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WADE WINGLER: Welcome to ATFAQ, Assistive Technology Frequently Asked Questions with your host Brian Norton, Director of Assistive Technology at Easter Seals Crossroads. This is a show in which we address your questions about assistive technology, the hardware, software, tools and gadgets that help people with disabilities lead more independent and fulfilling lives. Have a question you’d like answered on our show? Send a tweet with the hashtag #ATFAQ, call our listener line at 317-721-7124, or send us an email at tech@eastersealscrossroads.org. The world of assistive technology has questions, and we have answers. And now here’s your host, Brian Norton.
BRIAN NORTON: Hello, and welcome to episode 23 of ATFAQ. I want to welcome our panel today. We have a few of the regulars on the show and also a new person. We met we have a plus one today.
BELVA SMITH: Special guest. Yay.
BRIAN NORTON: The first person I would like to introduce is Belva Smith. She is the guru of all things vision and hearing related.
BELVA SMITH: Hey.
BRIAN NORTON: And also we have Mark who is the guru for all things mobility and cognition.
MARK STEWART: I’m thinking about the title, but hey everybody.
BRIAN NORTON: And we also have Wade who is host of the popular podcast AT update.
WADE WINGLER: Hey everybody. I
BRIAN NORTON: He is running sound and engineering for us and has our always popular wildcard question for the week. We also have David Fry here. David is on our mobility and cognition team pure key is an AT specialists and we brought him on for some questions that he has been getting recently. David?
DAVID FRYE: Thank you. It’s nice to be here.
WADE WINGLER: It is nice to have you today.
BRIAN NORTON: We make sure we get that in there.
BELVA SMITH: David’s going to bring a whole lot of tech guru stuff to us today.
MARK STEWART: He has some skills.
WADE WINGLER: And a big deep voice.
BRIAN NORTON: That’s right.
DAVID FRYE: I’ll try.
BRIAN NORTON: Excellent. For our new listeners, or for even our listeners who have been there for a while, I just want to quickly give you a little bit of information about how the show works. This is a question and answer show. Really we have two requests from everyone who is listening. The first thing is send us your questions. We love to hear from you. If you have an assistive technology question, there are several ways to get a hold of us. You can send us your questions on our listener line or give us a call and record a question life and will put on the show. That listener line is 317-721-7124. You can also email us at tech@eastersealscrossroads.org. Or send us a tweet at hashtag ATFAQ. We will be able to get those questions. The second thing we would love for our listening community to do is call in and provide your own feedback for the questions we are asked. Our goal is to develop an active listening community. If we don’t have good answers, here in our studio, we hope you guys do. We chime in and provide feedback to our listeners who have called in and asked the question. Please keep those two things in mind. If you have feedback or you have a question that pops in your mind, please let us know.
BELVA SMITH: Let’s throw a third things out there. Is asked them all to tell their friends about us, so our listening group can grow.
BRIAN NORTON: Absolutely. The more people, the more knowledge we can bring together.
WADE WINGLER: Like Amway.
BRIAN NORTON: That’s right. We really are just doing a pyramid scheme.
MARK STEWART: Of knowledge.
WADE WINGLER: Nicely done, Mark.
BRIAN NORTON: If you’re looking for our show, several ways to find us. You find us on iTunes. You can go to ATFAQshow.com. You find us on stitcher or on our website, www.eastersealstech.com.
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BRIAN NORTON: So I asked David to come in. We were sitting around 18 meeting earlier this week, and had a couple of questions that were being tossed around that we had gotten from some of the folks that we work with. I just thought David had some pretty good answers to those so I wanted to bring him in and tackle those questions. The first question is something that we run in to quite often, is when you run into that speech.dll issue with Dragon. Often times when installing Dragon, folks will get an error message that says speech.dll issue.
WADE WINGLER: What is a DLL?
DAVID FRYE: It’s part of how the program can process the information itself. It’s kind of like a bridge between two things. The Windows version of the speech.dll conflicts with the one that you try to install from Dragon. That doesn’t always happen. It happen a lot when Windows 8 first came out and now it is happening again when Windows 10 has come out. These effects for that is to go to the nuance page and research that and download a new version of it and reinstall it.
WADE WINGLER: Download a new version of Dragon or the speech.dll?
DAVID FRYE: The speech.dll.
BELVA SMITH: So you search for speech.dll when you go to nuance?
DAVID FRYE: Yes. You can also use Google and type in Dragon error speech.dll. It’s pretty common but doesn’t happen every time.
BELVA SMITH: But it is important that you do go to the nuance website to get that? You wouldn’t want to go anyplace else to get that?
DAVID FRYE: Right, due to phishing.
BRIAN NORTON: That is a very – is that a specific nuance file or is that a Microsoft file?
DAVID FRYE: I think it is a Microsoft file.
BRIAN NORTON: To have to reinstall to get it to work. If you guys ever run across a speech.dll issue, when you’re installing Dragon, and easy, quick way to be able to find the file is to go to nuance like you mentioned, search within their troubleshooting or their knowledge page base and look for that speech.dll file to be able to download that and install. Does that usually take care of it or are there other issues?
DAVID FRYE: Normally for the instance it does. That just has to do with accessing the profile for speech to text or controlling the computer. There is another related issue that is pretty common where it says after you have trained for a while and you go to exit Dragon and it is supposed to automatically save, it says something to the effect that the profile cannot be saved because the profile is being actively used. Which is ironic.
BELVA SMITH: I have actually seen that one.
DAVID FRYE: That is a common one. That is why I recommend people backing up their backups redundantly in case there is a corruption. If Windows updates and the registry changes or the programs file for Windows changes and Dragon isn’t working correctly, and you were to back up that profile, then you essentially load your profile back in and will automatically correct it. Especially in the beginning, you want to have at least two or three versions of your profile. I would recommend making one in January and one in March and one in May until everything gets worked out.
BRIAN NORTON: That’s interesting.
BELVA SMITH: If I have two or three user files, then when I opened up Dragon, each time I’m going to have to choose which one I want?
DAVID FRYE: No. It’s the master Dragon file. Let’s call it Dragon. Every time you export that profile to be saved, it is going to be called Dragon. Obviously in the place where you’re going to store your versions of the profile, you will need to rename it Dragon genera 16 and the next time you back it up in April is going to be called Dragon, so you want to rename that one Dragon April 16. So on and so forth. So that if you have a crash or have to install it on a new computer, you’re not starting over from scratch. But if you do have malware problems, virus problems, system instability problems, and then he was one doesn’t work, you can jump back to your performance before it does.
BELVA SMITH: Instead of going all the way back to the beginning.
DAVID FRYE: And having to restart.
BRIAN NORTON: It saves it as a separate file? Backups are separate then your active profile that your actively using.
BELVA SMITH: So it is not like you are creating another profile.
DAVID FRYE: You’re not creating a new user.
BELVA SMITH: A new user profile.
DAVID FRYE: More on that, you want to make sure that you back up somewhere other than your hard drive in case you have a hard drive failure. For light users of Dragon, it’s not that big of a deal just to start over. But for heavy users where they have spent countless hours getting things to work just right and they have to start from scratch, it is devastating.
BELVA SMITH: Cannot backed up to Carbonite?
DAVID FRYE: Yeah. Or in the cloud service. It depends on how much work that has been put into it. I would say the average is about a one gigabyte or so. You can use dropbox or any other cloud services.
MARK STEWART: I’m going to say a couple of things and ask to speak to something. So when we first started this out, we were talking about a DLL file that didn’t have to do with the user profile and had to do with the overall installation of the software. What we’ve been talking about lately is the user profile, the digital version of a person’s voice on Dragon. It simply is named by Nuance a “user profile”. In my experience, I guess this was back in a couple of years, but talking to tech support over the years at Dragon, when there is an issue with the user profile, they were pretty quickly default to it looks like it is corrupt. You just need to do the things that David is talking about. That’s what he’s going the direction he is. David, do you mind backing up on Dragon, exporting and importing?
DAVID FRYE: So there are a couple of ways you can do it. What I do typically is to go into profile and manage user profiles and go to advanced and export. Then it will ask for this nation, you choose your folder where you have the backups. Then it exports that pretty quickly. So if you were to have to reinstall Dragon after a crash or hard drive failure or any other catastrophic failure, you would install Dragon as a new user, so you would rename it new user file. It doesn’t matter. Then you would have to go back and recalibrate everything as if you did originally. That scare some people because they say what about my old profile. Once you have created that new profile, recently go in and import through profile, address user profile, import pure once it is in there, you have new user and the Dragon user and you would load the Dragon user and delete the so-called new profile and you’d be back to where you were.
BRIAN NORTON: Wow. So is all that is a pretty easy process to make that backup files. I know over the years I have run into clients that haven’t backed up their profiles. A lot of the clients we work with, at least that I have worked with over the years, have some issues with breath control and voice volume and so losing a user profile would be huge for them, for them to be able to get Dragon, after months of using it, we built up to where they were when it crashed, it could be a real concern for them. Definitely having people backup files and create those, it’s not a very complicated or sounds like a complicated process, but it’s something you have to stay up on.
MARK STEWART: I’m going to play with the words here. Isn’t it in most recent version of Dragon you can backup, there is a backup option?
DAVID FRYE: There is a backup as well.
MARK STEWART: That would just go to the local drive?
DAVID FRYE: I’m not sure of those differences but I use the export because it exports everything. That way you can move it off of your current hard drive.
BRIAN NORTON: And if there is anybody in our listening community who knows about that particular backup option, that would be great to hear from you.
DAVID FRYE: Import, export versus just backing up.
MARK STEWART: I was just making the assumption that backup is everything but to your local drive.
DAVID FRYE: Once again, I want to emphasize that whether you are backing up or exporting to make sure that you have at least two or three different versions of the same profile. Like I said, if you are backing up to the same location over and over again every month, you back it up and then find out two weeks later that Dragon is corrupted. The odds are that the profile that you backed up is also corrupted. You are back to square one. For those heavy users, you want to make sure you have redundant copies.
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DAVID FRYE: Another question we have is, sometimes with Dragon and getting Dragon installed, there is the need for a robust Internet connection to be able to download the files. Sometimes it can take upwards of two or three hours depending on your level of Internet connection and download speed. Because I think in the install process, I believe this is the case that there is some reaching out and downloading of some updated files and things like that that happens, or at least it’s been my experience that sometimes Dragon can take a long time to install depending on the computer.
DAVID FRYE: I don’t know if Dragon is available online. I think it is only available on the disk.
BRIAN NORTON: Is it? Okay.
DAVID FRYE: I believe so. There is no trial period there is a lot of phishing that offer that and they say Dragon is available as a download, but I do not believe it is. I believe it’s only on the DVD itself. However, if you have a laptop that does not have a DVD drive and you want to have that available, you can always get an external DVD drive and copy the entire contents to a thumb drive and you can run it like that without having to have the disk.
BRIAN NORTON: I think at times in the install process, I think it does download some updated files or file updates. It can take a couple of hours to get everything.
DAVID FRYE: It also depends on your processor and your RAM and that. I’ve seen Dragon take three hours or one hour.
BELVA SMITH: So if I’m getting ready to install Dragon NaturallySpeaking, I need to, number one, make sure I have enough room on my hard drive, and I’ve got Internet connection, and lots of time on my hands, and then as soon as I get my profile created, I should probably go ahead at that point and do a backup just so that if I have to start over again I can start from that spot without going all the way back? Or do I use it for a while before I worry about making a backup?
DAVID FRYE: You can wear it while. In the very beginning you are mostly doing the tutorial to show you where things are and how formats go. There are a couple of things that the new user should do. One of them is read text to improve accuracy. What that is is Dragon may be pretty good at picking up what you are saying, but it wants to hear how you would pronounce certain words that are in common. Then it can create a profile. Accuracy tuning is the second step to that. After you have read to it a few times, because it takes about a half hour to read through one session, you have invested four or five hours into it and you don’t want to redo that, that’s a good example of — it’s enough time that you shouldn’t have to go back and redo it, but not in the very beginning when all you’ve done is to test your microphone.
BELVA SMITH: So I’ve heard recently, especially a lot of folks saying you don’t have to train Dragon anymore. It is so intuitive that it will – in my experience, that’s just not true. To get a good experience, you need to train it. Is that correct?
DAVID FRYE: It depends on what you’re doing with that. Obviously if you have a more demanding need for it, then there is no way you can use it efficiently without training it. For the average college student, it’s going to be pretty accurate because it has gotten a whole lot better. But it is still not going to recognize certain words that you might use all the time, like if your last name is not a common one or the spelling is different. You’re going to go and improve those words. For instance, you can make commands for you don’t have to repeat yourself over and over. If you have a school email, you can have that as “school email”. That can save you some time. Is it absolutely necessary for everyone’s needs? Maybe not. But for most people, yes. There is a level of training that is required.
MARK STEWART: I would agree with that. It does do pretty well out of the box. It really depends on what you’re using it for. If you’re just using it for speech to text, it’s going to do pretty well, and if you have a “normal” voice, good voice volume, breath control, those kinds of things, and know the different commands, you won’t have to spend a month of training time doing that. If you are needing to use it for pretty complicated, sophisticated things on the computer, navigating and using it as a total access solution, will certainly you will need training. The interactive tutorial that does come with it is pretty good. It is pretty comprehensive. That’s a good thing.
DAVID FRYE: What is clever about Dragon is you can talk to your computer as if there was a person with a mouse and keyboard in front of them. You can tell it literally press enter and it will. You can tell it to click something, click okay and it will click okay. There are a few major commands that people don’t realize. Even if you don’t need it for specific things, it makes it easier to have a hybrid way to search the web so you can click and say Indianapolis Colts, press enter. That isn’t something that the average person would understand straight out of the box. That is a good example of training it.
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BRIAN NORTON: If you have an assistive technology question, give us a call on our listener line. That is 317-721-7124. Or if you have some feedback over the questions before, let us know that as well. Our next question was from an email from Dana Sherry. Her question was, I am messaging with regard to a project she is working on. I guess she is working on a gesture-based mobile app to assist BDI users, blind or visually impaired users to use smart phones. They are struggling to find out statistics on the number of blind and visually impaired users using smartphones in the US and India. The question was do you guys have any direction on where they can look for those types of statistics. I will throw that out to the group.
BELVA SMITH: I tried to find those same numbers. I don’t think there is a really good place to get reliable numbers. What I found was when the folks that developed Eye Note, the money identifier, they did some research and release some numbers at that time, which the app has been out for about four years. They did some research and came back with over 100,000 blind folks that could be possibly using the iPhone. I don’t know where they got that information because I tried to do some research and I couldn’t pull up anything.
BRIAN NORTON: I did some research. I didn’t see web statistics that I could find. A couple of places that I think would be good starts in trying to ask the question, perhaps calling some folks at AppleVis which is a great resource when you’re trying to look up apps for folks who are blind or visually impaired or different things like that. I also thought of maybe calling the AFB or NFB, American foundation for the blind, or national foundation for the blind. They might have some statistics like that. Again I had difficulty just like they did trying to find statistics. The other thing I would suggest is, for folks that are listening, anybody in our listening audience who may have a lead for where to kind of look for the information, we would love to hear from you and be able to get back with Dana Sherry and provide her places where they can look as they do some research for their gesture-based mobile app. If you do, let us know.
WADE WINGLER: I guess it is important to note that she said US and India. She is looking for information on both. My guess would be the US information is easier to find. I don’t know if they are tracking that in India or not. That is what they’re looking for. Chime in if anyone happens to know where they may look for that. We will report back.
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BRIAN NORTON: If you have a question, and assistive technology question, or feedback over our previous question, send us an email at tech@eastersealscrossroads.org. We would love to hear from you. Our next question is an email from Jimmy. I am looking for a headset that will allow someone to listen and talk on the phone simultaneously. Listen and talk on the phone, and also listen to the computer simultaneously. I’ll throw that out to the group.
BELVA SMITH: That is a tough one. I think you and I were recently talking about that ourselves. I would just direct Jimmy to headsetplus.com. They do have a phone number there where you can call and actually speak to a specialist on that. Off the top of my head, I don’t really know. But I think Mark has also looked into this a bit and might have some good feedback for us.
MARK STEWART: I do. Apparently, according to a confident tech support person at Plantronics, we have worked with Plantronics a bunch and a lot of different configurations. This was an interesting one. I think we all really appreciate the concept. A very important potential application is someone who is fully blind, might be using JAWS —
BELVA SMITH: Call center.
MARK STEWART: Right. They are working at a call center, and they would like to come without any distortion, listen to what the computer is saying and then also be able to simply have a regular conversation on the classic business the phone. Frankly, I called Plantronics about this question in particular, and really I called twice. The first time we ended up addressing the question – I got steered towards using voice over Internet protocol phones on the computer while also being able to listen to the computer, and if time allowed, you might talk about making sure people can do that. More people out there know that that can be done. With regards to this question in particular, they assured me that the Plantronics Savvy 700 — let me suggest an approach to back up I’m going to give you here. I would call Plantronics at 888-752-6876, navigate through and ask specifically for tech support and describe your situation. That’s what I did representing the person with this question. We ended up discussing specifically the savvy 700 and not a lot of other systems. With the savvy 700, you can set it specifically so that you can be hearing the audio from the computer and also hear the audio from the phone and you can speak on the phone. It will connect with mobile and the computer and connect with the phone and you don’t have to toggle between computer and phone. You can get the audio from both sources.
BRIAN NORTON: That is a wireless headset, right?
MARK STEWART: It is a wireless headset connected to a base and has the buttons to change those functionalities. So the charging and the main part of the Bluetooth connection is in that space, so it is an all-in-one base that connects by wire to both the computer and the desk phone. I know, Brian, you work with a version of this. It’s a really neat system because you can get it with lots of different headset options. You can get it with the smaller sized but padded leather at cups either binaural, both ears, monaural, one ear; or you can get it in a version that has a universal interchangeable headset where you can have it over just one ear and more like a classic Bluetooth for mobile phone. You can have that device that is one ear but is secured over both here with a wire over the back, or it can be over both ears. There are lots of different configurations you can use.
BRIAN NORTON: That’s interesting because I’ve used that headset before with certain clients. There are some buttons you can press. But to be able to set it up with that would really be an interesting one. Instead of having the dual cups over both ears, you can have a monaural set up inside of the other way around.
MARK STEWART: She showed me it can be done that way. I asked it very carefully. For example, I have a lot of experience using the Voyager legend and a lot of configurations. The Voyager Legend UC for desk, or there is a toggle switch called the MDA 200 that you can use to toggle between a desk phone and a computer. She said right out, great system, but it won’t specifically do this where you can hear the computer in the background and hear the phone. That is the savvy 700.
BRIAN NORTON: We will have to check that out. That is great. A little less techy, if you will, it’s more of a wireless set up. There is another Plantronics headset. The SKU number from a Plantronics standpoint SMH1783-11, is a dual channel headset. You actually have two ear cups or you listen out of both ears. What you have a wire that will lead you over to the computer so it just has a wire that goes into the back of the computer for your sound and has another wire which will run over to your phone. Your listening to the phone out of one ear and speaking into the microphone out of the one side and listen to the computer out of the other ear. That lets you hear things at the same time out of separate ears.
MARK STEWART: Do your research, it is in line, two wires, a wire coming out of each?
BRIAN NORTON: Yes. It’s an interesting set up. It’s been around for a long time. We have used in different call centers for folks. It is a pretty specific headset, about $300. I think that is in line with the savvy 700 microphone. Definitely some different options for folks. I am really intrigued because of the tech piece of the savvy 700. That is a wireless headset. That would be really nice not to be tethered to something so that if you’re in a call center for long period of time, it can be difficult. To get up and walk around periodically would be nice.
MARK STEWART: And you can tap a button and take a mobile call.
BRIAN NORTON: That is great.
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BRIAN NORTON: Our next question is I am working with a young person who has access to his laptop via an external joystick plugged into the USB port for many years. His joystick is starting to become unreliable and he was wondering if there are any new joysticks available on the market. I’ll throw that out to the group.
MARK STEWART: What you guys think is going on with this person? Mechanical failure is the way I take it, not change inability. Is that the way you read the question?
WADE WINGLER: Probably, yeah.
MARK STEWART: Things do wear out. Of course everyone wants to check out what is new on the market. I guess I’m reading it as it is wearing out but before he despises the new thing he wants to see what else is available.
BRIAN NORTON: I think when they mention starting to become unreliable, I think it was more it is wearing out then it is the user’s ability to use it.
WADE WINGLER: I think so too, because they are looking for new joysticks as opposed to a new access method.
MARK STEWART: We work with joysticks a lot. We are all going to mention the Traxxas. Statistically there is a chance that this is what he used. It would be okay to go back to that. Things do wear out over time and things really get a lot of use by folks over time. I don’t know of a reason to not continue to use that. It’s been around for years and years, and it’s tried and true. I like it has a lot of features to it.
MARK STEWART: It does.
BRIAN NORTON: David, if I am not putting you on the spot, you’ve been using it a bunch lately.
DAVID FRYE: I think that is the overall standard. It is the industry standard. There is a list of a few variations to it which we are going to go for later. The Traxxas is simple enough and very effective. If a new product were to come out that maybe works just as well but is a little more complicated, it actually is at best a lateral movement.
BRIAN NORTON: The thing I love about that trackball is, if you haven’t messed with it, it has a button guard that you can put on it that can be removable. You can leave it on or remove it for folks who may have specificity or tremors in their hands so they don’t accidentally hit buttons. I like that piece of it. I also like the fact that you can tie it in to either the X axis or Y axis. So you can go left or right or up and down and you can actually make it so that no matter where you move the joystick, it will only go up or down or only go left or right depending on the person’s abilities to be able to move the joystick reliably. I always love the running man button. There is a running man button. It is not a running man dancing on the bottom, but it is a little guy who is running on the button that will slow it way down. If your hand eye coordination is off or a little slow, and maybe makes reliable movements challenging for you, you can actually slowed way down so that it only moves incrementally across the screen until you go over top of what your target was. It is really reliable. It also comes with a couple of different options. You have a T-bar, a large spongy ball that can go on top of the joystick for folks who may have grip issues or need specialized scripts to be able to grab the joystick. It gives you some different options as well.
MARK STEWART: It is switch ready. Relevant thing has its lifespan, it’s made to take a little bit of a beating. There is the Optimax joystick that is out right now. It’s a little bit of a lower price, stripped-down version. Certainly the same idea as the Traxxas. It doesn’t have the button guard, but you do have switch access. Craig Burns, a colleague of ours, was just pointing out prior to the show that it comes in a wireless version which is nice and might be important for some folks. I don’t think we are talking about having this person change up their access method, but there is the big track switch adapted device that you almost think of it as a giant switch, but really it is a roll of ball that has a left and right but not it. You can connect some switches to it. Brian, you are making note of the Sam joystick that has been out there for a while. And there is taking advantage of power wheelchairs and working with their proprietary software and switching the mode on that joystick to computer access. There is a lot of high-technology out there. We don’t know whether this person who had asked this question uses a power wheelchair.
BELVA SMITH: It’s on like this person has been using the same method for quite some time. My suggestion for this individual and the person who is asking the question would be to find their local tech act project and see if they can get their hands on a loaner, a couple different loaners. For us here at Easter Seals in Indianapolis, that would be INDATA. They would be able to come out with a bunch of different methods of joysticks and trackballs we could look at. He would actually be able to try them out and see which one he likes the best.
WADE WINGLER: A lot of the programs will let you borrow it for 30 days. You can try it out and see. Mark, you mentioned a number of products. Maybe you said it and I missed it, but what is the general price range for these things?
MARK STEWART: Traxxas is $4-500, right guys?
BRIAN NORTON: It’s pretty expensive. It’s about $500.
MARK STEWART: The Optimax is more like $200 for the wired version. Wheelchair Systems is kind of its own question. Brian, the Sam joystick?
BRIAN NORTON: I don’t know the price of that one.
BELVA SMITH: I think this is something that you want to try out before, especially if they are going to be $4- or $500 before you actually invest that kind of money.
WADE WINGLER: It looks like the Sam is in the $250 or $300 range.
MARK STEWART: With Traxxas, you are paying for the features and for good components. I think history has shown that it is worth the money. Again, this person may have well had a Traxxas and had it for 10 years. They only last so long.
BELVA SMITH: Where would I start to research? Would I go to Amazon to find it?
BRIAN NORTON: A couple of places I would send you would be EnableMart. They have several trackballs or the sticks available. Also another place would be InfoGrip.com. They also have various input options, mice, keyboards, other kinds of access solutions for folks. Those would be to places I might start with. If you are looking, you mentioned the AT Act projects that are all across the country here in the United States, you can find those listed on our website.
WADE WINGLER: Www.eastersealstech.com/states. That will take you to a list of all the projects that are equivalent to the INDATA project.
BRIAN NORTON: That will provide you their address, phone number, you can be able to call them up and find out if they had a loan library. Every solution we talk about, every question that is related to a piece of equipment, we talk about different kinds of equipment, it’s a great place and great resource to be able to use and call and find out more information. Is it available in your state, can you get your hands on that to be able to try it before you buy it. Always look at that as a local resource, especially if you are here in the United States. They are in every state and every province as well.
MARK STEWART: Let’s say that this person has used a joystick for the last 10 years, it’s the same one, it was a really sound access method. Let’s say that that device, its electronics are simply starting to fail. It is going to be a replacement situation. With regards to joysticks, yes they are still used all the time. They are a great input method. We may want to lean toward simply replacing the exact same thing the person uses and then their motor memory will be the same and everything rather than trying some other type of lateral move as David said with regards to another brand of joystick or something like that. From an assessment standpoint, this might be a little bit of the question they are asking. What if they are just asking about new modern input methods? We don’t know this individual, but is there any voice usage? They should check out voice recognition technology now if it has been 10 years. It will be night and day. They should check out head mouse input technology because it will be a lot better than 10 years ago. That is a creative suggestion that they might take up.
WADE WINGLER: We know one thing that has changed is the joysticks seem to be pooping out, but other things may have changed. This might be a good opportunity to overall reassess the whole situation. That’s a great point.
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BRIAN NORTON: Don’t forget to give us a call on our listener line at 317-721-7124, if you have a question or if you have any feedback regarding that previous question we just asked. Our next question is I have an individual with difficulty taking her medications on time because her dosage times and types of medication change frequently and her primary caregiver is not with her all the time. Are there solutions for her to be able to dispense or get her the medications and the dosages that she needs? I know over the years we have had various home health aide companies come in and demonstrate to us in our team meetings and things like that different types of medication monitoring systems cat if you will, my own term that I just created. I will claim that eventually.
WADE WINGLER: If you don’t know the answer just think up a new word.
BRIAN NORTON: There are all sorts of different types of electronic tools. I found a couple of devices that we have seen. What is the e-pill dispenser. It is an automatic medication dispenser cat and you can do tablets, pills, those kinds of things through almost an alarm clock type of setting. Your physician or your therapist or your home health nurse will be able to fill those things up for you and at particular times and particular parts of the day it will dispense medication and notify you that you need to take your medication. There are a whole host of electronic dispensing types of options available for folks.
BELVA SMITH: I found a device called Med Center. It is a talking alarm and medication reminder. Basically it tells you it is 12:30 and you’re supposed to take your blood pressure medicine because you record the message you want to give. I don’t think that is a good solution or the correct solution for this individual because they are saying that it changes. It’s not the same thing every time.
BRIAN NORTON: Those electronic ones are prefilled till someone fills those for you and put the right dosages and the right compartments and they get dispensed at certain times of the day.
WADE WINGLER: One of the interesting things about this one is the key part of the question is that it changes. It is not that I take the same three pills at the same three times every day. It’s that the dosage or patterns are changing on a regular basis. I know a lot of the systems are sort of set it and forget it so it always kicks out these three pills at 9 AM and these four pills at noon and so on. It does the same thing every day. But I think the key to the situation is as different from day-to-day. The only thing I have found that looks like it might give you the sensibility that you need is a thing called Livi at LiviAtHome.com. I just did a tiny bit of research here, but it looks to me like it is a cloud-based system. It looks like a Keurig coffee machine from the visual of it. Someone can log into it like a pharmacist or caregiver and changeup the medication and dosage of those sorts of things on the fly, which I think is new and different as opposed to a system that is just loaded a month in advance and she thought the same thing every day. Unless I am reading this wrong, the system seems to give people the ability to change it up as he goes. I have to assume that it’s the only product I see in its category, so it may be that it may be costly or have some limitations in terms of who can fill it or control it or those kinds of things. That might be something to look at. Their tagline is “automatically awesome.” It talks about the ability to change it up as you go. It might be worth checking out.
BELVA SMITH: I also found e-pill medication reminders, but it looks like there is a monthly fee attached to that device. It looks like they can customize the pill dispenser as well. They might check that out. Google it, or here is the 800 number, 800-549-0095.
WADE WINGLER: David, you found something there about the Livi system. What was it?
DAVID FRYE: If it is up to date, is being launched now and should be commercially available soon and is a subscription-based at $100 per month.
WADE WINGLER: We are recording now the very first part of February in 2016. Hopefully listeners can check out and see that is available in their area.
BELVA SMITH: I had said that e-pill was going to be a monthly subscription, but it looks like they are bragging on the fact that they don’t have a monthly fee.
MARK STEWART: There is some interesting stuff with regard to support for the gadget. If you think about the availability of virtual technology and a topic called tele-rehabilitation. We do some work with the VA and computer access and there are some wonderful things going on with partner programs where case managers at the VA might send these devices that you’re talking about to the veteran, may be in a rural environment, and then they will have a case manager communicate with them maybe over Skype or virtually or even just by phone and help with the setup and support of this device. I think there is a little bit going on these days with regards to trying to come up with some progressive ideas helping folks out on the civilian side. There might be some funding through insurance companies of nurse case managers and things like that and people that can help make these things fly and provide a little bit of distance trainings.
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WADE WINGLER: And now it is time for the wildcard question.
BRIAN NORTON: Our next question is our wildcard question of the week. This is where Wade gives us the question off the wall and we have to try to answer that question. Wade, I will throw the microphone your way.
WADE WINGLER: Brian is going to roll his eyes when we talk about this one because this is related to a conversation we were having earlier in the date. Everyone here in the room has practiced assistive technology and is had to be in a situation where they are doing evaluations and helping people with disabilities make educated and informed decisions about what technology is going to help them be independent, successful on the job, the community school, or whatever. What do you guys do when it is your job to evaluate or your job to help a person with a disability and their technology need and you don’t agree with what they are interested in? The situation we are dealing with in this particular situation is someone who wants a custom-built, very expensive, tens of thousands of dollars device that will have to be built by a machine shop. Nobody is convinced that it is the right technology except for this person with a disability who is an adult, emancipated, make their own decisions, and in this particular case happens to be self-funded. He says I’ve got the money. I want this device that I want it to work well for me. We are not sure that it really is going to be worth it. It is not the right bang for the buck. We’re talking about someone who might be spending a whole lot of money on something that might not help that much. What do you guys do when you run into a situation where you have someone who says this is the technology I think I need or want and you think this not the right call. Is that going to work well for you. You really are not spending your money in a wise way. What do you guys do?
BELVA SMITH: I’ll go first. The first thing I would do with this individual, because the keywords that I picked up on was they are self-funded.
WADE WINGLER: Money is not the object.
BELVA SMITH: In this case, I would educate the individual as much as I could. I would put him in touch with perhaps the folks that are going to be customizing it for him. I would put him in touch with maybe someone who has used something similar to it or exactly, if it is not one-of-a-kind. And then give him some information about the options and stand back and say it is your decision and your money. I have but shoes that don’t fit very good, but I like them.
BRIAN NORTON: For me it is a moment of pause, because I feel like ethically in situations like that, I need to figure out how much I want to move forward with a project and whether I should be the right person to working on a particular project, especially when I don’t feel like the bang for the buck is there, that it’s going to meet the need, is not necessarily going to be as functional as the person hopes or remember it was to them. In situations like this, and I’m hesitant to move forward. I don’t know, other than bringing together his support system, if he has one. If he has people around him that advise him on his money and advise him about things that he does day in and day out, bringing together a team around him to have the conversation, not just between me and them, but with everyone involved to say is this something that you really feel like moving forward with. And for me, if the answer from everyone is yes, I then still have to take a step back and say how do I feel about it. Am I in the right decision? Am I going to be part of that?
BELVA SMITH: If it’s not going to hurt him – let’s say it’s not going to hurt him. It’s going to cut at best, be a good experiment.
BRIAN NORTON: Part of the question was it is thousands of dollars to be able to meet a particular need, coming out of the person’s own pocket and things like that. I still have room for pause in the way I approach that to say I don’t know if that is something I want personally to get involved with. That’s just me.
DAVID FRYE: I would like to chime in and say as far as my trying to be an advocate for them, it is their money, their decision. If I was in their shoes, and I’m convinced that this is exactly what I need, I’m kind of relying on the expert to make sure that I am not making any mistakes in the Longview. It might serve an immediate purpose, but overall is it the correct device. You kind of have to enter in a relationship with them for better or for worse. You want them to get the help they need, but you also have to look at long-term cost investment, if they could buy two items for less, with that help them more than this prototype essentially.
BRIAN NORTON: I think there are long conversations about expectations, but it is really going to take to make something happen, to make sure that they have a really full understanding. Personally for me, not just that I have a full understanding, but I might even put something down in writing with them to say, these are my concerns, these are the things moving forward for me. Because I am all about helping people, I want to see people succeed, I want to see them reach their goals, but if there are things that I pause about or hesitate about. I want to make sure they understand that and get a crystal-clear that he really do have my concerns.
BELVA SMITH: I think we are on the same page except I would go ahead and stand by them. I would give them all of my opinions. I would give them as much knowledge as I possibly could. But I am not going to prevent them from trying something that, who knows, it might be the best thing they’ve ever done. I’m not going to prevent them from doing that. Now, if you turn the question around and make it not self-funded, then that changes my opinion a lot.
MARK STEWART: I couldn’t find a place to chime in there. There are some phases I will play off of that I think are going to get slipped in here somewhere. Being consumer centered, degree of safety issue, least expensive reasonable alternative, use of the taxpayers money. I will play off of that even though it is private pay.
BELVA SMITH: But you are not making itself paid if you’re playing off of all that.
MARK STEWART: Right. I work for a nonprofit organization. By certifications, professional standards, ethics, I have my own rights. I need to be able to sleep at night myself. So I’m going to start thinking about this, playing off of the foundation of the work I very often do which is through a funding source that uses taxpayers money. The idea there is that we use some taxpayers money up front, and it pays off over the long run because now the person becomes a much more higher contributing member of the society and they can literally pay more taxes themselves down the road and help out the next person that comes along. It actually all makes sense. To do that, they have to have goals established that, while we are all about those goals being married person centered, very individualized, they can have a real twist that has to do with what the person wants and is interested in. We also want them to be very progressive goals. Yes, I think we can, let’s find a way. But, this is it 50 years from now, it is today. There can come a point in time where goals are not reasonable. So the goals need to be reasonable. I don’t mind saying, even if they are a little bit stretched creative goals, great. But reasonable. And then off of those goals, we need to find the least expensive reasonable alternative solutions to those two how to achieve those goals, not unnecessary Cadillac, good solid Chevy, and less and the wacky situation you can’t achieve the goal unless you have a Cadillac. That happens sometimes. And no more than that. I can sleep at night with that. Now what if the consumer says I am still playing off of the foundation of referral source, using taxpayers money, the greater good –
BELVA SMITH: But that wasn’t the question.
MARK STEWART: But I think it ties in. What if the person says I want to do it this way, spend a lot more money, it becomes an unreasonable goal professionally. We don’t think it can be done. I really pride myself in consumer centered work, but above all else do no harm. So safety is one of those few things that can trump consumer centered. Let’s say the person has a cognitive issue and they said I want this cat that, any other thing. I want you to teach me to run in front of traffic. I am so sorry, I will not do that. I have the right to do that. So safety trumps it all. Never goes, it’s not safety, but as Brian was talking about, the ethics, almost really that professional/common sense of things. Now let’s go to private pay. If the person has a cognitive issue, now I’m going to be more careful. So the person doesn’t have a cognitive issue; they are a very sound mind; they want to give me $20,000 to endlessly build something that professionally I don’t think will work for them and they are begging me to do it. So now I’m going away from the foundation that I set up. Let me go more to a black and white where, yeah at $20,000, do it for me or I will fire you. There is no safety issue, it is their money, I can’t see at all how it is going to work, I’m going to spend two months working on it. I think I have a right to decline providing services almost for my own reasons. It is not what I got –
WADE WINGLER: Especially if you have a waiting list of clients who need help that you will be putting off as well.
DAVID FRYE: There you go.
BELVA SMITH: But, Mark, I think you turn that around and made it focus too much on if they were using a standard funding source. Then you turned it around to it is going to be dangerous. I’m not looking at it being dangerous. I’m just thinking it is unexplored technology that this person has maybe read or heard about and they believe that it will work for them. I did say I believe that as long as there is not a safety risk involved, and that I have given him as much education as a candidate, I certainly want to be a part of it because, who knows cat that could be the next new thing that starts to then help millions of people.
MARK STEWART: I wasn’t disagreeing with anyone. I was just giving my take on it. That’s if there was no safety issue. I am playing off my current role. If I were in the private sector cat that would free me up differently.
WADE WINGLER: That is Stevie Wonder calling you and saying please develop this crazy yet helpful blind something.
MARK STEWART: There is no safety issue, can you take a stab at this? We are probably going to fail. I know Stevie wonder brags about how much money he has in the process. Are you kidding? I’m all over it.
WADE WINGLER: Because of time and because I’m a vice president of this organization and had to represent us, and plus I am a guy that opened this can of worms, Mark, I think your comment about stewardship of public resources and safety think absolutely critical to these conversations, we will stand for people’s independence here even if that means they are making a decision that we don’t agree with. Again, depending on who is paying the bill and our time and whether or not someone will get hurt. I think that generally has to be the answer. We are going to advocate for someone’s independence and help them to make the best decisions. And maybe reminding them that you are paying us for advice. You are paying us for our expertise. You can ignore it and do that, but at the same time we would stand for their right to make a decision with which we disagree. But it is a messy scenario. It is something that I am sure people in our audience probably deal with on a regular basis. I would love to hear people calling in and talking to us about their experiences with this cat because it is interesting and tricky.
MARK STEWART: This is absolutely pulling everyone, that’s right, there is something here that we are all saying that is the same. I love to hear it. David was chiming in, and Belva. Hopefully I was in my own way. This has not been historically the case over 100 years ago. This thing about consumer centered, this thing about we fight to listen to the person with the disability and respect what they are saying and respect their opinion about why they think this might be best for them.
WADE WINGLER: Years ago, they were ignored, period.
DAVID FRYE: At the end of the day, after hearing his ideas, the hope of what this might accomplish, there still has to be that two-way trust where he is going to say, okay, so I get what you’re saying even though I am so confident. What is your idea? You have seen more than me. Advise me. But ultimately at the end of the day, it is his call.
BRIAN NORTON: Great question, Wade. I appreciate that.
WADE WINGLER: I thought it was off the wall.
BRIAN NORTON: It was. Too off the wall this time. It was great. Thanks everyone for listening. I look forward to having you listen to us again here in a couple of weeks. If you’re looking for our sure what to tell other folks about our show, they can search assistive technology questions on iTunes. They can look for us on stitcher. Or visit ATFAQshow.com. Also, do take time to send us your feedback, send us your questions. You can call our listener line at 317-721-7124, or you can send us a tweet at hashtag ATFAQ, or email us at tech@eastersealscrossroads.org. We really want your questions. In fact, without that we really don’t have a show. Thanks everyone. Thanks everyone here in the studio. I appreciate everyone coming in. Take care.
BELVA SMITH: Thanks, David, for joining us.
MARK STEWART: Thanks for coming by, David.
DAVID FRYE: Thank you for having me.
WADE WINGLER: Thanks everybody.
WADE WINGLER: Information provided on Assistive Technology Frequently Asked Questions does not constitute a product endorsement. Our comments are not intended as recommendations, nor is our show evaluative in nature. Assistive Technology FAQ is hosted by Brian Norton; gets editorial support from mark steward and Belva Smith; is produced by me, Wade Wingler; and receives support from Easter Seals Crossroads and the INDATA project. ATFAQ is a proud member of the Accessibility Channel. Find more of our shows at www.accessibilitychannel.com.