Environmental Control System
Opening Doors and Lives
Computers give quadriplegic veterans independence, dignity and hope
By Brad Bass
Supplement to Federal Computer Week
Page 13


Airman 1st Class David Cantrell was fully conscious during the accident that
took away his ability to use his legs and hands and severely limited movement
in his arms.  

On a clear fall afternoon in 1985, he and four Air Force buddies were on
their way to a small-game hunting ground not far from their base in Oklahoma
City. Cantrell, who at age 22 stood 5 feet 9 inches tall and weighed l800
pounds, fell asleep in the cramped back seat behind the driver.  

The Jeep sped along at about 85 miles per hour on the wide-open interstate.
Around 4 p.m., Cantrell was jarred awake when one of the tires blew out. He
woke up just in time to see the vehicle swerve to the left and overturn in
the wide median. The top of the Jeep flew open, and all aboard were thrown
onto the grass.  

"I was the only one seriously injured, Cantrell said. "When we swerved to the
left, I remember the motion of falling to the right. And I remember waking up
on the ground. I remember the policeman and people talking to me." 

He can't remember how long he waited for ambulance technicians to take him to
a hospital in nearby Sallisaw, hut he does remember feeling sorry for one of
his friends.  

"In the ambulance, my friend was screaming and yelling," he said. "He was in
more pain than I was because I couldn't feel anything. I knew I had a broken
neck, but I thought, 'Well, I'll go to the hospital, and they will make me
better.'" 

Cantrell soon found out that his treatment wouldn't be quite that simple.
After the accident, he underwent torturous occupational therapy before he was
allowed to return to his parents' home in Opelika, AL. Depressed and angry,
he moved into his own trailer home a year later.  

Cantrell said it took him nearly four years to shake the feeling that he "was
the most pitiful thing on God's green earth." Then he began to fight back. He
learned how to drive a specially designed van, and he earned an associate's
degree in computer information systems. He resumed his social life, was
married in 1992 and moved to Memphis, TN, where he found a job as a counselor
with Paralyzed Veterans of America.  

But three years later, Cantrell's wife left him. Around that time, Farris
Hodges, chief of the Prosthetics Center at the Department of Veterans Affairs
Medical Center in Memphis, got a phone call from Cantrell.  

"He was extremely depressed," said Hodges, a veterans who lost the use of his
legs and one arm after stepping on a land mine in Vietnam. "He called me and
said, 'I can't do anything." Cantrell couldn't turn on the lights in his
ranch-style Memphis home. He couldn't operate his television or his home
computer, which he refers to as his lifeline.  

But all that changed when "Dilbert" entered his life in 1996. Dilbert is what
Cantrell has nicknamed - after his favorite cartoon character - his
personalized Environmental Control System, a computer system provided by the
VA. ECS uses voice recognition and the existing wiring in Cantrell's house to
perform tasks such as opening doors and dialing the telephone.  

"It's really been a lifesaver for me, as far as allowing me to be
independent," said Cantrell, 34. "There's no match for it." 

Besides giving veterans the ability to perform tasks they otherwise could
not, the systems give them the psychological and emotional boost that comes
with achieving goals on their own. ECS "illustrates the difference between
not being able to do anything for yourself and being able to do everything,"
Hodges said. "Think about being in your home and not being able to do the
simplest things like turning on a ceiling fan or turning on a light in a
room. You're just stuck there. ECS is like the difference between day and
dark." 

Sal Sheredos, program manager for technology transfer at the VA's
Rehabilitation Research and Development Service, said the Department began
developing ECS technology after Life magazine reported in the early 1970s on
paraplegic Vietnam veteran Ron Kovic, the subject and author of the book Born
on the Fourth of July, which later became a film.  

Responding to the publicity generated by the Life article, the VA Prosthetic
Center began developing technology to ease the burden of veterans such as
Kovic.  

The VA awarded a contract to a new company, Prentke Romich Co., to provide
prototype ECS units to VA spinal cord centers across the country. The units
were evaluated and improved, and manufacturers used the VA's work as a
springboard for their own innovations. The entire development effort cost
less than $1 million, Sheredos said.  

Sheredos estimated that the VA has provided systems for about 6,500 veterans,
a fraction of the number of people in the general population who have
benefited from ECS technology.  

The VA no longer invests in ECS development. "It is a priority in terms of
providing it to veterans, but we don't have any development going on,
Sheredos said. "We showed manufacturers there is a market for ECS, and that
kind of snowballed into a whole industry." 

The early systems were crude and used a pneumatic "sip-and-puff' tube. By
creating air pressure within the tube by inhaling or exhaling, users could
send electronic signals to a central unit at their bedside and call up menus
listing devices - such as televisions and ceiling fans - that the system
controlled.  

The older systems had an unfriendly user interface and only allowed veterans
to control items in the room in which the unit was installed. Some systems
also precluded other people from manually operating the connected devices.  

In the 1980s, the VA moved to a computerized ECS based on off-the-shelf
interface technology. Since then, the agency has farmed out much of its ECS
work to private companies and is incorporating off-the-shelf solutions, such
as voice recognition.  

Newer systems, such as the Simplicity model from Quartet Technology Inc. that
Cantrell uses, rely on voice recognition. Users love the feature, but it can
be an annoyance if the user has a cold or laryngitis. When that happens, the
system needs to be reprogrammed to respond to the user's "new" voice.  

During installation, which generally takes less than a week, home devices
such as light switches are fitted with receivers that accept infrared signals
from the ECS. ECS can open and close doors augmented with hydraulic systems
and electronic switching mechanisms that release a striker when activated by
a user's voice.  

A basic Simplicity ECS costs about $6,000 but can cost substantially more
depending on the number of devices connected to it Hodges said. Cantrell's
system cost $11,000.  

The systems are capable of hundreds of functions ranging from pointing and
clicking a mouse to adjusting the vertical hold of a television. They can
dial and answer phones and can store frequently used phone numbers. Veterans
can specify whether they want their ECS to have a male or female "voice", and
all of the systems are unfailingly polite. A typical conversation between
Cantrell and Dilbert, which, of course, has a male voice, proceeds as follows: 

    "Dilbert?"
    "Yes."
    "Light."
    "Excuse me?"
    "Light."
    "Light." 
    "Open."
    "Thirteen." This number specifies which light fixture is being
                controlled.
    "Turn."
    "Turn on." The light in Cantrell's bedroom goes on, something Cantrell
could not do before Dilbert arrived. 

Like Cantrell, John Moore realized he needed an ECS after a divorce left him
stranded without a caregiver in his Memphis home. Moore, a former ship
repairman for the Navy, became a quadriplegic in 1952. He tried to help a 5
year-old retrieve a lost ball at an office picnic. The child's ball had
rolled into a stream. Moore, noting that the water was too deep for the
child, dove in after the ball. He broke his neck.  

It was just one of those weird accidents," Moore says. "I was conscious
enough to hold my breath. But I knew I couldn't get myself over on my back.
All I could do was wiggle my shoulder. I just held my breath until they got
me out." 

Moore was rushed to the University of South Carolina hospital, where he under
went surgery. He was heavily medicated for about four months, after which he
became aware of the extent of his injuries.  

Moore first tried having a live-in aide help him, but "they just don't work,"
he said. Some people are real nice for a few months, but then, next thing you
know, they are leaving you laying in bed while they take your wallet and walk
out the door. I've had that happen to me.  

Moore, 39, received his ECS in January, and he uses it to control his TV and
his lights. Being able to control his overhead lights put an end to the
sleepless nights Moore had when his nurse would leave and forget to turn off
the lights. in February, he was awaiting installation of door controls for
the ECS.  

"Whoever came up with this system had a great idea," Moore said. "After I got
this, I realized I depended on someone else for everything. Now I don't have
to. [ECS] gives me that freedom. A little more independence is a lot more." 

ECS, like any technology, is susceptible to glitches. For example, a dead
battery prevented Moore from demonstrating how he uses his system. Cantrell
said even a slight change in the placement of his ECS antenna makes it
impossible for him to control his doors. He recalled how his remote unit for
sending ECS signals throughout the house went dead one day, forcing him to
prop open his backdoor with a towel for hours so that he could re-enter the
house after leaving for an appointment.  

Despite some minor problems, veterans who use ECS say it has been nothing
short of miraculous in their lives. James Kennon may end up being the first
lawyer who used an ECS to obtain his degree.  

Petty Officer 2nd Class Kennon was 25 and a Navy paralegal when his neck
broke after his pickup truck flipped over when he swerved to avoid running
over a dog. He lost the use of his legs and arms and was put on a ventilator
for three months. After more than nine months in the VA Medical Center in
Memphis, he returned home to live with his mother in Tulsa, OK.  

Three years later, he is attending the University of Tulsa Law School and
credits his ECS with making it possible. The system, using Dragon Dictate
software from Dragon Systems Inc., allows him to access documents from the
law library via the Internet. He also can send and receive e-mail and write
papers without assistance.  

The system has been a blessing not only to Kennon but also to Tina Nelson,
his girlfriend, who shares his home. Nelson said she spent countless
frustrating hours typing papers as Kennon dictated. "It's so much easier now.
All I do is put the headset on him and shut the door," she said.  

Perhaps even more important, ECS technology coupled with Kennon's optimism
that a cure for his paralysis is near - has given him confidence that he will
be able to practice law after he graduates.  

"I am absolutely convinced a cure is in the making right now," he said. But
even if I get out of law school and conditions are still like this, I do
believe that, with this computer and this system, I'm going to be able to
work. I'm sure of that." 


ECS Components

Hardware: Quartet Technologies Inc, models include lamp and appliance
modules. X-10 circuit modules, remote-strike release kits, microphone kits,
motion-sensing light detectors and wireless remote speakers. Voice mouse
keyboard also by Quartet.  

Software: Dragon Dictate Version 3.0 voice-recognition software for
interfacing with PC.