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AFB  ®
Technology News for People Who Are Blind or Visually Impaired
From the American Foundation for the Blind
 January 2008 Issue  Volume 9  Number 1

In This Issue . . .

Editor's Page

Letter to the Editor

Motivated to Make a Difference: An Interview with Frances West of IBM

We interview the director of IBM's Human Ability and Accessibility Center--Jay Leventhal and Paul Schroeder

Diabetes and Visual Impairment: An Update on the Accessible Blood Glucose Monitor Market

We evaluate new, accessible blood glucose meters--Darren Burton

Full Stream Ahead: A Review of the Victor Reader Stream

We review the popular new electronic book/MP3 player from HumanWare--Deborah Kendrick

Your Accessibility Is Extremely Important to Us: A Look at the Usability of Technology at Call Centers

We examine the accessibility challenges of call center jobs--Bradley Hodges

The Challenge of Assistive Technology and Braille Literacy

A company executive argues for more low-tech devices for writing braille--Tim Connell

Conference Report: Techshare 2007

We report on the 2007 Techshare conference, held in London--Rik Shepherd

AccessWorld News


Editor's Page

In this issue, Paul Schroeder and I interview Frances West, director of IBM's Human Ability and Accessibility Center. West discusses IBM's new focus on tools and services, and what that means for people with disabilities. She also speaks about Lotus Notes, IAccessible2, Easy Web Browser, and open document format. Read our interview with a key player at a mainstream company with a long history of working on accessibility.

Darren Burton provides an update on the accessibility of blood glucose meters. He examines the SensoCard Plus and the new Prodigy Voice, both of which feature a high level of accessibility and usability. The article also briefly discusses the new Advocate Redi-Code and Prodigy Auto Code, both of which are similar to the original versions of those meters, but which eliminate the need to calibrate the monitor to each new container of test strips. Read about the newest accessible devices for managing diabetes.

Deborah Kendrick reviews the Victor Reader Stream, the new player from HumanWare Canada. The Stream can play DAISY books, MP3 music files and text files. It is the first player on the market to be able to play the new Digital Talking Books being tested by the National Library Service for the Blind and Physically Handicapped (NLS). Read about this new player and all that it can do.

Bradley Hodges, of AFB TECH, examines the challenges of working in a call center. People who are blind or visually impaired are employed as customer service representatives in a number of industries. This article investigates the accessibility of the applications they need to use to do their jobs.

Tim Connell, president of Quantum Technology, writes about braille literacy. He states that, for people who are blind, braille is the foundation of written communication, and cannot be replaced by computer speech or audio. He argues that more low-tech products are needed to increase the teaching and usage of braille, now and in the future.

Rik Shepherd, of the Royal National Institute of Blind People (RNIB), reports on the 2007 Techshare conference. Techshare was held at the Novotel in Hammersmith, London, UK, on October 4th and 5th. Over 400 people from 25 different countries attended. Read about the stimulating sessions that comprised this conference.

Jay Leventhal
Editor in Chief

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Letter to the Editor

Much Easier Ways of Exercising

I am a research scientist at the Veterans Administration Research and Development center for Visually Impaired and Blinded Veterans. We are located in Decatur, Georgia, near the Emory University campus. I am blind with just light perception and am also a three-time member of the United States Paralympic team.

When I was an instructor in a variety of rehabilitation centers, I stressed physical fitness to the more than 800 clients I worked with. The usual complaint I received was the inaccessibility of gymnasiums as the reason for not exercising.

Although I have been a member of several gyms over the past twenty years, I still do the majority of my workouts at home! After my last trip to the Paralympic games in Athens, I gave my heavy weights to my teenage nephew and started a different type of regimen. I work out in my garage, and I have a treadmill and exercise bike. I only utilize a set of adjustable dumbbells and an adjustable bench. Add one Olympic barbell and a curl bar and I am still able to actively body build at the age of 43!

I have emphasized that the easiest way for most people to exercise is to walk! You can even walk in your own home or around your neighborhood. I have personally watched four former students transform their bodies in the past two years. One has just lost a total of 50 pounds and she never left her own home! The other former student has an adjustable bench and a set of adjustable dumbbells as well at home. She recently started using the services of a personal trainer, because she wants to take a set of great pictures this year. She is 50 years old, stands 5 feet 8 1/2 inches in height and weighs 140 pounds. She says she looks better in a bikini at 50 than she did at 20.

None of the four visually impaired (all legally blind and women) people that I have seen change their bodies the past two to three years ever dieted. Each made a lifestyle change. One even lost 130 pounds in the process. One more former student finally made the mental change a few months ago. He is 56 years old and has lost eleven pounds in the past two months. His visually impaired wife mostly does her exercising by swimming, but they have decided to give themselves a treadmill at home as a joint Christmas present this year.

I can design a workout regimen with nothing but body-weight, dumbbells, a mat, and an exercise ball, and keep any sighted or visually impaired person in shape. Routinely, when I am travelling, I will do a complete bodyweight workout to take the place of my normal workouts at home. I still believe that the primary reason that most blind or visually impaired people who want to exercise can't is because they think they have to work out with the traditional equipment that sighted people, who are not informed, use as well.

Vincent F. Martin

Atlanta VA Rehab R&D Center of Excellence in Vision Loss

Atlanta V.A. Medical Center

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Motivated to Make a Difference: An Interview with Frances West of IBM

In 1986, IBM formed the Special Needs Group to develop and market products specifically designed for people with disabilities, giving rise to the innovative OS/2 screen reader and, later, the Home Page Reader self-voicing web browser. Since then, IBM has substantially changed, shifting from a company focused heavily on developing technology products like PCs to providing the knowledge and services that support technology-rich environments. IBM's main revenue now comes from selling support services.

However, the focus on accessibility embodied in the Special Needs Group has continued, and changed, to assist IBM business units to integrate accessibility into IBM solutions, and focus on the maturing population. In 2006, the name was changed to the Human Ability and Accessibility Center to more accurately reflect IBM's vision of accessibility.

AccessWorld spoke with Frances West, the director of the center, to find out how IBM's focus had changed. We also wanted to hear about services and tools that the company currently offers, and to try to better understand how IBM is harnessing research and knowledge to push accessibility much deeper into the technology environment. Here is our interview with West:

AccessWorld: Many of our readers know IBM best for the DOS and OS/2 screen readers and the Home Page Reader self-voicing browser. How has the Human Ability and Accessibility Center's focus changed?

Frances West: The center is within the IBM Research Division. Part of the rationale was if you deal with accessibility, you need research. Research is like finance or human resources, a corporate function. In 2006, we changed the center's name because the market for disability is beyond just people with disabilities; [it includes] aging baby boomers. Thus, changing the name gives it a broader definition. We did not want the center to be typecast as catering to a small population. Disability is universal for every man and woman.

Head shot of Frances West.

Caption: Frances West, director of IBM's Human Ability and Accessibility Center.

AccessWorld: What does the IBM services and solutions focus mean for accessibility and people with disabilities?

West: IBM has switched its focus to services. A lot of issues are related to the web infrastructure. The Center educates ... [business units] on the value of accessibility and how to embed disability into their strategy and implementation.

... We can point to cases where accessibility was an asset. You cannot make accessibility work as a stand-alone business. The best scenario is accessibility built into the infrastructure. The problem is: people get confused. They make a leap to thinking accessibility should be seen as a stand-alone business. They do not have the resources to do that. We are beginning to understand the misconceptions of business executives.

AccessWorld: Your center staff members aim to shift the debate away from making the business case for including access toward including accessibility as part of a definition of a high-quality product or service.

West: This has to become a requirement. It is hard. You need to be supported by senior management. This is one of those areas in which corporate culture actually comes into play as a force.

AccessWorld: Are parts of IBM now working with you as champions in this area?

West: We have moved from the basement period and are pushing the agenda higher and closer to our core business than ever. We are making inroads. We get called on by senior executives. Each time, we prepare our case better. We have a lot of internal strategy sessions. They [senior executives] are asking tough questions. We are down to specific questions. For example, what can accessibility do for my hardware or software? We have to withstand this testing. We have to be conscious that we do not go down the path of thinking of accessibility as a stand-alone business. This will not yield a positive outcome.

AccessWorld: Tell us the latest about accessibility to Lotus Notes.

West: As you know, Lotus Notes is going through a transformation. It started out client centric. We are moving on to a web presence. The exciting part is that we announced Symphony, one of the first commercial products based on ODF [open document format]. Symphony is a suite of productivity tools that enables users to create spreadsheets, word-processing documents, and presentations based on ODF. It is available free for download.

West described Symphony as being "for casual users. It is not for the heavy-duty office worker." She added "We think that technology should be shared and open source in some cases to encourage innovation."

AccessWorld: ODF has been swirling around the blindness community. There is a fear about the base of screen readers built on a proprietary office structure. Should we be afraid of it?

West: Absolutely not. It is part of the natural evolution of technology. We started out with the PC revolution, when no one knew much about computers. In the past 20 years, a lot of technology has come along. At the core are the data that are stored in applications. The idea of ODF is to combine freedom of movement of data in different contexts on the basis of companies' needs. It is about opening data access. It allows freedom of movement of data. Within IBM, we are Windows users. Migration can be scary. It really is a choice, not strictly one or the other. Two years from now, it could be something else. People are now much more aware of accessibility needs and benefits. With the new standards coming out, accessibility will not be an afterthought. We are pushing to have accessibility built in, so we can appeal to a broader customer base.

AccessWorld: Screen-reader companies have emphasized broadening access to Microsoft Office applications. Are they working with you on ODF?

West: GW Micro and Freedom Scientific are active participants. It is a situation in which you [screen reader companies] have a cash cow on your hands based on Windows Office. This does not mean that there is no other action. The market will bear witness to this. If these companies are not part of this [effort] we would have concerns.

AccessWorld: If a company that a blind employee works for switches to ODF, should the employee panic?

West: I hope that the company will [provide] education. We will definitely provide these services. Training is required.

AccessWorld: We wanted to touch on Easy Web Browser and IAccessible2. What are these tools?

West: Tools, not rules, is our slogan. Section 508 is a policing policy. To achieve accessibility as an embedded structure, you have to focus on the development process. The way to do so is through tools. Not every programmer will know accessibility, so we make it easier for programmers. IAccessible2 is an open API [application programming interface] standard to complement MSAA [Microsoft Active Accessibility]. It allows assistive technology to provide functional programs and to edit documents in a more organized way. We donated IAccessible2 to the Free Standards group. Instead of each vendor figuring out how to plug its technology into applications, we are providing this information to vendors.

Easy Web Browser is an end-user application. It is a technology. For example, if you go to Macys.com, you will find a link. If you click on the link, you will go through a one-minute download of the application onto your computer. You can modify the font or text size and trigger a screen reader. It is not for blind users, but for senior citizens. It customizes to your preferences.

AccessWorld: Is IBM promoting Easy Web Browser as a tool or as a showcase for developers?

West: It is not a tool kit. It is used to start conversations with customers, who end up redesigning their web sites. In 2009, California will have a rule that kiosks and web sites will have to be accessible. Easy Web Browser can sit on a kiosk and be embedded into an existing web application to provide a better experience for users.

AccessWorld: Is IAccessible2 being used by GW Micro and Freedom Scientific?

West: They all helped develop it. RNIB [Royal National Institute of Blind People] has also been involved. We needed to have a way of translating sophisticated web 2.0 functions for users. That is the reason for developing IAccessible2. It is implemented in Firefox 3.0 and Lotus Notes Symphony Editor.

AccessWorld: We read an article recently about research by IBM Ireland on access to virtual worlds. Tell us about virtual worlds, such as Second Life. These virtual worlds are taking things to another level. What can we do about accessibility?

West: This is a huge new platform. AFB should be aggressive in reminding people that they need to take it into consideration. I think this platform is the next revolution. The whole Internet gaming experience is so catchy. At the same time, if we do it correctly, accessibility can be built in because it is still in the beginning stages. These applications can be tremendous for learning and leisure. Sears and Cisco have opened virtual stores in Second Life. You can shop online at Sears. You can go into a three-dimensional kitchen and move furniture around in a simulated way. As for education, children love games.

AccessWorld: We are also interested in learning more about you. How did you get involved in leading the Human Ability and Accessibility Center?

West: I have over 25 years' experience with IBM. I spent my time in sales and marketing. About four years ago, this opportunity came up in research. At first, I did not know a thing about accessibility. My husband encouraged me to take on something totally different. When I came in, I saw a great opportunity to create a difference in the world and to help drive the business side. This is the best job I have had at IBM. Every day I come to work motivated because I feel like I am making a difference. It is for the betterment of the world. I am extremely excited about the opportunity.

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Product Evaluation

Diabetes and Visual Impairment: An Update on the Blood Glucose Monitor Market

The latest demographic research shows that 3.2 million Americans with diabetes are blind or have low vision. Because of the close relationship between diabetes and vision loss, the researchers at the AFB TECH product evaluation lab have kept track of the devices that are used to manage this disease, which is affecting more and more people. In the March 2007 issue of AccessWorld, we introduced the Prodigy and the Advocate, two small, inexpensive blood glucose monitors that are produced in Taiwan by Taidoc Technology. These monitors have some speech output to accommodate people who cannot read the screen, but the speech output is limited and does not communicate all the information on the screen. This article examines the SensoCard Plus and the new Prodigy Voice, both of which feature much more accessibility and usability for people who are blind or have low vision. It also briefly discusses the new Advocate Redi-Code and Prodigy Auto Code, both of which are similar to the originals but eliminate the need to calibrate the monitor to each new container of test strips. The sidebar accompanying this article, "Blind Entrepreneur Takes Action," describes efforts by Bay Area Digital to develop an accessible blood glucose meter. That company is headed by Chris Gray, a blind man who is the former president of the American Council of the Blind.

Readers who are interested in the accessibility of blood glucose monitors should be aware that the Accu-Chek Voicemate talking blood glucose monitor that we evaluated in the September 2002 issue of AccessWorld was discontinued by its manufacturer, Roche Diagnostics. Although the price of the Voicemate was high ($500), and the monitor was heavy and bulky compared to other monitors, it was at one time the most fully accessible monitor on the market. It is disturbing to see it disappear from the market without a replacement being introduced, and although a replacement unit may still come on the market, we have heard no news from Roche to support this hope.

For readers who are not familiar with the issue, here is some brief information from a previous AccessWorld article explaining the use of a blood glucose monitor to manage diabetes:

Because with diabetes, the body is unable to use and store glucose, or sugar, properly, it is necessary for people with this disease to monitor their blood glucose levels. You measure your blood glucose level by placing a small sample of blood on a test strip inserted into the monitor, and the monitor analyzes the blood and determines a blood sugar level. Using a blood glucose monitor to measure their blood glucose levels enables people to keep these levels within a normal range by taking a dose of insulin or eating a certain food. When not managed properly, diabetes can be a deadly disease, attacking several internal organs, including the heart and pancreas, as well as the eyes. Blood glucose meters have revolutionized diabetes care by allowing individuals with diabetes to control their condition more actively. If you are not able to operate the meter and read the results, the meter is not usable, and you have a much lower chance of keeping the ravages of diabetes at bay.

The SensoCard Plus

The SensoCard Plus is distributed by BBI Healthcare in the United Kingdom and is manufactured by a Hungarian company called Electronica 77. It is priced in Europe at £49.99. BBI is in the middle of the cumbersome process of gaining approval from the U.S. Food and Drug Administration (FDA), so the SensoCard Plus is not yet available in the United States. However, BBI hopes to have FDA approval soon, and AccessWorld will inform you when it does.

The SensoCard Plus with a code card inserted.

Caption: The SensoCard Plus.

The SensoCard is a thin, credit card-sized monitor with built-in speech output that supports all its functions. It weighs 2.5 ounces and measures 3.5 by 2.2 by 0.3 inches, with a small speaker protruding an additional 0.25 inches from the back of the bottom panel of the monitor. It has a 1.3-inch-square black-and-white LCD (liquid crystal display) screen and only three control buttons. The round main control button is below the display screen on the right, and there are two arrow-shaped Up and Down buttons on the right side panel. There is a small slot in the front panel of the monitor for inserting a test strip and another slot on the bottom of the left side panel for a code card strip that calibrates the meter with each new container of test strips. There is an infrared data port on the back panel for transferring data to a PC, but there is no headphone jack.

The Prodigy Voice

Priced at $79.99, the Prodigy Voice is distributed by Diagnostic Devices and is manufactured in Taiwan by Taidoc Technology. It came on the U.S. market on November 19, 2007, and its speech output supports every function of the meter, far surpassing the accessibility of the original Prodigy, which we reviewed in the March 2007 issue of AccessWorld. The Prodigy Voice weighs 2.7 ounces and measures 2.0 by 3.5 by 0.8 inches. The front panel has a 1.34-inch by 1.75-inch monochrome black-on-gray display, with three control buttons just below. The round Power button is on the right and is larger than the other two buttons. It turns the meter on and off and is also used to enter Memory Recall mode. The Settings button is in the middle and has a smaller, triangular shape. The Repeat button is on the left and replays the last spoken message or test result. The speaker is just below the buttons. On the right side panel are two triangular buttons pointing up and down that are used to adjust the various settings and to scroll through the various readings in memory. The Eject button, on the top of the left panel, allows you to eject a used test strip easily and safely without touching it. The standard 3.5 millimeter ear phone jack, near the bottom of the right side panel, allows you to use a headphone for privacy or to connect a speaker to amplify the speech. The data port, just below the ear phone jack, allows you to download the meter's test results to a computer using Prodigy's download software.

The Prodigy Voice showing a blood glucose reading and the date and time.

Caption: The Prodigy Voice.

How Did We Evaluate the Monitors?

As with our previous evaluations of blood glucose monitors, we first examined the tasks involved in performing the basic function of obtaining a blood glucose measurement and evaluated how easily a person who is blind or has low vision could perform each task. We looked at each task and determined if it could be performed by touch alone or if vision would be required. We then did the same with other tasks related to several other features and functions of the monitors. We also looked at how easily a person with low vision could read the display information and perform the other tasks that require vision. In addition, we evaluated the accessibility of the print and electronic manuals.


Obtaining a Blood Glucose Measurement

The process of obtaining a blood glucose measurement is fully accessible on both the Prodigy Voice and the SensoCard, with speech output supporting the process the entire way and speaking your test results. Both feature high-quality recorded human speech, rather than synthesized speech, and both speak test results in only 5 seconds. Both also alert you if your reading is out of the normal healthy range. Both have control buttons that are easy to identify tactilely, and both require a small sample of blood, with the SensoCard requiring 0.5 microliters and the Prodigy Voice requiring 0.6 microliters. Both use strips with capillary action, which pulls your blood sample into the strip, eliminating the need to place a large hanging drop of blood onto the strip. The strips also stick out away from the meter, which greatly reduces the chance that you will need to clean blood from the meter. The Prodigy has a handy Eject button, so you can safely dispose of used strips without having to touch them.

Both meters use strips with a tactile notch for orientation purposes. The blood application end of the SensoCard strips is pointed, which helps to ensure that you do not put the strip in backward. The SensoCard alerts you if you accidentally inserted a used test strip, but it does not alert you if you inserted a strip upside down. It speaks the same message prompting you to apply blood, so you may inadvertently waste the test strip. The Prodigy Voice does not alert you of either of these errors, but if you use or incorrectly inserted a test strip, it will not prompt you to apply blood, so you will know something is wrong.

The Prodigy has a Repeat button to announce your reading again if you did not hear it the first time, and the SensoCard will repeat your reading if you press the Up button before you remove the test strip. Both meters can provide results in both milligrams per deciliter (mg/dL) and millimoles per liter (mmol/L), and changing from one type of measurement result to the other is accessible on both meters. Both meters play a shutdown tune and turn themselves off automatically if they are not used for a short time.

Accessing Past Readings in Memory

The memory function of both meters is fully accessible and is supported entirely by speech output. The SensoCard can store up to 500 readings and provides 7-, 14-, and 28-day averages. The Prodigy Voice can store up to 450 readings and provides 7-, 14-, 21-, 30-, 60-, and 90-day averages. It is easy with each meter to scroll through the averages and the individual readings, voicing the glucose level, date, and time of each reading. You can also clear the memory data independently on each meter, but the meter clears all the readings from memory, and you cannot delete one reading at a time.

The SensoCard allows you to mark an abnormal reading, such as one taken after heavy exercise or a large meal, that may throw off your averages. Marked readings are not included in your averages, but you must mark them immediately after taking them. These readings still appear when you scroll through memory, but the speech output tells you that they are marked results.

Coding the Test Strips

Most blood glucose monitors require that you set a code number to calibrate them to the test strips every time you open a new container of strips, and doing so is usually inaccessible for people who are blind or have low vision. However, the Prodigy Voice eliminates this step. It has an auto code feature that automatically codes the meter when a strip is inserted and eliminates any human error involved in coding strips.

The SensoCard still requires coding for each new bottle of test strips, but it uses a code card, eliminating the need to code the meter manually. You simply turn the monitor on and press the Down arrow after the welcome greeting. The voice says, "Code set menu. Insert the code card." You then insert and remove the code card in one fluid movement in the slot in the bottom of the left side panel. The card sets the code and reads aloud the code setting. The code card comes with each new bottle of test strips; it is a small plastic strip of paper about 1.5 inches long by half an inch wide and has a squared end that is inserted and a rounded end that you hold to insert it. You can code manually with speech support if you lose the strip, but you may need to get sighted assistance to read the code from the strip bottle.


The settings functions of both meters are fully accessible, with speech supporting the entire process. The function is called the Function menu on the SensoCard, and you are able to perform a system check, set the calibration code manually, upload your test data to a PC, set the time and date, delete your test memory, choose between mg/dL and mmol/L as the measurement unit, and set the voice to speak English or German or to be silent. The Prodigy settings include time and date, measurement unit, speech volume, and the delete memory function. The fact that the Prodigy's Settings button is no longer hidden in the battery compartment is another improvement over the original Prodigy.

Performing a System Check

An occasional system check is recommended when using most blood glucose meters to ensure proper performance. You may want to do this test after you have dropped your meter or left it in an extremely hot or cold environment, such as a parked car.

With the SensoCard, you use the talking menus and insert the check strip that comes with the meter. The meter performs a measurement and displays the result of the test. If the value spoken is within the range indicated on the label affixed to the pocket in the carrying case, then the meter is performing properly. The test is accessible, but you need to learn how to orient the check strip properly and to make a note of the range indicated on the pocket in the carrying case. If you lose the check strip, the test can also be performed with a regular test strip and the control solution available from the manufacturer.

The Prodigy Voice has what they call an Auto System Function Check, so you do not use a check strip. Instead, you use a regular test strip and the control solution from the manufacturer. The control solution bottle shows the range in which the test result should fall if your meter is performing properly.

Download Software

Both meters have free software available, so you can download your results to a PC. The Prodigy Voice requires a cable accessory to connect the monitor to a PC, and the cable is available from the manufacturer's web site. The SensoCard requires its "Light Link" adapter, which creates an infrared link to the meter. The software creates charts and graphs for monitoring your test history and prepares reports that you can send to your health care provider, so he or she can track your blood sugar levels over time. We used both Window-Eyes and JAWS to test the accessibility of the SensoCard software, but the Prodigy Voice software was not yet available at the time of our testing. Although Diagnostic Devices, Inc. told us that the Prodigy voice's download software was designed specifically to work with screen readers, we cannot yet confirm that.

An AFB TECH intern transfering data from the SensoCard to a PC.

Caption: An AFB TECH intern connecting the SensoCard to a PC via infrared.

The SensoCard software, called DiaTransfer, uses a nonstandard installation procedure that is inaccessible to screen readers because of unlabeled graphical buttons. After we got sighted assistance to install the software, we took a look at the software manual. Although the manual is an untagged PDF document, it was mainly accessible, except for some mouse-based instructions. The software itself, though, was not accessible using a screen reader. A highly skilled user of screen readers may be able to glom some usable information from the software, but there are far too many accessibility problems, such as unlabeled buttons and edit fields, to consider this software accessible or usable for people who use screen readers.

Our testers with low vision had success using ZoomText to use the software. The ZoomText tools to change magnification and screen colors worked fine. Although the speech functionality of ZoomText did not work perfectly, the ZoomText Speak It tool spoke the onscreen text much better than the screen readers did.

Warnings and Error Messages

The Prodigy Voice speaks all warnings and error messages that appear on the meter's display screen, such as a warning that your blood glucose measurement is too high or too low. The SensoCard also speaks warnings and error messages. With some of the messages, it just speaks the letter or number of the error, such as "Error C," and you have to look in the manual to determine what that code represents. At other times, it also speaks what the warning message means, saying, "Error 7: insufficient blood." Thus, it may be a good idea to keep a handy cheat sheet in braille or large print in the SensoCard's carrying case.

Battery Replacement

Both the Prodigy Voice and the SensoCard speak to warn you that the batteries are low and that it is time to change them. You can change the batteries independently on both meters, but it is a bit easier to do so with the Prodigy, which uses two AAA batteries, which are easier to orient tactilely than are the two small round, silver watch-style batteries that the SensoCard uses.


Each meter comes with a print manual in standard 12-point font, which is too small for most people with low vision to read. Each also has an electronic version of the manual available in PDF format. Although both are untagged PDF documents, only the SensoCard manual works well when you use a screen reader. The SensoCard also provides instructions that have been written with the blind reader in mind, providing good descriptions of the meter and how to perform tasks nonvisually. The Prodigy Voice PDF manual has some structural problems and does not work well with screen readers. Although most of the text can be read with a screen reader, the manual was not written with the blind reader in mind and does not provide good descriptions of the meter or how to perform tasks nonvisually. We also had to experiment with the reading order in Adobe Acrobat when we read the Prodigy Voice manual.

Low Vision Accessibility

Both monitors have a monochrome display screen with black text and icons against a gray background. These low-contrast displays are similar to the old calculator display screens and would not be preferred by most people with low vision. On the Prodigy Voice, the icons, such as the low-battery icon and the frowny face indicating an out-of-range test result, are too small to be seen by most people with low vision, but some of the text is displayed in large print and could be read by our testers with low vision. The results of the blood glucose measurement are in a 60-point font, and the time and date are in a 26-point font. However, the text indicating the type of measurement, such as milligrams per deciliter, is in a 6- to 8-point font. The SensoCard consistently uses large fonts, with font sizes ranging from 18 points to 60 points, which can be easily read by most people with low vision.

As far as the visual nature of the other physical characteristics of the monitors, our testers with low vision said that the labels on the buttons are too small for most people with low vision to read. Also, the button labels on both monitors are nearly the same color as the buttons themselves, providing no contrast to accommodate the reader with low vision. However, because the buttons are easy to identify tactilely, it is not as important an issue as the visual nature of the display screen. Of course, the speech output on these meters will accommodate a person whose vision is such that he or she cannot read the display screen.

The Prodigy Auto Code and Advocate Redi-Code

The Prodigy Auto Code and Advocate Redi-Code are two other blood glucose meters that came on the U.S. market in 2007. They are virtually the same as the Prodigy and Advocate evaluated in the March 2007 issue of AccessWorld. The main difference is that they both have added the convenience of an audomatic coding system, eliminating the need to calibrate the monitor to each new bottle of test strips. Although that convenience is also an accessibility advancement, nothing else has been done with these two monitors to increase overall accessibility. Although they speak to guide you through testing your blood and read out your measurement levels, they do not have near the overall accessibility as the SensoCard and the Prodigy Voice.

The Prodigy and Advocate Duo, which also came on the market in 2007, are basically the original Prodigy and Advocate meters combined with talking blood pressure monitors. However, we did not evaluate them for this article because the parts of the blood glucose meters are exactly like the ones we evaluated in the March 2007 issue of AccessWorld. Also, they are wrist-type blood pressure monitors, which are not considered to be as accurate as the over-the-arm cuff-type monitors that we evaluated in the September 2004 issue of AccessWorld.

The Bottom Line

The Prodigy Voice and the SensoCard are both highly accessible and are much-needed additions to the blood glucose meter market. They are smaller; cheaper; faster; and, in general, much better than anything we have had in the past as far as accessible blood glucose monitors. Although we are impressed with both meters, each has an advantage over the other here and there. We consider the Prodigy Voice to be a slightly more accessible and usable meter. The most obvious advantage of the Prodigy Voice is that it is available in the United States now, while the SensoCard is still awaiting FDA approval. The Prodigy Voice's earphone jack is a major advantage over the SensoCard, allowing you to use a headset for privacy or for connecting a speaker for amplification of the speech output. You can also adjust the volume on the Prodigy Voice, but not on the SensoCard. Although the SensoCard's volume is easy to hear in normal settings, it may be too loud in a setting where privacy is desired or too low in a noisy setting. The Prodigy Voice's Auto Code feature is another advantage of the Prodigy Voice, eliminating one step in the process and any human error that may occur when coding a new bottle of test strips. When you use the Prodigy Voice, you know if you have inserted a test strip improperly, which is not the case when you use the SensoCard. The Prodigy Voice's accessible download software is another advantage for those who are interested in tracking their measurement data on their PCs or e-mailing their data to their health care providers. Finally, the Eject button is a nice convenience found only on the Prodigy.

We want to stress, however, that we like both these new meters, and the SensoCard has some advantages of its own. The major advantage of the SensoCard is its accessible and well-written electronic manual, which many people may consider the most important factor. The SensoCard is also slightly smaller and more portable and uses large fonts more consistently on its display screen. Finally, it allows you to mark abnormal readings, so they are not included in your weekly and monthly averages.

Both BBI and Diagnostic Devices should be applauded for their efforts in making accessible blood glucose meters and for seeking input from many people who are blind or have low vision who will use the meters. In addition to contact with the American Foundation for the Blind, Diagnostic Devices worked with the National Federation of the Blind in developing the Prodigy Voice, and BBI is involved with the Royal National Institute of Blind People in the United Kingdom. We are happy that these small companies have brought accessibility to the market of blood glucose meters, but we would also like to see the large pharmaceutical companies that have dominated this market for the past several decades do something to serve people who are blind or have low vision. We also would like to see some movement toward accessibility with the other devices that people with diabetes use, such as insulin pumps, insulin pens, and home blood pressure monitors. Certainly, the 3.2 million Americans with diabetes who have some degree of vision loss are a large enough market to attract some interest from the manufacturers. What do you say, Roche? Johnson and Johnson? Abbott Labs?

Product Information

Products: Prodigy Auto Code, Prodigy Voice, and Advocate Redi-Code Blood Glucose Monitors..

Manufacturer: Taidoc Technology, Dot 4F, No. 88, Section 1, Kwang-Fu Road, San-Chung, Taipei County, Taiwan; phone: +886-2-6635-8080, Ext. 368; e-mail: anthony@taidoc.com, technical service: tony.cc1128@msa.hinet.net, customer service: service@taidoc.com; web site: www.taidoc.com.

U.S. Distributor of the Advocate: Pharma Supply, 3381 Fairlane Farms Road, West Palm Beach, FL 33414; phone: Customer Care Center, 866-373-2824; e-mail: info@pharmasupply.com; web site: www.pharmasupply.com.

Price: $46.99.

U.S. Distributor of the Prodigy: Diagnostic Devices, 5900-A Northwoods Business Park, Charlotte, NC 28269; phone: customer service, 800-366-5901, or technical support, 800-243-2636; e-mail: customer service, customerservice@prodigymeter.com, or technical support, techsupport@prodigymeter.com; web site: www.prodigymeter.com.

Price: Prodigy Auto Code $39.99, Prodigy Voice: $79.99.

Product: SensoCard Plus Blood Glucose Monitor.

Distributor: BBI Healthcare, Unit A, Kestrel Way, Garngoch Industrial Estate, Gorseinon, Swansea, SA4 9WN, Wales; phone: 01792-229-333; e-mail: info@bbihealthcare.com; web site: www.bbihealthcare.com.

U.K. Distributor of the SensoCard Plus: Royal National Institute of Blind People, 105 Judd Street, London, WC1H 9NE, England; phone: 020-7388-1266; e-mail: helpline@rnib.org.uk; web site: onlineshop.rnib.org.uk.

Price: No U.S. price currently available.

This product evaluation was funded by the Teubert Foundation, Huntington, West Virginia. We also acknowledge the valuable assistance provided by Marshall University intern Charles Wesley Clements.

Product Features

Feature Prodigy Voice SensoCard Plus Prodigy Auto Code Advocate Auto Code
Speech output for all features and functions Yes Yes No No
Auto-code calibration Yes No, but calibration is accessible Yes Yes
Blood sample size (in microliters) 0.6 0.5 0.6 0.7
Capillary strips Yes Yes Yes Yes
Cleaning required No No No No
Response time (in seconds) 6 5 6 6
Weight with batteries (in ounces) 2.7 2.5 2.8 2.8

Product Features

Feature: Prodigy Voice; SensoCard Plus; Prodigy Auto Code; Advocate Auto Code.

Speech output for all features and functions: Yes; Yes; No; No.

Auto-code calibration: Yes; No, but calibration is accessible; Yes; Yes.

Blood sample size (in microliters): 0.6; 0.5; 0.6; 0.7.

Capillary strips: Yes; Yes; Yes; Yes.

Cleaning required: No; No; No; No.

Response time (in seconds): 6; 5; 6; 6.

Weight with batteries (in ounces): 2.7; 2.5; 2.8; 2.8.

Product Ratings

Product Ratings

Product Ratings

Feature: Prodigy Voice; SensoCard Plus; Prodigy Auto Code; Advocate Auto Code.

Portability: 5; 5; 5; 5.

Ease of blood application: 4; 4; 4; 4.

Speech quality: 5; 5; 5; 5.

Accessibility of memory function: 5; 5; 1; 1.

Accessibility of manual: 3; 4.5; 1; 1.

Compatibility of download software with screen readers: 5; 2; 1; 1.

Overall accessibility: 4.5; 4.5; 2; 2.

Blind Entrepreneur Takes Action

Growing tired of the ongoing lack of attention paid to the accessibility of diabetes devices by the big pharmaceutical companies, blind entrepreneur Chris Gray decided to do something about it. Chris Gray is the former president of the American Council of the Blind, and his company, Bay Area Digital, is working on solutions for making blood glucose testing more accessible for the millions of people with diabetes who are blind or have low vision.

Gray visited AFB TECH in summer 2007 to discuss the work of Bay Area Digital. He showed us his prototype for an accessible blood glucose meter and another prototype for a little gadget that makes it easier to place your blood sample properly on the glucose meter test strip.

Gray told us that when he approached the big manufacturers of blood glucose meters about accessibility, he learned that the profit potential of the market of consumers who are blind or have low vision does not interest them. He said that they build a minimum of 7,500 to 10,000 meters per day, and our market is just too small to make a difference. With this point in mind, Gray's business plan is for Bay Area Digital to work on the accessibility and the manufacturers to worry about the accuracy and other competitive factors of the meters. He brought this idea to the Diabetes Care Division of Abbott Labs, makers of the Freestyle Freedom blood glucose meter. Bay Area Digital, along with the American Council of the Blind's Diabetes in Action division, is now collaborating with Abbott Labs to bring accessibility to the Freestyle Freedom. Gray has also asked for AFB TECH input on his prototype, which we are more than happy to provide, and AFB also fully supports his efforts to bring more accessibility to the diabetes market.

Gray said that he likes the Freestyle Freedom for a couple of important reasons. First, the meter does not have to be calibrated for each new bottle of test strips, which is similar to the auto code feature of the Prodigy Voice. Second, and more important according to Gray, is the auto-fill feature of the Freestyle Freedom's test strips. With auto-fill strips, the meter does not take a reading until the strip has the right amount of blood, greatly increasing the accuracy of the test and minimizing the need for multiple testing.

Gray first showed us his prototype for the gadget that makes it easier to place a blood sample properly on the glucose meter test strip. It is a simple plastic ring that attaches to your finger with a small band. It guides your lancet device to a spot on your finger and then guides the test strip to the same spot.

Gray's prototype blood glucose meter consists of the Freestyle Freedom connected via a serial cable to a laptop computer. The laptop runs Bay Area Digital's prototype software, which controls all the meter's functionality and speaks all the information that is displayed on the meter. It has other voice prompts guiding you along the way, and it is controlled entirely by keystroke commands.

Examining the prototype in the AFB TECH lab, we found that it provides access to nearly all the features and functions of the meter. It also adds an alarm feature to prompt you to check your blood sugar level throughout the day. Of course, Gray asked us to provide feedback and to let him know of any suggestions we may have. The only thing we really think he should add, as far as how the interface functions, would be a voice prompt telling you when the battery is low and needs to be replaced. Another minor issue involves entering digits when setting the alarm, the time, and the date. The software does not echo the digits as you enter them or delete the digits if you make a mistake. However, it does repeat the settings when you finish, and because it is a simple task, it is no problem to reenter the settings if you hear that you made a mistake.

Our biggest concern, which Gray agrees with, is portability. Being tethered to a computer is fine for testing at home, but because aggressive diabetes management requires several tests throughout the day, it is not always practical to carry a laptop with you everywhere. Of course, this is just a prototype, and Bay Area Digital's ultimate goal is to build this functionality into the meter itself or perhaps into a small unit that attaches to the meter. On November 13, Gray received notification that this integration will be funded for six months by the National Science Foundation. So, there should be a lot more to this story before long.

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Product Evaluation

Full Stream Ahead: A Review of the VictorReader Stream

Few new products in the assistive technology arena have drawn as much enthusiasm as the debut of the Victor Reader Stream from HumanWare Canada in July 2007. Largely responsible for its instant popularity was the accompanying announcement that the National Library Service for the Blind and Physically Handicapped (NLS) will launch a website that will be accessible to any eligible patron for downloading Digital Talking Books. The prospect of being able to play the familiar and loved NLS Talking Books on a handheld player—with the convenience of digital markup in the bargain—prompted many customers who are blind or have low vision to grab their credit cards and order, in many cases without having examined the product in advance.

Shipment of the VictorReader Stream began in early September, and the enthusiasm is still spreading. In November, more features were added, and there is a promise of more to come. What sets the Stream apart, in large measure, is the multiplicity of tasks it can perform. On this single device, you can store and listen to Talking Books from NLS, DAISY books from Bookshare, your music collection, and any text file from your computer. The Stream doubles as a handy voice recorder for personal notes, meetings, or lectures, and, as of November 15, is equipped to play books and programs from Audible.com. Perhaps most surprising is that it sells for $329 plus shipping, an unusually affordable price in the assistive technology market.

The Stream is a handheld device (similar in size to a deck of cards and weighing about 6 ounces) that has been designed with users who are blind or have low vision in mind. Its controls are all tactile and easy to operate, with the only visual indicator being a small LED (light-emitting diode) that enables the user with low vision to know when the unit is off, on, or charging. There are, of course, audio indicators for all the operations as well.

As I mentioned earlier, the Stream fits in the palm of your hand. The front contains a 12-button telephone-style keypad. The 5 key has the familiar nib for quick orientation. Above the 1 key is a square button, the Go To page or Heading key, and above the 3 key a diamond-shaped button, which is the Bookmark key. At the top are the small speaker grill and internal microphone. Below the keypad is a raised-line separator, below which are four more buttons. The bottom three are the Play/Stop button, flanked by the Rewind and Forward keys. The fourth key, centered above them, is a sleep timer. On the left edge of the unit are the round Power button and two arrow-shaped buttons that are used to control volume, speed, and tone. On the right edge are headphone and external microphone jacks and the Record button. Across the top is the small USB port; the AC adapter jack; and, in the center, the slot for the SD (secure digital) card, which stores all contents played on the Stream.

All content to be played on the Stream must be stored on an SD card. Although a USB cable is included in the package, it is recommended that you transfer data directly from your computer to the SD card using a card reader (a small device about the size of a thumb drive, with a USB connector for plugging into your computer at one end and a slot for the SD card at the other). Whether you transfer material to the card directly or to the Stream itself, the process could not be simpler. Material is simply copied from one place to the other using Windows Explorer; no special software is required. However, NLS books must be unzipped, and each book has about 20 files.

VictorReader Stream has its own folder structure that must be maintained for materials to play properly. Each SD card that is used has a folder called Talking Books (which is for NLS books and other DAISY content), a folder for music, a folder for text files, and a folder called Other Books. On November 15, HumanWare released an update that includes the capability of playing materials that are downloaded from Audible.com.

Although a folder called Audible must be created using the Audible Manager software, the Audible books are actually placed in the Other Books folder. This may sound confusing, but all of the setup and transferring of content is so intuitively designed that it remained confusing only for a minute or two.

Everything in the Stream is voice guided. For permanent messages—power on, power off, the names of folders, the number of books on a bookshelf, the functions of navigation keys, and so on—the voice heard is male, the "Victor voice," which will be familiar to any customer who has owned previous products in the VictorReader line. The built-in text-to-speech synthesizer is "Vocalizer," a female voice that is clear and easy on the ear.

Each of the Stream's folders is called a bookshelf. When you press the 1 key on the keypad, the Stream cycles through these bookshelves—Talking Books, Music, Text Files, Other Books, and Notes. The Victor voice (the male recorded voice) announces the name of the bookshelf and the number of books it contains. To go through the list of books on a given shelf, you use the 4 and 6 keys to move backward and forward through the list. This list of books is spoken by the female voice of Vocalizer. For DAISY books, the book title on the bookshelf is announced in the book narrator's voice.

What really makes the VictorReader Stream shine is the range of navigation possibilities that it offers. All navigation is done using the 2, 4, 6, and 8 keys on the keypad and is highly intuitive and easy to learn. In a Digital Talking Book or magazine from NLS, for example, you may be able to move forward and back by chapter, section, or other heading. Victor's time-jump feature allows you to move back or forward by 1-, 5-, or 10-minute intervals. With the bookmark feature, you can set bookmarks to highlight particular spots to return to, or you can place a highlight bookmark to bookmark a specific passage or quote.

When you read a file from the text files folder, a different set of navigational elements are offered. Here, you can navigate by screen, line, sentence, character, or word. In a file with DAISY markup—such as a book from Bookshare or a newspaper from NFB Newsline—you have the best of both worlds with the ability to move by line, sentence, character, or word, but also navigational levels 1, 2, and 3, which make it possible to move by section, chapter, or article.

Within the music bookshelf, there is a different style of navigation. You can navigate by folder or file. You can set the menu to random selection (shuffle) mode, and you can use the Go To key to go to a specific song, rather than a page. (This works only if you remember the number of the file where that particular song is stored.)

Nice Touches

  • You can jump from textbook to newspaper to music to your favorite fantasy, and the Stream will remember where you left off and resume playing from that point when you return.
  • Variable speed is available in all books, including those from Audible.com. In the music folder, however, where altered speed is not desirable, the speed is automatically set to 0 (normal). Then, when you return to a book or file in one of the other areas, the speed setting that you chose there is resumed.
  • Bookmarking capabilities are available in all areas, including the music folders.
  • When moving through the music folder—as is the case anywhere else in the Stream—Vocalizer announces the file number and name of the track.
  • You can delete a note or book or other file with the press of a button.
  • The lithium battery (which is user replaceable) takes 4 hours to charge fully and lasts for 12-15 hours.
  • By pressing the Info key, 0, you can find out at any time how much battery power is remaining, how much of the file you have heard and how much remains, the number of headings and bookmarks in the current book, and a few other things.

What the Stream Does Not Do

Well, the Stream will not make coffee, of course, and it does not vacuum. But here are a few other features or lack thereof worth noting:

  • It plays MP3 files, but does not play WMA files. In other words, you cannot play music stored in Windows Media Player files or recorded books downloaded from Unabridged.com or NetLibrary.
  • The Stream does not have a clock or alarm feature. (It does, however, have a sleep timer, which allows you to set the unit to shut off in 15, 30, 45, or 60 minutes).
  • The built-in speaker is not good for listening to more than status information while charging or transferring content. At its maximum volume, it can be heard only in a quiet room and in close proximity to the ear. Existing cell phone technology offers speaker designs that are both compact and have a clear and listenable signal. The Stream should do the same. For times when headphones are not the desired listening mode, however, small external speakers work well.
  • It should also be pointed out that although the 5 key does have a small, raised dot for orientation, it is much too faint to be useful to most customers.

Coming Soon

At this writing, HumanWare is waiting for Recording for the Blind and Dyslexic (RFB&D) to release its user authorization key for unlocking RFB&D files. When it does, which RFB&D promised would be in mid-December, but has not happened at the time of this writing, the Stream will also be able to play the vast library of textbooks that RFB&D offers in its AudioPlus format. (These books include DAISY markup, including a level for page numbers.) Also expected to be released in December is HumanWare's Stream Companion software, which will provide a simple interface for moving Talking Books from PC to Stream, and a provision for converting 3 GP audio notes files to .wav files. HumanWare was also on the brink of releasing an additional voice for the Vocalizer synthesizer. The current female voice is called Samantha; the new voice is called Tom. Each is integrated into its own software version, so users will have the choice of putting one or the other in the Victor Stream, not both at the same time. Listen to the samples of the Samantha and Tom voices, as well as the Victor voice attached to this article.

The Bottom Line

All too often, people who are blind or have low vision have raced to catch up and have tools that are at least on par with those of sighted people. Once in a while, assistive technology actually puts them in an advantageous position. VictorReader Stream may well be one of these exceptions. Pulling my own unit out on a bus or train, I can listen to any one of a dozen novels or collections of poetry, three newspapers with today's date on them, my own favorite music collection, a television episode (recorded and converted to an MP3 file), any one of a variety of favorite radio broadcasts, one of the dozens of documents and webpages I need or want to review, and more. Sure, there is room for improvement. But the VictorReader Stream offers an abundance of features in a tiny, powerful package and is one product that warrants a sustaining of that original excitement.

Manufacturer's Comments


"Incorporating so many advanced features into a portable and inexpensive package was a challenging an exciting project for HumanWare. We appreciate the enthusiastic response of the marketplace, and we continue to work on new features and improvements. Playback of both WMA recorded audio and BRF braille text formats are in development and are expected soon. To keep up to date on Stream developments, we invite you to subscribe to the Stream e-mail announcements list. Visit <www.humanware.ca/USA/stream.html> and select the register to Stream News Wire link."

Product Information

Product: VictorReader Stream.

Manufacturer: HumanWare Canada: 445, rue du Parc Industriel, Longueuil, Quebec J4H 3V7, Canada; phone: 888-723-7273 or 819-471-4818; e-mail: <ca.info@humanware.com>; website: <www.humanware.ca>.

Price: $329.

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Access Issues

Your Accessibility Is Extremely Important to Us: A Look at the Usability of Technology at Call Centers

Many careers and job opportunities are influenced by the accessibility of technology for those who are blind or have low vision. Recently, AFB TECH received a request to provide some advice to an employer near the AFB TECH office in Huntington, West Virginia. This request, to evaluate the usability of the technology in a call center, presented an opportunity for us to have a look at the challenges and the status of accessibility of call center technology.

For a number of years, job seekers who are blind or have low vision were encouraged to consider employment as customer service representatives. These positions took advantage of the emerging access technology of the late 1980s and early 1990s. The intervening decade has brought many changes and an almost-revolutionary transformation of the systems that customer service representatives use.

Have these changes made it less likely that screen readers and screen magnification can provide access? Are customer service jobs still open to candidates who are blind or have low vision? We asked several technical experts to give us some behind-the-scenes information and share their insights about the technology that is used in today's call centers.

The Inside Scoop

AccessWorld interviewed the information technology (IT) site manager for a large, 700-seat call center. Because of the highly competitive and proprietary nature of the call center industry, he has asked us to withhold his name.

AccessWorld first wanted to know what kind of technology the customer service representatives use. According to the IT site manager, the primary interface, in most instances, is based on HTML. This means that web browsing technology supports the presentation of information on the computer terminal that the representatives use.

The hardware in the call center with which the IT site manager is associated and most others that he is aware of is PC based. The system that the representatives use is not that different from a basic home or simple office computer. This means that access technology, such as a screen reader or magnification application, can be supported. In addition, a telephone headset and console are provided at each workstation.

So far, the picture may appear bright. Web browsing and HTML interfaces are well supported by several well-known access technologies. Unfortunately, there is much complexity, and there are many potential technical barriers. Although an HTML interface presents information, in many instances the information is actually old or inaccessible. An example is an application that is used by the representatives in the call center where the IT site manager works. At a certain point, the representatives invoke a terminal session. This part of the larger interface pulls specific information from the servers of the organization that the representatives are supporting. Although the interface is HTML and potentially accessible, the specific screen with the data is not. In this simple example, a well-constructed page is of no help if there are data that cannot be accessed. Regrettably, no alternative has been found in this particular instance, despite efforts to test and design for compatibility with access technology.

In another example, the IT site manager cited a major domestic airline. In the call center of that airline, no fewer than six different applications are used by each representative. A modern HTML application provides the primary interface. Testing revealed that while the HTML interface was accessible, the other five components were not.

We were interested to learn why so many vastly different components and seemingly incompatible technologies end up in the systems. The answer is that the client drives what information is accessed by the representative and how it is presented. In many instances—the financial industry, for example—it is common to have old databases holding the information about a customer. As time and business requirements evolve, new systems are added, but the old systems are rarely revised. Although some large call center companies create the user interface for representatives, they must rely on the customers' systems to provide the information as it is displayed. The resulting patchwork quilt of display technologies is inevitable.

Among the most difficult legacy technologies to provide accessibility for is screen scraping—moving data displayed on a remote computer to one's computer screen—because it cannot be reformatted on your computer. This method is commonplace, even in today's computing environment. The IT site manager was aware of access technology and clearly understood the methods and limitations of current-generation screen-access products. He stated that his company and several others he knows of routinely test for accessibility. The purpose of such testing is to attempt to expand the opportunities for employment of qualified representatives who use access technology.

The need to recruit and retain qualified representatives drives much of the human resource activity of the typical call center. AFB TECH was contacted by a nearby call center after the center's director of human resources had talked with several blind persons in the community about employment opportunities. I offered to make a brief on-site visit to look at the interface and make some observations.

When I arrived, I was greeted by the director of human resources and the head of the on-site computing team. The system that I evaluated was the standard setup that the representatives use. A current screen reader had been installed on the system. To its credit, the company had asked the blind individuals themselves to look at the system and try it for accessibility. These experienced screen-reader users reported some difficulty, which resulted in the request for information from AFB TECH.

My notes to the IT director and head of human resources reflect the following. The interface that I used was pure HTML and accessed with Internet Explorer. The screen was divided into several regions, distinguished by colored backgrounds in red and blue. The representatives were servicing the accounts for a nationally recognized direct distributor of food products.

The HTML, while well formed, was made difficult to use by a significant lag time for each screen to display. This lag time resulted in situations in which the screen reader could not be used for 20 seconds or more because the screen data had not loaded completely.

Several minor issues with respect to the web page itself were also observed. The result is that for this application, the technical difficulties are not directly related to accessibility. At the same time, the long time it takes to load a page will need to be resolved before a screen reader can be used.

A secondary issue emerged. A script that a representative reads to a customer is generated as the interface is used and the call progresses. In the call center where I evaluated the technology, representatives were free to read the script verbatim. They were also equally free to summarize the information, in a more natural conversational manner, once they were familiar with the process and relevant information.

The IT site manager commented that some companies are strict about representatives reading scripts. Some customers change the scripts frequently, and strict standards for their use are applied.

With this overview of our brief encounter with a call center application and practical insights from the IT expert, what should the user of access technology keep in mind if he or she is considering working at a call center?

The first task is to be totally familiar with your screen-access technology. Rapid and efficient movement among specific regions on the screen is critical to remain productive. Both conventional techniques, such as finding a specific link, and less conventional strategies, such as finding a specific word or phrase on the page, may be necessary.

If scripts must be followed, be sure that you can repeat the script in a natural voice as it is read by the screen reader. On the other hand, if you use a braille display, make sure your reading skills are up to the task.

With familiarity with your technology in hand, approaching call centers is the next step. Some organizations, such as major hotel chains, have a good track record of hiring and promoting representatives who are visually impaired.

Some call centers focus on a particular client. Still others may expect representatives to answer calls for a number of organizations with potentially different and inaccessible systems. You can often learn what the centers in your area offer by word of mouth. Ask your friends and acquaintances. You may be surprised just how much information you can gather.

Once a specific position is available, researching the technology is a must. If you are working with a vocational rehabilitation counselor, you need to ask for technology services. If you are going it on your own, it may be useful to contact your preferred screen-reader company directly. Although the developers of screen readers will not be aware of every kind of call center application, they will be able to connect you with organizations that specialize in providing access solutions to employers.

Networking with other people who are visually impaired who are working in the customer service field to learn more about opportunities is a logical step. AFB offers a resource at the web site www.afb.org/careerconnect. The web site, which connects mentors who are successfully employed with those who are seeking information about jobs, includes several individuals who work in the customer service field and are willing to answer questions and offer information.

Like a typical telephone call for technical support, our interaction with the call center in our neighborhood and conversations with those who are experienced in the field were brief. These contacts gave us some useful information and updated us on an area of employment that some people find rewarding. If you are interested in more information, we encourage you to contact either CareerConnect or other people who are visually impaired in your area.

If you are working in a call center, we would like to hear from you. How accessible is the software that you need to use? What problems have you encountered? Write to us at accessworld@afb.net.

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Access Issues

The Challenge of Assistive Technology and Braille Literacy

The speed of change has become a defining characteristic of the information age in which we live. The socioeconomic impact of this shift is global and far-reaching—connecting people, families, and local communities in new ways, while at the same time, increasing the global connectedness of us all.—Diana Carew, "Educating the 21st Century Citizen," The Catalyst, April 1, 2004.

According to the World Health Organization, there are an estimated 45 million people in the world who are blind. Approximately 90% live in developing countries and constitute one of the world's most invisible and poorest minorities. For all people who are blind, braille remains the foundation of written communication and is a true literacy medium that cannot be replaced by computer speech or audio. To write braille, assistive technology tools, such as braillewriters, are essential and can be considered an important component of braille literacy. In stark contrast to the vision of the future described by Diana Carew, the International Council for Education of People with Visual Impairment estimates that only 10% of children who are blind in developing countries have access to education or tools for writing braille

It is difficult to write about early braille literacy and writing tools without being seen to be critical of tradition and what has gone before. So it needs stating upfront that the standard mechanical braille-writing tools that are currently in use have provided magnificent service over many decades.

In this information age, we have witnessed fantastic progress in high-tech assistive technology, including braille access to computers and the Internet, personal electronic braille notetakers and personal digital assistants, braille translation and embossing, and much more. These developments in braille assistive technology over the past 25 years have been created primarily by the for-profit sector. On the other hand, mechanical devices for braille writing have remained mostly in the dominion of the nonprofit sector and have effectively been removed from the forces that lead to innovation and improvements in products and cheaper prices.

A New Option for Writing Braille

More than 15 years ago, Quantum Technology (a for-profit company) decided that the lack of choice for early braille-writing options was a worthy challenge, and we set out to develop a small braille-writing device that could be easily carried. We saw the major design challenge as eliminating the need for right-to-left writing (as with the slate and stylus), being able to check what was written and then continue writing, and having a single-piece construction (no stylus to get lost).

In short, our aim was to develop a device that resembled a larger mechanical braillewriter in operation, but was closer to a slate and stylus in size. After many attempts and redesigns, we finally achieved our aim, and the Jot a Dot was launched in 2006. The difficulty of bringing Jot a Dot to fruition has given us some insight into why so few alternatives to the braillewriter have been developed. It really is an engineering challenge to produce braille dots of the right shape and size consistently over a line, using a regular braille keyboard, in such a small product. It was also important to us to have it made of modern materials, lightweight and strong, to ensure that it was truly portable. This could be achieved only by mass manufacturing using injection moulding, a technique that requires a high investment of capital.

A teacher observing a student using the small Jot a Dot braille writer.

Caption: A teacher watching a student use the Jot a Dot.

Our research confirmed that the area of greatest need was in developing countries, where options for braille writing were limited or nonexistent. For this reason, we chose regular-weight paper as the preferred choice for Jot a Dot, since braille paper is rare, if available at all, in many of these countries. We also knew from other projects that good-quality durable braille could be achieved on regular paper, and the cost savings for everyone were significant.

So what has happened since Jot a Dot was released? We have found significant differences in the way Jot a Dot has been received in developed and developing countries. In developed countries, we found that few students are being taught the slate and stylus. The biggest interest so far has come from within education, from teachers and parents who recognize the importance of developing simple notetaking competence as a foundation skill of literacy. Jot a Dot has been welcomed as an addition to the range of tools that teachers use to develop braille literacy skills.

However, Jot a Dot has also highlighted some issues to do with prevailing attitudes and with an apparent lack of willingness to accept change. A frequent question has been this: Does the Jot a Dot replace the slate and stylus? The answer, of course, is no, it is simply another option. Our typical response is to point out that sighted children have literally hundreds of options for writing and scribbling from the earliest possible age. It is inconceivable that anyone would really question whether children who are blind deserve to have a second option.

An Unexpected Response

The really disappointing response has come from blindness agencies and organizations that, we assumed, would have welcomed a new braille writing tool. With the exception of Sight Savers International in the United Kingdom, there has been little or no support from agencies that serve people who are blind in most countries of the world.

Of course, this lack of support would be justified if Jot a Dot did not work or did not make good braille. There are now many hundreds of users around the world, and we have lots of data to support the fact that Jot a Dot is a viable and useful tool for taking braille notes. So we can only conclude that braille writing tools for early literacy are not a high priority or there is too much inertia and conservatism in the agencies that serve the blind community for Jot a Dot to make any sort of impact.

There are other examples of innovative braille-writing technology that has been developed by for-profit organizations and has struggled to be recognized or adopted. A good example is the Tatrapoint Braille Writer, developed in the Slovak Republic. The Tatrapoint is a low-cost mechanical braillewriter that has some important innovations, such as the ability to adjust the spacing of the keys to suit different hand sizes, the ability to use regular or braille paper, and a light touch needed for brailling. It is difficult to understand why devices like the Tatrapoint (which has been around for many years) have achieved such a low profile in the developed world. Attitudes may partly explain it, but the subsidies and financial support offered to more traditional devices may also contribute to the lack of recognition.

The Tatrapoint Braille Writer—a small plastic keyboard with a metal paper feed attached.

Caption: The Tatrapoint Braille Writer.

A Very Different View

In the developing world, Jot a Dot has been the center of a great deal of interest and excitement. As a lightweight and portable device, students are able to use the Jot a Dot at school and carry it home to complete homework. Early in 2007, an evaluation project was completed in Uganda, funded by the Australian government and implemented by Sight Savers International. This project followed 25 students for six months and evaluated how useful Jot a Dot is as a tool for braille literacy. The positive responses have led to the organization of a second project with a larger number of students in Uganda and another trial project planned for Tanzania.

A student touching the Jot a Dot's keys as the teacher explains its function.

Caption: Ugandan teacher teaching a student to use the Jot a Dot.

We tend to regard assistive technology as being only the high-tech and glamorous end of the spectrum of software and hardware tools that children who are blind or have low vision need. It is time for the low-tech devices to be regarded equally as part of the assistive technology continuum that children who are blind need to compete successfully in education, employment, and life. Braille writing, in the context of early braille instruction, should be recognized for what it is—the foundation of the attitudes, skills, and expectations for technology that children will carry with them for the rest of their lives.

As we head off at great pace into the 21st century, children who are blind will need wider choices and more innovative tools for literacy from the earliest possible age. And we need to consider how they are going to get them.

The vast majority of students who are blind who start braille instruction are presented with a braillewriter that has not changed in more than 50 years, and no one questions this lack of equity and the obvious discrepancy in the expectations for children who are sighted and those who are blind. What would happen if sighted children were presented with a 50-year-old typewriter as their foundation tool for literacy? No matter how good or solid or reliable that typewriter is or whatever proud tradition and history it embodies, their parents would have higher expectations. The parents would expect innovation, change, and choice as a natural extension of the role that technology plays in their own lives. As Carew (2004) suggested, "Change has become a defining characteristic of the information age in which we live."

However, the fact remains that the lack of choice in tools for early braille literacy and of expectations for new ones does not appear to be high on the agenda of blindness agencies in the developed world. If we start with the assumption that everyone who works in the field of blindness is highly committed and motivated and that we all share a common goal of assisting children and adults who are blind, then why is no robust dialogue taking place about this issue?

Is there really such a high level of confidence in the status quo and current braille-writing tools, or are other factors at work? Why do new, innovative options like Jot a Dot, Tatrapoint, and even the Mountbatten Brailler remain outside the mainstream, without subsidy, support, or endorsement from the agencies that control and influence early education and policy?

And why has innovation in the information age failed to provide the technological advances in braille writing that would result in new and cheaper products that are needed by children and adults who are blind in developing countries? It is a tragedy of epic proportions that millions of children around the world still have no tools for literacy.

It is more important than ever that we reflect on these questions and find a way forward for all children who will need better tools, skills, and expectations for their future in this increasingly technological world. Perhaps one way forward is to consider pooling the talents and strengths of for-profit and nonprofit organizations. Matching the innovative culture of the for-profit to the established and far-reaching infrastructure of the nonprofit may provide the platform and incentive for new braille-writing options to be developed. There is always a high cost of development for any new product, which is typically matched by the cost of commercialization and distribution. The nonprofit sector provides an opportunity for a low-cost distribution model, which would result in cheaper products being more widely distributed. Such partnerships should have as their focus the process of innovation and not revolve around a single product. If any nonprofit agency is listening, we would like to talk to you!

Children who enter school in 2008 will graduate from high school in 2021. What will their world be like? I can guarantee that it will be a world in which technological skills are critical to success, and the foundation for these skills needs to be imprinted from the earliest possible age. Children who are blind need to explore, play with, and use assistive technology options, both high tech and low tech, as soon as they can crawl. And they need choices—lots of them. Who is up to the challenge?

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Conference Report

Techshare 2007

More than 400 people from 25 countries flocked to the Royal National Institute of Blind People's (RNIB) seventh Techshare Conference at the Hammersmith Novotel in London on October 4 and 5, 2007. RNIB worked in partnership with seven other disability organizations—AbilityNet, Action for Blind People, Age Concern, British Computer Association of the Blind, Dyslexia Action, Royal National Institute for Deaf People, and Sense—to make this the biggest Techshare yet. The conference was opened by Kevin Carey, vice chair of RNIB, with keynote addresses by Axel Leblois, director of the Global Initiative for Inclusive Information and Communication Technologies, and Rob Sinclair, director of accessibility at Microsoft.

The three Techshare keynote speakers sitting at a table.

Caption: From left to right: Rob Sinclair, Axel Leblois and Kevin Carey.

The actual conference was on Thursday and Friday, but on Wednesday, October 3, there were a number of preconference workshops. Delegates could register to attend all the workshops and the two days, either or both of the seminar days, or just one or two workshops. On Thursday and Friday, there was a commercial display, Techshare Expo, with booths from numerous producers of assistive technology. Techshare Expo was, at times, open to the general public, as well as to Techshare delegates.

I signed up for one afternoon workshop held on Wednesday and for the conference on Friday. The RNIB web site listed all the sessions for each day, so it was fairly simple to decide which days would be most rewarding. The only problem was booking the workshop, since the details of when the workshops started were provided only in the confirmation e-mail message.

One workshop lasted the entire day, and the other three were half-day events. One workshop was so popular that it was run twice, morning and afternoon.

On the day, registration was easy enough, just a matter of turning up and remembering my name. I received the standard pack—a bag, a full program (available in standard print, large print, contracted or uncontracted braille, and DAISY on CD), a small can of mints, a tactile, twistable stress toy (hard plastic, though, so it was not really squeezable), a decent-sized notepad, and a chunky pen. The pen was a great hit with everyone, it seems, because the end twisted to reveal a hidden compartment, like something from a James Bond movie, except that the secret cache contained sticky bookmarks, rather than a hidden weapon. Still, there were more bits of paper with sticky bookmarks around than one would expect at most conferences.

The workshop I attended covered the differences between WCAG (web content accessibility guidelines) 1.0 and WCAG 2.0 and was fairly intensive, a lot more interesting and interactive than being lectured to for an afternoon, and useful.

The conference was held on the entrance-level floor of the Hammersmith Novotel, with four, five, or six sessions being held at any given time. Each session lasted 50 minutes—usually 30 to 40 minutes of presentation, followed by a question-and-answer session—with a 10-minute break between each session to allow for overrun. The sessions ran from 10 a.m. to 4:30 p.m., with a break for a buffet lunch in the basement, next to the Techshare Expo. With more than 60 sessions held during the two days, there was plenty to choose from.

Techshare also included the DAISY Consortium conference and featured keynote speeches by George Kerscher, secretary general of the DAISY Consortium, who talked about DAISY strategic directions, activities, and developments, and Jim Fruchterman, CEO of Benetech and founder of Bookshare.org, who announced that Bookshare is now available internationally. For a DAISY report on Techshare and more information about Bookshare, go to the web site on the DAISY Planet: DAISY Consortium Newsletter October 2007, <www.daisy.org/news/newsletters/planet-2007-10.shtml>.

My favorite presentation at the conference was by Abilitynet's Kath Moonan. Moonan talked about the accessibility problems of Web 2.0 applications and helped to get the message across by using captioned video recordings of interviews with users of assistive technology.

The panels took place in a series of lecture rooms off a central hall. The rooms had decent audiovisual equipment, and an RNIB person to run around with a microphone during the question-and-answer session. Apparently, there had been some technical difficulties on day one, but I did not experience any on day two. Real-time transcription of presentations was available, with the text displayed on a screen alongside the main presentation screen, although in one session, technical problems meant that the predictive text had not been set up properly, and a lot of the technical jargon was lost in translation, so to speak. For instance, at one point "Adobe" was rendered as "A dough bee." Despite the technical hitches, it was obvious that a lot of consideration had gone into making the conference as accessible to as many people as possible.

Throughout the event, RNIB staff members and volunteers were always on hand, clearly identified by their turquoise sashes (which, it must be said, did not really suit the men) and their willingness to aid anyone who looked lost or bewildered. The tactile floor plan was also available, and I found the quick-reference timetable particularly useful.

I was slightly underwhelmed by the Techshare Expo, although I may have been so because I had spent a day at the Sight Village conference in Birmingham a few weeks earlier and seen most of the exhibitors there. The two rows of booths seemed uncomfortably close to me, yet I was able to walk from one end to the other without being offered any demonstrations or free things. I think that the exhibition space suffered from being two escalators down from the main conference, so there was not much opportunity to pop in for a quick look between sessions.

Overall, this was an excellent conference. The workshop was more than just a lecture in a small room, and the main sessions were interesting and informative. The venue was fairly spacious, and the staff, both of the hotel and the RNIB, were helpful.

RNIB's Perspective

Richard Orme, Head of Accessibility at RNIB

Our original intention for Techshare was to bring together people who are working with technology to share what they know about how it can help people who are blind or have low vision. We also hoped that we could persuade some technology companies to tell us about their plans and understand how people are using their products. Well, several years later, we have experts coming from the other side of the world, not only to tell us what they know, but to learn how things are done in the United Kingdom. Some of our universities, charities, and commercial companies are engaged in groundbreaking work to push the boundaries of how technology can help and in making it easier and more affordable.

We are now reading through the feedback our delegates gave us and starting to plan for the next Techshare. There are two things that I hope will not change, though. First, this event will continue to be organized by disability organizations that are in touch with their members, so the agenda is set in line with the issues that are out there. Second, our aim is to provide people with usable new skills and information, so they can do their jobs or volunteer work better. I know I learned a lot at Techshare this year, and perhaps I will see you there next time.

For further information on Techshare, visit the following web sites: <www.rnib.org.uk/techshare>, RNIB: <www.rnib.org.uk>, and DAISY <www.daisy.org>.

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AccessWorld News

Sendero Site Changes

Sendero Group, the company that produces the popular GPS (global positioning system) software for BrailleNote mPower and BrailleNote PK, has released a patch, version 4.03, to correct a metric calculation problem in version 4.0. The company has also made some changes to its web site to make receiving upgrades a more efficient process. Licensed Sendero GPS customers can now download the maps and GPS software directly from www.mysendero.com. To download the new patch, simply go to the site and choose the link for mPower or PK.

For more information, contact Sendero Group: phone: 530-757-6800 or 888-757-6810; web site: www.senderogroup.com.

New BookCourier

Springer Design, manufacturer of the BookCourier, has announced that a new version will begin shipping in the first quarter of 2008. The new BookCourier will play several file formats, including WMA, OGG, and WAV, and will add the ability to play NLS Talking Books in an early firmware upgrade. It will offer variable speed in audio as well as text files, have a jack for an external microphone, and have the capacity to handle both SD (secure digital) and CF (compact flash) cards storing up to 8GB of material. The price has not yet been announced, but Springer Design says that it will be lower than the competition. A special trade-in deal will be offered to current BookCourier customers. For more information, contact Springer Design: phone: 925-242-0310; e-mail: sales@bookcourier.com; web site: http://bookcourier.com/WhatsNew.htm.

Leather Cases for Assistive Technology

Executive Products carries a number of leather cases that have been designed for specific assistive technology products that are used by people who are blind or have low vision. Cases are available for BrailleNote models, PAC Mate models, Book Port, BookCourier, canes, and a variety of cell phones. The latest addition is a customized leather fitted case that is designed to hold the Victor Reader Stream, which became available December 1. The case is designed so that the unit can be used while the case is on—offering access to the headphone jack, USB connection, SD slot, and so forth. It has a zippered case for additional SD cards, a six-inch wrist strap, and a belt clip. The case can be ordered for $35.99, from Executive Products: phone: 866-833-1444; web site: www.executiveproductsinc.com/catalog/index.php?cPath=278.

Microsoft Releasing DAISY Converter

A collaborative effort by Microsoft Corp. and the Digital Accessible Information System (DAISY) Consortium has developed a program that will convert open XML files to the DAISY format. This should be a significant step for people who use screen-reading software and need to access large documents and have the time-saving navigation features (jumping forward or back by page, chapter, section, and so on) that are provided by the DAISY format. To be released early in 2008, the XML to DAISY converter will be available from Microsoft as a free plug-in and will be compatible with Microsoft Office 2003 and Office 2007.

It All Makes Sense

GW Micro has added another accessible GPS product to the marketplace for travelers who are blind or have low vision. Called SenseNav (for Sense Navigation), the product is designed to work with the company's Voice Sense personal digital assistant. It includes the SenseNav software, an 8GB compact flash card holding all maps for the United States and Canada, a Holux M-1000 GPS receiver with an AC adapter, and an audio tutorial CD. SenseNav offers the ability to design routes for either vehicle or pedestrian travel and offers a virtual mode for exploring an area before one actually travels in it. As of January 2, SenseNav will sell for $1,549 or $3,944 if it is bundled with a Voice Sense. The company plans to offer a version that is compatible with the Braille Sense, but no release date for that version has yet been announced. For more information about SenseNav, Voice Sense, or other products, contact GW Micro: phone: 260-489-3671; e-mail: sales@gwmicro.com; web site: www.gwmicro.com.

National Conference

The American Foundation for the Blind's national conference will be held on April 4-5 at the San Francisco Airport Marriott Hotel. This conference will bring together experts and beginners across the vision loss and technology fields for a rousing discussion about the present and future role of technology. We will attempt to answer the questions: How does technology affect the lives of people with vision loss? What are the latest changes in technology? Can technology be fun? For more information, contact: Caitlin McFeely: phone: 212-502-7674; e-mail: cmcfeely@afb.net.

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January 30–February 2, 2008

Assistive Technology Industry Association (ATIA) 2008 Conference

Orlando, FL

Contact: ATIA, 401 North Michigan Avenue, Chicago, IL 60611; phone: 877-687-2842 or 312-673-6659; e-mail: <info@atia.org>; web site: <www.atia.org>.

March 3–7, 2008

19th International Conference of the Society for Information Technology and Teacher Education

Las Vegas, NV

Contact: Conference Services, Association for the Advancement of Computing in Education, P.O. Box 3728, Norfolk, VA 23514; phone: 757-623-7588; e-mail: <conf@aace.org>; web site: <http://site.aace.org/conf>.

March 6–7, 2008

Assistive Technology Across the Lifespan Conference

Stevens Point, WI

Contact: Wisconsin Assistive Technology Initiative, 800 Algoma Boulevard, Oshkosh, WI 54901; phone: 800-991-5576 or 920-424-2247; e-mail: <info@wati.org>; web site: <www.wati.org>.

March 11–15, 2008

California State University at Northridge (CSUN) Center on Disabilities' 23rd Annual International Conference: Technology and Persons with Disabilities Conference

Los Angeles, CA

Contact: Center on Disabilities, CSUN, 18111 Nordhoff Street, BH 110, Northridge, CA 91330-8340; phone: 818-677-2578; e-mail: <conference@csun.edu>; web site: <www.csun.edu/cod/conf/index.htm>.

June 12–14, 2008

Collaborative Assistive Technology Conference of the Rockies

Denver, CO

Contact: Assistive Technology Partners, Statewide Augmentative/Alternative Communication Program, University of Colorado at Denver and Health Sciences Center, 601 East 18th Avenue, Suite 130, Denver, CO 80203; phone: 303-315-1280; web site: <www.assistivetechnologypartners.org>.

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Copyright © 2008 American Foundation for the Blind. All rights reserved. AccessWorld is a trademark of the American Foundation for the Blind.

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