Case 8: Using Assistive Technology Devices to Improve Quality of Life

Background

WW (name and initials changed for confidentiality) was 47 years old when he was referred by his physician for an AT evaluation in June 2003. WW was diagnosed with MS in 1997 and continued working until 2001. WW resided at a skilled nursing facility in a suburban area. WW previously served in the Peace Corp, worked as a farm machine repairman, grain distributer, and a landscaper. Effects of MS in Participating in Functional Work Activities At the time of this evaluation, WW experienced the following limitations:

• Physical: WW experienced mobility impairments. He used a wheelchair to ambulate. He had some upper extremity weakness and reduction of range of motion. WW experienced both leg and arm spasms.
• Cognitive: No thinking or attention concerns were observed or reported. WW reported short-term memory deficits although no neuropsychological evaluations had been completed.
• Visual: WW reported no functional visual difficulties.
• Mood: WW reported depression.
• Hearing: No hearing difficulties were reported.
• Communication: WW reported no speech or communication difficulties.
• Environmental space: WW did not have telephone or Internet access in his room and was required to go to the nurse’s station to receive phone calls.
• Current Access to AT: WW had a computer that was approximately 2 years old. He used a standard keyboard and mouse (on the left) to access the computer. He did not have an adjustable keyboard tray at his workstation. WW used Microsoft Word for writing and correspondence and had a color printer.

Treatment Intervention Goals

WW would like to participate in some type of volunteer activity. WW was interested in improving computer access through assistive technology devices and software applications. WW would like to improve upon his quality of life. His avocational interests centered on the use of his computer to burn CDs (music), complete written correspondence and play computer related games. WW expressed interest in using a computer to assist other residents as the skilled nursing facility. WW would like to have access to the telephone in his room.

Assistive Technology (AT) Intervention

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

Adjustable Keyboard Tray: WW would benefit from an adjustable keyboard tray that could be easily adjusted to a height of 32”-33” and provide swivel right to left as well as adjustment tilt of tray.

Before

After

Trackball Mouse: It was recommended that WW receive the Kensington Expert Mouse Pro trackball to allow him to navigate when he is on the computer. This device has four programmable buttons to handle activities such as double clicking or drag lock with a single click. In addition, it also has six “hot buttons” for one to touch to access websites or applications.

Compressed Keyboard: WW would be able to improve upon his keyboarding abilities through the use of a compressed keyboard. This type of keyboard would allow for easy positioning for appropriate access. As WW’s MS is progressive it was also recommended that a keyguard for the compressed keyboard be obtained to increase his keyboarding accuracy in the future.

Word Prediction: “WordQ” is a word prediction software application that uses advanced word prediction to suggest words to use and limits keystroke requirements.

Adjustment to Disability Counseling and of Assistive Technology Needs: WW would benefit from continued counseling. He indicated that his family will investigate and install a telephone line in his room. This line could then also be used for Internet connection.

Outcome

All of the above recommendations were implemented and determined to be successful. WW demonstrated the ability to improve not only textual typing activities, but also use of navigational aids to use on-line (Internet) programs. WW expressed high satisfaction in the modifications and the obtained devices and software applications.

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