Tecla Shield, built by Komodo Openlabs Inc., is a portable assistive device for people with limited upper body mobility resulting from conditions including multiple sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), muscular dystrophy, cerebral palsy, as well as a stroke, brain or spinal cord injury. The Tecla Shield allows an individual to interact hands-free with their iOS and Android smartphones, tablets and computers. It works with all available assistive switches, including buttons, sip-and-puff controllers, head arrays, joysticks and the driving controls on a wheelchair.

Ryerson University in partnership with Komodo Openlab Inc. received ethics approval from the Joint Research Ethics Board for a joint research project where, a select number of patients at The Salvation Army Toronto Grace Health Centre (TGHC) participated in learning about current smart technology and how to access this technology through their mobile devices using the Tecla Shield. The feedback from patients is expected to further research and improve Komodo’s products for broader use. Komodo Openlabs Inc. funded the project and Ryerson’s research team conducted the study from February through to June 2016.

The Ryerson team worked with five patients at the TGHC including a quadriplegic, a patient who was blind, patients who have MS and ALS combined with other disabilities that affect their mood, movements, memory and their ability to concentrate for long periods of time. An assessment was made in consultation with each patient to determine their switch access capabilities and preferences. These patients would then have an individual and specific set-up with the Tecla Shield based on their needs. After a switch assessment is made, and the program is set-up there is a trial period in which the patient learns how to use the switch device in combination with automatic scanning speeds and scan preferences, such as row column scanning which selects items in rows with up and down left and right options. For example, after trying a cheek switch for a while a quadriplegic patient decided to change to a chin switch, which interfered less with his line of vision. Depending on the tremor severity, a MS patient may prefer using a joystick rather than a single or double button switch as it gives them more control over the selection process. The Tecla Shield gives patients access to various technologies while eliminating the need for multiple control systems. Instead of typing or scrolling, which requires fine motor skills and good vision, a MS patient with poor vision, for example, was able to use “voice over and speak screen” (an accessibility option) and a joystick to search and listen to audio books and FaceTime her two young boys. Patients were given weekly technical support and were asked questions to determine the usability of their switch access system.

Patients enjoyed doing something new or different with the technology. By using smartphone technology in new and different ways, they expanded their knowledge, engaged in ongoing learning, accessed entertainment and connected with friends, family and the broader community. Patients experienced both frustration in learning the technology but also enjoyment in doing things they never thought they could do. One patient commented, “It allows me to punch in numbers without using hands like telephone banking and hands-free talking or listening to books…never done that before.”

Based on user patient feedback the research team is looking at implementing a better system for charging devices which would combine charging of wheelchairs along with personal device charging such as a cell phone or tablet. Currently many chargers and electricity outlets are difficult to reach and use. Patients with limited mobility and their care providers should have an easy and expedient way to charge multiple devices through a single output conveniently located on their wheelchairs or on their beds.

The study also revealed that more and more patients are bringing their personally owned mainstream mobile devices, such as smartphones and tablets with them to a health care facility. Patients expect and want to use these devices and the accompanying apps for communication, leisure and Internet-based activities. Health care facilities are not currently well equipped technically or lag in policy implementation to support a user’s needs. When patients’ lose the ability to interact on an electronic screen through touch, they would at that point require assistive switch technologies such as a joystick or button. As people continue to lose their vision, built-in accessibility features on phones and tablets can be accessed such as voice recognition and screen readers. However, at this time, very few procedures are in place in health care facilities for the initial assessment, implementation and continued monitoring of assistive technologies with personal mobile devices. Ryerson and TGHC are working collaboratively to address the need for policies, procedures, and education around assistive technology implementation. They will also use this study to support and develop another research project. If successful, this innovative project could be a model for other hospitals to follow.

The Tecla Sheild research project ended June 30, 2016 with a party for the patients, care givers, family and friends. Komodo Openlabs Inc. donated Tecla Shields, joysticks and other assistive switches to all the patients who participated in the research project.