Digital accessibility for epilepsy

The internet is full of flashing and moving things and this can be a terrible experience for those who struggle with Epilepsy. Here's what you can do.

Epilepsy is an often misunderstood medical condition that affects an estimated 3 million adults and 470,000 children in the United States. This is around 1.2% of the US population. Statisticians document active epilepsy cases, but do not include those that are not diagnosed by a doctor or self-reported/parent reported. This means that some people could have epilepsy and be unaware of it. Some types of seizures don’t look like what most people think of when they think of seizures, so some cases may be missed.

Epilepsy can affect reading and comprehension in some people. The type of epilepsy is often a significant contributing factor.

Before we begin: What is epilepsy?

Epilepsy is a neurological disorder, the fourth most common in the world. It is characterized by seizure activity that can cause a wide range of symptoms and presentations. It is caused by surges of electrical activity in the brain that triggers recurring seizures. The propensity for seizures depends on the person’s threshold for seizure activity, meaning their sensitivity to stimuli that can act as a trigger.

Epilepsy causes seizures that are unprovoked and recurring, but it also causes sensitivities to triggers that can lead to a seizure. The diagnostic criterion for seizures is often contingent upon several criteria:

• Two seizures or a single seizure that has a high risk of more seizures – all unprovoked
• Several instances of seizure activity within a given time
• Seizure activity combined with increased risk factors for seizure activity such as brain injury or neurological conditions
• Seizure activity combined with increased risk factor for seizure activity such as a family trait

While doctors know what triggers seizures, the cause is often not known. Even when brain trauma is involved, the precise dynamics within the brain that lead to a seizure is still being researched because it simply is not known.

There are many different types of seizures, but they typically fall under one of three categories:

• Focal Onset (aware or impaired awareness) – Can start in a certain area of the brain or group of cells in the brain but on one side only.
• Focal Onset Aware – The person is aware and awake while having a seizure. Also called a simple partial seizure.
• Focal Onset Impaired Awareness – The person’s awareness is impaired, or they are confused during the seizure. Also called a complex partial seizure.
• Motor or Non-Motor
  
• Focal to bilateral tonic clonic
• Generalized Onset (impaired awareness) – Affect both sides of the brain simultaneously.
• Motor
  
• Tonic-clonic
• Other motor
• Non-Motor
  
• Absence
• Unknown Onset – The beginning of a seizure is unknown or if no one witnesses it or sees it when it occurs, such as if the person is alone when they have the seizure, or it is at night while they are asleep. As the seizure activity is explored and the doctor gains a better understanding of what’s going on, it may be diagnosed later as a generalized or focal seizure.
• Motor
  
• Tonic-clonic
• Other motor
• Non-Motor
  
• Absence

Motor symptoms usually involve jerking movements, flexing, muscle twitching, muscle rigidity, or the muscles can become weak. Non-motor symptoms usually involve staring spells, twitches, repetitive movements and they can affect just one part of the body.

Common issues for epileptics on the internet

People who have photosensitive epilepsy, meaning that their seizures are triggered by high contrasting patterns, flickering lights, strobing lights, or flashing lights. They may also have seizures at other times, but these situations seem to trigger seizures – mostly tonic-clonic.

So, a person with epilepsy who accesses the internet has to be careful about the type of content that they access. Even looking at videos on social media could lead to a seizure if they encounter content that could be seizure-inducing.

Many browsers are now taking steps to improve accessibility for epilepsy while also educating content producers on how to be more aware and careful of what they create. Digital accessibility has been an ongoing priority, not just with browsers, search engines, and content types, but also with companies, organizations, and even the government. There is a massive push to make the internet accessible for all, regardless of disability or impairment.

Solutions: Tips for reading with epilepsy

There are some things that people with epilepsy can do to have a safer reading experience. There are three ways that flashing can be caused on a computer. It can be the display, the computer, or the content. Flashing that is caused by the display or the computer may be an issue with the computer. However, users do have a good deal of control over their browsers, hardware, and operating systems.

Browsers – Use a modern browser and make sure it stays updated. The best browser for epilepsy has settings that make it easy to adjust to the necessary accommodations that a person with epilepsy needs based on their own personal experience. Chrome and Mozilla are two great accessible browsers, but others are quickly getting on board as well.

Personalization and accessibility settings

These settings will give you a lot of control over how content is displayed. Under accessibility settings, you can request to remove animations which may also be under reduced motion. Disabling Auto-Play is also important, although it does not work for GIFs, because that animation is self-contained. The settings do not affect it.

Reader mode

Depending on the browser, you may have to manually make some of these changes, but check for these accommodations:

1. Content blockers enabled
2. Text-to-speech enabled
3. Font selection enabled
4. Page Zoom enabled

Turn off GIFs

In the browser settings, turn off animated GIFs. There are also GIF blockers that are available as browser extensions:

• GIF Scrubber
• GIF Blocker
• Beeline Reader
• Photosensitivity Pal – This Chrome extension blocks content that has the likelihood of inducing seizures.

Operating systems

Windows 10 has a number of options that improve  and can be used to improve the browsing experience. The easiest way to find these settings is to access the search finder of the operating system and type or say “Accessibility.”

The World Wide Web Consortium (W33C) has guidelines for developers in its Web Content Accessibility Guidelines (WCAG) to make content accessible for people who have epilepsy. Some of the recommendations include:

• No content has any component that flashes more than three times within a 1 second timeframe.
• Flashing areas should be kept small, no larger than 341 pixels by 256 pixels.
• Reduced contrast for any content that flashes.
• Allow users to set their own custom flash rate.

Must-have apps for those with epilepsy

There are a number of apps available that can help people with epilepsy have a better online experience and improve their reading experience. These are some of the best apps for seizures.

HealthUnlocked

Connect with other people who have epilepsy or many other health conditions. It is a good way to network and get tips, ideas, support, and information.

Seizure Tracker

Available for Android, iPhone, and Alexa. A tremendous resource that includes apps designed to help track seizures and more. Warning! When accessing the website, there is a “Free! Sign Up” button on the left at the top third of the page just under the graphic. When you scroll to that section of the page, it is animated and shakes briefly.

Seizure First Aid

Also available on Apple, this app provides vital information including first aid if you encounter a seizure, as well as tools that let you time and track seizure activity.

Speechify

This text-to-speech app has a number of exceptional features that can make it easier for people with epilepsy or seizure disorders to read online:

1. Speed settings that read faster or slower, you choose
2. Text highlighter that can be turned off or on if you want to follow along.
3. Auto-scroll to limit screen exposure.
4. Dark mode

Living with epilepsy may mean some adjustments to your life, but it doesn’t mean you can’t have a good quality of life. Speechify can help. Visit our website to learn more and grab your free trial to give us a test drive and see what a difference text-to-speech can make for you.

FAQ

Can Gifs trigger seizures?

Some gifs do have the potential to trigger seizures in people who have a low seizure threshold or who are epileptic. Content that blinks, flashes, strobes, or flickers can be a trigger for photosensitive epilepsy. Any of the web technologies that involve motion, such as video, JavaScript, animated pngs, Canvas, animated gifs, CSS, or animated SVGs do have the capability to induce seizures, migraines, and other physical reactions, depending on the sensitivity of the viewer and the content that is portrayed.

Does epilepsy affect reading?

Some types of epilepsy can impact language patterns, making it more difficult to read. Many of the different types of epilepsy, particularly generalized epilepsy, affect a wide range of neurological functions that involve language, comprehension, and in some cases, reading.

Can reading cause a seizure?

There is a type of epilepsy called reading epilepsy. It typically begins in the teen years and is triggered by reading. At first, it triggers myoclonic seizures, which are brief jerks around the mouth and jaw. However, if the person continues reading while the myoclonic seizures occur, there is an increased risk of escalating to a tonic-clonic seizure.

Can people with epilepsy use the internet?

People with epilepsy can use the internet, but they should do so carefully. Devices with LED screens do flicker, although it may be imperceptible to most people. However, some screens do produce a visible flicker, although even an “invisible” flicker can be a trigger for some people. Add to that, the various web technologies that include video, gifs, JavaScript, and many others that have flashing, strobing, flickering, and blinking content and the potential for photosensitive seizures is increased.