Photo: Stanford University/Nature MedicineA paralyzed ALS patient uses a brain implant to steer a computer cursor to various targets.
Typing six words per minute may not sound very impressive. But for paralyzed people typing via a brain-computer interface (BCI), it’s a new world record. To pull off this feat, two paralyzed people used prosthetics implanted in their brains to control computer cursors with unprecedented accuracy and speed. The experiment, reported today in Nature Medicine, was the latest from a team testing a neural system called BrainGate2. While this implant is only approved for experiments right now, researchers say this demonstration proves that such technology can be truly useful to quadriplegics, and points the way toward regular at-home use. The two people who volunteered for this study have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, a degenerative neural disorder that leads to complete paralysis. Lead researcher Jaimie Henderson, co-director of Stanford’s Neural Prosthetics Translational Lab, calls it a “humbling experience” to work with quadriplegic patients who willingly undergo brain surgery and devote themselves to science experiments that will push forward this early-stage technology. “They’vebecome true partners with us in this endeavor,” Henderson says. The BrainGate2 system consists of an array of minuscule electrodes implanted, in this case, in a region of the motor cortex known as the “hand knob.” The electrodes record the patterns of electrical activity in the neurons there, which fire when the person either moves or imagines moving their hand. The BrainGate2 system also includes decoding software, which turns a messy signal into a clear command for an external device—in this case, a computer cursor. Other experiments have used BCIs to control robotic arms, and they could theoretically be used to control wheelchairs, cars, or anything else that can be moved by remote control. In this study’s first task, the participants repeatedly moved their cursors to targets on a computer screen (see video below), which they accomplished by imagining their index fingers moving on computer trackpads. They each averaged about 2.5 seconds per target. This is a significant improvement over a previous BrainGate2 trial, in which a different patient performed the same task but averaged 8.5 seconds per target.
The improvement, Henderson says, came from four factors. 1) The system architecture provided faster processing than before. With a lag time of only about 20 milliseconds between the user’s thought and the cursor’s action, the participants got useful feedback while doing the task. 2) Signal processing filters carefully extracted the neural signals from the ambient electromagnetic noise—a necessity, as these experiments were conducted in the volunteers’ homes. 3) The imagined motion that the participants ultimately used to control the cursor (an index finger moving on a trackpad) provided a clearer neural signal than other imagined motions they tried out (whole arm and wrist movements). 4) Perhaps most importantly, an improved decoding algorithm was better able to translate neural signals into intended movements. Essentially, it was better able to identify the direction the user intended to steer the cursor, and could therefore correct for deviations in the neural signal that would have otherwise steered the cursor off track. But what about the typing, you ask? For that task, the participants used the same imagined finger movement to pick out letters in a text-entering program called Dasher. With this interface, once the user selects a letter, the program predicts which letters are likely to come next and makes them easier to select, speeding up the construction of words.
One of the participants typed 115 words in 19 minutes, or about 6 words per minute. That user had previous experience with the Dasher interface using a different control method, but it’s still a pretty impressive result. While this participant is still able to talk naturally, such a communication method could benefit people who have lost the ability to control their mouth muscles, such as people with more advanced ALS or “locked-in” patients. Henderson and his colleagues have previously surveyed people with paralysis to see whether they’d be eager to adopt BCI technologies in their everyday lives, and what capabilities they’d hope to gain from such gear. High on the wish-list was the ability to communicate easily through fast typing, which the survey defined as 40 words per minute. Henderson says he has plenty of ideas for how to reach that ambitious target. A future study might make use of electrodes implanted in a region of the brain that encodes a person’s intentions to move, before they actually make a motion. “We want to see if using those signals from the planning part of the brain helps improve performance,” he says. It’s not clear what level of performance will be required before an implanted BCI device is considered ready for domestic use. But Henderson thinks the BrainGate2 system is well on the way: “We think we’re making very good progress,” he says.
MSI and eye-tracking company Tobii have announced a partnership to create eye-tracking-enabled gaming laptops which will incorporate the same Eye-X technology we saw in the Steelseries Sentry directly into the notebook's chassis. MSI will be showcasing the concept GT72 laptop at Computex this week, saying it's just the first product in a long line of expected joint ventures over the coming months.
“This concept notebook is only the beginning of our extensive partnership with Tobii - a partnership that will expand beyond hardware products and into the development of eye-tracking content and games,” said Eric Kuo, vice president of MSI. “First-hand, we’ve seen the way eye-tracking creates a richer and more immersive experience and we fully believe it will have a profound impact on the future of gaming.”
The 17.3in GT72 laptop will have an Nvidia GeForce GTX980M GPU with 8GB of GDDR5 VRAM as well as built-in Nvidia G-Sync technology. Tobii's eye-tracker, meanwhile, will run along the bottom edge of the screen.
As we saw with the Steelseries Sentry, which is a separate eye-tracking peripheral that connects to your PC via USB3, Tobii's Eye-X technology is compatible with games such as Assassin's Creed Rogue to control the camera, creating what Tobii calls an "infinite screen", and indie game Son of Nor to provide multi-dimensional movement. It's also compatible with theHunter: Primal and Starcraft II. While its in-game implementation could use a little work, it's a particularly useful tool for streamers, as it can be used to add an overlay to your screen that records where you look throughout a match of Dota II, for example, allowing you to compare your playstyle to other professional players. Tobii hopes that integrating its Eye-X tech directly into MSI's gaming laptops will help prompt other game developers, suppliers and OEMs to get on board with supporting the eye-tracking scene, and it's aiming to launch even more eye-tracking enabled gaming machines in the future. “Our partnership with MSI, following the announcements of the SteelSeries Sentry, Assassin’s Creed Rogue and theHunter: Primal, shows the power of eye-tracking and the strong trajectory it has in gaming,” said Oscar Werner, president of Tobii Tech. “The adoption of eye-tracking in the consumer market is still in its early stages and we are investing in technology, partnerships and the software ecosystem to reach our long-term goal of taking eye-tracking into mainstream computers. This partnership solidifies this trend.” Tobii and MSI will be bringing the laptop to the UK in the next few months, so we'll be sure to bring you our hands on impressions as soon as we can.
The Centers for Medicare and Medicaid Services (CMS) has issued a number of different policy changes regarding coverage for speech generating devices (SGDs) that have created some confusion and raised significant concerns within the ALS community. The ALS Association’s Public Policy Department has worked on these issues since they first arose and continues to advocate to ensure that people with ALS have access to communications devices that are so vital to living with this disease. The issues are summarized below and include what action The Association is taking and what people with ALS can do to help.
Capped Rental:
Beginning on April 1, 2014, Medicare is changing how it pays for SGDs, switching to a system called “capped rental.” Since 2001, people with ALS always have had the option of renting SGDs; however the overwhelming majority purchases them. Beginning on April 1, people no longer will have that option. Instead, they will be required to rent the device over a 13 month period. During the capped rental period, people with ALS will be contacted each month by the manufacturer to ask whether the SGD will be needed during the next month. As long as the answer is yes, the patient can keep the device. After the 13th month, these monthly questions about further use will stop and the patient will own the device. The payment system change does not apply to anyone on Medicare who currently owns an SGD. Capped rental also does not affect which devices Medicare will cover, or the evaluation and documentation required to support Medicare coverage. The ALS Association has been actively engaged on this issue since CMS first proposed the change in the summer of 2013. We have submitted formal comments to CMS and have partnered with other organizations, those in industry and with Members of Congress who share our concerns to urge CMS not to make this change. Our concerns are outlined in the comments to CMS, here http://bit.ly/1h2e2X8. They include:
Access: If people have an extended hospital stay or are in hospice while they are in the rental period, Medicare will not cover the rental fees. Instead, the device could be returned to the manufacturer while the patient would have to obtain a new one from the hospital or hospice or pay the entire monthly rental fee out-of-pocket.
Cost: People who rent SGDs for the full 13 month rental period will pay 5% more out of pocket than if they had purchased the device up front. Most recently, several Members of Congress sent a letter (http://bit.ly/1lX98PA) to CMS urging them to: 1) delay the implementation date; 2) reevaluate the data on which their decision was based (CMS relied on 1987 claims data); and 3) meet with stakeholders. A number of meetings have taken place with CMS and a number of scenarios are possible. Those include:
Full implementation on April 1
Delay implementation
Grandfather certain DME introduced to the market after 1987
Grandfather all SGDs since the devices are not intended for short-term use
The ALS Association continues to partner with other organizations to oppose the switch to capped rental and we will continue to strongly communicate that message to CMS. As the regulatory process moves forward, we will provide additional information and will alert the ALS community if grassroots action is needed. If CMS does not act to address our concerns, The Association will pursue other options, potentially including legislation, to ensure people with ALS have access to SGDs that play a critical role in their lives. In the meantime, if you or someone you know experiences any difficulty accessing SGDs or other Durable Medical Equipment, such as power wheelchairs or accessories, please contact your local ALS Association Chapter immediately. Chapter contact information is available here: http://www.alsa.org/community/. If you do not have a local Chapter, please contact The ALS Association’s Public Policy Department at advocacy@alsa-national.org. The Association will actively provide assistance to anyone experiencing difficulties accessing these devices and also will share these difficulties with CMS officials and Members of Congress so that they fully understand how policy changes impact people with ALS and why they must change.
Dedicated Devices
On February 27, 2014, CMS issued a guideline titled a "coverage reminder" that addresses the types of SGDs and the features of the devices that Medicare will cover. This guideline raises several questions about the features of currently available SGDs, and about the temporary "locking" or "dedication" practice that has been in place since 2001 for computer-based devices. Under current practice, non-medical applications such as email and word processing software, are “locked” on computer-based devices because Medicare will not cover those applications. However, people with ALS subsequently may have the manufacturer “unlock” these additional features by paying a fee, which again is not covered by Medicare. Both the wording of the document and the manner in which it was issued (coverage reminder as opposed to amending coverage policy) make it unclear exactly what implications it has for SGD coverage now and in the future. There is some speculation that this guideline would end coverage for SGDs or disallow coverage for devices that include non-medical applications such as word processing software, regardless of whether those applications are “locked.” At this time it is just speculation and it is not clear exactly how the guideline impacts current coverage policy. However, it is clear that this guideline does not end Medicare coverage of SGDs and it does not end coverage for computer-based devices, which have been available to Medicare recipients since May 2001. It also does not change the evaluation or documentation required to support Medicare coverage. As with “capped rental,” The Association is working with other organizations and with industry partners who share our concerns about the potential implications of the guideline. Together we will be working with CMS to clarify the meaning of the guideline and to ensure that people with ALS will continue to have access to SGDs, including computer-based devices. We also will keep the ALS community updated as the regulatory process moves forward and will alert the community if action is necessary. In the meantime, if you or someone you know experiences any difficulty accessing SGDs, including computer-based devices, please contact your local ALS Association Chapter immediately. Chapter contact information is available here: http://www.alsa.org/community/. If you do not have a local Chapter, please contact The ALS Association’s Public Policy Department at advocacy@alsa-national.org. The Association will actively provide assistance to anyone experiencing difficulties accessing these devices and also will share these difficulties with CMS officials and Members of Congress so that they fully understand how policy changes impact people with ALS and why they must change. If you have any questions about these issues or would like additional information, please contact the Public Policy Department at advocacy@alsa-national.org.
Is the market for augmentative and alternative communication (AAC) devices about to be bulldozed by the tablet revolution? Sal McKeown finds out…
At the annual conference of the national charity Communication Matters, Gary Derwent said the following: “My unscientific opinion is that iPads and Android devices will continue to increase in use in the field of AAC – and that ultimately, there is no long term future for ‘dedicated’ AAC [solutions].”
Gary is joint Head of Assistive and Rehabilitation Technology and Informatics Lead at The Royal Hospital for Neuro-disability (RHN), and is keen to see new developments in AAC for the 300,000 children and adults in the UK with specialist speech requirements. His argument is that while specialist devices may have more processing power, memory and storage capacity than iPads and Android devices, they are usually assembled using long-established designs and components – such as motherboards, processors and chipsets – that are increasingly outmoded, compared to the latest mobile consumer technologies.
Right now, people with cerebral palsy, neurodegenerative conditions or autism are lucky if they can secure funding for a specialist device from a company such as Dynavox, Tobii Technology or Toby Churchill. The costs of bespoke equipment can be in excess of as much as £5000 – and with demand outstripping supply, some young people may be left, quite literally, without a voice. In contrast, the combined expense of an iPad and a suitable app can be less than £500, potentially offering access to many people who would formerly have found AAC beyond their financial means. But can a set-up costing few hundred pounds really be a serious rival to a specialist, heavy-duty dedicated device?
In praise of tablets iPads and Android tablets tend to be small, easy to carry around and therefore easier to use in bathrooms or cars, whereas the dimensions of bulkier devices can cause problems. The downside is that consumer tablet devices are also often slippery and easy to drop, though mounting systems enabling different tablet models to be securely attached to wheelchair frames have recently started to appear.
Tablets are attractive items of technology and modern status symbols; with the best will in the world, dedicated AAC devices are not intrinsically desirable. There is no stigma attached to using an iPad or Android tablet, and both types offer great freedoms. Imagine enjoying a meal out with friends – it’s possible to use an app to talk to others at the table, take photos, instantly upload those photos to Facebook, send a text to your family at home and call a taxi at the end of the evening – all from the same device. More to the point, your fellow diners may well be using the same type of device themselves.
Tablets and the apps that run on them are easy to get hold of. You can scour the web, place an order and have the hardware delivered your door, then download the app(s) of your choice within minutes of turning it on.
However, unless you are a qualified assessor, your choice of hardware and software may be very wide of the mark. Without a specialist assessment, many users may not be developing their communication skills as successfully.
Not a medical device Tom Griffiths is a Trustee of Communication Matters, and works as an Assistive Technologist at Great Ormond Street Hospital alongside doctors, therapists and psychologists. Times have changed to the extent that the team may find that someone arrives for an assessment having already purchased an iPad. “Our job is to support children, parents and therapists in their decision making,” Tom explains. “The iPad is not a medical device and not designed for this market, so it is not always the answer to communication problems.” The team does, however, try to support ‘the whole person,’ and not just focus on one particular area. “Young people don’t just want to speak to someone in the same room,” Gary says. “They want to play games, access their curriculum and have a digital presence. We can suggest strategies and advise on suitable resources and apps, so the iPad can be a valuable tool for all these areas.” Whichever device ends up being chosen, it has to be dependable. Screens and hard drives tend to be the weak points in most computers, but iPads and other tablets now commonly come fitted with scratch-resistant Gorilla Glass and solid state hard drives that can withstand a lot of shaking. In some respects, newer tablets are fast becoming just as robust as specialist communication devices. Dedicated devices may be contained within good, rugged housing, but the reliability of their electronics can leave much to be desired. Things have been improving in that area, but there remain complaints that some dedicated devices spend a lot of time on the workbench. So while a case could be made for the industry not needing dedicated devices, it does still need dedicated research to be carried out, so as to ensure that the next generation of communication aids are the best that they can be
Methods of access Gary Derwent believes that the assessment and most of the support needed should come from statutory services and schools rather than suppliers, because an independent view is vital. Yet he also believes that suppliers have a crucial role in innovating and developing new technologies. The challenge, therefore, is to find a business model and a means of interaction between suppliers, commissioners and statutory services, so that people who use AAC can benefit from the latest innovations while at the same time receiving independent advice and the best support possible. Tablets provide access to touchscreen technology, and in some cases can be linked to a keyboard, but many users require other ways to make their computer work. These alternative input methods can include a mouse, trackball, joystick, a stylus-sporting headband called a ‘head pointer’ and advanced switch scanning or ‘eye-gaze’ technology, whereby the computer will register what the user’s eyes are focusing on and interpret their blinking to act as a switch when making a selection. This is one of the reasons why Paul Hawes, Managing Director of Smartbox Assistive Technology, welcomes the continuing development of new Windows and Android tablets. He points out that with Apple’s technology, every application on an iPad – and to some degree, the operating system that underpins everything – is run in isolation. This means that you are less likely to get viruses or dreaded blue ‘crash’ screens when things go wrong – but it can also make it very hard to transfer information and data between apps, or from the iPad itself to another device. “PC technology uses USB ports [and has a] a long history of supporting alternative access devices and programs that talk to one another,’ Paul says. “This means that no one is locked out of the technology due to having cognitive difficulties or physical disabilities.”
Gary Derwent in turn acknowledges that at present, there are several reasons why a dedicated device is the best option for many people – while noting that these reasons are likely to decrease over time. As newer, faster and more powerful iPads and Android devices continue to be developed, it’s entirely possible that the hardware and access issues experienced by people with AAC needs will be resolved by tablet manufacturers.
But whatever happens with regards to hardware, it seems that all the experts in the field are agreed that users must have access to specialist assessors, training and a good aftercare service if their needs are to be properly met.
Steve Evans
Case study – “Life is not over till the heart stops” This autumn, Steve Evans went to Goodwood to see the motor racing, Brooklands to see Concorde and enjoyed a Manic Street Preachers concert at the Shepherds Bush Empire. Steve has Motor Neurone Disease (MND), which has affected his speech and physical ability to the point where trips out require a lot of forward planning between the venue, his family and carers. He was diagnosed in 2007, and although the condition seems to have plateaued since 2010, he is now at a stage where he cannot speak unaided and is unable to move without assistance. He uses The Grid 2 – a software application from SmartBox Assistive Technology, which lets him use a computer as a communication aid with voice output, operate Windows and access the internet, as well as send and receive emails and SMS messages. It also connects to some home automation hardware that he has had installed in his house, thus enabling him to remotely put on some music, alter the angle of his bed, change the room temperature, turn on lights and switch TV channels.
“For anyone with MND, eye gaze is the only option,” Steve says. “I deliberately got a system before it was essential, to allow time to modify things and practice using it before I was dependent on it.”
Complete control Once he became proficient, Steve was able to use his computer for internet shopping, online banking and even share dealing. Now he can use PC-based remote access software to operate three other computers in the house, “That means I can sort out problems on my wife’s and kid’s computers, or configure network settings.” Given Steve’s reliance on eye gaze technology, his needs cannot be met at this time by an iPad or Android device with accompanying apps. Moreover, he will require support from specialists to continue meeting those needs as they change, if he is to enjoy the best quality of life that MND allows. “We don’t have a cure for this deadly disease for patients like me,” Steve concludes, “but still I remain an optimist. Life is not over till the heart stops.”
MIAMI — Carole Shearn isn't quite sure when she will lose the ability to speak, but she is sure of one thing: Her voice will still be heard, even when the words can no longer be spoken from her lips. The 70-year-old West Palm Beach, Fla., resident was diagnosed with ALS, also known as Lou Gehrig's disease, last October. Her form of ALS weakens the throat muscles first.
The progressive disease has no cure, but at the University of Miami Miller School of Medicine's Department of Otolaryngology, Shearn is the first patient to take part in voice banking - a program where patients who will eventually lose their voice due to diseases such as Parkinson's, ALS and cancer - can record key words, phrases and personalized messages to communicate when speaking is no longer an option.
Shearn uses Tobii Assistive Technology, a speech-generating device, which stores her recordings into categories. She can then use a mouse, touch the screen or even use her eyes to retrieve the sound files.
In case of an emergency, Shearn has even programmed a message saying "get help immediately" and "call 911." Tobii, which is compatible with Bluetooth technology, will call for her. "Truthfully, I was so amazed when I found out about the Tobii," she said. "It makes me feel good that I can personalize my messages to whomever. It is my lifeline."
ALS is a neurodegenerative disease that attacks the motor neurons. As the disease progresses, these neurons begin to degenerate and stop sending messages to muscles. Eventually, individuals diagnosed with the disease lose the ability to move their legs, arms and body.
According to the National Institute of Neurological Disorders and Stroke, 20,000 to 30,000 people are living with ALS in the United States. The average lifespan for a person with ALS is three to five years.
Because ALS patients lose strength and movement in their limbs, Tobii has a built-in eye tracker. Shearn can sit in front of the device - without moving any part of her body but her eyes - and still communicate effectively.
Jocelyn Odlum, a speech pathologist at the University of Miami, met Shearn at an ALS support group in West Palm Beach and then began seeing her at the clinic. After evaluating Shearn, she got her started on voice banking. Shearn has been recording her voice every day for the past two months. "Carole is an inspiration," Odlum said. "She took this disease and is doing everything she possibly can to be prepared."
Odlum says that once individuals are diagnosed with ALS, they should see a speech pathologist immediately so they can be introduced to these devices and helped. "Unfortunately by the time people come to see me they have no voice," she said.
Shearn has recorded basic phrases such as "Hello. My name is Carole," and "How was work?" But, she also has recorded some of her other favorite phrases: "What's up buttercup?," "What's new, super glue?," and "You snooze. You lose."
When Shearn was initially diagnosed, she had no idea what ALS was. She also didn't know that the disease had no cure. "That was very hard to hear," she said.
"I had tears in my eyes of course and I asked how long I would have to live and my doctor said he didn't know, three to five years, so we left the office on that," she said. Shearn's daughter, Jennifer Wagner, had been suspicious of early symptoms she had been noticing: slurred speech and choking spells, even when she wasn't eating. She researched her mother's symptoms and learned about ALS.
"It was very daunting and difficult to read," she said. "I had a pretty good idea of what the disease was and what it was going to entail, and I didn't want my mom to go through that."
Although Shearn can still drive and walk without any assistance, Wagner drives her mother from West Palm Beach to the university. She also started an open Facebook page called Carole's Crusade, where people can become more aware about the disease and follow her mother's progression.
"I know that I cannot cure the disease so my main goal is to bring attention to it," she said.
For Shearn, keeping a positive mindset has helped her cope with the disease, but she acknowledges she is not as hopeful and optimistic as she was eight months ago because she notices herself "getting a little worse."
"I was certain I was going to live past 90," she said. "I would still like to." But if she doesn't, Shearn says she feels she has done everything she has wanted to do - traveled to Rome, Alaska, Paris, England, Italy, Spain and the tip of Africa, been surrounded by good people, and had a successful 36-year teaching career.
"My life has always been about people so I don't crave a lot of outside influence," she said. "Our family is small, but we are tight. That has always been everything to me. I feel my life has been blessed."
Read more here: http://www.sunherald.com/2013/08/07/4854978/banking-on-your-voice-machine.html#storylink=cpy
A study suggests that, even if someone can't blink at will, their eyes can indicate a response to a question.
People with brain damage that has left them mute and motionless may be able to communicate with a system that measures the size of their pupils, a new study has found.
Individuals suffering from "locked-in syndrome" have lost motor control but remain aware and alert. The rare condition usually results when damage occurs to the brainstem, which controls motor function. Stroke, traumatic brain injury and amyotrophic lateral sclerosis (also known as Lou Gehrig's disease) can cause locked-in syndrome.
Many locked-in syndrome patients communicate with an alphabet chart, blinking to indicate their choices as a caretaker points to each letter. Others use devices that measure eye movement patterns representing "yes" or "no." Completely locked-in patients who aren't able to move their eyes at will may be able to use systems that translate brain activity into speech, although these often require surgical implantation and special training.
A new system called the EyeSeeCam measures changes in pupil size that happen involuntarily — even in people who lack motor control — and decodes them into yes or no responses, potentially offering an easier alternative for locked-in syndrome patients, including completely locked-in individuals.
In the 1960s, researchers discovered that pupil size can be used to measure mental effort: The bigger a person's pupils, the harder his or her brain is working. Neuroscientists used these findings to develop the EyeSeeCam, which takes advantage of how people's pupils dilate when they try to solve math problems.
Since this happens automatically, patients don't need to be trained to use the EyeSeeCam, said Wolfgang Einhauser, a neurophysicist at Philipp University of Marburg in Germany who helped develop the device. It's also relatively inexpensive, consisting of just a camera and laptop.
In a trial described Monday in the journal Current Biology, Einhauser and his colleagues asked patients 15 simple questions, such as "Are you 20 years old?" After each question, the computer presented the patient with yes or no options while showing a math problem onscreen. Patients solved only the problem associated with their response, and the mental effort caused their pupils to dilate. An infrared camera mounted to a headpiece measured their pupil size over time and sent the information to a laptop. A software program immediately translated the measurements into responses based on when they peaked.
When the researchers tested the EyeSeeCam on six healthy individuals, it decoded their pupil sizes into accurate answers almost every time. The researchers saw similar results in three out of seven locked-in syndrome patients, almost all of whom could manage small head movements. With some slight adjustments, it correctly translated the pupil dilations of two additional patients more than 70% of the time.
"We found that quite remarkable," Einhauser said.
Only one out of four patients with more severe locked-in syndrome — marked by more widespread brain damage — finished the trial, and his answers were no more accurate than guessing. The researchers also tested the EyeSeeCam on a minimally conscious patient with severely impaired cognitive ability. Although he couldn't answer the questions independently, he was able to solve math problems if the researchers pointed at them. The system translated these responses with more than 80% accuracy, suggesting that it could also serve as a diagnostic tool to assess a patient's state of consciousness, the researchers wrote.
Within the next two years, the researchers hope to finish fine-tuning the EyeSeeCam so that it works better for severe locked-in syndrome cases, Einhauser said. They also plan to make the device less cumbersome. It will eventually resemble a small webcam that can be hooked up to a laptop.
Although completely locked-in patients stand to benefit most from the EyeSeeCam, the trial participants still had control over their eye movements, said Niels Birbaumer, a neurophysicist at the University of Tuebingen in Germany who was not involved in the study. As a result, "we have no idea whether pupil size" accurately reflects yes or no responses, he said.
Mark Delargy, a physician at Ireland's National Rehabilitation Hospital, agreed. Although the study controlled for lighting changes and other environmental factors that can affect pupil size, internal variables, such as emotional state, are more difficult to control. Anxiety and pain can cause the pupils to dilate, for example.
But identifying these emotions in locked-in patients is tricky. "They won't tell you any new information," said Delargy, who was not part of the study. "You have to devise a question to enable them to tell you."
The EyeSeeCam's success in the minimally conscious participant has made the researchers confident that pupil dilation can serve as a means of communication, Einhauser said. Now that they've "provided the proof of principle," testing the system on completely locked-in patients is "definitely on the agenda," he said.
Even if pupil size does accurately reflect yes or no responses, the study tested only the EyeSeeCam, so it's undetermined whether it offers an advantage over existing systems, Birbaumer said. Still, the device "has potential," Delargy said. "This is one of the greatest hopes for rehabilitation of locked-in patients and for the opportunity to give a voice to people who have lost it." melissa.pandika@latimes.com
Handwriting comes more naturally than typing for many adults and is likely to be better preserved after neurological injury or disease. For those who have lost their ability to speak, a voice-output app may be the best way to be heard. However, nearly all voice-output communication apps require the user to type in a message, leaving those without keyboarding skills in the lurch. Two AAC apps offer writers a chance to hear their words by converting handwriting to text, then text to speech.
HandySpeech (universal iOS app for $29.99) excels at recognizing print, script and mixed case writing and outputting it in high-quality artificial speech. Voices can be male or female in US or UK English accents; 11 other languages are available for in-app purchase of $2.99 each. The app requires an Internet connection (wifi or 3G) for speech output, though if none is available, the user can work around the problem by selecting the text and making use of the device's text-to-speech function.
There are many settings to help the app better recognize handwriting, including the ability to exclude letter shapes that are rarely or never used. Users can type directly into the app if desired, as well as paste text from other apps. A great feature of this relatively low-cost AAC app is the ability to store phrases for quick communication. Unfortunately, the only way to save phrases is to type them in through the settings, excluding the handwriting user from the process of storing messages. Handwriting-to-speech is one of many features included in the full-service AAC app Predictable (universal iOS app for $159.99). While Predictable lacks the variety of settings to improve handwriting recognition, it offers the ability to use the voice when the device is not connected to the Internet. You can also easily output your message to email, Facebook, Twitter and SMS, or add it to the stored phrases list. Unfortunately, this app's useful word prediction feature does not work when using handwriting input. It is also difficult to insert spaces between words when combining handwritten phrases. For an app that turns handwriting to text without the voice output, please look back at my previous post on MyScript Memo.
