tag:theconversation.com,2011:/global/topics/assistive-technology-14281/articlesAssistive technology – The Conversation2023-12-19T13:14:40Ztag:theconversation.com,2011:article/2126002023-12-19T13:14:40Z2023-12-19T13:14:40ZDigital inaccessibility: Blind and low-vision people have powerful technology but still face barriers to the digital world<figure><img src="https://images.theconversation.com/files/562793/original/file-20231130-17-d6h2rd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Screen reader software converts text to audio for people who are blind.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/accessmattersnz/45982808441"> Access Matters/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Imagine that you have low vision and you’re completing an online job application using screen reader software. </p>
<p>You get through half the form and then come to a question with drop-down options the screen reader cannot access because the online form doesn’t conform to accessibility standards. You’re stuck. You can’t submit the application, and your time has been wasted. </p>
<p>Assistive technologies like screen readers go a long way toward closing the gap between people who are blind or have low vision and their sighted peers. But the technologies often hit roadblocks because the information they are designed to work with – documents, websites and software programs – don’t work with them, leaving the <a href="https://accessibility.day/">information inaccessible</a>.</p>
<p>There are <a href="https://data.census.gov/table?q=vision+difficulty&y=2022">8 million people with blindness or low vision in the U.S.</a> More than 4.23 million of them are working age, but <a href="https://data.census.gov/table?q=B18120:%20EMPLOYMENT%20STATUS%20BY%20DISABILITY%20STATUS%20AND%20TYPE&g=010XX00US&y=2022">only about half of that working-age population are employed</a>. Employment rates for people with blindness or low vision have historically been <a href="https://doi.org/10.1177/0145482X19887620">much lower than for the general population</a>.</p>
<p>An <a href="https://nationalskillscoalition.org/resource/publications/closing-the-digital-skill-divide/">overwhelming majority</a> of jobs across all industries require digital skills. Assistive technologies such as screen readers, screen magnifiers and braille notetakers provide people who are blind or have low vision a chance to succeed in school and the workplace.</p>
<p>Assistive technology has improved, and new technology for people with blindness or low vision is being developed all the time. The technology developed today by big tech companies for the general population often <a href="https://www.eastersealstech.com/2021/10/27/big-tech-brands-make-accessibility-mainstream-part-1/">incorporates built-in accessibility features</a> like VoiceOver in the iPhone and Narrator in Windows, both text-to-speech functions. These assistive technology advances have expanded job opportunities, and the percentage of people who are blind or have low vision in the labor force has <a href="https://www.disabilitystatistics.org/acs/2">increased over the past decade</a>.</p>
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<figcaption><span class="caption">Screen reader software allows people who are blind to read and write email messages as well as browse the web and work with documents.</span></figcaption>
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<h2>Out of sight, out of mind for the sighted</h2>
<p>But despite the abundance of assistive technology, people who don’t rely on it are typically unaware of how it’s being used at work and the challenges users experience with it. My colleagues and I are conducting <a href="https://www.blind.msstate.edu/research/current/project-1-access-technology-workplace">a five-year longitudinal study</a> to increase knowledge in this area that, we hope, can help prepare unemployed people who are blind or have low vision to enter the workforce. The study is slated to continue through 2025, with the last survey starting in late 2024.</p>
<p>While most of the people we surveyed reported being satisfied with the assistive technology they use at work, almost all also reported <a href="https://doi.org/10.1080/10400435.2023.2213762">challenges with it</a>. The most significant <a href="https://www.afb.org/aw/24/6/18368">challenges related to assistive technology</a> centered on the <a href="https://doi.org/10.1080/10400435.2023.2213762">inaccessible digital environment</a>: documents, software, websites, graphics and photos.</p>
<p>Digital content is sometimes technically accessible but unusable by people who use assistive technology. For instance, online job application systems <a href="https://journals.sagepub.com/doi/10.1177/0145482X231216757">often generate accessibility and usability challenges</a>. Inaccessible and unusable company software means those who are blind or have low vision are often left out of jobs they could easily perform simply because the employers’ software doesn’t work with screen readers. </p>
<p>People who are blind or have low vision have been harder to place in jobs than people with other types of disabilities due to inaccessible company software, Ross Barchacky, vice president of business development and strategic partnerships at <a href="https://www.inclusively.com/">Inclusively</a>, told me. The organization supports companies who want to hire people with disabilities, including matching them with qualified job seekers with disabilities.</p>
<h2>Digital accessibility</h2>
<p>Although the Americans with Disabilities Act does not mention the digital environment explicitly, the Justice Department has taken the position that Title III of the ADA, which covers public accommodation for people with disabilities, <a href="https://www.ada.gov/resources/web-guidance/">applies to websites and mobile apps</a>. Thousands of digital accessibility lawsuits <a href="https://info.usablenet.com/thank-you-2022-end-of-year-report-on-digital-accessibility-lawsuits?submissionGuid=25eec95e-7f14-4db8-a15e-3c0018c63dfc">are filed under the ADA each year</a>, and the number has increased substantially in the past five years. </p>
<p>Digital standard-setters have begun paying attention. The World Wide Web Consortium developed standards for accessible web content: the <a href="https://www.w3.org/WAI/standards-guidelines/wcag/#:%7E:text=The%20WCAG%20standards%20have%2012,determine%20%E2%80%9Cconformance%E2%80%9D%20to%20WCAG.">Web Content Accessibility Guidelines</a>, just revised in a <a href="https://www.w3.org/TR/WCAG22/">2.2 version</a>. The guidelines provide free guidance to help developers make their digital content accessible. Two related standards are the U.S. government’s <a href="https://appt.org/en/guidelines/section-508">Section 508</a> and the European Telecommunications Standards Institute’s <a href="https://appt.org/en/guidelines/en-301-549">EN 301 549</a>. <a href="https://accessibility.day/">Global Accessibility Awareness Day</a> was established in 2012 to encourage people to learn and think about digital inclusion for people with disabilities.</p>
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<p>Despite laws requiring and guidelines supporting an accessible digital environment, much if not most digital content is still not fully accessible. In its latest annual review of the accessibility of the top 1 million websites, the nonprofit <a href="https://webaim.org/projects/million/">WebAIM found an average of 50 accessibility errors per page</a>. Worse, almost all home pages – 96.3% – had <a href="https://www.w3.org/TR/WCAG20-TECHS/failures">Web Content Accessibility Guidelines 2 failures</a>. </p>
<h2>What can be done</h2>
<p>Accessibility can be built in from the beginning more easily than retrofitting after the fact. </p>
<p>For accessibility to be built in from the ground up, accessibility would have to be <a href="https://teachaccess.org/">part of the curriculum for digital developers</a>, but it typically is not.</p>
<p>Companies could require developers to create accessible software and refuse to buy software that isn’t accessible. Individuals can help by producing their own accessible digital documents – inaccessible digital documents were the <a href="https://www.afb.org/aw/24/6/18368">most commonly experienced challenge at work</a>. Microsoft has been working to make producing accessible digital documents easier with its accessibility checker and now with its <a href="https://www.microsoft.com/en-us/microsoft-365/blog/2023/03/08/create-inclusive-content-with-the-new-accessibility-assistant-in-microsoft-365/">new accessibility assistant</a>.</p>
<p>An accessible digital environment is possible, and it would result in greater employment opportunities for people who are blind or have low vision.</p><img src="https://counter.theconversation.com/content/212600/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michele McDonnall receives funding from the National Institute on Disability, Independent Living, and Rehabilitation Research. Grant number 90RTEM0007 provided funding for the research discussed in this story. </span></em></p>Assistive technology like screen readers for the blind help people with disabilities use computers and smartphones, but they can be tripped up if webpages or documents are improperly formatted.Michele McDonnall, Research Professor of Rehabilitation Education and Research, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2094912023-07-12T19:39:14Z2023-07-12T19:39:14ZPutting a price on exoskeleton assistance puts users in the driver’s seat of honing the tech<figure><img src="https://images.theconversation.com/files/537138/original/file-20230712-22-keuc4s.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C2761%2C3389&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How much would these robo-boots be worth to you?</span> <span class="attribution"><span class="source">Neurobionic Lab/University of Michigan Robotics Department</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>My colleagues and I have used a tool from economics to measure the costs and benefits of wearing an exoskeleton, and we found that it offers a modest average benefit of US$3.40 per hour while walking uphill, when considering the combined effects of the assistance and device weight. This modest value is in contrast to the value of the assistance alone, which was much greater, at $19.80 per hour. These values were derived using our novel approach, which subtracts the values of the costs and benefits. </p>
<p>Exoskeletons are mechanical devices that people can wear to boost their power or efficiency. They can be used to assist in manual labor or to aid in rehabilitation from injuries. Our approach brings the user into the evaluation process, which makes it possible to take into account the many ways people experience exoskeletons.</p>
<p>Perceptions are important. Users must want exoskeletons in their lives if the technology is to meet its potential of assisting mobility, endurance and safety. And that means users must perceive the benefits, and that these <a href="https://books.google.com/books?hl=en&lr=&id=v1ii4QsB7jIC&oi=fnd&pg=PR15&dq=Rogers+EM.+Diffusion+of+innovations.+Simon+and+Schuster%3B+2010+Jul+6.&ots=DM_xrPYsaV&sig=rhK6garGd-qY4CFKCb75s92fA24#v=onepage&q=Rogers%20EM.%20Diffusion%20of%20innovations.%20Simon%20and%20Schuster%3B%202010%20Jul%206.&f=false">benefits must outweigh the costs</a> of wearing the exoskeleton, including any added discomfort, weight or noise.</p>
<p>As a way to measure user perception, <a href="https://doi.org/10.1038/s44172-023-00091-2">we studied the economic value</a>, measured in U.S. dollars, of wearing an exoskeleton. To find these dollar values, we asked people how much money would be required for them to walk uphill for two minutes on a treadmill. The two-minute bouts were repeated in series for approximately 30 minutes. We also repeated these trials with users wearing the exoskeleton while it was unpowered, as well as not wearing the exoskeleton. By comparing the costs among conditions, our approach provides a foundation for assessing the economic value of the complete exoskeleton, its assistance and the cost of the added weight. </p>
<p>To ensure the participants provide a truthful estimate of their cost to walk for two minutes – and not to maximize their earnings – we used a special type of auction that ensures honest valuations, known as the <a href="https://doi.org/10.2307/2977633">Vickrey auction</a>. In a seller’s Vickrey auction, the winner is the lowest bid but gets paid the second-lowest bid. It is often used to measure the value of abstract concepts, because the Vickrey auction breaks the link between the auction winner and their bid and removes incentives to under- or overbid.</p>
<p>Today, many ways of evaluating exoskeletons are focused on hard-to-get data, such as <a href="https://doi.org/10.1126/science.aal5054">number of calories burned</a> and <a href="https://doi.org/10.1152/japplphysiol.01133.2014">complex motion analysis</a>. More subjective measures, such as <a href="https://doi.org/10.1126/scirobotics.abj3487">user preferences</a> of exoskeleton assistance, are difficult to standardize and are only recently beginning to gain traction. </p>
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<figcaption><span class="caption">Exoskeletons are being used in construction and manufacturing.</span></figcaption>
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<h2>Why it matters</h2>
<p>Our study highlights the sizable potential benefit of exoskeleton assistance. This is despite most of the value’s being offset by the cost of the extra weight. Through measuring this user experience, researchers and developers can refine exoskeletons for user perceptions. For example, these results highlight the need to develop lighter and more compact exoskeletons.</p>
<p>Our method of finding the economic value is intuitive, as the public is more likely to understand the value of dollars over energy-related biomechanical metrics, such as watts or joules. This approach also does not not require expensive specialized equipment, as is required for measuring metabolic rate, or how much energy a person would burn while wearing an exoskeleton.</p>
<p>This technique can be used to measure the value of not only different types of exoskeleton assistance, but also a wide range of technologies, activities and experimental conditions, and represents a useful alternative to the standard approach of assessing metabolic rate.</p>
<h2>What’s next</h2>
<p>With this data and approach, we plan to design exoskeletons that reduce the cost of wearing the added weight of the device. We also plan to research better control systems to increase the economic benefits.</p>
<p>In our study, we found that the benefits and costs varied greatly across individuals. Some people reported a negative overall value. We want to study these differences to determine why people have such different perceptions. Doing so can help overcome major hurdles in the adoption of this technology.</p><img src="https://counter.theconversation.com/content/209491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The company that developed the exoskeleton used in this research has licensed intellectual property on which Prof. Rouse is an inventor. </span></em></p>Asking users the dollar value of the costs and benefits of walking in exoskeletons is a better way of finding out how users feel about them than measuring calories saved.Elliott Rouse, Associate Professor of Robotics and Mechanical Engineering, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055772023-05-15T20:06:22Z2023-05-15T20:06:22ZGovernment plans to use NDIS purchasing power to help save billions – but they shouldn’t put products before people<figure><img src="https://images.theconversation.com/files/526083/original/file-20230515-224780-qjsrry.jpg?ixlib=rb-1.1.0&rect=34%2C17%2C5724%2C3804&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-woman-blindness-disability-using-computer-2158200539">Shutterstock</a></span></figcaption></figure><p>Last week’s federal budget included a <a href="https://budget.gov.au/content/bp2/download/bp2_2023-24.pdf">A$732.9 million investment</a> to get the National Disability Insurance Scheme (NDIS) “<a href="https://budget.gov.au/content/overview/download/budget_overview-20230511.pdf">back on track</a>”. In the next four years, there are also plans for a $15.3 billion reduction in NDIS costs. </p>
<p>One area of focus is <a href="https://budget.gov.au/content/bp2/download/bp2_2023-24.pdf">assistive technology</a>, an
<a href="https://www.who.int/news-room/fact-sheets/detail/assistive-technology">umbrella term</a> that covers products – from <a href="https://theconversation.com/from-glasses-to-mobility-scooters-assistive-technology-isnt-always-high-tech-a-who-roadmap-could-help-2-million-australians-get-theirs-183529">glasses to communication devices to wheelchairs</a> – and the systems and services necessary for their delivery. Getting assistive technology right is vitally important for an effective NDIS because the return on investment is up to <a href="https://atscalepartnership.org/investment-case">nine times what is spent</a>. Assistive technology enables people to do what’s important to them, including work and study. </p>
<p>Pre-budget <a href="https://ministers.dss.gov.au/media-releases/11011">announcements</a> flagged this focus and the 2023–24 <a href="https://budget.gov.au/content/bp2/download/bp2_2023-24.pdf">budget</a> provides further detail. Reportedly, some <a href="https://www.smh.com.au/politics/federal/the-five-plans-to-shave-15b-from-ballooning-ndis-costs-in-four-years-20230511-p5d7mw.html">$2.5 billion</a> in projected savings will come via <a href="https://ministers.dss.gov.au/media-releases/11011">proposed</a> initiatives including “preferred provider arrangements to leverage [NDIS] buying power” and an “assistive technology expert advisory panel”.</p>
<p>These targets are ambitious and there are important considerations for them to be successful.</p>
<h2>Putting the person first</h2>
<p>There are <a href="https://www.who.int/publications/i/item/9789240049451">internationally recognised steps</a> for assistive technology provision. The first is that the supply of assistive technology is <a href="https://www.arata.org.au/public/33/files/Publications/ARATA_StatementOnGoodPractice.pdf">person-centred</a>, not product or service-centred. This is because to get good outcomes, <a href="https://pubmed.ncbi.nlm.nih.gov/36361299/">individual goals and needs</a> should drive product selection, rather than a person’s needs being “fitted” to an existing product. The latter goes against <a href="https://www.arata.org.au/public/33/files/Publications/AT%20Industry%20Joint%20Statement%20OCT2022.pdf">good assistive technology practice</a> and could worsen NDIS participant outcomes.</p>
<p>The value of <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">assistive technology support funding</a> committed in NDIS participant plans – $1.38 billion at the end of last year – points to an opportunity to exert buying power and save money. However, purchasing strategies – which <a href="https://www.smh.com.au/politics/federal/the-five-plans-to-shave-15b-from-ballooning-ndis-costs-in-four-years-20230511-p5d7mw.html">may include bulk buying</a> assistive technology at discount prices – could lead to unintended consequences. </p>
<p>Risks include <a href="https://www.accc.gov.au/system/files/Joint%20ACCC%20NDIA%20NDIS%20Commission%20letter%20-%20January%202021.pdf">restricting</a> product selection or inadvertent market price fixing. It also means the government may wind up with a warehouse full of equipment waiting to be matched to a user, rather than the products scheme participants really require.</p>
<p>The current approach – using an evidence-based <a href="https://www.ndis.gov.au/providers/housing-and-living-supports-and-services/providing-assistive-technology#Atcodeguide">list</a> of product categories that guides NDIS participants and providers clarity on the options available – is more suitable. </p>
<p>For example, personal alarms can useful to alert others to the need for assistance but the reasons for assistance depend on the person. Disability-related needs, such as seizure and falls management, fire detection, alerts for phone calls or visitors, and orientation or memory prompts, should guide product selection. </p>
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Read more:
<a href="https://theconversation.com/ndis-cost-scrutiny-is-intensifying-again-the-past-shows-this-can-harm-health-and-wellbeing-for-people-with-disability-203336">NDIS cost scrutiny is intensifying again – the past shows this can harm health and wellbeing for people with disability</a>
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<h2>The right advice can be complex and cost more</h2>
<p>When assistive technology is <a href="https://www.ndis.gov.au/participants/assistive-technology-explained#understanding-at-product-risk">more complex or high risk</a>, it is recommended participants seek advice from allied health professionals. </p>
<p>Some assistive technology advisory services – such as state-based Independent Living Centres – were lost when they <a href="https://www.smh.com.au/national/nsw/what-happens-when-governments-can-t-agree-on-ndis-funding-they-cut-services-20230413-p5d03r.html">fell through funding gaps</a> that emerged when the NDIS was implemented. </p>
<p>This means people will most often get advice from product suppliers or when they contract advice from allied health providers. But hourly rates for allied health services funded by the NDIS have been labelled as “<a href="https://www.smh.com.au/politics/federal/shorten-vows-to-stop-price-gouging-as-providers-charge-more-for-ndis-funded-clients-20221005-p5bnc2.html">price gouging</a>” by leaders including NDIS Minister Bill Shorten. The suggestion here is that the same service is being charged at a much higher rate for NDIS participants. But this is incorrect. It fails to take into account the complexity and cost of NDIS work, or gap amounts paid for other allied health services, like those provided through <a href="https://www.health.gov.au/sites/default/files/documents/2021/10/askmbs-advisory-allied-health-services-part-a-chronic-disease-management.pdf">private health insurance or chronic disease programs</a>.</p>
<p>When it comes to assistive technology and home modifications, the trained technical expertise, necessary insurances, professional supervision and administrative processes required make delivery <a href="https://www.health.vic.gov.au/sites/default/files/migrated/files/collections/policies-and-guidelines/a/ah-position-paper---categories.pdf">highly complex</a> and costly.</p>
<p>For example, for an occupational therapist to codesign vehicle modifications with a wheelchair user, there are <a href="https://www.mdpi.com/1660-4601/19/21/14408">seven practice steps and three sets of stakeholders that need to be engaged</a> to deliver a good outcome. </p>
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<h2>NDIS participant and provider expertise should be central</h2>
<p>There are reports that a proposal to leverage buying power for assistive technology would rely on an <a href="https://www.smh.com.au/politics/federal/crackdown-on-prices-and-junk-therapies-to-slow-ndis-spending-shorten-20230501-p5d4kk.html">advisory panel</a>, something like the Pharmaceutical Benefits Scheme that negotiates medicine prices. </p>
<p>But expert advisory panels, such as those in other disability and <a href="https://www.tac.vic.gov.au/providers/resources/clinical-panel">injury management schemes</a>, are typically staffed by health professionals. </p>
<p>NDIS participants must be <a href="https://www.ndis.gov.au/news/6962-joint-statement-ndia-co-design-workshops">partners in panel design</a>. Any advisory panel should include people who use assistive technology, as well as health professionals who advise on it. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-glasses-to-mobility-scooters-assistive-technology-isnt-always-high-tech-a-who-roadmap-could-help-2-million-australians-get-theirs-183529">From glasses to mobility scooters, 'assistive technology' isn't always high-tech. A WHO roadmap could help 2 million Australians get theirs</a>
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<h2>Nothing about us without (any) of us</h2>
<p>The NDIS relies on informed and empowered participants and an effective and efficient provider market. </p>
<p>The most effective way to curb spending will be for the National Disability Insurance Agency (which administers the NDIS) to codesign processes with people with disability and their support network – sometimes called “<a href="https://ndsp.com.au/blog/people/making-assistive-technology-accessible-with-tom-melbourne/">need knowers</a>” – and any advisers they choose to engage. They can help identify reasonable and necessary assistive technology and get the best value for money. </p>
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<p><em>Correction: The wording in this story’s headline and content has been changed from “bulk buying” to “purchasing power” to align with reporting in the government’s 2023–24 Budget Measures Paper.</em></p><img src="https://counter.theconversation.com/content/205577/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Libby Callaway receives funding from the Australian government Department of Health and Ageing, and the Transport Accident Commission in Victoria. She is the voluntary President of the Australian Rehabilitation and Assistive Technology Association, and a voluntary Board Director of The Homer Hack.</span></em></p><p class="fine-print"><em><span>Natasha Layton receives funding from the World Health Organization and iLA (Independent Living Assessment, WA). She is a voluntary Board member with the Australian Rehabilitation and Assistive Technology Association, and the Global Alliance of AT Organizations, as well as representing Australian Standards to the ISO as an expert on assistive product classification and terminology.</span></em></p>Plans to use buying power to save money on assistive technology for NDIS participants should be approached with caution. Otherwise, savings may come at the cost of a person-first approach.Libby Callaway, Associate Professor, Rehabilitation, Ageing and Independent Living Research Centre and Occupational Therapy Department, School of Primary and Allied Healthcare, Monash UniversityNatasha Layton, Senior Research Fellow: Rehabilitation, Ageing and Independent Living Research Centre, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1835292022-05-26T04:54:38Z2022-05-26T04:54:38ZFrom glasses to mobility scooters, ‘assistive technology’ isn’t always high-tech. A WHO roadmap could help 2 million Australians get theirs<figure><img src="https://images.theconversation.com/files/465034/original/file-20220524-13-mosdok.jpg?ixlib=rb-1.1.0&rect=68%2C8%2C5682%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/blind-person-using-audio-book-600w-541087726.jpg">Shutterstock</a></span></figcaption></figure><p>This month, the first ever World Health Organization (WHO) and UNICEF <a href="https://apps.who.int/iris/handle/10665/354357">Global Report on Assistive Technology</a> was released. </p>
<p>The WHO estimates <a href="https://apps.who.int/iris/handle/10665/354357">one in three of us</a> will need assistive technology, ranging from glasses to mobility scooters, in our lifetimes. This number is set to grow with an ageing population and the rising prevalence of non-communicable diseases such as heart disease and diabetes, which are major causes of disability. </p>
<p>For <a href="https://news.un.org/en/story/2022/05/1118212">2.5 billion people globally</a> and more than <a href="https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release">two million Australians</a> living with health, disability or age-related conditions, assistive products are vital in daily life. The WHO estimates almost one billion children and adults <a href="https://www.who.int/news/item/16-05-2022-almost-one-billion-children-and-adults-with-disabilities-and-older-persons-in-need-of-assistive-technology-denied-access--according-to-new-report">are denied</a> the assistive technology they need.</p>
<p>The WHO/UNICEF report provides a range of recommendations for policy action that Australia’s new government should consider and learn from.</p>
<h2>What is assistive technology?</h2>
<p>If you use glasses or screen magnification on your phone, foot orthotics, hiking poles on uneven ground, or a powered mobility scooter to get to the shops, you are using <a href="https://www.arata.org.au/about-at/about-at/">assistive products</a>. Reminder alerts on your mobile phone, smart home and <a href="https://theconversation.com/stephen-hawking-as-accidental-ambassador-for-assistive-technologies-70627">text-to-speech technologies</a> are also in this category.</p>
<p>Then there’s the information, professional recommendations and training needed to fit, troubleshoot, learn to use or maintain your assistive products. Together, these products and services are called “<a href="https://www.who.int/news-room/fact-sheets/detail/assistive-technology">assistive technology</a>”. </p>
<p>The return on investment for assistive technology is around <a href="https://atscalepartnership.org/investment-case">nine times what is spent</a>, because it enables people to work and study, worship and play, control their homes and move around their communities. </p>
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<h2>How does Australia measure up?</h2>
<p>Let’s compare the top recommendations from the Global Report of Assistive Technology with Australian experiences. </p>
<p><strong>1. Improve access to safe, effective and affordable assistive technology</strong></p>
<p>Australia’s <a href="https://www.ndis.gov.au/">National Disability Insurance Scheme (NDIS)</a> funds support for about <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">10% of Australians living with disability</a>, including assistive technology products and services. </p>
<p>But outside the NDIS, Australians who need assistive technology <a href="https://assistivetechforall.org.au/at-funding-outside-the-ndis/">often have very restricted access to funding</a>. </p>
<p>They must navigate more than 100 different funding schemes in a “postcode” or eligibility lottery identified by the recent Aged Care Royal Commission as <a href="https://www.cotavic.org.au/policy/assistive-technology/">unfair</a>. </p>
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<a href="https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="tweet by Unicef representative about the importance of assistive technology" src="https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=685&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=685&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=685&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=861&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=861&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465036/original/file-20220524-17-7lup3w.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=861&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://twitter.com/EvaUNICEF/status/1526551681051377666">Twitter</a></span>
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<p><strong>2. Invest in research data, evidence-based policy, and innovation</strong></p>
<p>Australia is building a <a href="https://ndda.gov.au/">National Disability Data Asset</a>, for safe and secure sharing and linking of data. This will give governments a better understanding of people with disabilities’ life experiences. For now though, there is no detailed data collection on assistive technology use and unmet need in Australia. </p>
<p>On the innovation front, assistive technology that uses artificial intelligence (AI) or changes how a person receives support offers real potential to help people to live how and where they want to. For example, infrared movement sensors in homes - linking to AI - can learn patterns of typical or out of the ordinary events and alert a nominated family member if required, whilst still allowing a person to live on their own. </p>
<p>But Australia needs an <a href="https://www.csiro.au/en/research/technology-space/ai/ai-ethics-framework">ethics framework</a> for the use of AI, including by people with disability, to protect privacy, safety and effectiveness – and more broadly, <a href="https://humanrights.gov.au/our-work/rights-and-freedoms/publications/human-rights-and-technology-discussion-paper-2019">human rights</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/digital-inequality-why-can-i-enter-your-building-but-your-website-shows-me-the-door-182432">Digital inequality: why can I enter your building – but your website shows me the door?</a>
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<p><strong>3. Enlarge, diversify and improve workforce capacity</strong></p>
<p>Australia is facing <a href="https://theconversation.com/workforce-shortages-are-putting-ndis-participants-at-risk-here-are-3-ways-to-attract-more-disability-sector-workers-181473">workforce shortages</a> across health, disability and aged care. </p>
<p>The Global Report on Assistive Technology outlines roles for assistive technology users to be peer supporters, alongside expert health teams. </p>
<p>A skilled and diverse workforce is required, and will include both health professionals at the point of need (via telehealth or in person), and <a href="https://at-aust.org/home/training/at_mentoring.html">training</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/17483107.2021.1897694">employment pathways</a> for the assistive technology peer workforce. </p>
<p><strong>4. Develop and invest in enabling environments</strong></p>
<p>Recent Australian National Construction Code reforms propose minimum accessibility in new housing. This would allow people more choice in <a href="https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/article-19-living-independently-and-being-included-in-the-community.html">where they live, and who they live with</a>. </p>
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<img alt="Man in power wheelchair reaches to unload dishwasher drawer" src="https://images.theconversation.com/files/465190/original/file-20220525-16-yz85a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/465190/original/file-20220525-16-yz85a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=938&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465190/original/file-20220525-16-yz85a9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=938&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465190/original/file-20220525-16-yz85a9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=938&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465190/original/file-20220525-16-yz85a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1179&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465190/original/file-20220525-16-yz85a9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1179&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465190/original/file-20220525-16-yz85a9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1179&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A power wheelchair and dishwasher drawer makes this kitchen accessible.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>However, some states have <a href="https://www.theguardian.com/australia-news/2021/nov/26/accessible-housing-disabled-people-left-behind-by-shameful-building-code-stance-in-nsw-wa-and-sa">refused to adopt this voluntary code</a>. </p>
<p>When the <a href="https://www.ndis.gov.au/">NDIS</a> was introduced, government funding for independent assistive technology advice via state-based information and resource centres, called Independent Living Centres (ILCs), was lost. The <a href="https://www.askned.com.au/">ILC National Equipment Database</a> remains online, but the few remaining information clearinghouses – including the <a href="https://universaldesignaustralia.net.au/">Centre for Universal Design Australia</a> and the <a href="https://www.homemods.info/">Home Modifications Information Clearinghouse</a> – rely largely on the goodwill of dedicated volunteers to collate information and resources.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/its-shown-me-how-independent-i-can-be-housing-designed-for-people-with-disabilities-reduces-the-help-needed-181793">'It's shown me how independent I can be' – housing designed for people with disabilities reduces the help needed</a>
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<p><strong>5. Include assistive technology in humanitarian responses</strong></p>
<p>Australia is facing ongoing humanitarian crises with fires, floods and a pandemic threatening lives – and livelihoods. </p>
<p>Our research with <a href="https://www.mdpi.com/1660-4601/18/21/11273">people who use assistive technology and their families</a>, as well as <a href="https://www.mdpi.com/1660-4601/18/19/10477">providers</a> and <a href="https://www.mdpi.com/1660-4601/18/22/12031">civil society</a> showed that during the COVID pandemic, the public health response excluded assistive technology services. They were considered “non essential” by government. </p>
<p>In Australia, during the floods, accessible information and disaster preparedness for <a href="https://www.abc.net.au/news/2022-04-01/qld-brisbane-foods-disability-emergency-evacuations-planning-/100957608">people who use assistive technology was absent</a>. This meant that, for example, when the lift in the building of a wheelchair user broke, and the building’s intercom was down, there was no way for them to escape or call for help. </p>
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<strong>
Read more:
<a href="https://theconversation.com/homeless-and-looking-for-help-why-people-with-disability-and-their-carers-fare-worse-after-floods-178983">Homeless and looking for help – why people with disability and their carers fare worse after floods</a>
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<p>This information and support gap, and access to safe evacuations, was often filled by <a href="https://www.abc.net.au/news/2022-03-15/queensland-flood-disaster-impact-people-with-disabilities/100904664">local communities</a>. The knowledge of assistive technology users, their families and providers to <a href="https://www.getready.qld.gov.au/disaster-preparedness-people-disability">create more inclusive preparedness plans</a> will be vital for future disasters. </p>
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<h2>Time for change</h2>
<p>Assistive technology is key to a good life for one in ten Australians. </p>
<p>Labor made a pre-election commitment to a major review of disability services in Australia, and inherits potentially transformative Royal Commission recommendations across both ageing and health care. </p>
<p>The WHO and UNICEF Global Report on Assistive Technology provides a roadmap for the incoming government to involve users and their families in change.</p><img src="https://counter.theconversation.com/content/183529/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha previously received funding from the World Health Organization for research now published, and referred to in this article. Natasha is affiliated with the Australian Rehabilitation and Assistive Technology Association (ARATA), the national peak body for assistive technology stakeholders, as a Board Member..</span></em></p><p class="fine-print"><em><span>Libby Callaway receives funding from the Australian Government's Department of Social Services. She previously received funding from the World Health Organization for research now published, and referred to in this article. Libby is affiliated with the Australian Rehabilitation and Assistive Technology Association (ARATA), the national peak body for assistive technology stakeholders, as the current Voluntary President of ARATA.</span></em></p><p class="fine-print"><em><span>Louise Puli consults to the World Health Organization. </span></em></p>The WHO has released a major report on assistive technology. It says almost 1 billion children and adults can’t get the glasses, wheelchairs, technology, devices or other supports they need.Natasha Layton, Senior Research Fellow: Rehabilitation, Ageing and Independent Living Research Centre, Monash UniversityLibby Callaway, Associate Professor, Rehabilitation, Ageing and Independent Living Research Centre and Occupational Therapy Department, School of Primary and Allied Healthcare, Monash UniversityLouise Puli, Adjunct Researcher, Rehabilitation, Ageing and Independent Living Research Centre, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1703822021-10-27T13:14:47Z2021-10-27T13:14:47ZDevices that help people function in every day life are costly in Africa: here’s why<figure><img src="https://images.theconversation.com/files/427775/original/file-20211021-24-5olm30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than 200 million Africans need at least one assistive device. </span> <span class="attribution"><span class="source"> Lucian Coman/Shutterstock</span></span></figcaption></figure><p>Everyone has a right to certain products and devices that can help them function in everyday life. This is the stance of the World Health Organisation (WHO), which has published a <a href="https://apps.who.int/iris/bitstream/handle/10665/207694/WHO_EMP_PHI_2016.01_eng.pdf">list</a> of the most important of these devices. It includes things like walking aids, wheelchairs and braille displays. </p>
<p>But assistive technologies, as they are called, are difficult to access in many parts of Africa. This is a huge problem because the prevalence of disabilities on the continent is estimated at <a href="https://www.afro.who.int/sites/default/files/2021-08/AFR-RC71-11%20Framework%20for%20improving%20access%20to%20assistive%20technology%20in%20the%20WHO%20African%20Region.pdf">15.6%</a>. With a population of more than <a href="https://www.worldometers.info/world-population/africa-population/#:%7E:text=The%20current%20population%20of%20Africa,%22">one billion</a>, the number of people in need of at least one assistive product in Africa stands at over <a href="https://www.afro.who.int/sites/default/files/2021-08/AFR-RC71-11%20Framework%20for%20improving%20access%20to%20assistive%20technology%20in%20the%20WHO%20African%20Region.pdf">200 million</a>, and that figure is projected to double by 2050. </p>
<p>The WHO estimates that only about <a href="https://www.afro.who.int/sites/default/files/2021-08/AFR-RC71-11%20Framework%20for%20improving%20access%20to%20assistive%20technology%20in%20the%20WHO%20African%20Region.pdf">15% to 25%</a> of those in need of assistive technology products in Africa currently have access to them. </p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/10400435.2021.1985011">research</a> sought to find out why and to offer solutions to this problem.</p>
<h2>Human rights</h2>
<p>Assistive technologies are functional, adaptive, and rehabilitative devices. Not only does the WHO support a global commitment to making them more easily available, the United Nations also regards them as a <a href="https://www.ohchr.org/en/hrbodies/crpd/pages/conventionrightspersonswithdisabilities.aspx">basic human right</a>. This is because some people need them in order to exercise their rights. </p>
<p>Without access to the assistive technology they need, people can face exclusion and are at risk of poverty. They may also be perceived as a burden to their families and society. The positive impact of assistive technology products goes far beyond improving the health and well-being of users. There are also the socio-economic benefits of reducing direct health costs and having a more productive labour force, indirectly stimulating economic growth.</p>
<p>The 2006 UN <a href="https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html">Convention on the Rights of Persons with Disabilities</a> and its optional protocol was negotiated quickly and well supported by member states. It was also the first human rights convention to be open for signature by regional integration organisations. But its implementation has been shaky, particularly in Africa. </p>
<p>We <a href="https://www.researchgate.net/publication/354794495_Barriers_to_Accessing_Assistive_Technology_in_Africa">believe</a> this is best explained by the idea of economic and political institutional voids. These are basically gaps in political and economic systems, trade policies and markets. An absence of specialised intermediaries, regulatory systems and contract enforcing mechanisms creates higher transaction costs for doing business or even entering markets. </p>
<p>Seeing the problem in this way also helps to show how to solve it and achieve fair access to assistive technologies.</p>
<h2>Institutional voids</h2>
<p>First, there is little production of assistive technologies in Africa because the parts are generally expensive to make. Many indigenous producers use crude and unstandardised <a href="https://www.bbc.com/news/av/world-africa-49528426">materials</a>. </p>
<p>Second, assistive technologies that are not produced locally are expensive to import. There are no unified tariff structures for them within the continent. This means that costs vary widely from country to country. Often, when assistive technologies do get imported despite high tariffs, they might need to be adapted for the local environment. This increases the costs even further.</p>
<p>Third, assistive technologies are mostly excluded from health financing and insurance schemes on the continent. They are not often included in central medical store catalogues. </p>
<p>Fourth, there aren’t enough people at all levels of the health system with the required knowledge and skills to provide assistive technology services and products. </p>
<p>Fifth, and most crucially, there is no unified governance framework for assistive technologies on the continent. And there’s a widespread lack of awareness about why they are needed and how they can improve the lives of people who need them.</p>
<p>Most <a href="https://apps.who.int/iris/bitstream/handle/10665/207694/WHO_EMP_PHI_2016.01_eng.pdf">African countries</a> do not have national assistive technology policies or programmes. As a result, access to assistive products is difficult and many are left behind.</p>
<h2>Solutions</h2>
<p>African governments need to provide leadership, coordination and resources to plan and implement policies that increase access to assistive technologies. </p>
<p>Acting on the <a href="https://www.afro.who.int/sites/default/files/2021-08/AFR-RC71-11%20Framework%20for%20improving%20access%20to%20assistive%20technology%20in%20the%20WHO%20African%20Region.pdf">WHO African regional framework</a> is a good place to start. The framework has modest aims. For instance, it calls for 40% of African member states to have assessed their assistive technology situation and developed a national strategy to improve access by 2024. This will help 40% of the population in Africa that needs assistive products to get them without suffering financial hardship.</p>
<p>The African Union can learn from the European Union. The European Parliamentary Research Service has <a href="https://www.europarl.europa.eu/RegData/etudes/IDAN/2018/603218/EPRS_IDA(2018)603218(ANN4)_EN.pdf">commissioned and published</a> an in-depth report of assistive technologies. The report covers economic, political and socio-ethical perspectives and it tries to implement the declarations that assistive technologies are a basic human right. Such a focused and thorough evaluation is missing in Africa.</p>
<p>To produce technologies on the continent, the African Union should develop a market strategy. The current market is one where the players are left to fend for themselves, and so face high operating costs. These costs ultimately make assistive technologies expensive.</p>
<p>Producers should also embrace <a href="https://ideas.ted.com/the-genius-of-frugal-innovation/">frugal innovation</a> – the process of reducing the complexity and cost of an item and its production, usually by removing nonessential features.</p>
<p>Qualified personnel are another part of the solution. </p>
<p>Finally, but maybe most importantly, there is a need for a structured enquiry to highlight the gaps in economic, political, scientific, and clinical knowledge for assistive technology development and deployment in Africa – and a unified approach to solving the problems.</p>
<p>This would help millions of <a href="https://www.afro.who.int/sites/default/files/2021-08/AFR-RC71-11%20Framework%20for%20improving%20access%20to%20assistive%20technology%20in%20the%20WHO%20African%20Region.pdf">people in Africa</a> to achieve their basic rights such as access to education, freedom to live, and the right to work.</p><img src="https://counter.theconversation.com/content/170382/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nachiappan Chockalingam receives funding from public grant awarding bodies including the European Commission, British Council, Innovate UK and HEE. He is a director of a spinout and he also advises companies involved in the design and manufacture of assistive devices and technology. He also collaborates with NGOs to research the provision of AT. </span></em></p><p class="fine-print"><em><span>Aoife Healy and Tolu Olarewaju do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The WHO estimates that only about 15% to 25% of those in need of assistive technology products in Africa have access to them.Tolu Olarewaju, Lecturer in Management, Keele UniversityAoife Healy, Associate Professor of Human Movement Biomechanics, Staffordshire UniversityNachiappan Chockalingam, Professor of Clinical Biomechanics, Staffordshire UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1361042020-04-30T12:11:03Z2020-04-30T12:11:03ZMasks and distancing make it tough for the hard-of-hearing, but here’s how to help<figure><img src="https://images.theconversation.com/files/331529/original/file-20200429-51466-k9kdm7.jpg?ixlib=rb-1.1.0&rect=8%2C35%2C5982%2C3952&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An already tough situation is made worse for those with hearing loss.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-home-visiting-during-the-quarantine-royalty-free-image/1215677043?adppopup=true">filadendron/Getty Images</a></span></figcaption></figure><p>The Centers for Disease Control and Prevention has recommended that all Americans wear <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html">face coverings</a> when in public. Hospitals across the country are assuming everyone who walks through the door is a potential COVID-19 case, so are requiring patients to wear a mask and come alone. </p>
<p>These changes pose potential communication problems for about <a href="https://doi.org/10.2105/AJPH.2016.303299">60 million Americans who are living with hearing loss</a>, ranging from mild trouble to severe loss or deafness in one or both ears. The vast majority of people with hearing loss have never had a hearing test and do not use hearing aids, especially <a href="https://doi.org/10.1177/0898264315585505">in populations affected by health disparities</a>. For example, only an estimated <a href="https://doi.org/10.1001/jamaoto.2019.0433">5% of Hispanic/Latino adults with hearing loss</a> use hearing aids.</p>
<p>Along with my audiology and public health colleagues from the <a href="http://lwhl.arizona.edu/h3-coalition">Hispanic Hearing Healthcare Access Coalition</a>, we strongly recommend that communities take special measures to stay connected with the hard-of-hearing at this time. Mask wearing and social distancing <a href="https://youtu.be/Lbdi9ndxNj8">present a real problem</a> for many people with hearing loss. </p>
<h2>Harder hearing</h2>
<p>Human brains are <a href="https://doi.org/10.3389/fnins.2014.00386">designed to use visual cues</a>, like watching one another’s lips move, <a href="https://doi.org/10.1037/pag0000094">to help understand speech</a>. Wearing a mask eliminates this vital visual information. </p>
<p>Acoustically, <a href="https://www.hearingreview.com/hearing-loss/health-wellness/how-do-medical-masks-degrade-speech-reception">face masks muffle speech</a>. Donning a mask over a hearing aid or cochlear implant can be problematic or uncomfortable – causing some to remove their hearing devices. </p>
<p>The need to stay at least six feet apart for <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html">social distancing</a> can also make hearing and understanding speech more difficult. As distance increases, sound levels decrease. Research shows that moving farther away <a href="https://doi.org/10.1121/1.4976191">makes it more challenging for people with hearing loss</a> to focus their attention on understanding speech. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331532/original/file-20200429-51513-1t3a070.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People cannot rely on pre-pandemic habits to compensate, like leaning in to get closer, seeing a person speaking, or bringing a loved one to the hospital to help.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-putting-hand-to-her-ear-royalty-free-image/79122325">Image Source/Getty Images</a></span>
</figcaption>
</figure>
<p>Research shows <a href="https://doi.org/10.1002/nur.21540">background noise in a hospital makes it difficult to hear, understand and absorb key information</a>, with memory disrupted even if what was said in the moment was heard. After measuring sound levels in a Portland, Oregon Veterans hospital, researchers recorded background noise from medical and surgical wards then tested acutely ill patients. In the best-case scenario with low noise, hospitalized patients with mild to moderate hearing loss could recall only 58% of key words. This dropped to 30% recall at the highest levels of hospital noise tested. All these disruptions can have serious consequences.</p>
<p>People with hidden or <a href="https://doi.org/10.1002/lary.28604">undiagnosed hearing loss</a> may now be revealed, as their coping strategies falter. In this new reality, those who are hard-of-hearing and deaf may be unable to access public health recommendations, learn about available services or make informed decisions about their own care when speech is only auditory. This is especially true for people in hospitals, nursing homes or quarantine, who may find themselves suddenly isolated without assistance from family or friends. </p>
<h2>Enhancing communication</h2>
<p>The good news is that simple, effective strategies can boost communication during this time of wearing masks and beyond. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330763/original/file-20200427-145566-9o0oe6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Laura Coco, Au.D., a Ph.D. candidate at the University of Arizona, demonstrates the use of teleaudiology to connect remotely with someone with a cochlear implant.</span>
<span class="attribution"><span class="source">Laura Coco, Au.D.</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Face each other at a safe distance of at least six feet. Maintaining eye contact enhances social connection and keeps attention focused on communication. Speak more slowly and with care to make it easier for listeners. Speakers often <a href="https://doi.org/10.1121/1.2784148">naturally try to compensate by projecting</a>, but a more effective approach is <a href="https://doi.org/10.3766/jaaa.16.3.4">to speak more clearly, with greater enunciation</a>.</p>
<p>Ask others to repeat back what you said to confirm the message is being understood and not just heard. For health care providers, this <a href="https://www.ahrq.gov/patient-safety/reports/engage/teachback.html">“teach-back” strategy</a> is essential to ensure understanding, whether the discussion is in-person <a href="https://doi.org/10.1371/journal.pone.0206473">or remote</a>. </p>
<p>Real-time captioning can improve <a href="https://www.nad.org/2020/04/17/telehealth-during-coronavirus/">communication access in telehealth</a>, <a href="https://www.deafhhtech.org/rerc/accessible-virtual-meeting-tips/">virtual meetings</a> and <a href="https://theconversation.com/how-to-help-students-with-a-hearing-impairment-as-courses-move-online-134582">online education</a>.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/26161525/">Ask the deaf or hard-of-hearing</a> person, “How can I best communicate with you?” Try <a href="https://doi.org/10.1044/jshr.3404.921">re-phrasing the information</a> if the listener is having difficulty understanding your message. Write your message down or try speech-to-text if someone is having trouble hearing you.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330765/original/file-20200427-145544-1iha2gn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bryan Wong, Au.D., an audiologist and Ph.D. student at the University of Arizona, makes face shields for local Tucson hospitals.</span>
<span class="attribution"><span class="source">Bryan Wong, Au.D.</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Select quiet spaces with little background noise for improved listening. If available, use or make clear masks or <a href="http://3dprint.nih.gov/discover/face-shield">face shields</a>, which will help by <a href="https://doi.org/10.3766/jaaa.15151">restoring visual information</a> in speech.</p>
<p>Seek out and offer multiple forms of communication, such as written text or real-time captioning and assistive technology. For those who use American Sign Language, qualified interpreters can be accessed through video relay. People with <a href="https://www.acdhh.org/media/1846/dhh-covid-19-communication-cards.pdf">hearing loss</a> or <a href="https://www.acdhh.org/media/1844/db_cvhl-covid-19-communication-cards.pdf">combined hearing and vision loss</a> may want to bring a printed communication card along with them to the hospital. The <a href="https://www.hearingloss.org/coronavirus-covid-19-resources/">Hearing Loss Association of America</a> and <a href="https://www.nad.org/coronavirus/">National Association of the Deaf</a> are sharing guidance for patients and providers. </p>
<p>Following these recommendations can empower people to communicate more effectively with the hard-of-hearing. While many things are out of control at this time, everyone can choose communication strategies that will help each other.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/136104/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Marrone receives funding from a Patient-Centered Outcomes Research Institute® (PCORI®) Eugene Washington PCORI Engagement Award (EA-15629-UOA), the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health (R33DC015062), and the Arizona Community Foundation. </span></em></p>Audiologists recommend enhanced communication strategies in the time of coronavirus to help the nearly 60 million Americans living with hearing loss in one or both ears.Nicole Marrone, Associate Professor in Speech, Language, and Hearing Sciences, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/934162018-03-15T19:22:22Z2018-03-15T19:22:22ZStephen Hawking warned about the perils of artificial intelligence – yet AI gave him a voice<figure><img src="https://images.theconversation.com/files/210627/original/file-20180315-104671-141tng2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Stephen Hawking both warned about and benefited from artificial intelligence.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/PGroup-Hoo-Me-com-MediaPunch-MediaPunch-IPx-A-/e1bf381e99504336a034af9d16712f6d/44/0">Hoo-Me.com/MediaPunch/IPX/AP</a></span></figcaption></figure><p>The <a href="https://theconversation.com/a-timeline-of-stephen-hawkings-remarkable-life-93364">late Stephen Hawking</a> was a major voice in the debate about how humanity can benefit from artificial intelligence. Hawking made <a href="https://www.huffingtonpost.com/james-barrat/hawking-gates-artificial-intelligence_b_7008706.html">no secret of his fears</a> that thinking machines could one day take charge. He went as far as predicting that future developments in AI “<a href="http://www.bbc.com/news/technology-30290540">could spell the end of the human race</a>.”</p>
<p>But Hawking’s relationship with AI was far more complex than this often-cited soundbite. The deep concerns he expressed were about superhuman AI, the point at which AI systems not only replicate human intelligence processes, but also keep expanding them, without our support – a stage that is at best decades away, <a href="https://www.wired.com/2017/04/the-myth-of-a-superhuman-ai/">if it ever happens at all</a>. And yet Hawking’s very ability to communicate those fears, and all his other ideas, came to depend on basic AI technology.</p>
<h2>Hawking’s conflicted relationship with AI</h2>
<p>At the <a href="https://law.depaul.edu/about/centers-and-institutes/center-for-intellectual-property-law-and-information-technology/Pages/default.aspx">intellectual property</a> and <a href="https://law.depaul.edu/about/centers-and-institutes/health-law-institute/Pages/default.aspx">health law</a> centers at DePaul University, my colleagues and I study the effects of emerging technologies like the ones Stephen Hawking worried about. At its core, the concept of AI involves computational technology designed to make machines <a href="http://www.cambridge.org/us/0521122937">function with foresight</a> that mimics, and <a href="https://www.aaai.org/ojs/index.php/aimagazine/article/viewFile/1904/1802">ultimately surpasses</a>, human thinking processes.</p>
<p>Hawking cautioned against an extreme form of AI, in which thinking machines would “<a href="http://www.bbc.com/news/technology-30290540">take off</a>” on their own, modifying themselves and independently designing and building ever more capable systems. Humans, bound by the slow pace of biological evolution, would be tragically outwitted.</p>
<h2>AI as a threat to humanity?</h2>
<p>Well before it gets to the point of superhuman technology, AI can be put to terrible uses. Already, scholars and commentators worry that <a href="https://www.foreignaffairs.com/articles/united-states/2014-05-10/case-against-killer-robots">self-flying drones may be precursors</a> to <a href="https://theconversation.com/losing-control-the-dangers-of-killer-robots-58262">lethal autonomous robots</a>. </p>
<p>Today’s early stage AI raises several other ethical and practical problems, too. AI systems are largely based on <a href="https://www.technologyreview.com/s/604087/the-dark-secret-at-the-heart-of-ai/">opaque algorithms</a> that make decisions even their own designers may be <a href="https://theconversation.com/we-need-to-know-the-algorithms-the-government-uses-to-make-important-decisions-about-us-57869">unable to explain</a>. The underlying mathematical models <a href="https://www.technologyreview.com/s/608248/biased-algorithms-are-everywhere-and-no-one-seems-to-care/">can be biased</a>, and <a href="https://ai100.stanford.edu/sites/default/files/ai_100_report_0831fnl.pdf">computational errors</a> may occur. AI may progressively displace human skills and <a href="https://www.weforum.org/agenda/2016/10/top-10-ethical-issues-in-artificial-intelligence/">increase unemployment</a>. And limited access to AI might <a href="https://www.nytimes.com/2017/06/24/opinion/sunday/artificial-intelligence-economic-inequality.html">increase global inequality</a>.</p>
<p>The <a href="https://ai100.stanford.edu/about">One Hundred Year Study on Artificial Intelligence</a>, launched by Stanford University in 2014, highlighted some of these concerns. But so far it has identified no evidence that AI will pose any “<a href="https://ai100.stanford.edu/2016-report/executive-summary">imminent threat</a>” to humankind, as Hawking feared.</p>
<p>Still, Hawking’s views on AI are somewhat less alarmist and more nuanced than he usually gets credit for. At their heart, they describe the need to understand and regulate emerging technologies. He <a href="http://www.independent.co.uk/news/science/stephen-hawking-transcendence-looks-at-the-implications-of-artificial-intelligence-but-are-we-taking-9313474.html">repeatedly called</a> for <a href="https://futureoflife.org/ai-open-letter">more research</a> on the benefits and dangers of AI. And he <a href="http://www.independent.co.uk/news/people/stephen-hawking-artificial-intelligence-diaster-human-history-leverhulme-centre-cambridge-a7371106.html">believed</a> that even non-superhuman AI systems could help eradicate war, poverty and disease.</p>
<h2>Hawking talks</h2>
<p>This apparent contradiction – a fear of humanity being eventually overtaken by AI but optimism about its benefits in the meantime – may have come from his own life: Hawking had <a href="https://theconversation.com/stephen-hawking-as-accidental-ambassador-for-assistive-technologies-70627">come to rely on AI</a> to interact with the world.</p>
<p>Unable to speak since 1985, he used a series of different <a href="https://www.wired.com/2015/01/intel-gave-stephen-hawking-voice/">communication systems</a> that helped him talk and write, culminating in the <a href="https://www.bloomberg.com/news/videos/2015-07-30/the-machine-behind-stephen-hawking-s-voice">now-legendary computer</a> operated by <a href="http://www.hawking.org.uk/the-computer.html">one muscle</a> in his right cheek.</p>
<p>The first iteration of the computer program was exasperatingly slow and prone to errors. <a href="https://www.wired.com/2015/08/stephen-hawking-software-open-source/">Very basic AI changed that</a>. An <a href="https://opensource.com/business/15/8/open-source-intel-speech-system">open-source</a> program made his word selection significantly faster. More importantly, it used artificial intelligence to analyze Hawking’s own words, and then used that information to help him express new ideas. By processing Hawking’s books, articles and lecture scripts, the system got so good that he did not even have to type the term people most associate with him, “<a href="https://www.wired.com/2015/01/intel-gave-stephen-hawking-voice/">the black hole</a>.” When he selected “the,” “black” would automatically be suggested to follow it, and “black” would prompt “hole” onto the screen.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fFLVyWBDTfo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Stephen Hawking discusses a predictive system that helped him communicate.</span></figcaption>
</figure>
<h2>AI improves people’s health</h2>
<p>Stephen Hawking’s experience with such a basic form of AI illustrates how non-superhuman AI can indeed change people’s lives for the better. Speech prediction helped him cope with a devastating <a href="https://www.scientificamerican.com/article/stephen-hawking-als/">neurological disease</a>. Other AI-based systems are already helping prevent, fight and lessen the burden of disease.</p>
<p>For instance, AI can analyze medical sensors and other health data to predict how likely a patient is to <a href="http://doi.org/10.1126/scitranslmed.aab3719">develop a severe blood infection</a>. In studies it was <a href="http://releases.jhu.edu/2015/08/05/computer-algorithm-can-forecast-patients-deadly-sepsis/">substantially more accurate</a> – and provided much more advance warning – than other methods. </p>
<p>Another group of researchers created an AI program to sift through electronic health records of 700,000 patients. The program, called “<a href="https://doi.org/10.1038/srep26094">Deep Patient</a>,” unearthed linkages that had not been apparent to doctors, identifying new risk patterns for certain cancers, diabetes and psychiatric disorders.</p>
<p>AI has even powered a robotic surgery system that <a href="http://doi.org/10.1126/scitranslmed.aad9398">outperformed human surgeons</a> in a procedure on pigs that’s very similar to one type of operation on human patients.</p>
<p>There’s so much promise for AI to improve people’s health that collecting medical data has become a cornerstone of both software development and public-health policy in the U.S. For example, the Obama White House <a href="https://obamawhitehouse.archives.gov/node/333101">launched a research effort</a> seeking to <a href="https://allofus.nih.gov">collect DNA from at least a million Americans</a>. The data will be made available for AI systems to analyze when studying <a href="http://theconversation.com/four-ways-precision-medicine-is-making-a-difference-90459">new medical treatments</a>, potentially improving both diagnoses and patients’ recovery.</p>
<p>All of these benefits from AI are available right now, and more are in the works. They do suggest that superhuman AI systems could be extremely powerful, but despite warnings from Hawking and fellow technology visionary <a href="https://www.cnbc.com/2018/03/13/elon-musk-at-sxsw-a-i-is-more-dangerous-than-nuclear-weapons.html">Elon Musk</a> that day may never come. In the meantime, as Hawking knew, there is <a href="https://futureoflife.org/data/documents/research_priorities.pdf?x89399">much to be gained</a>. AI gave him a better and more efficient voice than his body was able to provide, with which he called for both research and restraint.</p><img src="https://counter.theconversation.com/content/93416/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ana Santos Rutschman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite his fears artificial intelligence might one day overtake humanity, Stephen Hawking knew from his own life how profoundly AI could improve humans’ daily lives.Ana Santos Rutschman, Jaharis Faculty Fellow in Health Law and Intellectual Property, DePaul UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/706272018-03-14T18:40:35Z2018-03-14T18:40:35ZStephen Hawking as accidental ambassador for assistive technologies<figure><img src="https://images.theconversation.com/files/210290/original/file-20180314-113475-1lqlm8y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A computer-generated voice was essential to Hawking's participation in the world around him.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Hawking-Flight/279f26e4d6074167b66df1a71009fb66/14/0">AP Photo/John Raoux</a></span></figcaption></figure><p>Imagine you’ve contemplated the great scientific theories of the past and arrived at new insights based on your own observations. Imagine you’ve organized these thoughts into compelling arguments. Imagine that what you have to say will likely advance humanity’s understanding of its existence. Now imagine your frustration if you were unable to use your physical voice or hands to speak or write the thoughts coalescing in your mind.</p>
<p>Such was the situation for <a href="https://www.nytimes.com/2018/03/14/obituaries/stephen-hawking-dead.html">Stephen Hawking</a>, the great explainer of the universe, who <a href="https://theconversation.com/tributes-pour-in-for-stephen-hawking-the-famous-theoretical-physicist-who-died-at-age-76-93363">died on March 14</a>. He was a brilliant physicist <a href="http://www.hawking.org.uk/publications.html">who published more than 230 scientific articles</a>, papers, books, book chapters and children’s books. He gave countless lectures and stretched humankind’s understanding of the nature of our existence. Hawking was well-regarded by his scientific peers but also explained his thoughts in ways that make sense to everyone else. This is an unparalleled contribution for anyone, but especially for someone whose communication was severely limited by <a href="http://www.alsa.org/about-als/">ALS, or amyotrophic lateral sclerosis</a>. </p>
<p>At age 21, Hawking was given the standard two to five years to live after his ALS diagnosis. He beat the predictions. Hawking lived with the physical effects of this neurodegenerative disease for more than half a century. </p>
<p>Fortunately, Hawking lived in a time when researchers were rapidly developing electronic technology to assist people with physical limitations in achieving increased independence. Here at Montana’s <a href="http://ruralinstitute.umt.edu">University Center for Excellence on Developmental Disabilities</a>, we investigate and promote services and supports that increase quality of life, independence and integration of people with disabilities. For us, Hawking was a valuable role model for more than the next generation of scientists. With his recognizable wheelchair and computer-generated voice, he demonstrated the value of technological solutions to liberating the voice of those with physical and communication disabilities.</p>
<h2>Tech fills in for functional limitations</h2>
<p>So-called assistive technologies provide a means for people to move from place to place, to eat independently, to see and hear what they can’t otherwise perceive. They include basic things like wheelchairs to help people move around, magnifiers that increase the size of text or images to make them easier to see, even nonelectronic items like large-handled kitchen utensils that are easier to hold; think about everyday things in your kitchen drawers such as can openers, spoons, spatulas and the like.</p>
<p>Assistive technologies range from the seemingly simple all the way to speech-generating devices (SGD) that provide a physical voice to those who don’t have one. <a href="http://www.bbc.com/news/technology-33991887">Stephen Hawking’s SGD system</a> combined relatively simple technology together in a unique and functional way. <a href="http://www.hawking.org.uk/the-computer.html">In his own words he described</a> how he managed a tablet computer with an infrared switch that he controlled with cheek movements:</p>
<blockquote>
<p>“[An open source program] provides a software keyboard on the screen. A cursor automatically scans across this keyboard by row or by column. I can select a character by moving my cheek to stop the cursor. My cheek movement is detected by an infrared switch that is mounted on my spectacles. This switch is my only interface with the computer. [The open source program] includes a word prediction algorithm … so I usually only have to type the first couple of characters before I can select the whole word. When I have built up a sentence, I can send it to my speech synthesizer. … I can also control the mouse in Windows. This allows me to operate my whole computer. I can check my email… surf the internet … or write lectures. My latest computer … contains a webcam which I use with Skype.”</p>
</blockquote>
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<figcaption><span class="caption">Stephen Hawking’s voice and the machine that powers it.</span></figcaption>
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<h2>Setting an example and normalizing SGDs</h2>
<p>Among his many accomplishments, one that might not be readily apparent was Hawking’s role as a “spokesmodel” for the use of assistive technologies. In a way, he was like a brand ambassador – a person who made the connection between consumers and products. He demonstrated throughout his adult life that technology was simply a tool that enabled him, and others like him, to fully participate and contribute to the world around him. Rather than one particular keyboard or software system, the “product” that Hawking promoted was the concept that physical limitation cannot hamper the human mind.</p>
<p>Tech solutions, all of which are part of everyday 21st-century life, are used to overcome physical limitations imposed by functional disabilities. From complex solutions used by well-known people – such as the late Christopher Reeve’s use of a high-tech wheelchair – to simpler ones like screen magnifiers on our computers and speech recognition “voice commands” on our smartphones, technology makes some tasks easier. In a very public way, Hawking demonstrated that it is OK – maybe even somewhat cool – to use technology to enhance or enable communication, to move around, work, play and fully participate in family and professional activities.</p>
<p>“Stephen Hawking is the most recognizable speech-generating device user in the world,” said Julie Doerner, the former clinical coordinator of MonTECH, a program I oversee at the Rural Institute for Inclusive Communities. MonTECH, one of 56 <a href="http://ataporg.org">statewide assistive technology programs</a> in the U.S. and its territories, loans equipment for free to Montanans with disabilities to help them with the tasks of everyday life including reading, bathing, typing, eating, or simply getting from place to place. She continued, “When I explain assistive technology devices to others, I use Stephen Hawking as an example. They all know who he is.” The response is usually, “ah, that’s cool!”</p>
<p>Hawking and other high-profile users show the world that technology is not strange, nor does it diminish or magnify them as human beings. The technology they use allows others to look past disability and focus their attention on who they are, on them as people. And Hawking’s fame raised the visibility of speech-generating technologies, helping them seem more commonplace than weird for people all over the world – both those who might need SGDs and those who might encounter others using them to communicate.</p>
<p>Advances in technology that help us interact with the world around us are <a href="https://www.entrepreneur.com/article/245192">limited only by our imagination</a>. We now take for granted that we can ask our smartphone questions, that it can guide us to our next appointment, monitor our heart rate, measure our steps, help us find and communicate with others, and on and on. Smart technologies are being incorporated into our kitchen appliances, shoes, vehicles and eyeglasses. These and the world of robotics stretch our thinking about ways in which <a href="https://www.pcmag.com/commentary/353201/the-future-of-assistive-tech-is-smart">technology can enhance human independence</a>, regardless of physical, and sometimes cognitive, limitations.</p>
<p>How these advances will benefit people with disabilities remains to be seen. One thing is certain though. The use of assistive technologies in our everyday world diminishes the differences between people with different abilities. We owe much to Professor Hawking’s example. Ah, that’s cool!</p><img src="https://counter.theconversation.com/content/70627/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martin Blair receives funding from the U.S. Administration on Community Living. He is affiliated with the Association of University Centers on Disabilities in Silver Spring, Maryland. </span></em></p>You can probably hear Hawking’s famously computer-generated voice in your head. His example showed tech as a tool that enables people with disabilities to fully participate in and contribute to the world.Martin E. Blair, Executive Director of the Rural Institute for Inclusive Communities, and Associate Professor of Teaching and Learning, University of MontanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/871082017-11-21T12:09:32Z2017-11-21T12:09:32ZWe built a robot care assistant for elderly people – here’s how it works<figure><img src="https://images.theconversation.com/files/195613/original/file-20171121-6013-1gfyfcr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Trinity College Dublin</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Not all robots will <a href="https://theconversation.com/does-the-next-industrial-revolution-spell-the-end-of-manufacturing-jobs-80779">take over human jobs</a>. My colleagues and I have just unveiled a prototype care robot that we hope could take on some of the more mundane work of looking after elderly and disabled people and those with conditions such as dementia. This would leave human carers free to focus on the more personal parts of the job. The robot could also do things humans don’t have time to do now, like keeping a constant check on whether someone is safe and well, while allowing them to keep their privacy.</p>
<p>Our robot, named Stevie, is designed to look a bit (but not too much) like a human, with arms and a head but also wheels. This is because we need it to exist alongside people and perform tasks that may otherwise be done by a human. Giving the robot these features help people realise that they can speak to it and perhaps ask it to do things for them.</p>
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<p>Stevie can perform some of its jobs autonomously, for example reminding users to take medication. Other tasks are designed to involve human interaction. For example, if a room sensor detects a user may have fallen over, a human operator can take control of the robot, use it to investigate the event and contact the emergency services if necessary.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/195212/original/file-20171117-7579-1g264cw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/195212/original/file-20171117-7579-1g264cw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195212/original/file-20171117-7579-1g264cw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195212/original/file-20171117-7579-1g264cw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195212/original/file-20171117-7579-1g264cw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195212/original/file-20171117-7579-1g264cw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195212/original/file-20171117-7579-1g264cw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Whose face is that?</span>
<span class="attribution"><span class="source">Trinity College Dublin</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Stevie can also help users stay socially connected. For example, the screens in the head can facilitate a Skype call, eliminating the challenges many users face using telephones. Stevie can also regulate room temperatures and light levels, tasks that help to keep the occupant comfortable and reduce possible fall hazards.</p>
<p>None of this will mean we won’t need human carers anymore. Stevie won’t be able to wash or dress people, for example. Instead, we’re trying to develop technology that helps and complements human care. We want to combine human empathy, compassion and decision-making with the efficiency, reliability and continuous operation of robotics. </p>
<p>One day, we might might be able to develop care robots that can help with more physical tasks, such as helping users out of bed. But these jobs carry much greater risks to user safety and we’ll need to do a lot more work to make this happen.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/O5TIjDp_Wxg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Stevie would provide benefits to carers as well as elderly or disabled users. The job of a professional care assistant is incredibly demanding, often involving long, unsocial hours in workplaces that are frequently understaffed. As a result, the industry suffers from extremely low job satisfaction. <a href="http://www.mcknightsseniorliving.com/news/where-turnover-is-highest-lowest-in-assisted-living/article/633364/">In the US</a>, more than 35% of care assistants leave their jobs every year. By taking on some of the more routine, mundane work, robots could free carers to spend more time engaging with residents.</p>
<p>Of course, not everyone who is getting older or has a disability may need a robot. And there is already a range of <a href="https://www.lifeline.philips.com/automatic-fall-detection.html">affordable smart technology</a> that can help people by controlling appliances with voice commands or notifying caregivers in the event of a fall or accident.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/194360/original/file-20171113-27635-1fghhtw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194360/original/file-20171113-27635-1fghhtw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194360/original/file-20171113-27635-1fghhtw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194360/original/file-20171113-27635-1fghhtw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194360/original/file-20171113-27635-1fghhtw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194360/original/file-20171113-27635-1fghhtw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194360/original/file-20171113-27635-1fghhtw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Never fear, Stevie’s here.</span>
<span class="attribution"><span class="source">Trinity College Dublin</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Smarter than smart</h2>
<p>But for many people, this type of technology is still extremely limited. For example, how can someone with hearing problems use a conventional smart hub such as the Amazon Echo, a device that communicates exclusively through audio signals? What happens if someone falls and they are unable to press an emergency call button on a wearable device?</p>
<p>Stevie overcomes these problems because it can communicate in multiple ways. It can talk, make gestures, and show facial expressions and display text on its screen. In this way, it follows the <a href="http://universaldesign.ie/What-is-Universal-Design/The-7-Principles/">principles of universal design</a>, because it is designed to adapt to the needs of the greatest possible number of users, not just the able majority.</p>
<p>We hope to have a version of Stevie ready to sell within two years. We still need to refine the design, decide on and develop new features and make sure it complies with major regulations. All this needs to be guided by extensive user testing so we are planning a range of pilots in Ireland, the UK and the US starting in summer 2018. This will help us achieve a major milestone on the road to developing robots that really do make our lives easier.</p><img src="https://counter.theconversation.com/content/87108/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Conor McGinn works for Trinity College Dublin and is a part owner of the intellectual property described in the piece. </span></em></p>Robots could free human carers to focus on the more personal parts of the job.Conor McGinn, Assistant Professor of Design and Robotics, Trinity College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/780012017-07-26T01:45:22Z2017-07-26T01:45:22ZThe hidden extra costs of living with a disability<figure><img src="https://images.theconversation.com/files/177584/original/file-20170710-5928-xbqobi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Costs of transportation and accessibility are just two factors that increase cost of living for persons with disabilities. </span> <span class="attribution"><span class="source">Corepics VOF/shutterstock.com</span></span></figcaption></figure><p>Disability is often incorrectly assumed to be rare. However, <a href="http://www.who.int/disabilities/world_report/2011/report.pdf">global estimates</a> suggest than one in seven adults has <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2329676">some form of disability</a>. </p>
<p>The term “disability” covers a number of functional limitations – physical, sensory, mental and intellectual. These can range from mild to severe and might affect someone at any time across the lifespan, from an infant born with an intellectual impairment to an older adult who becomes unable to walk or see.</p>
<p>What is perhaps less well-known is that studies consistently show that people with disabilities are disproportionately poor. They are more likely to become poor and, when poor, are more likely to stay that way, because of barriers to getting an education, finding decent work and participating in civic life. Taken together, <a href="http://www.who.int/disabilities/world_report/2011/report.pdf">these barriers</a> significantly and adversely impact their standard of living. </p>
<p>However, a new body of research reveals another major barrier, previously missing from most studies: People living with disabilities also face extra costs of living. Our team’s recent review of the evidence suggests that living with a disability may cost an additional several thousand dollars per year, adding up over time to be a significant financial burden on households.</p>
<h1>Calculating the cost</h1>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/178874/original/file-20170719-13593-1a9eskd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/178874/original/file-20170719-13593-1a9eskd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/178874/original/file-20170719-13593-1a9eskd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/178874/original/file-20170719-13593-1a9eskd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/178874/original/file-20170719-13593-1a9eskd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/178874/original/file-20170719-13593-1a9eskd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/178874/original/file-20170719-13593-1a9eskd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with disabilities may have more basic necessities than people without.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pretty-aged-granny-using-blue-cane-628135925?src=kI-X2eUyNwk5Y3w9dH5ZGg-3-64">Antonio Diaz/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Governments draw poverty lines at a level of income that they believe is sufficient to meet a minimum standard of living. Someone at the poverty line presumably has just enough resources to house, clothe and feed themselves at an acceptable level, and participate in the basic activities of being a citizen. Increasingly, countries provide <a href="http://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/publication/wcms_245201.pdf">cash benefits or food transfers</a> to people below this poverty line so they are able to reach this minimum standard for basic resources. </p>
<p>The problem is that people with disabilities have extra costs of living that people without disabilities do not have. They have higher medical expenses and may need personal assistance or assistive devices, such as wheelchairs or hearing aids. They may need to spend more on transportation or modified housing, or be restricted in what neighborhoods they can live in to be closer to work or accessible services.</p>
<p>When this is the case, then some people with disabilities might appear “on paper” to live above the poverty line. But in reality, they don’t have enough money to meet the minimum standard of living captured in that poverty line.</p>
<p>In <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2967775">our recent review of the literature</a>, we found that people with disabilities in 10 countries face large extra costs of living. These costs can range widely, from an estimated US$1,170 to $6,952 per year. In a developing country such as Vietnam, for example, the estimate stands at $595 for additional health costs alone.</p>
<p>We used a method called the standard of living approach, which estimates extra costs based on the gap in assets owned by households with and without disabilities. Extra costs accounted for a large share of income, from a low of 12 percent in Vietnam to 40 percent for elderly households in Ireland. </p>
<p>Comparing the costs of disabilities across countries is challenging. Recent studies measure what is actually spent, not what needs to be spent. Estimated costs might be less in developing countries not because it is less expensive to accommodate the needs of people with disabilities in those countries, but because the goods and services needed are not available. If wheelchairs or hearing aids are nowhere to be found, then a person cannot spend money on them. </p>
<p>This could lead to the paradoxical finding that, as a country starts becoming more inclusive, the measured costs of living with a disability could increase. But hopefully, at the same time, the ability of people with disabilities to work and go to school will also increase.</p>
<h1>Unanswered questions</h1>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/177577/original/file-20170710-5952-1ohs79m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/177577/original/file-20170710-5952-1ohs79m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/177577/original/file-20170710-5952-1ohs79m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/177577/original/file-20170710-5952-1ohs79m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/177577/original/file-20170710-5952-1ohs79m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/177577/original/file-20170710-5952-1ohs79m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/177577/original/file-20170710-5952-1ohs79m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A woman is escorted from protest opposing cuts to Medicaid in front of Senator Mitch McConnell’s office on Capitol Hill on June 22, 2017.</span>
<span class="attribution"><span class="source">AP Photo/Jacquelyn Martin</span></span>
</figcaption>
</figure>
<p>There is much we still don’t know about what it costs to live with a disability. In our comprehensive review of the literature, we found only 20 studies that estimated increased costs of living with a disability. The vast majority were from developed countries. </p>
<p>We need better information on how these extra costs may vary by type of disability, and how they may be affected by efforts to remove barriers to participation. For example, how would building a fully accessible public transportation system impact the extra transportation costs that people with disabilities face?</p>
<p>Our work also suggests we may need different income tests for people with disabilities when it comes to social protection programs. For example, should the income limit for receiving cash transfers or subsidized housing be higher for families with disabilities because they face these extra costs? Some countries, such as Denmark and the United Kingdom, provide benefits to support families with disabilities who bear these costs. </p>
<p>Another important question is whether these benefits are adequate. Do they allow people with disability and their families to reach at least a minimum threshold for standard of living? To what extent does this improve their participation in society or the economy?</p>
<h1>Supporting people with disabilities</h1>
<p>To address these questions, we need to monitor these issues over time. For that, we need more and better data on disability in different countries linked to good data on income, assets and expenditures. We recommend adding well-formulated disability questions to the standard household surveys currently used by most countries to chart their citizen’s wellbeing. The best example of such questions was developed under the aegis of the U.N. Statistical Commission via <a href="http://www.washingtongroup-disability.com">the Washington Group on Disability Statistics</a>. </p>
<p>It’s also important to undertake qualitative research. For instance, focus groups and in-depth interviews would help researchers better understand the needs of people with disabilities in their own terms.</p>
<p>Policymakers also need to make social programs sensitive to the issue of extra costs associated with disability – for instance, in income tests and benefit amounts or through social health insurance programs. Our review has led us to believe that even well intended anti-poverty efforts and social protection schemes that do not take into consideration the additional costs of living with a disability will leave millions of people who have disabilities, and their families, in poverty.</p><img src="https://counter.theconversation.com/content/78001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nothing to disclose.</span></em></p><p class="fine-print"><em><span>Daniel Mont, Hoolda Kim, Michael Palmer, and Sophie Mitra do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Depending on where you live, having a disability can cost thousands of additional dollars per year. Government programs often don’t account for that.Sophie Mitra, Associate Professor of Economics, Fordham UniversityDaniel Mont, Principal Research Associate in Epidemiology and Public Health, UCLHoolda Kim, Graduate Student in Economics, Fordham UniversityMichael Palmer, Senior Lecturer in Economics, RMIT University VietnamNora Groce, Chair of Disability and Inclusive Development, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/799042017-07-17T05:50:47Z2017-07-17T05:50:47ZThe future of artificial intelligence: two experts disagree<figure><img src="https://images.theconversation.com/files/178380/original/file-20170717-27601-vs3d1e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Will AI take over the world or lead to a bright future for humanity?</span> <span class="attribution"><span class="source">Shutterstock/PHOTOCREO Michal Bednarek</span></span></figcaption></figure><p><em>Artificial intelligence (AI) promises to revolutionise our lives, drive our cars, diagnose our health problems, and lead us into a new future where thinking machines do things that we’re yet to imagine.</em></p>
<p><em>Or does it? Not everyone agrees.</em></p>
<p><em>Even billionaire entrepreneur Elon Musk, who admits he has access to some of the most cutting-edge AI, <a href="http://fortune.com/2017/07/15/elon-musk-artificial-intelligence-2/">said recently</a> that without some regulation “AI is a fundamental risk to the existence of human civilization”.</em></p>
<p><em>So what is the future of AI? Michael Milford and Peter Stratton are both heavily involved in AI research and they have different views on how it will impact on our lives in the future.</em></p>
<h2>How widespread is artificial intelligence today?</h2>
<p><em>Michael:</em></p>
<p>Answering this question depends on what you consider to be “artificial intelligence”.</p>
<p>Basic machine learning algorithms underpin many technologies that we interact with in our everyday lives - voice recognition, face recognition - but are application-specific and can only do one very specific defined task (and not always well).</p>
<p>More capable AI - what we might consider as being somewhat smart - is only now becoming widespread in areas such as <a href="https://venturebeat.com/2017/05/05/3-ways-retailers-are-using-ai-to-reinvent-shopping/">online retail and marketing</a>, <a href="https://www.cultofmac.com/447898/google-home-google-assistant-siri-ai/">smartphones</a>, <a href="https://www.forbes.com/sites/roberthof/2016/04/08/toyota-guardian-angel-cars-will-beat-self-driving-cars/#6a0facff7f7f">assistive car systems</a> and service robots such as <a href="https://www.choice.com.au/home-and-living/laundry-and-cleaning/vacuum-cleaners/buying-guides/robot-vacuum-cleaners">robotic vacuum cleaners</a>.</p>
<p><em>Peter:</em></p>
<p>The most obvious and useful examples of current AI are the <a href="https://www.fastcompany.com/1768652/tips-mastering-voice-recognition-your-iphone-android-or-desktop">speech recognition on your phone</a>, and search engines such as <a href="https://support.google.com/websearch/answer/2940021?hl=en&co=GENIE.Platform=Android">Google</a>. There is also IBM’s Watson, which in 2011 <a href="http://www.techrepublic.com/article/ibm-watson-the-inside-story-of-how-the-jeopardy-winning-supercomputer-was-born-and-what-it-wants-to-do-next/">beat human champion players</a> at the US TV game show Jeopardy, and is now being trialled in business and healthcare. </p>
<p>Most recently, Google’s DeepMind AI called AlphaGo <a href="https://www.theverge.com/2017/5/27/15704088/alphago-ke-jie-game-3-result-retires-future">beat the world champion Go player</a>, surprising a lot of people – especially since Go is an extremely complex game, way surpassing chess.</p>
<h2>What major advances in AI will we see over the next 10 years?</h2>
<p><em>Peter:</em></p>
<p>Many auto manufacturers and research institutions are competing to create practical driverless cars for general road use. While currently these cars can drive themselves for much of the time, <a href="https://theconversation.com/driverless-cars-need-to-hit-the-road-come-rain-wind-or-shine-60436">many challenges remain</a> in dealing with bad weather (heavy rain, fog and snow) and random real-world events such as roadworks, accidents and other blockages.</p>
<p>These incidents often require some degree of human judgement, common sense and even calculated risk to successfully navigate through. We are still a long way from fully autonomous vehicles that don’t need a licensed driver ready to take control in an instant.</p>
<p>The same can be said for all the AI that we will see over the coming 10-20 years, such as online <a href="http://fortune.com/2016/12/21/virtual-assistant-usage-gartner/">virtual personal assistants</a>, <a href="http://www.abc.net.au/news/2017-04-05/artificial-intelligence-taking-lawyer-accountant-analyst-jobs/8415286">accountants, legal and financial advisers</a>, <a href="http://fortune.com/2017/01/10/healthtap-dr-ai-launch/">doctors</a> and even physical <a href="http://www.smh.com.au/business/property/robots-to-make-shopping-easier-20161205-gt410e.html">shop-bots, museum guides</a>, <a href="https://www.newscientist.com/article/mg22630213-200-robot-cleaner-can-empty-bins-and-sweep-floors/">cleaners</a> and <a href="http://mashable.com/2017/04/07/robot-security-singapore/#xy1h06gdbkq5">security guards</a>.</p>
<p>They will be advanced tools that are very useful in specific situations, but they will never fully replace people because they will have little common sense (probably none, in fact).</p>
<p><em>Michael:</em></p>
<p>We will definitely see a range of steady, incremental improvements in everyday AI. <a href="https://www.wired.com/2016/05/amazons-giving-away-ai-behind-product-recommendations/">Online product recommendations will get better</a>, your phone or car will <a href="https://venturebeat.com/2017/05/17/googles-speech-recognition-technology-now-has-a-4-9-word-error-rate/">understand your voice increasingly well</a> and your <a href="https://www.theverge.com/2017/3/14/14920842/dyson-ai-robotics-future-interview-mike-aldred">vacuum cleaner robot won’t get stuck as often</a>.</p>
<p>It’s likely that we’ll see some major advances beyond today’s technology in some but not all of the following areas: self-driving cars, <a href="http://www.zdnet.com/article/googles-deepmind-and-the-nhs-a-glimpse-of-what-ai-means-for-the-future-of-healthcare/">healthcare</a>, utilities (<a href="https://deepmind.com/blog/deepmind-ai-reduces-google-data-centre-cooling-bill-40/">electricity</a>, water, and so on) management, legal, and service areas such as cleaning robots.</p>
<p>I disagree on self-driving cars - there’s no real reason why there won’t be fully autonomous controlled ride-sharing fleets in the affluent centres of cities, and this is indeed the strategy of companies such as <a href="http://nutonomy.com/">NuTonomy</a>, working in Singapore and Boston.</p>
<h2>What approaches will lead to the biggest improvements in AI?</h2>
<p><em>Michael:</em></p>
<p>Major advances will come from two sources.</p>
<p>First, there is a long runway of steady incremental improvements left in many areas of conventional AI - large, complex neural networks and algorithms. These systems will continue to improve steadily as more training data becomes available and as scientists perfect them.</p>
<p>The second area will likely be biological inspiration. Scientists are only <a href="http://news.harvard.edu/gazette/story/2016/01/28m-challenge-figure-out-why-brains-are-so-good-at-learning/">just starting to tap into the knowledge about how brain networks work</a>, and it’s likely they will copy or adapt what we know about animal and human brains to make current deep learning networks far more capable.</p>
<p><em>Peter:</em></p>
<p><a href="https://en.wikipedia.org/wiki/Symbolic_artificial_intelligence">Old-fashioned AI</a>, which was based on pure logic and computer programs that tried to get machines to behave intelligently, basically failed to do anything that humans are good at and computers are not (speech and image recognition, playing complex strategic games, for example).</p>
<p>What’s quite clear now is that our best-performing AI is based on how we think the brain works.</p>
<p>But our current brain-based AI (called <a href="https://deepmind.com/">Deep Artificial Neural Networks</a>) is still light years away from emulating an actual brain. Enhanced AI capabilities in the future will come from developing better theories of how the brain works.</p>
<p>The fundamental science needed to cultivate these theories will probably come from publicly funded research institutions, which will then be spun off into commercial start-up companies, and then quickly acquired by interested large corporations if they look like they might be successful.</p>
<h2>How will artificial intelligence affect society and jobs?</h2>
<p><em>Peter:</em></p>
<p>Most jobs won’t be under threat for a long time, probably several generations. Real people are needed to actually make any significant decisions because AI currently has no common sense. </p>
<p>Instead of replacing jobs, our overall quality of life will go up. For example, right now few people can afford a personal assistant, or a full-time life coach. In the near future, we’ll <a href="http://fortune.com/2016/12/21/virtual-assistant-usage-gartner/">all have (a virtual) one</a>!</p>
<p>Our <a href="http://fortune.com/2017/01/10/healthtap-dr-ai-launch/">virtual doctor</a> will be working for us daily, monitoring our health and making exercise and lifestyle suggestions.</p>
<p>Our houses and workplaces might be cleaner, but we will still need people to clean the spots the robots miss. We’ll also need people to deploy, retrieve and maintain all the robots.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XCbJHr8TCi8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Do we still need a human in control of the vacuum cleaner?</span></figcaption>
</figure>
<p>Our goods will be cheaper due to <a href="https://techcrunch.com/2016/04/06/self-driving-delivery-vehicle-startup-dispatch-raises-2-million-seed-round-led-by-andreessen-horowitz/">reduced transport costs</a>, but we’ll still need human drivers to cover all the situations the self-drivers can’t.</p>
<p>All this doesn’t even mention the <a href="https://www.computer.org/web/computingnow/archive/february2015">whole new entertainment technologies</a> and industries that will spring up to capture our increased disposable income and to cash-in on our improved quality of life.</p>
<p>So yes, jobs will change, but there will still be plenty of them.</p>
<p><em>Michael:</em></p>
<p>It’s likely that a significant fraction of jobs will be under threat over the coming decade. It’s important to note that this won’t necessarily be divided by blue-collar versus white-collar, but rather by <a href="http://www.bbc.com/news/technology-34066941">which occupations are easily automatable</a>.</p>
<p>It’s <a href="http://knowledge.wharton.upenn.edu/article/the-robots-are-coming-to-take-your-job/">unlikely that an effective plumber robot will be built</a> in the near future, but <a href="http://www.mckinsey.com/industries/capital-projects-and-infrastructure/our-insights/imagining-constructions-digital-future">aspects of the so far undisrupted construction industry may change radically</a>.</p>
<p>Some people say machines will never have the emotional capabilities of humans. Whether that is true or not, many jobs will be under threat with even the most rudimentary levels of emotional understanding and interaction. </p>
<p>Don’t think about the complex, nuanced interaction you had with your psychologist; instead think about the one with that disinterested, uncaring part-time hospitality worker. The bar for disruption is not as high as many think. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/EivBxP3kqWs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The robot bartender.</span></figcaption>
</figure>
<p>That leaves the question of what happens then. There are two scenarios - the first being that, like in the past, new types of jobs are generated by the technological revolution. </p>
<p>The other is that humanity gradually transitions into a Utopian society where scientific, artistic and sporting pursuits are pursued at leisure. The short to medium-term reality is probably somewhere in between.</p>
<h2>Will Skynet/the machines take over and enslave humanity?</h2>
<p><em>Michael:</em></p>
<p>It’s unlikely in the near future but possible. The real danger is the unpredictability. Skynet-like killer cyborgs as featured in the <a href="https://moviesorder.com/terminator/">Terminator film series</a> are unlikely because that development cycle takes a while, and we have multiple opportunities to stop development. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/62E4FJTwSuc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">He could be back!</span></figcaption>
</figure>
<p>But AI could destroy or damage humanity in other unpredictable ways. For example, when big companies like Google Deepmind start <a href="http://www.zdnet.com/article/googles-deepmind-and-the-nhs-a-glimpse-of-what-ai-means-for-the-future-of-healthcare/">entering into healthcare</a>, it’s likely that they will improve patient outcomes through a combination of big data and intelligent systems. </p>
<p>One of the temptations or pressures will be to deploy these extremely complex systems before we completely understand every possible ramification. Imagine the pressure if there is good evidence it will save thousands of lives per year.</p>
<p>As we well know, we have a <a href="https://www.scu.edu/ethics/focus-areas/technology-ethics/resources/the-unanticipated-consequences-of-technology/">long history of negative unintended consequences</a> with new technology that we didn’t fully understand.</p>
<p>In a far-fetched but not impossible healthcare scenario, deploying AI may lead to catastrophic outcomes - a world-wide AI network deciding in ways invisible to us human observers to kill us all off to optimise some misguided performance goal. </p>
<p>The challenge is that with newly developing technologies, there is an illusion of 100% control, which doesn’t really exist.</p>
<p><em>Peter:</em></p>
<p>All our current AI, and any that we can possibly create in the foreseeable future, are just tools – developed for specific jobs and totally useless outside of the exact duties they were designed for. They don’t have thoughts or feelings. These AIs are just as likely to try to take over the world as your Xbox or your toaster.</p>
<p>One day, I believe, we will build machines that <a href="https://www.newscientist.com/article/mg22930661-800-vision-of-singularity-questions-ai-intellect/">rival us in intelligence</a>, and these machines will have their own thoughts and possibly learn in an unconstrained way. This sounds scary. But humans are dangerous for exactly the reasons that the machines won’t be.</p>
<p>Humans evolved in a constant struggle for life and death, which made us innately competitive and potentially treacherous. When we build the machines, we can instead build them with any underlying motivation that we would like.</p>
<p>For example, we could build an intelligent machine whose only desire is to dismantle itself. Or, we could build in a hidden remote-controlled off switch that is completely separate from any of the machine’s own circuits, and an auto-shutdown reflex if the machine somehow ever notices it.</p>
<p>All these safeguards will be trivial to implement. So there is simply no way that we could accidentally build a machine that then tries to wipe out the human race.</p>
<p>Of course, because humans themselves are dangerous, someone could build a machine that doesn’t have these safeguards and use it for nefarious purposes. But we have that same problem now with nuclear weapons.</p>
<p>In the future, just as now, we have to hope that we are simply smart enough to use our technology wisely.</p><img src="https://counter.theconversation.com/content/79904/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Michael Milford is a Chief Investigator at the Australian Centre for Robotic Vision, an Australian Research Council Future Fellow, Microsoft Research Faculty Fellow and Founding Director of the education startup Math Thrills Pty Ltd. He receives funding from the Australian Research Council, the Queensland Government, Caterpillar Corporation, Mining3, Microsoft, the Asian Office of Aerospace Research and Development and AMP.</span></em></p><p class="fine-print"><em><span>Peter Stratton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Not everyone agrees on how artificial intelligence will change the way we live. But it’s not all doom and gloom either.Peter Stratton, Postdoctoral Research Fellow, The University of QueenslandMichael Milford, Professor, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/807202017-07-12T18:03:27Z2017-07-12T18:03:27ZEnergy-recycling stairs could add a spring to your step<figure><img src="https://images.theconversation.com/files/177552/original/file-20170710-5923-flgkrn.jpg?ixlib=rb-1.1.0&rect=362%2C71%2C2043%2C1558&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Latching springs provide a boost.</span> <span class="attribution"><a class="source" href="https://doi.org/10.1371/journal.pone.0179637">Yun Seong Song et al (2017)</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>“Take the stairs!” we’ve all been implored, to help maintain our health. But what if taking the stairs is painful, difficult or, worse, potentially dangerous?</p>
<p>In most public buildings, we can opt for an elevator or escalator ride. But at home (unless you live solely on the ground floor), taking the stairs is usually a necessity, not a choice. And as people lose mobility with age, injury or disease, it becomes more challenging. Stair negotiation is one of the top five <a href="https://doi.org/10.1016/j.apmr.2007.08.129">most difficult physical tasks</a> for older adults; <a href="https://doi.org/10.1016/j.apmr.2007.08.129">in one study</a> almost half of nondisabled older adults reported trouble climbing up stairs, and more than a quarter reported problems going down stairs.</p>
<p>My research collaborator, <a href="http://www.cc.gatech.edu/%7Ekarenliu/Home.html">Karen Liu</a>, a computer scientist at Georgia Tech, noticed that her 72-year-old mother is still very active and can walk for miles – but complained about climbing stairs. Karen wondered whether we could engineer a little boost into her step while climbing stairs.</p>
<h2>Springy steps store and release energy</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/177544/original/file-20170710-5989-fox3vt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A brace helps with mobility by reducing the energy necessary to take a step.</span>
<span class="attribution"><a class="source" href="http://biomechatronics.cit.cmu.edu/publications/Collins_2015_Nature---Photos.html">Carnegie Mellon University College of Engineering</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Karen was inspired by an <a href="https://doi.org/10.1038/nature14288">innovative lightweight ankle exoskeleton</a>, designed by <a href="http://www.andrew.cmu.edu/user/shc17/">Steve Collins</a> at Carnegie Mellon. The exoskeleton is <a href="http://biomechatronics.cit.cmu.edu/publications/Collins_2015_Nature---Photos.html">worn like a brace on the ankle</a> and reduces the energy required of the wearer during walking. On each step, the exoskeleton stores and then returns energy to the user through a clever use of a spring and a mechanical clutch. </p>
<p>On each step during walking, we use energy in our muscles to first brake our bodies and then propel ourselves forward. The ankle brace helps with both of these jobs. It assists with braking by stretching a spring, and then with push-off by releasing the spring, relieving the work done by muscles for both tasks.</p>
<p>But Karen knows that her mother, like most people, would not wear an ankle brace or special shoes just to help her get up the stairs. Could the stairs themselves be modified?</p>
<p>A key insight came when she talked to our colleague <a href="http://pwp.gatech.edu/cnl/currentlabmembers/younghuichang/">Young-Hui Chang</a> at Georgia Tech. He pointed out that unlike level walking, climbing the stairs requires almost pure propulsion and no braking by our muscles, so no energy can actually be stored. Undaunted, Karen realized that even if energy can’t be stored when going up the stairs, it could be stored when descending, where our muscles are almost exclusively braking to slow our bodies against the pull of gravity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/177425/original/file-20170708-29852-1hgymd1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our muscles act as brakes when we go down the stairs, dissipating energy while lowering the body. When we go up the stairs, they act as motors, generating energy to lift the body.</span>
<span class="attribution"><span class="source">Yun Seong Song</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>That’s when she approached me with the idea of making stairs that themselves store energy as someone descends, and releases it back to the user on the way up. I thought the idea was crazy, but agreed to let <a href="https://mae.mst.edu/facultyandstaff/facultysong/">Yun Seong Song</a>, a talented mechanical engineer at Missouri University of Science and Technology who was a postdoctoral researcher in my lab at the time, work on the idea. Since Yun Seong has a lot of expertise building robots – <a href="https://doi.org/10.1109/TNSRE.2015.2396852">particularly exoskeletons</a> – we though he might be the perfect person to build and test Karen’s energy-recycling stairs.</p>
<h2>Easing the way up and down</h2>
<p>The results are <a href="https://doi.org/10.1371/journal.pone.0179637">a prototype of Energy-Recycling Assistive Stairs</a> (ERAS) that make it easier not only to climb but also to descend the stairs, the latter of which we didn’t expect.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/hgwKoo9J410?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Energy-recycling assistive stairs cushion on the way down and assist on the way up.</span></figcaption>
</figure>
<p>Similar to the energy-recycling ankle exoskeleton, springs are stretched when a person goes down the stairs, which has the added benefit of cushioning stair descent. In fact, one test subject said it felt like walking on pillows. We measured a 27 percent reduction in ankle braking torque of the trailing leg, which lowers the body going down the stairs. Going up the stairs, the tensioned springs are released with a timing that helps to push the trailing leg up when lifting the body, reducing the propulsive torque required by the knee of the leading leg by 37 percent. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=158&fit=crop&dpr=1 600w, https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=158&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=158&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=198&fit=crop&dpr=1 754w, https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=198&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/177426/original/file-20170708-8807-r1t1mg.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=198&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When walking down the steps, energy is stored in a spring as the movable tread lowers under the weight of the user. The spring then latches in place, ready to release energy to the user during stair ascent.</span>
<span class="attribution"><span class="source">Yun Seong Song</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>While we tried out our prototype only on healthy young adults, with further development and testing, it could potentially benefit users with limited mobility. We suspect our energy-recycling assistive stairs could ease the knee joint pain that’s often a reason for not taking the stairs. ERAS might also help mitigate falls – a major hazard when going down the stairs because braking against gravity is challenging for many. Perhaps the greatest benefit of ERAS could be making stair descent easier and safer for those with limited muscle strength.</p>
<h2>A cheap, efficient home option</h2>
<p>And since the energy-recycling steps are modular and compact, they can be added to existing stairs without the expensive remodeling required to install an elevator or escalator. Because there are no motors, the energy-recycling assistive stairs also consume little power. In contrast to passively riding an elevator, our prototype requires users to actively participate in stair-climbing, which could help them retain their mobility.</p>
<p>Energy-recycling assistive stairs thus open the possibility for people to stay more active and live independently in their homes even as they lose mobility due to injury, aging or degenerative diseases of the musculoskeletal and nervous systems.</p><img src="https://counter.theconversation.com/content/80720/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lena Ting receives funding from the National Institutes of Health and the National Science Foundation.</span></em></p>For those with reduced mobility and even just the normally aging, stairs can pose a big problem. A cheap and efficient new prototype could help.Lena Ting, Professor of Biomedical Engineering and Rehabilitation Medicine, Division of Physical Therapy, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/668022016-10-11T16:16:49Z2016-10-11T16:16:49ZInside the Cybathlon, where even paraplegics can feel the adrenaline rush of competitive sport<p><em>The arena vibrates with the enthusiasm of the spectators and the nerves of competitors. The <a href="https://www.ethz.ch/en/news-and-events/eth-news/news/2016/10/a-unique-competition-takes-of.html">first-ever Cybathlon</a> is about to begin – and both the sold-out audience of 4,600 and teams are justifiably excited.</em></p>
<p>The <a href="https://theconversation.com/cybathlon-will-showcase-what-bionics-could-do-for-millions-with-disabilities-54760">Cybathlon</a> is the world’s first athletics event where the competitors are those living with severe disabilities such as paralysis or the loss of limbs, supported by cutting-edge assistive technology such as prosthetics and implants developed by university research teams. The Cybathlon, which has just taken place, aims to harness competition to spur on the technology that could offer huge improvements to millions of people’s lives.</p>
<p>The event’s <a href="http://www.cybathlon.ethz.ch/en/the-disciplines.html">six disciplines</a> are based on the competitors’ physical needs, including agility courses for those with bionic arms and legs, obstacle courses including flights of stairs for wearable exoskeletons, powered wheelchair races, and a bike race for paralysed competitors using electronic muscle stimulation to move their legs. </p>
<p><a href="http://essexbcis.uk/main/cybathlon/team/">BrainStormers</a>, our team from the University of Essex <a href="http://essexbcis.uk/">Brain-Computer Interface and Neural Engineering Lab</a>, competed in the final category: a videogame challenge played by paralysed parathletes using a brain-computer interface.</p>
<figure>
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<p>Our technology captures signals through an EEG cap worn by David Rose, our pilot, who has been paralysed from the shoulders down for 29 years. Our system must correctly interpret his thoughts into four different commands, jump, roll, run or wait, which must be sent at 16 different platforms in the game in order for the videogame avatar to progress. To issue any of the commands, the pilot has to conjure up a different thought: for example, to “jump” David thinks of moving his feet, while “roll” corresponds to imagining a phone ringing. The pilot must conjure the thought corresponding to the required command quickly to enable the system to interpret it quickly and accurately in order to move the avatar faster than the other teams and win.</p>
<h2>Brain-powered racing</h2>
<p>On the day, we collect brain signal test data but unfortunately the signals are noisy, so the algorithms that interpret David’s thoughts will not work as well as in the lab. This is something we’d anticipated – EEG signals are very weak – so we developed a system that could mask the interference in order to extract the information we need. In the minutes before the race David is “in the zone”: he meditates to help his muscle spasms and keep calm, which might give us the edge we need to win. We check the commands are being transmitted to the Cybathlon game system, then the countdown and the game begins.</p>
<p>While David is fully focused on the game, team member Davide Valeriani and I follow his progress on the screen as he quickly moves into first position. Even with the noise from the audience, we can still hear David’s wife Hilary cheering over them. I secretly hope that this doesn’t distract David from the race – it doesn’t, and we finish first in our heat with a time of 146 seconds.</p>
<p>The final race of the qualifying heats is incredible: Eric Anselmo, pilot for the Brain Tweakers from EPFL in Lausanne, Switzerland, finishes in less than 100 seconds, pushing our team into fourth place. Tense, we watch as the second team’s pilot approaches the finish line, keeping a nervous eye on the clock as it approaches our team’s time. As 146 seconds passes, we are overcome with excitement, nerves, elation – and the pressure of knowing we will be in the final (by just two seconds).</p>
<p>In the final race, David competes against two pilots from EPFL and the pilot from BrainGain, a team from the Netherlands. David had seemed tranquil until now, but starts to get nervous. We train in our booth, but the external interference and the team’s excitement make it difficult to make much sense of the EEG signals. Worse, the interpreter has switched the “jump” and “run” commands, adding confusion to he task David faces.</p>
<p>The race starts and it’s nerve-racking, but now it all depends on how David can adapt his thoughts during the race. The four avatars start at the same pace, with all pilots making similar mistakes. But one of the Brain Tweakers’ pilots takes the lead, with David and the BrainGain pilot neck and neck. The last platform seems to stretch on eternally as we watch, clutching each others’ arms and mentally conjuring “run!” in our heads. </p>
<p>In the end, BrainGain gets the edge with a five-second lead, leaving BrainStormers to <a href="http://www.cybathlon.ethz.ch/en/cybathlon-news/cybathlon-results/bci-results.html">take the bronze medal in third</a>. But the effort of working towards the Cybathlon has paid off – at that moment, we’re the happiest team on Earth. A group of students who volunteered their time and efforts towards the project, we considered ourselves the underdogs – and reached the podium. We couldn’t have asked for more.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/141210/original/image-20161011-12002-ojddax.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/141210/original/image-20161011-12002-ojddax.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/141210/original/image-20161011-12002-ojddax.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/141210/original/image-20161011-12002-ojddax.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/141210/original/image-20161011-12002-ojddax.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/141210/original/image-20161011-12002-ojddax.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/141210/original/image-20161011-12002-ojddax.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">BrainStormers team celebration.</span>
<span class="attribution"><span class="source">Pilar Sopena Suils</span></span>
</figcaption>
</figure>
<h2>Forward to the future</h2>
<p>Our pilot David took some time to process his achievement. Formerly a wheelchair rugby player for the GB team he was visibly emotional – he’d never won a medal, he said. For David, what Cybathlon has achieved is to push the limits of what technology can achieve when put to practical use outside the lab. Throughout the two years I’ve worked with him, David has always been very enthusiastic about the possibilities of brain-computer interface technology to improve the lives of people with disabilities like his – to open doors and windows, for example. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/141246/original/image-20161011-12009-13ubg0x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/141246/original/image-20161011-12009-13ubg0x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/141246/original/image-20161011-12009-13ubg0x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/141246/original/image-20161011-12009-13ubg0x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/141246/original/image-20161011-12009-13ubg0x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/141246/original/image-20161011-12009-13ubg0x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/141246/original/image-20161011-12009-13ubg0x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The team’s brain-computer interface race bronze medal.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Some of the events saw the audience leave visibly emotional by what they’d seen – particularly the exoskeleton course, where a competitor who has been wheelchair-bound for years tackles a flight of steps. So I believe Cybathlon has fulfilled its goal of bringing home the difficulties of everyday life for the disabled, and to remind us to focus on how technology can help. The brain-computer interfaces developed for the race are easily adapted to control a wheelchair, for example, and I hope research teams bear these practical uses in mind rather than striving to build perfect systems that work only in lab conditions. The emphasis must be on usability and on bringing together technology providers and users – and that’s what Cybathlon has achieved.</p>
<p>Two years ago it proved difficult to find a pilot to take part in the event. Now I receive many emails from families of people with disabilities asking if I can help them. Talks are underway to organise the next Cybathlon alongside the 2020 Olympic and the Paralympic games in Tokyo. Despite the technological and psychological challenges, the event has shown the world – and the disabled competitors themselves – what it’s possible to achieve even while the world watches you think.</p><img src="https://counter.theconversation.com/content/66802/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ana Matran-Fernandez receives funding from BioSemi, who sponsored the BrainStormers team to participate in Cybathlon. </span></em></p>After the Paralympics comes the Cybathlon, where disabled athletes use bionics to compete.Ana Matran-Fernandez, Post-doctoral researcher, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/610592016-09-01T03:25:29Z2016-09-01T03:25:29ZCybathlon: A bionics competition for people with disabilities<figure><img src="https://images.theconversation.com/files/126787/original/image-20160615-14054-16isgqx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Testing new ways to navigate a complicated world.</span> <span class="attribution"><a class="source" href="http://www.cybathlon.ethz.ch/en/for-the-media/photo-gallery.html">ETH Zurich/Alessandro Della Bella</a>, <span class="license">Author provided</span></span></figcaption></figure><p>Millions of people worldwide rely on orthotics, prosthetics, wheelchairs and other assistive devices to improve their quality of life. In the United States alone, there are <a href="http://dx.doi.org/10.1016/j.apmr.2007.11.005">more than 1.6 million people with limb amputations</a>. The World Health Organization estimates the number of wheelchair users to be <a href="http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/">about 65 million people worldwide</a>.</p>
<p>It is important to improve the daily lives of people with disabilities or physical weaknesses, and allow them to be more independent. Unfortunately, current assistive technology does not fully address their needs. Wheelchairs cannot climb stairs; arm prostheses do not enable versatile hand functions. Powered support devices have limited battery life. The list goes on and on.</p>
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<img alt="" src="https://images.theconversation.com/files/126783/original/image-20160615-14054-cjn6as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126783/original/image-20160615-14054-cjn6as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126783/original/image-20160615-14054-cjn6as.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126783/original/image-20160615-14054-cjn6as.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126783/original/image-20160615-14054-cjn6as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126783/original/image-20160615-14054-cjn6as.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126783/original/image-20160615-14054-cjn6as.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people need help climbing stairs.</span>
<span class="attribution"><a class="source" href="http://www.cybathlon.ethz.ch/en/for-the-media/photo-gallery.html">ETH Zurich/Alessandro Della Bella</a>, <span class="license">Author provided</span></span>
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<p>People with disabilities are often disappointed with their devices’ performance, and choose not to use them. The main objection is that designs ignore user needs, such as individual preferences for device appearance, sizing and fitting for comfort and function, effort and time required to put on and take off, and device durability and weight.</p>
<p>Beyond the design issues, these tools are expensive. <a href="http://www.unicef.org/protection/World_report_on_disability_eng.pdf">Cost shuts many people out of using them</a>, regardless of how well they work.“ And stairs, steep ramps, narrow doorways and low tables can make the use of assistive technologies very cumbersome or even impossible.</p>
<p>It is an industry ripe for innovation. To encourage this work, I have founded <a href="http://dx.doi.org/10.1186/s12984-016-0157-2">a new kind of competition</a> promoting the development of useful technologies. In the Paralympics, parathletes aim to achieve maximum performance in sporting challenges. In our new contest, the <a href="http://www.cybathlon.ethz.ch/en/">Cybathlon</a>, people with physical disabilities will compete against each other at tasks of daily life, with the aid of advanced assistive devices – including robotic ones.</p>
<h2>Focusing on teamwork and technology</h2>
<p>In the Cybathlon, what’s being tested is not just the abilities of human athletes, nor only the equipment they use. Rather, it’s their symbiosis, balancing good technical performance of the device, and its control by the athlete.</p>
<p>Competitors will face off in six disciplines, for people with either limb amputations or limb paralysis of varying degrees, such as occurs after a spinal cord injury. We’ll organize a race focused on each of these technologies: powered leg prostheses, powered arm prostheses, functional electrical stimulation (FES) driven bikes, powered wheelchairs, and powered exoskeletons. The sixth competition is a racing game with virtual avatars controlled by brain-computer interfaces. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/126784/original/image-20160615-14016-1lbdyum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126784/original/image-20160615-14016-1lbdyum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126784/original/image-20160615-14016-1lbdyum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126784/original/image-20160615-14016-1lbdyum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126784/original/image-20160615-14016-1lbdyum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126784/original/image-20160615-14016-1lbdyum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126784/original/image-20160615-14016-1lbdyum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teams work together: a pilot in control, with others supporting and operating the technology.</span>
<span class="attribution"><a class="source" href="http://www.cybathlon.ethz.ch/en/for-the-media/photo-gallery.html">ETH Zurich/Alessandro Della Bella</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We ran test sessions in July 2015, and have slated the full competition for October 8 in Zurich. The devices involved can be prototypes developed by research labs or companies, or commercially available products. Competitors will be called pilots, as they must control a device that enhances their mobility. </p>
<p>Competing teams each consist of a pilot, scientists and technology providers, making the Cybathlon also a competition among companies and research laboratories. As a result there are two awards for each competition’s winning team: a medal for the pilot and a cup for the company or lab that made the device.</p>
<h2>The six competitions</h2>
<p>The competitions will simulate challenges people with disabilities face in daily life – situations that non-disabled people don’t think twice about but that can be insurmountable for others.</p>
<p><strong>Powered prosthetic legs</strong> Most leg prostheses require their users to <a href="http://dx.doi.org/10.1016/j.humov.2011.09.004">swing the artificial leg just so</a>, to properly align the knee, lower leg and foot. And they cannot transfer muscular power through the knee, using <a href="http://dx.doi.org/10.1016/S0966-6362(01)00162-X">thigh muscles to help climb stairs</a>, for example. </p>
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<figcaption><span class="caption">One of the best unpowered-knee prostheses, offering a quite symmetrical gait compared to most devices.</span></figcaption>
</figure>
<p>Powered leg prostheses can provide that missing power, but they are <a href="http://dx.doi.org/10.1016/j.robot.2014.08.012">difficult to control</a> unless the motor understands how the user wants to move. And even the best batteries are either too heavy or too short-lived to be a real solution. Our race will challenge pilots with above-knee amputations to use powered prosthetic legs to walk up and down stairs, stand up from a seated position, and otherwise navigate a complicated environment.</p>
<p><strong>Powered hands and arms</strong> Two-handed jobs, requiring either strength (like carrying a heavy box) or specific fine motor skills (like opening a small jar of jam) are challenging with even the best upper-arm prostheses. As a result, up to 60 percent of people with upper-limb amputation <a href="http://dx.doi.org/10.1016/S0363-5023(05)80278-3">don’t use their prosthetic device very much</a> or <a href="http://dx.doi.org/10.1080/09638280410001645094">even at all</a>. People are <a href="http://dx.doi.org/10.1080/03093640600994581">much less likely to reject</a> more advanced devices, like body-powered or electric ones. Pilots with amputations at or above the lower arm will use motorized prosthetic hands and arms to complete various household and food preparation tasks.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/126782/original/image-20160615-14051-1xjec7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/126782/original/image-20160615-14051-1xjec7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126782/original/image-20160615-14051-1xjec7k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126782/original/image-20160615-14051-1xjec7k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126782/original/image-20160615-14051-1xjec7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126782/original/image-20160615-14051-1xjec7k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126782/original/image-20160615-14051-1xjec7k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Two-handed jobs needing fine motor skills can be very hard to complete.</span>
<span class="attribution"><a class="source" href="http://www.cybathlon.ethz.ch/en/for-the-media/photo-gallery.html">ETH Zurich/Alessandro Della Bella</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><strong>Assisted cycling</strong> People with complete paraplegia don’t lose their muscles; they just lose the ability to control them. A technology called functional electrical stimulation (FES) can restore some of this function, sending electricity into otherwise dormant nerves to activate muscles. FES technology has been <a href="http://www.rehab.research.va.gov/jour/07/44/3/hardin.html">used for decades</a>. But the systems <a href="http://dx.doi.org/10.1682/JRRD.2011.03.0043">take a long time to set up</a>, don’t produce much muscle force, and tire out muscles quickly. </p>
<p><a href="http://www.rehab.research.va.gov/jour/07/44/3/hardin.html">Surgically implanted systems</a> give more <a href="http://www.rehab.research.va.gov/JOUR/03/40/3/pdf/Agarwal.pdf">specific control of particular muscles and higher force output</a>. But they are expensive and invasive, and carry more risks than external FES devices that are merely strapped to a person’s body. For these reasons, doctors and patients <a href="http://dx.doi.org/10.1038/sj.sc.3102101">don’t often use FES technology</a>.</p>
<p>In the Cybathlon, pilots with complete paraplegia will compete in a bike race, using FES devices to fire their leg muscles to drive the pedals.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/6ifHDkdY-k0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Helping cyclists pedal with functional electrical stimulation.</span></figcaption>
</figure>
<p><strong>Powered wheelchairs</strong> Despite the Americans with Disabilities Act and other laws and regulations, public buildings are still <a href="http://dx.doi.org/10.3109/17483107.2010.522680">hard to enter and navigate in wheelchairs</a>. Most outdoor devices are too bulky and not agile enough for indoor use; commercial indoor wheelchairs can’t travel over uneven terrain or steps. So-called <a href="http://dx.doi.org/10.1682/JRRD.2004.08.0101">intelligent or smart wheelchairs, which can autonomously navigate in known environments</a> have been available for decades, but are very expensive and <a href="http://ebooks.iospress.nl/volume/assistive-technology-from-research-to-practice">used by relatively few people</a>.</p>
<p>Wheelchairs are becoming more powerful, but often their control systems are <a href="http://dx.doi.org/10.1109/MCS.2005.1411382">neither as effective nor as comfortable</a> as they could be. To push development of these functions, pilots with paralysis will take powered wheelchairs through an obstacle course with ramps, stairs, bends, doors and uneven terrain. </p>
<figure>
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<figcaption><span class="caption">Powered wheelchair racing.</span></figcaption>
</figure>
<p><strong>Powered exoskeletons</strong> An alternative to wheelchairs are exoskeletal devices that <a href="http://dx.doi.org/10.1615/CritRevBiomedEng.2014010453">help people walk</a>. However, batteries only last a few hours, and the equipment is very bulky and heavy. Most of the <a href="http://dx.doi.org/10.1561/2300000028">commercially available multi-joint exoskeletons</a> weigh between 46 and 62 pounds (21–28 kg). One device, called ”<a href="http://dx.doi.org/10.3109/17483107.2015.1080766">REX</a>“ weighs nearly 88 pounds! </p>
<p>Current commercial systems are so limited that they can’t even climb slopes or stairs. An obstacle course will test pilots’ and teams’ abilities to develop systems that can move through difficult areas.</p>
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<figcaption><span class="caption">Moving with powered exoskeletons.</span></figcaption>
</figure>
<p><strong>Navigating by brain power</strong> In the brain-computer interface (BCI) race, pilots with paralysis of all four limbs will control a virtual avatar in a racing game displayed on a computer screen. The best pilots will be able to make their brain signals emit three different commands to overcome three different kinds of virtual obstacles. BCI technology is becoming more popular, but most systems take a long time to set up, can be uncomfortable, and <a href="http://dx.doi.org/10.3390/s120201211">don’t function well outside the lab</a>. That has prevented its <a href="http://dx.doi.org/10.1016/j.mayocp.2011.12.008">broad use in daily life</a>.</p>
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<figcaption><span class="caption">Racing with brain power alone.</span></figcaption>
</figure>
<h2>Pushing the boundaries of the possible</h2>
<p>The Cybathlon will bring together people with disabilities or physical weaknesses, researchers and developers, governments and other agencies that fund services and research. It will also showcase the importance of this work to the general public. Our hope is that over time, these devices will become more affordable and more functional.</p>
<p>Unlike the Paralympic Games, pilots can use any technical aids they need, as long as they are safe. That enables people with more severe disabilities to compete. The goal is not to be the fastest or the strongest participant; rather it’s to be the most skilled pilot who can use advanced technologies to best overcome the challenges of everyday life.</p><img src="https://counter.theconversation.com/content/61059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Riener receives funding from Swiss National Science Foundation, Swiss Department of Inner Affairs, and private sponsors. </span></em></p>People with disabilities are often disappointed with their devices’ performance, and choose not to use them. To encourage innovation, a new competition tests assistive technologies.Robert Riener, Professor of Sensory-Motor Systems, Swiss Federal Institute of Technology ZurichLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/547412016-04-11T02:59:13Z2016-04-11T02:59:13ZRobots can help young patients engage in rehab<figure><img src="https://images.theconversation.com/files/113331/original/image-20160301-4096-oqp96n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">RCH patient, Miles, working with NAO</span> <span class="attribution"><span class="source">Alvin Aquino/RCH</span></span></figcaption></figure><p>Anyone who has undergone any intensive physical rehabilitation knows the frustration, boredom and discomfort that comes with repeated exercises over days, weeks and even months. For young children and their families, rehabilitation is often a traumatic and emotional time.</p>
<p>Physiotherapists and doctors may be highly skilled in the art of child motivation and distraction, but such motivation costs precious time and resources. And despite their best efforts, not all sessions achieve positive results.</p>
<p>The advent of social robots is giving rise to new possibilities in paediatric health care.</p>
<p>So what does it take to deploy a robot as a clinic-ready therapeutic aid for diverse patients? What benefits does this technology offer? And how will patients and health professionals engage with robots in their daily practice?</p>
<p>We have been exploring these questions by using the highly engaging humanoid robot <a href="https://www.aldebaran.com/en/cool-robots/nao">NAO</a> as a therapeutic aid for paediatric rehabilitation.</p>
<h2>Robot helper</h2>
<p>At just 58cm tall and <a href="http://doc.aldebaran.com/2-1/family/robots/dimensions_robot.html">equipped with a range of sensors</a>, NAO is an ideal candidate for engaging and motivating children during rehabilitation.</p>
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</figure>
<p>The robot’s life-like gestures, such as gentle swaying, subtle responses to touch and sound, and watchful head movements, give it an unquestionably authentic presence that harnesses the attention of children, and adults alike. </p>
<p>Rehabilitation requires more than a child’s attention, it requires ongoing compliance with therapist instructions and the motivation to persevere. We have programmed NAO for three new roles to meet the needs of a therapy assistant: the motivator; the demonstrator; and the instructor.</p>
<p>As motivator, NAO provides both verbal encouragement and enticements to children through the promise of rewards such as dances, music and jokes. NAO might say to a child practising exercises:</p>
<blockquote>
<p>When we’re done, I will show you my awesome dance moves! </p>
</blockquote>
<p>It can provide more personalised phrases based on the patient’s interests:</p>
<blockquote>
<p>Slam dunk Derek!</p>
</blockquote>
<p>Demonstration is NAO’s most practical function. In this role, NAO introduces and describes each exercise before performing the action in front of the child. NAO then invites the child to perform a set with it. </p>
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<p>The third role has NAO is as an instructor, leading the child through a series of activities in the form of a game. NAO attentively tracks movement, provides feedback on technique and reacts to specific milestones with gestures and words of encouragement.</p>
<p>While still in development, this role has been strikingly effective with patients so far. </p>
<p>NAO’s instructions and motivational phrases have been programmed to largely emulate those provided by physiotherapists, yet, its words are clearly treated differently by children. NAO’s persona as a childlike peer rather than instructing adult and its novelty factor contribute to its success so far.</p>
<p>Beyond the capacity of any current speaking toy, NAO quickly builds a rapport with each child through the careful design and configuration of personalised interactive behaviours. </p>
<p>Rapport with patients should improve as more advanced machine learning, natural language processing and computer vision algorithms build up NAO’s situation awareness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/117770/original/image-20160407-13952-1ii66he.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Patient Miles with NAO.</span>
<span class="attribution"><span class="source">Alvin Aquino/RCH</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Towards a clinical trial</h2>
<p>Over the past 12 months, NAO has worked with more than 30 different individual patients at the Royal Children’s Hospital in Melbourne.</p>
<p>Physiotherapists have generally noted improvements in both patient compliance and mood when NAO is present compared to sessions when it is not. A formal clinical study, examining performance over a prolonged period is needed to establish the true therapeutic benefits of this technology.</p>
<p>Later this year, we hope to conduct a trial with children with <a href="http://www.ncbi.nlm.nih.gov/pubmed/22818117">cerebral palsy undergoing rehabilitation</a> following gait corrective surgery. The aim will be to use NAO as a therapeutic aid in post-surgery inpatient rehabilitation programs, and through this, gain a more accurate measure of NAO’s effectiveness as a therapeutic device. </p>
<h2>A replacement for physiotherapists?</h2>
<p>Although the results so far with NAO are impressive, there is the question of whether such socially assistive robots could eventually replace physiotherapists.</p>
<p>We think that’s unlikely. In fact, our observations suggest NAO’s benefits are greatest when working in a therapist-robot team.</p>
<p>We aim for NAO to perform certain tasks on behalf of a therapist, who often cannot attend every rehabilitation session. Using a simple interface based on existing clinical practise, physiotherapists will configure NAO to lead independent sessions of rehabilitation. </p>
<p>NAO will then provide assistance to other attending adults, such as parents and nursing staff, as the child works through rehabilitation exercises on ward, or at home.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/117772/original/image-20160407-13987-1wmojq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">NAO can be programmed to perform many therapy tasks but it won’t replace the human therapist.</span>
<span class="attribution"><span class="source">Chris McCarthy/SUT</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Beyond paediatrics?</h2>
<p>The work so far has been with child patients. Would a social robot such as NAO command the same authority with an adult?</p>
<p><a href="http://dl.acm.org/citation.cfm?id=2702592">A recent study</a> has shown that an adult’s motivation to follow a robot’s instruction can be significantly boosted when the robot exhibits simple interpersonal gestures matched to the adult’s personality.</p>
<p>A fascinating window of exploration is opening up for future social robotics research. The key next step is to move beyond proof-of-concept studies to formal trials that establish the effectiveness and legitimacy of this promising technology.</p><img src="https://counter.theconversation.com/content/54741/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This project, in partnership with the Brainary Interactive, received seed funding from the Traffic Accident Commission (TAC) as part of the TAC Small Grants Program. </span></em></p><p class="fine-print"><em><span>This project, in partnership with the Brainery Interactive, received seed funding from the Traffic Accident Commission as part of the TAC Small Grant Program.</span></em></p><p class="fine-print"><em><span>This project, in partnership with the Brainary Interactive, received seed funding from the Traffic Accident Commission (TAC) as part of the TAC Small Grants Program.</span></em></p><p class="fine-print"><em><span>This project, in partnership with the Brainary Interactive received seed funding from the Traffic Accident Commission as part of the TAC Small Grants Progarn. </span></em></p>The advent of social robots is giving rise to new possibilities in paediatric health care. But will they replace human specialists?Chris McCarthy, Lecturer of Computer Science, Swinburne University of TechnologyAdam Scheinberg, Adjunct assistant professor and Statewide Medical Director VPRS, Murdoch Children's Research InstituteFelip Marti Carrillo, PhD Candidate in Robotics, Swinburne University of TechnologyJoanna Butchart, Senior Physiotherapist, Royal Children's HospitalLeon Sterling, Professor emeritus, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/359362015-01-07T13:02:18Z2015-01-07T13:02:18ZCamera, mobile, headphones: the low-cost set up that can help blind people ‘see’<figure><img src="https://images.theconversation.com/files/68305/original/image-20150106-18610-1ds0h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early days yet...</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/yourdon/5659732504/sizes/l/in/photolist-9C8BhU-6pztRN-5aXQTM-5qRUfS-gQd6Vu-7rjeoE-7Nhh13-9d7zbu-8s2SW-casCCj-6bsvaL-eemWai-z5uw-hbEVNy-4Y1kmS-2q9Pr-yVyFJ-7RXrgV-8zZsJ6-8eohz2-4uA3Hc-5o3AD5-4uCfJs-g4Z3GN-j6Rxsk-2p3f44-d1WKms-gG6bpm-4yZjpU-aeYMvq-kieeoY-5PXDfY-sPRMw-5YfeSt-99qFoL-4uFCqS-3dLNgJ-o4DeWf-4EdrWK-nNvmzc-s8FE9-aX4UHB-7gUxRa-msi2jZ-5xjwKL-cEsPcj-4m1jUk-7oV6qn-bxEyti-pqdkaL-g6WxHK/">Ed Yourdon</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>We live in a visual world and build environments that rely heavily on visual perception. Want to find somewhere? You look on a map or read a road sign. Perhaps the GPS on your touch screen smartphone can help you. It probably couldn’t help you find your mislaid house keys or help you choose between a red and green apple but we don’t need it to, we have our eyes to do that.</p>
<p>Well, most of us do. For <a href="http://www.ncbi.nlm.nih.gov/pubmed/22133988">the 40m people who are legally blind</a> worldwide, functioning in these visual environments is much more problematic. The signs can’t be read, and the apples, without tasting, are the same. At least the GPS will “talk” to me but the touch screen keyboard is awkward. </p>
<p>Efforts to increase accessibility to the environment for the visually impaired are not new – white stick, guide dog, Braille – but rapid technological advancements in the past three or four decades have facilitated not only new assistive devices but also techniques to restore a visual percept in the blind.</p>
<p>One option is surgical. Electrode arrays implanted in the retina of the eye electrically stimulate surviving retinal cells to elicit <a href="http://stm.sciencemag.org/content/5/210/210ps16.abstract">a basic visual sense</a>. Research using implants such as the Argus II – the only approved retinal implant in the US and Europe – has <a href="http://www.ncbi.nlm.nih.gov/pubmed/20881025">demonstrated functionality</a> in <a href="http://www.ncbi.nlm.nih.gov/pubmed/23426738">simple tasks</a>, but implants suffer from limitations – technologically (it has very low resolution) and in availability.</p>
<h2>Sensory substitution</h2>
<p>There is another way, however, which requires no surgery and works with technology you may have in your home. Rather than replace the damaged part of the visual system this method tries to provide the “visual” information in another way – by using a different sensory system. This is sensory substitution. </p>
<p>Substitution devices can be divided into two groups based on whether the output is auditory or tactile. <a href="http://www.cbc.ca/news/technology/rewiring-senses-technologies-enable-humans-to-hear-colour-smell-time-1.2864312">Modern tactile devices</a> include the Brainport, which uses a camera, device and display unit to convert visual stimuli into tiny electrical signals on a person’s tongue. The main auditory devices, which convert the stimuli into sound, include The vOICe, PSVA and Eyemusic. The differences between them come down to the algorithms they use to convert the environment into sound. </p>
<h2>Sight into sound</h2>
<p>For auditory devices the technology can be basic: you need a camera to extract information from the environment, a PC or smartphone to run the conversion algorithm, and headphones to relay the converted signal back to the user – but the magic in how it works lies in how the brain processes sensory information and how this is used to inform the algorithm.</p>
<p>And it does work. The vOICe substitution device (the middle three letters stand for “oh I see”) <a href="http://www.ncbi.nlm.nih.gov/pubmed/1612614">was developed</a> by Dutch engineer Peter Meijer and uses a three principle conversion algorithm to tell the user where something is in the visual scene and how bright it is using auditory features such as pitch, volume, and stereo scan. If an object is high up, on a shelf perhaps, then it has a high pitch. If it is to the left, you hear it in the left headphone; visually bright then it is aurally loud. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/68298/original/image-20150106-18632-bokqln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/68298/original/image-20150106-18632-bokqln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=302&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68298/original/image-20150106-18632-bokqln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=302&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68298/original/image-20150106-18632-bokqln.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=302&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68298/original/image-20150106-18632-bokqln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=379&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68298/original/image-20150106-18632-bokqln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=379&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68298/original/image-20150106-18632-bokqln.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=379&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Inspect the gadget.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Even with minimal training users <a href="http://journal.frontiersin.org/Journal/10.3389/fpsyg.2013.00330/abstract">can display high acuity</a> and perform <a href="http://www.ncbi.nlm.nih.gov/pubmed/22208131">far above chance on tasks</a> such as <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0001840">object localisation and recognition</a> due to the brain naturally <a href="http://www.journalofvision.org/content/10/1/6.full">understanding</a> what is happening. </p>
<h2>Better performing than retinal implant?</h2>
<p>In <a href="http://booksandjournals.brillonline.com/content/journals/10.1163/22134808-00002462">a recent study</a> published in Multisensory Research, we evaluated how much information is needed to successfully recognise simple objects using the vOICe. The level of recognition was more precise than simulations for retinal implants. </p>
<p>In the future the two could be used in partnership – The vOICe and a retinal implant – with each device no doubt better for specific tasks. But in terms of performance, we think that sensory substitution devices currently perform better. </p>
<h2>Why it works</h2>
<p>Train people on these devices and the story becomes even more remarkable. Due to the plasticity of the brain, areas of the cortex – usually thought of as “visual” part of the brain – <a href="http://www.nature.com/neuro/journal/v10/n6/full/nn1912.html">show activation</a> in <a href="http://www.ncbi.nlm.nih.gov/pubmed/16581983">users of sensory substitution devices</a>. This is fascinating as it implies that rather than processing information specific to a sense/or sensory system, areas of the cortex are in fact processing information <a href="http://booksandjournals.brillonline.com/content/journals/10.1163/22134808-00002462">specific to the task</a>. </p>
<p>This applies to all of us, not just those with visual impairment. But it is with visual impairment where it is most applied of course. An increasing understanding of how the brain processes perceptual information, facilitated by studies using sensory substitution devices, is allowing the development of more effective training and new algorithms to provide further information <a href="http://www.ncbi.nlm.nih.gov/pubmed/24398719">such as colour and depth</a>. </p>
<p>While full visual restoration is some distance away, the advancements in invasive and non-invasive rehabilitation techniques signal a positive future for increasing inclusiveness and accessibility for the visually impaired population through simple technology. And if you want to try the vOICe for free, <a href="http://www.seeingwithsound.com/">click here</a>.</p><img src="https://counter.theconversation.com/content/35936/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dave Brown receives funding from EPSRC</span></em></p><p class="fine-print"><em><span>Michael Proulx receives funding from EPSRC</span></em></p>We live in a visual world and build environments that rely heavily on visual perception. Want to find somewhere? You look on a map or read a road sign. Perhaps the GPS on your touch screen smartphone can…Dave Brown, Research Associate , University of BathMichael J. Proulx, Senior Lecturer in Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.