Assistive Technologies What would you do?

Dec 22/Jan 23 Closing The Gap Solutions - Collaborating With Augmentative and Alternative Communication (AAC) Users Gains A New Perspective To Best Support Clients By Lydia Dawley

transition, employment & vocational rehab

The Assistive Technology (AT) industry is represented by a wide variety of specialties. Since there are only a handful of AT-degreed programs, many come to the AT field from varied programs of study. This paper takes advantage of that diversity of knowledge by asking “What would you do?” in various AT scenarios (actual cases from the AT team at Ernst & Young (EY) over the past nine years). Any personally identifiable information has been changed or deleted to maintain privacy/confidentiality. EY is a professional services firm operating in over one hundred fifty countries. Its AT team (a mighty team of two) have worked with customers in almost one hundred of these nations (all in a virtual environment). Since the team offers support for any assistive tech topic, there is no way team members will be highly knowledgeable in all medical areas. Also, their methods of helping customers may differ significantly from readers of this publication. This paper consists of various case studies from the AT team at EY. The goal is to spark curiosity in each reader because he/ she/they may have different ideas to help each customer. SCENARIO 1 – CUSTOMER LOSES ACCESS TO JAWS SCREEN READING SOFTWARE A customer reached out to the AT team at EY just before the end-of-year holidays and reported they could not access JAWS on their work computer. Up until this day, the individual had encountered zero issues with the program. A few extra challenges existed: • This was the individual’s last workday of the calendar year and they wouldn’t be back in the office until January (almost

a month away) and needed JAWS access during the break. • It was 11:00 PM local time in the customer’s area and they were the only person in the office building. Seeking assistance from an onsite person was not an option. WHAT DID THE AT TEAM DO? By asking open-ended questions (where answers could not be "Yes" or "No"), the team determined how the individual originally obtained their copy of JAWS and when the transaction was carried out. The individual had JAWS for one year and had not renewed their copy (it was a 1-year subscription). The AT team reached out to their contacts at the vendor to obtain a 90- day trial code (was obtained in a matter of minutes) and then passed that along via a Skype meeting to the customer. Fortunately, the AT team had built connections with the vendor who supplied software to EY in the specific country where the customer resided. The team reached out to their contacts at the vendor and the customer’s copy of JAWS was formally renewed before the end of the 90-day trial code. Scenarios like this led to a formal request for "Fusion" software (contains both JAWS and ZoomText software titles) and its inclusion in the “EY App Store”. Currently, anybody at EY in need of JAWS or ZoomText software can request "Fusion" from the “EY App Store” and it will download to their machine. The AT team also works with in-country IT teams to install "Fusion" on one’s EY machine before their first day of work (for new joiners).

KEVIN GROGG is a Product Manager for Assistive Technologies (AT) for Ernst & Young (EY) and has occupied the position for 9 years. His primary duty is to provide 1-1 AT services “at a distance” via Microsoft Teams. Before EY, he worked fifteen years at Shepherd Center, the last ten in the Assistive Technology department. He provided AT services for patients with spinal cord injuries or brain trauma. Mr. Grogg holds a BS in Management from Georgia Tech and a MS in Exercise Science & Biomechanics from Georgia State.

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SCENARIO 2 – ACCIDENT WITH A BANDSAW On Monday morning, the AT team received a call from a member of the EY Talent Team with an emergency request. A customer had been involved in an accident the past weekend with a bandsaw and severed the tips of three fingers. Since the standard method of typing could not be accomplished, the individual was very concerned for their productivity. The goal was to incorporate technology to maintain their high productivity level and not fall behind their peers. The team met with the individual on Tuesday and the following topics were discussed: • Dictation software – Since EY uses the Microsoft suite of products, the team brought up "Microsoft Dictate", which was available in Word, Outlook, PowerPoint, and OneNote. This was a tool the individual could enact “at that moment” and test its use. The team also mentioned Dragon Naturally Speaking dictation software to extend dictation to Microsoft Edge and to help with voice commands to substitute for mouse movements. • Sticky Keys – The team discussed this feature (built into Windows) that eliminates the need to hold down multiple keys at a time to enact keyboard commands. The customer made use of each function and was satisfied with the productivity gains achieved through their use. SCENARIO 3 – DIAGNOSIS OF PROGRESSIVE EYE DISEASE The customer reported increasing difficulties focusing on their screen. They were diagnosed with a progressive eye disease and wished to test various methods to make their screen easier to view throughout their day. The team focused on a few different areas: • Larger monitor – The customer preferred a single large monitor (42 inches) versus multiple smaller screens (32 inches). The AT team worked with the in-country Talent/HR team to procure a 42-inch model. • Changing Text Size - The team helped to change the overall text size of Windows icons and system programs. Also, the team enabled a slider bar for text size in the lower- right corner of Word & Outlook. The team also made sure the customer knew how to adjust the settings for the future. • Audio playback of screen text – The team guided the customer through use of the "ReadAloud" feature in Word and Outlook. This enabled the customer to hear their emails and Word documents. They also worked through the audio playback features within PDF programs. • Dictation of emails via the Outlook mobile app – The customer was not interested in using dictation software on their work laptop. Instead, the team focused on the dictation feature in the Outlook mobile app. This allowed the customer to dictate their messages and briefly scan for

completeness before sending.

SCENARIO 4 – CUSTOMER RECEIVED NEW HEARING AIDS AND ENCOUNTERED DIFFICULTIES USING THEM IN VIRTUAL MEETINGS The customer had previously used a single hearing aid (in- the-ear) and recently switched to dual over-the-ear hearing aids. While the new Bluetooth connectivity was great, the customer reported significant discomfort with their on-the-ear headset (pressing against the hearing aids). The customer was seeking an alternative headset. • A few alternative form factors were proposed – earbuds and/ or bone conduction headset (with built in microphone). • The team was curious if the customer would prefer a direct connection from their EY laptop to their hearing aids. • The customer wanted to try a bone conduction headset, and the results were fantastic! The customer was appreciative and has used this model since. SCENARIO 5 – RECENT DIAGNOSIS OF ADHD The customer reached out to the AT team after a recent diagnosis of ADHD and was seeking ways to better maintain pace during virtual meetings where information is always exchanged quickly. • Current method of notetaking – The AT team asked the customer about their current notetaking methods and where they felt it was lacking in the fast-paced work environment. The team asked for specific examples of when the pace became too much. This helped the team check for patterns and were there specific occurrences within a meeting where troubles were most apparent. • Connections between OneNote and Microsoft To-Do – The customer made heavy use of OneNote and reported their To-Do list was scattered with items from multiple OneNote pages. The team demonstrated the connections between OneNote and Microsoft To-Do (both programs are available to everyone at EY), specifically the "Outlook Tasks flag in OneNote. By placing a flag on a line of text (a To-Do item) in OneNote, the task is automatically synchronized in Microsoft To-Do. All To-Do items are available on one screen in Microsoft To-Do, versus multiple OneNote pages. This made it much easier for the individual to keep up with their To-Do items. • During the meeting – The team mentioned "Teams Captioning", a feature built into Microsoft Teams and available to everyone at EY. For the customer, the process of “seeing” the words in addition to hearing them made a significant positive difference in their initial level of understanding.

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SCENARIO 6 – DEBILITATING BACK INJURY The team received an emergency request from the Talent team regarding an individual who suffered a debilitating back injury that prevented the individual from working anywhere other than their couch. Because of this, the individual could not hold their laptop in any static position for long. Their main concern was maintaining high productivity and their role primarily involved the sending/receiving of email. • Dictation using the built-in microphone of the laptop – Given the severity of the injury, the customer could not easily wear a headset. While the laptop microphone is more susceptible to environmental noise, the customer was fine with it since they would be working 100% from home (in a controlled environment). • Emphasis on "Microsoft Dictate" – Since the individual was primarily concerned with email, the team worked through "Microsoft Dictate" in Outlook until the individual felt comfortable to use it on their own. The individual felt the injury would be temporary and did not see the need to use Dragon Naturally Speaking software. • Mobile use of Outlook app - The team also worked with the customer to take advantage of the Outlook mobile app, especially for dictating emails. • "ReadAloud" feature in Outlook – In addition to dictation, the team wanted to provide a way to play back audio of Outlook email to lessen the amount of time one must spend in any one position (staring at the screen). SCENARIO 7 – MANDATORY ELEARNING COURSE INCOMPATIBLE WITH SCREEN READING SOFTWARE A customer reported that a mandatory course for their job role could not be accessed using JAWS screen reading software. The customer was a veteran JAWS user and had tried numerous workarounds to rectify the issue, to no avail. The course had a due date within two weeks and the customer was highly concerned about completing the learning before the deadline. In addition to the course material, there was a mandatory quiz that could not be accessed. • A different AT approach - Instead of attempting to "make" the course software compatible with JAWS, the AT team worked with the Talent and Learning teams to produce an alternate version of the course and the quiz sections. Within a few days, the Learning team supplied a Word version of the course. This was possible because numerous online courses start as Word documents before being made into the eLearning format. • Providing the alternative to the custome r – Before sending the Word document to the customer, the AT team tested it with JAWS to make sure all was well. After JAWS read back the content successfully, it was passed along to the customer. The customer then worked with their Talent representative once they completed the class to then

complete the quiz. Talent and Learning teamed to provide a JAWS-compatible quiz section, and the customer was able to complete the class and successfully pass the quiz by the deadline. SCENARIO 8 – MIGRAINES EXACERBATED BY HEAVY SCREEN USE A customer reached out after experiencing increased incidence of migraines, brought on by heavy screen use (a requirement of their role). They used two screens: a 14-inch laptop screen and a 20-inch external monitor. • Recommendation of larger screens and solely using external monitors – The AT team worked with the customer to determine how they felt about larger monitors while shifting away from the small laptop screen. The team proposed two 24-inch monitors due to customer preference and the amount of desk space available (customer worked from home almost all the time). Also, the customer was amenable to using an external keyboard and mouse (had been solely relying on the built-in keyboard and trackpad from the laptop). A docking station allowed for all items to be plugged into a single source. This made a significant positive difference for the customer. • Physical placement of monitors – Along with new monitors, the team worked with the customer regarding optimal ergonomic placement of the screens. Beforehand, the customer was performing significant left/right and up/ down neck movements to go between their laptop screen and external monitor. The team recommended the new monitors to be placed around a center point (directly in line with the individual’s straight-ahead view) and to be at the same height (where one’s eye level was in line with the top of each monitor). SCENARIO 9 – HYPERFOCUS (MAINTAINING STATIC SEATED POSITION FOR 10 HOURS AT A TIME The team received a call from a customer who reported becoming highly engrossed in their work to the point where they did not take breaks through a full day of work (sometimes 10 hours non-stop). The individual mentioned this lack of activity resulted in negative health effects that lasted for days but also admitted that it’s difficult to break the habit. • Automated break-reminder software – A direct result of Covid, the team rolled out two options for break-reminder software that automatically prompted the individual to take a break. These software titles are available via the "EY App Store" globally. Anyone who works for EY can request the software and it will download to their machine. Neither program requires Internet access to function (after installation). • Wireless headset – The AT team also recommended a wireless headset to ease the ability to “walk around” and

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continue to participate in virtual calls.

SCENARIO 10 – NEW JOINER ENCOUNTERED DIFFICULTIES HEARING ALL PARTIES DURING IN-PERSON MEETINGS The customer was a new joiner, and in-person meetings comprised almost one hundred percent of their role. They mentioned being hard-of-hearing and said the number of speakers (and the fast pace) of each meeting made it difficult to follow (and understand the content). The customer found themselves taking extra time with notetaking and review afterwards (compared to their peers) and were concerned this would affect their job standing. • Software portion of the solution - Within EY, Microsoft Teams is the preferred virtual platform for meetings. Even though these meetings were in-person, the AT team found that an individual can set up and join a Teams meeting on their own (without any other participants). It was found that Teams Captioning could still be activated (even when a meeting only had one participant). • Hardware contribution to the solution – Even though the individual could use Teams Captioning during the in-person meeting, the built-in microphone on their laptop was insufficient to pick up all voices in the room. The AT team recommended an external Bluetooth speaker/microphone that could be placed anywhere in the room. • Combining hardware & software – The customer could place the Bluetooth unit in an optimal location without attracting attention. Within Teams, they set the audio input (microphone) to be the Bluetooth unit. Once these settings were ready to go, the customer started their Teams meeting (where they were the only participant) and activated captioning. • End Result – The combination of a single-participant Teams meeting, the Bluetooth speaker/microphone, and activating Teams Captioning allowed the customer to follow the spoken words from everyone in the meeting! While speaker attribution was unavailable (since only one person joined the Teams meeting), Teams did separate the spoken words from different users (for those inevitable times when people spoke over each other). The ten scenarios listed in this paper are only a small sample of the types of cases the AT team at EY works with daily. Readers may have different ideas for solutions, given the high diversity of thought in the AT field. It is hoped that the ideas in this paper will be beneficial when readers encounter similar situations.

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