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Traumatic Brain Injury and Spinal Cord patients require several unique adaptations to revamping their everyday living environment to facilitate the disabilities they have experienced. One of the several obstacles they face is how to undertake a redesign of their existing space economically while making the home capable of accommodating their needs.

Dave Ward, a quadriplegic at age 30, redesigned  his 1855 Historic Home to fit his needs and estimates that today it would cost approximately $9,000 to replicate the revisions he made. Following is an interview he gave to NPR in text format and a link to the audio version.

http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=6303285&m=6303290

“Dave Ward is the resident curator of the place he calls the Future Home, a house that he has turned into a model of “universal design.” It’s the idea that where we live — and the technology and products we use — should be designed so they are easy to use for anybody, including a quadriplegic, like Ward or an elderly person who’s frail or has cognitive disabilities.”

The Future Home is in the middle of a state park in Phoenix, Md., about an hour north of Baltimore. The house is historic, but it mixes the old with the futuristic.

“This house was first built in 1855,” Ward explains, “It was built as a tavern and inn, and it served the horse and buggy trade that traveled from Baltimore to Harrisburg, Pa.”

Back then, this big, white building was known as Smith’s Tavern. It’s right up against the old toll road. Today, on the long wraparound porch, the music of the wind chimes competes with the noise of the cars rushing by.

“Horse and buggies didn’t make as much noise as cars do,” Ward says.

Ward became interested in universal design by necessity. In 1977, at the age of 30, he became a quadriplegic after a fall.

Ward lived in this house before his accident. Now he has redesigned it so his personal-care attendant can live upstairs. The downstairs, where Ward lives, is a showcase of universal design, built to allow him to live as independently as possible. But he’s also made it a model for other disabled people as well as the elderly. Architects, designers and consumers come from around the world to see Ward’s house.

He starts the tour outside, at the main entrance.

“If we’re talking about access or universal design or home modifications, it all starts outside,” says Ward. “One of the things that’s real important for people is a place to park their automobile, and then to get from that mode of transportation to the front door without any barriers. In most cases, those barriers end up being steps.”

When Ward redesigned this place, he moved the main entrance to the back of the house, removed the stairs and added a smooth path that leads from his parking spot to the door.

The entrance uses a number pad instead of a lock-and-key system. With the pointer that he keeps attached to his hand, Ward can punch in a security code and the automatic door swings open.

Ward’s personal attendant pushes his wheelchair into the kitchen. From a remote control on his wheelchair, Ward pushes a button to turn on the lights.

“The kitchen is built so it has multiple-level work surfaces,” he notes.

Varied surface levels allow people to work standing or sitting.

“Many people can’t stand long enough to do an entire task,” he says. “For example, cooking or washing dishes or cleaning vegetables. And they want to sit.”

So there are two sinks on the blue and pink kitchen island in the middle of the large, square room. One sink is at standing height. The other is a few inches lower, for sitting. The stove top, too, can be raised or lowered to just three feet off the ground. And the cabinet of dishes comes down like an elevator.

A lot of things in Future Home move at the touch of a button. Curtains can be opened and shut by pushing a button, and a long coffee table can be raised until it becomes the dining room table.

Ward says the technology already exists to do all of this. It’s just that people don’t think of putting it in a house.

“Well, think about your car,” he says. “You’ve got climate controls all over your vehicle. We have voice control over many of the things in the car itself. We have powered windows within the car. We seem to find a way to cram that into a little vehicle, yet we haven’t looked at our own homes to think about how important it is to have the same thing there.”

Ward works in his home office as a consultant on design and on various state disability commissions.

“My favorite part of the house is probably the study,” he says. “Everything I want is within my reach in this part of the room.”

His computer is programmed to respond to his voice commands. By speaking, he can control his environment.

“Listen to me,” he commands; the computer turns on.

“Main Menu,” he says, and the computer talks back: “Okey Doke,” says the synthesized voice. Then Ward can give commands to close the shades or turn on the fan. For the television, all of the controls that you’d find on a regular TV remote control appear on his computer screen.

What would his life be like if he didn’t have a house full of all this technology?

“Well, I can tell you, because I lived it for quite a while,” he explains. “Coming home from a rehab facility, moving back into Mom’s house, it was, ‘Mom, can you take me outside? Mom, can you bring me in? Mom, can you turn the fan on? … On and on and on. Can you imagine what kind of pressure that is on an individual and how simple the technology is that we were using today to do all the things that Mom used to do for me?”

The devices add to the cost of a house, but Ward says it’s not as much as you might think, especially as more companies make more of these devices. Ward says when he built the house 14 years ago, it cost about $46,000 to put in all these devices. He says the same systems could be installed today for just a fraction of that — for less than $9,000.

A brain implant device that can be surgically installed in the patient’s brain to assist in forming, storing and recalling memories.

DARPA has selected two universities to initially lead the agency’s Restoring Active Memory (RAM) program, which aims to develop and test wireless, implantable “neuroprosthetics” that can help service members, veterans, and others overcome memory deficits incurred as a result of Traumatic Brain Injury (TBI) or disease. Teams will develop and test implantable therapeutic devices for memory restoration in patients with memory deficits caused by disease or trauma.

The University of California, Los Angeles (UCLA), and the University of Pennsylvania (Penn) will each head a multidisciplinary team to develop and test electronic interfaces that can sense memory deficits caused by injury and attempt to restore normal function. Under the terms of separate cooperative agreements with DARPA, UCLA will receive up to $15 million and Penn will receive up to $22.5 million over four years, with full funding contingent on the performer teams successfully meeting a series of technical milestones. DARPA also has a cooperative agreement worth up to $2.5 million in place with Lawrence Livermore National Laboratory to develop an implantable neural device for the UCLA-led effort.

“The start of the Restoring Active Memory program marks an exciting opportunity to reveal many new aspects of human memory and learn about the brain in ways that were never before possible,” said DARPA Program Manager Justin Sanchez. “Anyone who has witnessed the effects of memory loss in another person knows its toll and how few options are available to treat it. We’re going to apply the knowledge and understanding gained in RAM to develop new options for treatment through technology.”

TBI is a serious cause of disability in the United States. Diagnosed in more than 270,000 military service members since 2000 and affecting an estimated 1.7 million U.S. civilians each year, TBI frequently results in an impaired ability to retrieve memories formed prior to injury and a reduced capacity to form or retain new memories following injury. Despite the scale of the problem, no effective therapies currently exist to mitigate the long-term consequences of TBI on memory. Through the RAM program, DARPA seeks to accelerate the development of technology needed to address this public health challenge and help service members and others overcome memory deficits by developing new neuroprosthetics to bridge gaps in the injured brain.

“We owe it to our service members to accelerate research that can minimize the long-term impacts of their injuries,” Sanchez said. “Despite increasingly aggressive prevention efforts, traumatic brain injury remains a serious problem in military and civilian sectors. Through the Restoring Active Memory program, DARPA aims to better understand the underlying neurological basis of memory loss and speed the development of innovative therapies.”

Specifically, RAM performers aim to develop and test wireless, fully implantable neural-interface medical devices that can serve as “neuroprosthetics”—technology that can effectively bridge the gaps that interfere with an individual’s ability to encode new memories or retrieve old ones.

To start, DARPA will support the development of multi-scale computational models with high spatial and temporal resolution that describe how neurons code declarative memories—those well-defined parcels of knowledge that can be consciously recalled and described in words, such as events, times, and places. Researchers will also explore new methods for analysis and decoding of neural signals to understand how targeted stimulation might be applied to help the brain reestablish an ability to encode new memories following brain injury. “Encoding” refers to the process by which newly learned information is attended to and processed by the brain when first encountered.

Building on this foundational work, researchers will attempt to integrate the computational models developed under RAM into new, implantable, closed-loop systems able to deliver targeted neural stimulation that may ultimately help restore memory function. These studies will involve volunteers living with deficits in the encoding and/or retrieval of declarative memories and/or volunteers undergoing neurosurgery for other neurological conditions.

Unique to the UCLA team’s approach is a focus on the portion of the brain known as the entorhinal area. UCLA researchers previously demonstrated that human memory could be facilitated by stimulating that region, which is known to be involved in learning and memory. Considered the entrance to the hippo-campus, which helps form and store memories, the entorhinal area plays a crucial role in transforming daily experience into lasting memories. Data collected during the first year of the project from patients already implanted with brain electrodes as part of their treatment for epilepsy will be used to develop a computational model of the hippocampal-entorhinal system that can then be used to test memory restoration in patients.

After developing an advanced, new wireless neuromodulation device, featuring ten-times smaller size and much higher spatial resolution than existing devices,the UCLA team will implant such devices into the entorhinal area and hippo-campus of patients with traumatic brain injury.

The Penn team’s approach is based on an understanding that memory is the result of complex interactions among widespread brain regions. Researchers will study neurosurgical patients who have electrodes implanted in multiple areas of their brains for the treatment of various neurological conditions. By recording neural activity from these electrodes as patients play computer-based memory games, the researchers will measure “bio-markers” of successful memory function—patterns of activity that accompany the successful formation of new memories and the successful retrieval of old ones. Researchers could then use those models and a novel neural stimulation and monitoring system, being developed in partnership with Medtronic, to restore brain memory function. The investigational system will simultaneously monitor and stimulate a number of brain sites, which may lead to better understandings of the brain and how brain stimulation therapy can potentially restore normal brain function following injury or the onset of neuropsychological illness.

In addition to human clinical efforts, RAM will support animal studies to advance the state-of-the-art of quantitative models that account for the encoding and retrieval of complex memories and memory attributes, including their hierarchical associations with one another. This work will also seek to identify any characteristic neural and behavioral correlates of memories facilitated by therapeutic devices.

The performer teams are each composed of multiple universities, government research institutions, and private companies. The breadth of participation highlights the enthusiasm around the RAM program and hopes for its success.

RAM is part of a broader portfolio of programs within DARPA that support President Obama’s brain initiative. RAM’s emphasis on new discovery at a systems level reflects the great potential that lies at the heart of the president’s challenge to the neuroscience community.

RAM and related DARPA neuroscience efforts are informed by members of an independent ethical, legal, and social implications (ELSI) panel. Communications with ELSI panelists supplement the oversight provided by institutional review boards that govern human clinical studies and animal use.