Case 5: Increasing Computer Access to Improve Communication and Quality of Life

Background

HH (name and initials changed for confidentiality) was 56 years old when she was referred for an AT evaluation in June of 2006. HH was diagnosed with MS 9 years ago. HH resided at home with her sister who was her primary caretaker. HH previously was employed as an operational manager for a local fishing company but had since retired due to disability. She previously enjoyed active activities including kayaking, hiking, and gardening. Currently she spent her time watching TV and movies and reading. Effects of MS in Participating in Functional Work Activities At the time of this evaluation, HH experienced the following limitations:

• Physical: HH experienced mobility impairments. She was quadriplegic and had no functional movement of her upper and lower extremities. She had good range of motion in her head. She used a wheelchair for ambulation.
• Cognitive: No thinking, attention or memory concerns were observed or reported.
• Visual: No vision difficulties were reported.
• Hearing: No hearing difficulties were reported.
• Communication: HH reported increasing shortness of breath and difficulty getting enough air to project her voice.
• Environmental space: HH reported limited accessibility in her home and consequently spent a good amount of time in bed.
• Current Access to AT: HH previously had a laptop but reported not using it the last 2-3 years. The computer was 10 years old and was no longer stable. When she was using the computer she used a mouth stick for keyboarding and page turning. HH did not have the financial resources to purchase a new computer or adaptive equipment herself.

Treatment Intervention Goals

HH would like to use a computer for improved quality of life with the primary goals is to write a book. She was also interested in using a computer for communication via email, research through the internet, and independent reading.

Assistive Technology (AT) Intervention

HH was evaluated by Curt Johnson, MS, ATP, a Rehabilitation Counselor and Assistive Technology Practitioner in June 2006. The following equipment and adjustments were recommended based on evaluation and trials with equipment and taking into account HH’s preferences.

Laptop Computer: A Toshiba Satellite A100 was recommended. Virus protection software and a free modem based ISP was installed on the computer.

Microsoft Windows Accessibility Options: During the evaluation Windows XP accessibility features were implemented to increase font size and resolution. The cursor location and speed was also modified.

QuadJoy Mouse: The QuadJoy Mouse was recommended for HH for mouse emulation. It is 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.

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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 and adjustments, HH reported an increase in being able to participate in a variety of life activities that were previously not available to her.

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