Stories at the Dentist

Details of a current research project relating to dental healthcare is  being carried out by the University of Dundee AAC Research Group. The “Stories at the Dentist” project isn’t specifically about autism but would seem to be relevant. Dental treatment for people on the autistic spectrum can be problematic due to the high degree of communication needed between the dentist and the patient e.g. seeking consent from patients during consultations. For those with sensory issues touch/sounds/taste/sight lights etc.  involved in treatment can be overwhelming and distressing.

“The main objective is to create an effective and efficient means of generating personalised social stories for individual patients within the dental context. This study aims to develop a computer based communication system to support people with intellectual disabilities to understand dental procedures with the aim of reducing anxiety for both patients and clinicians, and to enable patients to be more involved in the decision making process.”

Visit the Stories at the Dentist project website for full details of this research and to see the prototype of an app used to support the work of this project. They are experimenting with social stories to explain processes involved in treatment and e.g. pictures of dental practice staff to introduce the environment.

Scottish Library Apps

The following Scottish libraries have apps for Apple (iPod/iPhone/iPad), Android and Blackberry devices

How to…time management apps for autism

In reading some of the research studies involving adults on the autistic spectrum, one of the more valuable functions an assistive device can have is to remind the person of upcoming events or the next step to take when tackling a sequence of tasks. Autism can make it harder for individuals to adjust to changes of routine so anything that will provide a pointer to what comes next could be useful. There can be times where people have poor memory and forget that they have important appointments to keep, or you become so engrossed in one particular task that you need some kind of “nudge” as a reminder to move to the next task. It’s no exaggeration to say that there are literally thousands of apps available for smartphones that can assist with time and task management – it’s a very highly utilised category of app for all people.

Clocks and alarms

Most mobile phones, even the most basic kind, have some kind of a clock feature built-in. And where you find a electronic clock you will often find means of settings alarms for alerts at particular times.  You can usually choose what sound or ring tone should be used when the alarm goes off, on some devices you can even choose to play a music track on your device. Also useful is a countdown timer – say you have a particular task that is supposed to be carried out within a certain amount of time, then set a countdown alarm and an alarm will go off after that particular amount of time has passed.

Using Clock app on iOS (iPhone/iPod/iPad)

Android alarms

On Android the clock app may vary by who manufactured your device, you may have an analogue clock face or a digital clock display and often the choice of which kind you prefer. A clock is usually displayed on your home page on your device (the screen you see when you first start it up). On some devices you can set alarms via tapping on the clock.

Calendars and event reminders

Similar to clocks for time, devices will usually have at least a basic calendar feature to show the date and days of the month. On smartphones calendar apps become particularly powerful when you are able to add your own events to their calendar for reference and optionally receive notifications and reminders. This can be an excellent way of planning for the future by making sure you don’t miss something important.

In the calendar entry for the event itself there may be space to enter names/addresses/photos, anything of relevance to that event or venue. For visual learners you may wish to add photos of people you are due to meet or buildings you have to visit. For events taking place at a different location you could include transportation/journey details in advance so that you don’t have to figure that out on the day when you may be more stressed. For events in the calendar you can add alerts that pop up something visual on your phone to remind you and/or play some sound.

Google Calendar

Using Calendar app on iOS (iPhone/iPod/iPad)

Details of how to use the Calendar app on iOS devices can be found in your “User Guide” document – downloadable from the Support:Manuals section of the Apple website.

See also

Review of Using iPads in AAC – Augmentative Communication in Practice: Scotland

“Established in 1991, Augmentative Communication in Practice: Scotland (ACiP:S) is a national network that links together specialist AAC services and professionals; children and adults who use AAC (and their families); statutory services and voluntary agencies; and that provides resources, information and support.”

In 2012 ACiP:S had a study day, “Using iPads in AAC” and the papers from that day can be downloaded. What’s useful is that they have many case examples of using particular apps with different people and seeing pros and cons for each individual.

A common finding was that tablet devices (compared to smaller iPod devices) were preferred for children just starting to learn language skills and those with poor dexterity as iPads have larger screens making them easier to use and read but at added expense and they are heavier to hold if no surface is available to rest the tablet on. Accessories used for making devices easier to hold for children and to provide stands for working at a desk included the Big Grips cases.

App reviews

Sally Millar of CALL Scotland has a good review of a selection of apps in her paper

Simple Photo and Video Apps to Support Communication [PDF]

List of apps used in paper case studies

Here’s a list of some of the apps that this group has documented in case studies.

CALL Scotland, Personal Communication Passports and webinars on using technology for inclusion

CALL Scotland focuses on expertise and training in communication and assistive technology for children.

Personal Communication Passports

CALL has done some very interesting work on creating support for Personal Communication Passports – Person-centred booklets for those who cannot easily speak for themselves.

“A way of making sense of formal assessment information and recording the important things about a person.”

They have helpful support materials such as free templates and how to print the documents. CALL Scotland also run on-demand training courses.

They are currently working on a new iPhone/iPad App, you can register your interest in the Personal Communication Passports app to be notified when it is released.

Webinars

CALL is  currently providing a series of webinars that include demonstrations of using particular software/apps with a focus on promoting inclusion in your organisation.

These are very helpful as you can see demonstrations made by those with a high degree of familiarity of the software including representatives from the companies behind the software,  and ideas for how to use the apps in practice. Also more general help on inclusion topics such as Dyslexia.

How to…show a banner of text or speak short phrases using Android (bus journey example)

This is a worked example to try and find an example of an approach that might help with existing problems giving a destination on Glasgow buses for those with travel cards (see Pros and cons of autism alert cards and travel cards for details).

In computing we normally call text that’s to be displayed in large lettering a ‘banner’.

So I did a search on the word ‘banner’ on the Google Play App store. And though not all match our intended use there are some that would seem to do what we want. Now if you’ve never downloaded an app from an App store what you very commonly find is that apps for free may have some advertising within them that may or may not be a barrier in what you want to do, mostly but not always paid apps don’t usually have adverts and will often have a larger range of things the app can do – we call these ‘features’.
N.B. If you have photo-sensitive epilepsy be very careful if you try these banner apps out. Most of them will, as a demo, scroll text quickly, some will flash or blink.

I was specifically looking for an app that might provide a banner of large text in clear type that could be read from a distance and in low-light conditions. This could mean that your phone/tablet could be held up to e.g. the bus driver to show what destination you want. Because place names can be long and won’t always all fit on the screen the text needs to be able to animate or scroll so the entire name can be shown. To get the maximum amount of width for text it helps if you turn the device on it’s side with the longer edge at the bottom, shorter on the sides i.e. ‘landscape mode’.

The following sample can display text or can speak short phrases. N.B. There are literally thousands of apps in the app store, I’m only using this as a worked example.

This particular app is free but be aware there is a little bit of advertising. This app allows for up to 15 phrases to be stored and reused though you can change them at any time. You very simply tap on one of the rows of text and type in what text phrase you want to use. In the settings for the app you can change the size of the text, scroll speed and background and foreground text colours, I’ve chosen a blue background and white text in my demo.

Banner text

You tap on the letters ABC in the middle of the screen to indicate you want to display a banner in solid lettering.

Banner selection of phrases

To display a banner, tap on the letters ABC in the square to the left of the text phrase you want. Screenshot shows a part near the beginning of “Sauchiehall Street”. The text fills the entire width of the screen and then scrolls the phrase continuously until you tap the screen again.

Sauchiehall Street

Voice

You tap on the picture of the loudspeaker to indicate that you want to use text to speech. Then you tap on one of the rows of text and type in what you want spoken. When you are ready to have the device speak on your behalf just press the loudspeaker next to whatever phrase you want to speak.

If you were using the same destinations repeatedly then using the app would be quicker as the text would already be entered so you would only have to tap the square ABC. This app will use the voice you have selected in your accessibility settings (see How to…Scottish voices for text to speech on Android for more details)

Voice Demo

I’ve recorded sound output via the Scroller – LED & Voice using CereProc Scottish voice ‘Heather’. I’ve just tapped through a list of names:

  • Trongate
  • Dumbarton Road
  • Sauchiehall Street
  • Saint Georges Cross
  • Wilson Street

Download the CereProc Scottish placenames [MP3]

How to…Scottish voices for text to speech on Android

Searching for synthetic voices for reading out text via Text-To-Speech (TTS) or speech synthesis systems found a Scottish company called CereProc. For a number of years they have been providing voices for desktop computers and now they have released versions that work on the Android platform for tablets and some of the newer and higher specifications of smartphones. This technology has come on in leaps and bounds in recent years and although not perfect and pronunciation may be a bit off for some words,  it’s certainly improving over time and may be an option for anyone wishing to have a device speak on your behalf.

There are some limitations like the hardware volume of the device will limit how loud the spoken sound may be which might not be loud enough in busy environments.

I’ve recorded examples of the synthetic speech that can be used on Android see the demo at the end of this post.

Tech note: In my tests I’m using a Google Nexus 7 tablet which you can currently buy for around £200.

  • Go to Settings
  • Go down to the System section
  • Choose Accessibility
  • Choose Text-to-speech output
The first time you access it you might need to install a text-to-speech engine – on the Nexus this provides a basic “Google text-to-speech” engine with a range of English (UK or US, French, German, Italian and Spanish. However you are free to choose any other text-to-speech engine you wish. 
CereProc’s paid for voices currently cost £1.19 each

N.B. The way the Glasgow voice is presented on the Play store it seems to be intended as a “jokey” example. This is a pity and don’t let that put you off as it does do an surprisingly good job of pronouncing in the Glasgow Scots dialect. In our example of Pros and cons of autism alert cards and travel cards one point raised was

“…With synthetic speech it’s important that the ‘voice’ shouldn’t lead to the person being ridiculed in public…”

Maybe more middle-class people might find the Idyacy Dodo Glasgow voice humorous but if you come from a more working-class area of Glasgow using some of the ‘posher’ Scottish voices like Stuart might make you the odd one out and possibly lead to mockery. So a lot depends on who you are surrounded by and the situation. Having the ability to switch between formal/informal voices easily could be an advantage in e.g. the workplace or interview situations vs. at home.

Here’s an example of how your text to speech section might look if you’ve installed a few different voices.
Android Accessibility texttospeech-2013-09-19-12-43-04
Android Accessibility text to speech

On Android there is a device-wide “TalkBack” option which is really intended for blind or low vision users – this will help navigate the device by reading out app names or notifications etc. However, Android doesn’t quite seem to be at the point where any text within any app can be dictated, it depends on whether the app developers have added support for it. So to really make use of installed voices you need to look for apps that support text to speech.

Audio Demo

Audio recording from the output of the tablet device speaking some sample text using CereProc Scottish Voices for Android [MP3].

See also How to…show a banner of text or speak short phrases using Android (bus journey example)

App helps children manage their health care routines

App helps children manage their health care routines.

App from Vanderbilt University. This is a free app at the moment but may have a charge in the future. They provide a sample (for children) about visiting the doctor which includes photos of e.g. getting your height and weight taken. Although this app was developed for children It’s generic so you can add your own routines quickly, it’s very simple to use and is good for breaking larger tasks into a sequence of smaller tasks or steps. Here’s some screenshots of an example of my own showing a visit to the autism team, I just used photos but you do have the option to use video instead.

    1. Choosing a routine

Choosing a routine

    1. Showing steps in the task
      If there are more steps than will fit in the screen then you’ll see arrows to let you scroll to them.
      Showing steps in the task
    2. Completing tasks
      You just touch the square when you’ve completed a task. It’s easy to see which steps have still to be done.

Completing tasks

Scottish Intercollegiate Guidelines Network (SIGN) and apps

“The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based clinical practice guidelines for the National Health Service (NHS) in Scotland. SIGN guidelines are derived from a systematic review of the scientific literature and are designed as a vehicle for accelerating the translation of new knowledge into action to meet our aim of reducing variations in practice, and improving patient-important outcomes.”

If you want to know about a particular health condition the guidelines can be very helpful for giving you an overview and an indication of potential therapies that may be available. For those in Social Care/Work they could help you understand treatment plans of your service users e.g. if your autistic clients have comorbid conditions such as epilepsy or depression. There are over 100 guidelines available and the guidelines are provided as downloadable PDF documents.
There is a free SIGN Guidelines app [Android]  and  SIGN Guidelines app [Apple]
They currently have one guideline and an app specifically for autism in children.  

Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders [Guideline 98]SIGN Autism patient guide

Review: The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies

The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies [PDF]

“Abstract. Personal digital assistants (PDAs) offer task management and organisational features that may be utilised to help people with autism spectrum disorder (ASD) function more successfully in the workplace. Additionally, onboard video cameras and addon software applications provide rich opportunities for the implementation of personalised vocational supports for individual workers. This article reports on three cases of workers with ASD who have been trained to use Apple iPod Touch PDAs as vocational supports in the workplace, resulting in improved functional performance and reduced behavioural challenges.

Keywords: Autism, assistive technology, cognition, occupational therapy, personal digital assistant, vocational rehabilitation”

From the Journal of Vocational Rehabilitation 37 (2012) 75–85

Regarding Apple iPod Touch devices:

“…These devices can be carried in a pocket, on a belt clip or on a necklace lanyard, making them appropriate for workers who must use their hands on the job…”

They used the devices to provide the following support

  • task reminders
  • task lists
  • video-based task-sequencing prompts
  • behavioral self-management adaptations
  • way-finding tools, and other supports

One example from the study was a successful pilot with Jeffrey who was having difficulties in his job in a fast food environment. The iPod was worn in a protective case on a belt clip. An occupational therapist worked with Jeffrey to set reminder alarms for tasks, different tasks were given different sounds with additional audio recordings of task notes that could be listened to for extra reinforcement. They didn’t need to use any additional apps, they just used the built-in apps like “Clock”.

You can find details of how to use the built-in apps by going to Apple’s website and downloading the appropriate iPod manual (these are usually PDF files)

e.g.  iPod touch user guide for iOS 6.1 Software (June 2013) [PDF]

Another trial was Lily, a 20-year old woman with Downs Syndrome and ASD. She was employed in a housekeeping duties role.

“…The Storykit application was downloaded from the Apple iTunes Store in order to build verbal and picture-prompting task lists, replacing Lily’s laminated paper prompts…Storykit allows a user to easily create talking picture books…

…The device led to improved work performance, fewer behavioural challenges, and a marked decrease in telephone calls for help to her job coach or mother during the workday.”

In the report they do acknowledge

…It is important to note that each of the three workers had functional cognition, vision, hearing and manual dexterity sufficient to interact with the iPod Touch without the need of accessibility adaptations. Many people with ASD have cognitive, sensory or motor conditions that would make utilisation of such a device problematic…

Once again this highlights how tailored use of any device needs to be to the particular impairments of the individual.

Interesting emerging new role for Occupational Therapists in supporting setting up electronic devices and installing and using appropriate apps. Particularly encouraging is that in each of the three case studies the use of the iPod device helped people complete work tasks with more autonomy and with less supervision in the workplace – one of the factors affecting employment. Some professionals are nervous about technology because they think it will be used to replace their existing jobs, what you can see from a study like this is just how important and valuable their existing skills are if they adapt to utilise new technologies as tools to enhance their roles and make better outcomes for their clients and reduce the stress on clients’ carers.

“…This is an exciting time for anyone in the fields of education, physical rehabilitation and vocational support, where we are seeing a long-awaited merging of consumer products and assistive technologies for all…”

More details about some of the extra apps used:

App: Storykit

So here’s an example of techniques based on a paper-based system being successfully transferred to a hand-held electronic device. Storykit is an iPhone/iPod app, a project of the International Children’s Digital Library (ICDL) created by the University of Maryland’s Human-Computer Interaction Lab.

App: VoCal

VoCal Voice Reminders By GZero Ltd. “…VoCal fuses a Dictaphone, Calendar and Alarm system into one…”