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Use Your Head: Improve Quality of Life with Hands-free Computer Access

We hear a lot about the benefits of using computers. Online education opportunities, work from home, communication with friends and family through social networking sites such as Facebook, and e-mail are all commonly available and can add to our quality of life. But for someone recovering from a stroke, these opportunities might seem far off - especially if using a keyboard and mouse is no longer physically possible. The good news is that there are alternatives to the standard keyboard and mouse that do not require hand movement. Depending on a person's abilities, at least three possibilities are commercially available:

  • Speech recognition.
  • Head tracking.
  • Eye tracking.

We'll touch on speech and eye technology and fully explore head tracking.

Speech recognition software such as Dragon NaturallySpeaking can greatly reduce the amount of typing required to enter text into a computer. If the user speaks in a typical manner without speech impediment, speech recognition can be a good way to enter text into a computer. While it is possible to use speech recognition as the sole means for accessing a computer (no keyboard or mouse required), most people find this to be a difficult and demanding choice. Using speech recognition in conjunction with another computer access method often works best. Stroke survivors who have good speech and some hand or head movement will find speech recognition a helpful option for improved typing speed.

Eye tracking systems use eye movements to enter text into computers instead of a keyboard. If eye movement is the only reliable movement that you have, then accessing a computer via eye control might enable you to achieve your computer-based goals. Unfortunately, this option can be pricey. Reliable eye tracking systems such as ERICA cost upwards of $7,000. However, if you have difficulty speaking and need a speech-generating device (SGD) to communicate, insurance might provide coverage of this technology. While eye tracking sounds like an easy way to control a computer, many people find it difficult to do for long periods because we use our eyes for purposes besides looking at what we want to select. These other eye functions compete with controlling the computer. That said, eye tracking technology continues to improve and offers people with few computer access options a path to independent computer use.

Head tracking technology is the middle ground between the two options presented above. Head tracking systems convert head movement into computer cursor movement. Move your head to the left and the computer cursor moves to the left. Special software called an on-screen keyboard enables a person to select keys by pointing the computer cursor at a desired letter and then type the letter into most computer programs. The most common way of selecting a desired letter on an onscreen keyboard is to hold the cursor steady over the letter for a predetermined amount of time until the letter is activated. Using a head tracker and an onscreen keyboard enables a person to have independent control of the computer - no keyboard or mouse is needed. The cost and capabilities of these systems vary, with complete systems available between $500 and $2,000.

At first glance, head tracking products seem to be very similar - and in some ways they are. Several of the available systems use built-in infrared lights and a camera to track the movement of a sticky-backed reflective marker applied to a person's head. However, each product offers a unique set of features and software, with some features being important to a particular person's needs.

Take the time to investigate your options carefully before making a decision. It is always good to try a product before investing a lot of money into it. Talk with company representatives about the features of their products and how these features can improve the ease of use of their system for the user you have in mind. Ask therapists what they think about the information you are receiving.

Questions you should consider asking when selecting among products include:

  • How well does the head tracker handle changes in room lighting? Because several head trackers use one or more camera(s) to track head movement, they can be sensitive to ambient lighting. Think about the places where the system will be used and ask product representatives whether the head tracker will work consistently in these conditions.
  • What positions will the individual using the technology be in throughout the day? Many stroke survivors find themselves in a variety of positions such as sitting up in a wheelchair, reclined in an easy chair, laying on their back or on their side while in bed, etc. Make sure the head tracker you are trying can be used in a variety of positions.
  • How does the tracker mount to a computer? Some head trackers attach firmly to a laptop. Other trackers are not easy to mount securely or are better with desktop monitors. Reliable mounting is important because it is likely that the person using the system will not be able to correct for changes in the setup.
  • What features does the head tracker have for making computer access easy? Each head tracker is designed with a specific group in mind. For example, the SmartNav head tracker is a sister product of a game controller and is designed for people with typical head movement skills, while the AccuPoint head tracker is designed for people with limited head movement skills. Company Web sites, representatives and sales materials will help you to find the product designed to meet your needs.
  • Which onscreen keyboard is recommended for use with the head tracker? Is it designed specifically for head tracking? There is a wide variety of onscreen keyboards on the market. Some of them were designed with head tracking in mind, and others were not. For example, the onscreen keyboard built into the Windows operating system isn't full-featured enough to meet the needs of many people who use a head tracker. The wrong onscreen keyboard can make the perfect head tracker difficult or impossible to use. Ask what keyboard the head tracking company recommends and why. Remember, the keyboard is as important as the head tracker - so be diligent in evaluating both of them.

The goal when selecting an assistive device such as a head tracker is to match the user's needs and abilities to the capabilities of a device. A person who wants to check e-mail once a week has different needs than a person who wants to do research on the Web, take classes online or participate in online social networking. For the infrequent computer user, an inefficient access system might cause them the minor inconvenience of spending a little extra time each week to write e-mails. For someone who wants to take online classes or has limited head control, an inefficient computer access method can make their goal unattainable.

Finding the right computer access method can have a huge impact on the quality of life of the person learning to live with the impact of a stroke. Computers provide a wide range of opportunity that might not be available to the stroke survivor through other means. Ask a lot of questions. With some searching, you will find the best that technology has to offer and the benefits it can provide.

By: Thomas Jakobs, P.E., President, InvoTek Inc.
By: Susan Fager, Ph.D., CCC-SLP, Assistant Director, Communication Center, Institute for Rehabilitation Science and Engineering Madonna Rehabilitation Hospital

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"Each product offers a unique set of features and software, with some features being important to a particular person's needs."

Available Head Trackers

  • InvoTek AccuPoint.
  • Madentec Tracker Pro.
  • NaturalPoint SmartNav.
  • Origin Instruments.
  • HeadMouse Extreme.

Each state in the has an assistive technology center charged with helping people find the right assistive device for their needs and abilities. Here is a list of these centers.

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