Since this course is self-directed, it is up to learners to decide what areas of the course they would like to pursue in depth. The course will introduce participants to a wide variety of adaptive technologies, though none will be covered in great detail. This is up to you. The course project will allow you to focus on a particular type of technology, and investigate it deeper.

We suggest the following goals:

• familiarize yourself with the full range of adaptive technologies available,

• create a resource that will assist you in using and assembling technologies for a particular situation (eg. a particular client, student, or group of students; see case studies for examples; see project information page),

• become an expert in at least one area of adaptive technology.

Many of you have been designated the "tech person" at your school or organization. These people may want to create a more general resource and become experts in a number of different areas.

We will have a moderator available to help you achieve your goal as either a generalist or a specialist. The resources and technology summaries contained in the course modules should be used as guides rather than comprehensive coverage of their topics. Participants should view the course content and resources and ask themselves:

• When and for whom would these technologies be appropriate?

• What are the advantages and disadvantages of one technology over another (eg. cost, functionality, availability).

• How could I combine this technology with others to create a technology package?

• What information can I not find that I should ask for help with in the course forums?

• How would I find more information on the topic by searching the Internet?

• Who else in the course has interests similar to mine? How could we collaborate to assist each other's learning?

 

1.1 Project Information [top]

Project Due Date T.B.A.

If you are taking the course for a certificate you are required to develop a small web site which will house your project. A basic understanding of HTML is helpful but not necessary. You may choose to work in groups of two or three, in which you can delegate duties among group members. If one of the members is a proficient user of HTML, that person can take on the duty of setting up the group's site. Of course that means balancing the amount of effort each member puts into the content of their group web site. Or, you may choose to work on your own and learn some HTML through the Tech Forum. Knowledge of HTML is an invaluable asset for those intending to use the Internet as a teaching tool. I would suggest you take the time now to develop this skill.

Exceptional sites will be given space on the SNOW server where they will be linked to the SNOW site and where they may be developed further after the course has ended. Others may download their sites and move them onto another server if they choose. On your home page, be sure to include your names and email addresses, who is responsible for creating what, and a link to the SNOW site.

Project suggestions:

The suggested projects below are only guidelines. With the diversity of participants the project topics will be left open. If you choose a topic other than one listed below, send me a brief proposal for your site by email, so that I can offer suggestions. Or, you might want to put your proposal before the other participants in the forums, and solicit ideas, or perhaps collaborators.

1. Choose one of the topics covered in the course (eg. Alternative Input Devices, or Augmentative Communication, or Voice Recognition) and develop a small web site expanding on the content presented in the course. You should:

   1. Divide your topic into three to five major subtopics.(eg. for Voice Recognition--software, hardware, continuous and discrete speech, keyboard commands)

   2. Create a homepage from which any other pages you create can be linked. Think of it as a title page and table of contents. You should include a short description of your site there as well.

   3. Collect the URLs (web addresses/bookmarks) of a number of related web sites and create a web resources page (or two or three). You can use the web resource pages of the course as models but try to find sites they don't already contain. If there are particularly relevant sites, do use them. Usually though, you should go to sites listed in the course resources and find links to other sites, or use the search engines for broader web searches.

   4. Create a series of short subpages to link from your home page. They can be pages like: Purpose, Web Resources, Summary of Technologies, Papers,... or what ever. Any of these pages can have subpages linked from them. Keep pages non-commercial, though you may link to commercial sites through a resource page.

2. Create a hypothetical child who requires assistive devices and assemble a adaptive system for her/him. You should:

   1. Create a homepage from which any other pages you create can be linked. Think of it as a title page and table of contents. You should include a short description of your site there as well.

   2. Collect the URLs (web addresses/bookmarks) of a number of related web sites and create a web resources page (or two or three). You can use the web resource pages of the course as models but try to find sites they don't already contain. If there are particularly relevant sites, do use them. Usually though, you should go to sites listed in the course resources and find links to other sites, or use the search engines for broader web searches.

   3. Create a series of short subpages to link from your home page. They can be pages like: The Child, Assessment, Interventions, Technologies, Web Resources, ... or what ever. Any of these pages can have subpages linked from them. Bring together different areas of the course to assemble a system for the child. Keep pages non-commercial, though you may link to commercial sites through a resource page.

3. Assess your need for assistive devices and create a resource that will help you in adapting and utilizing your abilities. You should:

   1. Create a homepage from which any other pages you create can be linked. Think of it as a title page and table of contents. You should include a short description of your site there as well.

   2. Collect the URLs (web addresses/bookmarks) of a number of web sites related to your area of interest and create a web resources page (or two or three). You can use the web resource pages of the course as models but try to find sites they don't already contain. If there are particularly relevant sites, do use them. Usually though, you should go to sites listed in the course resources and find links to other sites, or use the search engines for broader web searches.

   3. Create a series of short subpages to link from your home page. They can be pages like: My Needs, Adaptive Technologies, Useful Keyboard Commands, Web Resources, ... or what ever. Any of these pages can have subpages linked from them. Bring together different areas of the course and develop a set of resources which compliment your abilities. Keep pages non-commercial, though you may link to commercial sites through a resource page.

Posting Your Presentations

During week 1 you are invited to explore the follow topics and sections: 

1. About Adaptive Technologies

2. Alternative Input Devices

3. Adjustable Tables

4. Software or Freeware

5. Mouse Alternatives

6. Miniature and Expanded Keyboards

7. Switch Input

8. Web Resources

9. Augmentative Communications 

 

This workshop will introduce you to computer based adaptive technologies and alternative access systems for computers. For someone with a disability, computers can perform several functions.

• Computer access is needed to do everything everyone else is doing with computers (e.g., word processing, e-mail, computer games, etc.).

• Computers may also provide alternative methods of doing things which are difficult to do the standard way (e.g., banking by computer for someone with limited mobility or speech).

• Computer systems can augment or act as substitutes for impaired sensory, motor or cognitive abilities (e.g., reading machines, electric wheelchairs, cochlear implants, augmentative communication devices, wayfinding systems).

To benefit from any of the above the individual must be able to reliably control and interact with a computer. For this reason we will discuss alternative computer access methods in some detail.

One term that will be referred to throughout this workshop is the term Curbcut Advantage. This is derived from the cuts made to sidewalk curbs which were originally created for people with wheelchairs but which benefit almost everyone including people with baby carriages, rollerblades or shopping carts to name a few. This phenomenon is prevalent in this field: captions made for people who are deaf are used in noisy bars or by archivists to perform text searches on videotapes, voice recognition benefits the busy executive who can't type, etc.

Alternative Access to the Computer

In order to control a computer you must be able to achieve the equivalent of controlling a mouse, typing on a keyboard, reading a display and listening to auditory system cues. The user must also be able to interpret and determine the appropriate response to the computer user interface. Thus, access to the computer makes demands on visual, auditory, perceptual, motor and cognitive skills.

People who can benefit from alternative computer access systems include those who:

• have difficulty or cannot control a keyboard,

• find it difficult to control a mouse,

• have repetitive strain injuries,

• have difficulty or are unable to see the display,

• are unable to hear auditory cues,

• have a learning disability which makes it difficult to write or read text,

• require simplified interfaces due to cognitive impairments.

High Tech options for computer access

High tech options vary from utilizing built in or shareware/freeware software modifications, to adding sophisticated hardware and/or software packages that translate the user input or the computer output, and modify desktop management and system control. The options grouped below are usually available for either Apple or IBM compatible systems and are in order of increasing complexity.

Enhancements to the Visual Display

A number of adjustments can be made to the visual display using built-in system controls or free software. These adjustments provide higher contrast and can enlarge icons, display fonts and mouse cursors.

A number of screen magnification programs are available. These vary largely in the operating system they are compatible with. Features to consider are:

• the quality and degree of font smoothing at higher magnifications,

• the types of viewing windows available for viewing magnified text (full, overlay, lens, etc.),

• options for scrolling or moving to desired areas of the screen,

• options for tracking the cursor, the insertion point, alert boxes, focus, etc.,

• choices of text and background color,

• integration with screen reading,

• quality of image magnification,

• complexity of keyboard or mouse commands required to control the magnifier.

For clients who have difficulty reading or writing (due to a learning disability or emerging literacy) talking word processors and add-ons are available which highlight words or phrases as they are being read and allow reading in various chunks (e.g., by word, by sentence, by syllable). These programs also support writing by echoing what is being typed.

Alternative Displays

Alternatives to the visual display include screen readers which speak the text displayed on the screen and refreshable Braille displays which translate the text to Braille.

There are a number of screen readers to choose from. Screen readers which are compatible with Windows or the MacOS take various approaches to dealing with the graphical user interface. Some require that the user visualize the desktop and use the desktop layout as a reference for navigating, others reorganize the desktop in a two dimensional hierarchy. The approach best suited to the user depends upon their previous experiences and skills in grasping inherently spatial models. In setting up a screen reading access system, control of the interface without use of a mouse must also be considered. Many actions can be performed with keyboard equivalents, but the user must learn these. Input alternatives must be found for actions which have no keyboard equivalents (i.e., macros).

Considerations in choosing a screen reader include:

• the completeness, and cohesiveness of the display model presented,

• methods available to navigate to desired sections of the display or interface,

• differentiation of insertion point and exploration cursor (so that the user can look around without losing their place),

• supports to assist in orienting to status and location, (where am I, what is happening),

• options available for echoing what is typed (e.g., letter, word, phoneme),

• options available for reading text (present, next, previous word, line, sentence etc. ),

• pronunciation dictionaries, and speech options (e.g., rate, pitch, volume, prosody, modulation, voice, voice change tied to different functions),

• strategies available for getting information about non-text items, (e.g., reading tool tips),

• strategies for controlling interface controls which do not have a keyboard equivalent,

• compatibility with software applications the client wishes to use.

Braille displays vary in the number of cells that are displayed, (usually either 40 or 80), the method of navigating around on the display, the status information that can be displayed and the available quick reference keys or short cut keys available. Some Braille displays are designed to be compatible with screen readers.

Enhancements and alternatives to the auditory display

For individuals who cannot hear or fail to attend to auditory system cues, such as alert sounds, system software (ShowBeeps) can be used to provide visual cues in place of auditory cues. Captioning is only beginning to be explored for audio streams or audio tracks of videos. CD manufacturers, in response to ADA legislation and educational buyers, are beginning to provide text transcripts or captioning for audio. World Wide Web authors are becoming aware of the need for captioning, and file formats which accommodate a captioning track are being developed. Caption authoring packages are available to add multimedia and overlay captioning to computer based video.

Rate enhancement or literacy supports

Major word processors have a variety of features that may enhance the user's input. Abbreviation-expansion, spelling and grammar aids are a standard feature. Macros and templates are available which allow the automation of tasks and keystroke input. Word prediction, word-completion prediction and abbreviation-expansion software, with or without auditory feedback, aids users with slow keyboard input or those with difficulties spelling.

Mouse Alternatives and Replacements

Trackballs, joysticks and various forms of tablets are frequently easier to control than a mouse. The mouse pointer can also be controlled using head movement which is tracked using infrared or ultrasound technology. Buttons on many alternative pointing devices can be programmed to perform a double click or to lock down the mouse button for a drag. Mouse buttons can be replaced with switches (e.g., puff-sip switches, foot pedal switches, etc.) or with software that performs the mouse click, double click, and drag by dwelling on a target for a predetermined time and then moving the mouse cursor in one of 4 directions.

The mouse pointer can be controlled using keys on the numeric keypad, or keys on an on-screen keyboard. Mouse emulators exist for single switch users and users of voice recognition systems; these employ vector scanning strategies or grid systems to quickly zero in on the target.

Keyboard Modifications and Alternatives

Free software or operating system modifications allow changes to be made to keyboard response by: slowing response time; eliminating or slowing key repeat rate; and holding keys used in multiple key depressions when selected sequentially. Standard keyboards are also available with on-board memory for text or command macros. Mainstream keyboard alternatives include keyboards which are smaller, are more ergonomically shaped, provide more efficient keyboard layouts (e.g., DVORAK vs. QWERTY) and have built in Trackballs or other mouse alternatives.

Specialized keyboards have been developed to accommodate a variety of individual needs. Miniaturized keyboards accommodate those with limited range of movement or strength. These may have mouse emulation as a built in feature. Enlarged keyboards are more suited to those with poor motor control, but with adequate range of movement. Programmable keyboards allow for customization of the keyboard layout (key content, key size) with individualized overlays depicting the key contents for the user. Keys may also be programmed with mouse emulation functions.

Numerous on-screen keyboard software programs allow the user to select keystrokes, (letters, words, commands, phrases) using a mouse or mouse emulation.

Switch Input

Switch input is also used to emulate keyboard and mouse functions. Single, dual or three switch input of Morse code can be translated by a hardware and/or software interface into keyboard and mouse input to the computer. On-screen keyboards support a number of scanning strategies including:

• stop and continuous automatic scanning,

• inverse scanning (hold switch down to move cursor, release when target is reached, hit second switch or wait to select), step scanning, and

• directed scanning (direct cursor movement by holding one of four directional switches).

Considerations when choosing a scanning on-screen keyboard include the presence of:

• strategies for controlling the desktop and manipulating windows,

• methods of emulating the mouse,

• user definable keyboard layouts,

• integration of acceleration strategies such as abbreviation-expansion or word completion prediction,

• context sensitive keyboard layouts, and

• adequate control of scan speed, initial delay, debounce time and switch configurations.

Voice Recognition

Voice recognition of commands or text input is available with some operating systems. Voice recognition software that provides text input, mouse control and software application control, including optional levels of vocabulary and macros for various professions or specialty groups, is also available.

Current dictation systems do not allow the ideal, continuous speech, speaker independent, unlimited vocabulary dictation which most people expect. Although voice models in the system allow the recognition of words without explicit training, each user has their own voice model file which must be carefully trained to allow optimal recognition. Proper maintenance of the voice model requires vigilance to errors made by the user and the system and proper correction of the errors. Most voice dictation systems have very large dictionaries, but proper names and specialized vocabulary must be added by the user. Several dictation systems rely on mouse control to control the desktop and dictation functions.

Adaptive Technologies which Augment or Substitute Impaired Functions

One of the primary properties which allows computers to act as powerful tools for people with disabilities is the ability to translate. Computers can be used to translate auditory signals to visual signals or vice versa, small print to large print high contrast, Morse code to standard typing or an eye blink to words and phrases, to list only a few examples. Another property is the ability to efficiently perform repetitive, predictable tasks, thereby saving limited energy and time. A third property is the facility to store, process and allow the retrieval of large amounts of information.

However, presently computers are limited in mimicking human functions in that they:

• do not consistently learn from their mistakes

• do not repair themselves

• do not grow with the person

• do not react well to the unpredictable or surprising

• are terrible communicators both receptively and expressively.

The range of adaptive technologies and issues and considerations in choosing these will be explored further in various sections of this course.

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Introduction

Module by Linda Petty

What are alternative input devices? They are non-standard products and methods for inputting text and mouse commands needed to operate software, manage files and navigate a desktop in a graphical user interface. The standard input devices are the keyboard and two button mouse; for many people with physical disabilities these are awkward, slow or impossible to use. When considering other alternatives, a thorough assessment of the user's physical skills and computer needs is required. This is generally done by an occupational therapist who specializes in assistive technology, to ensure that the physical, cognitive, visual and ergonomic needs and factors are considered. Each of these technologies can meet a range of needs and each individual has unique needs and strengths. In this module, input devices will be suggested for specific disabilities or needs, however, a successful user/alternative input device match only can be made based on an individualized assessment. As we look at the variety of alternative input devices available, I would caution participants against picking devices from the information presented for specific users without a local assessment. Providing an assessment with appropriate range of equipment trials also prevents the frustration of the "try this, try that" approach, where less than optimal solutions are purchased to be later abandoned.

This section of the course will cover a broad range of commercial tools and technologies available to input text and mouse commands into a computer system. We will begin with simpler solutions and progress to the more complex and expensive. In each area I will give you illustrations of potential users of the input device as well as web resources for companies selling or developing the technology.

Selecting a computer access system for a client may entail choosing the assistive technology as well as the computer and all its components, or simply choosing the assistive technology which is compatible with the client's existing system.

Clients who can benefit from alternative computer access systems include those who:

• have difficulty or cannot control a keyboard

• find it difficult to control a mouse

• have repetitive strain injuries

These difficulties may be:

• Congenital, meaning from birth, such as Cerebral Palsy (as in Case Study #1 ) 

• Acquired through an accident which results in an injury, such as quadriplegia (as in Case Study #2) or a disease process, such as Multiple Sclerosis 

The computer input modifications required may be:

• Static, as the client's physical strengths and needs are stable or 

• Flexible, as on-going modifications will be needed to meet the needs of a changing condition, as in Amyotrophic Lateral Sclerosis (as in Case Study #3) or improving literacy or educational skills. 

Regardless of the client's input needs, remember that computer technology is changing rapidly and most computer systems will need to be replaced approximately every 5 years. Sometimes an older system still meets the client's needs, however, changes in operating systems and software compatibility often force upgrades to continue to exchange information with vocational or educational settings.

Think of the individuals you know using alternative input devices: how often have there been changes to their computer systems? What has been the need behind those changes?

 

Here are some of the lower tech methods/strategies for inputting to standard computer systems.

Sometimes a modification to the physical layout of the computer can enable a user to effectively access the standard keyboard, especially if keyboard modifications like Sticky keys or a slowed response rate are used to compensate for coordination difficulties. Positioning the keyboard on an angled, height-adjustable keyboard table, providing support through armrests or a wrist rest can all help stabilize the limbs to maximize accuracy. Positioning the keyboard at foot level is more functional for some users with better control of their lower extremities than the upper

Some users with poor motor control of the arms can use a stick held in the mouth or attached to headgear to depress the keys of a keyboard, with Sticky keys to help with depressing multiple keys sequentially. Keyguards are metal or plastic grids over the keyboard that allow a user to slide across them and then push a digit or stick down the holes to depress a key, preventing inadvertent hits. They can obscure the view of the keyboard and also are increasingly hard to purchase, due to the plethora of keyboards available.

Other users who benefit from wrist rests, adjustable keyboard heights and ergonomic positioning are those with Repetitive Strain Injury(RSI). RSI is an occupational hazard of our times, forcing some people to change types of work or limit keyboarding time. Although some can modify their work station and work styles to continue, others use Voice Recognition for keyboard and mouse input. For some information on this disability and equipment to compensate, see the Typing Injury Faq at http://www.tifaq.com

To look at equipment sources for this section, see Adjustable tables, wrist rests, mouth and chin sticks and keyguards in the Resource page.

 

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Operating System Modifications

There are some fairly easy modifications which can now be made via software to enable someone with poor motor control to use a standard keyboard or a mouse from the keyboard. Initially Apple and now Microsoft have incorporated these features in their operating systems. Look in the Control Panel of the computer you are using. If it is a Macintosh, these features are called Easy Access. If it is a PC running Windows 95, the features are called Accessibility Options. Windows 3.1, NT and DOS systems have to have these features added with a free utility available from the Trace Center or Microsoft, called Access Pack for Windows [ http://www.utoronto.ca/atrc/reference/tech/altkey.html ]or AccessDos [ http://www.utoronto.ca/atrc/reference/tech/altkey.html ]The modifications available are described as follows, although the names may differ between operating systems: 

Sticky Keys

Many software programs require users to press two or three keys at one time. For people who type with a single finger or a mouthstick, that just isn't possible. Sticky Keys allows users to press the keys of a key combination one at a time and instructs Windows to respond as if the keys had been pressed simultaneously. When Sticky Keys is turned on, pressing any modifier key--that is, ctrl, alt, or shift--latches that key down until either the mouse button or a non-modifier key is released. Pressing a modifier key twice in a row locks it down until it is pressed a third time. In Windows 95, to adjust StickyKeys go to Control Panel, Keyboard, or it can be turned on or off using a hotkey: pressing the shift key five consecutive times.

SlowKeys (In Windows 95 found under FilterKeys)

The sensitivity of the keyboard can be a major problem for some people, especially if they often press keys accidentally. SlowKeys instructs Windows to disregard keystrokes that are not held down for a minimum period of time, allowing users to brush against keys without any ill effect. When users put a finger on the correct key, they can hold the key down until the character appears on the screen; an optional sound effect also indicates when a keystroke has been accepted. To activate and adjust SlowKeys go to Control Panel, Accessibility Options, Keyboard, click on the FilterKeys checkbox, then the Settings button, and choose Ignore quick keystrokes and slow down the repeat rate. It can be turned on or off using a hotkey: holding down the Right shift key for 16 seconds. Users hear a warning after four seconds, an up-siren after eight seconds, a double-tone after 12 seconds, and a triple-tone after 16 seconds. Releasing the shift key after the triple-tone activates BounceKeys at the most conservative settings. (This hotkey also turns on RepeatKeys.)

RepeatKeys (In Windows 95 found under FilterKeys)

Most keyboards allow users to repeat a key just by holding it down. This feature is convenient for some but can be a major annoyance for people who can't lift their fingers off the keyboard quickly. RepeatKeys lets users adjust the repeat rate or disable it altogether. The functionality of RepeatKeys is adjusted through the Control Panel, or it can be turned on or off using a hotkey: holding down the Right shift key for eight or more seconds. (This hotkey can also turn on SlowKeys or BounceKeys, depending on how long the shift key is help down.)

BounceKeys (In Windows 95 found under FilterKeys)

For users who "bounce" keys and produce double strokes of the same key or similar errors, BounceKeys instructs Windows to ignore unintended keystrokes. The functionality of BounceKeys is adjusted using the Control Panel, Accessibility Options, Keyboard, FilterKeys, Settings, Ignore repeated keystrokes. It can be turned on or off using a hotkey: holding down the Right shift key for 12 seconds. Users hear a warning after four seconds, an up-siren after eight seconds, and another double-tone after 12 seconds. Releasing the shift key after the double-tone activates BounceKeys at the most conservative settings.

MouseKeys

The MouseKeys feature lets people control the mouse pointer using the keyboard. Users don't need to have a mouse to use this feature. Windows 95 is designed to allow users to perform all actions without needing a mouse. However, some applications may require one, and a mouse can be more convenient for some tasks. MouseKeys is also useful for graphic artists and others who need to position the pointer with great accuracy. When MouseKeys is turned on, the following keys navigate the pointer on the screen:

• Press any number key except 5 on the numeric keypad--these keys are also called the direction keys--to move the pointer in the directions indicated below.

• Press the 5 key for a single mouse-button click, and press the + key for a double-click.

• To drag an object, point to the object, press ins to begin dragging, move the object to its new location, and press del to release it.

• Select the left or right mouse button or both mouse buttons for clicking by pressing the /, -, or * key, respectively.

• Hold down the Ctrl key while using the direction keys to "jump" the pointer in large increments across the screen.

• Hold down the Shift key while using the direction keys to move the mouse a single pixel at a time for greater accuracy.

In Windows 95, the functionality of MouseKeys can be adjusted using the Control Panel. Go to Accessibility Options, Mouse, click on the MouseKeys checkbox and click the Settings button to customize the feature. Or it can be turned on or off using a hotkey: pressing the Left alt, Left shift, and num lock keys simultaneously.

ToggleKeys

ToggleKeys provide audio cues--high and low beeps--to tell users whether a toggle key is active or inactive. It applies to the caps lock, num lock, and scroll lock keys. The functionality of ToggleKeys can be adjusted through Control Panel, Keyboard,or it can be turned on or off using a hotkey, by holding down the num lock key for five seconds.

Adjustable Tables, Wrist Rests, Mouth and Chin Sticks, Keyguards

Software and Freeware modifications

There are a variety of other "helps" that can be added using software, such as word prediction, for slow typists or poor spellers, text-to-speech programs for those who benefit from auditory feedback, and more. Look at the programs available for the Mac and PC at these locations at the following sites:

• The Trace Center 

  http://trace.wisc.edu/

• Apple Computer's site 

  http://www.apple.com/disability/

• Virtual Assistive Technology Center 

  http://www.at-center.com/

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There are switch controllable mice, such as the Cross scanner and Mouse mover listed in our As you can imagine, control of the mouse is a must in this graphical user interface world is a must. This can be difficult for users with coordination problems or limited strength or range of movement. As we have already discussed, the keyboard keypad can function as a mouse using Mousekeys; this method of mousing around can be slow, but is effective. Many of the alternative keyboards have Mousekeys built in, so the keys on the keyboard can toggle between text input or mouse input.

Trackballs are upside down mice, with the ball on top and several buttons. Look for those which offer the left and right mouse buttons plus one or two more which can be programmed to be a double click or drag lock. Many local computer vendors stock trackballs- the programmable ones are also available from assistive technology vendors. technical glossary. These allow the user to use one to 5 switches to control the mouse- the more switches the user can control, the faster the mousing around.

Mouse input can also be given by high tech pointing devices, which transmit the location of a transmitter or reflective dot on the user's head to the computer system. Separate switches or just dwelling on a location are used for mouse clicks and drags. These are frequently used with on-screen keyboards for text input by people with limited movement due to quadriplegia or muscular dystrophy.

These keyboards emulate regular keyboards, offering all the keys needed for the Apple or PC.

Some miniature keyboards have these keys layered, so you first select the Function key, then press a number to get the equivalent of F2, for example. This takes more time, but minimizes the space needed, which is particulary important for users with minimal strength and range of movement. The most effective layout for such users is a center weighted layout, so the E, I, O, U, T, and Space are grouped in the middle and the other characters further away according to their usage patterns. This can take a while for someone to learn who has always used a QWERTY layout, so these keyboards are also frequently available in the standard QWERTY layout as well.

Enlarged keyboards suit someone with large range of movement with a foot or arm, and less than optimal accuracy for a regular keyboard. A young man I worked with who had ataxic movement due to Cerebral Palsy used his so much and so well that the letter names would bet worn off the keys. He is now doing well in a university business program....

For links to these products, see the Resource page for this module.

A programmable keyboard offers the flexibility of mapping the keyboard to suit the application or the user's input needs for content or access. A popular example is the "Intellikeys" which comes with overlays for Apple and IBM keyboards with mouse keys built in and adjustable response and repeat rates. This keyboard can be programmed with a software package to input strings of text or commands to the computer, and even read out text associated with the key as desired. This allows a teacher to create a customized overlay for a student to write a letter or journal, with common sentences or words under a paper overly which depict them in words or pictures. This type of early literacy activity frequently utilizes a talking word processor, so the text can be read back to the student. A student with poor targeting skills or playing a simple computer game can have only one or two items programmed and shown on the overlay. Overlays are quick to program and print off; a number of ready made overlays come with the products as well.

These keyboards can be equally useful in operating applications, such as web browsers. They can have functions like moving between links or to favorite sites and can call up text-to-speech software to read information out to students with literacy needs.

As the name suggests, this input mechanism is to make selections from a keyboard which is displayed on the screen, by a software package. Selections are made by mouse clicks from trackballs, mice or pointing devices or by dwelling on the keyboard location for a pre-established period of time. The disadvantage is the screen real estate lost to the keyboard- a large monitor is helpful. The advantage is the lack of movement required- the individual does not need to take their eyes off the screen to look at a keyboard. On-screen keyboards generally operate transparently with applications.

On-screen keyboards usually include sticky key features and some colour coding. Some incorporate word prediction or voice output for face-to-face communication. Some of the augmentative communication softwares offer programmable on-screen keyboards for those with literacy needs. Some keyboards have versions which can be operated by single or dual switches, becoming, in essence, scanning keyboards- more on scanning later. Keyboards vary significantly in price, with additional features like voice output, word prediction or scanning at marketed at higher prices.

Less direct methods of inputting keystrokes and mouse clicks are slower and less effective than direct methods of pointing or keyboard input. Individuals who have very poor accuracy in targeting or very minimal movement use switches to input data into applications. There are two main methods of inputting data using a switch:

• Scanning: 

  Using this approach, a line of letters, mouse input and possibly even computer commands are displayed on screen. A coloured marker moves across the array of choices in linear or in a row/column pattern. The individual hits the switch when the marker is at the selection they want to input. Again, due to the slow rate of input, other strategies such as word prediction, are frequently used with this input method.

• Morse Code: 

  Although rarely used among the general public, inputting the Dits and Dahs or long and short signals of Morse Code continues to be a fairly efficient means of computer input for switch users. I have known Morse Code users with disabilities such as quadriplegia or muscular dystrophy who achieved input rates of 20 to 25 words per minute. If the user has good voice control, voice recognition can be a faster alternative, but for those without, or with limited funds, Morse code can give full text and mouse input for Macintosh and Windows or DOS operating systems. Morse can also be augmented with speech or word prediction.

Switches themselves can be purchased from a variety of sources. The interface which produces the scanning array or Morse Code translation to the system is usually a combination of software and hardware.

See the Resource page for this module for switches and interfaces for scanning and Morse Code.

General Resources

For resources on mobility impairments, please see the:

• Adaptive Technology Resource Centre site.
  http://atrc.utoronto.ca

For equipment, please see a searchable database called:

• Abledata.
  http://www.abledata.com/

Alternative Input Device Sources

Adjustable tables, wrist rests, mouth and chin sticks

Adjustable furniture and ergonomic supports are available from your local office supply store or catalogue. Photos with item numbers are availible at:

• Typing Injury FAQ
  www.tifaq.com/

• Assistive Technology Inc
  www.assis-tech.com/

Mouse Input

For Mice and Trackballs please see:

• Technical Glossary
  www.utoronto.ca/atrc/reference/tech/altmouse.html

• Typing Injury Faq
  www.tifaq.com/mice/mice.html

Alternative electronic pointing devices are listed under:

• "Other Devices" at the Typing Injury Faq.
  www.tifaq.com/mice/other-devices.html

Expanded and Miniature Keyboards

For expanded and miniature keyboards see:

• TASH
  www.tashinc.com/catalog/ca_index.html

• In Touch Systems
  www.magicwandkeyboard.com/

Programmable Keyboards

For programmable keyboards see:

• Intellikeys
  www.intellitools.com/products/IntelliKeys/home.htm

• Key Largo from Don Johnson, Inc.
  www.donjohnston.com/catalog/catalog.htm

On-Screen Keyboards

For on-screen keyboards, see our list in the:

• Technical Glossary.
  http://www.utoronto.ca/atrc/reference/tech/altkey.html

Switch Input

Switches are availabe from:

• TASH
  http://www.tashinc.com/catalog/

• Don Johnston, Inc.
  http://www.donjohnston.com/catalog/catalog.htm

• Ablenet
  http://www.ablenetinc.com/

Scanning interfaces are available at:

• Don Johnston On-screen keyboards & Ke:nx (For students who need a switch to write) 
  http://www.donjohnston.com/catalog/catalog.htm

• Words+ products. 
  http://www.words-plus.com/

Morse code interfaces are listed in the:

• Technical Glossary on the ATRC website
  http://www.utoronto.ca/atrc/reference/tech/techgloss.html

---

Excerpted from "The Clinician's Guide to Assistive Technology" Computer Access Chapter by Jutta Treviranus and Linda Petty. Mosby Publishing, Inc. In publication

Application/Goal

The problem addressed by this application was to provide flexible computer access and equipment to meet the changing physical development and educational/ literacy/communication needs of a very young child with a congenital condition, Cerebral Palsy.

Function/Ability

Christopher was initially assessed for technology access in Dec. 1993, at the age of 4. Computer access recommendations were given to his community team for single switch programs to develop motor control and letter recognition. Further assessment and equipment trials in April 1994 resulted in the lease of a Macintosh LC II computer system with Ke:nx, several single switches and an expanded Unicorn keyboard and keyguard, Apple 11e emulator card and disk drive. Software included a Macintosh talking word processor, Intellitalk, Apple 11e early learning software such as Charlie Brown's ABCs, First Letter Fun, etc. Christopher's family and support workers were trained in running the system and programming overlays when the system was put in place in early June. The computer access was flexible, promoting concrete, direct upper extremity targeting for some software with limited targets and training scanning skills with hand targeting of single switches for other software packages. Christopher's motor control was affected by fluctuating muscle tone and reflexes; the flexible access promoted development of motor control while operating fun, age appropriate and educational software programs.

Other technology recommendations at that time were:

• improved seating and a power wheelchair training program for the following summer, using a DU-it Armslot switch for power chair access with limited upper extremity control, which resulted in a power chair and seating prescription in the fall

• communication book with a variety of large targets, spaced out for clarity of indicating choices

• a low tech switch operated signalling aid for telling jokes, passing on news from nursery school, greetings, etc.

• use of a similar Macintosh system for Grade 1 in Sept. 1994, with a CD ROM.

Re-assessment of physical access in April 1995 indicated increased muscle tone following a growth spurt, increased prominence of an Asymmetrical Tonic Neck reflex and increased athetosis affecting active movement patterns. Quantified computer access trials demonstrated to Christopher's parents and the support team the greater effectiveness of using a switch accessed with head rotation for critically timed access needs, such as scanning for face to face communication and letter input to the computer system. A Zygo lever switch and mount was added to his computer access set up and his computer was upgraded to a Macintosh Performa 580CD to give adequate RAM and CD ROM access for educational and reading programs. ClickIt software was added to the use of Ke:nx for single switch access to CD Roms, using programmable "hot spots".

Other technology recommendations included the use of a portable Apple Powerbook system with Speaking Dynamically, Boardmaker, ClickIt, Ke:nx and a talking word processor, Intellitalk, for use at school for face to face and written communication. This system was accessed with the lever switch to obtain the best possible speed and accuracy needed for scanning. As Christopher used the larger Armslot switch on his tray for driving, the Powerbook system was secured in it's place on his tray for in-class or in-home sessions only, rather than being available at all times. Christopher continued to use his communication book, eye gaze, etc. for immediate communication needs.

By the winter/spring of 1996, Christopher was demonstrating improved physical control, particularly of his right upper extremity. This was attributed to extensive driving practice with the arm-slot switch, maturation, excellent seating and therapy. A gated, center mounted joystick was introduced for driving, and after a training period, substituted for the Armslot switch. The new power chair access allowed for flexibility in mounting the portable computer system and new options for computer access using the joystick. Trials were next carried out with Direct Point computer access technology, where an interface allows the user to "drive" the computer cursor with the wheelchair control with a remote selection switch in summer 1996. This was successful, offering faster, more immediate access to face to face communication displays and an on-screen keyboard for computer access. The head switch was still used for selecting targets once the mouse pointer dwells over them, as this offered faster and more accurate than selecting with a timed dwell setting. As the Armslot switch was no longer positioned on the wheelchair tray, Christopher's portable computer system could be mounted with a modular bar and bracket to give him multiple work surfaces and more ready access to his portable system. The Direct Point is used to access both his stationary system for dedicated writing, literacy activities and the portable system for face to face communication and portable writing needs.

Considerations/Options

Technology is available to support even very young children with multiple disabilities, however, the funding and support systems need to be flexible to allow regular re-assessments and changes of equipment to suit changes in physical status and educational/communication needs. Integration, compatibility and overlap of training with systems used for communication and education need to be considered and promoted in choosing equipment.

Outcome/Social Validation

The computer access equipment described supported Christopher through very crucial formative years of development from ages 4 to 8, and from nursery school to Grade 2 in educational and communication content. The cost of the original computer system and access technology was approximately $3,000.00 USD, however, as Christopher had rapidly changing needs he was able to use a Province of Ontario leasing program. This provided flexibility and recycling of equipment as Christopher's needs for physical access and educational/communication material changed. As technology was also changing throughout this time, it supported the transition between the early use of Apple 11e software to Macintosh educational CD ROMs 2 years later. Costs of his later system of the DirectPoint, Performa 5800, etc. was approximately $3500.00 USD, with the access hardware being shared between the stationary and portable system. The changes in hardware, software and access methods were made following assessments or re-assessments which clearly demonstrated the gains in speed, accuracy and computer input and the compatibility needs of the school environment, which made the requests acceptable to the funding/leasing agency. The changes were done with thorough discussion and consultation with the family, school staff and support team, with documented rationale, resulting in full support by all concerned. The changes were also introduced sequentially, to prevent overwhelming the client and support system with new technology for computer, mobility and communication all at once. Christopher was able to access technology for age and grade appropriate written and face-to-face communication with a minimum of frustration due to his physical limitations. The uncounted costs of not providing this progressive access technology and support would have been behavioural problems due to frustration, limited literacy and communication skills and increasing dependence for any educational programming. In contrast, the client now can attend a regular school independently with some teaching assistance support for his equipment and full opportunities to participate in classroom and home learning opportunities.

Technology Resources

Macintosh computers: Apple Computers, Inc.

Ke:nx, single switches - alternative access interface for the Macintosh from Don Johnson, Inc.

1000 N Rand Rd, Bldg 115
PO Box 639 
Wauconda IL USA 60084-0639 
Phone:800-999-4660 USA & CANADA 
847-526-2682 USA & GLOBAL 
E-mail: djde@mcs.net
URL:http://www.donjohnston.com

intellitools

Unicorn keyboard, Intellitalk, ClickIt software: expanded keyboard and software from Intellitools Inc.

55 Leveroni Ct., Suite 9 
Novato, CA 94949 USA 
Phone: (415) 382-5959 
Email :intellitoo@aol.com
URL: http://www.intellitools.com

Armslot Switch Controller:

DU-it control Systems Group Inc.

8765 Twp. Rd. 513, 
Shreve Ohio 44676-9421 USA 
(216) 567-2906 

Speaking Dynamically, Boardmaker

Mayer-Johnson Co. 
P.O.Box 1579 
Solana Beach, CA 92075-1579 
Tel: 619-550-0084 Fax: 619-550-0449 
E-mail: MayerJ@aol.com
URL: http://www.mayerjohnson.com

Zygo Lever Switch:

Zygo Industries, Inc. 
P.O. Box 1008 
Portland OR 97207-1008 
Tel: 800-234-6006 or 503-684-6006 Fax: 503-684-6011 

Zygo Switch mounting:

David Cooper, Sunnyhill Health Centre for Children

3644 Slocan St.,
Vancouver, BC, V5M 3E8, CANADA 
(604) 436-6527

Direct Point:

Jerzy Antczak, Bloorview MacMillan Centre

350 Rumsey Rd., Toronto, ON M4G 1R8, CANADA 
(416) 425-6220 
E-mail: ortcja@oise.utoronto.ca

Excerpted from "The Clinician's Guide to Assistive Technology" Computer Access Chapter by Jutta Treviranus and Linda Petty. Mosby Publishing, Inc. In publication.

Application/Goal

Computer access technology for a high school student with an acquired long term disability of C4 quadriplegia that would be suitable for high school and post secondary educational settings as well as writing in the home environment. The client, Derren, used Peach Tree controls for power mobility and supportive seating. Macintosh computers were available in the high school resource room and drafting classes, however, the client and his family were very technically adept in use and support of IBM compatible systems.

Function/Ability

Initial assessment in Jan. 1990 was requested for access to a 386 IBM compatible system running WordPerfect 5.1 for home use. The client, Derren, had good control of head and neck movement and speech. As voice recognition was financially unfeasible and limited in performance, a miniature keyboard with built in Sticky Keys, the Bloorview Mini Keyboard, was prescribed for use with a mouth stick. This keyboard was a modified Sharp 360 pocket calculator and plugged into the keyboard port of the 386. It provided mouse emulation or could be used in conjunction with a trackball.

In 1991, the client had returned to a full high school program and found a voice activated tape recorder ineffective for note taking. Re-assessment indicated that a "notebook" computer, a new technology at the time, would have a small enough keyboard as to be effective for note taking and in-class work with a mouth stick, or could be paired with the use of a Bloorview Mini keyboard. A Sharp PC 6641(40 MB hard drive, 4 MB RAM) was prescribed with a custom mount and wheelchair battery adapter. The notebook system lasted approximately 5 years before the system became irreparable and unable to support compatible software needed for access and course work. Recommendations were given to the high school which provided a Bloorview Mini and trackball for use with the Macintosh systems for drafting and other graphics needs.

Derren enrolled in the University of Toronto following high school and was able to obtain Vocational Rehabilitation Services financial support for computer equipment at home to support his studies. At the onset of the migration from DOS to Microsoft Windows, Derren was able to upgrade his home system to Microsoft Windows version 3.1, accessed with the Bloorview Mini and a trackball. When the Bloorview Mini was no longer available, a SpaceSaver keyboard was found as a replacement. By 1996, Derren was able to upgrade his home computer system to a Pentium running Windows '95 and accessed using Dragon Dictate voice recognition, which had decreased significantly in cost and improved significantly in performance, and/or the SpaceSaver keyboard and trackball. Use of voice recognition will improve Derren's speed of text input for writing and ease the demand on neck musculature which is heavily used for driving as well as mouth stick access. A 21" monitor also decreases the need for accessing scroll bars and provides additional screen space for running multiple applications. At the University, a Pentium system was made available with Dragon Dictate for exam writing and on-site writing needs. The library was also modified to improve wheelchair access to the computer systems and offer sticky keys and mouse control via the system keyboards.

Considerations/Options

Commercial and access technologies are changing with increasing rapidity. It is important to address immediate needs with existing, but state of the art, technology, while recognizing that it will not be a permanent solution. Coordination with educational facilities and other areas of the client's environment is crucial to maximize the person's function across environments and prevent the unrealistic expectation that one piece of technology will meet all needs in all settings. Technical access solutions in the late '80's, early '90's often required custom fabrication of equipment like mounting devices, battery adapters, or modification of commercially available products, such as gave rise to the Bloorview Mini. Current access technology can frequently be found in mainstream product lines or companies which produce a commercial product that is marketed both to the mainstream and rehabilitation or disability markets, such as Dragon Dictate.

Technology Resources

SpaceSaver Keyboard - Datalux Corporation

155 Aviation Drive 
Winchester, VA 22602 USA 
Toll Free: 1-800-DATALUX 
Phone: 540-662-1500 
Fax: 540-662-1682 

Dragon Dictate, Classic Edition - Dragon Systems, Inc.

320 Nevada Street 
Newton, MA 02160 USA 
Phone: 1-800-TALK TYPE or +1-617-965-5200 
FAX: +1-617-527-0372 
E-mail: info@dragonsys.com
URL: http://www.dragonsys.com

Outcome/Social Validation

Each technical solution met the existing needs, however, each eventually became inadequate as newer technology offered greater speed of access or compatibility with current software needed for educational programs. The costs of the original Mini keyboard was $250.00 USD, the notebook system was $3,000.00 USD, with the custom mounting and power supply totalling $800 USD. The client's current system is a very powerful, state of the art, Pentium with a large monitor and 32 MB of RAM, retailing at approximately $3500 USD. Dragon Dictate, the Classic Edition, was obtained for $500.00 USD and the Space Saver keyboard for $125.00 USD. The client was able to receive funding through provincial Ministry of Health equipment programs and Vocational Rehabilitation Services to support the equipment purchases over time. Improvements in performance with each system were simple to document, as each system offered improved speed of text input and system control over the previous, or enabled the client to fulfill the normal scholastic demands which had previously been unmet.

The client is very satisfied with the speed and functionality of his current system, however, will want it to keep pace with the latest releases of commercial software and so will probably continue to upgrade the voice recognition access as new versions are released. The current solution offers the preventative measure of minimizing repetitive use of the client's neck musculature and virtually eliminates access barriers to commercial software used by future potential employers. Outcomes can also be verified by surveying the educational facilities as to the client's ability to meet institutional standards for workloads, exam writing time, etc.

Excerpted from The Clinician's Guide to Assistive Technology, Mosby, Inc. In Press. Computer Access Chapter, by J. Treviranus and L. Petty

Application/Goal

Dr. S. was a humanities professor at a large urban university. At the age of 48 he was diagnosed with Amyotrophic Lateral Sclerosis, a degenerative neurological condition. Dr. S.'s goals for computer access were to allow him to continue to teach, mark assignments, council students, exchange information with fellow academics and his department, prepare and modify his lectures and conduct research as long as possible. The goals for the computer access system were that it would adapt to his changing condition, and that it would not have a substantial initial learning curve.

Functions, Abilities, Considerations and Options

In response to his changing skills and goals, the computer access system went through a number of phases over a two and a half year period. Throughout the process, access system components were chosen which would require skills which could be transferred to access systems used at later stages

When initially assessed Prof. S. identified his major problems as: difficulty controlling a mouse, poor control of a pen, difficulty handling books and papers and fatigue when working at the computer for an extended period. Finger and wrist movement was well controlled while larger arm movements were more difficult. Holding or gripping objects caused fatigue. A trackball which required primarily finger and wrist movement was used to replace the mouse. Dr. S. was taught keyboard shortcuts for a number of mouse actions. He was also tutored in more efficient control of both the desktop and the most frequently used computer applications. A macro, abbreviation-expansion package was prescribed. His mailer was upgraded to a more efficient mailer which performed a number of the tasks automatically. He was also provided with a wrist rest , document holder and book holder. In anticipation of challenges in the future, a number of changes were made to his job tasks. Books or papers on the computer do not need to be handled, can be easily searched, can be read by a voice synthesizer and can be annotated. Professor S. was made aware of sources of electronic reference and research materials and electronic catalog tools. He was also referred to an electronic-text transcription service. When surveyed it was found that the majority of his students had computers or access to computers, many also had access to e-mail. Instructions were prepared for submitting papers and assignments on disk or over e-mail, and students were encouraged to do so. With assistance from academic computing staff and network staff at the University, a listserve was set up for exchange of information between Prof. S. and his students and between the students themselves. This was later used to conduct tutorials

Six months later his endurance and accuracy when using the standard keyboard had greatly deteriorated. He was loaned a miniature keyboard which required a reduced range of movement, reduced the pressure required to activate the keys and optimized the keyboard layout to decrease the movement required between keys. The volume of his voice had declined making it hard to deliver lectures. His lecture hall was modified to include a microphone and a computer projection panel. He was taught to prepare overheads and slides using an application called Power Point. This served to clarify his verbal lecture.

During the next phase the range of movement of his wrist was further reduced as was his finger control. He was able to control an analog miniature joystick accurately with his index finger when modified with a thimble like top. However, he was unable to keep the cursor over a target and activate a swi

Therefore, targets were selected using a method called dwell select: holding the cursor over the intended target until a time threshold was reached. He was prescribed an on-screen keyboard with a keyboard layout which matched the miniature keyboard. He also purchased a portable computer with a voice synthesizer and voice utility: to clarify his speech and converse with strangers