“It’s an enhancement to everything.”

Harnessing Assistive Technology to Improve the Lives of Veterans

When George Jones feels the stress of post-traumatic stress (PTS) coming on, he rides his hand cycle bike. He turns the wheels, and works out the stress, through the push and pull of his shoulders and arms. The Vietnam-War Veteran lost his legs to disease.

George Jones, left, laughs as an adjustment is made to his hand cycle bike.

Biking wasn’t always an option for George. He didn’t have a bike adapted to his needs. And pain pills used to be his relief for PTS. Now, though, biking “gets rid of it.” George received his bike through the Assistive Technology (AT) Program at the VA hospital in Richmond, Virginia. “It’s an enhancement to life,” he testifies. “It’s an enhancement to everything.”

The AT program in Richmond (one of five in VA and few in the country) exists for Veterans and Active Duty Service Members facing a new disability, a degenerating disease, or the loss of function that can come with age. The AT team guides them through the ever-increasing number of assistive technologies, working hand in hand with doctors and therapists. The team consists of program coordinator Melissa Oliver, an occupational therapist by training, and two of the three Rehab Engineers at the VA, Ben Salatin and Brian Burkhardt, who specialize in mechanical and electrical engineering, respectively. They help identify, customize, or even create the right device to help. Veterans and Active Duty Service Members work with the AT team as they seek to live their “new normal” and regain greater independence and mobility, power to control their surroundings, or an ability to communicate.

A 3D-printed iPod mount. iPods and other tablets can help disabled Veterans lead more “goal-oriented” lives.

For George Jones, that meant providing a hand cycle that lets him get outside. For Jonathan Hewitt, it meant finding the right voice-controlled phone to talk with caregivers and loved ones since MS made holding a normal receiver impossible. George Neagle needed a powered wheelchair he could control with his head; his Parkinson’s is too advanced to control one with his hand. And an iPod touch became an electronic cognitive device helping Joseph Hickey remember tasks, enabling a more “goal-oriented” life.

Touring the AT program’s workspace evokes images of a Best Buy; it teams and buzzes with dozens of different devices waiting to be tested by the staff or tried out by Veterans and Active Duty Service Members. There are devices that enable people, who can barely see, to read and type; tablets, controlled by a patient’s gaze, that give voice to people who can’t speak; and iPads that do much more than play Angry Birds. In the corner, the hum of a large 3D printer, employed to make enhancements or patient-specific products, cranks away, sounding a lot like a washing machine for something so cutting edge.

A 3D-printed iPhone mount and sip and a “Sip-and-Puff” control holder. Sip-and- Puff devices control motorized wheelchairs and other assistive technologies through inhaling and exhaling.

The number and quality of devices at use in the AT program testifies to the technological advance of society as a whole over the last few decades. In fact, according to a national database, the number of assistive technologies now numbers over 21,000 — up from only around 6,000 in the 1980s. A patient can control technologies with their voice, their eyes, or their breath. They can type commands on jumbo-sized keyboards or hit buttons that trigger a word or phrase such as “Hello” or “I’m having fun.” A single piece of technology might lock the door, turn on the light, play a DVD, and turn on the AC. The myriad combination of controls and goals means that no two pieces of technology are quite the same — just like no two Veterans face the same exact challenges. The trick lies in marrying the two: finding a device a patient can easily control that does what they need it to do.

Finding that right piece of technology can be daunting for a patient. Brian describes it as a knowledge overload. He and the rest of the team help guide Veterans through the process: “There are too many options,” Brian says. “There are so many variables, so we have to really key in on what do and what [the Veterans] want, what’s their situation, and what’s their medical condition.” Questions abound, especially since technological advances also lead to an increasingly wide gap between intuitive understanding and specialized knowledge, between being ready out of the box and necessitating more advanced programming.

A 3D-printed rotary mount for a patient’s motorized wheelchair.

Without Rehab Engineers, a clinician would have to spend large amounts of time familiarizing themselves with the different technology available or rely on vendors’ knowledge, which is both biased and generally limited to their product. Now, doctors and therapists can trust their in-house experts. Now, Veterans don’t have to come in to a doctor’s office multiple times to meet with different vendors. A single trip to meet with Ben or Brian can replace five or more meetings with vendors.

Beyond navigating what exists, Ben and Brian will work to adapt or create new technologies if what is available on the market doesn’t meet a specific patient’s needs. They’ve 3D-printed a new mount for a wheelchair’s “sip and puff” control, an app specific iPad keyguard for a patient with hand tremors, and a rotating smart phone mount for a patient with limited hand function.

From top to bottom, the vendor’s original mirror, the prototype developed by the therapist, and the first 3D-printed model designed for the Veteran.

A hygiene mirror that Ben printed for a female Veteran shows precisely what makes the personalized, iterative care of the AT program so valuable. Unglamorous but important, hygiene mirrors enable independence and dignity for disabled female Veterans and Active Duty Service Members. The vendor’s mirror, though, wasn’t the right size and shape for the patient. Her occupational therapist created a prototype of a new one, but it was too fragile and flimsy. Where before that might have been the end of the road, instead the therapist asked Ben for help. He designed and 3D-printed a new mirror mount, complete with a hinge that made it easy to use. This newly designed mirror fit the bill perfectly. With feedback from the Veteran, Ben created a second version that was more durable, sleeker, printed in electric blue as a single unit, with a simpler hinge, and added ribs for strength.

The final version of the mirror 3D-printed for the Veteran. Her name has been blurred out.

The mirror, like all the work at the AT Program, aims to improve the quality of a patient’s life. “[The bike] has made [life] better than I ever thought it would be,” says George. Technological advancements afford ever increasing opportunities and solutions. If the expertise, however, doesn’t exist to navigate and explain those opportunities, to fix them when they break, to explain how they work, to make people comfortable with them, then that promise gets squandered. Instead of just giving Veterans something based on what vendors recommend, as Brian puts it, “we bring [Veterans] in, they try it. If they’re in-patient they live with it [for awhile] so they know that when they leave, not only can they use it, but they like it.” When that happens, these technologies reach their full potential and, more importantly, Veterans and Active Duty Service Members realize new realities that wouldn’t have been possible even ten years ago. It opens worlds. It makes life better.

You can read more about the Assistive Technology Program at the Hunter Holmes McGuire VA Medical Center in Richmond, VA here.

From left to right, Ben Salatin (Rehab Engineer), Melissa Oliver (Program Coordinator), and Brian Burkhardt (Rehab Engineer) make up the AT team

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