When autistic children get stressed they often don’t show it. Instead, their tension might build until they have a meltdown, which can result in aggression toward others and even self-injury. Since autistic children have a difficult time expressing or even understanding their emotions, teachers and caregivers can have a difficult time anticipating and preventing meltdowns.

These types of social communication and emotion regulation difficulties lie at the core of Autism Spectrum Disorders (ASD), making interpersonal interactions overwhelming, frustrating and stressful for children and their families.

Furthermore, communication difficulties combined with atypical visual and auditory perception in ASD make traditional learning challenging, and suggests that perhaps independent, spontaneous and sensory-based learning may come more naturally to persons with ASD.

In order to study ASD researchers rely objective measurements of emotional states. Affectiva (@affectiva) was spun-out of the Affective Computing Group at the MIT Media Lab in 2009 by professor Rosalind W. Picard, Sc.D. (@rosalindpicard) and research scientist Rana el Kaliouby, Ph.D. and has since gone on to deploy its body sensor network technology in numerous settings to detect and record physiological signs of stress and excitement by measuring slight electrical changes in the skin, known as electro-dermal activity (EDA).

The key to this light and wearable sensor is its ability to compensate for motion and temperature. Read more to learn how the technology works.

The company’s core technology is the Q Sensor, a wearable biometric sensor in use at 150 leading universities and corporations which tracks user excitement, engagement, stress and anxiety. The Q Sensor is offered on the company’s website in two distinctive models, the Q Sensor Curve and the Q Sensor Pod. Beta versions of the Q Sensor device cost $2,000.

The curve-shaped Q Sensor is designed to wear on the wrist, so it is comfortable and unobtrusive to wear all day at work, play, or sleep. This makes it ideal for long-term measurement in clinical and therapeutic research.

The pod-shaped Q Sensor can be worn in several different ways, but the company provides custom bands for wearing the pod in the palm of the hand or on the wrist.

The Q Sensor can be worn as a wristband or a smaller module that can slip beneath a sweatband or a baseball cap to make it more discrete. The actual sensor is approximately four by four centimeters, can be wiped down, and the wristband itself can go in the washer.

The device also has a temperature sensor to help correct for mistakes, for instance the device can tell when a user simply enters a hot room rather than having an emotional reaction.

Q Sensor software displays skin electro-dermal activity, temperature and motion. You can view, annotate and share Q Sensor data, or download the raw data in standard formats. Additionally, Q Sensor software has dozens of built-in functions including annotation windows, ranger markets and multiple data views.

One example of a research team using the Q Sensor to study autism is at the University of Notre Dame, where they are currently measuring how children diagnosed with autism respond to interactions with a humanoid robot during therapy. The challenge is to measure children’s responses to the robots and improvements in their comfort levels over time.

The team began using the Q Sensor in October 2010 to see how the device readings compared with data captured using a tethered system developed by BIOPAC Systems which is often used in physiological research for measuring EDA. According to lead researcher Dr. Charles Crowell, the comparisons are “very similar” and “we’re happy to use the Q Sensors for the project.”

Affectiva’s other major product Affdex is software that interprets facial impressions to scientifically measure emotional responses in real-time using a standard webcam. Large companies and market research firms like Millward Brown use Affdex to deliver intuitive emotion insights for advertisements. Other long-term applications for this technology envisioned by the Affectiva team include interactive kiosks, emotion-enabled devices and gaming.

In July, Affectiva completed a $5.7M Series B financing round led by WPP’s London-based consumer insight group, Kantar, and Ohio-based Myrian Capital. The company announced in a press release they would be using the funds to speed up market deployment of the Affdex software product. The company had previously raised $2M in funding from its founders and Lingfield AB, and also won a $650,000 grant from the National Science Foundation.

The company recently leased space in Santa Clara, CA, which will serve as headquarters for Affectiva CEO Dave Berman, as well as newly-hired VP of Product Management Avril England, VP of Sales Brent Sapiro, and VP of Consumer Success Andy Dreisch. The company is actively hiring in its Waltham, MA office and its new Santa Clara office.

“If you’d like to join top scientists and engineers to tackle the next frontier of computing — emotion – please give us a call.”

Further Reading:

By: Darwin Wan, MS II

Speech and language difficulties are a feature of many different medical disorders, ranging from developmental disorders such as autism, to cerebrovascular diseases such as stroke.  While a variety of communication aids are already available on the market, many can be quite large, cumbersome, unwieldy and expensive, especially when the “medical” label is attached to it.

Developed by a team from the University of Toronto, MyVoice Communication Aid aims to disrupt this paradigm by offering an iPhone app (Android upcoming) designed to help patient overcome the challenges of speech.  The most notable advantage this app offers over other devices is that it is available on mobile phones; no additional physical devices are required.

Another immediate advantage is that the app is presently offered for free for 6 months, so there is no barrier to any patient with a compatible phone to try it, though it has been reported that it may eventually become subscription based, priced at $30 per month.

Upon opening the app, one is presented with a hierarchy of words and categories.  One is able to navigate through categories to select desired word or phrase.  Tapping on the words prompts the app to speak the word or phrase in a fairly natural-sounding (though not perfect) voice.



While the pre-programmed phrases provide some very basic functionality, it is in the customizability where the app truly shines.  Via an online management system on the MyVoice website, you are able to organize and create new word, phrases and sentences according to your own preferences and organization.  Or you can simply add pre-existing word dictionaries (with themes of sports, food etc.) to your account.  Any changes you make to your online account are synced instantly with a drag of the finger on the app.

The app is generally quite good at pronouncing your custom phrases, though it did definitely struggle on most of the medical terminology I tried.  It would be useful if the pronunciation of medical terms could be fixed, as it would be very useful for patients trying to describe their condition to others.  One can also add photos for each phrase if desired.


Another feature is the ability to use your phone’s GPS to find your location and present you with your custom phrases based on your location.  In the example below, I have added a few phrases to the website and associated it with “School”.  Whenever I am in school, hitting the “Find Location” button would bring up a list of nearby locations from which I can select “School”, and be presented with my custom phrases.



While there is definitely a lot to like about the app, it does take some effort to scroll through to find the exact phrases that one desires.  In testing the app out at a barbecue, I found it difficult to participate in conversations with the fluency and manner with which I would normally talk.  Simple and quick messages were easy to convey, but in depth conversations definitely proved to be a challenge.  I do imagine this to be a limitation of all communication aids in general, not just a mark against this app in particular.

Though the syncing mechanism between the app and website works very smoothly, I did find myself triggering inadvertently fairly often.  The app also syncs every time it is opened or awakened from sleep.  The net result was that I found the battery on my phone draining quite quickly.  I imagine that regular use of the app throughout the day would probably necessitate charging the phone every day, or a battery case for heavier users.  The user interface on the app and website also both have a bit of a learning curve, so users would be best advised to check out the tutorial on the website.

Overall, MyVoice Communication Aid is an excellent app that has the potential to really enhance the lives of a specific subset of patients with speech difficulties.  I imagine that patients with pure dysarthria will benefit from this app the most because their motor and cognitive abilities are good.  Patients with poor fine motor control may find it a bit difficult to navigate through the iPhone’s smaller screen, while patients with poor reading or comprehension ability may find it difficult to pick phrases.  MyVoice is certainly not a cure for all the speech problems in the world, but it definitely can play a huge role in enhancing the lives of patients with speech difficulties.

Likes

• Excellent tool for patients with speech difficulties but good motor and cognitive function
• Powerful customization options allow users to input and organize custom phrases
• Smooth syncing between the management website and the mobile app
• Innovative use of the GPS function to pull up location-specific phrases

Dislikes

• Drains battery noticeably with frequent syncs
• Navigation can be cumbersome and disrupt the flow of a conversation
• Patients with fine motor difficulties may benefit from an iPad version of the app (not customized for iPad currently)

Price

• Free (possibly subscription-based in the future)

Conclusion

• MyVoice is an outstanding communication aid that is very customizable, and free to try at the moment.  Patients with pure speech difficulties will benefit the most, while those with motor or cognitive difficulties may be unable to use the app.

Cost: Free

iTunes Link

In a Wall Street Journal profile on how iPad apps are being used by special needs children, such as those who have speech impediments and as a communication tool – Steve Jobs commented on how even he did not have the foresight to see that the iPad could be used in such a fashion.

“We take no credit for this, and that’s not our intention,” Mr. Jobs said, adding that the emails he gets from parents resonate with him. “Our intention is to say something is going on here,” and researchers should “take a look at this.”

Last year we reported on how how much cheaper Apple’s portabile devices were compared to the traditional speech software/hardware products, and how insurance companies were hesitant to reimburse for a significantly cheaper Apple products verse industry products.

At the time of our report last year, insurance companies were willing to reimburse up to $8,000 for a product that could be replaced by an iPod Touch with speech therapy apps would cost approximately $600.

Since our report on the topic last year – not much as changed.  Per  the WSJ cheaper Apple products are still not reimbursed by most private and government insurance, including Medicare.  Industry device manufacturers state their products are significantly more expensive because of economies of scale – they have a much more limited audience and since they don’t sell a high volume of devices they have to charge a high margin.

This argument has some merit – but why most insurers continue to be hesitant about reimbursing for a device that delivers similar functionality but is cheaper is still puzzling – especially to parents of these children.

Source: Wall Street Journal

App featured in picture and Wall Street Journal is Proloquo2Go, used for those with cerebral palsy, autism, down syndrome, apraxia, ALS, stroke, traumatic brain injuries, developmental disabilities
*iTunes link

As medical technology improves, common sense dictates it will become more innovative and sometimes even cheaper. Medical applications on a portable device are not new, remember the old school Palm PDA? It was a must have for physicians and medical students. Just the other day I saw an attending pull out one of those old bricks. Other than the platform, the biggest difference between those Palm medical apps and the iPhone medical apps are the developers. The barrier of entry into making an iPhone medical app is significantly less than it was back in the day. Anyone can make an iPhone medical app (learn some programming, or pay someone) and submit it to the App store. This has both positives and negatives, as documented on this site.

Anyways, before I digress further, this influx of new developers has lead to innovation, and significantly cheaper applications. In order to embrace these applications, insurers are going to have to change their archaic ways, and at the end of the day, it’ll help out their bottom line. So, that leads us to the title of this post, why are Medicare and other insurance companies refusing to pay $150 for text-to-speech software, yet willing to pay $8,000 for a device that does pretty much the same?

There is a fantastic article in the NY Times detailing Medicare and other insurance companies resistance to new portable medical technology. The reason for this resistance lies in the multi-functionality of the devices. Insurance companies will only cover devices that can be used for medical purposes, nothing more. Since mobile devices, like the the iPhone, can be used for non-medical purposes, such as gaming, it "disqualifies" them.

Whats worse is these strict "medical devices" are completely marked up, and why not? If the developers of these products know consumers are limited in their choice of medical applications, why not mark them up?

NY Times Article:

But the prices may seem hard to justify based on components alone. One $5,000 DynaVox product is essentially the speech software bundled with a two-pound keyboard that has a six-inch screen. And the manufacturers mark up standard accessories by as much as 2,000 percent. Prentke Romich, for example, charges $250 for a Bluetooth wireless adapter similar to those that cost $20 in stores…..

…..Betsy Caporale, a speech language pathologist in Danville, Calif., has tested various devices and software with children who have Down syndrome and autism.

The iPhone has been a runaway success with these kids,” she said. “It takes them about 10 minutes to learn how to use the iPhone, and there is this cool factor for them.

I would understand the resistance to the iPhone itself because of the needed AT&T contact, but the iPod Touch would be perfect for these types of applications. No service fee, just the flat rate for the device. Better yet, if I’m an insurance company, I’d pay a developer $8,000 to make a custom iPhone/iPod Touch Medical app that meets my requirements. The barriers of entry into the game have significantly decreased. Companies need to realize this and take advantage of this. End users have already realized this, just look at the success of the App Store.

At the end of the day, will these policies change? I don’t know. I do know one thing though, when there are a limited number of options to choose from, the end user will always pay more for less.