Disabled access to information technology — a protable adaptable,multipurpose device

The technology exists to allow severely physically disabled people to have a far more indepentdent lifestyle than many handicapped people enjoy today. To use an ever increasing range of sophisticated domestic equipment, without special modifications, an individually tailored control system and a universal accessing device are required. A portable multipurpose device allows multiply handicapped, non-speaking people a means of operating a variety of general-purpose or specialized pieces of electronic equipment at home and elsewhere, safely and independently. The device also provides a means of communication through the medium of computer-computer communication over telephone lines and will interface to a powered chair for independent mobility. Various features are provided which are not available from conventional environmental control systems. Through a specialized adjustable multipurpose switch system and a universal control device the handicapped person should be able to enjoy the independence afforded by the intelligent home of the future.     

First seven years of a new NHS mental handicap service 1974-81.

A new community-focused mental handicap service was started in a single-district area health authority in 1974. Almost 90% of all the severely mentally handicapped people in a population of 250,000 are now known to the service. Although two-thirds of long stay inpatients originally admitted with major behavioural problems have had them resolved, the remaining one-third with persisting problems are noted to have spent many years in large understaffed wards before transfer. Specialist services to mentally handicapped people are not synonymous with beds. The learning opportunities during the waking hours of a mentally handicapped person are where professional help must be concentrated, and extensive support services for those caring for the mentally handicapped at home must be set up. Absence of shared philosophies, policies, and planning among the health and local authorities has produced the problems and frustrations familiar to many professionals in mental handicap. Future developments must be based on clearly defined and declared principles.     

Wheelchair-mounted integrated control systems for multiply handicapped people

Integrated control systems allow disabled people access to multiple functions from a single input device (for example a set of switches). Multiply handicapped users are thereby able to switch efficiently between wheelchair control, communication, computer access and control of their environment, without third-party help. Integrated systems have been developed for multiply handicapped children and adults in the Barnsley area. The design philosophy has concentrated upon utilizing, wherever possible, commercially available assistance devices and remotely controlling these via logic-based integrated control systems tailored to the needs and abilities of the individual client. This approach presents few problems as the inputs to commercially available devices are often based on simple switch control. The systems already supplied have proved, after an initial training period, to be easy to operate and have led to a considerable improvement in quality of life for the users. Computer-based, wheelchair-mounted integrated systems are now being developed. A prototype system currently emulates the logic-based controllers described above, employing the screen to display information on the current status of the system. Future development will move toward a more flexible system which will be able to read a variety of input signals and control a large number of outputs. The system will also have the facility to utilize software-based communications, keyboard emulation and environmental control packages as well as business and education software. Such a system could be easily set up, via software, for use by any disabled person.     

A report from Poland: treatment and non-treatment of defective newborns

The author and his colleagues surveyed pediatricians in Warsaw, Poland, to determine the doctors' attitudes toward treating infants with severe handicaps. They used a questionnaire originally designed by Australian researchers to survey pediatricians and compared their findings with those of the Australian study. Szawarski notes important differences between the approaches of Australian and Polish doctors to the treatment of handicapped newborns. Polish physicians tend to display an unconditional respect for life, a paternalistic attitude toward decision making, and an unwillingness to distinguish between ordinary and extraordinary means of prolonging life. Half the Polish respondents would be willing to preserve the lives of severely handicapped infants at all costs. Szawarski discusses six factors that may help to explain why Polish physicians have a different approach from that of their Western colleagues to the question of selective treatment of handicapped newborns.     

Motor Imagery for Severely Motor-Impaired Patients: Evidence for Brain-Computer Interfacing as Superior Control Solution

Brain-Computer Interfaces (BCIs) strive to decode brain signals into control commands for severely handicapped people with no means of muscular control. These potential users of noninvasive BCIs display a large range of physical and mental conditions. Prior studies have shown the general applicability of BCI with patients, with the conflict of either using many training sessions or studying only moderately restricted patients. We present a BCI system designed to establish external control for severely motor-impaired patients within a very short time. Within only six experimental sessions, three out of four patients were able to gain significant control over the BCI, which was based on motor imagery or attempted execution. For the most affected patient, we found evidence that the BCI could outperform the best assistive technology (AT) of the patient in terms of control accuracy, reaction time and information transfer rate. We credit this success to the applied user-centered design approach and to a highly flexible technical setup. State-of-the art machine learning methods allowed the exploitation and combination of multiple relevant features contained in the EEG, which rapidly enabled the patients to gain substantial BCI control. Thus, we could show the feasibility of a flexible and tailorable BCI application in severely disabled users. This can be considered a significant success for two reasons: Firstly, the results were obtained within a short period of time, matching the tight clinical requirements. Secondly, the participating patients showed, compared to most other studies, very severe communication deficits. They were dependent on everyday use of AT and two patients were in a locked-in state. For the most affected patient a reliable communication was rarely possible with existing AT.     

Projecting the number of patients with first ever strokes and patients newly handicapped by stroke in England and Wales.

The common assumption that future increases in the number of elderly people will result in a parallel increase in the burden of care of long term disabled survivors of stroke was examined. The number of patients with first ever strokes and the net number of people handicapped after these strokes in England and Wales every five years until 2023 have been projected. Between the base year 1983 and the year 2023 an increase in population of about 5% will occur; first ever strokes are projected to increase by about 30% and deaths within six months of first ever strokes by about 40%. The net number of severely handicapped people six months after a first ever stroke is projected to increase by only about 8%, however, and the net number of people who are moderately or severely handicapped by only 4%. This paradox occurs because first ever stroke often kills people who have been handicapped by other causes, particularly if they are elderly. It is concluded that despite the limitations of these data they strongly suggest that the increased burden of health care of patients with first ever strokes in the next 40 years will be primarily that of caring for those in the acute stages of stroke and not with the management of chronic handicap after a stroke.     

Experimental increase of flying costs in a pelagic seabird: effects on foraging strategies,nutritional state and chick condition

A central point in life history theory is that parental investment in current reproduction should be balanced by the costs in terms of residual reproductive value. Long-lived seabirds are considered fixed investors, that is, parents fix a specific level of investment in their current reproduction independent to the breeding requirements. We tested this hypothesis analysing the consequences of an experimental increase in flying costs on the foraging ecology, body condition and chick condition in Cory’s shearwaters Calonectris diomedea. We treated 28 pairs by reducing the wing surface in one partner and compared them with 14 control pairs. We monitored mass changes and incubation shifts and tracked 19 foraging trips per group using geolocators. Furthermore, we took blood samples at laying, hatching and chick-rearing to analyse the nutritional condition, haematology, muscle damage and stable isotopes. Eighty-day-old chicks were measured, blood sampled and challenged with PHA immune assay. In addition, we analysed the effects of handicap on the adults at the subsequent breeding season. During incubation, handicapped birds showed a greater foraging effort than control birds, as indicated by greater foraging distances and longer periods of foraging, covering larger areas. Eighty-day-old chicks reared by treated pairs were smaller and lighter and showed a lower immunity than those reared by control pairs. However, oxygen demands, nutritional condition and stable isotopes did not differ between control and handicapped birds. Although handicapped birds had to increase their foraging effort, they maintained physical condition by reducing parental investment and transferred the experimentally increased costs to their partners and the chick. This result supports the fixed investment hypothesis and is consistent with life history theory.     

Prenatally diagnosed foetal malformations and termination of pregnancy: the case of Lebanon

Termination of pregnancy (TOP) is offered in many countries, for foetuses prenatally diagnosed with congenital malformations that are deemed incompatible with life or that are associated with a high morbidity. In Lebanon, a middle income country where religion plays a focal role, the law prohibits any form of TOP unless it is the only means to save the mother's life. It is the contention of the authors of this article that even if the foetus is a person, if it were medically revealed that there is a substantial risk that the newborn will suffer severe physical abnormalities that will cause it to be seriously handicapped; it is morally acceptable to terminate the pregnancy. Hence, TOP carried out for these indications is justified in the interest of the foetus and the child. Whatever the status of the foetus is, once born, it will become a full-fledged sentient being with all that this entails. When given the option of starting an existence, this person-to-be has the right to a minimum that allows him/her to enjoy a relatively good quality of life. Today, Lebanese obstetricians are confronted with the burden placed on them under the law to refuse TOP, or, when performing them, to forge records or deny having done them. This is why we strongly believe that the Lebanese policy on abortion should be amended.     

Chronobiological aspects of stereotyped motor behaviour in mentally retarded children

Normally developed children show many diverse patterns of behaviour. By contrast, the behaviour of severely mentally retarded children is restricted mainly to primitive motor acts called stereotypes. Due to the severity of the mental retardation, these children are also markedly reduced in their susceptibility to environmental influences. Systematic observations of the pathological motor patterns of these children make it feasible to investigate possible endogenous mechanisms related to these primitive motor activities. The stereotyped motor behaviours of six severely mentally handicapped children were observed continuously for several days. Each child performed at least two forms of stereotyped behaviour. Using spectra of variance and cross-correlation analysis, the data were investigated with respect to underlying periodicities. A 2.5-hour cycle was consistently found in every stereotyped activity observed. Furthermore, stable phase relationships were revealed between the periodic variations of different stereotyped movements in one and the same child. Thus the temporal courses of hand and oral stereotypes were synchronous, whereas head and whole-body stereotypes were delayed by half a phase with respect to stereotyped hand waving. A possible relationship is discussed between the 2.5-hour periodicity of stereotyped behaviour and Kleitman's "Basic Rest Activity Cycle".     

The perceived importance of appearance and oral function,comfort and health for severely demented persons rated by relatives,nursing staff and hospital dentists

Dental health is an aspect of the quality of life. Oral treatment goals for, the severely demented and the benefits of oral treatment are complex issues. Severely demented people can neither express their wishes nor make rational decisions about oral care. Acting “in the best interests” of a demented person who refuses or does not understand the purpose of treatment depends on what perspective and treatment priorities the advocate has. For oral treatment of a demented person the advocate may be a relative, a member of the ward staff or a hospital dentist. In a structured interview, the relatives of demented patients in a Stockholm hospital and members of the nursing staff were asked to rate the importance of goals for dental care. These ratings were also recorded for hospital dentists. In this study there was agreement on the importance of freedom from oral pain and fear of aspiration. Nursing personnel gave priority to aspects of good care such as being able to chew and enjoy eating. Relatives were also concerned with social behaviour and communication such as fresh breath, normal speech, and normal appearance. The ratings by the hospital dentists were generally lower which might reflect professional awareness of the limitations of treatment success implied by cognitive impairment.     

Interpersonal Similarity between Body Movements in Face-To-Face Communication in Daily Life

Individuals are embedded in social networks in which they communicate with others in their daily lives. Because smooth face-to-face communication is the key to maintaining these networks, measuring the smoothness of such communication is an important issue. One indicator of smoothness is the similarity of the body movements of the two individuals concerned. A typical example noted in experimental environments is the interpersonal synchronization of body movements such as nods and gestures during smooth face-to-face communication. It should therefore be possible to estimate quantitatively the smoothness of face-to-face communication in social networks through measurement of the synchronization of body movements. However, this is difficult because social networks, which differ from disciplined experimental environments, are open environments for the face-to-face communication between two individuals. In such open environments, their body movements become complicated by various external factors and may follow unstable and nonuniform patterns. Nevertheless, we consider there to be some interaction during face-to-face communication that leads to the interpersonal synchronization of body movements, which can be seen through the interpersonal similarity of body movements. The present study aims to clarify such interaction in terms of body movements during daily face-to-face communication in real organizations of more than 100 people. We analyzed data on the frequency of body movement for each individual during face-to-face communication, as measured by a wearable sensor, and evaluated the degree of interpersonal similarity of body movements between two individuals as their frequency difference. Furthermore, we generated uncorrelated data by resampling the data gathered and compared these two data sets statistically to distinguish the effects of actual face-to-face communication from those of the activities accompanying the communication. Our results confirm an interpersonal similarity of body movements between two individuals in face-to-face communication, for all the organizations studied, and suggest that some body interaction is behind this similarity.     

Physical Disability and Motivation

Motivating the physically handicapped individual to assist in his own rehabilitation is a complex problem. Difficulties in motivation are often based on disturbances in body image, which in turn are related both to the premorbid personality and the handicap. Treatment must be directed at the body image as well as the physical disability. Emotional disturbance following body injury should be expected and its absence is abnormal. Adequate rehabilitation entails a consideration of the effect of the rehabilitation process on the disabled person. The patient''s basic abilities must be used to improve motivation. Rehabilitation procedures must focus on practical ways of coping with everyday life. Physical disability can mobilize underlying inferiority feelings and increase the need for dependency. Judicious use must be made of success and frustration in the rehabilitation program.     

Time Slot Modeling of Life Habits in the Elderly for Decision-Making Support

This article investigates new steps for the implementation and the utilization of presence indicators to identify displacement activities of a person and to model their life habits. This modeling is based on preliminary measures of displacement rate variations over a period of time. A possible time slot division of activities is highlighted by the analysis of these measures, slight variations of slot boundaries could appear from day to day, from person to person. On this basis, we show how to build three new indicators by working from time slot to time slot, in order to detect alerts or drifts from “normal” behavior as soon as possible and in a more reliable way. These indicators include start and end times of time slots, displacement rate and duration of each time slot. The algorithm we propose has been tested in real situations to show its use and relevance. Results are finally integrated in a more ambitious process of detection and automatic decision-making support through the conception of a web interface.     

Talk to the virtual hands: self-animated avatars improve communication in head-mounted display virtual environments

Background

When we talk to one another face-to-face, body gestures accompany our speech. Motion tracking technology enables us to include body gestures in avatar-mediated communication, by mapping one''s movements onto one''s own 3D avatar in real time, so the avatar is self-animated. We conducted two experiments to investigate (a) whether head-mounted display virtual reality is useful for researching the influence of body gestures in communication; and (b) whether body gestures are used to help in communicating the meaning of a word. Participants worked in pairs and played a communication game, where one person had to describe the meanings of words to the other.

Principal Findings

In experiment 1, participants used significantly more hand gestures and successfully described significantly more words when nonverbal communication was available to both participants (i.e. both describing and guessing avatars were self-animated, compared with both avatars in a static neutral pose). Participants ‘passed’ (gave up describing) significantly more words when they were talking to a static avatar (no nonverbal feedback available). In experiment 2, participants'' performance was significantly worse when they were talking to an avatar with a prerecorded listening animation, compared with an avatar animated by their partners'' real movements. In both experiments participants used significantly more hand gestures when they played the game in the real world.

Conclusions

Taken together, the studies show how (a) virtual reality can be used to systematically study the influence of body gestures; (b) it is important that nonverbal communication is bidirectional (real nonverbal feedback in addition to nonverbal communication from the describing participant); and (c) there are differences in the amount of body gestures that participants use with and without the head-mounted display, and we discuss possible explanations for this and ideas for future investigation.     

Retrospective study of doctors' "end of life decisions" in caring for mentally handicapped people in institutions in The Netherlands.

OBJECTIVES: To gain insight into the reasons behind and the prevalence of doctors'' decisions at the end of life that might hasten a patient''s death ("end of life decisions") in institutions caring for mentally handicapped people in the Netherlands, and to describe important aspects of the decisions making process. DESIGN: Survey of random sample of doctors caring for mentally handicapped people by means of self completed questionnaires and structured interviews. SUBJECTS: 89 of the 101 selected doctors completed the questionnaire. 67 doctors had taken an end of life decision and were interviewed about their most recent case. MAIN OUTCOME MEASURES: Prevalence of end of life decisions; types of decisions; characteristics of patients; reasons why the decision was taken; and the decision making process. RESULTS: The 89 doctors reported 222 deaths for 1995. An end of life decision was taken in 97 cases (44%); in 75 the decision was to withdraw or withhold treatment, and in 22 it was to relieve pain or symptoms with opiates in dosages that may have shortened life. In the 67 most recent cases with an end of life decision the patients were mostly incompetent (63) and under 65 years old (51). Only two patients explicitly asked to die, but in 23 cases there had been some communication with the patient. In 60 cases the doctors discussed the decision with nursing staff and in 46 with a colleague. CONCLUSIONS: End of life decisions are an important aspect of the institutionalised care of mentally handicapped people. The proportion of such decisions in the total number of deaths is similar to that in other specialties. However, the discussion of such decisions is less open in the care of mental handicap than in other specialties. Because of distinctive features of care in this specialty an open debate about end of life decisions should not be postponed.     

Progressing from eugenics to human genetics. celebrating the 70th birthday of professor Newton E. Morton.

Eugenics, unlike science, involves decision making on various issues, and decision making involves the risk of making errors. This communication first clarifies the nature and seriousness of making errors known as type II in the statistical literature, i.e. the error of punishing a person when he is not guilty of the crime attributed to him. Eugenic laws in China and the eugenic movements in England and the United States are briefly reviewed. The explosive advances made in medical and population genetics in the last 40 years are replacing the conventional eugenics programs by new approaches. Modern genetic counseling has been introduced as the intermediate agent between the scientist and the family that needs advice. It is stressed that individual rights must be respected under all circumstances.     

Automatic Fall Detection System Based on the Combined Use of a Smartphone and a Smartwatch

Due to their widespread popularity, decreasing costs, built-in sensors, computing power and communication capabilities, Android-based personal devices are being seen as an appealing technology for the deployment of wearable fall detection systems. In contrast with previous solutions in the existing literature, which are based on the performance of a single element (a smartphone), this paper proposes and evaluates a fall detection system that benefits from the detection performed by two popular personal devices: a smartphone and a smartwatch (both provided with an embedded accelerometer and a gyroscope). In the proposed architecture, a specific application in each component permanently tracks and analyses the patient’s movements. Diverse fall detection algorithms (commonly employed in the literature) were implemented in the developed Android apps to discriminate falls from the conventional activities of daily living of the patient. As a novelty, a fall is only assumed to have occurred if it is simultaneously and independently detected by the two Android devices (which can interact via Bluetooth communication). The system was systematically evaluated in an experimental testbed with actual test subjects simulating a set of falls and conventional movements associated with activities of daily living. The tests were repeated by varying the detection algorithm as well as the pre-defined mobility patterns executed by the subjects (i.e., the typology of the falls and non-fall movements). The proposed system was compared with the cases where only one device (the smartphone or the smartwatch) is considered to recognize and discriminate the falls. The obtained results show that the joint use of the two detection devices clearly increases the system’s capability to avoid false alarms or ‘false positives’ (those conventional movements misidentified as falls) while maintaining the effectiveness of the detection decisions (that is to say, without increasing the ratio of ‘false negatives’ or actual falls that remain undetected).     

Culture,Conflict, and Translocal Communication: Mobile Technology and Politics in Rural West Bengal,India

As media reports of political movements from various locations have shown, mobile technology can be a powerful political instrument. This paper examines how political activists in West Bengal, India use mobile phones for their daily political work. I seek ways to recognize the disruptive and political potential of mobile technology without ignoring its social and cultural rootedness. I illustrate how riots and protests relate to the increase in translocal communication enabled by phones. I also demonstrate how the political use of mobile technology for extra ordinary events is grounded in the social and political processes of ordinary everyday life and draws from the local understanding of politics by emphasizing certain aspects of it. My article confirms the cultural continuity amidst the increase in translocal relationships but it also pinpoints how cultures harbour conflicts and alternative discourses which translocal communication helps to amplify.     

Intercellular communication of notochord cells during their differentiation in Cynops orientalis

Intercellular communication of notochord cells during their differentiation was studied by microinjection of a fluorescent dye.Lucifer Yellow,Close correlation existed between the incidences of dye coupling and quantitative evaluation of gap junctions.high incidences of dye coupling and of gap junctions occurred at a stage when notochord cells were active in the change of cell shape and cell arrangement.With the subsidence of cell movements,both dye coupling and gap junctions were reduced to lower levels.It was,therefore,Suggested that intercellular communication via gap junctions played an important role in the coordination of notochord cell movements.Gap Junctions of altered configuration occurred in notochord cells in late taibud stage.The comparison of incidences of dye coupling at this stage with those at other stages strongly suggested that the gap junctions of altered configuration functioned just as those of generalized type.