Full Issue: AccessWorld January 2014

Remembering the Birthday of Louis Braille

Lee Huffman

Dear AccessWorld readers,

The holidays are behind us now, and it's time to start looking forward to a new year. For many, that means New Year's resolutions and commitments to exercising, losing weight, eating healthier foods, and taking better care of ourselves. Statistically, people with vision loss tend to be among the most sedentary and unhealthy among all age groups, but it does not have to be that way. You may be surprised by how technology can help you become healthier in the new year. If getting into better shape is on your mind, check out Bill Holton's article on Bluetooth scales you can access with VoiceOver to track your weight loss progress through accessible apps. I also encourage you to check out J.J. Meddaugh's round up of the hottest technology products from the past year.

On another topic, AccessWorld can't let January go by without recognizing the birthday, contributions, and legacy of Louis Braille. The fact is, 200 years ago, a child or adult who was blind had no effective way to read or write independently. Today, thanks to Louis Braille's invention and advancements in technology, children and adults who are blind can read and write as well as their sighted peers. The invention of braille, a system of raised dots representing letters, numbers, and punctuation, truly revolutionized independent communication for people who are blind.

This month, AccessWorld celebrates the anniversary of Louis Braille's birthday, January 4, 1809. We also celebrate the braille code, named after its young inventor, and the expanded possibilities for literacy and independence this code created for people who are blind.

The AccessWorld team invites you to visit The Louis Braille Museum on the AFB website, which illustrates the life and legacy of the creator of the braille code. Using photographs, engravings, and illustrations from books preserved in the AFB Archives and Rare Book Collection, the museum traces Braille's life from his childhood in Coupvray, France, through his student years in Paris, to his invention of the braille code and the recognition of its importance throughout the world.

We also invite you to read The Reading Fingers, the full text of Jean Roblin's classic 1952 biography of Louis Braille, and "Braille, the Magic Wand of the Blind," Helen Keller's essay on Louis Braille, written around 1924. In this essay, Keller describes how the braille system works and relates how she benefited from learning and using braille. She describes the reading systems that existed prior to braille and the debates of the late 19th and early 20th centuries over competing embossed systems.

I also encourage you to check out Cay Holbrook's blog post, "Falling in Love with Braille," on the AFB FamilyConnect site. Another resource you may enjoy is DOTS for Braille Literacy. This free AFB newsletter includes information about new braille products, strategies for teaching, and resources for teachers, parents, family members, and anyone interested in braille literacy. It's available in braille and via e-mail. If you happen to be a teacher of visually impaired students or a professional in the field of vision loss, you may want to take Reinforcing Braille Using the iPad, a webinar available for purchase from the AFB e-Learning Center.

Today, braille has made the leap into the increasingly fast-paced world of technology via braille notetakers and braille displays. The following braille-related articles from the AccessWorld archives will be interesting and useful to those who are interested in, or users of, braille and braille technology.

The AccessWorld team hopes you enjoy this issue, and we wish you the best in the New Year!

Lee Huffman
AccessWorld Editor-in-Chief
American Foundation for the Blind

Comments and Questions

Dear AccessWorld Editor,

After reading Bill Holton's August 2013 article, A Review of the Voice Dream Reader for iOS: A One-Stop Solution, all I can say is, "Wow!"

This article was clear, thorough, and well written. Thanks to Bill Holton for taking the time to write this and explaining all of Voice Dream Readers' features to readers like me who are interested in possibly purchasing this app. I have already downloaded the lite version, but now… I am absolutely going to buy it!

Also, can you please let me know if there are other apps similar to this? I am fully sighted, but work with the blind and visually impaired community, am a reader for Sight Into Sound Radio in Houston and am also an employer who is interested in learning as much as I can about accessible technology for my new staff member who is visually impaired that will begin working with me soon.

Awesome review and keep up the great work!

Sincerely,

Chelsea C. Nguyen

Response from AccessWorld Author Bill Holton

Hi Chelsea,

Thanks for the kind words regarding my review of Voice Dream Reader. It is a very powerful program, and recent updates have added even more functionality, such as the ability to mark and highlight text using VoiceOver and to quickly move ahead and back in your text with a single one-finger swipe up or down. Another similar product is the Read2Go app from Bookshare, which includes many of the same features as Voice Dream Reader.

Dear AccessWorld Editor,

I really enjoy the AccessWorld publication. I have recently started using the AccessWorld app and am enjoying its convenience and portability. I would like to make a recommendation for a change in the AccessWorld app that I think will make it even better.

Many who read publications such as yours choose what they read not just on the subject of the article but also on the columnist who wrote it. I know I always enjoy the articles written by Deborah Kendrick and have been following her for quite some time. I find the omission of the writer's byline from the AccessWorld app screen listing the current issue's content to be a major shortcoming. This information could be included without much investment in screen real estate if it were placed on the line below the article title or in some cases it might even fit beside the title.

I hope you will consider making this change, because I feel it would be a big improvement to the AccessWorld app and would also be much appreciated by your readers.

Thanks for the great work done by AccessWorld and for considering my recommendation.

Happy holidays,

Alan Lemly

Dear AccessWorld Editor,

In response to the article by Bill Holton, Looking at the New Microsoft Accessibility Answer Desk, I would like to share my experience with the Answer Desk. I myself have had good success with this service. Out of the three times that I have used this service, I had one session where I got no help at all. The other two times I called, I had very good sessions.

Steven Whiteker

Dear AccessWorld Editor,

First, thank you for the invaluable information you share with us each month. I benefit from it personally, and in my work with blind and visually impaired Kansans with disabilities as a rehab counselor for our state. I read your magazine on my Victor Reader or Braille Sense.

Now, I have to jump through several hoops to find the "download entire issue" link.

Would you please consider making downloading your magazine very simple so those of us who use portable devices [can] capture the entire text of your magazine [more easily]?

If there's an easier way to do this already, I'm certainly willing to swallow my rather limited techy pride and take your advice.

Sincerely,

M. Todd Morando

Dear AccessWorld Editor,

I was very excited to read J.J. Meddaugh's Audio Description in Theaters: Making Theaters More Accessible article. I had given up on watching movies. But now I have checked the website of my local theater and found out that it does indeed offer video description. A door that I had closed may now be reopened!

Thank you for this wonderful magazine.

Regards,

Laura Griffith

Dear AccessWorld Editor,

Thank you for an excellent overview of the progress of movie theaters' audio description services in J.J. Meddaugh's Audio Description in Theaters: Making Theaters More Accessible article.

I am a Star Trek fan so I watched "Into Darkness" using the special headset.

Fortunately, my parents were gracious enough to do some research in advance to find out that audio description was available, but the movie theater staff had to be educated and told that I didn't need an Assistive Listening Device.

However, I found that the noise level of the movie made it difficult to hear the audio description.

I wish there were a way to equalize the volume so that a blind person could hear the dialogue and descriptive track clearly without sighted assistance.

In addition, if the person wanted to buy the movie later with an audio described track, how would he/she do this since there are many versions of the same movie and no centralized database for current described movies?

Thank you,

Rebecca Skipper

Dear AccessWorld Editor,

I really enjoyed Bill Holton's Looking at the New Microsoft Accessibility Answer Desk article on the Microsoft Accessibility support group. I am a totally blind person, and I discovered the Accessibility Support group just a short while ago, when trying to update my computer from Windows 8 to 8.1. I was having no luck at all, and the Microsoft Windows support team could provide no assistance. When I called back to the Answer Desk to attempt to get help with my issue again, the person at the Answer Desk connected me to the Accessibility group, who had me up and running with Windows 8.1 in no time. The problem it seems is that with the JAWS screen reading application installed, it blocks the download and installation of the update. So, the technician uninstalled JAWS, downloaded and installed the Windows update, and then reinstalled JAWS on my computer for me. And, this whole process took just over an hour. I know, without a doubt, that this is the best support that I have ever received as a blind person. Thank you for your article.

Regards,

Michael Boyd

AccessWorld News

AccessNote Updated to Version 1.2

The American Foundation for the Blind (AFB) is proud to announce that its notetaking app for the iOS platform, AccessNote, has been updated to version 1.2. AccessNote is designed to take advantage of the accessibility features of the Apple iOS. AccessNote has a clean and uncluttered interface, and it uses standard iOS elements so that a VoiceOver user can quickly operate the app using Apple's VoiceOver screen reader. With AccessNote, AFB is striving to bring the efficiency of a conventional standalone notetaker to iOS. AccessNote retails for $19.99 and can be found in the Apple App Store.

AccessNote version 1.2 includes many bug fixes and several enhancements. The Find function has been completely redesigned to be more streamlined and by popular request, it is now possible to import BRF files without changing the extension. To learn about all the changes and enhancements in AccessNote version 1.2, visit the complete change log.

We would like to thank our users for their feedback regarding AccessNote. We strive to make AccessNote the most useful notetaker in the App Store. User Feedback is invaluable in tailoring AccessNote to address issues encountered by our users, so if you encounter bugs or have ideas for future enhancements in AccessNote, please contact the AccessNote developers.

Mark Your Calendars for the 2014 AFB Leadership Conference in New York City

The 2014 American Foundation for the Blind Leadership Conference (AFBLC) is scheduled for February 27–March 1 at the Brooklyn Bridge Marriott. Conference attendees can take advantage of a low group rate at the centrally-located hotel and join colleagues new and old for three days of informative and thought-provoking sessions led by leaders in the field. Visit the American Foundation for the Blind Leadership Conference page for the latest information on this conference, which draws hundreds of professionals from across the country and around the world.

VisionAware Introduces Getting Started Kit for Those Newly Diagnosed with Vision Loss

With over 21.2 million Americans reporting trouble seeing, VisionAware has created a Getting Started kit for adults experiencing vision loss for the first time. VisionAware.org is a free online resource for the millions of people who have difficulty seeing, offering dynamic social networking and customized guidance with rich content and practical tips on living with vision loss. The Getting Started kit is intended to provide hope and help to handle the challenges of vision loss, and to connect users with the resources they need. Many people are unaware of specialized services and products available to them. The kit is composed of 10 "tip sheets," with each sheet addressing practical solutions to everyday tasks such as reading, cooking, using computers and other technology, helping friends and family understand what they can do, and more.

"These tip sheets represent just a small sample of the wealth of information visitors can find on VisionAware, including the latest news on vision loss and specific eye conditions, a community of peers and professionals, in-depth articles, and coping tips," said Priscilla Rogers, VisionAware Program Manager. "We hope anyone experiencing vision loss, as well as their loved ones, will use the tip sheets and then explore VisionAware.org."

The Getting Started tip sheets contain the following helpful information:

  • Steps to Take to Get Help, including who to see about vision loss and your roadmap to VisionAware
  • Questions to Ask Your Doctor about your eye condition
  • Bathroom Safety Tips
  • Kitchen Safety Tips
  • Tips for Making Print More Readable
  • Your Home Office (how to manage correspondence, finances, and other personal business)
  • Technology Tips, including an overview of access technology that can be helpful in everyday life
  • Keeping Fit
  • Having Fun, including options for continuing to enjoy leisure time activities or starting new ones
  • Dos and Don'ts When Meeting a Person with Vision Loss (for friends and family members)

A diagnosis of vision loss can be frightening, but armed with the right information, individuals who are losing their sight can learn how to best cope with vision loss. Visit VisionAware.org.

The 3rd Annual M-Enabling Summit to be Held June 9–10, 2014, in Washington, DC

The only global conference and showcase exclusively dedicated to accessible and assistive mobile solutions for seniors and users of all abilities, the fastest growing user group in the mobile market place.

The Summit provides an opportunity to network with over 600 high-level government and industry leaders in an environment dedicated to cutting edge technology, solutions, and the sharing of innovative ideas.

Held in cooperation with the Federal Communications Commission (FCC), the 2014 Summit is a must-attend event for anyone participating in this fast expanding market

In the spotlight at the 2014 Summit:

  • Mobile and social media leap forward in accessibility
  • Mobile at the center of smartphone development
  • The next generation of wearable gear
  • Opportunities for users of all abilities with BYOD (bring your own device)
  • Adaptive user interfaces
  • Market opportunities for new services for seniors and people with disabilities
  • How leading corporations promote consumer apps for users of all abilities

Comcast Accessibility: More Than Talking TV

As one of the giant communications entities, Comcast has captured its share or more of headlines in recent months. For those of us interested in accessibility for people who are blind and visually impaired, however, the company has grabbed our attention for an entirely different set of reasons.

Entertainment, specifically entertainment that comes into your living room via television, is an integral part of popular culture in the U.S. and elsewhere and for many who are blind or visually impaired access to that entertainment is difficult or impossible. Onscreen menus and the complexity of choices they deliver are daunting for many TV viewers who can see the screen to read them. If you can't see the screen, finding and using basic programming information is mostly something you just can't do independently. Now, with the dramatic and welcome increase in described programming prompted by the 2010 Communications and Video Accessibility Act, blind people are more interested than ever in watching television, and thus are more likely to sit up and listen when any company says they are going to do something about the current state of inaccessibility.

Comcast certainly seems to be serious about being the company to bridge the accessibility gap, not just for people with visual disabilities, but for all people who have ability or language differences. Eighteen months ago, Comcast hired Tom Wlodkowski to be vice president of their newly established accessibility department. Wlodkowski is blind himself and at least one member of his five-person team has low vision. In other words, Comcast has selected a leader who understands accessibility problems personally, and whose expertise holds the promise of finding solutions.

The solution of greatest interest to AccessWorld readers will, undoubtedly, be the new talking TV interface that Comcast will be rolling out in a limited trial during the first quarter of 2014. Before talking about that effort, though, a peek at the broader accessibility picture seems in order.

Location, Location, Location

Tom Wlodkowski says that he knew Comcast was serious about a stepped-up approach to accessibility during the interviewing process. Every senior management member of the company's executive team weighed in on interviewing him, he said, and that clearly indicated that his hiring was not being taken lightly.

Rather than being on the legal policy side of business or customer service (retrofitting accessibility, in other words, simply because the law requires it), Comcast placed Wlodkowski and his accessibility department next to product innovation. When new products or improvements to old ones are being created, rendering those products as usable and accessible to all customers is part of the conversation. The company maxim of building "a smarter home for everyone," in other words, seems to include people with disabilities in its vision.

The accessibility department and newly opened accessibility lab are on the same floor of the Philadelphia corporate headquarters as the product innovation department and all the innovation engineers, a clear indicator that the effort is more than symbolic.

The accessibility lab, a combination test lab and showcase, is designed to hold the kinds of entertainment and communications tools that actual homes occupied by actual people with disabilities might include. A computer with software and hardware for controlling the environment via eye movements, a computer with magnification software and text-to-speech software, braille playing cards and a braille Scrabble game are just a few of the items visitors might notice.

When a product or product enhancement is under development, the accessibility lab is the place for staff to give it a test drive.

More than Cable TV

Although cable TV might be the first product that comes to mind when we hear the Comcast name, Wlodkowski was quick to point out that the company is the fourth largest provider of telephone services, and is constantly striving to move all its services (television, telephone, internet services, home security, and home automation) toward creating that "smart" and, perhaps, more efficient home.

Mobile apps that allow Comcast customers to accomplish tasks ranging from activating lights or changing the thermostat, to texting the kids or checking tonight's movie availability are constantly evolving. And each of those functions presents its own set of accessibility challenges. Can a deaf person access a voicemail via text? Can a blind person navigate the website? Can a person who is quadriplegic operate the remote control to select the desired channel on the TV?

Comcast is striving to address these issues and more, and has created an Accessibility Center of 22 customer service agents trained specifically to answer questions regarding Comcast's various accessibility features.

And Now…The News You've Been Waiting For

While high-speed Internet, mobile apps, and telephone service all matter as much to blind people as to anyone else, the one area where access has been most blatantly unavailable is in navigating the myriad features available to sighted viewers in browsing, selecting, and saving television programming. Comcast announced at the largest cable trade show in October that they have finally developed a talking TV interface for the Comcast box.

Slated to be tested in the first quarter of 2014 by a small group of customers, the guide provides text-to-speech access to all those menus sighted viewers take for granted. You can hear which programs are available in which categories, how many episodes, which movies are available for renting, and oh yes, which programs offer video description. You can search by category or title or even by the descriptive feature itself.

The sample I heard for this article was a pleasant female voice (Carol is her name). Speed and pitch controls for the voice are not available at this point, but Wlodkowski said such features would undoubtedly be added soon. Also in the foreseeable future, he indicated, would be a voice input feature for the same system.

As a blind professional, Tom Wlodkowski has an enormous opportunity to assist one company in demonstrating by example how accessibility can work for everyone as a from-the-ground-up consideration. If he does it right, we'll all win.

Contact Information:

Comcast Accessibility Center for Excellence
Phone: 855-270-0379
Hours: 9 am–10 pm, Monday-Sunday
Live chat: Comcast Support

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John Blake, New CEO of Freedom Scientific

In June 2012, Freedom Scientific turned a page in its history as an industry leader in the field of access technology for people who are blind and low vision when the company welcomed its new CEO and president, John Blake.

Since unifying three major companies in the blindness field—Henter-Joyce (creator of the JAWS screen-reading program), Blazie Engineering (leader in refreshable braille displays and note-taking products for the blind), and Arkenstone (known most for its OpenBook OCR software)—Freedom Scientific has maintained a strong foothold in all three product areas, adding a notable collection of screen magnification products for low-vision users as well. A new CEO at the helm of Freedom Scientific, in other words, is news in the access technology industry. AccessWorld was quick to pursue a conversation with John Blake to find out where he is coming from and where he and the Florida company are heading.

Background

John Blake grew up in Rochester, New York. With an undergraduate degree from the University of Rochester and an MBA in finance from Rochester Institute of Technology, he comes to Freedom Scientific with a 20-year career history with Eastman Kodak, a Rochester-based corporate giant.

During his career with Kodak, he developed expertise in finance, marketing operations, and product management. For the last decade, he served as global general manager of the company. In 2012, when Eastman Kodak filed Chapter 11, it was time for a change for Blake, and he and Freedom Scientific were soon in conversation.

Blake is married, has three young children, and maintains residences in both New York and Florida. His leadership roles in Kodak, he says, provided not only a solid grounding in the roles of consumer electronics (particularly digital cameras) but also an understanding of markets and customers, all skills that are easily transferable to a parallel industry.

As the new CEO, Blake says, "You certainly have a plan in your mind that you share with stakeholders, but you first take the time to utilize the objectivity you have, listen to people (dealers and customers, those here and in other parts of the world), and try to formulate some ideas around where things are going well and where things need to be improved." It is better, he believes, as the new leader, to listen than to assert.

Status Quo

An essential element in moving forward with a new vision, Blake says, is to study the status quo and remove any barriers. Barriers in any company, and he says Freedom Scientific is no exception, can occur when a company does well (second to none in the industry, in his opinion) and develops certain biases and inertia within that successful performance. "Inertia is a strong force," he says, "people are comfortable doing what they have always done."

The team he has inherited, Blake says, is an excellent group of dedicated and knowledgeable leaders and, together, they are studying the market, where they are making investments, and where current changing technologies provide the best opportunities.

To familiarize himself with the access technology industry, John Blake is engaged in plenty of listening and observation. He is in conversation with dealers, agencies, and others in the industry around the world. Mostly, he is learning from his own staff.

"We are providing critical fundamental capabilities to people who are blind," he says, "enabling people who are blind to be productive. We do a great job and will never compromise that."

What he contends the company already has in its favor are its flagship product, JAWS, and its Focus braille displays, which he contends are the best in the industry. It only makes good business sense, he believes, to continue supporting and developing existing products.

But he wants to develop new products as well, taking advantage of new technologies to find even better ways of enabling people who are blind and people with low vision to be productive and independent. He and his team are studying new technologies, consumer trends, and looking at features like portability and various operating systems.

He cites with enthusiasm how, when his family lived in Singapore during his former corporate role, his children were able to communicate easily with their grandparents via video Skype. The grandparents were 10,000 miles away and yet, small children could see their faces and hear their voices every day.

"We need to embrace all new technological trends in the blindness field, too," Blake says, believing that there are still capabilities that the blindness industry has not yet taken advantage of, particularly in the realms of cameras, portability, and operating systems.

Future Directions

Are there new products on the Freedom Scientific horizon? Probably, but Blake isn't saying anything specific at this point.

If there is any noticeable change in the way in which Freedom Scientific does business in the near future, it may be in its relationships with customers. "We have a reputation for not always being the easiest company to deal with," Blake says, and his marketing background indicates a need for change in that particular area.

"We are actively listening to our customers and to others in the industry," he says, believing that a smart business person will always begin by listening to customers. "If you have happy customers, you have a happy business."

To read more about Freedom Scientific and directions that the company and its new CEO are taking, visit Freedom Scientific.

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Weighing the Accessibility of the Wahoo Balance Smartphone Scale and the Lose It! Healthometer Bluetooth Scale

It's time to make a New Year's resolution to lose a few pounds, well, maybe more than a few. From previous experience I know my best dieting results happen when I have to face a bathroom scale every morning. I have a talking scale, but I figured this would be an excellent opportunity to try out a few of the new Bluetooth-connected scales. I was able to obtain samples of two models, the Wahoo Balance Smartphone Scale and the Lose It! Healthometer Bluetooth Scale. At least for now each of these devices is iOS only (they use Bluetooth 4/Bluetooth Smart for wireless communication; as yet not all Android devices support this standard). I tested both scales with an iPhone 5, but they will also work with the iPhone 4S, iPad 3 and up, the iPad Mini, and the iPod touch 5G.

The Wahoo Balance Smartphone Scale

This smartphone-connected scale has a modern, sleek appearance. It's a quarter-inch thick, 12-inch by 12-inch sheet of frosted glass with curved edges and corners that rests on four pressure-sensitive feet. The scale's digital display shows through the glass from underneath with clear, black-on-white, 1 ¼-inch text. The feet are joined by two bars running front to back, and by the electronics housing, which runs across the upper, or "toe" edge of the scale. The "heel" edge has no understructure, making it quite easy to orient the scale properly by touch.

Along with the scale's digital display, the electronics housing also contains the battery compartment and a single button to switch the scale from pounds to kilograms. Two AAA batteries come pre-installed, but you do need to open the battery compartment and remove the plastic tab to expose the contacts. There is no power switch, but with Bluetooth 4, the batteries are supposed to last up to a full year.

The scale comes with zero documentation. Instead, there is a QR code that will take you to the Wahoo website printed on a small sticker beside the battery compartment, and on a single sheet of paper that covers the glass. Other than enabling the batteries, there really is no setup required for this scale, so I simply went to the App Store on my iPhone and typed "Wahoo" into the search box. The free Wahoo Wellness app appeared a few entries down from the top of the results list, and when I read the description, it was obvious this was the app I needed.

You don't need to discover and sync the Wahoo Balance through your device's Bluetooth menu; when you open the app, it will find the scale automatically. You do need to create a profile specifying your initials, your goal weight, and your height. The app uses this information compute your body mass index (BMI). Unfortunately, I was unable to enter my goal weight or my height without sighted help.

The Wellness app itself contains two screens of interest. The first begins with a "User" button where you can switch profiles, add a profile, or edit an existing profile. The app supports up to sixteen profiles. Below that button is a chart depicting your weight history, but only the date and weight range axes are readable by VoiceOver, so without at least partial sight, the graph is useless.

At the bottom of the screen the app lists your start weight, your most current weight, and your goal weight. The scale measures weight in one-tenth pound increments, up to 395 pounds.

Near the top of the screen there is a button labeled "259list." Double tap this button, and you reach the second screen, which lists your weigh-ins, along with the time, date, and calculated BMI.

The app will do its best to match a weigh-in with a particular profile, but if the new weight is well out of range of your last weigh-in, or if two people create different profiles but their weight is too similar, you will have to scroll down to the "Any of These Yours" section of the screen, highlight the proper listing or listings, then double tap the "Yup, the Selected Ones Are Mine" button to add them to your history. You can also delete weigh-ins from the app, a handy feature when, say, you had that extra slice of pie or your 4-year-old granddaughter decides to play "step on and off the scale."

You do not need to use the Wellness app to capture data from the Wahoo Balance. The scale will send data to a collection of third-party iOS apps, including iBody, MyNetDiary, Tactio Health, and Monitor Your Weight. I tried a few of the free offerings, and for the most part I was left disappointed with their levels of VoiceOver accessibility.

One free app that did work quite well was Monitor Your Weight by Husain Al-Bustan

Unlike many of the other weight tracking apps that duplicated the Wellness app's refusal to let me complete my profile without sighted help, the Monitor Your Weight app allowed me to complete the process, including both a target weight and a target date. The app then computed my BMI and body fat percentage, along with a suggested daily calorie count that would allow me to reach my goal by the target date.

The app Setting tab allows you to synch the app to the Wahoo Balance, the WiThings scale or the FitbitAria scale, though I only tested the app with the Wahoo Balance. You can also instruct the app to accept all data from the scale, or limit the data collected to one of the profiles you set up with the Wahoo Wellness app.

After making these choices, when I stepped on the scale for a few seconds I could hear the app screen refresh, alerting me that it had received a reading. The app's main screen now showed my current weight, along with other information such as daily and weekly weight loss, and my progress, in percentages, toward my goal weight, BMI, and target date. You can also e-mail this information, and on the History tab, review and edit your previous entries.

Recommendations

At $99.99 retail and $97.28 at Amazon.com, this scale is only a few dollars more than I paid for my current talking scale. After the initial setup, I found it quite useable with VoiceOver, and I very much like having the BMI calculations, calorie count, and weight history to motivate me in my weight loss program. If your New Year's resolution is to lose a few pounds, I suggest you give this scale a look.

The Lose It! Healthometer Bluetooth Scale

The Lose It! Healthometer scale is similar in size and shape to the Wahoo Balance: a quarter-inch thick, 12-inch by 12-inch sheet of glass that rests on four pressure-sensitive feet. There are more electronics in this unit, so the housing beneath the glass almost extends to all four edges of the upper platform. Three of the edges have concave surfaces, however, so this scale is equally easy to orient without sight. At 1.5 inches in height, the black-on-white text is just as clear as, and a bit larger than, the Wahoo Balance's display.

Another difference between these two scales is that the Lose It! Healthometer has four slightly raised contact pads on the top surface, which you stand on heel to toe, heel to toe, in bare feet. These pads measure your body fat percentage and hydration level by sending a tiny electric current through the pads. The current is so low as to be imperceptible. I never once felt it, though people with pacemakers are advised not to use this scale.

The Lose It! Healthometer came with four AA batteries preinstalled, along with a printed quick start guide, which was not really needed. This scale only pairs with the free Lose It! app; there are step-by-step instructions within the app to pair the scale with an Apple device. With the exception of various charts, the app was fairly accessible. Unfortunately, pairing the scale with the app was not.

When you set the Lose It! app to pair with your scale, it instructs you to remove the battery tab from the scale and then press the button. Removing the tab was easy, but the so-called button isn't so much a button as it is a depressable unmarked area on the bottom housing; it can be a bit tricky to locate.

Once you manage to press the button, the app refreshes, at which point you are asked to enter your profile initials—the scale supports up to four profiles—and then enable the "Athletic body type" icon if you exercise ten or more hours a week. So far so good, but the app then instructs you to step on the scale, and when your weight appears, step off, wait for your initials to appear on the display, then tap the scale to accept. The entire process is silent; there are no beeps from the scale or app to alert you. A partially sighted person may be able to accomplish this alone, but I needed sighted help.

Unfortunately, this is also the process you must follow every time you want to weigh in. With practice I was able to weigh in without assistance three times out of every four by standing on the scale for a ten count, stepping off for a six count and then giving the scale a tap.

Recommendations

Normally, I would consider this scale's lack of audible cues a true showstopper, but the Lose It! Healthometer does have some advantages. First, the list price is just $69.99, discounted to $63.69 at Amazon.com, which compares favorably to the $99.99 for the Wahoo Balance. Second, the Lose It! app offers much more than weight tracking. You can use the app to keep a food and exercise diary, and sync your data to the Loseit.com website, where you can join a large community of other dieters. You can also enter your weight manually, so even if you don't have a Lose It! scale, the app may prove a valuable and accessible resource to help you achieve your fitness goals.

Lastly, there is the data itself. Each of the reviewed scales provides BMI, but the Lose It! scale also calculates body fat percentage and hydration levels, and lets you set goals for each. Fat percentage is a much more accurate way to judge your fitness program success—you want to lose fat, not muscle. Hydration levels can tell you if that ten pounds you lost was actually fat or water weight. It can also let you know if you are staying properly hydrated, an absolute must for any diet or exercise program.

The addition of audio cues, even simple beeps, would make a world of difference when setting up and using this scale. Hoping there might be some sort of backdoor hack to unlock such a function, I spoke to one of the company's engineers. When I posed the question he informed me there was no way to add beeps, adding, "It never occurred to us a blind person might want to use the scale." Sadly, this sort of thinking, or lack thereof, is still all too prevalent among product manufacturers.

The Lose It! app I can wholeheartedly recommend. However, even with the valuable extra data this scale provides, I can only give the Lose It! Healthometer Bluetooth Scale a qualified recommendation. High-partial vision individuals and blind people with sighted help will fare best with this scale. Others who don't mind occasional frustration may also consider giving this scale a try, assuming you confirm an adequate return policy. I would not recommend this scale to blind couples who both wish to track their weight. The scale does accept multiple profiles, but I suspect the complications involved in trying to time that final tap to accept a listed profile would be maddening, at best.

Product Information

The Wahoo Balance Smartphone Scale
List price: $99.99
Also available at Amazon.com

The Lose It! Healthometer Bluetooth Scale
List price: $69.99
Also available at: Amazon.com and selected Wal-Mart stores

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Three New Techniques for Treating Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in people age 65 and older. Currently, an estimated 13 million people in the US have AMD, and the problem is expected to grow as the population ages. One large study found that people in middle age have about a 2-percent risk of developing AMD. However, by age 75, this risk increases to nearly 30 percent.

Tragically, most people who develop AMD go undiagnosed for up to seven years before the condition is detected and treatment can begin. There is currently no cure for AMD. At best, treatment can slow or sometimes even halt the progression of the disease. Considering the ever-growing number of cases of AMD, with worldwide health care costs rising into the hundreds of billions of dollars per year, scientists have doubled and redoubled their efforts to discover and develop new treatment options. In this article we'll describe three impending breakthroughs: two new treatments for AMD currently in clinical trials, and a brand new device called the AdaptDx, that will allow doctors to detect the onset of the disease almost as soon as it arises.

The AdaptDx Dark Adaptometer

The most common type of macular degeneration is the early or "dry" form of the disease. It occurs when tiny, yellow cholesterol-rich deposits called drusen build up between the retinal pigment epithelium (RPE) cells and the underlying layer of blood vessels. Drusen blocks the retina's ability to rid itself of waste products and to receive essential nutrients from the underlying blood vessels. Over time, the rods and cones that enable us to see begin to weaken and die. Colors grow less vivid, and our sharpest, straight-ahead vision begins to dim and fail.

Eventually, the disease reaches a tipping point, and further vision loss can be both sudden and dramatic. It's not uncommon for a patient to go from 20-20 to legally blind in less than six months. In 20 percent of cases the disease will progress to the even more damaging "wet" form, which can lead to near total blindness and which we will discuss further later in this article.

These changes are permanent. The sooner you can detect AMD and intervene the better. Unfortunately, according to Gregory R. Jackson, PhD, CSO of MacuLogix, Associate Professor of Ophthalmology, and Director of Clinical Research for Ophthalmology at Penn State College of Medicine, "By the time most patients are diagnosed they have already sustained substantial vision loss." Experts estimate that by the time of diagnosis at least 40 percent of patients are legally blind in at least one eye. "The other eye may have been compensating, so the patient isn't even aware he or she has been losing vision until it's too late," Jackson says. "Also, we're getting older, and we may not seek treatment in time because we understandably assume any vision loss is the natural consequence of aging eyes."

For most individuals, an optometrist is the primary vision care specialist. These professionals are not always equipped to detect early AMD, however. "Even retinal specialists can miss up to twenty percent of the subtle changes that signal the onset of the disease," says Jackson.

In the mid 1990s, when Dr. Jackson was studying night vision problems among older adults, he noticed the problems in the back of the eye that led to failing night vision were remarkably similar to the changes associated with AMD. When he redirected is research to study AMD patients, "I was floored by how many of them demonstrated poor night vision, even patients whose vision was otherwise still quite good."

Not only was the night vision in these individuals diminished, it took much longer for AMD patients to adapt from light to dark, when turning off a lamp, for instance, or when exposed to a camera flash. Jackson theorized these changes were at least partially caused by the drusen blocking the passage of vitamin A from the blood vessels to the retinae. Vitamin A is essential for both night vision and "dark adaptation." He also predicted that measuring dark adaptation might be one way to help diagnose AMD sooner than was currently possible. He was right.

"We took his results from the laboratory to the clinic," says John Edwards, who began working with Jackson in 2004. In 2008 they cofounded MacuLogix, and in February 2011 the company received FDA clearance to market their new device: the AdaptDx Dark Adaptometer.

Jackson and Edwards describe the AdaptDx Dark Adaptometer as a sort of stress test for the retina. The tabletop device is a large box, approximately two feet on each side, with a chin rest and eye tunnel at one end where one eye at a time is tested. The room lights are switched off to acclimate the patient to the dark, then, holding a response button in one hand, the test subject peers into the darkened tunnel and focuses on a red dot, which lights the center of a viewing screen at the far end.

The test begins with a bright flash of light to simulate daylight. Then the tunnel returns to darkness, only now a green dot is also projected just below the central, red dot. The subject presses the response button to signal that he or she has detected this green dot. Then it's time to start again.

During each test round, the green dot grows fainter and fainter. "Sort of the way a hearing test plays tones at increasingly lower volumes until eventually you reach a threshold beyond which the subject can no longer hear the sound," Jackson explains.

By comparing the speed of the subject's test responses to healthy norms it's possible to detect the onset of AMD at the very earliest stages, well before there is any vision loss, the appearance of drusen, or other retinal changes an ophthalmologist would currently use to spot AMD. It's also possible to track the course of the disease, and several pharmaceutical companies are already using the device for development of potential new medications.

Currently, the only treatments for early-stage AMD are anti-oxidant vitamins and other nutritional supplements, together with lifestyle changes, such as losing weight and stopping smoking.

"At this stage, it's mostly watchful waiting," says Jackson. "Of course if and when the disease reaches the tipping point where more aggressive drug therapy becomes useful, we'll be able to start those treatments immediately." Until AMD reaches that tipping point, the medications and other treatments discussed in the next section offer little to no value. But when that time does come, beginning treatment even a few months sooner can ultimately make a profound difference in the amount and quality of vision that can be conserved.

Retired hospital worker Joanne Polanichka participated in a clinical study of the AdaptDx Dark Adaptometer in 2011, and just recently she underwent a two-year follow-up. "I am lucky, I still have dry AMD. My vision is still strong, and I was relieved to learn things are stable and have not gotten any worse since my first test," she says. Joanne was first tested for AMD nearly fifteen years ago, after one of her sisters was diagnosed with the wet form of the disease. "My sister had AMD for years before she knew it, and today she has lost most of her vision," she says. Another of Joanne's sisters was also later diagnosed with wet AMD.

The AdaptDx is only now reaching the market, and consequently, it is not yet widely available. Hopefully, however, it won't be too long before early screening for AMD will become as routine and commonplace as testing for glaucoma. Says Joanne, "If we can catch it sooner and start treatment before things get worse, who knows what a difference that could make."

New Hope for Wet AMD

Approximately one in five dry AMD patients go on to develop the wet form of the disease. Overstressed immune cells in the eye begin to fail, and they are no longer able to block the growth of tiny blood vessels that invade the retina and leak blood, which is toxic to rods and cones. These leaking fluids give wet AMD its name, and there is no cure: the goal of treatment is to dry up these fluids and to stop the eye from creating new and fragile blood vessels.

Currently, the most effective treatment for wet AMD is a class of drugs called anti-VEGF medications. Vascular endothelial growth factor (VEGF) is the protein that promotes blood vessel growth, also called angiogenesis. Angiogenesis is necessary for body growth and wound healing, but when it misfires in overstressed retinal cells it can lead to wet AMD. VEGFs can also stimulate certain tumors to transform from benign to malignant, and in fact, the most popular medication for treating wet AMD, Avastin, was originally developed and FDA-approved in 2004 for the treatment of colon cancer.

Avastin and other anti-VGEF medications can only work if they are injected directly into the eye, and most patients require between eight and twelve injections every year to stem the tide of new vessel growth.

"The injections are horrible," says Jonathan Gathorne-Hardy, a noted British biographer, novelist and poet. "It's just nerve wracking to see someone coming toward your eye with a needle. When I had the first injection I jumped, and after the injection the eye felt bruised for days.

It's not a pleasant prospect, especially if it has to be repeated month after month for the rest of your life. Happily, however, researchers are now turning to a different page of that metaphorical Big Book of Cancer Treatments to develop a pair of exciting, high-tech wet AMD therapies that can reduce or even eliminate the need for anti-VEGF injections.

The IRay Radiotherapy System

For decades doctors have treated various cancers with high energy blasts of radiation that destroy the ability of fast-growing tumor cells to reproduce. Combining radiation treatments with traditional chemotherapies allows doctors to battle the cancer on two fronts. Logically, a similar combination of strong drugs and radiation could also be useful in controlling the fast-growing blood vessels associated with wet AMD. But until recently there were two major roadblocks.

"The energy levels of the radiation sources used to treat tumors is extremely high," observes Jim Taylor, CEO of California-based Oraya Therapeutics. "To reach and treat the retina using these oncology systems you would have to send the cell-destroying beam through the front of the eye, and much of this damaging radiation would pass right through the retina and on into other sensitive structures in the eye or into the brain."

The second difficulty in using radiotherapy to treat AMD is keeping the eye perfectly still long enough to administer the treatment. Oraya Therapeutics has solved both of these problems with their new, IRay Radiotherapy System. Here's how.

Instead of a single, strong beam of radiation, the IRay Radiotherapy System uses three tightly-focused, low-energy beams of x-ray radiation from a source no stronger than a dental x-ray or airport baggage scan. The 3.5 millimeter diameter beams are delivered one after the other through three different places across the white of the eye, at approximately the 5, 6 and 7 o'clock positions. "This way we can keep the radiation passing through the front of the eye at a minimum, and still deliver an effective, combined dose to a single target on the macula," says Taylor.

The IRay Radiotherapy System compensates for the weaker beam of radiation by delivering a much longer dose, up to four minutes total for each of the three beams.

Jonathan Gathorne-Hardy was one of the very first patients to receive Oraya Therapy. Jonathon has wet AMD in both eyes, and in August of 2010 he received a single IRay treatment in his stronger, right eye. "They strapped me into position to keep me as still as possible. I looked into the machine for twenty minutes, and then it was over. I was done."

A special contact lens had been placed on Jonathon's eye. A tiny post on the front was gripped by the apparatus to keep his eye more or less immobile while the x-ray source directed its beam through each of the three target positions on the sclera and toward a single spot on the central retina. The post also contained reflective markers that were tracked by an array of video cameras. "The cameras could detect when the post moved too far and the eye was out of position," Taylor explains. "The computer would stop the beam instantly, and not resume until the eye was back in the correct position."

Within weeks the vision in Jonathon's right eye had improved significantly. He wound up with a 9-letter gain on the Early Treatment Diabetic Retinopathy Study (ETDRS) Eye Chart. Today, nearly three years later, Jonathon continues to enjoy a 7-letter improvement. "I haven't needed a single injection in my right eye since the treatment," he reports. Jonathan still receives anti-VEGF injections in his left eye, but he's looking forward to having that eye treated soon, as well.

Jonathon's results are not unique. A recent clinical follow-up of 230 Oraya Therapy patients treated at 21 sites in 5 countries revealed a 45 percent reduction in the number of injections patients needed to keep their AMD stable. Half the patients required only one injection in two years, while a full 23 percent required no injections at all.

As of this writing the IRay Radiotherapy System is only available in the UK and Switzerland, though treatments will also soon commence in Germany. Here in the US, the company is finalizing plans for the final clinical trials necessary for FDA approval.

The SalutarisMD Treatment

A second radiation-based therapy for wet AMD may be poised to launch in the very near future. Salutaris Medical Devices, Inc. (SalutarisMD) is currently testing a handheld ophthalmic device that uses brachytherapy, which involves placing a therapeutic radioisotope as close as possible to the area to be treated, in this case the macula. Here's how it works.

The as-yet-unnamed SalutarisMD device uses a tiny amount of radioactive strontium 90 placed in a sealed, stainless steel canister at the tip of a curved cannula, a small tube used for medical procedures. The patient's eyed is anesthetized, and the pupil is dilated. The retinal specialist then slides the cannula between the eye and the eyelid, avoiding the eye muscles as he gently guides the probe around toward the outside back of the eye.

A fiber optic light at the very tip guides the way. "Using an ophthalmoscope, you can actually see the tiny pinpoint of light shining through the retina, which the doctor can use to move the cannula into position," says SalutarisMD CEO, Michael Voevodsky.

In just a few seconds the cannula is in place, with the tiny canister nestled against the back of the eye nearest the macula. The patient then receives a therapeutic dose of beta radiation lasting between five and six minutes, and then the cannula is removed. Nothing is left behind in the patient. That's it—the treatment is complete.

As with Oraya Therapy, the goal of the Salutaris treatment is to use radiation to cause the AMD lesions to regress, and to block the development and growth of damaging new blood vessels. The company believes their approach offers a targeted treatment that's focused specifically on the wet AMD. "The type of beta radiation we use only travels a very few millimeters," says Voevodsky. "So the exposure is limited almost exclusively to the macula, where it can do the most good."

In a recent clinical study performed in conjunction with the University of Arizona, six patients received the Salutaris MD procedure and were given monthly follow-up examinations. After three months all six experienced increases in "best corrected visual acuity" as measured by the ETDRS Eye Chart. After two years, four of the six patients still showed improved vision, and two had still not needed any anti-VGEF injections.

The Salutaris MD device is currently only licensed to treat wet AMD as an investigational device here in the US. The company is also working with Moorefields Eye Hospital in London, where they hope to begin further clinical trials within the year.

Contact Information

MacuLogix, Inc.
Address: 1214 Research Boulevard Hummelstown, PA 17036
Phone: 717-583-1220
E-mail: info@maculogix.com

Oraya Therapeutics, Inc.
Address: 8000 Jarvis Ave. Suite # 200 Newark, CA 94560
Phone: 510-456-3700
Fax: 510-739-1902
UK: 0800 690 6495
E-mail: info@orayainc.com

Salutaris Medical Devices, Inc. (SalutarisMD®)
Address: 4330 North Campbell Avenue, Suite 250 Tucson, AZ 85718
Phone: 520-638-7518
International: 00-1-520-638-7518
E-mail contact form: http://salutarismd.com/contact-us/

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Legislative Bill Would Establish Medicare Demo to Cover Video Magnifiers and Other Aids for People with Low Vision

For decades, the vision loss community has been advocating for Medicare's coverage of assistive technologies, particularly for devices for low-vision users. Currently, Medicare will not pay for any device that happens to use a lens, regardless of whether such device incorporates any other features. The Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for the management of Medicare, has ruled that devices, such as low-vision devices, that use a lens are excluded from coverage just as eyeglasses or contact lenses are, except in very narrow circumstances.

Now, for the first time, federal legislation may begin to change this unacceptable national policy by establishing a nationwide Medicare demonstration project to evaluate the fiscal impact of a permanent change in Medicare coverage to pay for low vision devices. The legislation, H.R. 3749, introduced by Reps. Carolyn Maloney (D-NY) and Gus Bilirakis (R-FL), would initiate a five-year demonstration project that would put low-vision devices in the hands of Medicare beneficiaries who, after a clinical evaluation by an ophthalmologist or optometrist, can benefit from a low-vision device and for whom such devices are medically necessary. The legislation is careful to require that the demonstration project be genuinely national in scope and is explicitly designed to yield reliable data and meaningful results. Once the legislation is enacted and the demonstration project is successfully completed, Congress will have significantly richer data upon which to consider changes to the Medicare program to make coverage of low-vision devices, especially the most costly devices, a permanent feature of the program. Precisely how many individuals will receive low-vision devices and how many physicians across the country will participate in the demo project will need to be determined by CMS, working in consultation with stakeholder groups, as it develops and implements the project. The legislation makes $12.5 million available for the project over five years.

The work that has led to the introduction of this important legislation should serve as a primer on how our field can effectively influence the policy process through joint labor. The American Council of the Blind (ACB) initiated the national effort to refocus our field's attention on the need to address Medicare coverage for low-vision devices. The nationally representative team of consumer, professional, and industry advocates that ACB brought together considered a variety of approaches to tackling the low-vision device coverage issue. The American Foundation for the Blind (AFB), as a participant in the ACB initiative, proposed that our field pursue a national Medicare demonstration project and prepared the legislative text that has been introduced in Congress. In addition to ACB's extensive advocacy on Capitol Hill, the VisionServe Alliance made this issue one of its principle legislative priorities at ACB's request when VisionServe members visited Capitol Hill last April. Lighthouse International, supported by other VisionServe leadership and member organizations, was determinative in securing our congressional champions. This field-wide collaboration serves as an example of the kind of effort that is best positioned to achieve results.

Advocates are encouraged to contact their members of the U.S. House of Representatives and urge them to co-sponsor H.R. 3749. We are actively working on Senate champions and will keep you updated as progress is made. Thank you for your advocacy!

For further information, please contact:
Mark Richert, Esq.
Director, Public Policy
American Foundation for the Blind
Phone: (202) 469-6833
E-mail: MRichert@afb.net

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A Technology Year in Review: 2013

Now that the holidays have come and gone, it's time to look back at the technology highlights of 2013. This year-end summary wasn't nearly as easy to put together as others have been in the past. There wasn't a breakout story (such as the introduction of talking iPhones) that would immediately jump out as the defining story of the year. While there were a few exciting new developments in accessible technology, no single product dominated the market like the Victor Stream did a few years ago. Perhaps the best way to summarize the past 12 months is to use the well-known saying, "The more things change, the more they stay the same." Let's take a few moments to reflect on what we saw and learned in 2013.

Breaking Barriers with Mobile

Often, when new technologies are released, those who are blind or visually impaired are not able to enjoy them at the same time as their sighted peers. As techology progreesed, those with sight could select their favorite shows from an electronic program guide on their televisions. They could use their landline telephones to save contacts or check for missed calls. They could control their ovens and other household appliances through digital interfaces. Much of this technology was, and sadly still is, inaccessible to people with vision loss.

AccessWorld has provided extensive coverage of how mobile phones, and especially the iPhone, have changed this paradigm, but it's worth repeating. Thanks to the speech and magnification features on modern cell phones, people who are blind or visually impaired are able to understand and harness the world around them in ways that were only dreamed of several years ago. To take this thought a step further, look at the specialized devices that a tech-savvy blind person once carried around that have now been largely replaced by the mobile phone. From simple devices such as a talking pedometer, watch, or money identifier, to more advanced tools like a talking GPS unit or digital book player, we're at a point where specialized devices are becoming obsolete.

In 2013, two major developments furthered this trend toward a one-device-fits-all mentality. Amidst much fanfare, the National Library Service for the Blind and Physically Handicapped (NLS) released their BARD Mobile iOS app in September. The Braille and Audio Reading Download service offers both recorded and braille versions of popular books and magazines. Before the BARD Mobile app, a digital book player such as a Victor Stream, BookSense, or NLS's own digital player was required to listen to or read these books. Of all of the popular services that provide accessible books, the NLS collection was the only one without a mobile app. Since the release of the BARD Mobile app, patrons can now download books wirelessly and listen to them on their cell phone.

Meanwhile, full-fledged GPS apps appeared in 2013 for both the iPhone and Android devices. Sendero, a name synonymous with GPS for over a decade, released the Seeing Eye GPS app in collaboration with the guide dog school of the same name. This brought many of the features of Sendero GPS apps for notetakers to mobile devices along with more modern functionality such as support for online data sources such as Foursquare. Meanwhile, the American Printing House for the Blind released Nearby Explorer, a GPS app for Android phones and tablets that includes millions of points of interest from Google as well as public transit data. Both apps cost slightly more than a mainstream solution ($69 a year or $9.95 a month for Seeing Eye, $99 for Nearby Explorer), but GPS is one type of app where some additional accessibility features can be quite useful. Most sighted users don't have a need to mark the doorway of a building or to be told the type of intersection they are approaching while walking, information that is easily available through specialized apps. At any rate, it's a huge improvement from the days when Sendero charged $1,600 for their GPS program for the BrailleNote or the nearly $900 original cost of a Trekker Breeze. And once again, it's one less device that needs to be carried around, and one less additional expense for a blind traveler.

Mobile devices are also opening new doors in areas where accessibility was largely impossible in the past. Fitness trackers, scales, and heart-rate monitors are now often bundled with mobile apps. As a side effect of this trend, much of the data collected can be accessed using speech, magnification, or braille. Home heating and cooling systems such as the Nest Learning Thermostat can be controlled wirelessly, often with an accessible interface. Cable companies are releasing mobile apps to control set-top boxes including changing channels and scheduling programs to record on a digital video recorder. Wireless thermometers can relay the temperature of meat while it is being grilled or cooked. Exercise equipment can be monitored and controlled from your cell phone or tablet.

The beauty of these and many other innovations is the possibility of increased accessibility. Previously, if one wanted to develop a talking heart-rate monitor, thermometer, or set-top box, hundreds of thousands of dollars in engineering and design work would often be required. For many companies, that's a huge risk that may or may not pay off in the long run. Compare that with modern electronics, which are often controlled by mobile apps. If proper guidelines are followed, many mobile apps will be quite usable and accessible with access technology with little or no effort from the manufacturer. This means new possibilities and new opportunities for the blind community. This also leads to a new set of challenges for the community as well, as manufacturers need to be educated on what it takes to make their apps accessible.

As a technology trainer and consultant, I've noticed another trend has developed when it comes to mobile, the adoption of iPhones by seniors and those new to assistive technology. In the past, talking smartphones were used by those with a fair amount of technical skill, while others would use simple feature phones such as the several accessible models from LG. Recently, I've seen a wider variety of people delve into the world of smartphones, especially the iPhone. People who may have never used a computer with a screen reader are suddenly checking their e-mail and listening to books on their phones. Advancements like the iOS voice assistant, Siri, have helped to break down accessibility barriers. Android phones with 5- and 6-inch screens have been highly regarded as viable solutions for low-vision users. Naturally, there is a definite learning curve when it comes to modern cell phones, but more and more people are making that leap and moving to an accessible mobile device.

That being said, the mobile world isn't perfect, and productivity apps remain a challenge. While some half-baked solutions exist for taking simple notes or reading some types of documents, a full-fledged word processor or database program remains a pipe dream. Microsoft is inching toward releasing mobile versions of Word and Excel and Google's recent purchase of QuickOffice has come with some initial accessibility support. However, we've yet to see a complete mobile solution for managing documents and spreadsheets. Notetakers such as the BrailleNote or BrailleSense also do a better job at handling contracted braille input and output and Nemeth Code than many mobile devices. As more and more children and college students move to using iPads instead of specialized notetakers, it's becoming vitally important to advocate for the same level of braille support that was previously available. If kids are taught using speech exclusively, their employment potential may become diminished. Many experts will tell you that listening to spoken text is not the same as reading, and we need to exercise our due diligence to ensure that proper braille training and education are not lost because of advancements in technology.

A Calculated Advance for STEM

Many organizations have been pouring their time and research into improving the outlook for people who are blind in the STEM (science, technology, engineering, and math) fields. Math in particular received a huge boost in 2013 thanks to a new product from APH and Orbit Research. As students enter advanced math classes in middle and high schools, one of the standard tools for computing complex equations for the past two decades has been the line of calculators from Texas Instruments. While some alternatives have been released in the past, the introduction of the accessible TI-84 Plus Talking Graphing Calculator was the first time that a mainstream graphing calculator had been made accessible. Now, students who are blind can perform many of the same advanced mathematical functions as their peers on a device already familiar to teachers. Students can download class data through a USB port or listen to graphs represented by stereo audio patterns. In high school, I remember feeling left out when the other students could use their fancy calculators and I was relegated to a simple scientific calculator that often produced inaccurate results. Now, students with visual impairments get to feel like they're a part of the group and can explore the world of mathematics along with everyone else. We look forward to following further developments with this calculator.

The Passing of A Math Pioneer

Meanwhile, we lost one of the most influential pioneers of mathematics for the blind, Dr. Abraham Nemeth. Out of personal necessity, Nemeth created the well-known braille math code that bears his name while teaching college-level math classes. Rather than give up and find a different career path, he tackled this issue head-on and created a code that is still widely used by braille readers across the country. Next to literary braille itself, the Nemeth Code is likely the most widely used today. Dr. Nemeth died in October at the age of 95.

Two Steps Forward and a Step Back for the Kindle

Amazon made headlines several times in 2013 with news relating to the Kindle, their hugely popular book reader and mobile tablet device. In October, the Kindle Fire HDX gained much-requested accessibility features, largely based on the Android 4.2 platform. It's now possible to read Kindle books, browse the Web, adjust preferences, and adjust magnification settings independently. While not perfect, it's a huge improvement from prior models, which offered little or no access.

Meanwhile, Amazon joined Sony and others in fighting a requirement for accessibility to lower-end Kindle devices which primarily act as e-readers. They argue it would be cost-prohibitive and an undue burden to design accessibility into these tablets. If Amazon and others get their way, this would mean blind consumers would be forced to pay more for an accessible device, as the HDX models retail for upwards of $250 while the Kindle Paperwhite and other devices that Amazon wishes to have exempted cost roughly $100. The Federal Communications Commission has yet to make a final ruling.

Amazon, Barnes and Noble, and Google have all released accessible versions of their mobile apps for both Apple and Android devices. This means that practically all of the major e-book services are now accessible in some form. While some of these mobile apps work better than others, it's worth commending those who worked to improve access to electronic materials. Hopefully, the same access that is now available using speech will be extended to refreshable braille displays in the near future.

Speaking of books, two additional developments may lead to millions of additional accessible books in the future. In June, The World Intellectual Property Organization (WIPO) passed the Marrakesh Treaty, which creates rules that allow for accessible materials to be shared across borders. This means that, potentially, books from NLS may be available in other countries while US consumers may have access to the books available through libraries in other countries. The treaty will need to be ratified by at least 20 countries to become valid. Meanwhile, Google won a landmark court case versus the Authors Guild, an organization that advocates for the rights of published authors, that was trying to stop Google's digital conversion of millions of books, many of which are no longer available. Google's victory opens up potential for new ways to disseminate this material, especially orphaned works that are no longer being published. Access technology users could also realize any benefits that may result. Put simply, we may be seeing even more accessible books in the near future. The state of access to books is moving from "if" to "how." Challenges remain, including finding succinct ways to convey images, diagrams, and mathematics using technology.

Conclusion

This was a year of trends, especially the usage of mobile devices by groups who may have never imagined it a few years ago. In the past, a year-end update may have been dominated by the latest release of JAWS or a new talking organizer. While dedicated access technology vendors still play a role in many of the devices and programs we use today, the attention has shifted away from legacy solutions and toward the next generation of technology. The access technology companies that evolve and diversify will be with us for this next wave of new technology. The ones that don't may soon become relics of the past. Regardless of what happens in our corner of the technology world, you can be assured AccessWorld will be there to tell you all about it. Here's to a prosperous 2014.

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