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Comment by nashadelic | Hacker News Reader

How did we not have this 10-15 years ago? It just feels like not enough people work on, or care enough about assistive tech till it impacts them personally.

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I work in a lab at a university where I'm currently working on building assistive music controls for disabled musicians. From what I've seen in my short time here is it seems like a lot of these kinds of projects don't often translate from the research space into viable businesses. Also, due to the highly variable physical and neurological characteristics, often assistive devices will need specific customization, tuning, and support. So these things also tend to be expensive.

This is exactly correct (I worked in AAC and BCI for years, and still collaborate with the group that I used to work closely with). To elaborate a little bit on your excelelnt answer: In addition to being enormously expensive and requiring heavy customization and personalization, assistive technology has other issues that go well beyond the core technical functionality. It also often requires significant up-front investment in configuration and training for the user, which needs to be done by a professional in the field, and then --- crucially --- also requires ongoing maintenance and re-training by skilled practitioners, which means there are ongoing operational expenses.

One of the reasons for this last bit is that many users of assistive technologies have very dynamic situations. For example, if they have a progressive condition like ALS, their mobility and other capabilities and needs will change over time; even if the user doesn't have a progressive condition, their living situation very likely will change over time, which may involve needing to re-work their setup. This might involve something as major as moving from one care facility to another, or having to adjust to the presence of a new pump or something that causes EM interference with your device.

Even for somebody with a very static medical condition and very stable living situation, their computing setup won't be static, so will need ongoing maintenance; or, alternatively, their computing setup will become static if they end up dependent on a particular piece of assistive technology, which can lead to a whole other set of issues (which is how you get people running ancient versions of Windows for years and years and years, because it's what their eye-tracker works on, and the vendor is long out of business and so never got it working on Windows 10).

The other piece to the puzzle is that, speaking as a gross generalization, users of assistive technologies tend not to be wealthy people (many speech and motor disabilities make it challenging to work). So, you've got an expensive product, often involving ongoing operational costs, with zero economy of scale, for a small and relatively poor customer base; this all adds up to what may fairly be described as "a very challenging business". Adding another layer of complexity, the economics of commercial assistive tech in the US have a lot to do with insurance Medicaid rules; the only reason there is any commercial activity at all in assistive technology and AAC is because under some circumstances Medicaid will pay for a device, within certain very rigid and complicated boundaries. So now your business also is going to have to juggle that problem in order to keep the lights on, which will add another layer of constraint to what is already a complicated situation.

On the other hand, when the right technology is paired with the right user and the right support, the impact on the quality of life for the user and their family can be truly enormous. Which is what keeps people working in the space...

At least one company I know of (though this was 15 years ago) had ridiculously high prices for their products. But they had extensive after-sales support, and the warranty was such that you could basically run over the unit with a car, and they'd still repair / replace it under warranty for free.

We're currently building a new AAC device which allows users to write/speak quite a bit faster, and we're encountering exactly the hurdles you mention. Would you be willing to exchange some helpful pointers about how to bring an AAC device to market? Contact info in my profile.

I suspect it’s a couple things. First, the skill gap - maybe someone begins needing assistive tech and has no idea how to start making. Second, perspective - as an able-bodied techy, I lack the understanding of the problem to build the right thing. Third, communication - can the one in need describe their need? This really requires reflection, and maybe skill. And lastly: money - how many of is can afford to work for months or years on a project that doesn’t (and likely won’t) pay?

Typing with eye movement. https://www.optikey.org/ Typing with head pointer. https://www.alimed.com/adjustable-head-pointer.html One handed typing. Various keyboard layouts. https://en.wikipedia.org/wiki/Dvorak_keyboard_layout#Variant... Speed recognition, Text to Speech, Windows accessibility features.

Products do get worked on and have been released. But yes, more work needs to be done and this product is a welcome addition.

We tried about 9 years ago :) we even open sourced the solution. At the time we felt there was not a big enough market so we decided to make it open for anyone to build upon our research.

http://pallette.io/instructions.html

Seems to be the case for so many assistive technologies. It is even more frustrating considering how high impact some of these technologies are.

Do you have any insights on how this space could grow other than State Funding or Insurance policy changes?

Exactly. Its unfortunate that this is the way the world works...but we hope that the MouthPad^ can change that tired script! Universal design benefits us all, not just those at the extremes -- we should all care. See the history of curb cuts on our sidewalks as a small example.

As someone who's not a quadriplegic, I want one of these.

For a short time in DC (District of Columbia, USA) government, I worked with Age-Friendly DC. They were all about universal design, obviously. I learned a ton - like how curb cuts are good for folks using canes, walkers, and wheelchairs, and those who push things like strollers. However, the Age-Friendly DC staff could have done much more to work with non-aged policy advocates and organizations, to show them the benefits of things like curb cuts.

Personally, I'm using a lot of what I learned from the Age-Friendly folks; my 83yo mom has moved in and the learning curve, while steep, got a head start with my government experience.

We have working systems like the Tongue Drive System (TDS) [0]. Tech companies seem out there [1] or [2] that offer solutions, but the a11y market is largely dysfunctional across the globe.

It is so difficult to get everyone the tech that works best for them. I was part of large EU funded project that wanted to fix this with an open source ecosystem [2]. However, I had to learn that although there are many innovative and engaged people it is really hard to fix seemingly simple problems.

[0] https://www.science.org/doi/10.1126/scitranslmed.3006296

[1] https://glosdex.com/

[2] https://tongo.tech/

[3] https://ds.gpii.net

I went to grad school for architecture at the end of the last century.

Tim was a classmate. He was and remains paralyzed from the neck down. At the computer Tim manipulated a trackball with a tool — rod connected to a flat mouth piece.

This is different, but I am not sure it is better. The trackball and stick were mostly mechanical, reliable, and straightforward to repair.

No special software. No need to charge. Tim’s tools were as reliable as a mouse. Not much of a choking hazard because of the stick either.

I’m not saying the mouth-pad is a toaster fridge. Only that it has technical complexity rather than mechanical simplicity.

I would think fewer moving parts is less complex. Considering it’s basically a trackpad, I doubt the hardware and software are bleeding edge.

It’s a radio and computer that goes inside a person’s mouth. That person can’t use their hands. How do they take it out and put it in?

Tim had a red solo cup size container next to his keyboard — he also typed with the tool in his mouth. [1] When he wanted to talk to someone, he stuck the stick in the cup and stood the tool up where he could pick it up again.

[1] I hadn’t remembered that because it’s been 25 years. Tim could also out sketch most people with a pencil in his mouth as well. He had a bachelor in fine art before the motorcycle wreck.

we did, there were at least 3 kickstarters (of which i ran one) but not enough people were interested.

that's so cool that you tried. how much did you spend on advertising for your Kickstarter? I totally would have kicked in if I'd heard about it.

MITs MO is to try to create a breakthrough tech and rapidly spin off startups from the tech. But I think the main barrier is that to operationalize hardware requires massive capital investment upfront for testing and then regulatory approval, this is mostly not possible for VC. So the students/profs who make the breakthrough do the next best thing: Patent and then sell it to a company that has the capital to do it.

But someone can correct me if I am wrong about this.

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