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Dr. Wolynski is a 2000 graduate of the New England College of Optometry. He consults for OrCam Technologies and the Florida Heiken Children's Vision Program, a division of the Miami Lighthouse. Dr. Wolynski is a board member of The Optometric Society and
The smart home market is expected to reach $121.73 billion by 2022.3 With these speculations, even stores like Home Depot now have a separate smart home device section. It is estimated that by 2020, there will be over 26 billion connected devices.
We often hear about what technology will do in the future, such as self-driving cars. However, our patients with visual impairment and blindness need help now.
Thankfully, we are seeing a number of assistive technologies coming to market, such as wearables, improved text-to-speech programs, improved magnification software, assistive apps and navigation tools. We are also seeing technology emerging in the mainstream that does not exclude those with a disability, and innovations, such as Apple watch, are already coming to market with accessibility features built in from the start.
One of the most popular technology items purchased during the 2016 holiday season were smart home devices-most notably Amazon Echo and Google Home smart speakers. These smart speakers not only play music, but they act as a personal assistant and are able to search the Internet, make lists, set alarms, play audio books, and control devices (turning your home into a smart home)-all by the sound of your voice.
While these functions sound fascinating and fun to use for most of us, think of what this means to our elderly patients as well as those who are low vision, blind or have other disabilities. For people who are elderly or with disabilities, smart home devices are now not just a novelty but can become a necessity and used as an assistive technology, providing more functional capabilities and independence.1
Like any new technology, smart home devices will take time time to catch on. Not surprising, millennials and those living in urban areas seem to be the most excited about smart home technology, according to Business Insider.2
The smart home market is expected to reach $121.73 billion by 2022.3 With these speculations, even stores like Home Depot now have a separate smart home device section. It is estimated that by 2020, there will be over 26 billion connected devices.4
The smart home is not a new concept; in fact, innovations such as the smart medical home for seniors, including fall detection began in the late 1990s to early 2000s.5
Smart homes have five elements:6
• Energy: Homes can be more energy efficient with programmable thermostats or automatic blinds.
• Security: Homes can be safe from intruders with alarms and/or cameras. Plus, some devices can help the elderly by detecting a fall.
• Atmosphere: We can control the mood with lighting and/or music. We can automatically change the color of indoor lighting based on the weather-for example, lights can turn blue on a rainy day.
• Convenience: We can use smart home devices to create a schedule, learn the weather forecast, or search the Internet by speaking to the device. We can create a shopping list by voice or place a scanning device next to our garbage that tracks what you throw away and need to replace.
• Entertainment: We can control the television, play music, and even have our house lighting flash and change color to the music playing.
Today, companies offer many devices to outfit any home. The theme for the 2017 Consumer Electronics Show (CES) in Las Vegas was connectivity, and many smart home devices were showcased. These automated connected devices are able to lock the door, control smart lights, and set smart alarm clocks to tracking what you throw away in your smart garbage pail and making a list of what needs to be replaced.
In order to control a function through a smart speaker, such as turning on the lights or locking the front door, patients must have devices or objects that are part of the “Internet of things (IoT).”
IoT is the networking of objects, devices, vehicles, etc. to collect and exchange data.
In order to control lights, for example, patients must purchase a device to control the lights as well as light bulbs with embedded sensors which allow them to connect to the Internet. Many companies make these devices, such as WeMo, Phillips Hue, Smart Things, Insteon, Nest, and Wink, to name a few.
Patients require a Wi-Fi connection along with a central command center known as a hub or smart hub. Smart hubs are run via a smart remote or smart phone app to control IoT devices in the home.
For example, Amazon Echo or Google Home is used as a “voice recognition hub” that can be hooked up to many existing smart home devices or used in conjunction with a central smart hub to control more devices or those not compatible. Currently, Amazon Echo is compatible with more devices because it has been available longer.
These personal assistants are gaining popularity due to their ease of use, versatility, and speech recognition capabilities. When Amazon Echo or Google Home is linked to a smart home device, you are able to control your home’s locks, garage door, lighting, and temperature; browse the Internet, and play music, control the television, read a book, and get information from the Web all by speaking a command.
For instance, I can create a scenario by using “if this, then that” (IFTTT) in which setting an alarm to wake me in the morning will then trigger my smart coffee maker to start. IFTTT is a free web-based service used to create an applet, also known as a “recipe.” A recipe is a set of actions, so if I say “Google, turn off lights” then that happens. Many pre-made recipes are ready to use, or you can create your own.
Voice-activated smart home speakers are offered by the two major players in this field: Amazon (Echo) and Google (Home). These devices have Wi-Fi and Bluetooth connectivity, a speaker, are able to connect to Android and iOS devices, and are accessible via a Web browser. Both devices can be easily connected to an IoT smart home device.
Amazon Echo is a family of devices that includes original Echo, Echo Dot, and Amazon Tap, all of which work with the voice assistant known as Alexa. In order to activate the device, an individual needs to say only, “Alexa” to wake it up, and state a function or command.
The original Echo device is a tall cylinder (9.3 inches high, 3.3 inches wide)with seven microphones capable of hearing you from across the room and has a higher quality speaker than the Echo Dot and Tap.
Echo Dot is Amazon’s second generation of the device, which is smaller in size (1.3 inches high, 3.3 inches wide). It is capable of connecting to your own speakers via Bluetooth or a wire and has a lower price.
Amazon Tap is weighs just over a pound and is portable (6.3 inches high, 2.6 inches wide), so you can take it on the go. According to the company, it has a battery life of nine hours of continuous playback.
Google Home is newer than Echo; it was released in 2016. The cylindrical shape is similar to that of Echo (5.62 inches high, 3.79 inches in diameter). Reviews of the device claim that Home works better than Echo when answering follow-up questions when searching the Web. Because Home is newer, it may not yet be compatible with as many smart devices as Echo.
Setting up these devices is easy-which for someone with limited technological ability or a disability is a plus. Just plug it in, connect it to the Internet via an app, and then ask it to play your favorite music or get the news. To connect with other smart home devices, see what companies the unit is compatible with and purchase those devices. Keep in mind a smart hub may be required if certain devices are not compatible or if multiple smart home devices are desired.
New technology doesn't come without its problems.
There have been question about privacy while using these devices because they always on and listening while plugged in. In one instance, police wanted to confiscate a homeowner’s Echo to examine it for possible evidence in an ongoing murder investigation.7
Sometimes smart home device owners find an unexpected package on their doorsteps after they have spoken of ordering an item but didn’t place an actual order.8
Some are concerned about the possibility of someone hacking your smart lock or being locked out of the house during a power outage when Wi-Fi connectivity is down.
Does everything need to be smart? This depends on the needs and wants of the individual.
In my experience, patients with congenital forms of visual impairment or blindness are tuned into available new technology. In fact, frequently these patients are informing me.
As the elderly are living longer, optometrists are likely seeing more acquired visual impairment causing depression and lower quality of life. Some 10 to 15 percent of seniors have depression, which rises to 27 to 34 percent in patients with a visual impairment.9
Recommending new technology such as smart home devices may be able to help these patients by making tasks easier and creating more independence. We should not assume that early dementia or a mild decrease in cognitive abilities will prevent patients from adopting new technology. There are no identifiable traits about who is able to use technology; these decisions should be made on a case-by-case basis.10
Earlier this year I attended the 2017 California State University, Northridge (CSUN) Assistive Technology Conference. While there, I talked with many blind or visually impaired people. There was much excitement about smart home technology, and it seemed many people were already using it.
For example, Charlie Collins, founder and CFO of Vision Dynamics who himself is legally blind, commented on his use of smart home technology.
“It makes accessing music, weather, news, and information so much easier,” he said, “all I need to do is ask. Being legally blind, it has given me independence with ease.”
He shared a story about how his device was able to assist in providing information.
“While away at a conference, my wife called to ask when my flight departed for home,” he said. “Instead of trying to go through my phone to find the information, I told her to ask Alexa-she was instantly able to get the information.”
Smart home devices are not only going to revolutionize the home but will allow our low vision and blind patients to access information with ease and improve their quality of life. While these devices might not be for everyone, consider mentioning them to your patient or his family. Who knows, perhaps someday we will have a HIPAA-compliant smart device to help out in the exam room: “Alexa, which is better, one or two?”
1. Loucks K. How Smart Homes Can Empower Disabled Homeowners. Modern Smart Home. Available at:. http://www.modernsmarthome.com/how-smart-homes-can-empower-disabled-homeowners/. Accessed 8/22/17.
2.Greenough J. The American Smart Home Market: 2015. Business Insider. Available at: http://www.businessinsider.com/the-american-smart-home-market-2015-slide-deck-2015-8/#-9. Accessed 8/22/17.
3. Markets and Markets. Smart Home Market by Product (Lighting Control, Security & Access Control, HVAC, Entertainment & Other Control, Home Healthcare, Smart Kitchen, and Home Appliances), Software & Service (Behavioral, Proactive), and Geography - Global Forecast to 2023. Available at: http://www.marketsandmarkets.com/Market-Reports/smart-homes-and-assisted-living-advanced-technologie-and-global-market-121.html. Accessed 8/22/17.
4. Morgan J. A Simple explanation of ‘The Internet of Things. Forbes. Availabel at: https://www.forbes.com/sites/jacobmorgan/2014/05/13/simple-explanation-internet-things-that-anyone-can-understand/#6d0fe1a21d09. Accessed 8/22/17.
5. Hendricks D. The History of Smart Homes. IoT Evolution. Available at: http://www.iotevolutionworld.com/m2m/articles/376816-history-smart-homes.htm. Accessed 8/23/17.
6. Carlson T. The 5 elements of smart homes. Modern Smart Home. Available at: http://www.modernsmarthome.com/the-5-elements-of-smart-homes/. Accessed 8/22/17.
7. McLaughlin EC. Suspect OKs Amazon to hand over Echo recordings in murder case. CNN. Available at: http://www.cnn.com/2017/03/07/tech/amazon-echo-alexa-bentonville-arkansas-murder-case/index.html. Accessed 8/22/17.
8. Allen K. 6-Year-Old Mistakenly Orders Dollhouse, Cookies Worth $162 While Chatting With Amazon Echo. ABC News. Available at: http://abcnews.go.com/Technology/year-mistakenly-orders-162-worth-treats-chatting-amazon/story?id=44577327. Accessed 8/22/17.
9. Bruijning JE, van Rens G, Fick M, Knol DL, van Nispen R. Longitudinal observation, evaluation and interpretation of coping with mental (emotional) health in low vision rehabilitation using the Dutch ICF Activity Inventory. Health Qual Life Outcomes. 2014 May 4;12:182.
10. Lim FS, Wallace T, Luszcz, Reynolds KJ. Usability of tablet computers by people with early-stage dementia. Gerontology. 2013;59(2):174-82.