“It’s definitely not a toy,” says Nate Higgins. “I really depend on it a lot.” The “it” is his Alexa-powered Amazon Echo smart speaker, and Higgins, who lives in Chatsworth, Georgia, is a quadriplegic who has been confined to a wheelchair since 2001.

Most of those who own an Echo or its smaller sibling the Dot (shown above) treat these voice-activated devices as novelty items that can amaze their friends by getting a weather report or reeling off jokes on command. But Higgins uses his Echo assistant for essential tasks—from reading books to controlling a programmable thermostat—that he couldn’t accomplish on his own.

“The independence it provides is just overwhelming,” he says.

Higgins is part of a growing number of individuals with disabilities who are finding expanded uses for the Amazon devices.

“The voice-activated feature is a way to address a number of barriers for people who can’t move their hands,” says Henry Claypool, a policy consultant with the American Association of People with Disabilities, a nonprofit advocacy group based in Washington, D.C. “The specific challenges of people with disabilities may seem routine to others. But simply getting groceries or scheduling appointments can be taxing for someone who has difficulty operating a telephone or navigating the internet.”

Less Expensive Than Specialized Equipment

According to Claypool, 1 in 5 individuals in the U.S. has a disability of some kind. The market for devices targeting them, so-called “adaptive technology,” is around $17.7 billion annually, according to a 2015 report by BCC Research. This encompasses everything from joystick-controlled wheelchairs to more commonplace devices, such as hearing aids.

But the relatively modest size of each slice of that market may curtail the pace of innovation. And many of these specialized devices are very expensive. To cite just one example, with a retail price above $5,000, the HumanWare Braillenote Touch 32 Braille note taker costs far more than even a very high-end laptop.

The Amazon Echo, on the other hand, was developed for a broader consumer market, and adaptive users are, well, adapting it for their own specialized needs. The benefits have been myriad, from the rapid development of new apps, or “Skills” (as Amazon calls them), for the device, to its relatively low price of $180—and just $50 for the company's similar Dot—which has allowed users on a limited income to buy the devices.

Amazon has several assistive-technology teams that help to develop products for this market as well adding features to current products like the VoiceView screen reader for Amazon’s tablet and Fire TV platforms. However, those teams didn’t need to add anything to the voice-command smart speakers, so growth of this informal “adaptive Alexa” movement has largely been organic, spread largely by word of mouth.

There are no statistics on how many persons with disabilities are using one of the Echo products, or a competitor product released by Google this fall. However, Claypool speculates that the number could be in the hundreds of thousands, considering that Amazon has sold more than 5 million of its Alexa-powered speakers, according to industry reports.

One Device, Many Uses

When he first heard about the Echo a year ago, Higgins was skeptical that its benefits would outweigh its nearly $200 cost, but when he researched more of the features last summer, he was sold. “I found out that it would read books with Amazon Audible and turn lights on, and with just those two things combined, I knew I had to have it,“ he says.

While its core skills of delivering music, information, and purchasing products through Amazon’s retail site have proved useful for Higgins, the Echo’s ability to control his Nest thermostat has made perhaps the biggest impact on his daily life.

“People with spinal cord injuries like myself, we can’t regulate our body temperatures like most people can. I can’t really sweat like everybody else does,” he explains. The Echo-Nest interface allows him to manage an important aspect of his daily life without help from a caregiver. “It’s really awesome. I can turn the heat up and down in the middle of the night without hollering at my mother.”

For Bev Weiler, a 54-year-old Bloomfield, Colorado, book-and-periodical-editor-turned-therapist, the Echo has become a family affair. She first bought one a year ago to help her 89-year-old father, who was coping with a sudden loss of vision due to a thyroid problem.

“He’s a retired anesthesiologist who’s also a crazy reader,” Weiler explains. “I set it up so he could use Audible books. He could get NPR on it. He’d ask it what time it was. I set up the Google calendar so he’d get up in the morning and ask, ‘What appointments do I have today?’”

Bev Weiler also has severely limited vision because of a degenerative eye disease. After seeing how the Echo worked for her father, she quickly realized she needed one for herself. She started out by using the basic functions: music, from Simon and Garfunkel to Green Day, and books, from Fredrik Backman to the Outlander series.

But Weiler, like Higgins, came to rely most on one of Echo’s Skills, which are added continually and now number in the low thousands. In her case, the Echo's most important function was helping her manage the lighting in her house. Weiler’s vision is significantly impaired but she’s not totally blind, so her house is outfitted with extra-bright LED lights that allow her to get around and even work in the kitchen. But there’s a Catch-22: It’s hard and even dangerous for her to get across a darkened room to find the switch to turn the lights on. The Alexa-powered Echo has become a high-tech alternative to that infomercial classic, The Clapper.

“I can get out of bed and I say quietly, “Alexa, turn on the kitchen light,” she says. “And then I can see where I’m going so I don’t fall down the stairs.”

Ahead: More Skills—and Competition

Weiler says that she's looking forward to controlling more aspects of her home through her Echo, as new products come onto the market and prices drop. Appliance makers including LG, Whirlpool, GE, and Samsung have all announced or launched such products recently. These include refrigerators, cooking ranges, and even robotic vacuum cleaners.

For some users, Alexa's simplest abilities are the most potent. Using the device to compile a family shopping list has been a huge help to a Kansas resident named Becky and her husband, Bob, who has Parkinson's disease. (Becky asked us not to publish their last name or hometown.) 

“While most of us don’t think a thing about getting up to walk to the shopping list that hangs on the refrigerator, it is a Herculean effort for him,” she explains. “Sometimes by the time he would get to the list, he’d forget what he was going to write down. Or he’d get there and his hands wouldn’t work to write on the list. That’s seriously frustrating to someone with a disability,” she says. “Being able to tell Alexa, ‘Add eggs’ made life better for both of us.”

And the shopping-list function helps in a surprising way, as well. “There have been times when he has checked the Alexa app to see if items are disappearing off the grocery list, and then he knows he doesn’t have to worry about me and knows I’ll be home soon,” Becky says. “I know it sounds silly but that’s the kind of thing that people living with disabilities face, and anything that can give comfort is a huge deal.”

While the Echo remains the dominant player in this small but emerging adaptive market, that’s due largely to Amazon’s significant head start over its competitors rather than any obvious technical advantages. In coming years Google’s Home assistant, or similar voice-controlled devices from companies such as Apple or Facebook, could easily become the device of choice for the adaptive community. This will largely depend on the functionality that third-party skill developers add to the devices and on which voice-activated assistants gain the widest support among makers of appliances and other home devices. 

Regardless of how the market shakes out, as the connected-home trend grows over the next few years, adaptive users are poised to become important beneficiaries.

“The price of devices like these typically comes down, and functionality spreads and works its way into other devices,” says Claypool. “I think we’ll see the Alexa as gateway to things that they never even thought of when they designed it. It’s just the beginning for people with disabilities.”