Wednesday, November 30, 2011

Eye Gaze device trial: Tobii C15 with CEye

We've been working on a method of communication with Emma for a loooooong time now!  We have a variety of approaches - picture cards, hand gestures, iPad, looking at things, etc.  Most are initiated by someone other than Emma.  I've been looking for a way that Emma can initiate conversations, tell us all the good things going on in her head, and let us in on all her jokes because this girl is usually smiling and laughing!

This year at school we have a huge focus on her expressive communication.  Emma started using some scanning programs on a Dynavox and took to it pretty quickly.  I talked about it in this post.  Some drawback to this method are that it takes a long time to do the scanning and there are some challenges because of Emma's double whammy of hearing loss and poor motor control.  I have always thought that an eye gaze system would be a good option for Emma.  Last year we had a trial with the Dynavox with Eyemax eye gaze communication device and it was a disaster.  Make that a DISASTER.  I had high hopes going into the trial and came out feeling pretty defeated.  While there are many people out that that use and love the Dynavox eye system, it was not a good fit for Emma and so we kept plugging along with our various communication approaches.

I belong to a yahoo group of Moms with children with CP and a few of the children are doing quite well with the eye gaze systems so I didn't give up on the idea of eye gaze for Emma.  There were good parent reviews on the Tobii CEye and the PRC Echo2 devices so I talked with her SLP at school about wanting to try the eye gaze devices again.  Yesterday, the sales rep for the Tobii came to school for Emma to trial the Tobii CEye device.

I was reserved about the trial.  I remembered how excited I was for the Dynavox trial and I didn't want to be disappointed again like I was before.  I decided to go in with an open mind and see what Emma wanted to do.  No pressure on her or me.  Right off the bat the sales rep. impressed me.  He spoke right to Emma, gave her his business card first and then handed them out to the rest of us, asked her most of the questions.  Emma took to him immediately.  I'm sorry to say that it's all too often that people don't include her in the discussions just because she can't speak.  This man respected her as a person and knew that she was the most important person in that room for the trial.  It was very refreshing!

Emma tested the Tobii C15 and the C12 device.  The Tobii C-Series family of devices are "portable communication aids for text and symbol based communication, computer access and environmental control.  They are easy to set up and use, have batteries that can be replaced without having to shut down, feature side caps that can be changed and much more." (all items in quotes on this post are from the Tobii product literature)  The C15 device has a 15" screen, the C12 device has a 12" screen.  That is the main difference between the two.  Both were outfitted with the Tobii CEye, an "optional eye control module for the Tobii C12 and C15.  Accurate and precise tracking, works with most users, largest trackbox on the market."

What is an eye gaze device?  "Eye control is an alternative and complementary input method to using a mouse and a keyboard.  By looking at a screen you control the mouse and you click by blinking, dwelling (staring at the screen for a certain length of time) or using a switch."  The computer has a touch screen so you could also access it with your hands and we also tested where Emma would use her eyes to pick a box and then we would click the switch to select that box.

I have to say that it was super easy to calibrate the device for Emma's eyes.  It took about a minute!  I was very impressed with the Tobii for that reason alone.  After testing out several options, it seemed that Emma did the best with her eye gaze and a dwell time of 1.2 seconds.  We navigated through several screens.  There was a screen where she could pick a book she wanted to read and then it opened up and she could select the pages to have them read out loud.  She did great with that!  Here is a small video of her and the books that I took the second time she chose to look at books.  We had been working on the books for a while so she was getting a bit tired when I finally realized I should take some video.  The volume is low because she previously was playing music with the machine and her eye gaze and the volume was super high for that program so we had to turn it down.

We also had a screen where it looked like a storybook page and a child in a wheelchair was sitting at a table with his friends.  There were bubbles on the table and presents around and Emma could use her eyes to select items.  When she selected the bubbles with her eyes, a grouping of options filled the outside perimeter of the screen.  She then "played" with her eye and selected a few of the options.  One was "blow lots of bubbles", so her SLP blew bubbles for real.  Then she chose "let me blow bubbles" so we let her try and blow them.  She did a few other things, such as comment "this is fun", on this page and it really seemed to capture her interest.  It was a nice way to interact and I could see this as a great tool for actual activities in the classroom where we take photos of the kids and put them in the scene and Emma could call out her friends names, tell them to blow bubbles, etc.

Another thing she did during the trial was look at some flash cards.  We would ask her where is the *animal* and she would look at the screen and use her eyes to select it and then the device would speak the name.  We only had one card up at a time, but you could put several up there and ask her to select matching items, odd one out, etc.  I think she would have a lot of fun with this!  Here is a little video of her with the flash cards, again she was a bit tired when I pulled out the video camera but she was still participating!  The blue dot is what her eyes are looking at, in case you are wondering how to tell where she is looking.

We also tested out a fun little dice rolling page.  It is a random dice rolling generator we could use for things like playing a board game as a family.  Emma could use her eyes to roll the dice and then the dice outcome would pop up on her screen and we could then move her piece.  We could likely even put a command on that page that says "Can you move my piece?" or "Your turn" or "My turn".  I can see some really good options for this page!  The nice thing about this, too, is that we could use our fingers to select the dice roller and just use the device to play without needing actual dice.  It would let us interact with Emma a bit more and wouldn't put her as the odd one out.

Emma was really on a roll for this trial and so we put up a music page.  Emma could pick between different music and turn it on to play.  The rep then danced (see, I told you he related well to Emma!) until the music halted and she had to select more music to play for him to dance again.  He suggested this was a good page to play freeze dance with her classmates.  Emma seemed to really like this page, and it was a bit similar to Simon Says that I programmed onto her iPad that we would play sometimes.  It just seemed so much easier for Emma to access the screen with her eyes than accessing it with her hands.

The trial lasted for about 1.5 hours.  Emma was distracted for part of that time, but not as much as I would have expected.  I was happy to see that she was interested in the activities we were doing on the screen with her and she attended to them for a long period of time!  After all, 1.5 hours is a long time for a 4 year old to pay attention to something.  It's also a long time for adults, but we were all so into the trial I didn't notice the time going by.  Emma did so well that it was wonderful watching it all unfold.

So, where do we go from here?  The rep. suggested we rent the device for a month through insurance instead of asking them to pay for the device right away.  It is hard to get these devices paid for through insurance and he said there is usually better acceptance if insurance does a month's rental first.  The monthly rental is very high, and the device price is even higher.  I looked online and found our state's AT lending library has the older version of the device Emma tested available for an 8 week loan period.  I think we might want to start with that while we get the ball rolling with insurance.  I also think we might want to test the ECO2 device to make sure we are ordering the best one for Emma.  Insurance won't pay for another one for a long, long time so we need to make sure we order the best device for Emma.

Once again I'm excited about the possibilities for Emma's expressive communication.  I always thought her CIs would mean that she would talk, but maybe her way of talking will be different than I expected.  Maybe she will talk with a computer.  I am at a place right now where having her talk, in any way possible, is exciting to me.  I am excited for her, excited for her future.  I still remain positive that Emma will use her voice one day for communication, but until that happens we are pursuing other options and so far the eye gaze device we trialed yesterday seemed like the best option.  The future seems very bright, indeed!

1 Comments from readers:

Kara Melissa said...

Wow! I am so excited for you and Emma! Reading this post was so helpful to me, thanks for taking the time to write it all up. I am going to share it with the AAC team we are working with to see if this is something we could try for Sebastian. Right now we are working with switches and simple statements in his class. So I can see this as a next step. Awesome.