Communication Devices for Stroke Victims?

chowbok asks: "My grandmother recently had a stroke, which left her with the inability to speak or move the right half of her body. It also seriously impaired her motor skills on the half she can move, so she can't write. She does understand what is said to her, but she has no way to communicate. I'd like to set something up for her so that she can write notes. What I have in mind is a keyboard with rather large keys (perhaps 2" square) and a screen or monitor of some sort. I'm sure they make such stuff specifically for stroke victims, but anything labeled 'medical' will undoubtedly be astronomically expensive, even if it is a rather simple device like what I have in mind. I thought it would be easier to build one or find something similar (perhaps a toy or some such). I thought Slashdot readers might have some good suggestions along these lines. I'm not totally against doing it with a computer with a modified keyboard, but that seems like overkill when all I want is really a 'video typewriter'. Has anyone seen anything that might work for my purposes, or might serve as a good starting point?"

You could try...

[Murphy's Paradox]

Getting yourself an old pc or laptop with a fair sized monitor, modifying (or buying) a keyboard to have large keys, and having the laptop load up a text editor on startup. Doesn't have to run any paticular OS (probably something more stable than Windows though) and just a simple text editor of your choice. Murphy's Paradox... The more you plan, the more can go wrong, thus the higher chance for failure

Re:You could try...

[isorox]

The more you plan, the more can go wrong, thus the higher chance for failure

Really? I think you are lying, you later say

Murphy's Paradox... the more you plan, the more can go wrong, thus a greater chance of failure.

This would probably get you started...

[JHMirage]

Big Keys Plus Keyboard [it4kidz.co.uk]

I found it by searching google for "really really big keyboard" ... no joke.

DOnt take this the wrong way

[Unknown Poltroon]

But look at those big keyboard style things that they try to use to teach chimps language. THe usually seem to be a big wall mounted thing with large keys to make it easy to press. Maybe you could find out where/how they get those made. Im guessing theyre modified from some other use.

Also, just dont think computer. Perhaps an old fashoned keyboard typewriter with bigger buttons glued on it or something. Morse code? Scrabble tiles?

You want a computer; here's why.

[orthogonal]

I'm not totally against doing it with a computer with a modified keyboard, but that seems like overkill when all I want is really a 'video typewriter'.

No, you want a computer.

Why, you ask? So that you can get some sort of predictive typing interface. You'll probably also want something that allows easy one or two key selection of common words and phrases.

That way your grandmother won't have to type as much, or feel self-conscious as
P E O P L E
W A I T
F O R
H E R
to laboriously type out sentences which they've probably already guessed.

Suggestion: predictive typing based on words already typed, with a completion list mapped to a meta key and some other key, and a special meta key that pops up a list of words and phrases, each mapped to a single key:

A - "Hello"
B - "Goodbye"
C - "Visiting hours are over, you annoying cretin"

Ok, maybe not that last one.

If she's especially immoble, you might even use a two button mouse, and some Huffman encoded alphabet that includes stock words and phrases. While learning the Huffman encoding might be laborious, this could be made considerablly easier with large on screen prompts:

> Press mouse button one to select any of "A E I O U", press mouse button two for any other letter or word.
> You pressed mouse button one. Now press mouse button one again for the letters "E" or "A". Press mouse button two for "I O U" or to start over."
> You pressed mouse button two. Press mouse key one for "I". Press mouse button two for "O" or "U" or to start over.
...

Touchscreens?

[Anonymous Coward]

If you look hard enough you can find used 15" touchscreen CRTs for fairly cheap. Of course, you can buy the same things new, or with LCD displays, or as kits to add to an existing CRT or LCD. You could get one or two of touchscreens hooked up and have a virtual keyboard as large as you want. Of course this may require writing you own virtual keyboard software to get the sizes you want, and you probably should provide some sort of click or beep or other feedback, since you lose the tactile feedback by chooseing touchscreens.

That might all be too much work and is probably overkill for your situation, but it's an option you may want to consider if you haven't already.

What you want to do is....

[Captain Pedantic]

Have something like what Steven Hawking [mchawking.com] uses. It shouldn't be too complicated to build either.

What I can envisage is something that builds the words on screen, and outputs them to something like Festival [ed.ac.uk]. You could script this yourself with perl or python or something. Something like a Toshiba Libretto [amherst.co.uk] would be the perfect form factor.

The biggest problem would in fact be data entry. Obviously, any standard keyboard's keys would be too small to be usable, and any keyboard with 2" square keys would be too big. So the best bet would be to pry off the 80 odd existing keys, and replace them 10 to 20 large keys (making them is an excercise left to the reader), and set up some kind of key chording. If you get hold of a word list (and add any personal words, ie a names list, etc) you could also set up some kind of type ahead scheme.

All in all, very doable, and fairly inexpensive.

Stephen Hawking!

[Sepper]

From the description, i immediatly thought of professor Hawking... He suffered from disability and reduce mobility like the one you describe...

You might want to check is web page [hawking.org.uk]

Why a keyboard?

[Wuffle]

I remember quite a while ago seeing this really big rollerball mouse made by Microsoft that was designed for children. Maybe you could hunt one down (MS site has nothing on it that i could find) and use that in combination with some sort of on-screen keyboard.

Some ideas

[MalleusEBHC]

Since you say that she doesn't have enough motor skills left to write, it seems to me that a better idea than making a keyboard for her would be to create a menu of all her commonly used sentences. Typing out notes would be much more strenuous. What I have in mind would only need 4 buttons: forward, back, select, and toggle (between the menu of phrase choices and output). The output would just be a buffer containing the last x number of lines you wanted to display. She could use the toggle button to switch to her menu, traverse it with the back/forward buttons, and then hit select to display the message.

As for the hardware, I think this method would be a little easier. Modifying an existing keyboard to create a tech-ish solution would be fairly difficult, but a low tech solution (if you are adept at carpentry) would be to build a wooden box with a hollow bottom to lay over some existing keyboard. The box would have 4 big buttons, each on a spring. The large buttons on the surface would be connected to a rod that would depress just one key. You could tie the 4 keys to the 4 program options (forward, backward, toggle, and select) in your software. Then you just need any old crappy computer/monitor combo.

T9, phrase-based, joystick, ???

[cybermace5]

Couple of ideas here.

You don't want to make it painstakingly slow for her to type out a sentence. That makes it really hard for even an oversized keyboard to work.

A keyboard with 2" keys will be over 28" wide. Moving from key to key will be even more difficult when her arm gets tired. Keyboards are optimized for two-hand use; it's tiring enough using even a regular keyboard with one hand. (Stop it! This is serious!)

A version of T9 input gets around the size limitation; she could operate a 6"x8" pad easily without moving too far. If there was a custom app that let her tree down through word lists, that would be ideal. Say she wants to say "granddaughter." She hits the 4-G-H-I key once and a pointer scrolls to the G's. Then she hits the 7-P-Q-R-S key three times to get to the gr's (a list of perhaps half a dozen words). She could hit the 2-A-B-C key once to narrow it down further, or use a scroller wheel to select the right word. If a word does not exist in the database, she can enter a non-matching mode to tap in the word so she can use it later.

Another method, if she has even less dexterity, is a joystick or wheel that can scroll through letters and words, perhaps in a directory-like fashion as above. Only requires two basic movements and a button press, and hardware is easily custom-built. Common phrases can be added, or even custom mad-libs type templates for common conversation topics, requests, etc.

Hope this helps in some way!

Re:T9, phrase-based, joystick, ???

[cybermace5]

No kidding, every time I'm forced to type on my phone, it feels like I can't use half my body and the other half doesn't work well either.

Isn't funny, really. When using my phone to type, I can sympathize with how difficult it must be to always communicate with these kinds of methods, when speech, typing, sign language, and writing are out of the question.

Re:T9, phrase-based, joystick, ???

[aberson]

I can't remember the name, and google isn't behaving, but a while back there was something where you dragged your mouse to the right over the letter you wanted to choose. All letters were represented, but in different sizes depending on how likely it was that it would appear. Coupling that with a joystick would be perfect.

Re:T9, phrase-based, joystick, ???

[aberson]

found it - DASHER.
on slashdot here [slashdot.org] and here [slashdot.org]. lotsa fun, downloadable demo.

Re:T9, phrase-based, joystick, ???

[darqchild]

i experimented with the java applet,
it's definately not suitable for somone with a physical disability.
the algorithms for statistically determining the next letter were great, and i think it could be applied elsewhere, but i think this was a poor implementation

"Locked In" Syndrome

[baz00f]

There was a fascinating article in the Jan 20? New Yorker magazine about the ongoing attempts to establish communication with patients who have diseases that render them ultimately "locked in"- they have little or no discernable responses to outside stimuli, but are most likely completely aware. There's a German guy who was featured in the article who has some of the most advanced non-invasive brain monitoring equipment for patient use. He tries to train the patients to modulate frequencies and amplitudes using biofeedback. Amazing what you can accomplish with just binary "Yes, No" responses. Even at about 0.1 Hz...

The journalist relates the story of Jean-Dominique Bauby who was magazine editor and suffered a stroke in his forties. He was completely paralyzed except for a blinking eyelid, yet he was able to write a book "The Diving Bell and the Butterfly: A Memoir of Life in Death" [amazon.com]

use Perl;

[zobo]

There was an interesting presentation [oreillynet.com] at last year's OSCON by someone who developed something like what you describe in Perl/Tk for a quadriplegic friend.

low-tech approach

[jon doh!]

if you're willing to do something in the interim, my wife's grandmother had a plastic coated sheet of paper she used when she was in the hospital and couldn't talk. It was divided into grids and had pics and words for common phrases such as "i'm tired", "i'm hungry", "it hurts.. (then a drawing of the human body for her to point to)", "i'm thirsty", lots of others. they actually had it at the hospital, but it would be easy to make one up. maybe several with different sets of phrases even..

Re:

[account_deleted]

Comment removed based on user account deletion

Dasher

[Roadmaster]

Dasher was featured on slashdot a while ago. "Dasher is an information-efficient text-entry interface, driven by natural continuous pointing gestures. Dasher is a competitive text-entry system wherever a full-size keyboard cannot be used". It has two features that are important to your situation: one, it has predictive behavior, meaning that it sort of guesses what you want to write and makes it easier to say "that's exactly what I meant", all this without losing the ability to input stuff even if dasher can't guess it; and it doesn't require a keyboard. You could even rig some sort of visual tracker so the user won't need anything but her eyes.

Check out Dasher here [cam.ac.uk].

Big Keys Keyboard

[sigwinch]

The Big Keys Keyboard [ergo-2000.com]. It has 1 inch square keys. It is advertised as helpful for "Cerebral Palsy, Motor Neurone Disease (MND), Multiple Sclerosis (MS), Parkinson's Disease, Upper Limb Disorder (ULD), Autism, Downs Syndrome, Learning Disorders, Severe Learning Difficulty (SLD), Arthritis, Stroke, Impairment of Motor Skills, Poor Sight or Partial Sight / Visual Impairment, and Rheumatism". Price is $157.

They also sell a programmable foot switch [ergo-2000.com] with a keyboard interface for $120.

Stephen Hawking

[FosterSJC]

I do not know how serious "seriously impaired" is. But even a large keyboard may require too much mobility/flexibility to operate efficiently. While it does not seem from your post that her condition is as bad as Hawking's (ALS a.k.a. Lou Gherig's Disease (sp.?)), she may benefit from an interface similar to his.

According to this old write-up [hawking.org.uk] on Hawking's website, he uses a simple DOS interface. A cursor moves across the screen (through the letters?), and he stops it on the desired letter with a click of a button. Now, this could be improved upon easily if your grandmother has slightly more mobility, though it requires some reaction time. Add word-guessing software (and sentence guessing) that learns her most common words to help speed up text entry, as per the suggestions above. I envision a two button device... a hacked mouse for example... where the left button selects the letters from a scrolling cursor, and the right button selects the words that pop up as suggestions simultaneously.

A cursor scrolling through the letters, stopped on "G"... "A" was entered first:

A B C D E F G etc...

She enters: A G

Suggestions List: (pops up under the scrolling cursor, so she can continue to enter letters if she likes, as the suggestions narrow)

AGE

AGO

AGORAPHOBIA

- - - - - - - -

AGE COMES BEFORE BEAUTY.

AGED BEEF TASTES BETTER.

etc.

As she becomes accustomed to the software, you can gradually increase the scroll time through the letters; and, as she enters more and more text, the system will get better at guessing what she will say and rank the probable selections higher in the list. Also, depending on how many buttons she can use (2 is quite enough), you can add certain functions to combinations of clicks. For example, Hawking lacks an "undo" button. Here, you could make it 'right click - left click - right click' in relatively quick succession. Or, to switch to numbers and punctuation, you could program it so that she pressess both buttons simultaneously, or set it to another combo, etc.

Finally, a quick google shows a project [radiophony.com] working on open source (albeit VB) software to improve upon Hawking's interface while keeping in mind the poor mobility of ALS victims.

Speech Output Devices

[Anonymous Coward]

shameless plug: Prentke Romich [prentrom.com] makes dedicated speech output devices. Pre-stored words and messages can be stored and retrieved efficiently. Call the 800 number and they will put you in contact with a local speech-language pathologist (also a company rep) who can help you choose the correct technology and device. /shameless plug

Keyboard

[Op911]

Your sentiment in trying to find your grandmother a keyboard to communicate with is admirable but I think that perhaps you might do better to speak to the speech pathologists at the institution where she has been hospitalized and is receiving rehabilitation. The problem is that a left middle cerebral artery territory stroke (of which you are describing a partial territory stroke given preservation of comprehension) is that it isn't just the motor functions with the right hand that are destroyed, but the actual LANGUAGE areas as well... meaning that not only can she not move her mouth, but the part of her brain that used to deal with finding the right words to express a concept are also gone. The result is that in many cases such patients not only are unable to speak, but also are unable to write (and presumably also unable to type). Your speech pathologists may be able to help provide you with alternate forms of communication with pictureboards etc which will likely be cheaper and more workable than oversized keyboards which she may be able to use anyway regardless of motor limitations if her expressive language areas have been destroyed by the stroke.

Ideal device

[csmiller]

There is a device which is idea for this, unfortunatly I can't remember what its called. However, it is shaped a bit like an egronomic trackerball., with no ball, and 5 buttons under where your fingers naturally lie. The device is normally right handed, but there probably are left-handed versions. I remeber a PDA about ten years ago having one, as well as a regualar keyboard.

In use, you press a combination of buttons for each letter you want, the combinations are chosen so that they resemble the glyphs for each letter, say X is all but middle, J is middle and thumb (both are of thse are based on the end points), etc.
I've used one before, and eventaully could learn how to get it work, but I fimd a keyboard far easier.