Crowdsourcing Ability

As smart mobile devices become ubiquitous, we are beginning to see crowdsourcing as a way to help people with disabilities. Crowdsourcing is calling upon people online for information, services, and capital rather than using traditional or institutional sources. Below are three examples of platforms designed to build online communities of service for people with disabilities.

Launched on January 15th, 2015, Be My Eyes (BME) is an app which allows people with visual impairments to summon sight in real time from a network of volunteers. Any time they need help, a user with visual impairment simply hits a button on their BME app (they are able to navigate the screen using other apps like VoiceOver, which translate screen content to synthetic speech). BME then sends a message to a randomly selected volunteer in the network asking if they’re available to help. If they accept the request, the two are connected via their phones and the volunteer can see through the help requester’s camera. If, for example, the person who is visually impaired needs help reading a label, they would simply hold the camera up to the label, allowing the volunteer to read it out loud.

VocaliD is another app which “crowdsources ability,” only for speech rather than sight. We’ve all heard Stephen Hawking’s robot-sounding computerized voice system. Although he seems to have embraced it (after many years), others who use such speech-generating devices feel estranged from their own voices. “We wouldn’t dream of fitting a little girl with the prosthetic limb of a grown man,” said VocaliD’s founder Rupal Patel, “so, why then the same prosthetic voice?” Patel’s solution: crowdsource a vast library of voices which can then be blended together using cutting-edge technology to create “custom vocal personas.” “Voice donors” simply download the app and record a series of words using their smart phones.

Finally, in 2013, National Public Radio (NPR) created an online map for accessible playgrounds called Playgrounds for Everyone. Anyone with internet access can see and contribute to the map. Its purpose is to provide an up-to-date database for parents of children with disabilities and to expose underserved neighborhoods to governments.

These examples are only the first glimmers of what will become an expansive constellation of crowdsourcing platforms for people with disabilities. Especially as augmented reality, 3D printing, and the “internet of things” become more widespread, the possibilities for crowdsourcing are going to explode. We as OT practitioners are positioned to be at the center of entrepreneurial ventures parlaying these capacities to the benefit of our client populations. At the very least, we should keep our “clinical tool boxes” current with the latest applications.

Game-ifying your Kegels

Somebody has finally done it: invented a video game for your vagina. Yes, the Smart Kegel Exercise Aid (SKEA) features a sleekly designed “controller” that goes into the vaginal cavity and communicates wirelessly with an app on the user’s phone. A number of games will eventually be rolled out, but the one SKEA uses for their prototype is called “Alice in Continent.” When the player contracts her pubococcygeus muscles pressure sensors in the controller relay a signal to the phone, causing Alice to jump over obstacles as she runs through the woods.

For those not familiar with Kegel exercises, they are designed to strengthen the muscles of the pelvic floor which, if weakened, can lead to problems with bladder control, pelvic prolapse, and sexual function. Aging, abdominal surgery, obesity, pregnancy, and childbirth are risk factors for weak pelvic floor muscles. While men can also benefit from Kegel exercises, they are more frequently used by women.

SKEA was created by physicist Tom Chen of Linkcube Studio, a small company based in Beijing, China. Linkcube Studio received over $50,000 in Kickstarter funds this spring and is currently sending out its first shipments of SKEA.

Occupational therapists, especially those with Pelvic Muscle Dysfunction Biofeedback Certification, educate clients every day about the benefits of Kegel exercises. In the near future, SKEA presents opportunities for OT research: how well does it work? Does it improve compliance with Kegel exercise programs? Does it make Kegels more enjoyable? If it passes scientific muster we can expect to see it integrated into OT practice, and who knows, maybe someday it will become its own e-sport genre with high-stakes competitions around the world.

Flotation therapy

Flotation therapy, also called Restricted Environmental Stimulation Therapy (REST) or Sensory Deprivation, involves an enclosed, light- and sound-reducing tank filled with less than a foot of water which is saturated with over 800 pounds of Epsom salt. The water is the same temperature as the surface of the skin, about 91 °F (33 °C). People lie in the tank on their backs and float (due to the high salinity of the water) for however many hours they desire. The combination of sensory reduction and the feeling of weightlessness is deeply relaxing.

In January of 2014 I tried flotation therapy for two hours in Chicago’s SpaceTime Tanks. When I first climbed into the tank and closed the door, a mixture of excitement and anxiety came over me. The utter silence and darkness made me feel eerily alone and the humidity made it difficult to breathe normally. I could also feel the salts rushing into every little breach of the skin, cuts on my hands and feet I didn’t even know were there. After some ten or fifteen minutes the discomforts subsided and it was just me and the symphony of sounds produced by my body–the contraction of my heart, the steady inflation and deflation of my lungs, and the occasional gurgle of my stomach.

After an hour or so I got used to the sound and found myself in a place of quiet, lucid resting. It was as if my body and even my mind were relaxed to the point of sleep, yet I was still there, awake and abiding in some interstitial state. This didn’t last for long, though. Eventually my mind woke up and began talking, as it does, about a conversation I had earlier that day, about how much I spent on food and drinks last night, about why one of my Facebook statuses got zero “likes,” about what the final episode of Lost really means, and so on. To distract myself I began pushing off the walls, bouncing around in the tank like a Microsoft logo in one of  those early Windows screensavers. For the remainder of the float I cycled through these stages: relaxation, thinking, distraction, relaxation, until the New Agey music faded in and cued the end of my session. After showering and toweling off, I talked to woman working the front desk about my experience. She said it was common, and like anything, the more you do it the more control you have.

Although flotation therapy is widely considered more of a spa treatment than a therapeutic intervention, numerous studies have surfaced in the last thirty years which point to it as effective for managing chronic pain, stress, autism, chronic tension headaches, depression and anxiety, and muscle tension pain. It has also been shown to enhance cognitive behavioral therapy for Obsessive-Compulsive Disorder with Schizotypal Personality Disorder, reduce hypertension, treat addiction, and to improve memory, creativity, athletic performance, and right hemispheric processing in the brain. Occupational therapists work with patients who could benefit from flotation therapy in all of the aforementioned capacities. There is enormous potential for OT researchers to produce their own findings and ultimately integrate them into standard practice. Given the cognition-enhancing properties of flotation therapy, could it synergize other OT interventions for Traumatic Brain Injury or stroke? Given its efficacy in reducing pain, could it facilitate therapy for clients with fibromyalgia or arthritis? Given its utility in managing depression and anxiety, how could we put it to use in mental health settings? The number of prospective hypotheses is astronomical. I intend to investigate this unique technology in my own career and hope others do the same!

Microsoft HoloLens

(If you are unfamiliar with HoloLens watch the video before reading!)

Early this year Microsoft unveiled HoloLens, wireless augmented reality goggles with a self-contained computer. As opposed to virtual reality goggles (like Oculus Rift), which create a wholly immersive virtual experience, augmented reality goggles project holograms into the user’s field of vision. The headset features spatial sound so you can “hear” holographic projections, even if they are behind you. While the exact release date is unknown to the public, there is speculation that it will be at the end of 2015.

Augmented reality devices will not only revolutionize computing and entertainment as we know it, but will also have innumerable therapeutic applications. As can be seen from the video, one of the most prominent features is hands-on, 3D design. Therapists will be able to sit side by side with a client and design custom adaptive devices which may then be 3D printed on site in minutes.

Another feature shown in the video is interactive instruction. This will take the possibilities of Telehealth to new levels. Imagine being on a Skype call with a colleague overseas who is working with a client while wearing HoloLens. You can literally see the world from her point of view, talk into her ear, and draw arrows and other visual cues directly into her field of vision. Meanwhile, she will be able to project your image however large or small onto a nearby wall, surface, or wherever is most convenient.

There will be an explosion of therapeutic apps built for HoloLens, one of which will be instantaneous goniometric measurement. The computer will be able to identify human bodies and project constant, real-time Range of Motion measurements into the air beside them. Depending on how well the computer recognizes bodies and body parts, we may even be able to toggle to “x-ray” vision with virtual overlays of bones, muscles, nerves, blood vessels, and organs in a given area.

There will also be many options for clients who own HoloLens. People with dementia, for example, will be able to post virtual prompts and reminders all over their living space. These reminders could range in complexity from traditional “sticky notes” to prerecorded audio or video clips. For people with cognitive or intellectual disabilities, task sequencing could be tailored to place. Say, for example, a therapist conducts a traditional task analysis for making a peanut butter and jelly sandwich and, with the client, arrives at a set of directions which works best. Together, they then use HoloLens to create a step by step interactive template which can be initiated at any time. Later in the week, the client walks into the kitchen wearing HoloLens. Their own voice says into their ears “what would you like to do in the kitchen?” and several icon-coded options appear at various locations: above the cabinet is a blue icon for a peanut butter and jelly sandwich, by the coffee machine is a red cup of coffee, and on the dishwasher is a yellow stack of dishes. When the client selects the sandwich icon, their prerecorded voice says “open this cabinet and take out the bread” and an arrow materializes, pointing to the cabinet. In the bottom right corner is a green button reading “NEXT” that the client pushes when they have completed the first step. Then, the second step begins, and so on until the sandwich is made. These are only two examples, but the possibilities for on demand teaching, learning, and cuing are limitless.

Of course, HoloLens is only the beginning of augmented reality. Innovega, Inc., an eye-wear tech company, is currently working on augmented reality contact lenses. And the US Defense Research Projects Agency (DARPA) is, believe it or not, developing a “direct neural interface” chip that will augment reality from within the brain. But that’s for another post.