Case 1: Modifying the Work Environment to Improve Productivity, Organization, and Enhance Endurance

Background

SS (name and initials changed for confidentiality) was 53 years old when she was referred for an AT evaluation by the Division of Vocational Rehabilitation (DVR) in March 2003. SS was diagnosed with MS approximately 18 years prior. SS was self-employed with her husband in their electronics store. SS worked in an office and used a computer. Her work activities included:

• completing purchase orders
• general posting
• payroll
• monthly expense reports
• taxes
• Inventory

Initially, SS had two different workstations. There was also a cot in the back office area for her to rest when experiencing fatigue, e.g., in the afternoons.

Effects of MS in Participating in Functional Work Activities

At the time of this evaluation, SS experienced the following limitations:

• Physical: SS experienced mobility impairments, fatigue, significant weakness, reduced bowel and bladder control, pain. She used a power wheelchair with a joystick on the right side. She had limited fine motor control with both arms and hands, but more intense on the left side. SS reported her energy level was best in the morning, when she was well rested.
• Mood: SS reported depression.
• Cognitive: No thinking, attention or memory concerns were observed or reported.
• Visual: SS reported some difficulty with visual acuity. She wore corrective lenses and had a cataract on her left eye. She experienced some variability with vision; her best vision was in the morning.
• Hearing: No hearing difficulties were reported.
• Communication: No reported difficulty.
• Environmental / Work space: SS reported difficulty with positioning, placement and use of the mouse with computer related work, as well as limited overall desk space. She reported difficulty with adjusting the computer screen when her visual difficulties were exacerbated. The visual difficulty also affected her ability to keep her place (visually) on documents during data entry. Finally, she noted difficulties with efficiently accessing documents and organizing information.

Treatment Intervention Goals

SS was interested in identifying AT devices / equipment to improve her accuracy and productivity with computer tasks on the job, and to assist with organization and access to work documents and materials. SS wanted to enhance her endurance, e.g., length of time she was able to work, through adjustments in access to and comfort with her equipment.

Assistive Technology (AT) Intervention

SS was evaluated by Curt Johnson, MS, ATP, a Rehabilitation Counselor and Assistive Technology Practitioner at the University of Washington Medical Center (UWMC) Assistive Technology Clinic in March 2003. The following equipment and adjustments were recommended, based on evaluation and trials with equipment and taking into account SS’s preferences.

L-shaped Desk: The L-shaped desk was recommended with a return on her right side, as this is the side where she had the best function. It was also specified that the desk should not have interior legs and be of an appropriate height to facilitate wheelchair access.

Desk Before

Desk After

Adjustable Keyboard Tray: The adjustable keyboard tray was recommended to improve ergonomic access to the computer keyboard. It was specified that the tray needed to be of an appropriate height relative to the SS’s power wheel chair access and have the ability to swivel side to side and tilt.

Flat-Panel Monitor with Adjustable Arm Support: The flat-panel monitor with adjustable arm support was recommended to allow for purposes of visual comfort and reducing visual fatigue. In addition, it would create more space on SS’s desk.

Wireless Optical Mouse: The wireless optical mouse was recommended to improve flexibility and ease of targeting.

Multiple Document Resource Holder: The multiple document resource holder was recommended to aid in organization of and access to key information required for her job. It was specified that this should be mounted on a three position arm that could be positioned close for visual needs, but then retracted when not in use.

Focal Copy Holder with Guideline Ruler: The focal copy holder with guideline ruler was recommend to assist SS with holding documents and providing a visual aid (the ruler) to visually keep her place on documents.

ZoomCaps: ZoomCaps are large adhesive labels to affix to each key on the computer keyboard. These were recommended to aid vision with searching for keys.

Focal Copy Holder with Guideline Ruler (left), Zoom caps (center) and Wireless Optical Mouse (right)

Windows Control Panel Modifications (for visual enhancement): Several adjustments to the windows operating system were recommended to help vision and physical access to the computer. These adjustments included:

• Increasing the size of text and graphics
• Use of “sticky keys,” to reduce needed keystrokes with one-handed keyboard use
• Use of “filter keys” to ignore brief or repeated keystrokes
• Relocation of office equipment to the right side of SS’s desk was recommended, as this is her strongest side and would facilitate ease of access.

Outcome

All of the above recommendations were implemented, except for the Windows accessibility options. All of the recommendations were determined to be successful. A plan was put forth to follow up regarding further computer accessibility options, if needed. Following installation of recommended equipment and adjustments, SS expressed satisfaction with her new workstation. In addition, she demonstrated good ability to make good use of the equipment and recommendations.

Return to Assistive Technology & Universal Design Resources:

• Assistive Technology & Universal Design Resources