ATU459 – iTalkDoc with Bonnie Arnwine

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Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs.

Show Notes:
Bonnie Arnwine – President National Autism Resources
Autism Society of America link: http://bit.ly/39ebPuI
Alt Text Art Story: http://bit.ly/394FLcP
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Like us on Facebook: www.Facebook.com/INDATABonnie Arnwine:
Hi, this is Bonnie Arnwine and I’m the president of National Autism Resources. And this is your Assistive Technology Update.

Josh Anderson:
Hello and welcome to your Assistive Technology Update, a weekly dose of information that keeps you up to date on the latest developments in the field of technology, designed to assist individuals with disabilities and special needs. I’m your host, Josh Anderson with The INDATA Project at Easterseals Crossroads in beautiful Indianapolis, Indiana. Welcome to episode 459 of Assistive Technology Update. It’s scheduled to be released on March 13th, 2020.

Josh Anderson:
For this Friday the 13th episode, we have Bonnie Arnwine on to talk about iTalkDoc and how it can help individuals with autism when they’re visiting the doctor or being seen by emergency personnel. We also have a story on about putting alt text behind pictures of artwork and sculptures, and just kind of how that works. Don’t forget if you’re listening to us on Apple Podcast, we always appreciate any kind of feedback that you want to put on there. You can also always send us an email at tech@eastersealscrossroads.org. You can call our listener line at 317-721-7124 or drop us a line on Twitter @indataproject. We always like to hear from our listeners with suggestions of how to make the show better. Let’s go ahead and get on with the show.

Josh Anderson:
If you’re not an assistive technology user or someone who kind of works in accessibility, you may or may not know what alt text is. So alt text is these tiny little bits of code that describe pictures online. These would become much easier to put in a PowerPoint, and some other programs actually have a little alt text editor now where you can easily put this information behind the scenes. And in fact, it will actually use AI to guess what a picture might say. But what about art? Artwork’s very subjective if you really think about what people actually see. So I found an article over at Art in America, and it’s titled How Museums are Making Artworks Accessible to Blind People Online. It’s written by Emily Watlington. And it begins off by talking about some different ways that art museums are changing the alt text on their online pictures.

Josh Anderson:
It starts off by talking about three different descriptions of artwork called Marble Statue Group of Three Graces, from the second century AD. So these are just the three descriptions that it have. It has marble statue group of three nude women standing in line, fragmented sculpture of three idealized, female nudes missing their heads and facing in different directions, and marble sculpture of three headless nude women with their arms around each other. So those are three different descriptions that they actually had people write. They took those three and put them together into the alt text they actually used for the picture online, which is fragmented marble sculpture of three nude women with missing heads and their arms around each other. So they took the important parts to really make sure that they’re describing what this picture actually shows. This is a really good article and it gets very in depth into why there’s alt text and some different ways that different galleries are doing this.

Josh Anderson:
So usually alt text, you’re not going to see it. Again, it’s behind the scenes. And unless you’re using a screen reader in order to access these web pages, you’re not going to know it’s there. But some places actually are putting this alt text in the forefront. So it talks about the Museum of Contemporary Art in Chicago, and it actually puts the alt text on top of the picture. Now, you can click out of it if you want, but it will actually give you a description of what it is that you’re seeing. Because it realizes that this can help people maybe who aren’t just blind and visually impaired, but just to see a description of the piece of art can maybe help them understand what they’re seeing or just with any kind of really disability, it just might make it a little bit more accessible.

Josh Anderson:
And of course, then it gets into how some things made for individuals with disabilities really help everyone. It talks about curb cuts, which I think we’ve talked about on here before. It talks about Alexander Graham Bell and how he’s used these kind of things. Then it gets into talking about how Google image searches a lot of times we’ll use this alt text to find pictures and how that could be a little bit of a danger to this alt text because places might start putting alt texts that’s going to work better with the Google algorithm, as opposed to actually describing what it is in order to help those folks that are using assistive technology to access these pages. So it just talks about how that could end up becoming a problem.

Josh Anderson:
It also talks about the importance of making these alt text really good, descriptive, and making sure that they’re not sexist, racist, anything like that, that that information isn’t getting in there because eventually it will probably be artificial intelligence putting this alt text behind the scenes, just because of cost, because of time, and because that’s really probably a pretty good use of artificial intelligence. But considering that the artificial intelligence will be learning from what it sees, from what it sees in these other alt texts, we need to make sure that we’re doing them really well so that they will be able to create good descriptions that are actually useful for individuals who actually need them to be able to access these things.

Josh Anderson:
It also talks about maybe just using the artists as the folks who do the alt text, so actually having them describe different works of art, how they see them and how they perceive them, and then actually making that an artistic expression in a way in order to get these different pictures that are online to have better descriptions, to have better alt text and to have better information and make it to where the museums cannot use the excuse of, “Well, we don’t have the time or the funds to make everything accessible to individuals.”

Josh Anderson:
It’s very good article. It’s pretty long, but it really gets into some of the behind the scenes stuff and some other information. But I will go ahead and put a link to this over in the show notes so that you can go check it out. But it really is a very good article and just talks about the different reasons why alt text is important, but also why, when it comes to art, maybe just plain old descriptions of things isn’t quite enough, and making sure that we’re getting good descriptions in so that this art is accessible to people of all different abilities.

Josh Anderson:
Going to the doctor is probably my least favorite thing to do. I usually avoid it until the pain of my wife’s cold gaze is more painful than the hassle of a visit to the physician. I always have a hard time explaining how I feel and what’s wrong. But what about individuals with autism? How do they express to first responders, emergency room staff, and doctors how they’re feeling? Well, our guest today may just have an answer. Bonnie Arnwine is the president of National Autism Resources, and she’s here to talk about a new app called iTalkDoc. Bonnie, welcome to the show.

Bonnie Arnwine:
Thank you. It’s great to be here

Josh Anderson:
Bonnie, I can’t wait to get into talking about the technology. But before we do that, could you tell our listeners a little bit about yourself?

Bonnie Arnwine:
Sure. So my name is Bonnie Arnwine. I’m the president of National Autism Resources. I started this company in 2008. Before that, I was the head of strategic training and development for a division of Knight Ridder. I was introduced to the world of autism in 1998 when my son was diagnosed, so autism is very near and dear to my heart.

Josh Anderson:
It seems like a lot of folks that I talk to, there’s always a personal experience that leads them into what they end up doing. Before we get into talking about the technology, tell us a little bit more about National Autism Resources.

Bonnie Arnwine:
I’d love to talk about National Autism Resources. So we are primarily an education supply company. We develop practical supports that help with inclusion and access to the community. So we have education curriculum, visual supports, sensory room equipment. We also have a commitment to creating an inclusive workforce. So we work closely to hire through the Department of Rehabilitation. We really believe in our tools, so we use them daily in our facility to support our employees. So if you purchase something from us, I just want to say thank you for supporting our vision of creating an inclusive workforce.

Josh Anderson:
Excellent. I always love when things like that are brought back in. And I, well, still work in [inaudible 00:09:13] and came from that, so that’s a big passion of mine. So I’m glad to hear that you guys are doing that.

Bonnie Arnwine:
Yeah, well a lot of times there are many people that have really good talents. They just need an opportunity to learn how to segue into the professional world. So it’s really been a joy and a pleasure to help start people on their professional journey. It’s a passion that really drives what we do here.

Josh Anderson:
Excellent. Well, we had you on the show today to talk about the iTalkDoc app. So tell us all about the app.

Bonnie Arnwine:
Well, iTalkDoc is a free app. It’s designed to help individuals who have communication challenges communicate with first responders, their family doctors about health needs. It’s an app that’s pretty near and dear to my heart because I believe everybody needs tools so that they can communicate adequately with health care providers. It’s a very simple app. When you open the app, it has three options. One is touch where it hurts, so it shows an outline of a body, an option to touch how you feel, and another option to touch a screen that conveys emotions. The idea is a doctor can present the app or a parent can present the app and a person can, say, touch the head of the body. And then icons will pop up that show headache, sore throat, dizzy, eye, ear, so an individual can, if they’re feeling dizzy, they can just touch the dizzy image so that immediately a caregiver or a doctor knows, “Okay, this person is feeling dizzy.”

Bonnie Arnwine:
We created this app because sometimes these types of icons are hard to find. If you touch the how do you feel option on the front page, then images come up as hot, cold, throw up, low pain, high pain, tired, dizzy again, just as a means of communicating abstract concepts in a more visual, concrete manner. And finally, the emotion chart conveys a variety of emotions. I have a question, fine, surprised, sad, scared, sleepy, I don’t understand, so that, again, we’re facilitating communication in maybe an environment that could be pretty stressful.

Josh Anderson:
Well, not just stressful but I think you brought up a good point there about time’s of the essence in some of these situations.

Bonnie Arnwine:
Absolutely.

Josh Anderson:
And sometimes if you’re using another communication board, like you said, it’s hard to get to those, especially because they’re not used that often.

Bonnie Arnwine:
Absolutely. So this app is designed for the phone or the tablet. And our idea was that a nurse or a parent or a first responder, we all have our phones with us all the time, could immediately just pull up their phone, turn on the app, and start communicating.

Josh Anderson:
Bonnie, do you have to be on the internet for the app to work or does it work offline?

Bonnie Arnwine:
Well, there’s two options. It works best on the internet. This is the first version. We’re planning on updating the app, so stay tuned. So it does work better if you’re connected to the internet. However, we do also have a free download. At the top of the app in the right hand corner, there’s a download button so you can download a paper copy of the communication pictures to facilitate communication.

Josh Anderson:
Oh, very nice. So you could have those on hand if you need, in case you’re rural or maybe don’t have a really good connection.

Bonnie Arnwine:
Yes, yes.

Josh Anderson:
Bonnie, you brought up a good point about things just being a little bit stressful whenever you’re communicating with first responders and stuff like that. What are a few tips that you can share about maybe communicating with someone on the autism spectrum who is under stress or in these situations?

Bonnie Arnwine:
Thanks for bringing that up. So a lot of times when an individual is stressed and they have communication challenges, their ability to communicate is lowered. So you could have somebody that’s got pretty good verbal skills but, when they’re under stress or they’re in pain, their ability to verbalize can be a lot more difficult. So this app works with people who don’t have verbal skills as well as those who do. Many times our mode of, I guess, intervention, when there’s an emergency, is for lots of people to come and lots of people to surround the person who needs help and for lots of people to start talking. And actually that’s counterproductive for many individuals on the autism spectrum. Many people with autism struggle with sensory sensitivities. They can be easily overwhelmed by sirens, flashing lights, lots of talking, fluorescent lighting, monitors, beeping. So as much as possible, it’s best, when you’re trying to communicate in these types of situations, to have one person do most of the communicating and to try and talk in a calm, quiet voice. If at all possible, use a yes or no questions.

Bonnie Arnwine:
On the iTalkDoc app at the bottom of every page there’s two large squares that say yes or no. So that’s to facilitate you asking yes or no questions and giving the communicator the ability to just point to the answer, yes or no. Many individuals on the spectrum need time to formulate an answer, especially when they’re under stress. So when you’re asking those questions, take your time, give a few minutes, or 30 seconds, or whatever. It could seem like a long time. It may feel unnaturally long for you, but make sure that you give that individual enough time to process the question and then answer it. Sometimes you can be counterproductive if you ask a question, you go, “Oh, they don’t understand,” you rephrase it again, “Oh, they don’t understand.” And really they’re still trying to formulate an answer from the first question you asked them.

Bonnie Arnwine:
If you need to touch the person, tell them first, because again, it’s very new and they may be sensitive to touch. And if at all possible, demonstrate to somebody next to them what you’ll be doing. So if you need to put… A lot of times now we have these ear thermometers, right? Where we put the thermometer and touch someone’s ear to take their temperature. So maybe demonstrate for them, with the person next to you, taking the temperature, and then show them, “Now, it’s your turn. I’m going to take the temperature.” These are just a few things that you can do. There’s a lot of great resources out there now. The Autism Society of America’s put together a really helpful guide that includes some video, so definitely check them out. They’ve done a great job trying to put some tools together for first responders.

Josh Anderson:
Well, I think all that’s really great because, yeah, I know sometimes, especially for first responders, something that they may think is the medical issue may just be a behavior because of all the stress and the stimulation.

Bonnie Arnwine:
Yes, yes.

Josh Anderson:
And they may misdiagnose or even not see what actually is the problem. So I think that’s all really great, great help.

Bonnie Arnwine:
Absolutely. Yeah, you’re absolutely right. Well, the impetus for this or the catalyst that really got us talking about developing iTalkDoc happened when we were at a conference at St. Louis Children’s Hospital. We were at a trauma-informed conference that centered around autism. And while we were there, one of the nurses shared a story about a young man who came into the ER room. He had autism and he was obviously injured, but he was nonverbal and his mother was incapacitated. She was unable to speak for him. So the young man was under a lot of stress. They took him into a side room to evaluate him. He wouldn’t sit on the table and he was trying to make sense of the situation. So he slowly, methodically started taking everything off the counter and lining it up on the ground. And he was 16, about 200 pounds. When they went near him, he was trying to push them away. And they had absolutely no idea how to communicate with him.

Bonnie Arnwine:
And in that moment, when I was listening to this story, it was just my own personal nightmare. I thought, “Oh my goodness.” My son now is verbal and he can communicate pretty well, but I have many friends and colleagues who use assistive technology to communicate, who have significant communication challenges. So what happens if you’re in a car accident and your communicator gets damaged or you’re in a car accident and you’re unable to use your communicator and the people that are trying to help you are unfamiliar with your communicator? So I left that conference thinking, “This is something that we can address. This is one issue in a million issues that we can make a difference in.” And so that was the beginning of creating iTalkDoc.

Bonnie Arnwine:
And there is a trend that individuals with autism, the number of individuals coming into the ER with autism, has really gone up in the last few years, something like 500%. And we saw that trend here at National Autism Resources. We had a lot of nurses, first responders calling in saying, “Hey, how do we communicate? What kind of tools do we need to have so that we can provide excellent service to individuals with autism?” So we saw this coming and we saw this need, and it’s an important need. So that’s why we were really committed to try and find a solution for it.

Josh Anderson:
You brought up another good point there just about the parent. Because I know a lot of times parents do a lot of the communication for an individual.

Bonnie Arnwine:
Yes, yes.

Josh Anderson:
And they’re not always there. I mean, especially when a medical emergency happens, an accident, something like that. If they’re not there, I mean, and the individual, well any individual, you get pretty scared when you’re used to having that kind of support system there.

Bonnie Arnwine:
Absolutely.

Josh Anderson:
So just having something easy and streamlined could really be very, very helpful.

Bonnie Arnwine:
Yeah, I agree. It’s been exciting for us hearing the different stories of people using iTalkDoc. and I just received a note from, I think it was the Cleveland Unified School District, that they had downloaded 5,000 copies of iTalkDoc across all of their devices. Because it is a challenge when somebody, you’re not sure if it’s a behavioral issue or if they’re in pain. And these icons are hard to find. So a lot of times parents, because they spend so much time with their children, really can sense or communicate quickly and efficiently with their son or daughter. But out in the community, if the parent’s not around, you’re exactly right, it becomes much more challenging.

Josh Anderson:
You kind of started there, but could you tell me a story about someone that’s been helped by iTalkDoc?

Bonnie Arnwine:
Sure. It’s pretty exciting to hear the feedback. We just got an email from a parent, actually, who was having trouble communicating with their child. They were at the ER and she said, “Thank you so much because my son was able to use the app and point to where it hurts. We zoomed in, and it was an issue, he was very nauseated, which really helped the doctor to quickly diagnose and move in the right direction, because it was unclear. It was really clear he was in pain, but we had no idea what part of his body was in pain. So that was really exciting for us. It makes us feel so good because you want people to have access to the best possible care. So it was great that the app was able to help him quickly get the care that he needed.

Josh Anderson:
Definitely. So what’s on the horizon? What’s next? I know you said that you guys are on the first iteration of it now, what are you looking to maybe change or expand in the future?

Bonnie Arnwine:
Well, I’m really surprised at the response from the app. It’s been wonderful. And I’m surprised that it’s been used in a variety of ways, not only with individuals with autism, but it’s been used with the elderly, with people who have dementia. It’s also been used with people who speak other languages. So we’re really looking at expanding the app to be translated into different languages. We’re also looking at expanding it to go beyond just emergency, or maybe adding some more levels. So we’re actually going to be putting a Kickstarter together to expand the app some more. And the app will have several levels so that we can have more in-depth communication in case somebody has to be hospitalized or in case somebody is admitted into intensive care. So be on the lookout for that. It’s going to take a while before it’ll be ready. But I joke around and say we’re a company of turtles because slow and steady wins the race. We’re going to work on this and expand it and make it as good as possible to support the community.

Josh Anderson:
Well, that’s good that you’re taking your time on that stuff though. Because what you don’t want to do is make it too cumbersome, too big to the point where it’s not going to help for what you actually made it to do.

Bonnie Arnwine:
Absolutely. Absolutely. It’s really tricky because if you provide too many choices then over-choice becomes overwhelming, and then communication is lost. So it’s a fine balance, right? Of trying to provide just enough, so that someone can communicate, but not too much so that it becomes useless. So it’s a lot of trial and error.

Josh Anderson:
I like the way that people are giving you feedback, because that’s always helpful to know what works better for them and how it can be made better to help them even more.

Bonnie Arnwine:
Absolutely. And if you go to the app, we are actively asking for feedback. So at the bottom, we had a little feedback form. It’s totally anonymous, but we really appreciate feedback. We’ve gotten great feedback on, “I wish you had these certain icons,” “Can you translate it into this language?” So again, “Can you make this app or version of the app that we can download on the phone so that it doesn’t have to have internet connection?” So all of the feedback has been really helpful for us. So we’re looking forward to incorporating that feedback into the next version.

Josh Anderson:
Excellent. Bonnie, if our listeners would want to find out more about iTalkDoc or about National Autism resources, how would they do that?

Bonnie Arnwine:
Thank you for asking me that. You can visit nationalautismresources.com. There you’ll see our full product line. We have our resources page, and there you can find information on the iTalkDoc app. We have a whole page there that explains what the app does as well as links to the Apple and Google Play stores so that you can download it. Again, it’s free. Also, if you are looking for educational supplies or visual supports, sensory items, we would appreciate your business. And thank you again for supporting us and supporting an inclusive workplace.

Josh Anderson:
We’ll put those links in the show notes. Bonnie, thank you so much for coming on today, talking about the iTalkDoc app and National Autism Resources. And hopefully we’ll be able to have you back on sometime in the future as those updates come out and things get even better.

Bonnie Arnwine:
I would love to come back. Thank you for having me here today and for getting the word out on iTalkDoc.

Josh Anderson:
Do you have a question about assistive technology? Do you have a suggestion for someone we should interview on Assistive Technology Update? If you do, call our listener line at 317-721-7124. Shoot us a note on Twitter @indataproject or check us out on Facebook. Are you looking for a transcript or show notes? Head on over to our website at www.eastersealstech.com. Assistive Technology Update is a proud member of the Accessibility Channel. For more shows like this, plus so much more, head over to accessibilitychannel.com. The views expressed by our guests are not necessarily that of this host or The INDATA Project. This has been your Assistive Technology Update. I’m Josh Anderson with The INDATA Project at Easterseals crossroads in Indianapolis, Indiana. Thank you so much for listening, and we’ll see you next time.

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