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AFB  ®
Technology News for People Who Are Blind or Visually Impaired
From the American Foundation for the Blind
 March 2004 Issue  Volume 5  Number 2

In This Issue . . .

Editor's Page

Letters to the Editor

Diabetes and Visual Impairment: Are Insulin Pumps Accessible?

Insulin pumps can be lifesavers for people who are diabetic--but can visually impaired users overcome the obstacles?--Darren Burton, Craig Swisher, and Mark Uslan

Getting Your Forms in Shape

Filling out forms can be one of the worst parts of navigating a web site using a screen reader. Find out why--and how web designers can make these forms accessible--Crista Earl and Elizabeth Neal

Accessing Power: A Review of the Democratic Presidential Candidates Web Sites

The Internet has played a major role in this year's presidential primary campaigns. Candidates' web sites were surprisingly accessible as tools for making a choice--Jay Leventhal

Dancing the Roomba: Artificial Intelligence That Sweeps the Floor

Imagine a device that not only sweeps the floor, but is also accessible--and it makes you laugh!--Deborah Kendrick

A History of Accessibility at IBM

Read about the illustrious history in assistive technology of a company that has done more for people with disabilities than any other in the Fortune 500--Annemarie Cooke

No (Small) Degree of Success

An interview with Gayle Yarnall, president and owner of Adaptive Technology Consulting, who parlayed her job skills training into a very successful business--Deborah Kendrick

AccessWorld News

Calendar


Editor in Chief Jay Leventhal
Contributing Editors Paul Schroeder, Founding Editor
Deborah Kendrick, Senior Features Editor
Crista Earl
Mark Uslan
Managing Editor Ellen Bilofsky
Associate Editor Rebecca Burrichter

AccessWorld® is published bi-monthly by AFB Press, American Foundation for the Blind, 11 Penn Plaza, Suite 300, New York, NY 10001. Products included in AccessWorld® are not necessarily endorsed by AccessWorld® or AFB staff.

All rights reserved. Copyright © 2004 American Foundation for the Blind.

AccessWorld is a trademark of the American Foundation for the Blind.


Editor's Page

When we use the phrase "assistive technology," we often make the mistake of thinking of a narrow range of computer-related products. More and more in this digital world, however, people who are blind or visually impaired need access to an increasing variety of inaccessible devices. It is true that the market for screen readers, screen magnifiers and accessible PDAs (personal digital assistants) is relatively small. Yet, when you tour the exhibit hall at an assistive technology conference, you are surrounded by booths of companies selling these products.

These companies can hope to sell thousands, maybe tens of thousands of their products to computer users. A much larger population, the 5 million diabetics in the United States experiencing vision loss, is a group that is not having its needs met. In "Managing Diabetes with a Visual Impairment" September 2002, AccessWorld reviewed blood glucose monitors The results showed that much needs to be done to provide equal access to testing equipment for diabetics who are blind. We revisit the topic of diabetes management in this issue, and find insulin pumps even more inaccessible. Where are the advocates and consumer groups on this issue? Why is this market of millions of people being shut out of managing their illness?

Darren Burton, Craig Swisher, and Mark Uslan of AFB's Technology and Employment Center in Huntington, West Virginia (AFB TECH), evaluate the accessibility of insulin pumps for diabetics who are blind or visually impaired. Diabetes is a rapidly growing epidemic affecting nearly 17 million people in the United States, nearly a third of whom have vision problems, with annual costs estimated to be $132 billion. An insulin pump can only be issued by an endocrinologist and, because of the complexity involved, must be used in close conjunction with that endocrinologist and a certified diabetes educator. Insulin is delivered around the clock as needed in a more effective and less invasive way, rather than by separate injections. The use of insulin pumps is growing rapidly in the general population. Find out how inaccessible these devices are, and what our evaluators recommend for people who are blind who may benefit from using them.

If you are a screen reader user, you have probably had trouble navigating a web site in the last few days or hours. Crista Earl and Elizabeth Neal, Web Content Manager at AFB, write about how to create accessible web forms, one of the most difficult parts of web design. From searching for information to purchasing products, it is hard to accomplish anything online without filling out and submitting a form. This article covers designing forms logically, labeling controls, keyboard accessibility, tables, the evils of using radio buttons, and more. The next time you want to write to a web site designer to complain about how difficult it is to use a particular site, this article will allow you to explain what changes need to be made.

I survey the web sites of the candidates vying for this year's Democratic presidential nomination. The web played a major role in news stories leading up to the first primaries, especially Howard Dean's use of it to raise money and attract interest to his campaign. I was pleasantly surprised to find that, for the most part, all the sites were accessible and could serve as tools for choosing a candidate.

Deborah Kendrick reviews the Roomba Robotic Floorvac from iRobot. This small, automatic vacuum cleans rooms and entertains anyone in its presence at the same time. Some accessibility features are built in—for example, the power switch beeps when Roomba is turned on, and when you select a room size, small, medium or large, a short musical sequence is played. However, the manual is currently not available in accessible format, and the virtual wall unit, which keeps the Roomba from falling down stairs, is not accessible. It is true that nature abhors a vacuum, but this is one you may love.

Annemarie Cooke, Senior External Relations Officer at Recording for the Blind and Dyslexic, writes about the history of accessibility at IBM. Big Blue has an illustrious history in this area and has done more for people with disabilities than any other Fortune 500 company. This article spans the years from the original IBM Screen Reader and its developer, Jim Thatcher, to IBM's future plans and projects related to web accessibility and Section 508 of the Rehabilitation Act (which establishes federal standards for the accessibility of electronic and information technology).

Deborah Kendrick interviews Gayle Yarnall, president and owner of Adaptive Technology Consulting in Amesbury, Massachusetts. Yarnall began her career in the assistive technology field by training people to use the original Kurzweil reading machine in the late 1970s, worked at Telesensory Corporation and then started her own successful company.

We are delighted with all the positive feedback we have received in response to the free, web-only January issue. More people are reading AccessWorld now than ever before. We welcome your comments, questions, and suggestions, many of which are published either in AccessWorld Extra or the letters column in AccessWorld. The space constraints of a print issue often kept us from publishing letters in the magazine, but, starting this month, the letters column is back--as long as we receive material to fill it, of course.

Jay Leventhal, Editor in Chief

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Letters to the Editor

Antidote to Cutbacks

Congratulations on the launch of your free online version of AccessWorld. With cutbacks, your wonderful magazine wasn't available to me over the past few years, but I will again be able to refer customers to the wonderful and unbiased information in your pages!

Laurie McEvoy
Ministry of Children's Services, Toronto

Disk Drawer No More

Thanks so much for the review of the Daisy readers. It's nice to have them compared. One additional piece of information that would be helpful would be to know how the disk is inserted into the machine. The Victor Pro has a standard CD drawer that pops out to receive the disk and we've found them to be one of the more fragile parts. Does the Victor Plus use the same system or is the disk just inserted into a slot? One advantage of the clam-shell design is that the disk is just placed in the machine (though the laser-reading part is still exposed to exploring fingers). We've just purchased several of the Scholars and I've discovered that it's easy to not realize the battery cover isn't latched, which prevents the disk from turning.

Diane Nousanen
Texas School for the Blind and Visually Impaired, Austin

Editor's Response

The Victor Reader Plus has a slot into which CDs are inserted. As the disk is pushed in, a mechanism grabs it and finishes the job.

AOL for All

Because I have been an AOL subscriber since 2002 and I am using Window-Eyes, I would like to point out an inaccuracy in your article about AOL. You said that it is not yet advisable to use AOL with Window-Eyes. GW Micro has supported my work with AOL since version 6.0, and Window-Eyes works quite well with AOL. I have not yet upgraded to AOL version 9.0, but can tell you that AOL has made great progress through version 8.0 with accessibility and I have had almost no trouble with accessibility. So you might revise your comment about AOL and Window-Eyes, since it is definitely not true.

Gail Selfridge

Editor's Response

We used JAWS because our contact at AOL advised us that AOL had more contact with Freedom Scientific to date during their development process since AOL 7.0. Brief attempts to use Window-Eyes with AOL 9.0 were not very successful, so we went with AOL's advice.

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Product Evaluation

Diabetes and Visual Impairment: Are Insulin Pumps Accessible?

Diabetes is a rapidly growing disease that affects nearly 17 million people in the United States, with annual costs estimated to be $132 billion. Because of the seriousness of the disease and its relation to blindness and low vision, we at AFB TECH have been investigating the accessibility and usability of the devices that are used in managing diabetes. In September 2002, we presented the results of our evaluation of blood glucose meters ("Managing Diabetes with a Visual Impairment") by Mark Uslan, Caesar Eghtesadi, Angie Spiker, Karla Schnell, and Darren Burton) in AccessWorld to raise consciousness of the issue within the blindness community. In June 2002, we presented a more in-depth evaluation of blood glucose meters in the medical journal Diabetes Technology and Therapeutics ("Accessibility of Blood Glucose Monitoring Systems for Blind and Visually Impaired Persons," by Mark Uslan, Khosrow Eghtesadi, and Darren Burton) in an effort to demonstrate the importance of accessibility to the manufacturers of these devices. In this article, we take the same approach with insulin pumps.

Background

Diabetes, which impairs the body's ability to store and use glucose properly, attacks many areas of the body. More than 5 million people have some degree of vision loss because of diabetes, which is the leading cause of blindness in adults in the United States. It is estimated that 8% of legal blindness is caused by diabetes, and up to 24,000 new cases of blindness that are due to diabetes are reported every year. Diabetes is also the leading cause of end-stage renal disease and nontraumatic lower-limb amputations. A person with diabetes is twice as likely to develop high blood pressure and has 2 to 4 times the risk of developing heart disease.

When a person has diabetes, his or her pancreas does not produce the insulin that is necessary for the body to store and use glucose properly. Insulin pumps are devices that deliver insulin into the body in a way that is similar to the actions of the pancreas. This is often the preferred method of insulin delivery and has been shown to be more effective in maintaining normal blood glucose levels than are multiple insulin injections. In addition, just as the pancreas does, insulin pumps use fast-acting insulin, in contrast to traditional insulin therapy that uses slow-absorbing insulin. The use of fast-acting insulin reduces the variance in insulin absorption and helps maintain steady blood glucose levels.

Why Evaluate Insulin Pumps?

An insulin pump can be issued only by an endocrinologist, and, because of the complexity involved, its use must be monitored closely by an endocrinologist and a certified diabetes educator. A diabetes educator plays a critical role in training a person how to use an insulin pump, which can be extremely important for an individual who is blind or has low vision. As is the case with many mainstream devices, insulin pumps were not designed with users who are blind or have low vision in mind, and they have serious accessibility problems. However, we know that there are people who are blind or have low vision who use insulin pumps in close coordination with a diabetes educator and other sighted assistance. So, in addition to alerting manufacturers to accessibility problems, we evaluated insulin pumps to show people who are blind or have low vision what is involved in using one. Insulin pumps are expensive, costing between $3,000 and $6,000, so it is important to be informed before you make such a large investment. Of course, you should investigate what portion of the cost may be covered by insurance, but insurance may not cover the entire cost, and your portion of the cost, or copayment, may still be significant.

How Do Insulin Pumps Work?

Insulin pumps are the shape of a deck of playing cards, about the size and weight of some of today's compact cell phones, and they can be kept in a pocket or clipped to a belt. They have small liquid crystal display panels and a varying number of buttons that are used to program the devices' computer to control how much insulin is to be delivered. Insulin is stored in a reservoir inside the device, and it is pumped into the body day and night through an infusion set. The infusion set consists of thin tubing that is connected to the reservoir on one end and has a thin needle, or cannula, on the other end. The cannula is inserted just under the skin anywhere that there is no bone, with the abdomen being the most popular area of the body. Some of the pumps have insertion devices to make it easier and less painful to insert the cannula, but with the other pumps, the cannula is inserted manually. The infusion set can be disconnected from the pump and left in the skin during showers or rigorous exercise, but a new infusion set must be inserted every two to three days to avoid infection and the buildup of scar tissue.

Effective blood glucose monitoring is also an important part of insulin-pump therapy to ensure that proper blood glucose levels are being maintained. Like the pancreas, an insulin pump constantly delivers varying amounts of insulin into the body. This constant delivery of insulin is known as a basal rate, and the rate should vary throughout the day, depending on your activity level and food intake. A bolus is another way that insulin pumps deliver insulin. A bolus is a larger amount of insulin given all at one time, and a person with diabetes may decide to give himself or herself a bolus after a meal or if a high glucose level has been detected by a blood glucose meter. These basal rates and boluses must be programmed into the pump using the control buttons to navigate the menu system that appears on the display.

How We Evaluated Insulin Pumps

For this evaluation, we gathered all eight of the insulin pumps that have been approved by the Food and Drug Administration (FDA) and are on the market in the United States. The pumps we evaluated include the 508, the Paradigm 511, and the Paradigm 512 from Medtronic MiniMed, which has the majority of the insulin pump market; the IR 1000 from Animas Corporation; the DANA Diabecare II from the SOOIL Development Company; the Cozmo from Deltec; and the D-TRONplus and H-TRONplus from Disetronic Medical Systems. However, while we were conducting our evaluation, the Disetronic pumps were taken off the market by the FDA because of manufacturing flaws, but the company is still servicing the units that people already own. Also, as this product evaluation was going to press, MiniMed and Animas introduced new pumps.

Photograph of eight insulin pumps in three rows.

Caption: The eight insulin pumps evaluated: From the upper left, MiniMed Paradigm 511, MiniMed Paradigm 512, MiniMed 508, Disetronic H-TRONplus, Disetronic D-TRONplus, SOOIL DANA Diabecare II, Deltec Cozmo, and Animas IR 1000.

We analyzed the way an insulin pump is used and controlled and determined which features must be accessible for people who are blind or have low vision to use it successfully and independently as part of their diabetes-management efforts. We then determined how accessible those features actually are.

Are the Important Features of an Insulin Pump Accessible?

Menu Navigation and Display Information

All the pumps are programmed and controlled using a menu-navigation system that is not accessible. None of the pumps has speech output, and although the pumps emit some beeps and tones to confirm some actions, the majority of this audio output is not meaningful enough to be useful. The information presented on the display screens is often too small for most people with low vision to read, and the contrast is poor. Besides presenting menu-navigation and programming information, the displays also present important warnings and alarms, but the majority of that information is also not accessible. Although the beeps and tones that accompany the warnings and alarms alert you that something is wrong, these signals alone do not tell you what exactly is wrong or what to do about it. So, a person who is blind or has low vision would have to get sighted assistance quickly to find out exactly what is wrong and to correct the problem.

On the positive side, all the pumps except the SOOIL pump have audio bolus features that provide an accessible way for a person to give himself or herself a bolus of insulin. They feature beeps and tones that are meaningful, and you can confirm the amount that has been programmed before you deliver the bolus. For example, if you want to give yourself a 2-unit bolus of insulin with a MiniMed pump, you press the audio bolus button four times, once for each half unit. Then, the pump will produce four tones to confirm the amount before you deliver the bolus.

The accessibility of this bolus delivery is important because much of the other pump programming can be done ahead of time with assistance from a certified diabetes educator or sighted friend or relative. Because a bolus may need to be given at different times of the day, the fact that it is accessible lessens the need to rely on sighted assistance.

Documentation

Insulin pumps are complicated medical instruments, and their improper use can be dangerous to your health or even lethal, so it is important for the manuals and user guides to be accessible. All the pumps come with print manuals, but only the Animas pump has a large-print manual available on request, and none has a braille manual. The pumps all have manuals or user guides in electronic format, but these guides are all in PDF file formats and were not designed to be accessible to screen-reader software. However, we found no problem reading the manuals with screen-magnification software. Training videos are available for MiniMed pumps that do provide some useful information, but they are not designed to be fully accessible or to provide all the necessary information to a person who is blind or has low vision.

Tactilely Identifiable Buttons

The pumps have only three to five control buttons, and they can be identified without a great deal of difficulty, but there is room for improvement. Some are too close to one another, and others are too flush with the panel. All the buttons on the pumps are round, except those on the Deltec Cozmo, which has two round and two oval buttons. Different shapes, such as a triangle pointing up for an Up navigation button, could improve the ability to identify buttons tactilely. Although the buttons on the Animas pump are nearly flush with the panel, they are made of a much smoother textured material than the material on the rest of the panel, which is a good approach to improving the identification of buttons.

Filling and Replacing the Insulin Reservoir

Insulin reservoirs need to be refilled and replaced periodically, and the ease and accessibility of doing so varies from pump to pump. The MiniMed 508, Animas, SOOIL, and Deltec pumps require that a syringe be used to draw insulin from a bottle, but there is no way for a person who is blind to know how far to pull back the plunger to get the correct amount of insulin. Also, if the plunger is pulled back too far, it pops out of the reservoir, and insulin can be spilled or contaminated. This process is easier and more accessible with the MiniMed 511 and 512 pumps because they have reservoir filling guides that stop the plunger at the correct fill level. Disetronic has eliminated this reservoir-filling process altogether by providing prefilled reservoir cartridges for both pumps. The reservoirs are easy to place back into all the pumps except the 508 and SOOIL pumps, which require some additional steps. The pumps all have on-screen warning messages to indicate a low reservoir level. Although the warnings are accompanied by beeps or tones, these warnings do not differ from other sounds that the pumps emit to give a definite indication that the reservoir is low.

Infusion Setup and Insertion

After a filled reservoir is loaded into a pump, the infusion setup-and-insertion process creates the insulin's pathway into your body. Although it may take a bit of practice and training from a certified diabetes educator to master the process, most of it is accessible and can be done independently with most of the pumps. Connecting and disconnecting the tubing from the pumps, as well as inserting the cannula into the skin, can be done tactilely on all the pumps, but a priming process must also take place to ensure that the tubing is clear and insulin can flow unhindered. This priming process is accessible only on the MiniMed 511 and 512 because you are automatically taken to the priming function when it senses a new reservoir, and there is sufficient audio prompting throughout the process. With the other pumps, you must memorize how to navigate the inaccessible menu system to initiate the priming process.

The insertion devices that come with the MiniMed pumps make it easier to insert the cannula into the skin, but it may take some minimal practice to master the devices. The process can be performed tactilely, but it requires some practice to learn how to feel how everything is connected and disconnected.

Software

Animas has diabetes-management software for your personal computer that can be used to upload data from the pumps and to create reports of insulin delivery over time. The software can also help you calculate the correct insulin-delivery amounts. However, the software was not accessible using either JAWS or Window-Eyes. The MiniMed 512, the Deltec Cozmo, and the Disetronic D-TRONplus have software that performs the same diabetes-management functions, but their software can also be used to program the pumps. Although the Deltec and MiniMed software programs were not accessible using JAWS or Window-Eyes, the Disetronic software was accessible. We were able to set basal profiles and send them to the pump via the infrared ports. The software warns the user to confirm that the settings were properly transferred to the pump, but a person who is blind or has low vision cannot do so. SOOIL has not introduced software yet, but it plans to do so in 2004.

Battery Replacement

Most of the pumps have simple battery-replacement procedures. You simply remove the battery cap with a coin or screwdriver and replace a standard AAA battery or battery pack, and the whole process can be done tactilely. However, the MiniMed 508 and Animas use 357 silver oxide batteries that are used in many wrist watches. Because there is only a slight difference to the feel of the positive and negative ends of these batteries, it is difficult to orient the batteries in their housings properly. All the pumps have low battery warnings, but as with the low reservoir warnings, they are inaccessible.

Can People Who Are Blind or Have Low Vision Use Insulin Pumps?

Insulin pumps are relatively inaccessible devices without any speech output. They are also complex medical instruments, and improper use can be dangerous. Unlike the inconvenience experienced when an inaccessible cell phone cannot be used properly, the results of improper insulin delivery can be lethal. However, we do know that there some people who are blind or have low vision who are successfully using insulin pumps, and we assume that they are doing so in close contact with a certified diabetes educator or other health care provider and with some sighted assistance.

The Bottom Line

If you have diabetes and a visual impairment, and you think that you may be a candidate for insulin-pump therapy, we encourage you to consult extensively with your endocrinologist and certified diabetes educator to learn as much as possible about the pumps. Although none of the pumps can be programmed and operated entirely nonvisually, the MiniMed 511 and 512 pumps provide a bit more accessibility than do the others on the market. The reservoir-filling guides, insertion devices, and accessible priming feature on the 511 and 512 make these pumps the easiest and most accessible to get insulin flowing into your body. The audio bolus, easy-to-identify buttons, and easy battery replacement are other positive features of the MiniMed 511 and 512. The Disetronic pumps also have some accessible features, and they are the only pumps with prefilled reservoir cartridges, but they are no longer on the market because of FDA violations.

Insulin pumps are revolutionary in the advancement of diabetes management, and their use is spreading rapidly. From 1990 to 2001, their usage increased from less than 9,000 to over 160,000 persons, but because they are so inaccessible, many people with diabetes who are blind or have low vision are missing out on the benefits they provide. Manufacturers must realize this shortcoming and design the next generation of insulin pumps with more accessibility in mind. Adding speech output is the most important step toward full accessibility, so that people who are blind or have low vision can safely and independently use insulin pumps.

If you or someone you know is blind or has low vision and uses an insulin pump, we would like to hear from you, so we can get more direct input from users on the issues involved in using these pumps and the management of diabetes. Your input could help us in our efforts to convince the manufacturers to design more accessible diabetes-management devices.


Funding for this product evaluation was provided by the Teubert Foundation, Huntington, West Virginia. The authors thank Steven Taylor of Marshall University for his research assistance and the Marshall Diabetes Center of Cabell Huntington Hospital, Huntington, West Virginia, for providing insulin pumps to evaluate.


Product Features

Features MiniMed
508
MiniMed 511 MiniMed 512 Animas SOOIL Disetronic H-TRONplus Disetronic D-TRONplus Deltec
Audio Bolus Yes Yes Yes Yes No Yes Yes Yes
Insertion Devices Yes Yes Yes No No No No No
Reservoir Filling Guide No Yes Yes No No Yes Yes No
Software Diabetes Manage- ment Diabetes Manage- ment Program- ming and Diabetes Manage- ment Diabetes Manage- ment None None Program- ming and Diabetes Manage- ment Program- ming and Diabetes Manage- ment

Product Features

Audio Bolus: MiniMed 508: Yes; MiniMed 511: Yes; MiniMed 512: Yes; Animas: Yes; SOOIL: No; Disetronic H-TRONplus: Yes; Disetronic D-TRONplus: Yes; Deltec: Yes.

Insertion Devices: MiniMed 508: Yes; MiniMed 511: Yes; MiniMed 512: Yes; Animas: No; SOOIL: No; Disetronic H-TRONplus: No; Disetronic D-TRONplus: No; Deltec: No.

Reservoir Filling Guide: MiniMed 508: No; MiniMed 511: Yes; MiniMed 512: Yes; Animas: No; SOOIL: No; Disetronic H-TRONplus: Yes; Disetronic D-TRONplus: Yes; Deltec: No.

Software: MiniMed 508: Diabetes Management; MiniMed 511: Diabetes Management; MiniMed 512: Programming and Diabetes Management; Animas: Diabetes Management; SOOIL: None; Disetronic H-TRONplus: None; Disetronic D-TRONplus: Programming and Diabetes Management; Deltec: Programming and Diabetes Management.

Product Ratings
Product Ratings

Product Ratings

MiniMed 508; MiniMed 511; MiniMed 512; Animas; SOOIL; Disetronic H-TRONplus; Disetronic D-TRONplus; Deltec

Audio Bolus: MiniMed 508: 5.0; MiniMed 511: 5.0; MiniMed 512: 5.0; Animas: 4.5; SOOIL: NA; Disetronic H-TRONplus: 5.0; Disetronic D-TRONplus: 5.0; Deltec: 4.5.

Alarms and warnings: MiniMed 508: 1.5; MiniMed 511: 1.0; MiniMed 512: 1.0; Animas: 1.5; SOOIL: 2.0; Disetronic H-TRONplus: 1.0; Disetronic D-TRONplus: 1.0; Deltec: 1.0.

Reservoir filling and replacement: MiniMed 508: 3.0; MiniMed 511: 4.5; MiniMed 512: 4.5; Animas: 3.5; SOOIL: 3.5; Disetronic H-TRONplus: 5.0; Disetronic D-TRONplus: 5.0; Deltec: 3.5.

Battery replacement: MiniMed 508: 3.0; MiniMed 511: 5.0; MiniMed 512: 5.0; Animas: 3.0; SOOIL: 5.0; Disetronic H-TRONplus: 5.0; Disetronic D-TRONplus: 5.0; Deltec: 5.0.

Tactilely identifiable buttons: MiniMed 508: 3.5; MiniMed 511: 4.0; MiniMed 512: 4.0; Animas: 3.5; SOOIL: 3.0; Disetronic H-TRONplus: 3.5; Disetronic D-TRONplus: 4.5; Deltec: 3.5.

Product Information

Products: 508, Paradigm 511, and Paradigm 512

Manufacturer: Medtronic MiniMed, 18000 Devonshire Street, Northridge, CA 91325; phone: 1-800-MINIMED; e-mail: online--in a form on the web site; web site: <http://www.minimed.com>.

Price: $6,000 for all pumps.

Product: DANA Diabecare II

Manufacturer: SOOIL Development Co., DANA Diabecare USA, 2601 North Hullen Street, Suite 100, Metairie, LA 70002; phone: 866-Diabecare (342-2327); e-mail: online--in a form on the web site; web site: <http://www.theinsulinpump.com>.

Price: $3,000.

Products: H-TRONplus and D-TRONplus

Manufacturer: Disetronic Medical Systems, 5151 Program Avenue, St. Paul, MN 55112; phone: 800-280-7801; e-mail:<info@disetronic-usa.com>; web site: <http://www.disetronic-usa.com>.

Price: No longer on the market.

Product: IR 1000

Manufacturer: Animas Corporation, 590 Lancaster Avenue, Frazer, PA 19355; phone: 877-767-7373; e-mail: online--in a form on the web site; web site: <http://www.animascorp.com>.

Price: $5,050.

Product: Cozmo

Manufacturer: Deltec, 1265 Grey Fox Road, St. Paul, MN 55112; phone: 800-826-9703; e-mail: online--in a form on the web site; web site: <http://www.delteccozmo.com>.

Price: $5,595.

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Untangling the Web

Getting Your Forms in Shape

Web designers who care about creating accessible web sites know they need to label images, write links whose text will make sense out of context, and make many other simple-to-implement accessibility changes. But what about the accessibility details that are harder to implement, harder to understand, and harder to test? In this article, we will tackle one of the trickier issues that can turn an otherwise accessible web site into a frustrating experience for web users who are blind or visually impaired: forms.

Forms are an important method that web designers use to gather information from the users of a web site and provide them with customized information in return. A site's search function, for example, relies on a very simple form--the search box--to collect the terms that people are interested in so that the web programmer can provide search results that will meet their needs. The checkout process in an online bookstore is an example of a longer, more complicated form. The same basic rules apply to both, however, and a few simple changes can greatly improve their accessibility. This article will explain some of the problems you may be encountering with forms and will provide some suggestions you can pass on to a designer of a site--or that you can use yourself in designing your own accessible web sites.

Logical Layouts

Forms need to be designed in a logical, consistent way. Make sure the question or description for each input field (a text box, checkbox, or select menu, for example) is on the same line as the input field itself.

Place the label consistently on the same side of the input field, and be sure to explicitly tell the user which bits of information are required. Don't be subtle! Many web designers rely on color or bold text alone to indicate which items are required fields. Obviously, this technique is of little help to a user who is blind or visually impaired. We recommend actually making the word "(Required)" part of the label for each mandatory field. This practice will benefit users who have low vision, who are color-blind, or who are accessing the site with a screen reader. It is also helpful to users with cognitive disabilities. In general, being consistent and logical in form design will help all users.

Keyboard Accessibility

Many users do not use a mouse, but instead use the keyboard to move through the form. One of the main barriers to keyboard accessibility can be the use of client-side scripts, small sections of programming code that run in the user's browser instead of on the web site's computer. Be cautious about using client-side scripts to change the browser's focus, manipulate the data, or submit forms. These techniques can make a form impossible to use with the keyboard alone.

Here is an example that will be all too familiar to screen reader users. On a web page is a select menu (combo box or drop-down menu) of choices that start with "Choose One" or "Select a Category." You tab to this item, do whatever your screen reader wants you to do to "activate" the combo box (probably hit Enter) and start arrowing down to see what the choices are. Boom, you're off to another page. What other page? You may never find out.

What has happened? Some select menus are programmed to take an action as soon as you have selected an item. These forms often use a client-side script with what JavaScript calls an "onChange event," triggered when you release the mouse button after selecting the desired item in the drop-down menu. Since the keyboard user must pass through the first four items to select the fifth, this select menu does not work. The screen reader user has reading and navigating tied together in one action, so this user is not only yanked away to the wrong page, he or she does not know what it will be. To prevent this from happening, provide a Submit button that the user can select at leisure after reviewing all the items in the select menu.

Labeling Form Controls

When you access a site using a screen reader, it can be extremely difficult or impossible to know what information is supposed to be supplied in forms. A person tabbing his or her way through an incorrectly marked-up form may hear no more than "Edit, edit, edit, radio button not checked, radio button not checked, Submit button." Clear as mud, right?

This problem is solved by using labels in HTML (hypertext markup language, the set of tags used to format and display content on the web). Labels connect the question or explanatory text with the input field. Once a form is properly labeled, a screen reader will read the text label identified with the input field, no matter where the label appears on the screen. It is still important to make the visual layout of the form logical and consistent, but identifying labels within the HTML can make forms much easier for people to use with screen readers and other assistive technologies.

Label markup is a bit tricky, though. To make the form accessible, explicitly label each input field by enclosing the text associated with it in a <label for=""> tag. Then, add an ID attribute to the input field and make both the ID and LABEL FOR equal to the same value. ID values must be unique. You cannot give more than one input field in a form the same ID value. ID values are also case-sensitive, so check your work carefully. Note that the name and ID of an input field are not the same thing. The input field must have both a name and an ID in order to work correctly with the label. Here is a sample of HTML for a text field that uses the <label for=""> tag:

<label for="fname">First Name:</label>

<input type="text" name="firstname" id="fname" size="20">

Another common mistake that designers make is to use the <label for=""> tag correctly, but to forget to put text in it! So, the code checks with an automatic checking tool, but the user is not helped at all. Don't forget to label the control with meaningful text.

After labeling each input field properly, read through the form using a screen reader. Make sure that the labels actually make sense; the answers alone will not do the trick. You want to make sure that the screen reader reads the questions, too. Check boxes labeled "French, Italian, Russian" might be requesting information about the user's national heritage, or something else entirely. There are two ways to handle this problem. One is to enclose the question as part of the first option's label. For example:

<label for="French">What is your favorite type of salad dressing?<br>

French</label> <input id="French" type="checkbox" name="dressing1" value="checkbox"><br>

<label for="Italian">Italian</label> <input id="Italian" type="checkbox" name="dressing2" value="checkbox"><br>

<label for="Russian">Russian</label> <input id="Russian" type="checkbox" name="dressing3" value="checkbox">

Now, when you move to the first checkbox you'll hear, "What is your favorite type of salad dressing? French checkbox not checked." If you were taking a multiple-choice quiz set up using this approach, you would hear the question combined with the first choice of response each time you arrive at that first option.

The other approach is to use a "fieldset" tag, and then create a "legend" for the fieldset. A fieldset tag groups several different input fields together.

<fieldset>

<legend>What is your favorite type of salad dressing?</legend><br>

<input id="French" type="checkbox" name="dressing1" value="checkbox">

<label for="French">French</label><br>

<input id="Italian" type="checkbox" name="dressing2" value="checkbox">

<label for="Italian">Italian</label><br>

<input id="Russian" type="checkbox" name="checkbox3" value="checkbox">

<label for="Russian">Russian</label>

</fieldset>

Although this method is cleaner than the first method, it is not supported by all forms and versions of assistive technology. For example, JAWS 5.0 reads the form just presented very nicely when not in "forms mode," but does not read the question while you are actively filling out the form. Window-Eyes 4.5 reads only the types of salad dressings, without the question in both instances. If you want your form read by the widest variety of users, use the first method.

Avoid Radio Buttons

Radio buttons are a form of input field that presents the user with a group of options that can be chosen by clicking on a button. You can select only one radio button at a time. When you select another button, the original button is deselected. Radio buttons are not supported consistently by all versions of browsers, screen readers, and combinations of the two. Even a correctly labeled and tagged set of radio buttons is a very difficult control for users of screen-reading technology. The problem is that in order to hear the radio button options, you must land on one of the buttons. But the very process of landing on the radio button (shifting the browser's focus to it) will "push the button," changing your selection. If a "choose only one" situation is called for, a select menu is preferable.

If a web designer cannot be convinced to avoid radio buttons, then the radio buttons must be coded correctly. Each radio button in a series should have the same name, but a unique ID. Therefore, each radio button in a series should have a unique label. As mentioned before, another helpful approach is to enclose the radio button options in a fieldset, and then add a legend to the fieldset. Here is an example of properly coded radio buttons:

<fieldset>

<legend>Sex</legend><br>

<input id="male" type="radio" name="sex" value="male">

<label for="male">Male</label><br>

<input id="female" type="radio" name="sex" value="female">

<label for="female">Female</label><br>

</fieldset>

Select Menus

The default item in a select menu should clearly define the purpose of the box. For example, "Select your age range" is more self-explanatory than simply diving in with "18-25." Many screen readers and browsers fail to connect the label with the select menu, so, when users tab to it, they may never hear the label. The options inside the select menu are always read, though, so the first item should explain the purpose of the menu. And, as described in the Keyboard Accessibility section, make sure select menus work with the keyboard as well as with the mouse.

Tables

Many web forms are designed using a table structure, with labels in the left-hand column and input fields in the right-hand column. Remember to mark up structure, not appearance. Use the table summary meaningfully. People are going to read it. If the table has headings, then be sure to use the "scope" attribute to let users know if the heading corresponds to a vertical column (scope="col") or a horizontal row (scope="row").

Buttons

Standard buttons are automatically accessible--no special labeling is required. But if a fancy, graphical button is used, an alt tag (alternative text that describes the image) must be supplied. Always provide a button to submit forms. Don't use JavaScript to automatically submit them.

The Bottom Line

In summary, if you lay out your forms logically and consistently, make proper use of labels, and avoid client-side scripts and radio buttons, your web forms will be much more accessible to users who are visually impaired.

For more information about creating accessible web sites, see the fact sheet "Designing an Accessible Web Site" in the Web Accessibility section of the American Foundation for the Blind's web site, <www.afb.org>, or visit the World Wide Web Consortium's Web Content Accessibility Guidelines at <http://www.w3.org/TR/WCAG10/>.

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Access Issues

Accessing Power: A Review of the Democratic Presidential Candidates' Web Sites

Presidential campaigns keep getting longer and longer, and there is more and more information to help voters choose a candidate. The web is playing a major role in this year's campaign. This article surveys the web sites of the seven Democrats who were vying for the nomination as of January 27, 2004, the day of the New Hampshire primary. Candidates are listed in alphabetical order.

All the web sites have forms to sign up for e-mail updates, "blogs" (informal web logs written by the candidates or their staffs), and links to read the pages in Spanish. I was pleasantly surprised to find that all the sites are reasonably accessible. Most links and controls are labeled. Captions are provided for pictures, although Alt-text usually is not.

One problem that I found on several sites involved combo boxes, a Windows control that allows you to select one from a list of choices--for example, one of the days of the week. When you encounter a "friendly" combo box, you can press Enter, arrow down to your selection, and then tab to the Submit button. However, "unfriendly" combo boxes are ones that are programmed to react when a user clicks the mouse on them, rather than when the Submit button is selected. A user of a screen reader who hits the down-arrow key is interpreted as "clicking," so you are silently whisked off to the second choice in the list. If you hit the Back button or Alt-left arrow, you will return to the combo box and find that the second option is highlighted. The solution for users of screen readers is to press Enter, followed by Alt-down arrow, and expose several choices at once. You can now arrow down to your choice and press Enter twice. (The first Enter closes the combo box; the second makes your choice.)

The Candidates

General Wesley Clark

Links and controls on the home page <www.clark04.com> are labeled. On the Issues page, several links are labeled only "Click here." There is no link or control to allow you to search the site.

Howard Dean

Links on the home page <www.howarddean.com> are labeled. The button to start a search of the site after you type in your search term is not labeled. On the home page, there is a combo box labeled Official State Sites. It is an "unfriendly" type of combo box, and it opens in a new browser window. A search for "disability" found 313 items, and a search for "blind" found none.

Senator John Edwards

Some links on the home page <www.Johnedwards.com> are not labeled, nor is the button to sign up for e-mail updates on the campaign. Some links for news stories are simply labeled "Read more here."

A search for "disability" found 8 documents, and a search for "blind" found 3 documents containing quotes, such as how current medical plans are "robbing families blind." This is the only site that includes an explanation of web accessibility, although the designers did not practice what they preached 100 percent of the time.

John Kerry

Almost all the links on the home page <www.johnkerry.com> are labeled. There are "unfriendly" combo boxes, such as one to find the campaign offices by state. A search for "disability" found 126 items. A search for "blind" found repeated references to the Bush administration "turning a blind eye" to this or that group.

Representative Dennis Kucinich

On the home page <www.kucinich.us/index.php>, links and controls are labeled. The site uses Google to search. As a result, searching for "disability" brought up 160 results, including a Google-sponsored link from Wesley Clark's site. A search for "blind" returned 12 results.

Senator Joe Lieberman

Links and controls on the home page <www.joe2004.com/site/PageServer> are labeled. There are unfriendly combo boxes. Searches for "disability" and "blind" found no items.

Reverend Al Sharpton

Navigation links on the home page <www.sharpton2004.org> are not labeled, and some links are labeled "Click here." There is no link or control to search the site.

The Bottom Line

All the candidates have sites that contain a lot of information and are surprisingly accessible. I have noted a few problems found on one or more of the sites, but, for the most part, people who are blind or have low vision who are voting in a Democratic primary can use these sites to help choose the candidate they prefer.

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Product Evaluation

Dancing the Roomba: Artificial Intelligence That Sweeps the Floor

A mainstream manufacturer that makes an earnest effort to ensure that its products are accessible to people with disabilities always gets my attention. iRobot Corporation has not only made that effort, but has produced a product with genuine mass appeal as well. The Roomba Robotic Floorvac offers a stress-free, hands-off solution to cleaning floors: You set the Roomba in the middle of a room, turn it on, and then take a nap or read a book, or (as I did) sit on the couch and laugh out loud at the antics of the little critter as it works. Reminiscent of a little flying saucer, the Roomba is about 3 inches tall and 12 inches in diameter--and, like the robots of science fiction, truly seems to have a personality!

Photo of the Roomba clearing a clean swath in a muddy carpet.

Caption: The Roomba.

A Tour of the Roomba

The Roomba is a robotic sweeper that cleans floors while unattended, thus allowing you to do something else. From the top, the Roomba has a fairly flat, circular surface. The only items found on the top surface are a lift-up carrying handle (which lies flush with the top when not in use) and three distinctly separate rubber buttons. Around the outer rim of the device are a power button, a battery indicator light, and a jack for connecting the AC adapter. Next to the adapter jack is the Roomba's dirt tray, to be emptied after each use of the machine. The bottom of the Roomba contains an assortment of large and small brushes and the large battery pack that, when inserted, is flush with the bottom surface.

Run, Roomba, Run!

The simple explanation for operating the Roomba is that you set it in the center of a room; press the power button; select one of the three buttons on top for a small, medium, or large room (based on a range of measurements given in the manual)--and get out of the way. The Roomba initially spirals in what seems to be a random pattern, skittering off in one direction until it bumps a wall. At the wall, it may cruise up and down the wall for a while, sweeping as it goes, or begin zigzagging about the room, moving under and around furniture collecting dust and pet hair and dirt as it goes. Sensors prevent the Roomba from tumbling down stairs. The first time the Roomba cleans a particular room, supervision is recommended. After that, you can turn it on and leave.

The first time the Roomba "works a room" can be pretty entertaining. In my family room, for example, the Roomba began in the center of the room on wood flooring. It spiraled in an outward direction for a while, toddled over to the south wall, bumped into it a couple of times, and then moseyed down the wall. After a bit, it zipped out into the center for a while, moved up onto the carpet, swept there for a while, and then went back down onto the wood. At the north boundary of the room, it motored perilously close to the single deep step, but never teetered at that edge.

It is something like watching a toddler or a puppy encountering a room for the first time--both amazing and amusing to see the intelligence at work. After the novelty and entertainment value settle, however, this new "pet" truly can be left alone to do its job.

Roomba Proofing the Room

The robot's intelligence is artificial intelligence, after all, which means that we humans are still smarter. As with a young child or pet, taking certain precautions enables a session to go more smoothly. Before you put the Roomba to work, you need to pick up all stray objects on the floor--loose cables, stray socks, last night's magazine--and, for the best results, move small pieces of furniture that may complicate its navigation. Objects that could be easily toppled--a small houseplant, for example--should be moved from the Roomba's path. The manufacturer recommends the appliance for hard surfaces--wood, tile, linoleum, and low carpets--and advises that it not be used for deep pile or shag carpeting. I found that in one room, the Roomba moved without difficulty from wood to a medium-pile carpet and back again, while in another, it could not move from wood to a low carpet with fringe. Although the manufacturer suggests that such problems can be remedied by turning fringe under, the Roomba was not able to make the "leap" from the wood floor to the carpet once the edge was rolled under and thus thickened. A good solution to this situation was to place the virtual wall unit at the edge of the problematic carpet, allowing the Roomba to sweep all the room except the area where it could encounter trouble. The virtual wall unit is a small box that sends an infrared beam that the Roomba translates as a barrier. To operate it, you simply turn it on, select the length of "wall" you wish to create from three options (defined in the manual), and aim the unit's eye in the desired direction.

Accessibility Features

Accessibility features are built in--for example, the power switch beeps when the Roomba is turned on, and when you select a room size, the machine plays a short musical sequence before it goes to work. The robot is fairly noisy while it is operating, although not as loud as most upright vacuum cleaners, rendering conversation in the same room manageable. (For a person who is blind, the machine's noise is actually something of an advantage, since it makes it easy to follow the Roomba's movements by sound.) If the Roomba gets hung up on, say, a sock that was left in the corner or the fringe of a rug, it makes some sputtering noises and shuts itself off. When it has completed a room, it plays a musical sequence as it shuts itself off and then emits intermittent beeps for about five minutes. Again, for a blind person, these beeps are useful in locating where the Roomba has stopped when it has finished the job.

Although the Roomba itself is equipped with ample audio cues to make it accessible to a user who is blind or has low vision, the virtual wall unit is not. The unit makes no sound when it is powered on or off, so it is difficult for someone without light perception to detect whether it is on or off.

The original Roomba is silver, the Roomba Pro is slate blue, and the Roomba Pro Elite is merlot red. With each model, the buttons for room size--S, M, and L--light up and are easily seen by a person with low vision.

 Photo of a dog lying in front of a couch while Roomba sweeps the rug, covered with paw prints, nearby.

Caption: Roomba may be just the thing for those messy paw prints.

The unit does require regular maintenance, which will be manageable for most people who are blind or have low vision, but only after some practice. After every 10 uses (5 in households with pets or long hair), the unit needs to be cleaned. Removing the dirt tray or "particle bin" after every use is simple; just press down and slide it out, shake the dirt into the trash, and slide it back in. Cleaning out the filter chamber is almost as easy--just a matter of snapping open a door and clearing out the debris within. Removing the brushes for cleaning, however, is somewhat daunting. A deeply recessed small screw must be loosened with a small Phillips-head screwdriver, and a few pieces removed, cleaned, and reinserted. It is not simple, but it can definitely be done without sight. If it is done routinely as directed, this maintenance process will become simpler with practice.

Learning how to maintain the unit, however (or operate it for that matter) is all detailed in a print-only user's guide. The company plans to release all documentation on an audio CD, but the CD was not available at this writing.

What It Does and What It Doesn't

Roomba cleans floors of all types (except deep pile and shag carpeting). Its short stature enables it to go under beds and other furniture and into corners, where traditional vacuums typically have difficulty. Its wall-hugging capability does an excellent job of sweeping along baseboards and into corners. Empty the Roomba's removable dirt tray after each use, and it is readily apparent that the machine has done some work. It does not deep clean, however, as an upright heavy-duty vacuum can, so should not necessarily be seen as a complete substitute for the traditional vacuum cleaner. In a home with pets, children, or a lot of traffic, cleaning periodically with a more powerful vacuum, with daily Roomba cleanings in between, may net the best results. On the other hand, an environment with little traffic may well be maintained by the Roomba alone.

The Bottom Line

The Roomba is completely operable by a person who is blind or has low vision with a little adaptation. The built-in audio cues provide all necessary information, with the exception of the remaining battery life. Typically, however, the battery lasts for two to three medium-sized rooms. Cleaning one room takes from about 20 to 45 minutes. The virtual wall unit has no audible cue to indicate whether it is on or off, which could result in unnecessarily running down batteries or, worse, not blocking the Roomba from a designated area as desired. The maintenance required will take some time to learn but can be performed by a person without sight. Taking all the pros and cons into consideration, the Roomba is an accessible, user-friendly device that performs the task it promises and is great entertainment in the bargain.

Product Information

Product: Roomba Robotic Floorvac

Manufacturer: iRobot Corporation, 63 South Avenue; Burlington, MA 01803; web site: <www.roombavac.com>.

Price: The original Roomba, in silver, with one virtual wall unit: $229. The Roomba Pro, in slate blue, with two virtual wall units and a remote control: $229. The Roomba Pro Elite, in merlot red, with two virtual wall units and a remote control: $249.

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On-the-Job Profile

A History of Accessibility at IBM

If you are reading this article, there is a good chance that you are using a screen reader, a term that is as generic to assistive technology as Kleenex is to facial tissues or Jell-o is to gelatin desserts. What you may not know, however, is that Screen Reader was once a proprietary product of IBM, rather than the generic term for the way people who are blind or have low vision gain access to computer screens. In fact, our terminals became "talkies" just 20 years ago, in 1984, largely because of the work of Jim Thatcher, then a mathematician for IBM, the world's largest technology company. This auspicious anniversary is an appropriate time to look back on the pioneering efforts of IBM and what it plans for the future.

Photo of Jim Thatcher.

Caption: Jim Thatcher.

Like so many nondisabled people who become involved in the disability community, Thatcher had a personal connection: Dr. Jesse Wright, his then-thesis adviser at the University of Michigan, is blind. In 1963, Thatcher became one of the first Ph.D.s in the then-nascent field of computer science. He and Wright then joined IBM as mathematicians. Those were the days that predated personal computers (PCs), with "dumb" terminals like the IBM 3270 that were connected to a mainframe computer and couldn't be coded or modified and were totally inaccessible to people who were blind or had low vision. The PC was in its infancy, and, according to the biography that Thatcher provided for this article, he and Wright "started working on an audio access system" for the IBM Personal Computer in 1984. This work culminated in IBM's announcement in 1986 of one of the first screen readers for DOS, called IBM Screen Reader. Thatcher later led the development of IBM Screen Reader/2, the first screen reader for a graphical user interface on the PC.

"The 3270s were what people were using; we saw PCs coming on," Thatcher recalled during a telephone interview from his home in Austin, Texas. He noted that, at that time, IBM had a prototype of a talking terminal, known then as SAID (for Synthetic Audio Interface Driver), developed by Al Overby of IBM Raleigh. Through the work of Thatcher and Wright, SAID was developed into the IBM Screen Reader for DOS. "I had no idea it would become an IBM product because I was just having fun, making the PC accessible for Jesse," Thatcher continued. Thatcher retired from IBM in 2000 and now works as a consultant on accessible technology.

Staff Access Came First

Infused with the energy of evolving technology, "the PC times were very vibrant," according to Thatcher. "Everyone was helping everyone else; it was very open. A PC could plug in and act like a terminal. It was important to blind people to make their PC plug in and talk to a mainframe. There were lots of blind people working in computers because of talking terminals." Thatcher noted that IBM Screen Reader did not become a trademarked product; at the time, the company was focusing on accessibility for the benefit of its staff members who were blind or had low vision. IBM points with pride to its history of diversity in its workforce, having hired the first black person and the first three women for its professional staff in 1899 and its first professional with a disability in 1914. Thatcher noted that dozens of blind IBM staff members beta tested the screen reader.

The accessibility factor was not considered a major marketable feature. Over time, however, this view would change. In the meantime, Thatcher continued his trailblazing work for IBM, leading the later development of IBM Screen Reader/2, the first screen reader for a graphical user interface on the PC. He was intimately involved in the development of IBM Home Page Reader (the talking browser that is now one of IBM's preeminent accessible products for people who are blind). Thatcher's biography notes that in 1996, he moved from IBM Research in Yorktown Heights, New York, to join the IBM Accessibility Center in Austin, where he led the effort to include accessibility in the IBM development process. A key part of that effort was the establishment of the IBM accessibility guidelines specifically for use within IBM's development community.

Photo of Chieko Asakawa.

Caption: Chieko Asakawa, a researcher at IBM Japan who is blind, using IBM Home Page Reader.

Thatcher received numerous awards for technical work over his 37-year career with IBM, including a Distinguished Service Award from the National Federation of the Blind in 1994 and the Vice President's Hammer Award for his work with the U.S. Department of Education on the development of software accessibility standards in 1999. Thatcher is also the coauthor of Constructing Accessible Web Sites with Paul Bohman, Michael Burkes, Shawn Lawton Henry, Bob Regan, Sarah Swierenga, Mark Durban, and Cynthia Waddell (published by Glasshaus, in the United Kingdom, in April 2002 and by Apress, in the United States, in July 2003).

On the Cutting Edge

IBM has consistently been on the cutting edge of access technology, helping to formulate the guidelines for the World Wide Web Consortium (W3C) Web Accessibility Initiative. In 2003, the company was among five corporations, four nonprofit organizations, and one individual to receive the New Freedom Initiative from the U.S. Department of Labor for "exemplary public and private partnerships" that further the Bush administration's objectives "toward employment of people with disabilities."

Quoted in a corporate news release, Andy MacDonald, IBM's senior vice president of human resources, noted: "Over the years, our nationally recognized policies, training and mentoring programs were created to ensure employees with disabilities are welcomed, valued and productive in the IBM workplace, and the 2003 New Freedom Initiative Award reinforces our efforts." This award, from the U.S. Department of Labor, was in recognition of IBM's training and mentoring programs for people with disabilities. In addition to its equal opportunity hiring practices, the company was also recognized for its dedication to making technology products and services accessible to people of all abilities, as well as its commitment to research in this area through the IBM Accessibility Center.

IBM Accessibility Center

The Accessibility Center is part of IBM's research organization, which is the world's largest information technology research organization, with more than 3,000 scientists and engineers at eight laboratories in six countries engaged in developing innovative marketplace technologies. IBM has produced more research breakthroughs than any other company in the information technology industry, according to a company news release.

Randy Horwitz working on a laptop computer, with part of an IBM web page projected on a large screen.

Caption: Randy Horwitz of the IBM Accessibility Center using Home Page Reader.

"The disability market can't be a niche market; it's too small," said Phil Jenkins, accessibility program manager and senior engineer at IBM's Austin facility. "So the company has transitioned into the goal and direction of universal design in its products and services, announcing a global initiative, in June 2003, to offer consulting business to business to provide accommodation solutions."

The following services are part of IBM global technologies' partnerships:

  • Providing visually impaired French computer users with a free, pared-down version of Home Page Reader that accesses French government web sites (thus satisfying the European Union's requirement to make government web sites accessible).
  • Working with Crunchy Technology, a Washington, DC-based web company, to improve the U.S. Department of Agriculture's Office of Small and Disadvantaged Business Utilization web site. This three-way collaboration transformed the web site and online forms into accessible areas and opened up opportunities for applicants who use assistive technology to compete for governmental projects and contracts. Jenkins described IBM's part of the activity as conducting a global "search and replace" and correcting any features that would make such a site not usable with assistive tools.
  • Working with the U.S. Postal Service to make the agency's web site comply with new revisions to Section 508. These regulations require the government to make workplace information available in accessible forms to all employees who have disabilities. The joint project helped create a web site that is friendly to AT users.

In fact, Section 508 of the Rehabilitation Act (which establishes standards that govern the accessibility of electronic and information technology for federal employees with disabilities and customers with disabilities who use federal services) is one of the major motivators for IBM to shift toward the goal of universal design. (Note that the 508 regulations were compiled by blind technology guru Doug Wakefield).

"It's no longer a case of 'do we want to' when it comes to features of accessibility," Jenkins said. "We have to. The government will buy from our competitors if we don't. 508 created a de facto standard for business." Similarly, Jim Sinacchi, director of diversity communications, Global Workforce Diversity, for the IBM headquarters in Armonk, noted: "We have to build our hardware and software with accessibility built in; it's like an air bag in a car or safety in a Volvo."

In addition to section Section 508, another motivating force for building accessibility into products is the growing market of baby boomers, who, as they age, are losing vision, hearing, and mobility," Sinacchi added. He sustained a spinal cord injury in a surfing accident years ago and now uses a wheelchair.

The futuristic possibilities of a totally accessible workplace were what the company tried to show at a splashy presentation at the 2003 CSUN conference (the annual Technology and Persons with Disabilities conference of the California State University at Northridge), an exhibit that left many attendees who were blind puzzled about the purpose. "Engineers who design the stuff will say that the product is cool, and blind people will reply, 'Yeah, but what will it do for me?'" Jenkins stated. Thatcher suggested that "the resources required to produce that multimedia event might have better been directed toward addressing the question of how to make the wireless world more accessible to people with disabilities."

Neither Sinacchi nor Jenkins would specify what new products people who are blind can look for in the near future. Sinacchi did note, however, that IBM is working on upgrading Home Page Reader and is also working on a project to have instant messaging work with speech output.

More information on IBM's accessibility initiatives can be found at <http://www.ibm.com/able>.

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Interview

No (Small) Degree of Success

In 1976, Gayle Yarnall suddenly found herself the single mother of three young children. She was 30 years old, had never gone to college, had never held a job, and was a relatively recent resident of Colorado. She also happened to be blind. Today, she still has never been to college, and she is still blind. She is also president and owner of a company that is worth half a million dollars.

Photo of Gayle Yarnall talking on the telephone and using a braille notetaker.

Caption: Gayle Yarnall helping a customer in the office of Adaptive Technology Consulting.

Through a governmental grant program that was designed for people who need education and training so they can work, Yarnall learned to operate the $50,000 Kurzweil Reading Machine that had been donated to the library at the University of Colorado. Thus, her first job--and introduction to the world of assistive technology--began when she was hired to train others to use the machine. Two years later, in 1978, Kurzweil (now distributing the $30,000 version of the machine) needed a training department, and Yarnall relocated to Massachusetts to assume the position of Kurzweil's first trainer.

At Kurzweil, she said, she realized she had found much more than a solution to feeding herself and her children. "I had found something I really liked to do--and was good at. . . . The engineers at Kurzweil taught me a lot and were good about answering all my questions." Eventually, Yarnall and others connected the Kurzweil to an Apple computer and the Apple to a tape-based VersaBraille, so that, probably for the first time, "we were scanning print and reading it on a braille display."

Taking the Plunge

By the mid-1980s, she had gone to work for Telesensory, first in technical support and eventually as the New England sales representative. "I was bonding with all the New England agencies," she recalled, "and began to realize that I was more of a service provider. Companies like Henter-Joyce and GW Micro were coming on the scene. There were lots of good products and choices, and I couldn't just tell everybody that they needed one company's products."

In 1994, when her new husband, Neal Kuniansky, took a new job that provided them both with good health insurance coverage, the moment she had been thinking about for some time had arrived. She took her small savings and a deep breath and plunged into owning and operating her own business. And she has never regretted it.

In the beginning, Adaptive Technology Consulting (ATC) was just Gayle Yarnall, lugging computer equipment around from agency to agency, selling and training her way to an eventual profit. She hired a driver-bookkeeper but took no salary for the first six months and only a small salary into the second year. "I didn't really mean to be so much into sales as we are now," she said, "but that's what happened." Eventually, she decided to set up a space for customers to come to her.

Stop and Shop

Situated in a small business area amid a cell phone store, a computer consulting firm, and an Irish dance studio, ATC sells and provides training for most of the well-known products in the field of technology for people who are blind or have low vision. The company now has eight employees and provides competitive salaries, health benefits, and a retirement plan. "Once you hire people," Yarnall stated, "you feel a certain responsibility to take care of them. We have to do well."

Customers can visit the ATC offices for a demonstration of Kurzweil and OpenBook, JAWS for Windows and Window-Eyes, a variety of video magnifiers, braille and voiced notetakers, braille displays, and more. Recently, Yarnall added a room where "walk-ins" can purchase a variety of low-tech assistive devices, such as talking watches and handheld magnifiers. "The key in this business is to diversify," Yarnall said. "You can never be sure what will be popular next year and which products will disappear. . . . With customers walking in off the street, we're also getting more publicity. Someone who buys a talking watch may think of us later when he or she wants to figure out how an elderly relative who is losing sight can use a computer."

Some training and consultations take place on the premises, but ATC employees also provide training in adaptive technology products in schools, agencies, universities, libraries, and businesses. Customers come from Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island. By selling a wide variety of products, ATC is in a position to configure systems to meet individual needs.

Yarnall does not have time to do much training herself these days. Much of her time is spent at the computer (equipped with an old PowerBraille display and the JAWS screen reader), handling e-mail correspondence or logging telephone orders and inquiries. On the day of her interview with AccessWorld, for example, she talked with a dealer who was interested in selling low vision products, chatted with a customer who wandered in to look at the retail showroom, and prepared to meet with a parent and child who had scheduled a consultation. For years, she has maintained a daily log--a running list of every piece of business that is handled. Requests for information, literature that has been sent, products that have been sold--every contact--are listed in the log. "It's a wonderful way to keep a journal of the year's activities" she noted, "and to locate a piece of information." Since only Yarnall and one other employee are blind, it is important that the log be kept in an accessible format. Years ago, the log was kept in braille, but she now maintains it in Microsoft Word, so that anyone in the office can gain access to its information.

A Kid in a Candy Store

Yarnall took a huge risk when she founded ATC, and she knew it. Still, she did her homework well before she took that major leap. "You have to watch for just the right moment," she advised. "Pay attention, make your decision, and don't be afraid."

For Yarnall, the advantages have been many. For one thing, she noted, with every piece of adaptive technology on the market on hand, coming to work is "like being a kid in a candy store." She never wishes she were working for someone else, she said, and never wishes she were younger. "I love what I'm doing. I'm not a painter or a writer or even a very good cook, but here, I can exercise my creativity. Each year, I think, 'This is the best.'"

Adaptive Technology Consulting can be reached at P.O. Box 778, Amesbury, MA 01913; phone: (978) 462-3817; e-mail: <gyarnall@adaptivetech.net>; web site: <www.adaptivetech.net>.

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AccessWorld News

CCTVs at Home and on the Go

The Aladdin Rainbow is Telesensory's newest line of color video magnifiers. Each magnifier has a 14-inch monitor, a large depth of field for viewing three-dimensional objects, and a smooth, nonglare reading table that supports heavy books. The CCTV is sold in three configurations. The Rainbow has six settings, including full color, black and white, and several selectable foreground and background colors. The Rainbow Pro features an added tint and color saturation control, vertical and horizontal line markers, and shadow mask to help track text. The Rainbow Elite offers an array of image-control features, such as adjustable tint and brightness, auto focus with manual override, and professional features, including line markers and highlighting and three color-select viewing modes (yellow letters on a blue background and green or amber letters on a black background). The cost for the Aladdin Rainbow line ranges from $2,695 to $2,995. For more information, contact: Telesensory, 520 Almanor Avenue, Sunnyvale, CA 94085; phone: 408-616-8700, extension 3293; web site: <http://www.telesensory.com/about5-22.html>.

The Flipper Stand was recently released by Enhanced Vision for its portable Flipper and FlipperPort closed-circuit television (CCTV) products. The Flipper is an auto-focus, full-color portable video magnifier that rotates 225 degrees with a magnification range of 6x to 40x near; 1x to 24x distance. The FlipperPort has lightweight glasses that connect to the Flipper device and display images from the camera unit. The Flipper Stand is designed to elevate the Flipper up to 15 inches above a flat surface, such as a desk or table, and rotates left and right. The stand also converts to a desktop video magnifier when the Flipper camera is pointed down toward the table. The Flipper system is battery-operated and can be connected to a television or monitor. Pricing for the Flipper product line ranges from $1,395 to $1,795. For more information, contact: Enhanced Vision, 17911 Sampson Lane, Huntington Beach, CA 92647; phone: 888-811-3161 or 714-374-1829; web site: <http://www.enhancedvision.com>.

Online Computer Training by Carroll Tech

The Carroll Center for the Blind recently launched Carroll Tech, an expansion of its Computer Training Services program. Carroll Tech offers online classes in the use of computer applications with a screen reader, Freedom Scientific's JAWS for Windows, or with ZoomText, a screen magnifier by AI Squared. The center plans to offer 24 online classes in 2004. Each six-week course makes use of online manuals, streamed videos, e-mailed exercises, auto-graded quizzes, and audio chat sessions. Available at the introductory, intermediate, and advanced level, the classes cover the use of the Microsoft Office applications, Outlook, PowerPoint, Access and Excel. Thanks to donations from the Gibney Family Foundation, Lions Clubs International, and the Boston Foundation, the current cost to take each six-week class is $50. For more information, contact: Brian Charlson, vice president, Computer Training Services, Carroll Center for the Blind, 770 Centre Street, Newton, MA 02458; e-mail: <charlsonb@carroll.org>; web site: <www.carroll.org>.

Make Sense of Microsoft XP

National Braille Press recently released two books about XP, the newest Microsoft operating system and related applications. What's Different About Word XP? is a reference card that answers the basic questions for people who are switching from another version of Word to Word XP, including how to use the Microsoft Office clipboard, how to manage styles, and how to perform a mail merge function. Written by Sharon Monthei, the author of Word Wise 2000, this title also includes step-by-step instructions for configuring Word XP to work well with speech and braille. The publication is available in braille (one small volume) or PortaBook for a cost of $5. Windows XP Explained: A Guide for Blind and Visually Impaired Users is a thorough introduction to Windows XP for new users or for those upgrading from a previous version. Written by Sarah Morley, the text describes basic computer terminology and Windows concepts, such as the desktop or the Start Menu, introduces more advanced Windows XP functions and features, and includes a comprehensive listing of keyboard commands. For readers who find graphics helpful, a collection of large-print and tactile screen illustrations is available for an additional cost. The book is available in braille, large print, cassette, and disk for a cost of $20; a set of all four formats sells for $75. For more information, contact: National Braille Press, 88 St. Stephen Street, Boston, MA 02115; phone: 888-965-8965 or 617-266-6160; e-mail: <orders@nbp.org.>; web site: <http://www.nbp.org/xpexplained.html>.

AFB Announces 2004 Access Award Recipients

On Friday, March 5, The American Foundation for the Blind will present its 2004 Access Awards. AFB's Access Awards honor individuals, corporations, and organizations that are eliminating or substantially reducing inequities faced by people who are blind or visually impaired. This year's recipients will be Janet Barlow, Billie Louise Bentzen, and Lukas Frank for working to standardize audio pedestrian signals; IBM Corporation for promoting accessibility throughout its company and in its products; and Allison Driver and Scott Strauss of Spiegel and McDiarmid for helping improve cell phone accessibility. The awards will be presented at a ceremony held in conjunction with the 18th Josephine L. Taylor Leadership Institute in Washington D.C. For more information on AFB's Access Awards, contact: Jim Denham, chair, AFB Access Awards Committee; phone: 304-523-8651; e-mail: <jdenham@afb.net>.

Free Exhibition for Visually Impaired People and Their Families

On April 6, 2004, the Royal National Institute of the Blind (RNIB) will host Vision 2004, its 12th exhibition on education and employment issues for people who have visual impairments, their families, and those who work with them. Vision 2004 will take place in London, England, is free to enter, and is open to visitors of all ages. Exhibitors will include technology companies, special schools and colleges, social services, voluntary societies, disability nonprofit organizations, and retail businesses. There will be live musical performances by blind and partially sighted people and two free workshops for children who are blind and visually impaired on music and art. For more information, contact: Vision 2004 Hotline, RNIB; phone: +020 7391 2315; web site: <http://www.rnib.org.uk/vision2004exhibition>.

Personnel Changes

As of January 30, 2004, Larry Lewis has resigned as vice president of blindness sales for Pulse Data HumanWare and is no longer employed by the Pulse Data Group. He has taken a position with Tieman BV, a Netherlands-based provider of adaptive braille cells and refreshable braille terminals. Lewis will serve as vice president of blindness sales to establish and manage a blindness division for Optelec, which is owned by Tieman. Vinnie Rappa, Pulse Data HumanWare's current vice president for low vision sales, will assume Lewis's position on February 1, 2004. For nearly three decades, Rappa has taught orientation and mobility, directed programs at Helen Keller National Center, worked as a sales representative for assistive technology for people with visual impairments, and managed sales oganizations with several of the industry's leading companies. For more information, contact: Pulse Data HumanWare; phone: 800-722-3393 or 925-680-7100; web site: <www.pulsedata.com>. Optelec USA; phone: 800-828-1056; web site: <http://www.optelec.com>.

The Story of My Life is Free Online

With the expression, "It is with a kind of fear that I begin to write the history of my life," Helen Keller began her autobiography, The Story of My Life. To commemorate the 100th anniversary of the publishing of the book, the American Foundation for the Blind (AFB) has made the original text available free online. First appearing in 1903 to critical acclaim, the most popular of Keller's works remains a widely read classic of American literature. The fully accessible online version is accompanied by historic photographs from AFB's Helen Keller Archives and interesting facts about the book and Keller. Visit <www.afb.org/mylife> to read this groundbreaking and thought-provoking work. For more information, contact: The American Foundation for the Blind; phone: 212-502-7600; web site: <http://www.afb.org>.

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Calendar

March 15–16, 2004

Assistive Technology Applications Certificate Program (ATACP) Workshop

Los Angeles, CA

Contact:

Kirk D. Behnke, Center on Disabilities, California State University, Northridge; phone: 818-677-2578; e-mail: <kirk.behnke@csun.edu>; web site: <http://www.csun.edu/codtraining>.

March 15–20, 2004

19th Annual Technology and Persons with Disabilities Conference

Los Angeles, CA

Contact:

Center on Disabilities, California State University, Northridge; phone: 818-677-2578; email: <ctrdis@csun.edu>; web site: <http://www.csun.edu/cod>.

March 23–25, 2004

FOSE (Federal Office Systems Expo) 2004

Washington, DC

Contact:

FOSE; phone: 800-791-FOSE (3673) or 202-772-5746; web site: <http://www.fose.com>.

April 6, 2004

Vision 2004: 12th Royal National Institute of the Blind Exhibition

London, England, United Kingdom

Contact:

Vision 2004 Hotline, Royal National Institute of the Blind; phone: +020-7391-2315; web site: <http://www.rnib.org.uk/vision2004exhibition>.

July 12–16, 2004

Assistive Technology Applications Certificate Program (ATACP) Workshop

Monrovia, CA

Contact:

Kirk D. Behnke, Center on Disabilities, California State University, Northridge; phone: 818-677-2578; e-mail: <kirk.behnke@csun.edu>; web site: <http://www.csun.edu/codtraining>.

July 13–15, 2004

Sight Village: 8th Annual International Exhibition of Services and Equipment for People with a Visual Impairment

Birmingham, England, United Kingdom

Contact:

Queen Alexandra College; phone: +0121-428-5050; e-mail: <enquiries@qac.ac.uk>; web site: <http://www.qac.ac.uk/sightvillage>.

August 2–6, 2004

Assistive Technology Applications Certificate Program (ATACP) Workshop

Washington, DC

Contact:

Kirk D. Behnke, Center on Disabilities, California State University, Northridge; phone: 818-677-2578; e-mail: <kirk.behnke@csun.edu>; web site: <http://www.csun.edu/codtraining>.

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Copyright © 2004 American Foundation for the Blind. All rights reserved. AccessWorld is a trademark of the American Foundation for the Blind.

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