Electronic aids for daily living.
ABSTRACT Electronic aids to daily living (EADLs) are devices that facilitate the operation of electrical appliances in a given environment for a person with a severe physical disability. These specialized devices can provide tremendous psychological and functional benefits to someone with a severe disability, their family members and caregivers. This article provides an overview of the utility, functionality, access, acquisition, and evaluation of EADLs. It also highlights challenges in obtaining and measuring the benefits of these devices.
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ABSTRACT: An electronic aid for daily living, using Morse code as an adapted access communication tool, is presented in this study. The study aim is to help quadriplegics operate appliances, allowing them to live more independently. This system consists of four modules: the assistive computer input device, application software, communication control board, and the appliance control nodes. ZigBee is used to avoid the problem of "line of sight" encountered with infrared transmission to permit long-distance transmission without space limitation. Also, a visual design methodology reduces the burden of operating the application software. Users can easily click control buttons on the application software through the assistive computer input device. Within a one-month evaluation, three subjects, quadriplegics who were users well-trained on operating the assistive computer input device, could smoothly manipulate the system from the beginning and became dependent on the system progressively. Data based on system activity was recorded. Also, the subjects and care-givers were questioned about their experience with the system during the evaluation period. According to the results, the three subjects totally agreed that the system changed their life significantly and the most used function was the control of television. Finally, care-givers of the three subjects appreciated the benefit of this system. They experienced fewer interruptions of their daily routine.
Electronic aids for daily living
Electronic aids for daily living (EADLs) are devices used to help people
access, operate, and control electrical appliances in the home, school, or
workplace. The primary purpose of an EADL is consistent performance of
necessary daily tasks. These devices also maximize functional ability and
independence. Other names for EADLs are environmental control systems
and environmental control units.
Persons who use and benefit most from these devices are those with severe
physical limitations that affect their mobility and upper limbs. Common diag-
noses are tetraplegia, muscular atrophy, muscular dystrophy, cerebral palsy,
multiple sclerosis, and amyotrophic lateral sclerosis.
EADLs are controlled either by an ability switch, touch screen, voice rec-
ognition, or integrated with other controls; controls can be integrated with
computer access, wheelchair controls, or augmentative communication
devices. For persons who use a switch to operate an EADL, a dual switch
offers more control by allowing them to scan and select at their own speed and
ability. Single-switch operation requires the user to activate the device by
scanning through a list of choices, which limits the speed of operation to the
scanning speed programmed into the unit. Integrated controls that operate an
EADL are helpful and often necessary when a person has a limited number of
switch-control sites available. For example, by integrating controls, a person
can operate an environmental control system through the same controls
(“sip’n’puff” switch, joystick, head array, etc.) used to operate a wheelchair.
Two broad categories of EADLs exist: computer-based and stand-alone. A
computer-based EADL is a combination of hardware and software that is
added to a computer system and allows control of the environment. A stand-
alone EADL does not rely on a computer for its function. In general, a
computer-based voice-activated EADL can offer superior voice recognition,
vast amounts of visual and auditory feedback and prompting, and superior
programmability. Although a computer-based system can be used for other
functions in addition to control of the environment, the system becomes more
vulnerable to viruses, glitches, and crashes. Stand-alone EADLs are not sub-
ject to the general vulnerabilities that can plague a computer system that is
used for multiple applications. Stand-alone systems usually offer fewer
options in terms of feedback, prompting, and programmability. Stand-alone
systems are often more easily transported. Additional EADL resources can be
Roger Little, MS
JRRD, Volume 44, Number 5, 2007
found in the Appendix (available online only at http://
EADL feedback to the user may be visual or audi-
tory. Visual feedback can be either static or dynamic.
Static visual feedback could include a fixed label on
each option. Dynamic visual feedback allows the
options to change in accordance with the user input or
option being presented. Auditory feedback could be in
the form of a beep or a given word or phrase. Depend-
ing on the EADL, a combination of visual and audi-
tory feedback is possible.
DEVICES TO CONTROL
Common types of electrical appliances controlled
by EADLs are telephones, lights, door openers, door
locks, fans, drapes, blinds, beds, audiovisual equip-
ment, home climate controls, call systems, and secu-
rity cameras. These appliances are usually controlled
by one of the following methods: (1) infrared (IR),
(2) X-10, and (3) direct connection.
IR controls many different appliances in the same
way a television remote control. IR transmission
requires “line of sight.” As a result, the controlling sig-
nal cannot operate a device located in another room or
even in the same room if the two devices cannot “see”
one another with a ray of light. If a device requires IR
control, an IR extension cable or distribution box can
be used to extend the signal to the remote area. Alter-
natively, IR can be transformed into a radio frequency
(RF) signal, which will allow more pervasive trans-
mission of the signal.
X-10 is an industry standard for communication
among devices used for home automation. It uses
household wiring (electric power line) to carry short-
wave RF signals to the devices to be controlled. This
type of control is limited to turning devices on and off.
Lights can also be dimmed or brightened. In many
cases, the home electrical service does not need to be
modified. INSTEON is a newer technology that sends
dual signals—a power line communication, like X-10,
as well as an RF signal that travels through the
air. INSTEON has several reliability advantages over
X-10: (1) two different types of signals are sent; (2) if
the receiving device does not obtain a clear signal, the
sending device resends the signal; and (3) each receiv-
ing device resends the signal once it is received. This
allows the network to be stronger as more devices are
added. INSTEON is also backward-compatible with
X-10 and accepts multiple addresses.
Direct connection implies that other devices are
connected to the EADL unit. These devices can
include telephone lines, intercom systems, bed con-
trols, external speakers/microphones, IR extenders,
and external relays.
ELECTRONIC AIDS FOR DAILY LIVING
When someone is deciding on an EADL, many
factors must be considered, namely personal factors,
equipment, environment, and funding. Personal fac-
tors include accessibility needs, preferences, cognitive
and physical abilities, technology background, desire
to use technology, degenerative conditions, and voice
quality and changes. Other factors to include when
considering equipment are the place(s) the EADL will
be used, the layout and size of each area, the devices to
be controlled, the electrical condition of the controlled
environment, the bed/chair mounting, the switch type,
the required integration with existing assistive technol-
ogy equipment, and the particular EADL limitations
and benefits. Funding has always been a limiting fac-
tor and can be the largest hurdle in obtaining equip-
ment; funding factors include cost and the goals or
requirements of the funding agency.
The basic cost of a full EADL system can range
from $3,500 to $6,000. A completely installed system
with door openers and other options can cost $8,000 to
$15,000. Typically, the only funding available for
EADLs is from vocational rehabilitation agencies, the
Department of Veterans Affairs, workers’ compensa-
tion, civil and nonprofit organizations, and philanthro-
pists. Medical insurance does not cover EADLs;
however, medical insurance in the United States dif-
fers from medical insurance in other countries. Some
LITTLE. Guest Editorial
countries consider EADLs part of their health benefits.
In the United States, they are not seen as a medical
necessity and, therefore, are not funded by medical
Individuals who can benefit from these devices
need to be educated about and informed of the
increased quality of life they can offer. Some indi-
viduals purchase elaborate televisions, stereos, and
other electronic devices; however, EADLs are usu-
ally considered devices that someone else should
provide. Often, when a drastic medical catastrophe
does occur, personal funds are channeled to other
needs that take precedence.
Due to lack of funding in general, technology
transfer into EADL devices has been slow. Compa-
nies in a small market have difficulty keeping
abreast of and incorporating the latest technology in
their systems because technology is a fast-moving
and ever-changing target.
For the EADL market to change drastically in
the United States, funding for the devices will likely
need to become more accepted. Such a funding
change will only occur if insurance providers can
see cost reductions in attendant or long-term care.
Objective, widespread, conclusive studies have not
been conducted to prove this benefit.
The use of EADLs may find greater support as
these devices are integrated with other technologies.
Augmentative communication devices are being
recognized a medical necessity in some cases and
are being funded by insurance companies. Since
many of these devices cannot perform EADL func-
tions, some growth in this area may be expected. In
addition, environmental control capabilities are now
being integrated into wheelchair controls, which
may also help to expand the EADL market.
As people who have grown up in the technologi-
cal age become candidates for this type of technol-
ogy, a stronger acceptance and desire to obtain this
type of equipment will likely exist. Voice recogni-
tion and wireless access are becoming more com-
monplace for computers and EADLs, so systems
based on these technologies will also likely increase.
The widespread use and availability of cellular tele-
phones, wireless personal area networks, and Voice
over Internet Protocol technologies may also find
their place among EADLs. Finally, smart home
technology is becoming more prevalent and will
likely help further the use of EADLs.
Roger Little, MS
Rehabilitation Engineer, School of Health and
Rehabilitation Sciences, University of Pittsburgh,
5037 Forbes Tower, Pittsburgh, Pennsylvania