Case Study 2
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.