Case 2: Modifying the Living Environment to Increase Independence

Background

BB (name and initials changed for confidentiality) was 57 years old when he was referred for an AT evaluation by his physician in August 2005. BB was diagnosed with MS approximately 7 years prior. BB resided in a skilled nursing facility in an urban area. He previously was employed as a manager in a jewel distribution company and would write articles about fine jewels. Effects of MS in Participating in Functional Work Activities. At the time of this evaluation, BB experienced the following limitations:

• Physical: BB experienced mobility impairments. He had no functional movement in his lower extremities and used a power wheelchair approximately 3 times a week. He has poor upper extremity proximal strength but has good right hand movement. He has poor residual movement in his left upper extremity and is unable to open his left hand.
• Cognitive: No thinking, attention or memory concerns were observed or reported.
• Visual: BB reported no functional visual difficulties although he wore reading glasses to view a monitor.
• Hearing: No hearing difficulties were reported.
• Communication: BB had decreased speech volume which made it hard for listeners to hear him. He had no other speech difficulties.
• Environmental space: BB shared a room with one other gentleman in a small room in which space was an issue.
• Current Access to AT: The computer in the facility was for all of the residents and therefore had limited flexibility in regards to adaptive equipment. He previously had an IBM laptop which was now 14 years old and not functional. BB did not have the financial resources to purchase a new computer or adaptive equipment himself.

Treatment Intervention Goals

BB would like a new computer to increase his independence, improve communication options, provide productive activities, expand avocational interests and allow him to research areas of interest. BB was interested in improving access to his TV remote and his cordless phone.

Assistive Technology (AT) Intervention

BB was evaluated by Curt Johnson, MS, ATP, a Rehabilitation Counselor and Assistive Technology Practitioner in August 2005. The following equipment and adjustments were recommended, based on evaluation and trials with equipment and taking into account BB’s preferences.

Laptop Computer: A Toshiba Satellite A70 with a wide screen XGA display was recommended. The computer has Wi-Fi capabilities and he will use the wireless Internet services in his residence when available. Until then, he used a free ISP that is available in the city he resides in.

Mini Switch Click: BB was observed to be able to accurately use a standard mouse when targeting icons or on-screen keyboards. Due to fine motor difficulties he was not able to click the mouse. The Mini Switch Click was positioned at the right side of his head and acted as a left click when it was activated. It has a USB port and plugs into the computer.

On Screen Keyboard: “WiViK3” on screen keyboard was recommended as it has a variety of features to improve productivity and accuracy. It has a number of features including dwell selection or switch-based scanning, word prediction, visual enhancements, text-to-speech and abbreviation expansion. BB was particularly interested in the text-to-speech component as another expressive communication option.

Magic Arm: BB’s phone and TV remote were mounted with Velcro onto the Magic Arm which is an adjustable mount that was positioned on his right hand side. In this position he was able to access both devices. He used a headset on the phone for private phone conversations or if he wanted to improve phone reception.

Review of Microsoft Windows Accessibility Options: BB was given a refresher course in relation to computer access and windows accessibility options (sticky keys). His computer was also modified for enlarged fonts, icons and mouse point, with mouse speed also reduced. BB was also assisted in setting up a personal e-mail account through a free service.

Outcome

All of the above recommendations were implemented and determined to be successful. Following installation of recommended equipment and adjustments, BB reported an increase in participation in a variety of life activities, some of which were not available to him previously. He planned on resuming contact with past friends and return to writing. Computer savvy friends and family served as technical support.

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