Improving Computer Access and Environmental Controls

Background

CC (name and initials changed for confidentiality) was 54 years old when she was referred for an AT evaluation by her nurse practitioner in March of 2004. CC was diagnosed with MS many years ago. CC resided in a skilled nursing facility in a suburban area. Effects of MS in Participating in Functional Work Activities At the time of this evaluation, CC experienced the following limitations:

• Physical: CC experienced mobility impairments. She presented with flaccid paresis of both lower extremities, hypertonicity of both upper extremities with flexion contractures of hands, fingers, writs, and elbows bilaterally. She used a wheelchair but was unable to independently operate her chair. CC also reported fatigue.
• Cognitive: No thinking, attention or memory concerns were observed or reported.
• Visual: CC reported adequate vision with corrective lenses. She reported occasional difficulty with small or detailed print on a monitor, which was generally more associated with fatigue and improper positioning.
• Hearing: No hearing difficulties were reported.
• Communication: CC reported no speech difficulties except when she was using voice recognition software after many hours. During these instances her volume and clarity would decrease.
• Environmental space: CC had a computer in her room that she used on a daily basis. She had considerable difficulty with the positioning of the monitor.
• Current Access to AT: CC used her computer from 10 am to 1 pm. During this time she wrote emails, surfed the internet, completed journaling activities, and wrote short stories. On her computer she had Dragon NaturallySpeaking (professional 7.0) that she used to access the computer. She used a single switch that is clipped to her collar for activation of her environmental control unit (NEMO) which was mainly used for telephone activities. CC reported maintenance and activation issues with the NEMO switch related to positioning. Also attached to her collar was a call button for the nurse.

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

Treatment Intervention Goals

CC would like to improve computer access related to positioning and visual needs. CC was interested also in improving switch options for her environmental control unit and speaker telephone position when answering from a reclined position.

Assistive Technology (AT) Intervention

CC was evaluated by Curt Johnson, MS, ATP, a Rehabilitation Counselor and Assistive Technology Practitioner in March 2003. The following equipment and adjustments were recommended, based on evaluation and trials with equipment and taking into account CC’s preferences.

Flat-panel monitor: It was recommended that CC receive the Dell (E152FP) 15 inch flat-panel color LCD monitor to improve her ability to view her monitor.

Microsoft Windows Accessibility Options: During the evaluation, Windows XP accessibility features were implemented to increase font size and resolution. The mouse cursor was also changed to a large black pointer.

Adjustable LCD monitor arm: Monitor positioning could be improved through the use of an adjustable LCD monitor arm such as ErgoMart SAA-7000.

Before

After

Microlight Switch: CC had difficulty with activating the NEMO system at times. This could be improved with a microlight switch that is positioned with a “snap-to-fit” modular hose (part #40452).

Before

After

Exponent Telephone Stand: It is recommended that to improve positioning of CC’s telephone and NEMO system she should receive the Exponent Telephone Stand (Fry Electronics part #420880).

Before

After

Outcome

All of the above recommendations were implemented and determined to be successful. Following installation of recommended equipment and adjustments, CC reported an increase in being able to comfortably using her equipment including improved ability to see small text on her monitor as well as access to ECU.

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