2000 Conference Proceedings

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Taking Assistive Technology To The Highest Degree: Earning A Doctorate Using JAWS, Dragon

Todd Schmiedl, MA, MS
Froma Cummings, OTR/L
3100 E. Roosevelt
Phoenix, Arizona 85008

This session will be a case study presentation from the perspectives of the client (who is himself a professional) and an occupational therapist, assistive technology specialist. The presenters will 1) quickly review Todd’s background and achievements, 2) discuss the rationale for a review of his clinical status consistent with his current work tasks, 3) share the excitement of how his new technology has empowered even greater independence and success than he had ever anticipated in his doctorate program in clinical psychology and 4) answer questions from the audience.

Todd is a 37 year old married man and grandpa who sustained an incomplete C4-5 spinal cord injury with occipital lobe head trauma in 1980 (19 years ago). This left him with a motor status of quadriplegia and vision described as legally blind. There is double vision, blurred vision and inability to see print of any size.

Following the trauma, Todd spent 8 months in an acute care setting followed by 6 months of intensive in-patient therapy at the Rehabilitation Institute of Chicago. After his discharge, he became ‘a game show junkie’ until a neighbor respected his interests, and, learning of his fascination in neuropsychology, encouraged him to explore books on tape. His curiosity in medicine motivated him to better understand himself and desire to pursue studies in this field to be able to eventually help others.

While completing his undergraduate work at the University of Illinois, Todd used readers and writers to read his textbooks to him, dictate his papers, takes notes and complete exams all the time, every day. Todd states that this was a real nightmare, but assistive technology was not then what it is today. In those days (1987), voice input was just in its infancy and atrociously expensive.

Todd smoked the MCATs and applied to 152 medical schools. His academic record, above average scores and recommendations should have gained him admission to the top medical schools. Todd wanted a medical degree in psychiatry. Admissions officers, however, informed him that they had had blind students and they had had students who had quadriplegia but a blind quadriplegic was just too much of a risk!!!!

But this didn’t stop Todd. He did the whole process again still hearing the same results. So he enacted his back up plan, a Masters degree in Rehabilitation Administration. He was ever ready for the challenge, beginning with the GRE. In Todd’s words, "Bring it on!"

Neither was assistive technology available to Todd while he completed his first Masters’ degree in Rehabilitation Administration. So, he used the same strategies again, now for even more rigorous tasks including research, publishing articles, and completing three major projects. He completed the whole Masters in one year, doubling up on all the course work. He graduated with honors, as he had in his undergraduate program.

When Todd tried to find work in Chicago is in his field, he was unsuccessful because, as prospective employers told him, "You have a great education but no experience." No one would hire him to give him the experience. But all was not lost. He affiliated himself with the Center for Independent Living, working for minimal wages to get the experience everyone said he needed. He fought the battle with the Department of Rehabilitation Services, knowing he needed to use computer technology but hearing over and over again that he could not get a computer until he had a job. Todd knew he could not get a job until he could use a computer. He went to the top, engaging his network of friends and acquaintances, and a computer suddenly became available to him. He started using Dragon Dictate (voice input to the computer) and Vocalize (a screen reader) in 1992.

Todd met the love of his life and the happy couple moved to Arizona. His good fortune continued, as he was accepted into the doctoral program in clinical psychology at the Arizona School of Professional Psychology. That was a happy day. He began his studies using the DOS version of Dragon Dictate and Vocalize, and his technology was upgraded to Dragon Dictate for Windows and JAWS in 1996.

Todd used this combination of technology, because, even after researching alternative assistive technology solutions, he was told that what he was using was as good as it gets. He continued to work away, realizing frustration at his speed and accuracy of input to the computer and limited access to the internet. His wife had to do all his on-line research for him. His current cadre of assistive technology, i.e. a Pentium 166, Hewlett Packard Scanner, Dragon Dictate 3.0, JAWS and desktop microphone were great but not quite great enough. In 1999, Todd’s Vocational Rehabilitation Counselor listened to his needs and referred him for an assistive technology assessment.

The focus of this assessment, at the Arizona Center for the Blind and Visually Impaired, was 1) to determine potential assistive technology to assist Todd to increase his speed and accuracy in computer access (possibly using Naturally Speaking) and 2) explore voice amplification/clarification options to assist listeners to reliably understand his speech in the therapist/client relationship. The transdisciplinary team addressing Todd’s strengths and needs at that time included a team occupational therapist, Speech and Language Pathologist, rehabilitation teacher for the blind and visually impaired and a computer specialist.

At that time, the professional team found that Todd engaged in elaborate conversation with unfamiliar communication partners, turning his head toward the speaker and also turning his head to listeners as if to hold them in conversation. His speech was often quiet and difficult to understand. He did not always take breaths between phrases and beginning and ending sounds were often unclear. It was easier for the listeners to understand his speech when the context was shared. His sentences were lengthy and listeners often ‘got lost’ from the beginning to the end of his ideas, especially if some of the key words were not understood. Listeners commented that they had to listen very carefully to understand Todd’s speech.

Todd had a voice amplifier, but this device had developed some mechanical problems and was not working consistently. Although the device helped by amplifying Todd’s voice, it did not enhance the clarity. It was estimated that, even with the speech amplifier, unfamiliar listeners understood less than two thirds of Todd’s speech.

Todd was dictating using Dragon Dictate 3.0, with the text being read back to him using JAWS 3.0. Todd had a desktop microphone positioned with a gooseneck to the recommended position. This allowed him almost full access to the computer. The software was configured so that Todd dictated one word at a time, waiting for the screen reader to read each dictated word to him. This one on one correlation allowed Todd to correct any errors to the previously dictated word. Todd used this method to write papers, progress notes and complete other school assignments. It took about 1-2 hours to complete a typed page.

It was noted that Todd’s speech quality was very different while interfacing with the computer than during face to face communication. At the computer, Todd carefully enunciated each word, distinguished beginning and ending sounds and spoke slowly. Voice recognition was functional in the dictate, command and spell modes. There was more difficulty with multi-syllable than single syllable words.

Todd demonstrated the ability to alter his speaking patterns into the computer. He was asked to clearly enunciate a short phrase and take a breath prior to speaking again. He was also asked to take a breath before speaking a multi-syllable word. Todd practiced these new strategies and the screen reader was adjusted accordingly. This enabled Todd to increase his input speed to 2 typed pages (uncorrected with 80-85% accuracy) in 30 minutes.

Exploration of potential assistive technology solutions towards more independence and success in his roles as a student and doctoral candidate continued for an 8 week period. The research process, coupled with Todd’s readiness to attempt new strategies and approaches was wildly successful. Professionals and manufacturers recognize that using a combination of voice input to the computer with screen reading is a highly complex sophisticated coupling. This software combination should theoretically allow the user to achieve an input speed approximating 12 WPM. Todd had surpassed this expectation, achieving input of 36 WPM with 85 % accuracy. This rate/accuracy, though markedly improved, was still inadequate to assist Todd in his roles of a student and soon as a professional.

The assessment process, using a test, try and retest model, made comprehensive recommendations re: software and hardware to empower Todd to be more independent and successful in his roles as a student/doctoral candidate (including clinical psychology practicums) and potentially as a clinical psychologist. It was recommended that Todd would access the computer independently using a combination of assistive technology. This would enable him to input the computer (using voice activation) at an accelerated speed, have text read to him (text which he had created or had been scanned in), access the internet, complete forms and use the telephone. The assistive technology solutions would be used in the academic and clinical settings. He was currently using older versions of Dragon Dictate and JAWS. The speed of input and output of this combination of software was inadequate to meet Todd’s perceived needs. The recommended software would allow Todd to achieve an input/output speed consistent with his current needs of a student and intern and also accommodate his projected needs as a professional, potentially at a rate to approximate 80WPM with 100% accuracy.

The recommendations to maximize successful computer input and output included the following: 1) Pentium III 450 Desktop computer or updated version to accommodate system specifications for recommended software and accessories (including microphone, speakers, DVD, zip drive, automatic turn on/off etc.), 2) Dragon Naturally Speaking Professional 3.52 or the newest version available, compatible with the hardware and software, 3) JAWS 3.3 Screen Reader using Internet Explorer, 4) JawBones to successfully link JAWS to Naturally Speaking, 4) training using Dragon Naturally Speaking and 5) Hewlett Packard Flat Bed Scanner HP 6250 or newer version compatible with other hardware and software, 6) hands free phone option for Dragon 7) medical and psychological dictionaries and 8) OmniForm.

At the same time, Todd had the opportunity to use the Electronic Speech Enhancer. This technology not only amplifies but also clarifies the communicator’s own speech. Todd spoke to familiar and unfamiliar communication partners in quiet and noisy environments while wearing the Speech Enhancer. His listeners were able to understand almost 100 % of his speech, even when they were not looking at him. Todd did not alter his speech patterns, i.e. he continued to speak softly and rapidly. His listeners could even understand his speech when he spoke rapidly and when he was passionate about this topic. He commented that, because he could hear his speech, he was able to make corrections to improve the integrity of his conversation.

Todd did not have to work as hard to speak while wearing the Speech Enhancer. He verbalized this observation, but the ease of communication was evidenced in his tone. His left hand was not tense and his facial muscles were observed to be more relaxed. There was more animation in his voice.

The Electronic Speech Enhancer was also recommended as part of the assistive technology assessment in August, 1999. More specifically, the unit for persons with more impairment was recommended. In addition, a variety of microphone/head pieces were recommended to avoid sensitivity reactions on his face and ear. This would also afford him a ‘spare’ should be drop a headpiece while taking it off or putting it on. It was suggested that Todd would wear a speaker and also have a desk speaker available when he is speaking to a larger group. Finally, it was recommended that Todd receive speech therapy to maximize his intelligibility using the Electronic Speech Enhancer.

This device was to be used as a stand-alone in social and professional interactions. The literature describing the Speech Enhancer also states that the system can be used directly with Dragon Naturally Speaking. This coupling of technology would also significantly enhance Todd’s use of voice input to the computer.

This scenario brings the reader to the current status. Todd received his Master’s Degree in Clinical Psychology on October 1, 1999. He was awarded the first place winner, college category for his outstanding achievements recognized in the Ability Counts Awards Program by the City of Phoenix, Mayor’s Commission on Disability Issues on October 7, 1999.

He is awaiting his new technology, which has been approved by Rehabilitation Services Administration at the district level (Phoenix, Arizona). Todd is told that the products are forthcoming.

Todd’s voice recognition on his old software is not always correct, but his message is clear. Todd dictated the following using his old technology. He did it slowly to give you the fullness of content. It took quite a while to put these words on paper.

" Have been utilizing Dragon dictate classic 3.0 in conjunction with JAWS for Windows 3.0 since 1996. I am a third year doctoral student in clinical psychology, and also happen to be a visually impaired quadriplegic. Using dragon dictate with Jaws I am able to be virtually independent with my papers, reports, progress notes, and other miscellaneous tasks. I am able to achieve speeds of approximately thirty-six words per minute with an accuracy of eighty-five percent. Their is know one else I am aware of who is accomplishing this degree of speed and accuracy with these two products. I would enjoy the opportunity to present my mastery of these products at the CSUN conference. I am certain the product manufacturers would be pleased to see their products pushing the envelope beyond what they thought possible. Thank you for your time"

As of this writing, the next chapter is not yet written. Todd will happily share the results of his new freedom of speech with you in March of the new millenium.


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