While smartphones and tablets like the iPad, iPhone and Android devices are transforming how most people communicate, learn, shop and entertain themselves, a huge population of people with mobility impairments, like quadriplegics, lack the dexterity, stamina or concentration required to operate a touchscreen device, like an iPad. This can include people with a broad range of medical conditions including:

  • Spinal Cord Injury (Quadriplegics)
  • Cerebral Palsy (CP)
  • Multiple Sclerosis (MS)
  • Stroke
  • Amyotrophic Lateral Sclerosis (ALS)
  • Autism

The potential of iPads, and related mobile devices, to transform the lives of people with disabilities is phenomenal as they can be used as very flexible, universal and update-able tools (vs fixed “made for the disabled” hardware) for activities like reading (E-books), education (online courses), communication (email, texting, telephone), speech generation, environmental control (thermostat control, TV remote), and rehabilitation (prompting exercise regimes, “neuro-gaming” rehab apps). In this case, quadriplegic users need only update the iPad apps to keep up with new advances vs acquiring a new piece of hardware.  Here are some alternatives for quadriplegics to access the iPad and iPhone.

1. Voice Only Control (or All Voice Control) 

It’s intuitive that an all-voice control option for the mobile device would be a sensible solution to allow quadriplegics access to a mobile device. There are voice controlled bluetooth headsets, smartphones like the Moto X listen to you all the time or you can jailbreak the iPhone to facilitate hands-free access to Siri, but practical issues limit the viability of this approach:

  • Noisy Environments – While voice control works well in the confines of a single dwelling house, it is nearly useless in urban environments.
  • Battery Drain – Having Apple’s Siri or Google Now listening all the time for voice commands can lead to significant battery drain.
  • Limited access – While you can make phone calls, you are still limited in the functions you can access, having to pick up all calls automatically or being unable to hang up on demand or dial an extension (i.e. in a corporate menu). 
  • No smart functions – The advanced functionality of the device (text, email, web, apps etc). remains inaccessible to the user
  • Limited to Clear Language: Users with an accent, low-volume voice or that have a speech impairment also not be able to take advantage of this solution.  

For a more complete explanation of what speech recognition can and can't do, see this post: http://gettecla.com/blogs/news/15118049-siri-vs-ios-switch-control-for-hands-free-iphone-access

    2. Mouth Stylus (Mouth stick) 

    A mouth stylus is a good solution quadriplegics with upper body mobility impairments, but good head control and little spasticity. For these users, the stylus acts as a finger would, allowing the user to select options on the screen and navigate the device, but does not allow the user to do advanced gestures required by many new apps.  

    For simple gestures, the iPhone and iPad have an accessibility feature call AssistiveTouch, that can emulate multiple finger gestures or that can provide access to functions that are usually controlled with hardware buttons (i.e. volume, lock screen). While this access is available, this is a slow access method that would not be suitable for time-sensitive tasks like picking up calls. It’s also a difficult solution for quadriplegics that have issues with fatigue, or lack steady motion control. 

    3. Dedicated “Accessible Apps”

    While not a universal solution for accessing the full iPad, some specialty apps have been designed with mobility access for quadriplegics “built in”, allowing the users to perform specific functions like making phone calls or sending text messages. A quadriplegic would normally control the app through switch interface such as pressing a big button with their fist, elbow or shoulder. 

    While useful for basic functions, this implementation will not allow full access to mainstream apps that an able bodied person would be accustomed to using. 

    4. Full iPad Accessibility for Quadriplegics using a Tecla Shield

    Quadriplegics and others with mobility issues can achieve full access, wireless control of an iPad, iPhone or Android device through input devices familiar to the mobility impaired, such as wheelchair driving controls and adapted switches (e.g. simple buttons, sip/puff, blinking inputs). In the same way you would control a wheelchair with these input devices, a user can similarly gain complete control over their mobile device. The switch or joystick hooks into the Tecla Shield, which is wirelessly connected to the iPad or other mobile device by Bluetooth. Tecla users can open, close any app and fully navigate the entire iPad or mobile device. This allows them to typing/dictating text messages and emails, watch videos, read e-books, and control their environment. Quadriplegic iPhone users can also answer and hang up the phone with a few simple clicks. 

    Tecla is designed to adapt quickly to different inputs and can be used with 1-6 input switches or utilize a joystick for the very fast “4 way control” access.  In this way, optimal speed can be obtained for a wide range of unique mobility conditions. This also allows users with newly acquired conditions (like spinal cord injuries) to start simply, and add switches as their rehab progresses. 

    Unlike a stylus where a quadriplegic often needs assistance to begin using the an iPad, the Tecla allows greater independence and portability for the user. Once set-up, a user with an iPad mounted on their wheelchair is fully mobile and can turn on their device and access all functions without outside assistance. In the case of iPhone users, the additional ability to make and pick up calls further enhances communication.

    The Tecla also has some “shortcut” features built-in that allow quick access to Siri voice control for instances where it is quicker to dictate a command to Siri (like looking up an address). Other built-in short-cuts include quick access to the iPad homescreen and quick show/hide of keyboard in apps that utilize the screen keyboard input. 

    Tecla Shield Switch Interface for Quadriplegic iPad Access

    Tecla provides access not just to apps created for it, but to the entire platform. Tecla users can take advantage of the same apps all other users enjoy. This means that that in addition to basic functions like sending messages and making phone calls (for iPhone users), but also:

    • Read e-books from the Kindle store
    • Play music and movies from iTunes (or any other source)
    • Control their homes (TV, Thermostat) with smart home hardware from Logitech, Belkin, Phillips or Nest
    • Interact with news, online education, and other mainstream websites

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    Written by Rich Emrich — April 24, 2014

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