Panic Attack? There’s an app for that!

I had my first panic attack exactly 3 years ago, outside my doctor’s office. I’ve also had some PTSD flare ups recently so wanted to share this older blog post about my first panic attack as a reminder to myself and hopefully a help for others who have panic attacks.

In 2015, stress from recent health crises and triggers from childhood trauma culminated in a very scary experience–the panic attack in the parking lot of my doctor’s office. My friend was able to talk me through breathing /stopping hyperventilating and came to get me and take me home.

I later talked with my therapist about plans to prevent a future full-blown panic attack. She suggested noticing symptoms that came up as my anxiety increased. For me this is sweating, pounding heartbeat, and feeling trapped. Knowing this, she suggested using several interventions to prevent escalation and  breathing techniques to try to calm myself. This worked and helped for the next couple of days.

That is, until I was at an emergency preparedness conference and they were talking about critical incident stress management (CISM). I had recently run into a woman who I worked with when she/we were attacked and she was choked at our workplace. She could have been killed in the attack. After that incident, we had a critical incident debriefing. At the conference, the memories of that incident started to come flooding back, along with the feelings of guilt having recently run into my former colleague. Then, the conference presenter showed a video of workplace violence as an example—in a hospital setting (which was the setting of our attack). So, then I was done for. I hastily left the room and retreated to a quiet corner down a hallway.

I was breathing rapidly and tried to call a therapist friend immediately as my attempts at regulating my breathing were failing miserably. I got a voicemail. Not wanting to bother the friend that helped me last time, I decided I was going to try to go it alone until the therapist could call back.

the front page of the PTSD Coach App

I remembered that I had downloaded PTSD Coach, an app designed by the Veterans Administration, onto my iPhone and had been using it for anxiety and depression. The app has a tool for managing symptoms and one of the symptoms you can select is “Reminded of Trauma.” I selected that and rated my distress on a level from 1-10. I gave myself an 8 and the app suggested tools accordingly. It gave me the option of distracting and laughing/reading a comic book. I thought to myself ummm no, that isn’t going to work right now, so I gave that a thumbs down and asked for a new tool.

PTSD Coach then suggested Deep Breathing—putting on headphones and being led through a breathing exercise. Nice idea, but I left my headphones at home and I was at the end of a hallway where people could possibly hear me. New tool please!

Then we started to get somewhere—the app suggested slowly counting to 100. Yes, that helped me calm down some. Progress! After that, I asked for yet another tool, and it guided me through the RID Tool. R= relax. The app suggested breathing in and out slowly. As you breathe in think “let,” and as you breathe out think “go.” A 30 second timer started counting down.  You can then add 30 more seconds or move on. I took another 30 seconds.  The I=identify the trigger. The app suggested going over the last few minutes and hours and identifying what reminders of your trauma you encountered. I easily listed these in the space provided.  It then said once the triggers are identified, it is important to notice how it is just a reminder, and not the actual trauma happening again. At first I thought, “Well, duh, I know that,” but telling myself that did actually help. Then I filled in the box about how this experience was different from the actual trauma. In D, you decide what to do now, the app said you can try to decrease the trigger’s power by deciding to stick around and see that you can handle it and that your stress will actually go down the longer you stick it out. It also suggested if you are angry or in danger of harming yourself or others, you should take a time out and seek support. I decided to sit outside the meeting room for a little longer in peace and rejoin the conference at the next break. I did attend a few more sessions then found myself completely exhausted and decided to leave the conference early.

Meanwhile, I tried one more tool before going back to the conference. The app suggested a grounding exercise, “Walk slowly focusing your attention on what it feels like to take each step.” This was a great way to re-center and continue calming myself. I got outside for a walk and remembered that walking and being in nature always helps me. After my walk, the app asked me to again rate my distress level. I gave myself a 5. Much better than before.

***Note if you give yourself a 9 or 10 the app does suggest calling for help using people you have pre-loaded into the app and/or nationwide hotlines.

Have you tried PTSD Coach? Has it helped? Any other apps that help you?

Transitioning from School to Life: AT Considerations

By Laura Hall, MATP Staffer

Graduation cap, diploma, and books

Transitioning from school to life is an exciting time for any student.  Yet, accessing assistive technology once out of school can be a much different process.  In K-12, the Individuals with Disabilities Education Act (IDEA) requires that assistive technology be considered for all students during the IEP process.  If AT is determined to be necessary, the school district must provide it.  School districts also have access to ALT + Shift’s AT lending library.  The lending library allows schools to borrow devices for up to eight weeks, enabling the IEP team to evaluate the effectiveness of the AT before purchasing the product.

The process changes once a student transitions out of high school.  Students are no longer covered under the IDEA and schools are no longer obligated to provide assistive technology.  This means that students must be more proactive in advocating for the assistive technology they need whether they are transitioning to higher education or employment.  Students should be involved in transition and IEP meetings to discuss and prepare for their assistive technology needs beyond high school.  In K-12 education AT is considered the property of the school district, however, it may be worth asking if the student can take the assistive technology with them beyond high school or purchase it from the district.

In higher education, the student is responsible for pursuing the AT and accommodations they need in college.  Most colleges and universities have disability services offices that can help with this.   Professors may require a formal letter to request accommodations, like extra time on tests, or a notetaker in classes.  The Michigan Association of Higher Education and Disability (MI-AHEAD) has resources on transitioning from high school to secondary education, including a list of considerations related to AT and accommodations.

Green and white road sign reading "new job, just ahead"Michigan Rehabilitation Services can help students transitioning from school to work. through their Pre-Employment Services.  They can attend IEP’s and offer consultation services beginning at age 14, so becoming involved with MRS early may support the transition process.  The Youth Transition Services FAQ document through MRS contains a wealth of information about the services they provide.

For more information on transitioning from high school to life, check out the resources below:

The Michigan Assistive Technology program also has an archived webinar “AT and Secondary Education” and a resource document as well.

Have you transitioned successfully from school to life?  What was your experience?  Do you have any other resources to share?

The Little Joys of Text Browsers

Cat lying on its back, apparently overweight
A Visually Complex Website

Modern browsers are gigantic affairs, designed to manage the remarkable variety of content available online, but also designed to do many more things, using a wide diversity of add-ons, scripting systems, plugins, revenue enhancement tools, and so on, ad infinitum. Now that wide bandwidth is more the rule than the exception, this makes some sense. But text-only browsers have been around for a quarter century (see Lynx, the oldest still being used), and they continue to be useful even in our ecosystem of browser behemoths.

I saw an item discussing the release of an up-to-date version of the WebbIE Web Browser 4, from the UK (see the download at, and the notice reminded me of all the small niceties of using a web browser that only focuses on the text:

  • The browser runs very fast, even on slow connections.
  • You don’t have to worry about malware or popups carried in graphic content.
  • It’s really easy to print the text without having to also print every single graphic chunk that the content creator or the advertiser thought was Very Important for you to see. This is especially useful if you want to use a PDF converter print driver so that you can share the text without carrying along all the graphics.
  • The Webbie Browser works with free screen readers like NVDA and Thunder (a webbie application screen reader. See the overview and link at the end of the post).
  • You can do a basic access test on any website simply be comparing what you get in Webbie, and what’s on the screen. Such a test won’t cover all access issues, but it does give you some direct insight into what people who need to use text as the core of their web access are getting from the site.

If you have another good use for a text browser, put it in the comments to this post!

Webbie has a variety of other applications that are text focused and well-maintained. They include the WebbIE Web Browser, PDF Reader, RSS News Reader, Clock, Calendar, Podcatcher, BBC iPlayer Radio and TV programs, and BBC Live Radio. The apps require Net Client version 4, included with the installer.

You can get all of them at


A Personal Emergency Response Alternative?

After the sudden death of her husband on New Year’s Eve, a friend was really in a daze. She has a lifelong hearing loss and now has arthritis that can flare up in times of stress. She also had a stroke a few years ago and has fallen at home before.

Her family and friends thought some type of personal emergency response (PERS) device was needed. She and her husband had tried a service in the past and hated it.  They had the service calling at all hours for false alarms, would forget to put the device on and did not think it was worth the money.

apple watch in rose gold with fabric bandHowever, as someone with training in art and design, she loves Apple products and has an iPhone. We decided to try the Apple Watch from Verizon which will connect to service even if her phone is not nearby. Apple phones and the watch now have an SOS feature.

Apple Watch face with the SOS featureThe SOS feature on the watch works in few different ways, depending on how you’ve set it up.  Here’s information on how to make an SOS call:

  1. Press and hold the side button on your watch until the Emergency SOS slider appears.
  2. Continue to hold down the side button. Wait for a countdown to begin and an alert to sound.
  3. You can also choose to turn off auto call and instead drag the Emergency SOS slider to start the call.
  4. When the countdown ends, your watch automatically calls emergency services.

You can also add emergency contacts using the Health app on your iPhone. When you have emergency contacts identified, after an emergency call ends, the SOS feature alerts your emergency contacts with a text message, unless you choose to cancel. Your iPhone/Apple Watch sends them your current location, and, for a period of time after you enter SOS mode, it sends updates to your emergency contacts when your location changes.

hand holding apple watch with icons of all apps on the face

She loves the watch and finds new feature on it every day! I’ve reminded her how to use the SOS feature a few times, but we haven’t actually called 911 yet. The other day, she was talking to a neighbor and she’d forgotten to charge her phone. The phone turned off due to low power in the middle of the call. The neighbor was worried and called back. She was able to answer the call using her watch and explain what happened. Otherwise she would have had the First-Responders at the door.

She’s also learned to ask Siri on the watch to call people. This could be a helpful first step if she needs some help but it’s not a life threatening situation. We’ve begun practicing with these feature by calling friends who are close by and willing to help.


  • The best AT is the one the person will use.
  • The watch is fun and attractive.
  • If she doesn’t hear the phone ring, which happens at times due to the hearing loss, the Apple Watch vibrates on her wrist for notification and she can see who is calling. This is also an advantage as she may decide to just call back if the phone is not close by.
  • The Apple Watch has multiple uses while a typical “panic button” or Personal Emergency Response is limited in function.
  • No monthly fee though for the cellular version, Verizon has a monthly $10 line charge.


  • Battery life. The watch needs to be charged just about every day.
  • Many falls happen in the bathroom and, according to Apple:  “Showering with Apple Watch Series 2 and Apple Watch Series 3 is ok, but we recommend not exposing Apple Watch to soaps, shampoos, conditioners, lotions, and perfumes as they can negatively affect water seals and acoustic membranes.”
  • It’s difficult or impossible to practice using the SOS feature. If you can contact your local 911 you might be able to go all the way through the steps to practice, otherwise risk accidentally having first-responders show up at your door!
  • Cost may not be covered by some services/insurance while the traditional PERS could be covered.

For my friend, the Apple Watch has been a source of joy in a dark time. It remains to be seen how useful it will be as PERS.  Have you used a smart watch as Assistive Technology? Please share your experiences!

Here’s some more information on using the Apple Watch and SOS feature:

Pregnancy AT to the Rescue!

By Aimee Sterk, LMSW, MATP Staff

I’m just about to hit 32 weeks pregnant. With my age (42), and gestational diabetes making for a big baby to carry around, I’m starting to get very tired very fast. I’m also much more awkward and find myself having to grab things to catch my balance. Luckily, I went through this a mere year ago with our first baby we got to hold, so I’m resurrecting this blog from that pregnancy.

From 2016:

my new tub set up with my shower bench installed and my handy handheld showerheadI told my husband the thought of showering exhausted me. And, smart man that he is, (and married to someone that works in AT), he immediately suggested a shower chair. It was a relief to even hear him offer. He measured our tub and took off for the nearest Meijer and came home with just what I asked for—one as wide as possible, without a back, with drainage holes and height-adjustable. Paired with our pre-existing handheld showerhead, I had the most relaxing and comfortable shower I have had in months! Yay for AT!

When I posted about the shower chair on a Facebook group I’m part of for pregnant women, so proud of my husband’s brilliant idea, several other women said they already had purchased shower chairs as well and loved them too. One even had a stylish teak one. Her budget is larger than mine the teak ones I found on Amazon were in the $100-$130 range while my plastic bench was $35 at Meijer and $25 on Amazon.

lotion applicator--small oval sponge on a stickAlso newer to me, is difficulty putting on my socks and administering medication for my toe. Again, AT to the rescue. A sock aid and long handled lotion applicator, and I am back in business. My favorite sock aid has fingers that are easy to squish together to load the sock and terry cloth on the outside to better grip the sock. It is called the Carex sock aid or sometimes the sock aide flexible deluxe and is about $9 on Amazon. sock aidThe lotion applicator I chose has replaceable sponge heads and is about $15 for two applicators and 6 replacement sponges.

Final on my wish list are shoes that can handle edema (without laces). This summer I found sandals to be the perfect option. When my feet were swollen, I just adjusted the Velcro straps larger for more comfort. Then when the swelling went down, I could make them smaller again. Now that winter is here, I’m not finding good options for expansion and contraction so I’m just borrowing my mom’s shoes that are bigger.


What AT do you find useful when fatigue is affecting you? Or edema? Or pregnancy?

Winter Weather Protection for Your AT

by Laura Hall, MATP Staff

Old man winter blowing out snow

Well, the weather outside is frightful today, with the Lansing area expecting up to 10″ of snow.  For users of assistive technology, winter weather is certainly not always delightful.  During these months we are often more reliant on our AT, which makes it even more important that they are well maintained and protected from the elements.

As a powerchair user, winter can feel isolating because it is so hard to drive in the snow.  As great as my new chair, the Flash is, it doesn’t stand a chance against the white stuff.    While snow and ice will always be difficult for wheelchair users, ensuring that your chair is in the best shape possible can help.  Replacing bald tires can make all the difference.  In her blog “Maintaining Your AT – Wheelchair Edition”  Lucia Rios gives some great tips for maintenance, like working with a bike shop to replace parts.Mobility Light on WalkerSpiked walker or cane tipShoes with traction cleats

Using a walker, cane, or crutches can be especially treacherous during the winter months, and while care must always be taken to reduce falls, there are a few AT items that could make things easier.  For example, a mobility light, that attaches to the tubing of a walker, crutches or a cane, can help increase visibility and awareness of obstacles.  Spiked tips for walkers and crutches may also help with stability.   Shoe traction cleats may also provide more grip while walking in the snow.   The American Foundation for the Blind has other tips for white cane users in their article Traveling with Your Cane in Winter Weather.

man's head, wearing a headband with warmers over earsDid you know that winter weather can cause damage to hearing aids?  Cold temperatures can drain batteries faster.  Damage can occur when moving from the cold weather outside to the warmer temperatures inside as condensation builds up.   Audiologists recommend opening the battery compartment when not in use to allow for airflow. Wearing earmuffs, a hat, or a headband (some have inserts for hand warmers) may also protect the device, and some people use a hearing aid dryer or dehumidifier.

To discover other ways to protect you and your AT this winter, check out our webinar “Your Assistive Technology in Winter“.

As much we may complain about the winter and snow, there is no denying it’s beauty and the fun that can be had during the season.  I hope these tips help you to get out and enjoy what the season holds.



Winter scene from the Keewenaw Peninsula
Winter in the Keewenaw.  Credit: K. Wyeth







How Paid Leave Can Be a More Flexible Accommodation

Return To Work Cycle, with 3 sections, Accommodations (Accesibility Standards, Duty to Accommodate, Assistive Technology),Support For Recovery (Sick leave-injury-on-duty leave, Disability benefits-workers compensation, early intervention, case management and remain-return to work plan), Prevention (Employee Assistance Program and Wellness Programs, Special Working Arrangement, Occupational Health and Safety legislation and standards, Emergency and business continuity plans)
Returning To Work

Until recently, the general approach to paid leave as an accommodation was to allow or require it unless it reached the ADA threshold of an “undue burden”. For example, Federal ADA guidance suggests the following two-factor approach to this threshold:

“Undue burden means significant difficulty or expense. In determining whether an action would result in an undue burden, factors to be considered include —

(1) The nature and cost of the action needed under this part;

(2) The overall financial resources of the site or sites involved in the action; the number of persons employed at the site; the effect on expenses and resources; legitimate safety requirements that are necessary for safe operation, including crime prevention measures; or the impact otherwise of the action upon the operation of the site;”

In a case in the 7th Circuit, Severson v. Heartland Woodcraft, Inc., No. 15-3754 (7th Cir. Sept. 20, 2017 for Illinois, Indiana, and Wisconsin), the court’s decision set a much more specific standard, by saying that several months or an indeterminate length of paid leave would meet the “undue” threshold. Of course, this decision could be appealed, or other Federal Circuits could define this threshold differently. But, it is typical in civil rights law for relatively flexible standards to become more and more specific over time. This very ordinary evolution of law can be seen clearly in special education law and rules decisions, for example.

I think our community has to assume that over time, paid leave as an accommodation will become less and less flexible. We need to embrace approaches that introduce more flexibility in the use of paid leave, and which support more control by us in the use of it.

One way that has been around for a long time is to look at rehabilitation during paid leave less mechanically than, “You are on rehab leave until you are fully rehabilitated.” Individuals who have experienced a work-related injury receive their rehabilitation services at their work site, and even in the actual workstation,  they used before the accident. PT and OT, for example, are provided focused on outcomes that are tied directly to what the person did prior to their injury.

Embracing the concept that accommodation should not be just passive support, but could be organized around a more flexible concept of “return-to-work”, Assistive Technology could be a resource for an at-work sequence of rebuilding the old job around the new reality of the disability. This kind of support could be implemented without making any assumptions about indeterminate accommodations or what might constitute the ultimate configuration of AT for a person as they reimagine how they might do their old job well. The person could work into a supported version of their job gradually, by learning to adapt and as the need for accommodation evolved during personal recovery. Customization, always a core of effective AT, could be expanded to include the expectation that the configuration of individual accommodations would change during recovery.


Accommodation and Compliance Series: Return-to-Work Programs

Return to Work or Stay at Work and Accommodations: Part 1

Return to Work: A Snapshot: Part 2