Compass is the Electronic Assistive Technology (EAT) service at the Royal Hospital for Neuro-disability and deals with all areas of rehabilitation through technology.

Three years ago, John, a 45-year-old engineer, suffered a brainstem stroke that left him unable to move any part of his body except blink his eyes. Today he is able to use a computer to write letters to his children and access the internet to pursue his passion for football and music. He can also drive a powered wheelchair and control household equipment such as a TV and stereo.

Following his stroke he was admitted to the Royal Hospital for Neuro-disability, in Putney, South London, and as part of his rehabilitation he was seen by a team called Compass. The team was created three years ago to provide assessments for people receiving rehabilitation at the hospital, and the service is now being made available to those living in the community and other hospitals.

The Royal Hospital for Neuro-disability is a 240-bed hospital specialising in severe neurological disability in adults. It is divided into rehabilitation and residential sections. Specialist units include two Huntington's disease units, a profound brain damage unit for the assessment of patients who may be in a vegetative state or low awareness state, a ventilator dependent unit, a behavioural unit, a transitional living unit for patients returning to the community and a disability management and rehabilitation unit.

In addition to Compass, the hospital utilises computers extensively in rehabilitation. The OT computer room comprises 18 computers. These are used for assessment and rehabilitation of cognitive and physical abilities and can also be used for leisure and internet access. The music therapy department also uses computers to allow people with complex disabilities to participate in making music and expressing emotions.

Compass deals with all areas of electronic assistive technology (EAT). These include computers, communication aids, access devices, powered wheelchairs, environmental controls and the integration of all this equipment. The team consists of five members, a coordinator, an occupational therapist, a speech and language therapist, a computer technician and a rehabilitation engineering technician. Compass can also call on other professionals including physiotherapists, psychologists and an extensive wheelchair and special seating service.

Compass priorities

Getting the access method and switches correct is the first priority for Compass. When John was admitted, his only voluntary movement was an eyeblink. The Compass team started by trying an eyeblink switch, which reflects a tiny infrared beam into the eye to detect the blink. However, John started to recover some movement of his left thumb and this proved to be a better switch site.

Initially John's thumb movement was not strong enough to activate a mechanical switch consistently for more than a few minutes. John also wore hand splints during the day which prevented him using most switches.

Therefore the Compass team built a touch sensitive plate into John's hand splint so that he could activate a switch with an extremely light movement, while still wearing his splints. As the movement in his thumb became stronger a mechanical plate switch was introduced. By this stage John was wearing his splint overnight, leaving his hands free during the day.

Once switch use or another access method has been established, communication is usually the next priority. When he was admitted John used eyeblinks to communicate, looking up for 'yes'and closed his eyes for 'no'. He spelt out phrases using auditory scanning with a paper alphabet chart. This communication system was effective for John, but relied on everyone else being familiar with his system.

Compass introduced John to Discover:Switch, a single switch scanning programme that ran on an Apple Mac laptop. He quickly learned how to spell out messages. A variety of other communication aids were tried, but John chose the laptop system. He preferred the look of a laptop to that of a dedicated communication aid and it also allowed other functions such as internet access and games. The Discover:Switch system was expanded to include mouse control. John became an extremely proficient computer user and was able to teach himself skills such as using a spreadsheet.

Compass will always try to use the least high-tech solution that will work, as the less technology involved, the fewer maintenance problems. Many patients start off using specialised technology, but as rehabilitation progresses they change to mainstream technology, or don¹t require high- tech aids at all.

A quick study

Wayne is a young man who was admitted to the Royal Hospital following a road traffic accident. On admission Wayne could activate a switch slowly by moving his whole arm, but had difficulty timing this movement.

He was initially introduced to games on an Acorn computer which allowed him to practise the timing of switch activation. As his hand-eye coordination improved, he used his switch to control his TV through an environmental control.

For communication the team started off with a FreeStyle touch screen communication aid. It became clear that Wayne's hand movement was improving so quickly that this was not necessary. Wayne was soon able to stop using switches and move to keyboards. Gradually keyboards with smaller and smaller keys were introduced: first an Intellikeys membrane keyboard, then a Bigkeys keyboard. Eventually Wayne was able to use the small keyboard of a Lightwriter communication aid.

Similarly, he no longer required the environmental control to operate his TV. The team ordered a large button remote control, but before this had even arrived Wayne progressed to using a standard remote control.

The Compass team are involved in several research projects to develop new equipment and techniques.

One current project involves the use of a virtual reality system to simulate driving a powered wheelchair around the hospital. This system is intended to let patients who require complex custom-made wheelchairs practise wheelchair-driving skills while their powered wheelchair is being made.

Once John had mastered his laptop, his next goal was to try a powered wheelchair. John used a single switch scanning wheelchair controller. This used LED lights which lit up, alternately indicating different directions. John pressed his switch when the direction in which he wanted to go was illuminated. John was able to control this accurately, but if he coughed or sneezed his arms could extend involuntarily and he could drop the switch. Although infrequent, this was a problem.

By this stage John could turn his head slightly. The Compass team embedded a switch into his wheelchair headrest and this was used as an emergency stop switch for his wheelchair. However, John still relied on help when he wanted to stop using the computer and start using his chair or vice versa. The Compass team designed and built a custom-made wheelchair controller which allowed John to independently change between using his computer and using his wheelchair.

Once all equipment has been provided, Compass focuses on ensuring that the equipment will continue to be useful for as long as possible. The key component of this is training anyone who will be involved in using the equipment following the person's discharge.

After 18 months at the Royal Hospital, John went to live in residential accommodation close to his family. Training materials and instructions were produced by Compass for local staff and a number of training sessions were carried out.

The local environmental control team also visited and supplied an environmental control system that could also be integrated into John's existing wheelchair controller and used with the same switches.

Out of bounds

Compass' external assessment service primarily intends to target people
within the M25 area, but more distant assessments would be considered.

Preferably users will travel to the hospital, as much of the equipment is quite bulky to transport, but team members can also go out to assess people when necessary.

An assessment charge is made and this is usually calculated according to the person's needs.

For more details on Compass or the Royal Hospital for Neuro-disability contact Gary Derwent, Compass Coordinator, tel: 0208 780 4500 ext 5237.

Posted: 21 Jan, 2002, Ability issue 41