Bobby Miller
Writer Website
Assistive Technology for Various Levels of Paralysis
3,000 words
There are various levels of paralysis depending on how much body control the individual has lost. Paraplegics have lost use of their legs, quadriplegics have lost use of everything below the neck, and locked-in people have lost use of every external body part except the eyes. A growing amount of incredible technology has allowed these individuals to perform tasks they never thought were possible.
Paraplegic Aids
The first disorder we’ll explore is paraplegia, which MedTerms.com defines as “paralysis of the lower part of the body, including the legs.” Although people with the condition have long been able to move around in bulky wheelchairs, technology now offers different options.
One option is the ReWalk, a robotic exoskeleton that fits on the body to allow leg movement. “Paraplegics will be able to stand, walk, even climb stairs,” according to AMS Vans, a blog devoted to disability news. “Users walk with the help of crutches, and movement is controlled by shifts in the center of gravity and upper-body movements.” The lightweight suit has braces featuring motors at the joints to allow for movement. The product’s official site adds that it comes with a computerized watch featuring buttons that activate special functions.
Credit: ReWalk.com
Launched in 2012, the company Argo believes the ReWalk has a number of benefits. A person can walk upright to make easy eye contact, access areas without ramps, and reach objects in high places. Since the user can now move their legs, they can perform a wider variety of exercises than wheelchair-bound individuals can, as its website reports. Walking affects bone density, decreases body fat, improves cardiorespiratory fitness, and allows for smoother bladder and bowel functions.
The ReWalk system does have limitations, though. Only people weighing below 220 pounds can wear it, which certainly isn’t good news considering one third of the US population is obese. Also, the personal version of ReWalk is currently unavailable in the US; it can only be found at rehabilitation hospitals. Jay Courant, a worldwide training director of Argo, said in an e-mail that even if they can manage to provide one for personal use, it will cost about $75,000.
A similar device is the Esko, which EskoBionics.com advertises as “a gait training exoskeleton intended for medically supervised use by individuals with various levels of paralysis or hemiparesis due to neurological conditions such as stroke, spinal cord injury or disease, traumatic brain injury and more.” By donning it in just five minutes, a paraplegic individual can walk again. It allows for walking speeds up to one mile per hour. It is currently available in the USA, Europe, and South Africa for $100,000 and “unlikely to be covered by insurance,” according to USA Today.
Quadriplegic Aids
eHow.com defines quadriplegia as “paralysis or a lack of an ability to use all four limbs (arms and legs), also known as tetraplegia” in Europe. This may affect a surprising number of people. Yahoo claims that “high-level spinal cord injuries, one of the major causes of paralysis, currently afflict about 250,000 people in the United States.” A peek at Census.gov will tell you that’s roughly the population of Orlando, Florida.
Since quadriplegics do not have any control of their body below their necks, they can’t even use their arms and hands to move a wheelchair, write, flip through a book, or use a computer. Fortunately, technology exists to help those with quadriplegia.
Tongue Drive System
Dr. Maysam Ghovanloo of Georgia Tech has developed what he calls the Tongue Drive System. True to its name, it allows individuals to drive a wheelchair using nothing but their tongue, as Georgia Tech’s YouTube videos explain. The idea came to him because there is a high-level connection between the brain and tongue, meaning that most people with even severe spinal cord injuries can still move it.
To use the system, a magnetic adhesive is attached to the tongue, though a magnet can be pierced or implanted for permanent use. Next, the user puts on what looks like a communication headset with two microphones. But the tips of each end aren’t microphones: they’re sensors.
Credit: Georgia Tech's YouTube page
To turn the wheelchair left or right, the user simply moves their tongue left or right at the bottom of their mouth. To go forward or backward, they put their tongue at the top of their mouth. There’s also a handy command available for when users want to shut off the Tongue Drive so they can talk or eat.
Although this technology has largely been applied to wheelchair movement, it can also be used to control a computer cursor. Coupled with an on-screen keyboard, one could browse and type as if using a mouse and standard keyboard. According to Dr. Ghovanloo, if you can control a computer, then you can control anything that can be controlled by a computer. This, of course, opens up a wide array of possibilities for quadriplegic individuals.
Testing has shown promising results. People using the Tongue Drive System can learn to navigate with their wheelchair and play specialized computer games within just thirty minutes. In 2013, Dr. Ghovanloo showed that able-bodied people can use it equally well. He also hopes to mount the magnet receptors in people’s gums rather than a headset so that it will be more discreet. However, he has told Yahoo that “a commercial version is still years away.”
He went on to mention that people’s performance with the Tongue Drive System is about three times better than the traditional sip and puff system—even for people who have long depended on it. Often given to quadriplegic individuals, the sip and puff system basically mounts a straw right within range of the mouth. It can detect the difference between hard and soft breathing. A hard sip, for example, may push the wheelchair forward, and a soft sip may push it back. A hard puff may turn left, and a soft puff may turn right; it depends on the user’s preference.
Since the traditional sip and puff system is difficult to use, limited, and often inaccurate, technologies such as the Tongue Drive are exciting developments for paralyzed individuals.
Camera Mouse
Quadriplegics also have the option of using Camera Mouse, a program free of financial costs, advertisements, and gimmicks. Simply put, you control the mouse pointer on a screen just by moving your head. To use it, all you need is a computer—Mac or PC—running on Windows XP or higher, as well as a webcam. For people without a Windows OS, there is a similar program called Head Mouse Extreme by Origin Instruments, but it sells for $1,225.
Professor James Gips and Professor Margrit Betke of Boston College came up with the idea for Camera Mouse back in 2000 and made the program available in June 2007. Since then, it has been downloaded nearly 2 million times. According to the aptly-named CameraMouse.org website, it allows computer access for “people with Cerebral Palsy, Spinal Muscular Atrophy, ALS, Multiple Sclerosis, Traumatic Brain Injury, [and] various neurological disorders.” There are even some individuals with repetitive stress injury that enjoy the hands-free technology.
Credit: CameraMouse.org
The camera follows a point on the user’s face, and it moves the cursor when they move their head. “Dwell time” allows the user to hold the cursor at a certain point for a second or two to click. Although double-clicking is possible, one settings option allows users to open Windows icons with just one click. For typing, people can use an on-screen keyboard such as the Midas Touch Keyboard, also provided for free by Boston College. The time involved for clicking does not make Camera Mouse optimal for fast-paced games, but playing traditional board games like checkers or chess online is entirely possible. Armed with this special type of mouse and keyboard, quadriplegic users can perform many of the same computer tasks as able-bodied people.
Voice Commands
It should also be pointed out, though, that voice commands commonly found on electronic devices can allow quadriplegics to use electronics too—without the neck pain. I, for one, tried using Windows 7’s Speech Recognition for hours and still found correcting its many errors to be a slower option than normal typing, so its usefulness may depend on the user.
But as Nuance.com explains, there are more nuanced dictation devices available. The Dragon program is $75 for computers and free for smartphones. Also, the Tecla Shield DOS connects a user’s wheelchair to a smart phone or tablet for full control through voice commands. It costs $299. Needless to say, the Tongue Drive and Camera Mouse would be better options for people with speech impairments.
Brain-Machine Interfaces
Many paralyzed individuals still have their inactive limbs. For such people, as LiveScience.com reported in 2010, “wearable robots” are in development. Under the lead of Nicholas Hatsopoulos, professor of neuroscience at the University of Chicago, research is being conducted on material that covers limbs and allows them to be moved just by thinking about it.
Credit: LiveScience.com
For example, we could put a robotic sleeve over someone’s arm, connect it and their brainwaves to the right electronics, and let them move said limb. When this happens, many people will experience the “feel” of this themselves, since many patients have “partial sensory feedback,” according to Hatsopoulos. These sleeves tend to allow 40 percent faster and more accurate movement than separate robotic limbs. And they’re so easy to use that a trained monkey could do it . . . literally. That’s how the wearable limbs have been tested. So far, this exciting technology has not been distributed publicly.
LiveScience.com has also reported that separate robotic limbs show promise. In 2012, Researchers Andrew Schwartz and Elizabeth Tyler-Kabara of the University of Pittsburgh created a very accurate mind-controlled robotic arm. “The scientists developed microelectrode arrays that connect brain cells to electronic circuitry,” the website explains. After using brain scans to figure out where to put the electronic grids in the test patient’s brain, “They implanted the devices into her left motor cortex, the part of the brain that controls movement of the right arm and hand.”
Credit: LiveScience.com
Although the robotic arm is slow, it is accurate 91.6 percent of the time thanks to its advanced joint and wrist movements. The patient could perform tasks such as handling an egg, stacking cups, and pouring one half-full glass into a measuring cup. Most importantly, she could eat a piece of chocolate all by herself for the first time in years. All she had to do was imagine that she was moving her own arm. This takes weeks of training, and the FDA allows only twenty months of testing per patient, but she thinks it’s worth it. These studies could end up revolutionizing people’s lives.
Researcher Jennifer Collinger, also hailing from the University of Pittsburgh, speculates that “it might even be possible to combine brain control with a device that directly stimulates muscles to restore movement of the individual’s own limb.”
Locked-In Syndrome Aids
Some people have paralysis even worse than quadriplegia, though. Known as locked-in syndrome, this allows no movement from any body part—save for the eyes. It might seem impossible to communicate with people who can, almost literally, do nothing but think and look around as others care for them. In fact, back in the days of old, eye movement was the only way we knew these people were conscious, as Roxanne Palmer of the International Business Times has explained.
However, thanks to recent innovations, these individuals can now communicate with others.
Eye Technology
Since locked-in people can still move their eyes, different technologies can allow them to communicate on a surprisingly high level. For instance, these individuals can use computers. The Tobii PCEye can track a person’s pupil even if they’re wearing lenses or glasses, according to the company’s official website. The individual looks at the purchased screen, which uses a USB cable to connect to a “normal” computer or laptop equipped with Windows. By moving their pupil to operate the cursor and on-screen keyboard, the person can do just about anything a typical computer user can. Glancing at a taskbar on the right side of the screen allows the user to perform multiple types of clicks.
The user looks at the left screen while the computer’s actual screen sits to the right. Credit: Tobii’s official YouTube page
Researcher Päivi Majaranta of the University of Tampere has pointed out that typing with “eye gaze” technology takes two to three times longer than hands-on typing, though. Also, the Tobii PCEye costs $3,900. This might sound expensive, but it grants entirely paralyzed individuals the ability to communicate with others, read material online, write creatively or professionally, and more. You can’t put a price tag on benefits like that.
However, there are people who have total locked-in syndrome. According to G. Bauer, F. Gerstenbrand, and E. Rumpl’s study in the Journal of Neurology, a totally locked-in individual does not even have voluntary eye movement. This, of course, makes technology such as the Tobii PCEye completely useless to such people.
Even someone with virtually no control over their bodies has limited forms of communication, though, thanks to a development that just took place in August 2013. According to the International Business Times, scientists at Philipps-University Marburg in Germany have found a “link between pupil dilation and mental effort.” Basically, your pupils will grow bigger if you’re thinking hard about something.
So, to communicate with a totally locked-in person, you can start by asking them a yes-no question such as, “Are you forty years old?” Tell them to solve the math problem associated with their answer. Display “yes.” Then display a relatively tough math problem. Watch to see if their pupils dilate. After a moment, display “no.” Then display another relatively tough math problem. If their pupils dilate the second time, that means they were thinking hard about the latter math problem, so their answer is “no.” Notice how their answer to the math problem doesn’t matter: we just know they were thinking hard to solve it.
With this in store, we could ask any kind of multiple-choice question to a totally locked-in person. It might take a while and have its limitations, but a family could receive some insight regarding what a loved one is thinking.
Mind-Controlled Computers
The eye’s not the only gateway to the soul, however. As aforementioned, brain-machine interfaces have already been applied to robotic limbs. But what if we allowed locked-in people, even those with no eye control, to perform tasks on a computer as well?
Professor Frank Guenther of Boston University decided we might as well try letting locked-in people use computers with their brainwaves. As you’ll recall, brain-machine interfaces worked by letting people imagine moving their limbs, and the robot would mimic the movement. However, Guenther’s technology works by matching a computer cursor to various body commands.
The blog AMS Vans reported that a cap powered by EEG (electroencephalography) is placed on the patient’s head. If they imagine moving a certain body part, they activate certain brainwaves, which in turn make the cursor move certain directions. For instance, by imagining a right-hand movement, the user puts the cursor on the “ah” vowel sound. Currently, Guenther’s work has been used to allow patients to make only basic speech sounds.
Credit: Blog.AMSVans.com
Brain Actuated Technologies, Inc. has taken things a step further by producing “a headband fitted with sensors [that detect] electrical signals from facial muscles, eye movements, and brainwaves,” according to its website. Known as Brainfingers, this headband allows individuals with just the slightest ability to control facial muscles to use computers. This won’t help totally locked-in people, unfortunately, but it can benefit a wide variety of individuals. The site explains that “our clients have included individuals with Cerebral Palsy (CP), Lou Gehrig’s Disease (ALS/MND), Spinal Muscular Atrophy (SMA), Muscular Dystrophy (MD), Traumatic Brain Injury (TBI), and Spinal Cord Injury (SCI).”
Alston Daniel, diagnosed with ALS, uses Brainfingers. Credit: Brainfingers.com
The website claims Brainfingers is easier to use than eye-gaze technology (such as the Tobii PCEye) because it does not require staring at certain points of the screen or involve blinking controls. The site also boasts that it’s easier to use than head movement technology (such as Camera Mouse). And unlike the other products, Brainfingers can even be used to “enhance [able-bodied people’s] experience of video game play” by allowing them to input commands more quickly than typical hand-eye coordination allows.
Sunil of Seattle, WA testified on the website that “the software is very thoughtfully designed and easy to use for the profoundly disabled. It can be fine-tuned in several ways to pick up the faintest signal.” Although he can only move his eyes and jaw, he can accomplish many tasks thanks to Brainfingers. “I manage the family finances using Microsoft Money, communicate with family in India using Microsoft Outlook, research anything and everything using Internet Explorer,” he said. This has allowed him to help develop assistive technology and have a “fun life again.”
This revolutionary system comes at a price. “The cost for the basic system is $1,800,” Andrew Junker, the president of Brain Actuated Technologies, told me via e-mail. “The cost for what we call a full support system, training and support for three years and three year warranty is $3,800.” If you plan on using it just to enhance your PC gaming experience, though, they can offer it for $1,500. These costs might seem steep, but again, the ability for a paralyzed person to communicate, work, play, and more can definitely make it worth the price.
Additional Resources
Scientists continue to research how paralyzed and other disabled individuals can live much like able-bodied people do. According to the AMS Vans blog, neurology researchers such as Zhigang He of the Harvard Medical Center have found ways to regenerate certain nerve connections in mice after spinal cord injury. If this finding can be applied to humans and their other nerve connections, such as the ones connecting limbs to the brain, we may one day cure paralysis.
In the meantime, there are many assistive devices available for those who are paralyzed or suffer from another disorder. Websites such as AbleData.com, EnableMart.com, and InfoGrip.com sort their products by the disability they’re alleviating.
Bobby Miller originally wrote this article for the digital magazine Nvate in December of 2013. Due to its age, some of the information or links in the article may be outdated.