Providing Computer Access for Persons with Quadriplegia

Background

DD (name and initials changed for confidentiality) was 54 years old when he was referred for an AT evaluation by his physician in March 2004. DD was diagnosed with MS many years ago. DD 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, DD experienced the following limitations:

• Physical: DD presented with spastic quadriplegia and remained in bed throughout the day, with the exception of approximately 2.5 hours when he was in a wheelchair. He has no use of his upper or lower extremities.
• Cognitive: No thinking, attention or memory concerns were observed or reported.
• Visual: DD wears mono-vision contact lens.
• Hearing: No hearing difficulties were reported.
• Communication: No hearing difficulties were reported.
• Environmental space: DD shared a room with two other gentlemen 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. Prior to his current medical status, DD used his desktop computer at home and had a working knowledge of Microsoft Windows and early version of Dragon Naturally Speaking. Due to the limited space in his room, he was unable to relocate previously used desktop to his room. In addition, the computer is outdated and did not have the capacity or speed for current software applications. DD did not have the financial resources to purchase a new computer or adaptive equipment himself. DD uses a mouth-stick to dial his telephone and remote control holders using PVC pipe that was constructed by a friend.

Treatment Intervention Goals

DD would like a viable means to access a computer. He believed a computer would increase independence, improve communication options, provide productive activity, expand avocational interests and allow him to research and design adaptive equipment for himself and others.

Assistive Technology (AT) Intervention

DD was evaluated by Curt Johnson, MS, ATP, a Rehabilitation Counselor and Assistive Technology Practitioner in March 2004. The following equipment and adjustments were recommended, based on evaluation and trials with equipment and taking into account DD’s preferences.

Laptop Computer: A Toshiba Satellite P20 with a wide screen XGA display was recommended. The computer has Wi-Fi capabilities and DD will use the wireless Internet services in his residence.

QuadJoy Mouse: The QuadJoy Mouse was recommended for DD for mouse emulation. It was designed for quadriplegics and has all the functions of a standard 5 button wheel mouse. Cursor direction is completed by moving the joystick with one’s mouth and clicking completed by either sip or puff.

On Screen Keyboard: “OnScreen” on screen keyboard developed by IMG was recommended as it has a variety of features to improve productivity and accuracy. It has a number of features including word prediction, visual enhancements, text-to-speech and assignable key functions for macro scripts.

Outcome

All of the above recommendations were implemented and determined to be successful. Following installation of recommended equipment, DD reported an increase of recreational activities and a return to activities he previously enjoyed. He reported feeling that the AT provided opened up a “whole new world” to him.

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