Rehabilitation and Prosthetic Services

By: Meg Dimpfel, MOTR/L, ATP 

Overview

The Quha Zono is a wireless gyroscopic alternate mouse control, for access to personal computers, cell phones, or tablets. While most typically used in one of multiple head-mounted fashions, the Zono can also be programmed for use on any part of the body, such as the hand, foot, or leg. The Zono is mounted to the user's body through a variety of optional manufacturer accessories. Left and right clicks are made through use of a dwell feature, single-switch activations, or mouse click software downloads. Double click and similar features can be programmed as well.

Indications

• Veterans who are unable to utilize standard or other mass-market mouse control for effective and efficient computer access.
• Veterans with cognitive skills to translate head and non-standard mouse control physical movements to on-screen mouse feedback.
• Veterans with the cognitive and physical abilities to utilize one of the various mouse click options
• Patient populations likely well-served with this device
• ALS
• MS
• Quadriplegia, particularly C2-C5, or those with cervical central cord injuries, for whom more main-stream hand/arm controlled options are not feasible
• Similarly complex neurologically impaired Veterans
• Bilateral UE amputees
• Those on long-term bedrest for wounds or related complications, requiring wireless mouse control and without good options for a surface on which to place a hand-controlled mouse or a mouse to accommodate to positional changes through the day

Contraindications

• Cognitive impairment to the extent use of a non-standard style mouse cannot be accommodated to or learned.
• Due to small size of the device, this item will be at danger to be lost or misplaced by the user or caregivers, therefore living situation and caregiver reliability should be taken into account. 
  

Criteria for Evaluation of Assistive Technology Device

Affordability: The product is based and produced in Finland, with United States distribution through one primary and ten secondary national vendors as listed on the websitewww.quha.com. The price of the device itself is $999. Mounting accessory prices start at $59. Single switches (available from US vendors who also sell the Zono, or separately per clinician preference) range from $90 for a mechanical switch to $350-$400 for puff or air switches which mount directly to the device when head-mounted.

The product comes with the following parts:

• Quha Zono mouse
• USB receiver
• Zono button adapter
• USB charging cable
• Adapter for the button adapter, to enable dual switch control instead of single
• User manual and CD which contains additional Zono programming capabilities

All mounting options are sold separately and should be ordered with the product; these are sold by the manufacturer.

Manufacturer mounting options include:

• Headband (worn overhead, like a headband)
• Head Mount Kit, which includes a neckband (wraps behind the user's head, from ear to ear) and the light eyeglass clip
• Light eyeglass clip (to attach to Veteran's personal eyewear or may also

  be used on a strap wrapped on the user's foot, arm, hand, etc)

• Eyewear kit (glasses style-frame which sits on the users ears and nose, and holds the Zono in position on the side of the head)
• Baseball cap

Additional cost will be incurred if mouse click selections will be made with single or dual switches, or on-screen software instead of the built-in dwell feature.

There are not interchangeable batteries or routine maintenance costs.

Compatibility: The Zono can be used with both Windows and Mac based personal computers, as well as non-iOS based tablets and cell phones. The Zono is not compatible with iOS based tablets or cell phones. Listings of specific criteria for computers, tablets, and cell phones are included on the manufacturer website. Of note, the Zono can also be used with tablet-based ECU/SGDs for alternate mouse control on these devices as well. The Zono CD software for advanced mouse adjustments is only compatible with Windows based computers, therefore any advanced setting adjustments (ie: setting up the mouse for use on the foot instead of head) require a Windows based computer with CD drive. These settings are stored on the mouse itself, so once adjusted the mouse can then be used on the Windows or iOS devices described above.

Consumer Repairability: The Zono mouse itself is a completely self-contained unit and the battery is rechargeable and cannot be changed by the user. Any damaged parts would likely require replacement.

Dependability: The device has proved dependable to this time, and has been trialed in the writer's clinic on Windows and Mac PCs, as well as using a variety of click methods and body location attachment points. The battery is advertised to last 4 days between charges. It goes into a sleep mode when not in contact with the USB dongle but does not require any activations to wake the mouse back up for use.

Durability: The device is durable and is not expected to require significant/frequent repairs. If at some point the device or its accessories become inoperable, it is likely that it will need to be replaced rather than repaired.

Ease of Assembly: Device assembly requires very little setup. The Zono will need to be charged and then attached to the mounting interface being used. Installation can be very simple "plug-and-play" if the Veteran is using the device on the head with the default settings.

Further setting adjustments to the Zono itself, or changes to the computer's mouse control settings will require additional setup via the software which requires a Windows computer with CD driver to access, or can be downloaded from the Internet. A user with basic computer knowledge should be able to connect and set up the device with the instructions provided and on-line resources. The wireless USB dongle interface connects to a standard computer USB port or can connect to a mini-USB port on a tablet with a separately purchased adaptor (not available from Quha directly). The unit comes with simple and concise instructions for set up and use; additional tutorial videos and FAQs for setup and use are available on the manufacturer's website. Once set up, the user will likely need to adjust their computer mouse settings, either through the computer's control panel or the advanced settings software CD included with the device.

Ease of Maintenance: The vendor claims the fully charged Zono battery will last 4 days; this has not been tested in clinic by this writer. The Zono can be charged only via a wall plug; there is not a USB charging option. All casings and mounts are made of plastic or rubber and therefore easily cleaned/disinfected accordingly.

Effectiveness: The Zono is generally intuitive in the use and function. It was successfully used by the writer of this review on Windows/MAC laptop and desk top systems, with head, hand, foot, and upper arm access points. Adjustments to speed and responsiveness can be made with the Zono software or the standard computer mouse settings.

Flexibility: The Quha Zono can be used with factory settings on the head, either foot, or either hand. The device is able to accommodate to a variety of directions of positioning on any of those locations (ie: if the device is attached and set for use on the "left hand", it does not affect performance if the device is attached to the user's left hand while pointing to the left or the right). Additionally, a user or clinician can set up the device to work on any customized location on the Veteran's body. For example, this writer has successfully trialed custom setup of the device strapped to the upper arm to simulate use by a person with an above elbow amputation. Users with limited range of motion or positional deformities are able to utilize their own best movements for custom horizontal and vertical activations of the device.

    When used with switch click access, the switch can be connected to the Zono itself or the USB dongle on the electronic device. This enables a variety of positioning options to match the user needs.

Learnability: If the user is able to utilize the system without adjustments to their mouse or the advanced settings, they would only need to charge it in advance, plug the USB into their computer, and turn the Zono on. No specialized training is required.

Adjustable options which would optimize user performance include

• Adjustment of computer-based control panel functions such as mouse speed
• Adjustment and trials of various switches for left and right click options
• Adjustment of the software advanced settings such as body locations, vibration attenuation settings, mouse click options, etc.
• Trial of various body locations for optimized access and minimized fatigue.

Operability: The mouse requires a single large button activation on the side to wake it initially, but the battery will last throughout the day. The Zono can be used from a wheelchair, bed, or any other position and moves with the patient. The Zono does not require direct line of sight to the USB dongle receiver in order to function, and the overall Bluetooth range is large enough that the device works effectively from across a large room, therefore a user could be lying in bed, and activate a computer located across the room.

Personal Acceptability: Since the user must wear the device, some individuals may not be interested from this perspective. Overall the device is light weight and subtle, depending on how it is worn. It may get in the way of other activities in the day (ie: use of a head array to drive a wheelchair if positioned on the head; or use of a hand cuff to eat a meal when positioned on the hand), so use should be considered in this wide variety of daily contexts and in recognition of potential interferences.

Physical Comfort: A variety of headbands, straps, etc have been trialed by this writer with good comfort. It should be noted the headbands are not adjustable, so may not fit all users. The device could easily be used with a user-specific designed mount or modification to existing mounts without interference to the device functions. The eyeglass clip is notably soft and pliable and could be used to attach the device to a pant leg, sock cuff, or similar location without risk to skin.

Portability: The device can be quickly taken on/off of the user or the device being activated and moved to a new device. Since the settings are stored on the Zono itself, only device-specific settings would need to be changed on a new device for the Zono to work. With assistance from a caregiver (due to the likelihood of limited physical abilities of the Zono user) the USB could readily be installed onto a new computer or device and the user would quickly be independently accessing the new device. The Zono can be programmed to attend to multiple USB dongles so can be used across devices in this manner as well, but the manufacturer recommends ensuring separate devices are turned off so the Zono does not attempt to control two devices at the same time.

Securability: The Zono is worn by the user, so depending on individual vulnerabilities, may have securability concerns. The device is small, so risk of theft may be present, though the device use is not readily apparent to an unfamiliar user so may not be an appealing target for this reason.

Supplier Repairability: The device does not have features that would be repaired, but more likely replaced. A creative clinician may be able to come up with alternate customized mounting or repairs to the accessory/mount options, but in terms of the device itself, the Zono and USB dongle are self-contained and do not lend themselves to repair or battery replacement.