side view of a man wearing a headset, speaking into the microphone against a bright blue background

Combining Software and Devices to Maximize Computer Access

For some people technology might make some tasks a little easier or help them be a little more efficient, but for a person with a disability, technology may allow them to

independently perform tasks that they otherwise would not be able to do. Dan M., a 40-something with the degenerative neuromuscular disorder Friedreich’s Ataxia, is a wonderful example of how technology can have a tremendous and liberating impact on someone's life.

Advancing Opportunities’ Assistive Technology Specialist Kristen Russell, OTR, ATP, conducted an assistive technology evaluation with Dan though the New Jersey Division of Vocational Rehabilitation (DVR). He currently works as an Avon consultant, and spends the majority of his work time on the computer. Despite already having a wheelchair accessible desk and a Big Keys large key keyboard, Dan was having difficulty with computer access due to his fine motor and visual challenges.

Dan identified several issues with computer access: he had difficulty seeing his mouse cursor and smaller fonts on the monitor; switching between his mouse and keyboard was difficult, and he became fatigued when typing on the keyboard. Because of these issues, he had to dictate much of his work to his assistants. His goal through this evaluation was to be able to perform computer tasks more independently, accurately, and efficiently. Dan was also hoping to improve his typing speed.

After observation, discussion, and the exploration of many different options, Kristen identified specific tools for a trial period. To address visual concerns, he trialed Zoomtext Express, which provides some basic features for someone with a visual impairment, including the ability to have an enlarged and colored mouse cursor and basic screen magnification. Dan found this tool to meet his needs visually.

He also trialed an Intellikeys keyboard with the Qwerty USB Overlay, which provides mouse and keyboard access on the same overlay. This allowed him to use the mouse without having to switch between the keyboard and the mouse. Even though Dan was pretty certain he would not like to use a keyguard, which is a plastic plate that sits above the keys on a keyboard and has an individual hole for each key, he agreed to give it one more consideration.

Keyguards often assist computer users with fine motor difficulties press keys more accurately without inadvertently pressing other keys. The keyguard in conjunction with some setting changes helped Dan type more accurately. He also found that they keyguard is very helpful in preventing his cat from “adding” to his documents when walking across the keyboard, many, many, times per day. The Intellikeys with the keyguard helped to minimize his fatigue, improve his accuracy, and also provided him with access to keys that were not available on the Big Keys Keyboard.

Dan also trialed Word Q word prediction software. Word prediction programs attempt to “guess” what the user is trying to type, and display a list of options based on the letters entered. Dan found that while this software did not speed his typing significantly, it did allow him to type with less fatigue. Kristen and Dan were able to add some Avon terminology to this software, which helped him type produce specific words and phrases with many fewer keystrokes. In addition, he found the text-to-speech feedback from Word Q, which allows him to hear back what he has written, to be extremely helpful. This allows him to hear each letter that he presses, and helps him to rely less on his vision, which has helped to decrease his fatigue.

Initially, speech recognition software was not something Dan was interested in trying. His speech is affected by his disability and it can be difficult for others to understand him at times. He had tried Dragon Naturally Speaking in the past and found it extremely frustrating and inaccurate. After getting to know Dan and his excellent computer skills over time, as well as seeing others with speech impairments use speech recognition software successfully, Kristen convinced Dan to give Dragon Naturally Speaking one more try. Dan trialed the software over a month, and found that it was able to recognize his voice very accurately. His strong computer skills, in combination with his consistent speech and high motivation to learn to use the software, allowed him to be successful with speech recognition. Since Dan has difficulty putting on a headset, he uses a desktop microphone and this lets him use Dragon without any assistance.

After acquiring these devices and software from DVR, Dan received training on everything. During this training period, Dan found himself using Dragon Naturally Speaking more and more. He memorized many commands, and used Dragon for much more than dictating text. He quickly learned to open Microsoft Outlook, create a new email, dictate the email address, subject, and entire email, and send the email all by voice! He often found using voice commands to be easier and more efficient than using his mouse. He still benefitted from having good access to his keyboard and mouse for those times when Dragon didn’t cooperate, but by in large, he relies very heavily on this software. During a recent timed typing sample, he typed a twenty word sentence using his keyboard in six minutes and dictated the same sentence into Dragon Naturally Speaking in fifty seconds with no errors!

Over time, Dan found he was having difficulty keeping the Intellikeys keyboard in the position he found least fatiguing to work in. After some troubleshooting to find the optimal position, Kristen figured it was time for a visit from Doug Reed, a Rehabilitation Technician who fabricates custom solutions in the Advancing Opportunities’ mobile workshop he drives around the state. Doug was able to create a desk mount for the Intellikeys that keeps the keyboard in the optimal position for Dan. Dan is able to pull his wheelchair directly up to the keyboard, therefore eliminating the need for him to reach for and position the keyboard himself. Doug set this up temporarily using Velcro until Dan was certain the keyboard was in the exact position he wanted. Once Dan was sure the positioning was perfect, Doug returned to permanently attach the desk mount to Dan’s desk.

With these tools, Dan has found that he can use the computer for much longer periods of time with less fatigue. This will be very important for him moving into the future when he may become fatigued more quickly. These assistive technology tools have helped him to be able to perform his job tasks with much more independence and efficiency.

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