My wife Allison has primary progressive multiple sclerosis,which has made her quadriplegic, that is, without use of her limbs. In 2007 she had to spend many hours a day in bed, where there was basically nothing to do. Allison missed her computer.
My mission was to assemble a system that would let Allison perform the following instrumental activities of daily living while either in bed or seated in her wheelchair, with minimal or no assistance:
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Use of a personal computer with access both to the Internet and to a local network.
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Methods of providing input to the computer:
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A mouse replacement.
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Keyboard replacements.
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To place and receive telephone calls without operator assistance.
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To read electronic documents.
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To compose text.
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To send and receive e-mail.
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To make purchases and payments and to perform other financial transactions over the World Wide Web.
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To plan menus.
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To print documents.
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To download and use available software.
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To use the World Wide Web, including performing searches and writing her own Web pages.
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To select and view television programs and listen to radio.
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To play and record DVDs and CDs.
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Rudimentary environmental controls, specifically the ability to turn certain house lighting on or off.
Allison’s computer is a refurbished Apple Power Mac tower (part number F9748LL/A1) with dual 2.3GHz G5 PowerPC CPUs, running the latest versions available to us of the Mac OS X operating system (10.5.7 as of this writing). We buy Internet and cable television access from Time Warner Cable.
Seated atop her monitor, Allison’s
head-tracker mouse is the NaturalPoint
SmartNav3 AT,which
replaces the usual hand-operated mouse by emitting a beam of infared
light and converting the reflections bounced off a dot she wears on her
forehead into cursor movements and mouse-button presses via its own
software. Thus does the SmartNav track her head movements. Clicking is
triggered by dwelling,that is, by keeping the on-screen cursor
stationary for a user-specified number of seconds.
Instead of pressing keys on
a manual keyboard in order to enter text, Allison selects her input via
the head-tracker mouse from an on-screen keyboard.
Allison’s on-screen keyboard is AssistiveWare’s KeyStrokes
3.6.KeyStrokes provides not only a “hunt-and-peck”
interface to individual letters, but also a choice among some proposed
word completions that it provides in real time, based on what Allison
has typed so far.
Allison’s monitor is a Samsung SyncMaster 2253BW22-inch LCD monitor with a 1680 x 1050 resolution. She judged this to be the largest monitor whose surface she could comfortably traverse with her head-tracker mouse.
A microphone enables Allison to dictate to word-processing software and speak commands to the operating system as an alternative to typing on the on-screen keyboard. The microphone she uses is the DVForge MacMice MicFlex USB desktop microphone, one of the models approved for use with MacSpeech’s iListen, her speech-recognition software.
Allison employs the same microphone to place and receive
telephone calls using Vonage’s Voice Over IP (VoIP) router and
X-PRO-Vonage 2.0 software.
E-mail is possible because of the combination of the Internet connection, Mac OS X’s Mail application program, and alternative input methods.
Allison has cooking software to collect recipes, plan menus and make a shopping list. She can order groceries online from Lowes Foodsand have them delivered.
Allison can send print jobs either to her Hewlett Packard i860 color inkjet printer or to my Brother HL-1670N laser printer.
A dedicated cable converter box from Time Warner provides a TV signal. Allison uses the Elgato EyeTV 250 Plustelevision tuner and the EyeTV 3 software to select channels and record programs and also to control the IRTrans USBdevice, which functions as a remote control for the cable box.
My approach, given a modest budget, was to use Allison’s existing system and buy only that equipment needed to make it portable and usable whilst seated in a wheelchair or reclining in bed.
We had set up Allison’s system in a fixed location
and could have moved it only with heroic effort. Better would be to
mount the system in a standard equipment
racklike those used in telecommunications applications and
in computer server rooms. Portable and rugged racks with a cabinet
enclosure and casters are also widely used by the musicians and DJs
who travel with a substantial load of computer equipment.
Sound Construction & Supplysells several sizes of the Isobox Post sound isolation box,a temperature-controlled, acoustically insulated, enclosed mobile rack, used in recording studios. Not wanting to be caught short on capacity, we chose the largest size (hence the name “Big Rig”), the Isobox Post 24‑45, measuring 24" wide, 45" deep, and 42" (24 rack units) high, with the G5 rackmount sliding tray system.This model reduces noise by about 30db, has shock-mount rails and 3.25" heavy duty casters.
None of the components of the existing system came with rack-mount hardware, but they could be secured to shelves or to the sides of the rack by a combination of bolts, screws, clamps, wire ties, adhesives and Superlock/Dual Lockor Velcro.
Since the G5 would now be enclosed in a soundproof box, Allison needed a separate speaker, for which I chose the Zvox Mini single-cabinet surround sound system and it placed atop the rack case.
Since no Ethernet port was available near the bed, Allison also needed wireless access to the router, provided by the D-Link DBT-120Wireless Bluetooth 2.0 USB Adapter. For overcoming hangs and freezes and performing occasional system maintenance, I added a wireless keyboard and mouse.
The display unit contains the devices that Allison operates and that provide her with feedback, namely the mouse replacement, microphone and display.
For Allison to be able to view the display and use the attached head-tracker mouse while in bed, she needs the display to be positioned at bedside. An aide must be able to tilt the display upward, downward or sideways, left or right, to bring it closer or move it away. Mack Bailey Enterprisessells a product called the Boom Arm Starbase Workstationwith a 26-inch-diameter, weighted five-point rolling base and a boom arm adjustable for angle, length, rotation and height. When attached to the Heavy Duty VESA LCD Monitor Mount, the boom arm can support a monitor of up to 22 pounds.
Because at first we had a monitor exceeding 22 pounds, and because we were extending the monitor so far over the bed, we ordered the Boom Arm Starbase Workstation without the usual 30 pounds of counterweight. The stand uses standard Olympic weight discs, which I obtained locally, eventually settling on 100 pounds as a weight that prevented any tipping during movement.
The microphone is mounted on a Magic Armfrom R.J. Cooper, which is a modified Bogen/Manfrotto photographic boom arm attached to the Starbase’s boom arm.
Although we were unable to afford replacing the G5 tower with a 2.66GHz Quad-Core Intel Xeon Macintosh (Nehalem), we did have enough American Express Membership Reward points (115,600) to get an Apple Mac Mini (part number MB463LL/A, retailing at $600) with an 64-bit Intel Core 2 Duo CPU, 1GB RAM (expandable to 4GB), a 120GB hard drive, DVD burner, NVIDIA GeForce 9400M graphics processor, and support for FireWire 800, USB 2.0, Gigabit Ethernet and 802.11n wireless LAN. We intend to run Mac OS X 10.6 (Snow Leopard) on the Mac Mini.
While we do still intend to do the upgrade to the Nehalem when we are able, the Mac Mini allows some immediate improvements in usability, namely:
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Allison will be able to install MacSpeech Dictate, the successor to the now-unsupported iListen product. Dictate, based on the acclaimed Dragon Dictate, requires an Intel processor.
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Allison will be able to use Netflixto stream movies over the Internet to Allison’s machine. We already have a Netflix account that allows us to watch DVDs physically mailed to our home, but to stream content required a Mac with an Intel processor.
To ensure no loss of function during the upgrade, we decided to leave the G5 tower in place and use a KVM switch to switch between the G5 and the new Mac Mini. Thus, if there is any problem with the new system, the old one is still immediately available.
Not just any old KVM switch
would do; Allison must be able to operate the switch herself. Although
most KVM switches now allow switching to be triggered by pressing one
or more hot-keys, it was not clear that hot-key keypresses generated by
KeyStrokes—or any on-screen keyboard—would activate the KVM switch. We
opted for the Gefen
EXT-DVIKVM-241SL,a two-port KVM switch that allows
switching of a single DVI display, two USB 2.0 devices and audio output
between two computers. The Gefen KVM switch also allows switching to be
triggered via an infared signal. Allison already has an IRTrans remote
control replacement that can be trained to emit the signals that will
cause the Gefen unit to switch.
There remains one “killer app” that Allison requires and that in turn requires Classic support: the MasterCook menu-planning software. The most recent version of Mac OS X that will run Classic applications is Tiger. Since Allison has Tiger installed (in addition to Leopard) on her G5, she can still run Classic and thus MasterCook.
- Activities of daily living/Instrumental activities of daily living
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“Activities of daily living are activities related to personal care and include bathing or showering, dressing, getting in or out of bed or a chair, using the toilet, and eating.…” —National Center for Health Statistics
“Instrumental activities of daily living are activities related to independent living and include preparing meals, managing money, shopping for groceries or personal items, performing light or heavy housework, and using a telephone.…” —National Center for Health Statistics
- Dwelling
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When using a head-tracker mouse, keeping the on-screen cursor stationary for a user-specified number of seconds in order to simulate some special action, usually the pressing of a mouse button.
- Head-tracker mouse (also known as a “head mouse” or “hands-free mouse”)
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A device that replaces the more common hand-operated “mouse” input device whose movements are used to position an on-screen pointer and whose button-clicks are associated with selection or other action to be performed on the object indicated by that pointer.
When the user’s hands cannot be used to operate a mouse, a mouse replacement allows the computer to translate voluntary/deliberate movements of some other part of the body to control the positioning of the on-screen pointer and the selection of actions to be performed on the object pointed to.
In Allison’s case, movements and clicks of hand and mouse were replaced by head movements and “dwelling”, tracked by the movements of a beam of infared light bounced off a reflective dot stuck on her forehead.
- On-screen keyboard
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A representation of a computer keyboard, presented as an image on a monitor screen, whose “keys” can be selected by the action of a mouse or mouse replacement to simulate keypresses performed on an actual keyboard.
- KVM switch
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A hardware device that enables the connections of a single keyboard, video monitor and mouse (hence the acronym KVM) to be switched from one computer to another.
- Primary progressive multiple sclerosis
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A chronic, progressive illness that affects the central nervous system. Primary progressive MS exhibits a gradual progression rather than the attacks and remissions of the more common relapsing/remitting form of MS.
- Quadriplegic
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“One affected with paralysis of both arms and both legs.” —Merriam-Webster’s Collegiate Dictionary, Eleventh Edition
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