>> Hello, my name is Emma Smith and I'm an occupational therapist working at the University of British Columbia. Today we will be discussing mobile device integration for manual and powered wheelchair users.
>> We will chat creek we about the learning outcomes we wish to achieve today. The first one, by the end of today we want to be able to describe three consideration for assessing degree Schnitzer wheelchair users. Also, I would like you to get to the point where he can describe three options for mounting mobile devices to either manual or powered wheelchairs. Finally, last two options for device integration with on the market powered wheelchair electronics packages.
>> To begin with, we really want to consider the capabilities of mobile technology in the kinds of things that mobile technology is able to do. Personal, like all of us have the experience, we can do everyday computing that would be things like checking your email, your social media, a be sending a text message or two. Everything we want to be able to do is communication. This might be for some of our clients have difficulties with medication because of a certain condition. We are looking at augmentative and alternative communication devices in speech generating devices. Our mobile technology is able to do that. One exciting thing that mobile technology connector is environmental control. We have a lot of options on the market now for controlling things like lights, fans, locks on your door. Even a slow cooker. We have lots of options for environmental control. Then, we have health monitoring for things like your blood pressure, pulse, and that type of thing can be controlled through your mobile technology.
>> When we think about how we actually use the technology, we think about access options. There's a variety of ways that we access our devices. Primarily, right now are devices are accessed through [ Indiscernible ]. We touched the thing on the screen that we want to activate and that allows us to use the device. That does not work for everyone. There are some alternatives. One of those alternatives is assistive touch where we can touch the device, but we have to do it in an alternative way. We may use a peripheral stylus. We could use a mouse or keyboard, particularly on android and Apple devices for keyboard. We cannot see his voice. Many of you might be familiar with Syria on Apple devices and Google which allows to interact with mobile devices using our voice and speech. We also have the option to use switches. This looks different on Apple devices versus android devices. But this axis is an option now. Something we want to consider for clients who may not have the capability to use that touch device or the specific pitch use of the interface.
>> When we look at this, we are looking for more typical to less typical. It gets more complex as we go along the spectrum from touch through to switch access. When we think about direct taxes, we're thinking about access to the device in the way that it was intended to be used. This is the way it was designed for use and when we are thinking about touch interfaces, direct access is the way it was intended to be used.
>> Will we think about Apple, that is touch only. They intended these devices to be used with your finger touching or with a stylus. On android devices, it was decided that. They've given us the option for mouse use as well. That also counts as direct access. We have multiple options when we consider how we are going to use touch. The first, if for not using a finger, would be a an assistive device. It might be a stylus. You can get them cheaply, pretty much anywhere. There are some which are more complex than others which allow us a little more option. Both assistive device like a stylus would be a great start. If the person has problems targeting, sometimes they can use gloves where they cut out of tip in the finger and it allows the head to interact with the fingertip that's been cut away from the glove. We may also use third-party keyboard which would be connected through Bluetooth setting. There are a lot of settings we can use in the interfaces which allow us to change how the key point interacts with the device. We also have the capability to use touch accommodations on Apple devices or on the IOS software. Touch accommodations allows to modify how the device response to touch, which allows the person to use the device in an alternative way. IOS and Apple also has assistive touch. This is another setting where we are able to modify how the device response of these is touch to allow them to interact with the device and the way they are able to.
>> We can all see his peripherals. We can use a mouse on android devices in the can be either wired through a download or can be wireless through a Bluetooth connection. On both Apple and android devices, we can use a keyboard. There are lots of keyboards available on the market which connect via Bluetooth or, if you have a new Apple device, you can potentially be using a smart keyboard which connects through a hard connection. There are multiple ways we can use keyboards as well. I think it is worth mentioning here that for peripheral devices, for some of our crazy music a computer for years, the mouse or keyboard that they are accustomed to using, can be connected to Apple or android device through a simple interface. Their Bluetooth interfaces which allows to use an interface through mouse or keyboard to something they are accustomed to. Or, we could give a wired in for  interface through an android device. Apple at the moment, does not allow us to do so.
>> One other way that we can access our devices through proportional mouse simulations. This is specific to android or Windows devices. It actually allows us to use our personal joystick on a shared to emulate mouse use on my device. Unfortunately, it is not available on Apple devices but if you have clients using android this is an option. What it means is we have the potential to use the proportional joystick that's already on the wheelchair or a head array which someone is accustomed to using for driving for 360° of mouse simulation. This offers much more controls than switch action might, if that's the direction you are thinking going. But it does require fine fine motor movement.
>> If they are able to drive with the device, they are probably able to use that device for mouse simulation. It's proof noting and considering for your client as you go through the process of assessment.
>> We also have the possibility of using digital mouse simulation. This is where someone might be using multiple switches to drive the chair, but we can connect that to the mouse cursor and use those switches to drive the mouse cursor around the screen. We don't have the full degree of 360 control so it has to be used specifically with forward, backward, side to side but it can be used for switched had a race. This which is currently being use or for [ Indiscernible ] drivers. It doesn't necessarily require the use of a separate switch, which is connected to the device. Again, this is only available on android or Windows devices and, unfortunately and not on Apple devices. We talk about switch access, we can talk more about what the Apple can use.
>> I mentioned voice access earlier. One way we can interact with the devices to force access. It does require the use of a clear speaking voice. Similar to any other force access system that someone might use. In terms of our operating system, voice option, I'm going to talk with the three major players here. IOS uses SIRI. It  often sets up automatically when you ask it to respond. Android uses Google and it has similar functions where we can ask it to restart automatically when it says  when we say eight target keyword. We have options for voice access across the three major players when it comes to mobile devices. These are limited but they do provide is excellent access to the device. For a lot of our clients, they end up using multiple access options. Maybe, they are using voice something, but they're using a switch or mouse for other things because it is best for them in the moment. Or, maybe they use voice only for dictation because typed on the keyboard is a pain but these and mouse for navigating their device.
>> There are also app specific voice options. Like Dragon naturally speaking, available voice recognition allows us to export to mail or text in order to get the words you need in terms of dictation.
>> There are limitations to voice access. The biggest one is that most voice access requires Internet access. You have to be in a wireless enabled some.
>> Considering such access as a next step down our line around alternative access, we can control our entire device is one more switches. These can be anywhere from button to a lever, a proximity our movements which or another sensor that the client might be accustomed to using or something you assess abilities. There are a variety of switches that can be connected. They need to be connected through the use of an interface. A switch cannot put directly into an  a device. It has to tax or an interface. That's an intermediate device. What you see on the screen now is a switch and a race device and a tablet. That switch tax through the interface device that turns into signal that can be understood by the tablet and the tablet pen can take that switch input. These interface devices can be done in a variety of ways, whether it is a wired interface device or wireless interface device. When we're looking at interfaces, those wireless ones that are available are things like the Internet Bluetooth switch or Bluetooth enabled wireless devices. These are great for some reasons, but they have their drawbacks.
>> One of the great things that you can continue to charge the device while you are using switch because it doesn't occupy your charging port. On the slip flipside, the device does not require batteries are charging. Is an issue there somebody needs to chart just another thing at the end of the day. Furthermore, if the use their battery or charge during the day, it means they lose access to their device. It's always a point for concern. The other thing for consideration is that with the Bluetooth devices, they do have the potential  potential to lose their parent. That was true of earlier devices, but it still a possibility that you could loose their pairing.
>> In terms of wired devices, we are looking at Perera L, setbacks or. These devices don't require charging. They also take off your charging port. There are now devices which allow you to do a church through that you can charge through the device into your mobile device. One of the great things is they don't have challenges with pairings. That means your client is unlikely to lose their pairing throughout the course of the day, meaning they will continue to have access to their device. Some clients are not too keen on these because they don't like the eye do you of being wired to their mobile device, but it is an option for a client who does not have assistance throughout the day if something should go wrong.
>> I will speak a little about the iOS switch control. This is the software available on all Apple devices which are newly purchased. It has been placed since I last time. For those of you who have clients who are working with older devices, since iOS 7, it might not be as advanced as iOS 10. We can either do a Bluetooth or wired switch. We also have the option of doing I had switch or full-screen switch. The head switch response to movements which are left or right movements of the head. But I have found that it is terribly reliable. I don't recommend using a.
>> The full-screen option is interesting because it can be used for several purposes. I use it for training so I don't need to connect switch. I can just program the full-screen to be that switch and I can provide some training on how switch access works. It can also be useful for a client who might be able to target the phone and tablet in general but is not actual  actually able to target a specific area of the screen. You can use the full-screen switch to get access to the device with a nonspecific target of the screen. Any time they had the screen, that would activate the switch. All of the controls and iOS are programmable for the main menu. There are many programmable options. You are able to use either roll call and scanning or point scanning which is like Christ scanning if you're familiar with that on a piece of the system where you can pinpoint a specific spot on the screen.
>> Switch control can be used with or without voiceover, so you may be able to get voiceover for someone who has visual impairment to work with your switch control. But there is also the option for audio feedback, which is different from voiceover. If you have someone that has a bit of our new feedback, that can be available through the signs. There is also adjustments for speed, the whole length of the switch, how often the switch will activate when you repeat in the short period of time, and release time required before it activates. Those are just some of the adjustments but there are many adjustments available through iOS switch control. At the very powerful system, which means it's complex when you begin 20, but over time, as you learn more about the system, the complexity action turns into potential.
>> Android switch access has been integrated since lollipop 5.0 .2 from most new android devices devices should have switch access. It provides accessibility and your settings. But it's limited. Can get more action if he had to switches. They are making improvements consistently. You the better access overtime. Rain now, it's not quite as powerful as the iOS switch system is. When we think about Windows surface tablets, [ Indiscernible ] looks different. It looks like it in a PC. You would get use the excess, had my. Or Swifty. We can also get PC-based software to think through Gregor or cross trainer. They can be put into a Windows surface tablet. All of a sudden, you have alternative options that you might not have had on that Apple device.
>> Of course, once you get the switch access or whatever, we have to consider how it's going to work with our life. Not everybody who needs switch access uses a wheelchair, but many or most of..Many who uses such access uses a powered wheelchair, but some do. We have to consider how it's hard to work with a wheelchair and with the devices they are already using.
>> There are a lot of considerations when we are integrating direct access. If there is an touch, it's all about location. If you have worked with individuals who have limited access in terms of physical capacity, even a small change can make a huge difference to whether someone is able to access their device. I recommend making sure that you do as much assessment as possible, checking a variety of different locations for the vice, distance from the body as well assistance from the center of the body. Even angle of the device both top to bottom and side to side, can make a huge difference as to how they are able to access it. Once you have found that precise location, I really recommend that you like it down as much as possible to make sure they continue to excess. Of course, if your client has good motor skills, then you might be able to give them a little bit more play and maybe they are able to access the device and change the position themselves based on what's comfortable. It depends on your client. If you are going to use the mouse, you really need to think about things like how are you going to mount the mouse and whether you're going to use joystick integration instead of mousing. There are other considerations about must use that you I think that in addition to the actual mounting of the device. If they are using a keyboard, the first thing you want to consider is onscreen keyboard is because it is the easiest and requires the least hardware. If they are going to use a standard keyboard, then mounting it becomes a consideration that you need to think about. So, you want to think about where the keyboard is going to go for the best access and how it is going to interact with them in their daily life. Are they going to be able to get in and out of their wheelchair crankset will they be of the move out of their environment with the keyboard in place. If they are not, how are they going to get to keep their to the one they need. Will they be able to move independently. If they are using at keyboard, alternative text and parts. Apple has said text expansion. You might want to think about this as you work to make sure that they don't have to type just as many letters. Maybe they have to only type in three letters to say Hello, how are you today , instead of having to type out the entire sentence. You can program it to say HHY  and that would turn into Hello, how are you as soon as a  press the space key. This can make it easier our clients and ourselves by programming with the devices capabilities already.
>> When we are thinking about mouse simulation, this is about Bluetooth connection from the joystick to the device. Were talking about powered wheelchairs specifically. This is a great option. There are multiple ways that we can get the mouse to click using the joystick. So joystick also point down to make [ Indiscernible ] programmable through the joystick programming at where. [ Indiscernible ] specific nudges in certain directions. We can add a switches or use built-in switches for mouse clicks. We also have the option of using a [ Indiscernible ] a software. If we get the mouse to that target on the screen, it will actually click for them once they have hovered over it for some period of time. Multiple options to consider and certainly it does make mouse use easier with these devices.
>> If you are integrating voice access, there are other considerations. We need to consider the speaker and microphone needs. How far is the speaker with them?  Are they going to be able to access it?  Is the speaker only going to pick up their voice, microphone  or will it pick up the world and the environment around them. That can interact with what is going on around their life.
>> We need to consider how they're going to turn on the voice access. Is it going to be voice activated?  Or you can say pay theory  SIRI  and it will turn on. You had to consider this also pulls a drain on the battery's when they cannot. Do they have, voice apps  access might not be the best access. You might want to consider an option. You might want to [ Indiscernible ].
>> That's why we we can conserve battery giving access to voice. You can also set up other buttons. You can integrate other system so you can have voice access. They become critical. We also consider what we can see in the screen when we think about a. You get really clear voice access but it's not going to be useful for them.
>> That we come to voice access which is more complex and requires more in terms of integration. So when we are thinking about such access, the location of the split as opposed to the device becomes critically important.
>> The switch itself, that has got to be a separate assessment, just assessing with the patch such access is for the person. We really need to think about the type of switches and required movements activate that switch, which is best for the client's capability. The first thing you might want to ask yourself is: other wheelchair controls an option?  If the person is a driver and using a powered wheelchair, can we simply use the wheelchair controls they are are already this season for switch back and train them to use it for second test. If that is not an option, then we have to start looking at external switches. Like you said before, there are lots of external switches on the market, but we need to make sure that it is the best switch for the person she's. We also want to think about other required functions. They need to switch to activate the controls on the chair and you want that to be consistently accessible regardless of they are using the switch access on their mobile device and we have to use switches that don't conflict.
>> You also want to think about their required movements. Do they have appropriate movement to be able to access the switch in the most efficient and effective way?  Or, is a quite attired in throughout the day. Will they have access by the time 6 o'clock rolls around because it had too much during the day. We have to think about the type of switches and their required movements.
>> Another major consideration is line of sight in visual feel. So line of sight is important especially for our drivers. We want to make sure that they have an unobstructed path of sight while they're driving and that they are not going to bump into things because they are template or phone is in the way of an obstacle that they cannot see. It's very important to consider line of sight as we go through things. There are lots of ways that we can get to that and get around it which I will talk to about as we go through we also want to think about the axis to enforce. If you consider that this person might be using it this speech generating price, this is really their voice in the community. It's great if we can mounted in a particular location that's out of the way and does not need to get in the way of their driving truck today. If that provides them using the voice access their environment, then we have a problem because suddenly we form with their voice. Think about when you think about where to put that switch access.
>> Creek positioning is critical. What a make sure they have access so they can see the screen so we don't have difficulty with their.
>> So, what about mounting?  We know the device needs to be mounted onto their reach. That's good. We just need to think about the options. One of the wonderful things that the new devices in the tablet and phone is it compared to the old devices that they may have been working with, they are lightweight.
>> We have options we would not have had in the past in terms of mounting. The options have bloomed.
>> Have clear screens that have light adjustments so we're not necessarily as concerned about the angle for light. We may have been in the past because the screens are so much clearer than some of the old computer-based systems we're using and they may have just the ambient light. That gives us more options in terms of mounting. We also know that we have multiple mounting options. There are a lot of options available for commercial or off-the-shelf options. Given that we have all these alternatives, that means our job of mounting has become quite a bit easier.
>> The big question is: how to figure out where it goes?  There are so many things to consider. We have to take into account the type of access. If they are using direct access, it needs to be in the right place. You need to be able to access that device with a finger or whatever of the using for direct access. If you're looking vision, how well can you see the screen to target uses switches that they might be using. Do they have access to vision, if not, are they using voice over and are the able to hear the device. You may have to mount a speaker so they can hear it and an environment that has a lot of ambient noise. You want to think about how the person transfers in and out of there wheelchair and how those devices like in the way. Also, how they navigate. If they are doing the transfer and pivoting, can [ Indiscernible ].
>> Maybe the doorway is too narrow. You will have to think about things like access other tables or locations. When you pull up to a table, is the device going to bump into it?  Does that mean they can't edit a table in a ask how can you accommodate for that?  That's important. Or the sink, if they need to pull up to the sink when they go to the washroom. Can they get close enough to that sync.
>> We want to think about the overall footprint of the chair, how much space is the taking up in addition to the rest of the space of the chair takes a. Hausa going to interact with their environment and impact their day-to-day use. We have to think about storage consideration when they are driving or using transportation. For those clients who are not going to drive with their device permanently mounted to their chair, where they going to pull but it?  They may have regulation around these of transportation like public transportation or their personal band. We need to think about that and about where the mound is going to go and whether it is secure, whether it's going to be a hazard when they are using that transportation option. As I mentioned before, line of sight for driving is really important, particularly if it's going to be mounted permanently. We want to make sure they are able to see I had of them.
>> We will go through this type of access. We will start with direct access. Of course, the amount should always be placed in the most useful position. I know that sounds simple, but it does take a lot to consider. Deposition is likely going to be where the user does not fatigued easily. If they have to reach to access it, they will fatigued throughout the day and that will cause on interruption in their use of device. You may consider that the positioning may be modifiable by the user or it can be fixed. It may be that the user has enough motor control that they are able to use mounting system put in place to modify the position of the device based on their use of the day. It may be that for some uses, what position is great, but for another use, another position is needed. A great example for this is for things like watching YouTube videos versus emails. If you're just watching an email, having it mounted in front of you is not terrible and you have good access visually to the device. But if someone is doing email and they have to use on-screen keyboard, having to type all those letters while it is mounted vertically, might not be the best. They have to bring it into horizontal, whether they have a trail or its angled in front of their lap, may give them better access to the keyboard without much fatigued. You want to take about whether they can modify the position of the device and, if so, what the best uses are.
>> You might want to think about a fix device, particularly if the person is very limited direct access and needs targeted position. Then you really want to make sure to let down the position to make sure doesn't could change that the day and impact of access by somebody else who may be well-meaning, but it may cause challenges for your user. Also want to make sure that you are you  your user is accessing all areas of the screen. That means all for cars as well as the center and areas in between. While you are doing assessment, please check for that. Check in your independent position, that they are still able to access all areas of the screen. If they are not, there may be an area they may want to target at some point which they are not able to get to and the lack of access may significant impact their use of the device.
>> The one thing I cannot stress enough is that it needs to be done with a trial. So trial, trial, trial. If you have the opportunity to leave the device and tobacco week later to see how their dirt doing, that your best scenario because then you can make those modifications to make sure the person is able to access their device.
>> 1 inch can make a huge difference. For that matter, I have an inch can make a huge difference, for those
>> This can make the difference between their ability to communicate with the environment or not or inability to control an environment from their home or not. It's important that we get this piece right.
>> When we think about voice access, the amount needs to be place where the user can respond to prompts and reports there. Often, voice access systems require a voice popular screen or see that our voice recognition and have actually been completed in a way that we intended it to be. So then visual PC becomes really important. As I mentioned before, it also needs we close enough for their voice access to be used in a crowded situation. This can become problematic when a person is out about in the community. They may be fine at home with their caregivers or in their office or school environment. But, maybe when they get to a coffee shop or to another event outdoors in the community where there is a lot of ongoing, ambient noise, this may be a problem because voice access may find interruption from competing voices in the environment.
>> Is important to be able to be used in that environment. This is where you might want to consider the use of two axis or two systems. Primary way a person accesses the device that may be your switches to adjust as a backup. If the person is an environment where they are not necessarily able to access the voice, they can actually turn on their switch access and use it as a backup. That was so allow them to use the device in all environments and means that they won't necessarily lose access to the voice or means of controlling the environment just because it is crowded or noisy. You may want to consider that. Of course, that Mark will be taken into consideration when you add switches. You want make sure that will be working well for the user when they need to use it.
>> Now, we get to switch access. Of course, the amount should place a device where the user can see the screen where he could see the prompts. Same thing with voice access. Maybe even more critical in this case. If,  you're using this switch access or iOS, you there will be lots of things going on the screen that they need to respond to. They iOS system access the system is done with a series of maize. You can turn those off for new users who don't need the level of complexity that experience user might need. This menus can help you to do everything that you need to do on the screen. They are responsible for helping you do things like printer drag or highlight. There are lots of things at this menus can do. They can actually speed up or slow down the scanning rate. They can change volume on the controls. So, without access to this menus are being able to see this menus, that becomes problematic. So, consider placing the device where the user can use a screen. If you're working with someone who is visually., It will be different. They will be using voice over. Then, the device E3 this worthy user can hear what's happening on in the system. This can be used with headphones. They can be wired or Bluetooth headphones. That way the user can hear what's going on. And their able to respond to this prompts. You might also use speakers, all those intricate with the environment in a different way. You also want to make sure that the user can reliably access switches. This is potentially problematic for two reasons. One is to make sure the device position to interact with the switch position.. This is especially meaningful to their head. Make sure they are able to use those without interaction from things like turning around if different lots of room. Extra those switch access positions in place and that they don't interfere with the mounting of the device which becomes very critical.
>> We do need to think now about this issue which was brought up but not spoken. Permit versus remote global else.
>> We need to think about what that means for the user in their day-to-day life in their environment. The first thing you want to consider is transferring needs.
>> When they're getting in and out of their wheelchair, how are they transferring Carson they need a solution that meets all their needs. If that person cannot move the device, they will need assistance. That's really important to think about whether during the transfer.
>> So, if you're looking at cancer options, you might consider options like foldaway mouse with a mount will fall to the side of the Wiltshire to get away, sewing way, were swings and placed in get out that my outline or transfer line for the person or entirely removable mount. If you're going to go with removal Pall Mall, you may sure that when it's removed or replaced, that it goes back to that position. There we select down so goes back to the same position. You need to consider] you will be using on the chair.
>> You also want to think about this transportation needs. Remember, these mounts are not crash tested. If you're putting the person into a van or bus, the mountain likely needs to be removed in order for them to be safe while they are driving. The worst-case scenario would be that something might happen like a collision and that device would cause them harm. We need to think about transportation needs and whether we can still it.
>> The user may need to drive without the amount in front of them. With a means is that the user does not have access to the voice when they get to the location, particularly if they are independently driving in their environment and don't have an attendant with them.
>> If they are going to be driving with Dr. device mountain, think about how they are going to get access to that device when they arrive at their location or if they need to get assistance while they are driving.
>> Then, if they are going to drive with the device mounted, then they will have in front of them, the line of sight becomes critically important.
>> I mentioned some of the reasons why we have concerns about removal of model. I want you to remember that removable mounts does not promote independence in the community, especially for those users who have limited motor capacity. The second we remove on and place it in the backpack, they don't have access to the backpack and mount the device themselves, they lose their independence in the community because they may lose their divorce or environment to control. This is the primary consideration for why we might mounted device permanently versus a removable mount. If they are going to mount permanently, we need to think about a few things. We need to think about whether the user can see around the device to where it is mounted. So, when it is for them, does it take out the full field of you that they have?  Or is it only taking a part of it?  Do have enough more control and their conquered upper body to actually move around the mount to see where they're going. One way this can be addressed with some devices is tantamount that allows him to go to position where you are only seeing the near side of the device as opposed to full screen.
>> You can use police or a tie for them to put back.
>> Often, they can see this and they can lose their points by. Do you have strategies to address your blind spot, if not, what cues can you provide. You need to think about the strategies to address those blind spots. Is it okay to have a blind spot, we have some to drive our vehicles, but we have strategies to see around mirrors. Insights, can they make sure that they are looking around it. Something that help our mirrors. We can also use great things that into most of our mobile device now. It a rear facing camera. These face the front of the user. That face our. We can actually bring up the camera on their device, use the rear facing camera so looks out beyond the device and it provides a window to the world behind the device. She used for facing the rear facing cameras is an option. In these cases you have to make sure the device has enough power and you may need to consider how it's going to power the device if you loose  they lose their access to power.
>> There are a number of options in terms of mounts on the market. If you are a user who is not going to necessarily use a wheelchair or if they have a tray on the Wiltshire, you might consider tabletop mounting. There are action Systems which allow you to act on the position of the chair table or prevent them let looking around while the users that. There are also steps that can be used that tend to be less stable. Some of you may have seen the big mounts which are usually targeted to the actual size of your device. Popular device into the back in a provides a nice stable service in excess for the device. There are Mounts on the side of the table or the dashboard tray. The clamp on and allow you access to that device. These are not necessarily the most wrong bust if your client has high tone. But the tabletop mounting options are typically cheaper and more readily available. They can be ordered off of online services so they are easily accessed. If their high tone and present device, they will be the best option because they will not be the most stable.
>> We also have a variety of commercial nonmodifiable mounting options. A great example is mountain mover from [ Indiscernible ]. It allows us to give a very precise location of the device and I will say that they are not terribly cheap so it is worth considering. Deposition of the device is a change in the case the solid mountain base and structure for it. It also amounts to the wheelchair. An option like the mountain mover or whatever option you are looking at in terms of a nonmodifiable commercial option is available.
>> There are also devices from a company called Toy factory. You'll see in these pictures, these are clamp on devices that allow you to clamp down to a tube on the side of the wheelchair. They allow you to do a precise lot down position of the device. They are a little cheaper, which is really great, but they don't necessarily come with the same capability for making adjustments that you might want to do for locking down the device. The user will be able to change the position or someone in their environment may be able to change them. But they are an option and certainly available.
>> Daisy makes a number of mounts, whether it's at four mounted system, on a roller, or tabletop mount system. But also, there wheelchair bracket. These are just a little bit more commercial   custom commercial option. That device can be mounted in a incredibly precise location. They also have removable swing away and foldable options. Some things like a modifiable mount might be an option for the user that needs a custom solution, but you want to pull something off the shelf or that is commercially available.
>> The last one I will talk about in terms of these modifiable mounting options is some three had that. The cost of these very because they are custom devices but they are done through a commercial entity. The nice thing about the readapt that they have a variety of heavy versus lightweight devices. You can get something that's less bulky whereas, if you need something more robust because you are using heavy device, then you might look to something that has a little thicker tubes and more strength in its pieces.
>> They have permanent detention so the wheelchair which are helpful because they make sure to help the device is mounted in the same place if it's a removable device. I Daisy, they offer for stamps and tabletop mounts. What's really cool about the re-at is they offer assessment kit so they can  you can purchase in assessing That has all of the pieces you need to set up a mount and then get that mount shipped directly to you once you know exactly what you need and the pieces are ready to go.
>> We also have a new option called their virtual mounting solution where you actually position the device we needed to be, take some pictures, and additional information and is signed at those pictures and information to readapt and they send you a customized mount basin images and measurements. This is a great way that you can actually, using your own mobile device, you can set up a mount system for client, make sure it's exactly in the place he needed to me without having that assessment kit or caring pieces with all the time, and then send it away but that mount built for you.
>> The virtual mounting solution, a really cool option that's available from readapt now.
>> Now we need to think about wheelchair integrations. I've talked about this already but I want to talk about it more. We have a couple options. Bluetooth simulator is. That's an option in Windows, and I can be is was a Bluetooth mouse  mouse. We can turn our joystick or had away into switches which can be used on android or Windows or switch to a switch device. You can also use and android wired switch so does have to come through the wheelchair allocates. We could set up a separate hardwired switch system for our users.
>> Each of our manufacturers have their own option now. [ Indiscernible ] has a Bluetooth I device module which can be built into the Arnett devices through joystick. It allows you to do all that Bluetooth control with any of your mobile devices. There is a relatively simple process of setting up that switch and getting everything going. Once it is set up, it will consistently. To the same device. [ Indiscernible - audio cutting out ] you get everything moving and when that person next to their device, then they are able to access it through their tracks. And you are able to make sure they have all the pieces they need without adding any extra wires or any other pieces to their wheelchair.
>> Quantum also has devices through their key logic three. There is an integrated switch MSS is here where you're able to do a simple setup on your mobile device, could switch access and then move forward with it. That will consistently pair with your device as you set up your wheelchair each day. With a consistent pattern, he had to go into a new mode access to Bluetooth system. One great thing about both of these and the I will take quite as well, it disables the capacity while using the device. If only car manufacturers would do that we wouldn't have so many issues with driving and texting.
>> Sunrise, we can access their device in similar ways. They have an alternative which is switching to a head array. It allows full proportional control of a Bluetooth now  mount. These are worth considering for the clients who are working with.
>> I will say and remind you that sunrise this offer a Bluetooth mouse through their actual electronics as well. It's not limited to the head array. You can also use the joystick or any other alternative for emulation of the mouse or switch access. Finally, I would like to take you through just a few ideas of case studies. How might this get integrated into everyday work and work with the clients?  The first case society I will percent is someone who had cerebral palsy. She had a lot of extraneous movement. She had some control of her hand if she was positioned well. That was important. She had to be positioned well in her chair. Her tone an extra movement made it difficult to access that device. She was concerned with and a lot of teens are concerned with was that she be as normal as possible, so should not look like she was different to her peers and that she is actually able to use the same devices that her peers reason. What was great was that we had multiple options for switch sites. Because of the CP she had difficulty with her voice and speech. We were looking at switch access having multiple switch sites made a big difference pictures using her device as a communication device. She often had interest in control of your music, camera, communication and Facebook. One thing we had to think about was what kind of device will we use here?  In her case, we decided to go through an Apple device. She has great switch options and access to switches on the Apple device is so robust. We had all of the capacity to make all of the decisions we need to make about her switch access. In this case, we set up an Apple switch device. We did not necessarily need to monitor because she had good range in her neck. It did not need to be mounted aside. We were able to mount a slightly after the sides that we didn't have the same difficultly with - issues driving. We mounted the switches and areas convenient to her to ensure she would be positioned well throughout the day. Because she had multiple switch sides, we were able to set up to switches to do scanning and that allowed her more control over her device. Jesse had the capacity to switch to cross scanning if necessary perch was able to control every aspect of her device through those to switches and through that process appears like we had to be careful about where they were meant to to make sure that if there were an eternal movement, they did not hit the switch accidentally.
>> The second case study offers an adult who had 3/4 cup quadriplegia. There is very little in terms of such access in the terms of the rest of his body. They did have such access site to the left and right of his head. We discussed the potential of using sip and pass as an option for his device using switch access. He wasn't interested in using his device through his driving method. You did not want another thing that he was doing through [ Indiscernible ] and path. He did want that strong away. He had four days full and complete voice control. He had more options. Is cognitively intact.'s technician was excellent which meant we could deal with the complexities. He wanted access to email, his calendar, browser. Was apparently, he was working with a Mac on a day-to-day basis which he wanted to integrate well with his computer. This was a great candidate for an Apple or iOS device. Because of the way he integrated with his NAC, we were able to do more with the Apple. We were able to set up a combination of such access and voice input/output. He uses access site for some things and that he uses force access for others. If there was something that cannot be done through voice access in a particular if, use the switch accesses the left and right side of his heads.
>> Mounting was really important in terms of the decision to position we mounted it in. We did have to put it in line of sight, but because he was cognitively well, is able to navigate those blind spots if he knew to. Unfortunately, because of his physical capacity, he wasn't able to stow his device independently so he did not need help.
>> Our third case study is a teen with muscular dystrophy. He had limited strength. He was very cognitively well. Most of the challenges were motor. He used a macro trace   joystick to drive. He is interested in computer programming. We elected in this case to go with an android device. Because they allow you more customization in terms of the device as a whole, more importantly, because of that micro joystick driving, a man a lot of sense for him to use it a joystick to control his device as well. He was able to use that joystick with the mouse ambulated to control his device and Kate control  full access to that device. Great access to him and to control everything he needed to control and because he was using a smaller device, using phone, his line of sight wasn't much of an issue. We were able to do  mounted to the front of his chair. It depends on the device needs for the person what their preferences are. And in this case, that is what were best for him.
>> There are a number of resources which you may want to consider when you are looking at what is out there and access to all of these devices and such access in general. The first is [ Indiscernible ] provides a great set of resources from on the iOS switch access I. They have resources which have done well and keeping him today. Their online systems provide a lot of potential. We can go on and look at those [ Indiscernible ] iOS guides. I've also used in Iowa switch guide which you can find in my website if you're interested. I haven't been able to keep it up-to-date, but it provides a little bit of a different cut Mack and what it looks like.
>> Hands-free is an iBook which is available. He's actually a switch user in Australia who developed this iBook in collaboration with a clinician he has been working with. They produce this iBook for free. It's worth downloading if you are an iOS user. You can look them up online. Hands free is a great book
>> RJ Cooper, their website has a lot of as well. You can use them both on iOS and android. Consider their website for additional information. Then you tube videos and a great source of any excess questions you may have. Lots of people have done screen recordings. You can check out understood how to get access to these devices or even mounting systems. You can look up YouTube videos. Lots of available options in terms of resources. You can get in touch with the people who develop those resources. Most people are willing to share what they now and help out with some of those tasks.
>> I have put my contact information here. You're free to email me or contact me with difficulties or questions you may have. I will be happy to answer them moving forward. I hope that we were able to accomplish those objectives for today and that you learned a lot about what works and what you might want to consider when doing switch access integration or mobile device integration with wheelchairs. I look forward to speaking with you soon.
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