Shepherd Center’s App Factory Aims to Make Technology More Accessible
App-based technology helps people with disabilities thrive at everyday tasks.
There is a handheld trainer that guides you through exercise programs designed specifically for people with spinal cord injuries. And there’s a discrete assistant that can help you practice calming deep breathing – extra useful when you have post-traumatic stress (PTS) or have sustained a traumatic brain injury. There’s also an app that eases the process of scheduling multiple reminders – for medication times or weight-shifts to prevent pressure wounds if you have a spinal cord injury.
You can find these and about 20 other apps in the Apple App Store for iOS users or Google Play for Android users. They are all innovations that have origi-nated from Shepherd Center’s App Factory, the brainchild of Mike Jones, Ph.D., FACRM, vice president of clinical research and assistive technology at Shepherd Center, and his team. The program’s goal?
“To develop app-based technology that will help people of all abilities manage health conditions and participate more fully in life,” explains Tracey Wallace, MS, CCC-SLP, a clinical research scientist and speech-language pathologist who recently became the project director of the App Factory.
The App Factory’s innovative work is funded by a five-year grant from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) in the U.S. Department of Health and Human Services.
Keeping Up with the Times and Moving Faster to Market
The App Factory is itself an innovation.
“Each year, we reserve part of our grant budget to create contracts with developers and researchers to develop apps,” Wallace says.
This is different in terms of how other federal or privately funded grants are administered. Other grants often last for five years and fund fewer people with a narrower area of research and development, all over a longer amount of time. Shepherd Center leaders wanted to avoid investing in some-thing that would be outdated before it could even get into people’s hands.
“The App Factory model allows us to look at what’s current and what new features and functionality exist in mainstream technology each year and take proposals that will capitalize on the current technology,” Wallace says.
Pitching the idea to the federal government to trust Shepherd Center and its grant partners not to lock in the research and development plan at the beginning of the grant seemed risky at the time, Dr. Jones says. It hadn’t been done before.
“We thought, ‘They’re looking for innovation,’” Dr. Jones recalls. “This was very innovative. You can’t predict where technology is going to go, so we needed to take some risks.”
It paid off.
“After we got the award, we got the call from one of the associate directors of the agency and they said, ‘We love this idea!’” Dr. Jones says.
The App Factory is creative in other ways besides breaking up the grants into mini contracts.
SIDEBAR: APPS DESIGNED FOR ACCESSIBILITY
In addition to academic centers, private businesses can also apply and compete for the contracts. In fact, several tech startups have been developing apps under the program and have been responsible for launching the most apps.
The federal funding enables develop-ers to create applications for smaller audiences with specific disabilities. That work helps meet important needs. However, it’s work commercial busi-nesses might be less likely to undertake under normal circumstances because it is less lucrative.
Lastly, developers are awarded funds for hitting milestones such as making the app available to the public, rather than getting a lump sum of money at the outset. Shepherd Center’s research team found that this increases the likelihood that the technology facili-tated by the grant will get into users’ hands – something very important for fulfilling its mission. As of summer 2018, 22 apps have been published with more than 740,000 downloads, Dr. Jones says.
Because smart devices are so pervasive, developing tech-nologies for them helps make the Factory’s developments accessible to a larger number of people with disabilities, Dr. Jones says.
“You don’t need a separate device,” he adds.
Previously, much of government-funded technology development had been focused on developing show-stopper, big-ticket technologies. Think of a souped-up wheelchair that can climb stairs, says John Morris, Ph.D., clinical research scientist and former App Factory program director.
“Not everyone can afford that technology,” Dr. Morris says. “It's not often covered by insurance, and it's clunky and requires a lot of maintenance. It might satisfy the needs of some people in some circumstances, but what makes the App Factory different is the idea of meeting consumers where they are, in a more direct fashion.”
By making apps, the investment is made in creating computer code to build applications. These apps are then packaged and distributed on already existing platforms like the Apple App Store for iPhones and iOS users or Google Play for Android users. This helps make it easier to get apps into users’ hands because it doesn’t require an investment in hardware or the development of a new distribution channel. Additionally, people already know to go to these online stores when they are looking for ways to streamline their lives.
Shepherd Center and its partners at Northeastern and Duke universities see a need for app development well into the future, Dr. Jones says. “The whole focus is to help people live well – so we can use technology to support their ability to live independently and safely in the community.”
SIDEBAR: APPS DESIGNED FOR ACCESSIBILITY
Shepherd Center and its partners at Northeastern and Duke universities are helping make technology more accessible for people with disabilities through their App Factory. Following is a list of apps that either have been launched and are currently supported and available or under development thanks to funding from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) within the U.S. Department of Health and Human Services.
Currently Available Apps
Assists with: managing stress through diaphragmatic breathing for people with mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD)
Available on: Google Play for Android Wear smartwatches
When people endure stress, they experience the fight-or-flight response. Their heart rate increases and breathing becomes shallow, exacerbating anxiety. Slowing their breathing, particularly when exhaling, helps calm them. BreatheWell Wear assists the user in performing deep, slow, diaphragmatic breathing by providing visual and auditory guidance to pace breathing, including a display of the user’s heart rate in real time. It also provides the user with the option of listening to calming sounds and music or selecting a song from their own music library. BreatheWell Wear allows users to program reminders to practice during periods of low stress to help them perform the breathing technique effectively during periods of high stress.
Core target users include military service members living with mTBI and PTSD, and therefore usability testing is being completed at Shepherd Center's SHARE Military Initiative, a rehabilitation program dedicated to serving service members living with mTBI and PTSD.
Assists with: mobility impairments due to ALS, MS, SMA or high-level spinal cord injuries
Available on: Google Play for the Android platform and supports devices on a Wink network
People need to access and control things in their environment. The Pow!r Mount provides revolutionary freedom of independence to position and interact with equipment such as speech devices, laptops, phones, cameras, tablets, hydration and suction equipment. Including the ability to control things in their home further extends and increases their independence and self-reliance, and impacts their health, confidence and general well-being.
The Pow!r Mount Plus app adds home control capabilities to the Pow!r Mount app, enabling people to control smart devices in their home using their phone or tablet. The original Pow!r Mount app positions and controls the Pow!r Mount,by BlueSky Designs. Both apps can be controlled by directly touching the screen or using accessible switches plugged into the Pow!r Mount’s End Cap.
Assists with: exercise modifications for people with spinal cord injury
Available on: Apple App Store and Google Play for Android
People with spinal cord injury can achieve and maintain a healthy lifestyle by doing exercises shown and described in how-to videos. Users can do these exercises in a gym with the assistance of a trainer or caregiver. Please be sure to consult your physician before beginning any exercise program.
SpeakUp: An SPL MeterAssists with: speaking volume
Available on: Google Play for Android operating systems
SpeakUp is designed for people that need assistance modulating or increasing their speaking volume. The target use population are pediatric patients that have difficulty modulating the volume of their voice and children who have difficulty using a loud voice. The adjustable nature of the application allows it to be used with adults, most notably those with Parkinson’s disease.
Assists with: non-verbal communication
Available on: Google Play for Android operating systems
Speech2RTT® is an Android application that enables people who are deaf, hard of hearing, and non-verbal to communicate with anyone – using their Android smart phone or tablet. It works over cellular networks and for Wi-Fi calling.
Speech2RTT® captions and then streams the text of what is being said, in real-time, between individuals. If a user cannot speak, or opts not to speak, they can type what they want to say in real-time.
Assists with: reminders for people with spinal cord injury or other conditions or illnesses
Available on: Google Play for Android devices
Many people with spinal cord injuries (SCI) often have a tough time with the built-in alarm functions of a smartphone. Unfortunately, the app versions haven’t been much better. Designed for people with full manual ability, many of them are difficult to use for someone with limited dexterity.
Tetra Alarm is set up so you just need to select a box corresponding to a particular time. Tetra Alarm is not only a useful tool for people with SCI, but also for people who have other injuries or chronic illnesses that have affected their memory and cognitive function.
Assists with: spinal cord injury, tetraplegia
Recovery of hand and arm function is often a high priority for individuals with tetraplegia following spinal cord injury (SCI). Evidence suggests that therapist-delivered motor training can improve motor function in SCI, greater than spontaneous recovery alone.
This project aims at developing new training software platform ‘CoTrain’ that works in combination with existing portable hardware to create a device which can be taken home by patients to increase training time between visits. It will also allow the therapist to track their patient’s progress over a period of time.
The prototype software currently runs in Matlab
Assists with: brain injury, memory issues
EyeRemember Wear is a mobile app that allows a person with memory challenges following brain injury to voice-record important information related to individuals in their circle of family, friends and caregivers, and be reminded of the information when they are with those individuals. The app was originally developed for and released on Google Glass and was recently adapted app for Android Wear Smartwatches (currently in beta testing).
iMup: A Body Position Tracker for iOS
Assists with: posture improvement
iMup, is an app under development for iOS devices. It is designed for patients in a hospital setting who need to work toward progressive posture improvements and maintain improved positions for longer amounts of time. iMup works by reading data streamed from a small sensor worn on the user’s body and determining body position based on built in algorithms. Research has shown the more time a patient spends out of a prone position in bed, the shorter their hospital stay. The greater the improvement in position, the more positive the results are to the patient.
Assists with: complex communication needs
PicTalker is a talking photo journal for people with complex communication needs developed for Android operating systems. At completion, the app will allow users to take pictures, videos, and recording of their surroundings and activities. These media files will populate various calendar views to allow for easy access, sharing, and chronological order capturing. This app will allow users to communicate and record their experiences.
Assists with: stroke, one-sided neglect
Project Neglect is a training tool for physical and occupational therapists to train users with one-side neglect. Neglect is a condition prevalent with victims of stroke. It can affect visual, sensory, or perceptual aspects of a person’s life. In general, one-side neglect is associated with a lack of awareness to one-side of the person’s body. Neglect can appear differently for each stroke survivor.
Written by Robin Yamakawa
Photos by Louie Favorite
Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, multiple amputations, stroke, multiple sclerosis, and pain. Ranked by U.S. News as one of the nation’s top 10 hospitals for rehabilitation and the best in the Southeast, Shepherd Center treats more than 850 inpatients and 7,600 outpatients annually with unmatched expertise and unwavering compassion to help them begin again.