/m0ngr31/kodi-alexa](https://github.com/m0ngr31/kodi-alexa)

I'm truly sorry about your dad. That's a scary situation for him to be thrust
into.

------
mindcrime
A company I used to work for did a project once, deploying a lot of home
automation for someone with mobility issues. It's been a few years ago, and
the tech has probably changed a lot since then, but they used OpenRemote[1]
heavily as part of the project. It might be worth looking into.

[1]: [http://www.openremote.com/](http://www.openremote.com/)

------
jiiqo
I work with assistive technology and many of the clients are quadraplegic.
Because your dad can control his head accurately, the best computer access
device for him is definately a head mouse. Eye tracking solutions are tiring
to use and unaccurate.

I have tried most of the commercial solutions available and I think the best
headmouse for your dad would be Zono mouse
[http://www.quha.com/products-2/zono/](http://www.quha.com/products-2/zono/).
It is very easy to use and is as accurate as normal table-top mouse.

------
11thEarlOfMar
You might take a look at Neuroswitch from Control Bionics:

[http://www.controlbionics.com/about/](http://www.controlbionics.com/about/)

------
base2john
Sorry to hear about your family's situation, but hopefully he's able to get
back to work soon.

Tecla is great you should give it a try. Depending on his comfort and ability
a head tracking mouse from Orin is pricey but works really well with a
laptop/desktop setup. Dragon Naturally speaking is useful too.

Also he should make an appointment with a local assistive technology
practitioner soon to get a run down of all the options, both low and high
tech. You can find these ATP folks at most all rehab hospitals.

Good luck

------
onlydnaq
You could take a look at tobii [1]. They make some interesting products where
they combine eye tracking, speech analysis and other stuff to create user
interfaces for people with specific needs.

[1] [https://www.tobiidynavox.com/en-US/tobii-dynavox-pceye-
plus/](https://www.tobiidynavox.com/en-US/tobii-dynavox-pceye-plus/)

~~~
Voltbishop
Tobii is horrible for people with disabilities. Their reps are driven by
making money, their devices dry your eyes out because of the amount of IR they
put on your eye balls. And they don't offer extended support. And forget
trying to run these devices if you have glasses or any eye condition!

~~~
jonnycowboy
Sad to hear, I demoed a system with a Tobii sensor and it performed very well
(even with my glasses). We were wondering about the effect of the constant IR
blasts (are they continuous or pulsing?), thanks for the input.

~~~
Voltbishop
Bring a old cell phone that's sensitive to IR light and place it in front of a
tobii system. You'll see they're pulsing at a high frequency something like 30
lights at a >60 refresh rate per second, to the point you can actually see the
light on the users face (using sensitive camera). Not all eye tracking
companies put this much light on your eye's, but Tobii seems to be cutting
corners - to make up for short coming in image processing. It's a brute force
method to eye tracking.

The sensation you get after running a tobii is feeling like you've been up
past midnight staring at a bright screen. Most people don't get that it's the
eye tracker that makes you feel this way. Some of the other more respected
companies take the amount of IR light placed on your eye balls seriously and
try to drastically reduce it.

Talk to Tobii about it and they'll just bury it and say "there are no none
health risks, or regulations about having that much IR light on your eye".
Basically no one has set a threshold for how much IR light should be on a
person's eye thus it isn't a problem "we should worry about".

------
mattbgates
This company develops software for the handicapped:
[https://getaccessibleapps.com/](https://getaccessibleapps.com/)

I think they've created software that can bypass captchas and will work with
you to develop software that can help your dad.

------
jbannick
Contact Barrie Ellis World expert on motion impairment assistive technology.
Barrie.ellis@oneswitch.org.uk

------
nikki-9696
Sorry to hear. You might find a lot more useful advice on Reddit, if you
haven't already posted there.

------
kinova
There is this robotics arm that helps gaining autonomy. There are options that
allow the user to use his tongue, head or breath to control the arm. It
interfaces easily to the wheelchair controls.

www.kinovarobotics.com

------
xrange
Dasher might be something worth looking into:

[http://www.inference.org.uk/dasher/](http://www.inference.org.uk/dasher/)

------
rroriz
There is a startup in Brazil that promote DIY Assistive Projects:
[https://www.meviro.org](https://www.meviro.org)

------
mudil
Medgadget has lots of ideas for rehab and assisting devices out there.
[http://medgadget.com](http://medgadget.com)

------
tinus_hn
There was a talk by a C4 paraplegic at WWDC this year that shows his setup.

~~~
j_s
Perhaps
[https://developer.apple.com/videos/play/wwdc2017/110/](https://developer.apple.com/videos/play/wwdc2017/110/)
?

Convenience for You is Independence for Me

 _Why design apps with accessibility? Meet Todd Stabelfeldt, founder of C4
Consulting, who has lived with quadriplegia since the age of 8. Over his
decades-long struggle for increased independence in both his personal and
professional lives, Todd has become a noted expert in technologies for persons
with disabilities, which he has found can offer not only a level of autonomy
but also empowerment and dignity to the mobility impaired. Leading by example,
Todd runs a successful business but his real passion lies elsewhere. Hear how
apps designed well with accessibility in mind have changed his life as a
husband, father and as owner of the “Quadthedral“, his family 's HomeKit-
enabled smart home._

\--

Unfortunately [http://asciiwwdc.com/](http://asciiwwdc.com/) hasn't been
updated with a searchable transcript for 2017. I'm having trouble viewing the
video in a browser on my PC; the download links are under "Resources".

------
htatbr
I worked with quads as a college grad student. I also worked with HIV patients
in US Peace Corps. You really need to watch for sepsis. Watch out for catheter
infections. [https://www.indiegogo.com/projects/the-connected-catheter-
by...](https://www.indiegogo.com/projects/the-connected-catheter-by-spinal-
singularity#/) I would not allow any quad to use a catheter more than a short
time. Spinal singularity will fail by increasing infections. A new DNA tech
may change this.
[https://nanoporetech.com/products/smidgion](https://nanoporetech.com/products/smidgion)
[https://www.youtube.com/watch?v=OK5nNSwt3MA](https://www.youtube.com/watch?v=OK5nNSwt3MA)
[https://www.cs.columbia.edu/2016/dna-sequencing-in-
classroom...](https://www.cs.columbia.edu/2016/dna-sequencing-in-classroom/​)

Sepsis now dominates the hospital ICU. It is what kills most AIDS patients
too. Antibiotic resistance is driving costs. The ICU is now 40% of US hospital
budgets. This is bankrupting state and federal budgets. This is why medicare,
medicaid, obamacare are bankrupting US Govt (Fed and State) budgets. In 2013
health dominated state budgets.

State spending on health care now exceeds education spending. Look at NM's
past budgets.
[http://www.usgovernmentspending.com/compare_state_spending_2...](http://www.usgovernmentspending.com/compare_state_spending_2016b20a)

​ Today 1/4 of US VA and Indian Health patients are diabetic. US Defense Dept.
funding must now compete with Medicare. Today 40% of hospital costs are for
growing ICU's and chronic disease. 1/2 of US Medicare cost = chronic disease
from diabetes.

NM ICU's are dominated by chronic disease. [http://www.amazon.com/Where-Night-
Is-Day-Politics/dp/0801451...](http://www.amazon.com/Where-Night-Is-Day-
Politics/dp/080145168X)

40% of US hospital budgets now pay ICU/chronic disease costs. This cost is
going up annually. [http://money.cnn.com/video/technology/2013/07/24/fortune-
tra...](http://money.cnn.com/video/technology/2013/07/24/fortune-trailblazers-
icu-telemedicine.fortune)

Can MinION help pre ICU patients better control diet and sepsis infection.
[http://www.bloomberg.com/news/articles/2015-06-03/deadly-
inf...](http://www.bloomberg.com/news/articles/2015-06-03/deadly-infections-
drive-billions-in-hospital-bills-to-medicare) A complete bacterial genome with
MinION
[http://www.nature.com/nmeth/journal/v12/n8/abs/nmeth.3444.ht...](http://www.nature.com/nmeth/journal/v12/n8/abs/nmeth.3444.html)

Minion can find septic bacteria fast.
[https://genomemedicine.biomedcentral.com/articles/10.1186/s1...](https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-016-0326-8)

henry.brown@state.nm.us

