Case 6: Improving Computer Access to Increase Participation in Life Activities

Background

JJ (name and initials changed for confidentiality) was 60 years old when she was referred for an AT evaluation by her physician in May of 2006. JJ began having MS symptoms in 1969 and subsequently was diagnosed with MS. JJ resided at home with her husband in a rural town. Effects of MS in Participating in Functional Work Activities At the time of this evaluation, JJ experienced the following limitations:

• Physical: JJ 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: Visual deficits were reported.
• Hearing: No hearing difficulties were reported.
• Communication: No communication difficulties were reported.
• Current Access to AT: JJ used a mini joystick mounted on midline joystick bracketry that swung in to her chin to control her power wheelchair. She previously used the computer but had been unable to the past several of years. JJ’s husband stated that he would be able to build a new workstation, purchase a new monitor and computer, but would not be able to fund the adaptive devices.

Treatment Intervention Goals

JJ would like to improve upon her daily activities by having access to the computer.

Assistive Technology (AT) Intervention

JJ was evaluated by Curt Johnson, MS, ATP, a Rehabilitation Counselor and Assistive Technology Practitioner in May 2006 at the assistive technology clinic. The following equipment and adjustments were recommended, based on evaluation and trials with equipment and taking into account JJ’s preferences.

Adjustable LCD monitor arm: Monitor positioning would be improved through the use of an adjustable LCD monitor arm such as ErgoMart’s model 7000 LCD arm. This arm would provide JJ with improved flexibility, comfort and LCD visibility. An LCD monitor was purchased by JJ and her husband.

QuadJoy Mouse: The QuadJoy Mouse was recommended for JJ 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.

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.

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.

Outcome

All of the above recommendations were implemented and determined to be successful. Following installation of recommended equipment and adjustments, JJ 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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