Thinking outside the box led Alexicom Tech to provide communication device users with an Internet-based, portable, subscription service.

Frustration Leads to Innovation

“Why isn’t this internet based and device independent?!” The question reverberated through Fredi’s exasperated mind after wading through more than a year of red tape to obtain a government subsidized AAC (Alternative Augmentative Communication) device for his young autistic son. He was dramatically underwhelmed by the self-contained unit, produced by a well-established company, when it finally arrived:

It took some time to get going, and I couldn’t believe how incapable it was for how much it cost — this machine that basically only has one function. It seemed to me it could have been created by someone with a little bit of computer software knowledge and it wouldn’t have cost ten thousand dollars!

He was resentful that, as a public school teacher serving his community, he couldn’t begin to afford the device that would allow him to use his training to teach and communicate with his own son. He also knew that others would perennially be forced, as he had, to be turned down by his insurance company before he could begin the long application process with DDD (Division of Developmental Disabilities). He continues,

I took the machine over to Karen, who had been a mentor working with our robotics team at the high school. She knew something about getting in the back side of computer programs and understanding how they work. I asked her to guess how much it cost, and when I told her, she almost fell over. I wanted to shake up the whole paradigm.

The First Internet-Based AAC System

The Alexicom Tech company and system, named for Fredi’s son Alex, offers all of the traditional, expected functions. On-screen icons are activated to generate synthetically spoken words or phrases, but since the dream of an internet-based application was realized, no resident software is needed and it can run on virtually any platform. Karen, explains:

You can use any sort of input device that has an interface with a computer (a traditional desktop, tablet or touch screen PC, even the iPhone or iPod). You can use your mouse like on a standard web page, but you can use tab and return to get through the picture cells, every tab gets you to the next cell, shift tab reverses you through the cells, and if you want to speak a cell you can hit return.

The team was diligent, however, in offering multiple methods for human interface with the system:

You can also use software for the mouse, it’s called ‘X-Mouse Button Control’ software, which is free and available online, that allows you to use your mouse like a two-switch switching device. Or you can even use camera tracking software — a free ‘CameraMouse’ program — that you use by providing a high contrast feature on your face. You click on that feature, and as you move your head, that’ll move the mouse across the screen, dwell, and click. Touch screen does work really well though, because you have immediate contact w the screen and don’t have to move a mouse around X and Y.

Alexicom Tech, ultimately, is a service as much as a technology, and one that permits handlers to access the functionality from portable devices as well as the home and school computer as needed. It can run on Smartboards and is being used by teachers with entire groups of students, and the system comes with initial templates that permit communication in English and Spanish and other languages to begin working within minutes. It is fully customizable as well, and teachers can develop libraries of icons and commands to be shared throughout school districts. Parents and teachers can share authorship privileges, creating opportunities for strong collaborations.

Flexibility and Simplicity as Key Design Goals

Karen explains that Shockwave Flash or QuickTime is used for streaming audio files, so that for most systems there is no time lag in beginning to play files that are being downloaded (some mobile devces, due to their design, are exceptions). She continues,

We wanted to make it very easy to get pictures off the internet so you can go directly into Google or Bing.com, Yahoo, Flicker.com, anyplace where you can get an image URL. You can copy that link, paste it into a textbox on our edit page, then press update, and it automatically copies that image to our server. So you don’t have to go through the process of putting them on a flash drive to go from one computer to another. It just goes from that place in the internet world to this next place in the internet world and it never touches you.

“The ability for us to be internet based was huge: it opened up all the images in the world,” adds Fredi, intimating that users or support personnel can select photographs and created graphics that will best fit idiosyncratic conceptions of words and ideas, and convey complex shades of meaning that go far beyond typical cartoonish or stylized representations. Pages can be 10 rows by 10 columns, substantially larger than most system handling capabilities, and these representations can be revised and grow with the advancement of the child. Using his own experience in using other AAC devices, he adds,

The other important thing is the ease of creating the pages. There are drop down menus for every function. If you didn’t have a tutorial and played with it, as long as you’re an average internet user, you can easily figure this out in maybe ten, twenty minutes on your own. If you use the tutorial, you can learn how to do this in maybe five minutes, and you can learn how to create a page that fast. It’s intuitive.

Demo pages are available from Alexicom Tech’s website, with video tutorials being produced this summer, and the company offers bundles that include computerized devices. In particular, they highlight a partnership with Hewlett-Packard and their new line of touch screen and tablet technologies.

Fredi’s Dictum: It Must Be Affordable!

Alexicom Tech was able to offer arguably superior communicative functionality to a very large school district in Arizona for a cost of twenty thousand dollars, while a traditional competitor’s bid came in at three quarters of a million dollars for the five year contract period. Fredi emphasizes that Alexicom Tech can constantly upgrade all clients on a continual and immediate basis, and that there are no stand alone devices to fail, requiring a typical $800 repair bill and a month of down time. As long as a child can be placed on another input device, with Alexicom Tech, communication is seamless.

Fredi is proud that families can determine if the service will work for their child and situation and “be out no more than forty bucks!” with a single month’s service fee, more importantly reinforcing his fundamental goal that it is “very affordable for a middle income family even to buy it on their own, to keep the service going. And the touch screens we’ve been talking about cost as little as $479.”

Given the power of the idea and the clearly illustrated magnitude of cost savings that indicate whole new market space, the team laments a series of ‘copycat’ companies that have followed their innovation now offering competing web AAC services, and patent infringement action is in process in some instances. Still, they find this a validation of their fundamental design and business model.

Fighting the System

The breakaway model of internet-based AAC delivery concept has brought network television attention. Yet even with the excitement and the low cost that would seem to strongly incentivize governmental purchases, Alexicom Tech experienced substantial push back by the systems that typically provide AAC devices for individual clients, including issues with Medicare/Medicaid and DDD. Jerry explains that there was an entrenched belief that federal or state law in Arizona prohibited using any technology involving the internet, and which could be used for more than one dedicated purpose. Further, there “was no known billing code”. DDD would not initially authorize access to Alexicom Tech, and Karen explains that “not having that blessing was a hindrance — no Speech Language Pathologist (SLP) wants to do an evaluation with a product DDD is going to turn down.”

Jerry showed his mettle for helping to launch the company, even fighting to add the support of state legislators to add pressure and eventually got Alexicom Tech approved through Arizona’s DDD. His efforts illustrate that leveraging changes to state bureaucracy was nearly as critical as the technical design:

I’ve taken this challenge on: researching, finding codes, and so on. There is one Medicare/Medicaid code, E2511, specifically for software that works with a personal computer or PDA. So once we got that we began the approval process, registered with the FDA… There’s a whole bureaucratic process we had to go through to move this forward. We met with them and they were very resistant, saying they couldn’t fund what they called a ’subscription.’ I had to really push to get this through DDD — nobody had any answers. Finally we showed there was no ruling, statue, or law requiring it to be ‘device dependant’ — it took a lot of persistence, but was finally approved. It saves the state 60-80% of the cost for augmentative communication.

Seeing Results

Karen is keen to point out that she involved SLP’s early on to “give me guidance, and counsel me on what features we needed to include.” Now she is obtaining feedback from these professionals that children adapt to the system more quickly than traditional AAC devices. SLPs are also confirming that the more sophisticated icon image choice is allowing more specific communication, even allowing professionals and parents to discover new things about the children using the system.

Perhaps her most compelling and personal story is of a family whose child repeatedly pressed the Alexicom Tech symbol they had created for ‘apple’ at a specific time they were making smoothie drinks. They hadn’t been aware of their child’s preference for the fruit, and for the first time were able to add it to the blender.

This greater specificity in communication may even permit states to obtain better measures of outcomes to demonstrate more accurate Annual Yearly Progress for students served by special education under the IDEA.