Making the Switch

by Alyssa Quintero on March 1, 2008 - 3:58pm

QUEST Vol. 15, No. 2

For Salome McCaffrey of Gulfport, Miss., four small fiber-optic switches have opened the door to a whole new world of mobility and communication.

Salome, 24, who has spinal muscular atrophy and almost no independent movement, spends at least 16 hours a day on her computer surfing the Internet, sending e-mails, playing games, writing stories and painting — none of which would be possible without her switch system.

Salome and Rucker
Salome McCaffrey of Gulfport, Miss., is grateful for the four fiber optic switches she received from Rucker Ashmore (right), president of Adaptive Switch Laboratories. McCaffrey, who has SMA, simply breaks a light beam to operate her wheelchair and computer. She currently corresponds with more than 200 people nationwide via e-mail and the Internet.

“It opened the world for her, and now there’s nothing she can’t do,” says Debbie McCaffrey, Salome’s mom.

Salome corresponds with people from all over the country, seven days a week. When Hurricane Katrina hit Gulfport in August 2005, 277 people tried to reach her via e-mail and the Internet to make sure she was all right.

Prior to getting her switch system, Salome used a standard joystick to operate her wheelchair and a regular mouse to use her computer, but she found it increasingly difficult, and “always had to stop and rest.”

“She had limited use of her wheelchair and laptop, and she would get very frustrated,” Debbie explains. “It was horrible for someone that intelligent to be bound up.”

A wish come true

In 2001, after attending a local presentation on switches that included equipment from Adaptive Switch Laboratories, Salome wrote a letter to the Make-a-Wish Foundation, requesting the chance to meet ASL’s staff. Instead of a trip to Disney World, she wanted to “meet the man who could fix it so that she’d be able to work her wheelchair and operate her computer.”

Salome’s wish came true — she visited the ASL headquarters in Spicewood, Texas, where she met the staff, received the four-switch system and learned how to go.

“She took off the first day we got the system,” Debbie remembers. “We went to the mall to test the system, and she left us. Then, at a Sam’s Club, she took off and went up to a man who was in a manual wheelchair, and she asked him, ‘you wanna race?’ It was amazing that she became that independent in just a day.”

For Salome, the learning curve was minimal. It took her about a week to master the system for both her wheelchair and laptop.

“She didn’t need our help anymore,” Debbie recalls. “She wanted to be able to do it on her own.”

Salome’s four fiber-optic switches — each the size of the head on a straight pin — take up a 1-inch span on her wheelchair tray.

While in her chair, she uses her long fingernails to break the beam for each switch and drive the chair. When she’s in bed using her computer, she uses her thumb and index finger to slightly move a small cocktail fork to break the light beam and activate the switches. The switches are so sensitive that even a piece of dust or a stray hair can activate them, so Salome is careful to keep them clean.

Unfortunately, the interface that allowed Salome to drive her chair somehow was lost during Hurricane Katrina and the family has not yet been able to replace it. Although she again needs someone else to drive her chair, the switches allow her to control its tilt and recline features.

When operating her computer while lying in bed, the switches sit in a makeshift plastic holder on her stomach. Debbie explains that Salome’s head is tilted upward while she’s on her back. Her hand is folded into a fist and folded back at the wrist. She then moves her hand in a rocking motion to activate the switches using the small fork.

“Most people don’t realize that their children can do a lot more than they’re doing, and it’s because they don’t have the means to do it in terms of the adaptive equipment,” Debbie explains. “The fiber optic switches are awesome, phenomenal.”

In conjunction with REACH interface software, Salome types using one of the REACH on-screen keyboards in scanning mode. She also activates three switches that allow her to hit enter, move left and right, and move up and down.

To say that Salome’s life changed the day she started using her switch system is quite an understatement. Today, she loves to draw, paint and write stories on her computer, and she especially loves interacting with people all over the country via her computer. And, it’s all possible thanks to four tiny switches.

Switch defined

Jack Hurst
Jack Hurst of Marietta, Ga., has ALS and uses a single-switch scanner that’s operated with an EMG (electromyographic) switch. The switch is attached to his face and reads the impulses from his jaw muscle to drive his power chair. Hurst flexes his jaw muscle to activate the system, and bites down and holds when the indicator light reaches the desired selection.

Switches enable users to direct computer or wheelchair operations by means of a single action — such as the tap of a finger, chin or toe.

They’re a gateway to maintaining and enhancing independence and freedom for people with neuromuscular diseases who can no longer type effectively on a keyboard, click a mouse or use a joystick to drive a power wheelchair. Switches enable them to perform the same functions with less fatigue.

Switches come in all shapes and sizes, and the kind you select depends on what you want to do and how much strength you have to do it.

“If someone with muscular dystrophy is getting to the point where they realize they’ve lost function, we try to show them that they can have independence with driving and using a computer by changing from a joystick to a switch,” said Lisa Rotelli, vice president of Adaptive Switch Laboratories, which specializes in providing power mobility options and computer access.

In order to use switches to run a wheelchair, computer, communication device or environmental control unit, the device must have a switch interface that connects the switch and enables it to function.

Switches feature a wide range of technology, from simple plug-in buttons to eyegaze systems that track eye movement to activate a selection. In these systems, users typically wear a dot sticker on their forehead or eyeglasses, while a special camera tracks the dot and controls the computer according to the person’s head movement.

Switches can be attached to any part of a wheelchair, so you can use your head, foot, toe, knee, trunk or shoulder to send signals to the control box.

For example, people often use head arrays with switches in the headrest to operate the wheelchair’s drive functions, leg rests, seat elevation, and tilt and recline.

One switch, two switch, three ...

ASL proximity switches
Proximity switches don’t require direct touch, which can aid people with muscle weakness. Companies like Adaptive Switch Laboratories and Switch-It manufacture single proximity switches, head arrays with proximity switches, and proximity switch systems to operate wheelchairs, computers, AAC devices and environmental control units.

With switches often comes scanning. Scanning software highlights rows or sections of choices on a screen in sequence, and the user activates the switch when the correct choice is highlighted. Scanning can be used to drive a wheelchair or type a sentence.

Single-switch scanning generally requires less physical control and may be less tiring; however, it reduces scanning options and leads to a slower rate of input. On the other hand, multiple-switch scanning provides a wider range of scanning options, and increases input rates and efficiency.

While switch scanning may be slower than using a regular mouse or joystick, “for some, it’s the difference between driving and moving or not at all,” said Byron Guisbert, ASL’s director of education.

What’s available

For people with neuromuscular diseases, many experts agree that it’s beneficial to use switches that require little physical movement or strength, including fiber optics and proximity switches.

Steven Nichols
After using a standard joystick and head array, Steven Nichols of Clifton, Va., now drives his wheelchair via a single-switch scanning system. Nichols, who has ALS, has some movement in his legs, so he activates the system and selects the various drive options and wheelchair functions by squeezing his knee against a red button switch.

Fiber optic switches consist of tiny fibers that are extremely sensitive to even the slightest touch. You don’t press a fiber optic switch, but break an infrared beam of light. These switches have an adjustable activation range from touch to a quarter of an inch, meaning the user only has to get within a quarter of an inch of the switch to activate it.

Proximity, or “no-touch” switches are activated by body heat when they sense any part of the body in the activation range. For example, if any part of the body gets within an inch of the proximity switch, it will respond.

When a person’s breathing ability is strong and he or she isn’t easily fatigued, a sip-and-puff switch may fit the bill. Sipping, or drawing in a breath, activates one switch and puffing activates the other, telling the wheelchair or computer what to do.

Other adaptations include small dual switches that can be activated by a tongue, nose, chin or finger. A microswitch is a single switch that can be activated with a thumb or forefinger, while an eyebrow switch can be mounted on a hat or eyeglasses and activated by a slight upward movement of the user’s eyebrow. And of course, there are basic button switches that can be mounted in a variety of ways for easy wheelchair and computer control.

What’s it cost?

The costs for switches and interfaces vary, so it pays to do some research. Pricing typically depends on whether you’re looking for multiple or single-switch options, and on the switch interface required by the device.

For example, Tash offers a switch-interface joystick ($525) that accommodates four switches. A simple button switch can start at $50, while a head array with four switches from Switch-It starts at $3,500, depending upon the setup and other options. Switch-It offers switch systems with proximity sensors, ranging from $2,000 to $3,500 depending on the number of switches and wheelchair brand.

At Adaptive Switch Laboratories, single fiber-optic switches start at $700, and proximity switches start at $650. ASL specializes in driver control packages (switches, interface, mounting option) that allow operation of both wheelchairs and computers. The packages can help save money because they include both the switches and power chair interface. ASL’s fiber-optic driver-control package with four switches starts at $4,650, and their proximity-switch driver control package with four sensors and the lap tray starts at $4,500.

Planning ahead can save money. Guisbert notes that in order to go from using a wheelchair’s joystick control to one of ASL’s switch systems, the wheelchair controls must include a display screen. If you don’t get the display screen up front when ordering the chair, it typically costs about $900 to buy separately.

Planning for change

Head array devices
You can drive your wheelchair by using your head. Head array devices require adequate neck strength in order to operate the switches in each part of the headrest for effective driving.

With neuromuscular disease, needs change over time, so work with your health care team — physician, physical therapist (PT), occupational therapist (OT) and a reliable rehab technology supplier — to select a wheelchair with expandable electronics and to select the proper computer switch-access method.

Because it takes time to file for insurance and order new equipment, especially for a power wheelchair, it’s important to keep the health care team apprised of any changes in functional abilities, such as difficulty using your joystick. Otherwise the control method may become ineffective or unsafe for you before a new system is in place. And it’s valuable to work with a new control system before it’s required full time.

“You always should investigate other options so it doesn’t become an emergency,” Guisbert says.

Try before you buy

Adaptive Switch Laboratories
Adaptive Switch Laboratories specializes in customized switch systems for operating wheelchairs and computers, including its four-switch fiber optic array package with lap tray. Three switches control forward, left and right movement, while the fourth controls reset, mode change or reverse. The system also includes the power chair interface and tray driving platform.

Once you know that you need switches to operate your computer or wheelchair, start with your local MDA office’s equipment loan closet to borrow equipment that may suit your changing needs. (Local offices can be reached by calling 800-572-1717.)

While doing product research, be sure to contact companies that specialize in switches for help and guidance in selecting a new switch-access method. For example, consumers can borrow anything manufactured by Adaptive Switch Laboratories for a free 14-day equipment trial, says Guisbert. ASL simply needs to know your wheelchair’s electronics and the type of computer you’ll be using in conjunction with the wheelchair controls.

People with disabilities also can borrow devices from local AT lending libraries, as well as from equipment loan programs offered through the State AT Act projects (see “AT Funding Challenge,” January-February 2007).

And, you can visit the Alliance for Technology Access Center in your area. The centers, which provide no- or low-cost AT assessments and consultations, allow people with disabilities to borrow and try a variety of AT devices and software.

(800) 322-0956

Adaptive Switch Laboratories
(800) 626-8698

Alliance for Technology Access Centers
(707) 778- 3011

Enabling Devices
(800) 832-8697

Origin Instruments
(972) 606-8740

RJ Cooper & Associates
(800) 752-6673

State AT Act Projects
(703) 524-6686

(800) 376-9888

(800) 463-5685

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