Page 14 - Mobility Management, May 2019

ATP Series
ALS & Alternative Driving Controls
more independent.”
She added, “In the clinical rules that are set up within our
funding system, we can prescribe equipment if a patient’s medical status has changed. But to prescribe equipment that is not flexible and adaptable is to set up for failure. By the time you get funding authorized, the client may have changed again.”
After transitioning to a switch system, that system can
continue to be adapted. “You can move the switch system,” Norton explained. “There are switch systems that clients can drive with their knees, if they have the ability to rotate their knee out. You can put switches at the feet. We have a number of clinicians who set up systems with left and right turning on the right foot plate and forward and reverse on the left foot plate, or whatever works best for that client.”
Is the Future of Driving Right in Front of Our Eyes?
When considering the future of alternative driving controls for clients with ALS, eye gaze is an intriguing possibility. Eye-gaze technology has been around for decades and has often been used to facilitate communication, both written and spoken, through tracking a user’s eye movement across a screen. This technology has been further developed to interface with power chairs, allowing users to drive using only eye movements.
Promising Potential for Clients with ALS
The possibility of controlling a power chair using only the eyes
is an alluring option for clients no longer able to easily operate other standard or alternative drive systems, and it holds particular promise for people with ALS. Because of the progressive nature of ALS, drive controls are often adapted and changed throughout the course of a client’s mobility plan, but eye gaze could have longer staying power and require much less energy to operate.
“Eye gaze is wonderful and it needs to happen,” said Lisa Rotelli, Director of Adaptive Switch Laboratories. However, all systems have limitations. Rotelli has been working with eye gaze since 2006, and one of her concerns is that eye gaze is largely environmentally specific. “All systems that are being prescribed need to be flexible, and need to meet all of a patient’s needs,” she said. “Changing one’s seat position through the day is critical, and most patients diagnosed with ALS will tell you that communi- cating throughout their changing needs is ultimately critical and has to always be addressed.
Eye gaze could have unique parameters. For example, think of the “backup” cameras available in newer cars: Instead of turning your head and looking over your shoulder, the backup camera projects a real-time image of what’s behind you. Now imagine that instead of driving forward by looking through your
windshield, you drive by looking at a real-time image generated by a forward-facing camera. Because eye gaze needs to maintain contact with the wheelchair user’s eyes, consumers might need to use a camera and screen to see what’s ahead, rather than scan- ning the environment with their eyes.
Fine-Tuning Eye Gaze for Wheelchair Operations
Gabriel Romero, VP of Sales & Marketing at Stealth Products, sees eye gaze as an important technology, but one that needs improvement. “You can only use it indoors. There’s still not good light-blocking for cameras,” he noted.
What Romero really wants to see is better data collection on clients. “The future of this diagnosis, when it comes to equip- ment, is the artificial intelligence that we can start gaining in understanding what is happening through those transitional phases,” he said. “Understanding what type of strength they’re losing at what time, and that helps us to improve, helps us to make recommendations.
“It’s data gathering. The best way to gather data is through their devices. Being able to see how far they’re able to push
that joystick and what time throughout the day they are losing [strength]. These are selections and detections that can be added to the system to make some great suggestions to the end user. Artificial intelligence has been used for years in different facets of our everyday technology, and I think that being able to under- stand how to gather that data and how to use that data when it’s being monitored, especially in clinics, is paramount for both the therapist and the ATPs in making selections.”
This data could help clinicians better predict how ALS will prog- ress, which could enable them to make better decisions about what the client and chair will need. With that knowledge, clinicians could, at least marginally, get out in front of the disease.
Until there’s a cure, timely anticipation of what a client needs could be the next best thing. m
As we went to press, Numotion announced it will distribute the Independence Drive eye-gaze system, an idea that originated from Steve Gleason, whose Team Gleason foundation supports and advocates for people living with ALS. Look for more news in upcoming issues of Mobility Management.
14 MAY2019|MOBILITYMANAGEMENT
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