Introduction
    In order to effectively evaluate, select, and train consumers/users to use ECU's, you should study this module, read chapter 5 in your text book, answer the study questions, look through catalogues before class. In addition, be familiar with the glossary table 10-1 and table 10-2, figure 10-4, appendix 10-2 and handout 10-1. During the lab sessions, you will practice with various devices, followed by case-study discussions of how to enhance the function and safety of various clients.

Objectives
Upon completion of this module, you should be able to:

1. Define and describe an ECU, including each part (input, throughput, output, feedback).
2. Assess a person's needs and ability to use an ECU in various environments.
3. Analyze various transmission methods for different environments (AC, IR, RF, voice and ultrasound.)
4. Select a "high cost" and an "affordable" ECU for a variety of  consumers who have physical, cognitive, or sensory        impairments (case studies).
5. Train consumers and caregivers in the application and maintenance of ECU'S.
6. Reference major ECU manufacturers, resource persons, and references.

    Let us begin with a few examples of persons who can benefit from using ECU's:

• Jane, a five year old with poor hand skills, can turn on a television with an adapted remote ECU control from her bed; or
• Jerry, a teenager who has only functional motion of his head, can control his television, telephone, radio, lights, and fan with an ECU controlled pneumatic switch.
• Robert, an office worker who uses a wheelchair, can open doors, turn on a coffee pot, control a slide projector, and use an electric letter opener and a stapler with using an ECU that is interfaced to the powered wheelchair control.
• Virginia, a homemaker who has severe joint pain and limited physical endurance can control any electrical appliances (tea kettle, blender, mixer, lights, electric drape pull) using an ECU remote control carried in a basket on her walker.
• Harry is an elderly person with a hearing impairment who is alone most of the day and needs to be reminded to take medication at a designated time. This can be done by a computer programmed ECU that turns on a light to remind him.

What is an ECU? It can be defined as:
a means to purposefully manipulate and interact with the environment by alternately accessing one or more electrical devices via switches, voice activation, remote control, computer interface, and other technological adaptations. The purpose of an ECU is to maximize functional ability and independence in the home, school, work, and leisure environment (Bain, DiSalvi, Gold, Kollodge, & Schein, 1993, p.55).

    Most ECU's are used by persons with severe disabilities when they are in bed or in a wheelchair.  They can be effective throughout the home, at school, and in the workplace. All environments where an ECU will be used must be considered, especially to determine if a portable system is required.

Controlling Methods for ECU's
    The major means of controlling ECU's for the past 15 years have been AC house wiring, infrared (IR), radio frequency (RF), and ultrasound. In recent years, there have been an increasing number of systems that can be voice activated and/or computer driven. (See Chart A and table 10-1 in text.)

Most ECU's consist of four Assistive Technology Device (ATD) components:

• Input or access, is the means by which the user sends signals to the system to activate it.
• Throughput or transmission, receives the input, processes it, and then sends a signal to the appliance/light.
• Output, is the manner that the appliance/light is activated or deactivated when the signal has been received and processed correctly.
• Feedback, usually a visual, auditory, or tactile display relaying to the person that the system is operating. (See Figure 1).

Input                             Throughput                         Output                         Feedback

Command           House wiring            Lamp on           Light
center buttons                     module
(See Figures 10-2 and 10-3 in text.)

Now that you are aware of persons who can benefit from ECU's, what ECU's are, and how they operate, the next step is to learn how to evaluate each part of the system, the user's abilities and goals, the tasks the user wishes to accomplish in all present and future environments, the characteristics of various ECU systems, and any interfacing needs (e.g. to computer, AAC, or power wheelchair).

 Assessment (See table 10-2 and appendix 10-2)
    An assessment for any ATD is best conducted by an interdisciplinary team, with the consumer and caregivers being primary participants. Other members of the team may include occupational and physical therapists, Language Pathologists; seating and positioning specialists; the nursing staff; rehabilitation engineers; and rehabilitation technology suppliers.

    Before undertaking an ECU assessment, the seating and positioning of the consumer must be evaluated, and care must be taken to ensure that the addition of an ECU will not interfere with any other ATD's or routine activities of daily living. The assessment of a consumer for an ECU requires an evaluation of the consumer's abilities, all the tasks for which the ECU is needed, all the environments in which the tasks will be performed, the various ECU systems available, and how to best integrate environmental equipment with existing ATD's.

Evaluation of the consumer (physical, psychosocial, and cognitive abilities)

    The ECU Needs Assessment (appendix 10-2) can be used to determine the consumer's needs, possible access methods, feedback, integration with other equipment, and funding concerns.

    The consumer's major physical/motor abilities that need to be considered include:

1. position for use when lying, sitting, and standing (remember the force of gravity when supine is different than the force when sitting);
2. the control site or the best body part to control the device;
3. and the consumer's strength, range of motion (ROM), endurance, coordination, muscle tone and motion planning is usually done by an occupational or physical therapist, or can be retrieved from the medical chart.

1. the consumer's motivation to use an ATD
2. the consumer's fear and frustration level toward electronic devices, and
3. the consumer's need for independence versus the need for attention. Another psychosocial factor is the caregiver's opinion on the value of the ECU (e.g. is the setup too time-consuming or complicated).

Evaluation of the environment

    After the consumer's abilities, goals, and tasks have been identified, all present and possible future environments must be evaluated, including: the home/building wiring and architectural barriers, and local physical weather conditions. Some other factors to consider are: all computer driven ECU's should be plugged into surge protectors with battery backup, voice activated ECU's may not be practical in noisy office or classrooms, liquid crystal displays (LCD) are difficult to read in bright sunlight, and any possible interference with the ECU's transmission methods needs to be anticipated. The consumer and/or caregiver must assist with the environmental evaluation. Interview, pictures, diagrams, or home videos are helpful If a rehabilitation team member can do a site visit of the home and workplace, this information can be very useful in the final selection.

Evaluation of ECU operational characteristics (Handout 10.7)

    The first step is to determine how the ECU will be activated (input): will it be through direct selection, switch scanning, or voice; are momentary or latching controls required; how many low-voltage appliances need to be controlled; will a telephone be part of the integrated system or a separate unit; will the ECU be activated directly through a powered wheelchair, alternative augmentation device (AAC), or computer?

    The next characteristic is the throughput or transmission (see Figure 10.6). The most common transmission methods are AC house/building wiring, IR, RF, and ultrasound, additional electronic modules are frequently needed. (Note that modules intended for X-10 systems can not be used with ultrasound or IR systems.) The most frequently used transmission system is X-10, which has appliance, light, and heavy-voltage appliance modules. The X-10 modules have to be preset for house codes (A-P) and unit codes (1-16). The house code enables different people in the same building or room to control all of their individual devices. Each lamp and/or appliance has both a unit code (1-16) and a house code (A-P). For example, the house code on the controller is set at B, a lamp is set with a unit code of 1, and a radio is set with a unit code of 4, both have the same house code (B). It is important to be familiar with the X-10 system as it is frequently used and is often a part of other ECU systems.

    Another remote transmission system or means of throughput is an IR signal that is sent to an appliance that is in direct line-of-sight. Remember, the IR remote control delivered with a TV or stereo can taught to receive signals from a RELAX or Scanning Director once they (RELAX and the Scanning Director) have learned the appropriate IR signal to emit. IR signals can be extended by using POWERMIDS. (See handout 10.3.)  Signals can also be converted to electrical (X-10) signals by using an IR converter.

    The X-10 remote uses the radio frequency (RF) method of transmission to send radio signals to a receiver that converts the signal to an electrical (X-10) signal. RF signals are typically limited in range to 30-40 feet, but they do not have to be in direct line-of-sight of the receiver. (Refer to Figure 6).

    Another method of transmission is ultrasound. For example, the Ultra 4 command controller sends ultrasound signals to color-coded modules (See Figure 10-3), only four per room. The receivers/appliances do not have to be in line-of-sight. Ultrasound waves do not transmit through walls, and they bounce off some metal objects. (See Figure 10-6.)

    Other characteristics of an ECU to be considered are the appliances/ lamps to be turned on or off (output). It is not recommended to use low voltage X-10 ECU remotes to control heaters, air conditioners, or microwave ovens, or some electrical hospital beds, all of which need their own control system. Most lamps and electrical appliances used in the home and the workplace are safe.

    The feedback of an ECU system is usually visual (light goes on), auditory (music or voices from TV, VCR, or radio), tactile, such as the breeze from a fan. Because ECU's are used in bed and in wheelchairs, their portability and size must be evaluated. As with any ATD, and ECU evaluation should consider whether the system is commercially available, safe and reliable, practical, affordable, and who will maintain and/or service it.

Selection (See table 10-2, Figure 10-4, Handouts 10.1 and 10.4)

    The selection of an ECU should be made only after the Needs Assessment has been completed and discussed with the future user. Occupational therapists are the rehab team members who should be most familiar with various systems that are available and they should take the lead in the selection process. I have found it helpful to begin with the most simple and least expensive system, keeping in mind the cognitive level and needs of the user, all the environments, what other devices it must be integrated with, and the available funding. I cannot stress strongly enough every user is entitled to the best possible and appropriate device, not the latest high tech device that you saw at a recent conference. Refer to Handouts 10.1 and 10.4 for comparison. Once the ECU level has been determined, the user should have the opportunity to practice with different systems. Next the rehabilitation team should meet to confer on the final selection and determine who will order the complete systems. When the systems arrives, a member of the team (the occupational therapist, rehabilitation engineer, or technologist) needs to check it and assemble it. It is critical to know whether the user will also need a powered wheelchair or an AAC before the final selection of the ECU to ensure that all devices are compatible . Most current powered wheelchairs have ECU boxes or Auxiliary boxes to serve as the power source for the ECU; however , this was not the case 5 years ago when each manufacturer used their own designated ECU controller system.

TRAINING THE USER AND THE CAREGIVER

    Usually the occupational therapist will be responsible for training the consumer and the caregivers in all uses of the system and its maintenance. It is highly recommended that manufacturers= catalogues and names of people to contact for repairs be given to the consumer. It is also helpful to give the user diagrams of how the system is assembled, with corresponding permanent labels attached to the equipment.

    I have found it beneficial to begin the training sessions by having the user practice all the TV commands then the remote lights and appliances commands and lastly the phone. However, the order should be "what the users wants to do or needs to do first."

    Once , users are comfortable with the basic commands, they and their caregivers must learn how to assemble all of the parts following the manuals or directions. Remember that you or the caregiver may not be there to troubleshoot when the TV remote does not receive the signal and the user is watching a favorite program with a friend. Users should be familiar with all ATDs operations and be able to instruct others in how to assemble or troubleshoot. Research has shown that many users abandoned equipment once it fails. That is why diagrams or color coding each part is helpful and you as the training member of the rehab team should include this as part of the training. It is also helpful to have resource people's phone numbers taped to the ATD.

    The next step in the training process is to teach the user and caregiver how to maintain the equipment and who they can call for assistance. Again, this is the reason the user should be given catalogs, diagrams, and phone numbers for each ATD. It is highly recommended that the user be supplied with a folder containing this valuable information. Remember, ATDs are useful, some are very expensive, and many are abandoned (Phillips, 1992).

Telephones (also refer to Text chapters 7 and 8)

    An important and safety factor for personos who use any ECU's is telephone control and whether it can be integrated with the selected ECU or needs to stand alone.  There are current many telephone available that can meet the needs of people with various physical and sensory disabilities including: speaker phones, cordless portable phones, automatic dialing and redialing memory features, phones with large buttons that can be activated with hand or mouthsticks, headsets, and voice activation dialing. For more details refer to chapters 7 and 8.  In addition, there are fax and answering machines, and special devices for people who have hearing impairments such as TDD. Section IV of the ADA ensures that interstate and intrastate telecommunications relay services are available to people with hearing and speech impairments.

Monitoring Systems

    Personal response systems are technological devices worn or carried by people who wish to live alone or who are left alone, such as the frail elderly, people with disabilities, or young adults who are old enough to care for themselves after school, but who need help if there is an emergency. These monitoring devices can be activated by hand or through switches such as a light pressure "pillow", or sip and puff, or an eyebrow switch. Once the switch has been activated, a signal is sent to a monitoring center, which then puts the user in touch with a relative, friend, neighbor, or an emergency service. Many cardiac users are linked directly to a hospital monitoring center. Another effective and inexpensive monitoring system is the "baby monitor", which is sensitive enough to hear breathing anywhere in the same house. As with any ATD, be sure you carefully assess the potential user and be cognizant of the users tolerance to equipment and the psychological factor of being dependent on aids.

Follow-up and Re-evaluation

    To ensure that the selection and training process are effective all ECU's should be followed-up and re-evaluated. It is recommended that the assistive technology professional call the consumer one week after discharge and that a follow-up visit be made one month later. Then a phone call should be made twice a year because changes can occur in the consumer abilities and tasks, in the technology of the device, and the environment.  If this follow-up is not possible, it is especially important that the user know who to contact for assistance.  (See appendix 10-1 for major ECU manufacturers.)

Funding

    Funding is often available to purchase devices but not for training purposes. Research has show that the lack of training can lead to abandonment (Phillips, 1992). Therefore, professional and consumer should advocate for payment of services in accordance with the Tech Act. Funding can also be justified on the basis of safety. Anyone left home alone must have a means of exiting the residence (e.g. door opener) and a means of calling for help (telephone). It is often the creative efforts of the rehab team members to find funding for ECU's, because most governmental agencies consider ECU's a luxury and many insurance companies have limits on the amount of funding for equipment. We will discuss various means of obtaining funding in class and please share with the class some of your experiences.

Study Questions

1. What are three other parts besides the feedback of most ECU's ?

2. Name and give an example of each transmission method discussed in this chapter.

3. What factors must be considered when a person with a spinal cord injury needs to use an ECU from his/her powered wheelchair and from bed?

4. Suggest an ECU for a young adult who has poor coordination, wants to change the channels of a TV and has limited funds.

5. List 5 ECU's resources (people, catalogs, manufacturers, or articles) that you can use to expand your knowledge of how ECU'S can enhance the function of your clients.

NOTES