Tag Archives: assistive technology

Trendie Tubies

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[A makeshift clothes line made by tying yarn up on a bookshelf. Clipped to it are three cloth circles. One is a yellow cat on a black background, another is light brown owls on a light green background, and the last is blue flowers on a white background.]

I don't normally advertise products here, but I thought anyone using a feeding tube might be interested in these things. They are called Trendie Tubies. They are absorbent cloth pads, in a variety of styles, designed to be used around the opening of your feeding tube once it's healed enough to stop needing the kind of dressings you might need right after the surgery.

I absolutely love them. They're absorbent, they're comfortable, they don't feel anything as awful as having dressings taped to your skin. They're very soft. And they have all kinds of neat designs. My favorite is the owls. Here is a picture of what they look like when they're being used:

[Photo of a Trendie Tubies thing with blue flowers, on a GJ tube over light skin with blue clothes surrounding it.]

They have a little Velcro thing you can't see, so they can fit around all different sizes and kinds of tubes.

Here's what their About page says, so I don't end up paraphrasing it:

Trendie Tubies Accessories are hand crafted by a Mother-Daughter Duo.

All items are handcrafted and not mass produced so each item is unique and will not be uniform.

Trendie Tubies are a comfortable & absorbent machine washable pad that helps with the leakage that is common with G-tubes,

J-tubes and GJ-tubes. They work for both button tubes and peg tubes and even trach's!

Each Trendie Tubie Accessory is approximately 2 3/4 inches round and made up of 3 layers of fabric sewn together.

-The top layer is a soft flannel with a cute design of your choice.

-The middle layer is cotton terry cloth to absorb any moisture and leakage.

-The bottom layer is fleece for a soft comfortable feeling next to the skin preventing irritation and granulation tissue.

-They have a small Velcro tab for easy closure and are double zig-zag stitched to minimize fraying edges.

All materials have been pre-washed.

Allergy Alert – We have an extended family of dogs, cats & horses…be aware just in case allergies are a concern.

We strive for 100% customer satisfaction.Your comments & feedback are always appreciated.

Here's a link to the Trendie Tubies website, where you can buy them.

I bought one for every day of the week. Three owls, two cats, two flowers. I can't recommend them highly enough. And I'm posting this because, as far as I know, most people haven't heard of things like this. The VNA wanted me using gauze dressings the rest of my life, which I really didn't want. They say they're machine washable but we've been hand washing them because it's more convenient, then hanging them up on the bookcase to dry.

 

Communication page I used to handle that invasive woman I met.

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It’s been quite some time since I posted my letter to the woman who accosted me on my way to the para transit van. But I wanted to update people on how I handled the situation when she approached me the next day. Which was a success.

I knew that I have trouble coming up with new language of any kind in high stress situations, especially involving people with bad boundaries. So I spent most of the night creating a new page for my communication software.

I use Proloquo or Proloquo2Go for most of my communication these days. My super-expensive, clunky Dynavox has been collecting dust in a corner ever since I first got Proloquo2Go years ago. Proloquo2Go has two separate sections. One where you type and it speaks out loud. Another where you can say something by pressing on one or more pictures.

I created a page where everything was about boundaries in one way or another. These are things I’m often unable to say in real time. I have a hard time remembering its possible to say these things. And coming up with words. And monitoring my emotions in response to situations. And communicating around invasive people. And pushing words past what feels like a barrier between my mind and everything else. Let alone all this and more at once.

Here’s the page I created:

[Description: A communication page arranged as a grid with one sentence per square. Each one has one word or sentence. Words in parentheses are what the previous sentence is an abbreviation for: Back off. Don't patronize... (Don't patronize me.) Don't talk to me. Don't touch me. Don't want talk about. (I don't want to talk about it.) Fuck off. Get out of my face. Go away. I am not a child. I don't care. I don't do eye contact. I'm not kidding. I've a right to be mad. (I have a right to be mad.) it's not funny. Leave me alone. Now. Please. Stay away from me. Stop it right now. Stop. That hurts my brain. You put me in danger. (You're putting me in danger.) you're hurting me. You're too close to me.]

I tried to make it so that I could use various levels of politeness, forcefulness, and rudeness depending on the situation. One way I did this was with different icons. Obviously, “leave me alone” and “fuck off” are very different. But another way I did it was by adding icons for “please” and “now”, the two squares outlined in blue. This made it so, by hitting two buttons in a row, I could say “please leave me alone” or “leave me alone now”. So I have a pretty good variety of intensity I can use.

I was expecting her the next day. She had said she wanted to meet me in the morning. So I prepared myself. I tried to stay connected and aware of my surroundings. She sat down at the table next to me. And she watched until my staff person had to leave me alone for a minute. Then she approached.

Because I was expecting her, I was prepared for the onslaught people like her carry with them. That thing where when they get close to you, it almost feels as if they are overlapping with you. So in my head I made sure to mentally separate us, which made it easier to communicate. I hit “please” and “stay away from me”. She yammered some sort of explanation and went back to her table.

I maintained deliberate mental distance the rest of the morning that I was anywhere near her. My case manager later made an effort to find her. She’d heard the story from a guy who witnessed it, and she wanted to report this woman. But we never found her. And things went just fine the rest of the day.

In any alternate universes where I didn’t make this communication page, the likely outcome is much worse. I would have been pretty much trapped around this woman, and that would have done a kind of emotional damage that takes time to recover from. It’s nothing that has any kind of official name, it just leaves me more vulnerable to other people like her until I can reverse it.

Another important thing I did besides create the communication page, was to rehearse everything many times beforehand. If I don’t do something like this, it’s hard to use the communication icons. Contrary to popular belief, just having the ability to type or use icons, doesn’t solve every communication problem.

And without rehearsing, there’s a big chance I’ll never use a page like this. My fingers won’t know where to go. My mind won’t remember it’s possible. My eyes won’t remember to look through the page to find possible things to say. My will won’t be able to push through the barrier between experience and expression. And much more. That’s a lot of places for communication to break down.

It is absolutely vital that people who use communication devices, have ways to respond to violations of our basic boundaries. Disabled people are far more likely than others to have others behave invasively with us, ranging from subtle to violent. People teach us from our earliest years onward that such invasion is normal, natural, and something we should accept without complaint. We have to have the means to say no.

And we have to have the means to say no forcefully, even rudely. We need to be able to use cuss words, even if we have the kind of personality that would never use them. Sometimes the only reason that we appear unnaturally even-tempered is because we’ve never been allowed to be otherwise. We have the right to say fuck off, but people don’t always give us the ability to do so.

Of course, even if we say things like that, there’s no guarantee anyone will listen. Some people’s reactions when I get mad, remind me of the way people giggle at my cat when she swipes someone who touched her in a way that hurts her. It’s like she and I aren’t real enough to them, so our anger is cute and funny.

I’ll also never forget the time someone made an asinine comment when I was out in public. I typed a response and stuck the speaker up to his ear so he could hear it. All his friends burst out laughing. One of them said “Dude, that guy’s cussing you out using a machine!” Which is… so much not the response I was going for.

But still. We need to be able to have the full range of responses that other people can have. To do otherwise smacks too much of that idea that we should be passive and sweet all the time. Being able to say no, being able to cuss, being able to tell people to go away and leave us alone, these are some of the most important things people with communication impairments can learn to say. But often people don’t teach us that stuff, they don’t want us to know it.

Another important thing: Communication pages like this are not just for people who absolutely can’t ever speak. They are for anyone, anywhere, who for whatever reason would be unable to say things like this in situations where they need to be able to say it.

I’ve run into too many people lately who desperately need something like this, but are afraid to use it because they don’t fit the popular image of someone who needs a communication device. Some of them have even been told that it’s horrible or disrespectful of them to even consider using a communication device. But my position on it is that having the most effective communication method possible can result in better emotional and physical health, in some situations it can even save lives.

So given all that? If something like this can make your life better, for any reason at all. Whether you can’t ever speak, can only sometimes speak, can only speak about certain topics, can speak but it isn’t what you mean, can speak but typing or using picture icons works better or uses fewer mental resources. Or anything else like that. Do whatever works best for you, and screw anyone who tells you different.

Anyone who feels the need to act as the supreme gatekeeper of all things assistive technology… not only do they have too much time on their hands, but they are letting ideology get in the way of real people leading better lives. And that is just plain wrong, and fundamentally unfair to people who could benefit from a communication aid.

 

DIY Communication Devices

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Disclaimer: This is about a communication device that Anne helped me set up as a backup communication device (all my other backups — mostly bought used, some bought broken to replace parts in dead ones — have by now long since died or otherwise become unusable by me). Make one of these things at your own risk. Before you buy it, look into it more, understanding that so far neither Anne nor I have figured out how to get full functionality out of the software, and that it involves various vaguely techie stuff like looking for DLL files to download and stick in the right directories and stuff, or the thing simply will not work at all. And this device may be totally unusable to some people for a number of reasons that have to do with the size and shape of the machine, input accepted, etc. It’s not a replacement for a primary communication device either, but an excellent backup for some people, and for other it might be what they’d have to settle for until and unless they got something better.

Anyway, none of my backups work well enough for me to use at the moment (most don’t work at all), and even my main communication device is well-nigh impossible to use with the telephone in my house because of pesky things like logistics, priorities, and the laws of physics.

But I thought this sort of thing would be useful for anyone who has speech difficulties, whether it’s a physical thing, a cognitive thing, an emotional thing, or whatever. Anne said she’s thinking of publishing a guide on putting one of these things together, and that sounds like a good idea to me.

The best part about this is that all the parts can be found used and/or refurbished. This is a good thing because a huge number of disabled people are one or more of the following:

  • Under, at, or near the poverty line (unable to afford new equipment, might be able to afford old equipment)
  • Unemployed or underemployed
  • Uninsured or underinsured
  • Severely doctor-phobic (either because of the same condition that causes the speech problem, or because many disabled people have been so badly abused by parts of the medical profession that we end up fearing the whole thing)
  • Unable to speak (or speak clearly) for reasons that insurance wouldn’t cover, that medical professionals want them to ‘just get over’, or that would mean discriminatory treatment if people found out the reasons. (For instance, someone so anxious they can’t talk to supermarket clerks might find a medical professional unwilling to get them a device, even if the supermarket problem logistically needs to be solved before the anxiety problem can be solved; alternately they might encounter potentially life-threatening medical discrimination if their doctor found out they had a problem most people consider psychiatric.)
  • Intermittently unable to speak, which sometimes means insurance won’t cover it (although insurance funded my first device while I still had intermittent speech that was superficially good the moments I had it)
  • Under insurance plans that only let them have one device for a huge variety of situations, including situations where you really need a small and lightweight device (when your normal one might be big and heavy for good reason)
  • Speech-related trouble that is so mild that insurance wouldn’t cover it, but that still impact the person’s life heavily enough they want an alternative.
  • Etc.

So basically, not everyone can get a device. This isn’t a perfect solution because it still costs money and not everyone has money. But something you can get for anything between $100-400 depending on where you get things and how lucky you get, is still better than getting a worse device for $2000 (yes, I have seen far worse for that amount of money).

The parts are:

  • An HP Jornada of the sort that have a keyboard. (Mine’s a 728, Anne’s is a 720.) Although technically this could also run on something that takes a stylus, as long as there’s an onscreen keyboard (in fact parts of it run better on standard PDAs than on this series of Jornadas). I’ve seen these things go for anywhere between $10 and $250, and obviously a lot depends on the condition and where you’re getting it, and also whether you need to buy a new battery for it or not.
  • An external speaker that will have louder sound than the PDA itself (because the PDA has very minimal sound in most situations you’d wnat to use one in), and high enough quality to carry the voice. Anne and I both independently came to the conclusion we’d get Altec Lansing orbits, but there are undoubtedly better things out there than this, especially for people with coordination problems or hand weakness given how it turns on and off. I’ve seen those go for anything from $5 to $100.
  • A voice from Cepstral ($20 each, I picked Callie, Anne picked Diane)
  • A couple of DLL files since Jornadas usually run Windows Handheld 2000 and the software is written for more standard Pocket PCs. It’s specific versions, Anne and I are testing a lot of them to see which ones are best. They don’t provide full functionality of the Cepstral software, but then again that might be a screen shape issue. Full functionality, however, is nice, but not necessarily needed.
  • Velcro (Anne’s method so far), duct tape (my method so far), or some other means of affixing the speaker to the back of the Jornada.

And here’s the result:

jrnd1

jrnd2

jrnd3

My hands are there for size comparison, though the angle can make that confusing. Be aware I have small hands.

I have not yet got a video for it, and don’t hold your breath waiting, I haven’t been good at making videos lately at all.

Anyway, the plus side so far (some of these would be drawbacks for other people):

The portability. Sometimes I don’t have the energy, time, and/or inclination to lug a Dynavox around.

The size. Which is the reason I can’t use the Dynavox on the phone at the moment with other logistics and priorities within my apartment. Practically the moment I got this thing together, I had to make a pretty high-priority phone call to one of those services that calls you back later. I hadn’t been able to take those calls by myself in ages. So I didn’t get it a moment too soon.

The battery life seems pretty long so far. I have heard it’s longer on a 720 than on a 728, presumably because the 728 has more memory (AFAIK the only difference between the two). I haven’t had time to test this.

Keyboard size. I have tendonitis and not having to move my hands as far is really helpful. (I can’t imagine ten-finger touch-typing on this with large hands, I’m not even sure whether people with average-sized hands can do it or not.)

The shallow and light keys. The combination of tendonitis and hypermobility makes me dislike any key that’s hard to press. These are very easy to press. (Which might be a pain for someone who wants a lot of tactile feedback when the buttons are pushed.)

The minus side so far:

Some of the menus cut off halfway down, Anne and I have not figured out a way around it. (If anyone is willing to help us find something that allows us to either scroll the desktop down past the bottom of the screen, or take an already-running program and wrap anything going off the bottom of the screen onto the top of the screen, let one of us know. If anyone’s able to program a better-suited either cheap or freeware frontend to the Cepstral voices with the same functoinality, also let us know. This, among other things, is preventing us from saving our voice configurations, we have to slow down the voices and (in my case) lower them a little, every single time.)

The external speaker is hard to turn on and off, due to having to grab it and twist in a very particular way. It seems like it could break easily too, and it’s gotten stuck in between on and off several times.

The DLLs were a pain to get, both of us had to do them from scratch. We might provide better information on that later.

I don’t know that this will be a problem for me or not yet, but I’m not sure how durable this thing is. I no longer fling communication devices at walls or bash them on my head, but I’m still given to forgetting I have a hand, and consequently dropping things as my hand reverts to neutral or fails to correct for some other movement.

I haven’t figured out a way to mount it to my wheelchair yet, let alone at the right height. I wonder whether cannibalizing a mount-plate would be feasible, or whether that’d introduce other problems (it’d have to be able to come on and off even the mountplate quickly, because it has a USB cradle it has to fit into for charging and communication with my computer). Don’t know yet.

I have not yet gotten Ubuntu linux to recognize the Jornada as even existing, let alone talking to it. Still working on it. Haven’t yet tried using wine, I just booted to windows altogether.

I have also not yet tried finding the equipment to plug one into the phone directly. You can buy a thing from Radio Shack for about $15ish IIRC, that is meant for recording telephone calls with and playing tapes back over the phone. You connect it to the phone, flip it into “play” instead of “record”, plug it into the headphone port of the device, and you have a real (if sometimes awkward and ungainly) means of using a device’s sound output directly into the telephone. Depending on the situation an amplifier might also be necessary in between the communication device and the previous doohickey I just explained (I don’t know the word for them).

Anyway, I’m very happy with it so far despite its shortcomings, and looking forward to being able to improve on it. I am sure many variations on the same theme can be made, some of them more cheaply than this, some more expensively. Cepstral is a great source of cheap voices. Joel has made JTalk software to be used with different voices, on a different platform. Neither his nor Anne’s projects are intended to replace a person’s primary mode of communication, there’s too much that could go wrong that way. But as a backup or supplement to another means of communication, they can be excellent, and I’m very happy with it.

They should do all assistive technology this way.

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I just finally got my resized ring splints (finger splints), and they don’t look like splints at all. Several people online have asked me to show them and talk about what they’re like in case they or their kids need them, so I’m including pictures and discussing them and their use here.

Here’s the view from the back of my hands, where they look like rings:

Fingers with silver ring splints

And here’s the view from the palms of my hands, where you can see how they connect together:

Silver ring splints on hands palm side out

What’s the point of this?

Among other things, handwriting can often be difficult for people who have joint hypermobility. (Here’s the webpage of the hypermobility syndrome association.) That’s when joints bend further than they normally do. The most common cause is benign joint hypermobility syndrome (my diagnosis) which is extremely common, especially among women, and it runs in my family. But there are also several rarer syndromes like Marfan’s and Ehlers-Danlos that have it as one of their traits (and there’s some debate as to whether BJHS is a very mild version of one of those or something separate). A lot of people don’t know they have it unless they have an extremely severe form, although even some people with the rarer and more severe problems don’t get diagnosed easily. There’s a fairly easy way to test yourself to see if you should get checked out for it, which is this test (in which I get either a 7 or 8 out of 9 — but be aware it’s possible to do it wrong if you have perceptual problems, the first time I saw such a test I thought I scored lower than a doctor and PT scored me as; also be aware that if you have various other symptoms (especially widespread joint pain or dislocations), or if a close relative does, you can still sometimes be diagnosed with BJHS with a score between 1 and 3, so best to check with someone who knows what they’re doing.

I don’t know if it’s true or not that autistic people are more likely to have loose joints like this. Tony Attwood claims it is (note that when he says “Asperger’s” he’s often including examples of other autistic people without that label):

One of the movement disturbances associated with Asperger’s syndrome is lax joints (Tantam, Evered and Hersov 1990). We do not know if this is a structural abnormality or due to low muscle tone, but the autobiography of David Miedzianik describes how:

At infant school I can seem to remember playing a lot of games and them learning us to write. They used to tell me off a lot for holding my pen wrong at infant and primary school. I still don’t hold my pen very good to this day, so my handwriting has never been good. I think a lot of the reason why I hold my pen badly is that the joints of my finger tips are double jointed and I can bend my fingers right back. (Miedzianik 1986, p. 4)

Should problems occur from lax joints or immature or unusual grasp, then the child may be referred to an occupational therapist or physiotherapist for assessment and remedial activities. This should be a priority with a young child, since so much school work requires the use of a pencil or pen.

(That’s from page 263 of The Complete Guide to Asperger’s Syndrome by Tony Attwood.)

So, I’d always thought I was “just” dysgraphic in school. I was always having my grip corrected and my only way to produce neat handwriting was to eventually learn to ignore severe pain in my hand. I had one set of people try to help me grip it better in elementary school, and another set of people while I was in college, but nobody did an assessment of my flexibility levels. Then after diagnosis with hypermobility last year, all this stuff started to make sense.

So, what these splints do, is they make it impossible for joints to hyperextend (extend beyond their normal limits), or at least to do so very much. Here’s my finger being bent without a splint:

finger bending backwards at tip and middle knuckle

And here’s the same finger being bent with the same amount of force, but with a splint:

Finger being pressed on with a splint on but not bending

You can see that in one picture the joint bends backwards a lot and in the other one it doesn’t.

This also makes a difference in handwriting. Here’s one of my versions of a grip on a pen without a splint (sometimes I use 3 fingers to stabilize things, sometimes 2, but same result):

Holding a pen without splint with fingertips bent back

It hurts just to hold a pen like that for less than a minute.

And here’s my grip on a pen with the splint:

Gripping pen with splints on

So there’s a big difference there.

And the difference it’s making for me is less pain while handwriting, less pain while typing, less pain in general. The actual bending itself doesn’t directly cause the pain. What does cause pain is the constantly having to press harder and further on everything because if I press more lightly my fingers just bend back instead of accomplishing whatever they’re supposed to accomplish. (This is why people with hypermobile fingers are usually slower at playing certain musical instruments, there’s a finite rate at which we can press because it takes us longer.) And having them bent backwards like that in the long term doesn’t do any favors to my joints either.

Which is why I’d say, if your kid is having trouble with handwriting, please get them checked for this. I’ve talked to way too many people who are parents, or who know parents, with kids with handwriting problems, and I ask if the kids are super-flexible, and they say yes. But they rarely connect the two on their own, and neither do the schools.

I wish I’d had them when I was seven years old and struggling to handwrite only to be accused of not trying when my hand gave out, and having even my odd (they called it ‘immature’) grip seen as a behavioral problem rather than a physical one. I really believed that ‘not trying’ thing, too, since I had no sense of what was and wasn’t normal pain-wise. So I eventually learned to ‘try’, which meant, mask pain to the best of my ability and keep writing, and I finally got neat handwriting five or six years later (and in fact got so skilled I could write in several different handwritings, forwards and backwards, because of how hard I was working). But that hasn’t entirely lasted as I’ve gotten more body awareness than I used to have, as well as more of a sense of how much pain is too much to ignore.

When I tried handwriting in the occupational therapist’s office today, I kept waiting for the pain and it didn’t happen. I’m not sure thumb-related pain will fully go away (see below), but I didn’t experience it today. And I certainly didn’t experience the general hand pain I normally do that probably comes from stress on the things that do all the moving things in the joints (I don’t know all the words for these things).

Here are the splints off my fingers by the way:

a thumb splint and two different kinds of finger splints

The big one with the chain attached is a thumb splint. The other two are two kinds of finger splints: One to prevent mild-moderate hyperextension and the other — the one with the little round spacer thing in between the two rings — to prevent severe hyperextension. I’ve got the mild-moderate ones on my pinkies and middle fingers, and the severe ones on my pointer and ring fingers.

The one thing the occupational therapist said these things could not do, is fully stabilize the base of my thumbs, or stabilize at all the base of my pointer fingers, which are my two loosest sets of fingers. She said it’s just not capable of that level of support and I’ll have to try something else if I want more support than I’ve got on those.

I’ve also got less pain typing. Normally there’s a sort of sharp pain that starts in my wrists or hands and shoots into my fingers, very similar to what walking without ankle braces does to my legs. And that’s gone as well as far as I can tell.

Anyway, what I was thinking when I got these, is they should do all assistive technology this way. These aren’t just functional, they’re also pretty. (And for people who can afford it, they even make versions with stones set in them and stuff.) A lot of assistive technology gets hung up on looking like it crawled out of a hospital or something. These splints are taken by most people as just jewelry. (I’ve been wearing the pinky ones for a month now while waiting for the rest to be resized.) My mom said when I got these I’d end up looking like a hippie, but oh well, it wouldn’t be the first time. :)

I know there’s been some progress in making other assistive technology attractive, but it hasn’t come as far as these splints have for the most part.

(To find people who make splints like these, there’s Silver Ring Splints in America and Silver Splints in Scandinavia, the Netherlands, and apparently the rest of Europe too. There’s also a plastic kind that are cheaper but also less comfortable and don’t fit as well, and then another plastic kind that’s custom-made that I saw on a mother’s blog for a hypermobile kid who had cute little multicolored and obviously customized plastic ones. I’ve also heard that you can replace the bracelets that hold the thumb splints on with your own custom ones, so I’m thinking about doing that. Also, many of these companies will also make them in gold if you’re allergic to silver.)

The interesting thing to me, also, is that assistive technology likely to be used by non-disabled people (which is to say, most assistive technology, of the sort that isn’t normally singled out as assistive even though it is) is often already made with aesthetic considerations in mind, whereas assistive technology for disabled people (the kind that is normally singled out as assistive) generally isn’t. Since, of course, assistive technology primarily used by non-disabled people isn’t singled out as medical, and since, of course, medical seems to mean uncomfortable and ugly a lot of the time when it comes to equipment.

And, basically, if you have the means to get any splint that works this way for you or someone you know who needs it, you should try. It has been worth both the wait (since February, and a longer wait than usual because I had to send most of them back to the company for resizing) and the hassle. I’ve been letting anyone know who seems to have hypermobile joints (which is a lot of women I run into and a few guys, including a staff person who described getting out of class in high school by popping his thumb out and claiming it was broken), almost all have been interested, and almost none have ever heard of this as a potential cause for their joint problems or handwriting problems. Same with parents I talk to whose kids have this problem, they’ve often never heard of it (or of any solutions for it) even if the school is kicking up a major fuss over things like handwriting and even if the kid is really obviously flexible. So anyone who might run into someone in this situation, keep that in the back of your head, because doing something about it can save a lot of headaches (or, I guess, hand-aches).