Low Tech vs. High Tech

What is the difference between low tech and high tech in regards to Assistive Technology?

First, it is important to understand what is assistive technology to begin with.  To paraphrase many definitions that are available, assistive technology is the use of a device to assist with improving the function of the user.  For example, a pair of glasses can be considered assistive technology as they assist with vision.  A walker can be considered assistive technology as it helps with walking or ambulation.  There are also different levels of assistive technology, and this can be broken down into low and high tech devices.
 

Low technology does not require a power source.  Sometimes this can be the easiest and most practical of solutions in assistive technology.  Low tech devices are items that facilitate independence in an area as does high tech devices.  Examples of low tech are a cane for assistance with walking, a pencil grip for children with grasp issues, or even glasses to assist an individual with seeing their environment.  

Even if an individual can benefit from high tech assistive technology, it is always important that they have a low tech "backup".  Technology can fail, batteries die, and emergencies can happen.  In these cases, an individual will continue to meet their needs using their low tech device.  Also, low tech devices might be all a user needs.  High tech is not indicated for everyone.

Before we discuss high tech devices, there is another classification that many individuals use, mid tech.  The difference between mid tech  and low or high tech  is that mid tech has a battery source.  Typically, they have limited capability but do have a power source.  This can include communication devices that can be pre-programmed with single pre-saved phrases or simple remotes that can control an individual's lights.  

 Again, mid tech can also be an appropriate option for individuals.  They are simple devices that can facilitate independence for the user.

High Technology:

Users of high technology are typically individuals with significant functional impairments.  This can includes folks with spinal cord injuries, Lou Gehrig's disease, or muscular dystrophy.  Examples of high tech devices are:

• Communication devices with alternative access methods such as eye gaze
• Stand alone environmental control units, with alternative access, that can control multiple devices in the user's environment
• Computer workstations with alternative software and hardware for access, such as a head mouse or dwell click software 

These devices can assist a person with the most minimal of movement to independently communicate or control their computer.  

Funding can be a challenge for these devices and they can be quite costly.  Communication devices (or AAC devices) can often be partially covered by insurance companies.  A qualified professional can assist with the selecting the appropriate device for the user's needs and goals, as well as obtaining funding for best device choice.

What have your experiences with these forms of assistive technology?

Mouse Keys

What Are Mouse Keys?

Mouse keys are an alternative way to perform mouse skills for individuals that have physical impairments that would limit their ability to utilize a conventional mouse.  Mouse keys allow the numeric keyboard to emulate mouse functions.  For example, when the user presses the number 8, the pointer will move up.  Pressing the number 6 moves the pointer to the right.  When using mouse keys, the conventional mouse is not required.  The image below helps illustrate these buttons and their correlating movements.

This feature is available with both the Windows and Macintosh operating systems.  Below are screen shots of where to access this feature in both operating systems.


Macintosh:

Windows:

The rate of speed of the mouse point can be modified in the settings to accommodate for the users needs.  Access of the numeric keyboard can be achieved through direct selection of the an individuals hands on the keyboard,  a mouth stick or pointing device on the physical keyboard, or use of the on screen keyboard.  In addition, if is easier for the individual, the mouse pointer can be made bigger for increased independence in the mouse settings (please see an earlier post).  


Mouse keys is another example of how simple modifications can facilitate independence for an individual with a disability.

Alternative Mouse Control

There are many ways that an individual with disabilities can control their computer.  If the individual can control their mouse, they can typically control their entire computer.  This can be achieved through alternative access methods such as head, eye, or mouth control.

Using a Quad Mouse:

An example of an alternative mouse is a Quad Mouse or a mouse that the user can control with their mouth.  

A Quad Mouse is a joystick that plugs into a computer that enables an individual with significant physical impairments control their computer.  The user moves the joystick with the mouse to move the mouse pointer.  For example, if the individual moves the mouse up with their mouse, the pointer on the screen moves up.  

How does the user click with this mouse?  

The user can click one of several ways.  The first way is to use dwell click software, see previous blog post describing this:  

http://adaptableworld.blogspot.com/2012/03/what-is-dwell-click-software.html 

The second way to click is through sip and puff clicking.  Through sipping and puffing, the user can emulate all mouse functions.  This includes left and right click, double click, and lock and drag.

An additional way that the user can click is through an ability switch that is mounted at a site of accurate movement.  This can be through a very small movement, such as a toe or finger, or a gross movement, such as a knee or elbow.  When accessing a switch access site, it is very important to choose an area that does not fatigue.  

How does a user type?

The user types using an on screen keyboard.  This can be the keyboard that comes within the accessibility options of the computer.  Additional on screen keyboards can be installed that have features to increase efficiency with typing such as word prediction.

It is always important to remember to trial various types of hardware and software before making the final decision on the most appropriate equipment.  After a fully evaluation, assisting with setup and training is just as important to facilitate independence for the user.

Direct vs. Indirection Selection?

Selection Options for Device Use:

When evaluating an assistive technology device,  the selection method is one of the most important aspects of the evaluation.  The if the appropriate type of selection method is not being utilized then the user cannot be as efficient and might become frustrated with the device use. These selection methods can be used with computer access, communication devices (AAC or SGD), and environmental control units.

Direct Selection:  Direct selection simply is just what it sounds like; you press a switch and your "selection" is made.  An everyday example of direct selection is a light switch; you "flip" the switch and the light turns on or off.  Other examples of direct selection is the left or right buttons on the mouse, dwell click software, or touch screen use/access for computer skills.  Direct selection can be a very quick form of access for the appropriate individual.  If it is not appropriate, then the individual might spend an extended amount of time to fix errors or be unable to effectively access the device at all.  Direct Selection does not need to be performed with a hand but any body part or technical device in order to make a selection.

Indirect Selection or Scanning:  Indirect selection is also known as scanning which is an indirect way of accessing a device.    

The user will access a switch which will begin intermdiate steps or scanning in order to make a choice.  There are several different types of scanning.  Either one or two switches can be used with scanning; these switches are mounted or positioned at the body part with the best strength or that will not create fatigue with use over time.  

The most common form of scanning or indirect selection is linear scanning.  With linear scanning, the user accesses their switch which begins the scan.  This scanning moves row by row.  When the scan gets to the line with the letter or choice that the user wants, they access the switch again; this begins a column scan.  Once the scan gets to the desired choice, the user accesses their switch again and the desired action happens.  This could be a pre-saved phrase for communication or a letter for typing with an on screen keyboard.

Inverse Scanning is performed with the user holds their switch down to being the scan.  The user holds their switch down until the desired choice is highlighted and lets go to have their choice made.

Group Scanning:  With group scanning, the user accesses their switch and groups are highlighted.  As the group with the desired choice is highlighted, the user accesses their switch.  It then will narrow the choices with a linear scan.

Item by Item Scanning:  The user accesses their switch to move the highlight or cursor in order to make a choice.  This method requires multiple switch access "hits" in order to get to the desired choice.

Other, individuals are concerned that scanning is slower than direct selection.  Points to consider are if the individual is unable to perform direct selection without making a considerable amount of mistakes, indirect selection will be more efficient and less fatiguing.  

Indirect selection is appropriate for an individual with limited movement.  For example, if the user has only one area of movement such as one finger, scanning would be an appropriate access method for access of the computer or a communication device.

Positioning is very important for scanning use.  The switch must be mounted to the area with the best strength so that the user will not become fatigued over time.  Switches can be mounted to any surface such as a wheelchair, tabletop, or bedrail.

Considerations with scanning is that it requires a higher cognitive load.  The user must be able to anticipate the scan and understand the cause and effect of indirect selection.

There are many features that can be modified with scanning.  These include:

• The rate of the speed of the scan
• The type of scan
• The type of feedback
• Audio
• Click sounds
• Reading the scan choices out loud
• Visual
• Highlight color
• Magnification of the scan
• One or two switches

When evaluating an assistive technology device, the type of selection is one of the most important parts of the evaluation and consideration of particular devices.  It is important to remember that the most appropriate access method might not be established within the first session; it can take time to figure out the best method as well as the modifications required to make this method the most appropriate.

Using a Joystick as the Mouse

There are many options for alternative mouse hardware.  In earlier posts both a head mouse and a trackball mouse have been explored.  What about a joystick mouse?


Traditionally, a joystick has been associated with gaming devices.  In addition to gaming, a there are joystick mice available that can be very helpful for individuals with both physical and cognitive disabilities. 


The standard mouse that comes with a desktop computer can be very challenging for people with various impairments.  The movements required for effective mouse use can be very difficult.  How many times have you had to lift up the mouse and place it back down to get your pointer back on the screen where you can see it?  What if the user has upper extremity weakness from a stroke or tremors from Parkinson's?  How do you think this would affect their mouse function? 


It can also be difficult for individuals to understand the cause and effect of the types of movements required to move the mouse that translate to the movements of the pointer on the screen.  This can make the mouse extremely difficult for the user with cognitive impairments.


The use of a joystick mouse can eliminate these problems.  With a joystick mouse the movements seem more intuitive than with a standard mouse.  For example, if press the joystick up, the pointer moves up.  Many hardware options can include alternative methods for clicking as well as the shape and size of the joystick itself.  This can assist people with grasp issues by having the flexibility to change the joystick top.  

The joystick mouse pictured above comes with interchangeable joystick top options as well as buttons for double click, single click, right click, lock, and speed changes.  The accessibility of the buttons can create increased ease of use.   


In addition, if access of any joystick buttons are a challenge, any ability switch can be used for click features.  This can be plugged directly into the joystick mouse, dependent on the model, or with the "swifty" USB adapter for ability switches.  Dwell click software (discussed in an earlier post) can also be used for click needs.

There are joystick mice that are not only geared towards individuals with disabilities but people that require a more ergonomic computer workstation setup.  

The mouse pictured above will hold the users hand in an ergonomic position in an attempt to decrease or eliminate repetitive strain injuries.  The right and left click is performed by the thumb positioned at the top of the joystick.  Again, if clicking is an issue, ability switches or dwell click software can be used.


Additionally, software can be used to "turn" any USB joystick into a mouse.  The software acts as a driver, interpreting joystick movements into mouse movements to move the pointer. 

Always remember that changes in the control panel might still be required to facilitate independence with any adaptive mouse hardware or software.  With the appropriate adaptations, the mouse does not have to be a challenge for a wide range of individuals, helping to create an adaptABLE world!   

Word Prediction Software

What is word prediction?


Word prediction software is a very important tool in regards to typing and communication.  It is seen with both computer access assistive technology as well as with communication devices.  


It is a software that predicts the words as the user is typing.  The goal is to decrease the amount of keystrokes of the user.  Depending on the user, this can can have a variety of benefits including increasing the typing speed of the user or decreasing spelling errors.

When using word prediction software, a word list is displayed on the screen.  The user will press the corresponding button in order to choose the appropriate word.  In some programs, the correct word can be chosen with the mouse as well.  This can be used with email, text based documents, social networking, or any program where text is inputted.  


How is this different from word completion software?


Word completion software works in the same way as prediction but it makes predicts the word as you type it.  When the user sees the word they are intending to type, they press the corresponding button.

With both word prediction or word completion software, there are varying modifiable features that different programs have.  This can include but are not limited to:

• Method of prediction
• Frequency of use
• Alphabetically
• Number of words on the list
• This can slow the user down as they will require extra time to scan the list
• Words can be programmed or added to the program dictionary
• Such as the user name
• Some programs will "learn" new words automatically
• Font size of the words on the list
• Spaces to be added after choosing the word off the list or at the end of a sentence
• Text to speech options
• If this is an option, the words will be spoken as they are chosen off the list
• This can also include text speech of letter by letter or at the end of the sentence  
• The voice (male or female)
• Rate of speed of the speech
• Phrase prediction
• Some programs will not only predict words but phrases as well.  For example, if the user types the word "how", "how are you" can be part of the prediction as well as single words.

Why is word prediction or word completion software beneficial?


There tends to be differing thoughts as to if word prediction or word completion software really increases rate of speed with typing.  In of the some literature, it is explained that word prediction software will only increase rate of speed if the user types less than 15 words per minute.  Although this is a good standard to keep in the back of your mind when trying this software, there are many other benefits to its use, outside of possible increase in speed.  


Outside of rate of speed, this type of software can assist many types of individuals.

• Fatigue
• Individuals that fatigue quickly with typing can decrease the amount of keystrokes required for typing skills.  This can facilitate energy conservation and increase the amount of time tolerated for typing.
• Pain
• If the user experiences pain with extended typing, this software would decrease the amount of "button pressing" required.
• Impaired spelling
• Words predicted would be spelled correctly, decreasing errors and time spent correcting errors.
• Word finding issues
• If the user has difficulty with word finding or even mild aphasia, if they can type the first letter with word completion and prediction, the desired word would be on the list.  This could be difficult if the word is not initially prediction, requiring the user to type additional letters.  This would work best couple with text to speech features.
• Can also assist folks with learning disabilities, adult and children
• OnScreen Keyboard users:
• Increases the efficiency of OnScreen Keyboard (OSK) users, especially for individuals using alternative access such as a head mouse.  The use of this software would increase efficiency and rate of speech when typing.  Many OSKs come with word prediction and completion software.  This includes the standard OSK in the accessibility options in Windows 7.

Word prediction or word completion software is a very important tool for individuals with disabilities or difficulty with access.  If you think that this software would be helpful for yourself or someone you know, remember that it is very important to trial different programs to see which features are right for you.

What is an On-Screen Keyboard?

Many individuals do not know what an on-screen keyboard is (or that it is already on their computer).


An on-screen keyboard is exactly what is sounds like, a keyboard that is on the screen or monitor of your computer.  It is another way to type or access your computer.  It can replace the keyboard hardware that came or is part of your current system.  An on-screen keyboard can be used with any program that requires text.  This includes the internet, TextEdit, Microsoft Word, Excel, etc. 

If the individual cannot use the standard computer (the hardware) due to physical limitations, an on screen keyboard can eliminate this issue.  For example, if the user is using a head mouse for alternative mouse skills, the on screen keyboard would allow that individual to type.  If the individual is able to effectively use any mouse (mouth mover, trackball, joystick for example) but has significant issues with keyboard use, the on screen keyboard would be very important.  Individuals that would benefit from on-screen keyboard use can vary from Parkinson's to people with a spinal cord injury.


In order to "press your button" or click on the desired letter, dwell click software or an ability switch can be used.  Dependent on the keyboard that works best for the user there are various ways that the keyboard could be modified.  This could include the color, size of the font, ability to dwell and the features associated with that.

Other options can include word prediction (to be featured in the next blog post), phrase prediction, or even favorite websites for increased internet access.

How can you get an on-screen keyboard?

The most economical option would be to access the on-screen keyboard located on your computer.  Both the Windows operating systems and Macintosh have on screen keyboards as part of their accessibility options.  The amount of modifications available in these keyboards might be different or not as vast as keyboards for purchase.  An easy way to find the on-screen keyboard in your computer just type it in the search window.

To purchase an on-screen keyboard many of the companies will allow anywhere from a 14 day to 30 day free download.  An Assistive Technology Practitioner can also be helpful in educating the individual on companies, features, and possibly perform an evaluation to assess the appropriate keyboard.  Keep in mind that what works for one person might not necessarily work for the you so that trialing various options are very important.  

Computer Accessibility:


The computer is the one of the only pieces of technology that is mass marketed that comes with accessibility options.  The accessibility options are geared towards individuals with physical or sensory impairments.  These options are to change keyboard or mouse access, as well as the screen appearance and add features for individuals that are hard of hearing.  Both Windows and Macintosh operating systems have these features built in, and both operating systems have similar features.

The ease of access center in Windows allows you to adjust these settings to the users needs.  In the Macintosh operating system is it Universal Access:

The Keyboard Features:


Sticky Keys:  You can turn on sticky keys by either going through the control panel on both systems or by pressing the Shift Key five times.  This allows the users to create two keyed characters without having to press both keys down at the same time.  For example, the user would press shift then the key that they want capitalized.  This is very helpful for individuals that are one handed users. This can work for symbols and CTRL-ALT-DELETE as well.


Filter Keys: This feature "filters" out repeated keystrokes.  This can be modified, changing the amount of time that the system waits before it filters or allows the key to accessed.  This can be very important for individuals with tremors that cause multiple keystrokes.  


Toggle Keys:  This feature creates a tone when either CTRL, ALT, or CAPS LOCK is pressed.  This is very important for individuals that might accidentally hit CAPS LOCK without knowing.  Often, many individuals are "hunt and peck" typists, not looking up at the screen until they are done typing.  If they kit CAPS LOCK without knowing it then their whole document is in all caps and they would have to delete and start over.  This feature is very helpful in cueing the user to prevent this issue, increasing their efficiency and decreasing their frustration with typing skills.


For the next few blog posts I am going to continue to explore how adaptations can be made to the operating system of a computer, both within the accessibility features and in other ways to increase the performance of the user.