ATU488 – Avaz with Narayanan Ramakrishnan Part 1

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Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs.

Narayanan Ramakrishnan:
This is Narayanan Ramakrishnan and I’m the CEO of Avaz Inc., creators of Avaz AAC, FreeSpeech and Reader. This is your Assistive Technology Update.

Josh Anderson:
Welcome to your Assistive Technology Update, a weekly dose of information that keeps you up to date on the latest developments in the field of technology, designed to assist individuals with disabilities and special needs. I’m your host, Josh Anderson, with the INDATA Project at Easterseals Crossroads in beautiful Indianapolis, Indiana. Welcome to episode 488 of Assistive Technology Update. It’s scheduled to be released on October 2nd, 2020. On today’s show, we’re going to kick off AAC Awareness Month. That’s right. October is AAC Awareness Month and we’re going to kick it off today with Narayanan Ramakrishnan, the CEO of Avaz. He’s going to be on to tell us about Avaz and everything that it has to offer AAC users, as well as other folks. We have a quick story about using assistive technology to help some individuals feel a little less isolated during these strange times that we all find ourselves in. We want to thank all you for listening and don’t forget that you can always reach out to us. You can send us an email at tech@eastersealscrossroads.org. You can call our listener line at (317) 721-7124 or check us out on Twitter @INDATAproject.

Josh Anderson:
Hey there, folks. I’m very excited to announce that we’ve been able to revamp our entire INDATA website. So if you go over to eastersealstech.com, that’s eastersealstech.com, you can check out our whole new website. We try to make it a little bit more accessible, a little bit easier to find the information that you might be looking for, a little bit easier to direct you straight to this show. But, I guess if you’re listening to this show to find out about the website, you probably don’t really need that help. But, you can find out about our clinical services, our AFP program, our loan library, our device demonstration, our depot and all the other great services that INDATA does. You can also find your local AT act in your state straight there from our website. So if you have a little bit of extra time on your hand and you want to find out more about the INDATA Project, about our YouTube channel, our podcasts, or the other services that we offer, just head on over to eastersealstech.com and check out our whole new website.

Josh Anderson:
Do you find yourself a little bit more time on your hands? Maybe you’re really busy and only have a little bit of time to listen to podcast, or maybe listening to this has you thinking, well, what about this? What about that? Well, if you’re short on time or if you have questions about assistive technology, we have other podcasts that might just fit your needs. The first one is Accessibility Minute. This one-minute long podcast gives you a little taste of assistive technology and really wet your whistle to got you go out and find out more about a piece of technology and how it might help those you work with, yourself, or maybe a friend or family member.

Josh Anderson:
If you happen to have questions about assistive technology, we have Assistive Technology FAQ or ATFAQ. The show is hosted by Brian Norton and features yours truly along with Belva Smith and Tracy Castillo as we all talk about assistive technology with questions that come in from email, phone calls and other means. We also don’t always know the answer, so it’s very important that we have listeners that can help us out with some of those questions. Because while we like to think every once in a while that we may know everything, we’re proven wrong almost daily on that one. So if you’re looking for more podcasts to listen to, if you’re short on time and need a really quick podcast, or if you have questions about assistive technology, make sure to check out Accessibility Minute and Assistive Technology Frequently Asked Questions wherever you get your podcasts.

Josh Anderson:
Our first story this week comes from healthcareglobal.com and it’s titled Assistive Tech Helps Prevent Children Becoming Isolated. It’s written by Leila Hawkins. It talks about a UK charity called Lifelites. So, Lifelites is donating iPads and something called a Tech Trunk to different children’s hospice all around the UK. They do this to make sure that children can stay connected to carers and family, and remain active during a pandemic. Along with the iPads, this Tech Trunk is a portable case packed full of assistive technology for children who can use it. The iPads, of course, have a drop-proof case on them and some special accessibility features set up just so that they’re a whole lot more usable. They’re using these to offer virtual hospice services such as doctors dressed as clowns, music sessions via Zoom, support groups, and just connection to family that may or may not be able to be around the individual due to a weakened immune system, their disability, or maybe some other needs that just make it to where they cannot be in person, especially during social distancing and other things put in place due to the pandemic.

Josh Anderson:
So, things they’ve been able to do is set up virtual play dates for folks, online musical therapy sessions, virtual birthday parties, and other kinds of therapy sessions that, again, may or may not be able to be administered in person just due to the pandemic and health concerns. Some of the things included in this Tech Trunk can be different access devices, be it switches, Eyegaze, things like that, and also a Mobile Magic Carpet. This allows children in wheelchairs to have experiences like kicking around leaves or splashing around in a pool with fish swimming in it. There’s also a selection of games, including football, educational activities, and cause and effect games. It says the Lifelites, this charity has been donating these packages for 20 years already. Of course, with the pandemic, the need has really and truly went up because some folks just cannot leave the house, cannot leave the place where they are due to those health concerns that I suppose all of us are dealing with right now.

Josh Anderson:
I’ll put a link to this story over in our show notes. I know that social isolation is a huge problem right now and something that really probably affected a decent amount of people across the globe already. But, it’s just been exacerbated by folks having to stay at home, folks being scared to go out, and people just not really getting together like they used to. In a while, things, at some point, will probably get back to some semblance of normal. That doesn’t mean that the repercussions of the social isolation might not still be felt cognitively or emotionally for a lot of individuals. I think we’re going to see a whole lot more of this fact. We’re working on the kind of programs here to be able to go out and help individuals with the use of technology to be able to stay in touch, to be able to talk to friends, talk to family, attend doctor’s visits, go to church, and just be able to still be together even though we’re all across a little bit bigger of a distance.

Josh Anderson:
Listeners, did you know that October is international AAC Awareness Month? The goal of this month is to raise awareness of augmentative and alternative communication, and to inform the public about the many different ways in which people communicate using AAC. Well, what better way to start off October than talking about AAC? Our guest today is the CEO of Avaz Inc. They’re going to tell us about all that Avaz has to offer in the world of augmentative and alternative communication. Narayanan, welcome to the show.

Narayanan Ramakrishnan:
Thanks so much, Josh. It’s great to be here.

Josh Anderson:
It’s really great to get to talk to you today. Before we get into talking about the technology, could you start off by telling our listeners a little bit about yourself and your background?

Narayanan Ramakrishnan:
Sure. So, I am the CEO of Avaz and we make assistive technology products for people with special needs. A bit about myself, I’m trained as a computer science engineer. I’ve been working in the assistive tech space for the last 12 years. As we started off creating India’s first AAC app, Avaz, and that was in 2009, Avaz came out, so in the last 10 years, we’ve had the opportunity to work in the space to not only create AAC product but also look at different ways in which we can empower parents and even special educators, or therapists and paraprofessionals. At the heart of it is the person with the disability that we want to empower and you also give the ability to their caregivers to ensure that this entire process is smooth. So, there’s a lot of work on that end at Avaz.

Josh Anderson:
I have to ask real quick just because I’m always interested on how people get into this. So, you’re a computer programmer. What made you come to the world of assistive technology?

Narayanan Ramakrishnan:
So we are based out of India, just to point that out. I used to volunteer in the school here in India and that’s when I saw assistive technology being used. This was used by a kid who was strapped on a wheelchair. He was using a phone with a joystick and being able to control a software on a computer and be able to express his talks, write documents. That was my first exposure to assistive technology. I was like, “Wow, this is what I want to do. This is what I want to be creating.” And so, it so happened that I was lucky enough to look at some of that, have that experience. I’m really grateful for the school there for providing me that great experience.

Narayanan Ramakrishnan:
And then, I was able to get a master’s degree from Georgia Tech in Atlanta. So, I was there in the US getting a master’s degree, focusing on user experience and working on a lot of other assistive tech projects. So, there’s a lot of work that goes in the space of autism, in the space of rehabilitation, agile tech. So, I was really lucky to see that and learn from that. That’s what I wanted to do. I was very, again, lucky to have that moment of epiphany in a way. Oh, this is cool. This is something I want to do.

Josh Anderson:
No. I just always love finding out how people get into this. That’s a pretty normal story that once you see, you’re like, “Wow, it can do that. Oh, I have the skill to be able to help. Excellent.” Well, very good, very good. Well, let’s talk about why we actually have you on the show. Give us just a brief overview of what is Avaz.

Narayanan Ramakrishnan:
Sure. So, Avaz is a picture and text page communication system for people with any kind of communication challenges. So to begin with, Avaz, the word, it means voice in Hindi. Hindi is one of the largest spoken languages in India. As I was saying, Avaz is India’s first AAC system. And so, what it does, at the heart of it is Avaz. It brings in a pretty robust picture vocabulary so that people can create sentences using a picture vocabulary. So, it has all the core words. So, core words are basically the most important words that usually end up making almost 80% of our conversations. So, Avaz has a lot of focus on those core words so that people can actually make those sentences or make what they want to say pretty quickly. Also, the fact that literacy is so crucial for everyone, we’ve integrated a very powerful keyboard also into Avaz. So then, people who are transitioning from pictures can continue to be able to even get into literacy by a bit of powerful prediction using powerful predictive text pictures and spell check, et cetera.

Narayanan Ramakrishnan:
So, the whole concept of Avaz is that it is a way which you are able to communicate what you want when you want it to. So, that’s the heart of it. It’s amazing how people use AAC to just express so many things, right, which we, when we are talking, take for granted. So, that’s what I feel really powerful about any AAC tool for that matter is that it gives you the power to express that a lot of other people take for granted.

Josh Anderson:
Most definitely. I realized as you were talking, just talking about communication, that I’ve been mispronouncing Avaz the entire time of this interview. So, I promise not to do that anymore. I will try to get that changed a little bit. For folks who don’t really know what AAC is, who is AAC for?

Narayanan Ramakrishnan:
So a lot of people, say, someone with a condition of cerebral palsy or someone with autism, they have difficulty in either generating speech, they find it difficult to control their oral muscles, or it could be like a condition due to a stroke that they are unable to generate speech. Those people are the best candidates for something like AAC. Also, the AAC is argumentative and alternative. So, what happens is that it augments someone who is not able to communicate fully. So if a lot of people with autism, for example, find it convenient to use Avaz to communicate rather than use their speech because it makes them less anxious, right, so having a conversation through the app makes them slightly more confident than having to verbalize it, so in those cases, it really augments their communication. In some cases, it might be an alternative to voice itself. So, it’s the alternative mode of communication. So, the people basically facing challenges in communicating by a speech use AAC to communicate their parts and express their emotions, et cetera.

Josh Anderson:
You touched on this a little bit before, but what are some of the tools that you’ve integrated to help educate parents, caregivers, therapist, and that support system for the individual?

Narayanan Ramakrishnan:
Yeah. So, it’s very interesting, Josh. When we started on creating Avaz, we saw that in India, for example, there are not many trained speech therapists. Whereas, across the world, across, say, in a country like the US, there are many more speech therapists who are trained and professionals, who are working in the space. So, what we realized was that we had to really build basically support systems for parents within the app so that they can provide the strategies and the intervention for the child. So, we are supporting the parents to have this entire AAC intervention at home. Right? So, that’s basically how we started seeing that because parent involvement is super critical for that success.

Narayanan Ramakrishnan:
What was interesting there was that when we started integrating… We started integrating very simple things, right? So for example, we started with your parent. Avaz has a huge vocabulary of 2,500 words. How do you create a sentence in Avaz? So, let’s add that. So then, the parent types out a sentence and the app actually guides them how to create that sentence. It will tell you, “Go to this folder, go this folder.” It’s almost like an animated sequence of events that they will be able to see on how to create a sentence. So, this ties back to the very critical aspect of how the parents and the people around the person using AAC should also be using the device, what’s called body link. So, it’s very important that people around the AAC, the communicator, also use their device to model language. This basically helps the communicator to understand better and also then see that, oh, this AAC is not very different from anything else. Everyone else is also using it. So, they’re able to see people use and model the same language that they are using.

Narayanan Ramakrishnan:
Now, the parents, that’s how we started. And then, we realized that parents had to be taught simple tips and strategies. Right? So, the parents or therapist who is trained and who has a lot of training, and then they go through different courses in AAC, but we wanted to glean some of those basic tips and strategies that can get the parents started. So, things which a lot of therapists and professionals will often say is that since the child is either not communicating or nonverbal, they keep asking the child questions in the hope that they will respond. So, what happens is that we don’t realize, parents don’t realize it, that they keep asking questions and the child is just not responding. The child has just switched off. So, there are simple tip or a simple strategy saying that, hey, stop asking too many questions. Instead, why don’t you talk about different things and prompt the child to contribute to that conversation, right?

Narayanan Ramakrishnan:
So you and I, for example, are having a conversation. So, it’s not only… We are able to build on top of each other’s thoughts and that’s how any interaction works. If the parent is asking all the questions that the child is like, imagine asking only questions to a 13-year-old or a 14-year-old. He’s just going to be pissed, a disappointed child.

Josh Anderson:
Yes.

Narayanan Ramakrishnan:
So, that’s the kind of simple tips and strategies. One of the interesting things that came about to this was that we built a small game called Communication Adventures. Right? It’s like you are a parent and you have to interact with this. So, it’s almost like choose your own adventure. Based on that, you can interact with the child who was using AAC. What you are trying to do is, as a parent, you’re trying to say what is the best strategy in that situation. So, the situation is that, say, Johnny who uses AAC is in the kitchen at 7:00 AM in the morning. How do you start a conversation with him, right? It’s a very basic thing. But, you’re giving the parent ideas on what they can do, what are the different activities, what are the little situations they might be in, and how they can make the best of that situation.

Narayanan Ramakrishnan:
So, a lot of it is giving ideas and tips and strategies. We are very thankful to the community itself because a lot of this came through from parents who have posted about their experiences, experts who have posted about one of the best practices. So, we’ve taken some of that and put it into the app itself. And then, we did this in India. The really nice thing was that we thought this challenge is actually applicable around the world. That’s how we started doing a lot of work with school districts in the US as well where they’re using Avaz. And then, the parents are using the entire training component to get to understand the app better and communicate better. So, it almost started off with a challenge that we saw in India. But, we could see that it could easily translate across the globe itself.

Josh Anderson:
Speaking about challenges across the globe and everything, how have you had to adjust to your service delivery or how have you been able to adjust to the pandemic and having to use telehealth a little bit more?

Narayanan Ramakrishnan:
It’s been quite an interesting time as well, Josh. Like I mentioned, Avaz is close to 75,000 people around all 15 countries. Obviously, there is a lot of changes right now because of the pandemic, because these people would go to therapy centers or go to schools where they would have their therapy sessions and get access to therapy. Now that there is a pandemic with virtual teletherapy coming in, what we realized was that it would be great if this entire teletherapy, the entire efficacy of the teletherapy session is as good as the face-to-face session, right? That’s the goal that we want to achieve, that it should be better or at least as good as the in-person therapy session. In these situations, also it’s obviously that a lot of people with disabilities are immunocompromised. So, you really don’t want to have too many face-to-face therapy sessions as well.

Narayanan Ramakrishnan:
So, what we did was we spoke to a lot of therapists, asking how they were doing their teletherapy sessions and trying to understand what would be the best way to integrate teletherapy within Avaz itself. What we realized was that a lot of times, therapists are setting up a Zoom session and then trying to tell the parent and coordinate with the parent, “Okay, set this up. What did the child tap?” So, there’s a lot of communication that’s happening, whether the therapist is talking to the parent and then they are seeing what the child is actually doing on the other end. This might require extra hardware as well, right, one of those document cameras to see. So, there’s a lot of tech involved and a lot of people may not have multiple devices at home.

Narayanan Ramakrishnan:
So all these challenges in mind, what we did was we built a small teletherapy support within the app itself, install Avaz Live. All you have to do is basically connect with your therapist or the parent, or therapists connect with their clients. All this is secure and HIPAA compliant, et cetera. All you have to do is the parent enters a code and then you are in almost like a Skype session within the Avaz app itself. And so, you can see the video of the child. You can see a video of the client and the parent can see your video. And then, the real interesting thing is that you can remote control the client’s device. So, you can basically program their device. Because in AAC, it’s very important that you personalize the device for the client. So with Avaz Live, the parent need not bring the device to you so you need to program it. Instead, you can take remote control and just program the device, set it up for them.

Narayanan Ramakrishnan:
The next level is that you are able to prompt the child. You can have entire teletherapy session through Avaz Live where you’re able to even prompt the child as to what are the words that they can use. So, there is a lot of help within the app itself that will make this entire teletherapy session much more effective. At different levels, Josh, you’re not only ensuring that the parent who’s supporting the communicator gets trained because the therapist is able to provide all the support to the app itself. Secondly, they don’t really need a device at all. They don’t need an extra device. All they need is the iPad which has Avaz installed. So if they already have that, the teletherapy session becomes a much more… You just have to enter a code and then you’re set up. That’s all.

Josh Anderson:
That’s great. Not only it’s great, especially now in the pandemic and things like that, but just getting to appointments sometimes can be a huge challenge. Even like you said, if there’s not enough therapists in the area, you may have to go miles and miles and miles to be able to get somewhere. So, that’s excellent and not having to have a whole nother device. Plus, I feel like that allows the individual using the communication device to be more involved and to really feel like they’re more part of it-

Narayanan Ramakrishnan:
Right.

Josh Anderson:
… as opposed to, as you said, the therapist telling mom who’s then trying to convey that to the person using the communication device. So, that’s great and that’s something that I know will help folks way down the road even when things get back to some kind of normal someday.

Narayanan Ramakrishnan:
Yes. Actually, many conversations that I’m having with even therapists for that matter is that a lot of clients are preferring virtual therapy sessions because the travel is reduced and they seem to be finding it equally effective. So, there is a growing acceptance of this entire teletherapy model itself, which is, I think, great for the entire ecosystem itself because it just gives access to so many more people. Right? So imagine a therapist in the US can consult with a client, say, in India. Imagine bridging this entire lack of professions in India can that be bridged in different ways. So, it just opens up a lot of possibilities.

Josh Anderson:
It really does and could help a lot more people a whole lot quicker. Because if you’re in the US or in India, you can see 10 patients a day all over the world as opposed to having to wait for people to travel and run into that. So, that’s excellent.

Josh Anderson:
Well, folks, unfortunately, that is all the time that we have today. So, make sure to tune in next week where we will have the exciting conclusion of our interview with Narayanan all about Avaz and some of the other things that they have to offer in the communication space. Thank you so much for listening and we can’t wait to see you again next week.

Josh Anderson:
Do you have a question about assistive technology? Do you have a suggestion for someone we should interview on Assistive Technology Update? If you do, call our listener line at (317) 721-7124. Shoot us a note on Twitter @INDATAproject or check us out on Facebook. Are you looking for a transcript or show notes? Head on over to our website at www.eastersealstech.com. Assistive Technology Update is a proud member of the Accessibility Channel. For more shows like this plus so much more, head over to accessibilitychannel.com. The views expressed by our guests are not necessarily that of this host or the INDATA Project. This has been your Assistive Technology Update. I’m Josh Anderson with the INDATA Project at Easterseals Crossroads in Indianapolis, Indiana. Thank you so much for listening and we’ll see you next time.