Mr. J is a 57 year old male with quadriplegia (C4, 5,6) who resides in a
nursing home located in the Chicago, IL area. He currently is using a power
wheel chair with auto recline and leg elevation for mobility, rest and pressure
sore management. Mr. J spends much of his day working with his computer located
in his room. He is currently employed part time, and uses the computer extensively
to complete his work requirements. Mr. J is very knowledgeable about computers
and all the latest hardware and software. He uses a variety of software programs
to complete his work including graphics, database, programming, and word processing
applications. He must also use the computer to access the Internet for information
to complete his job, leisure enjoyment, and discussion groups regarding spinal
cord injury and other leisure interests of his.
Mr. J was referred for a computer access evaluation, as his current system
was no longer adequate to complete his job duties efficiently. He also described
his system as very unreliable as it would often crash several times during
each application. ("I have to beat on the side of the computer to make it
work… the hard disk is failing"). Mr. J wished to get a new system to meet
his needs, and desired equipment training and new access methods training
for the new system as well. Most of Mr. J's day revolves around his computer
as evident by his statement, "When I'm not working, I'm doing something else
on the computer."
Mr. J sustained his spinal cord injury 30 years ago, and has been in the
nursing home since. He relies on public aid to cover his expenses, which exceed
$40K per year just for room and board. In order to cover additional expenses
like clothing, medication, appliances, etc. he must rely on his computer skills
and equipment to support these needs.
Based on the above information, what ideas/questions do you have regarding
potential funding sources for Mr. J's computer system? Additionally, based
on his level of spinal cord injury, what questions do you have regarding modes
of computer access and environmental layout? What specific suggestions and
concerns do you already have to start brainstorming a potential problem and
solution list? What do you plan to evaluate the first time you meet Mr. J?
Considering Mr. J lives 40 minutes from your work site and you are asked to
do an on-site evaluation, is there any information you would like to know
to help plan your initial meeting/evaluation?
What follows is information obtained from a "Computer Access Questionnaire". The questionnaire was provided to the patient via mail from the intervening occupational therapist, and was completed by the patient with the assistance of a friend. The significant findings of the evaluation are included below:
(Place your cursor over "display options" for more information)
Now that you have more specific information regarding Mr. J's functional
skills and needs, what ideas do you have for computer access methods for Mr.
J? What about his environment? Environmental control? How about integration,
or ways to maximize the technology he knows how to use well?
Since Mr. J has been using the computer for years, he must have figured
a way to access it effectively. Without providing you with his solution, you
should still be able to problem solve several potential solutions to help
Mr. J access his computer. Take a moment to review the ideas already swimming
through your mind, and feel free to use this
helpful link to give you more info on potential solutions.
Now that you have taken time to consider possible solutions for computer access and environmental layout for Mr. J, you should now have a pretty good idea on how to assess Mr. J. In this case, we are fortunate to have an individual who has already been using the computer for years. Most of the information that we need will indeed come from the consumer regarding what works for him.
Given his level of injury and resultant hand function, how do you envision Mr. J being able to control the trackball and access the buttons?
Drawing-[display options]
Given his level of injury, how is Mr. J going to be able to hold onto his stylus to accurately use it to make finely detailed drawings? Are there any adaptations to the stylus that could be made? What about other access areas than the hand/fingers?
Keyboard Use-
What type of keyboard will Mr. J be able to use to maximize his efficiency with typing, and controlling his software? How will he be able to access it? Will Mr. J be able to use the keyboard for all his needs, or do you think he may need additional methods of text and command input? Where would you start in your assessment?
How would you modify his approach to accommodate for this? In other words, how could you enable Mr. J to keep his wrists pronated in a comfortable position without losing the ability to activate the keys using the typing sticks?
Monitor Needs-
Mr. J currently uses a 13-inch color monitor. As stated previously, he has difficulty seeing icons on the screen, and print is also difficult to read.
What specific ideas and/or suggestions do you have for Mr. J? How would you try these out? What process did you use to come up with your suggestion?
Hardware Needs-[display options]
Mounting Needs-[display options]
How would you set up his work area so that he can remain as independent as possible, and still be able to use all his computer devices and peripherals? Where would you locate the keyboard, mouse, monitor, drawing pad, phone, etc…so that it is all within reach?
Mr. J has already made a significant number of modifications to his workspace, and has a rather custom built desk. Incorporating D-ring pull straps, and drawer glides, he is able to slide his keyboard and drawing pad in and out so he can reach when needed (click here). Mr. J has a desk set up he is comfortable with. The desk needs a few minor repairs as bolts are missing and a bracket is coming apart. He has expressed interest in leaving the desk design and repair to his brother who can help him.
Specific recommendations for Mr. J have been included to help integrate the
information. See itemized equipment list.
Funding-
Considering Mr. J's needs and what he plans to continue to use his computer for, what potential funding sources should be considered? What key words and/or phrases should be used when considering the request for funding? Although many of these questions can be answered on a location (state or community) basis, the following links should still be of some help. You may also want to do some information gathering for potential funding sources in your own community. http://www.corecom.net/ATA/sfat.html#funding
With the help of his employer, Mr. J contacted the state Department of Rehabilitation Services (http://www.dors.state.il.us/atec) to express his need for a new system and evaluation so that he may continue his employment. After recognizing this requested need, the Department of Rehabilitation Services helped Mr. J obtain a referral to the Assistive Technology Unit (ATU) at the University of Illinois at Chicago for a computer access evaluation.
Birth date/Age: 11/05/40, he is 58 years old.
Diagnosis: Quadriplegia
Functional Vision: Mr. J wears bi-focal glasses, and has a difficult
time seeing print on his current 15" monitor. He indicated that his "eyes
give out" often, and is forced to stop using the computer due to eyestrain.
Mobility: Mr. J uses an Invacare Storm Series electric power reclining
wheel chair. He operates it using a Joystick with the small finger on his
left hand (he loops his finger into a ring-shaped joystick). He sits in his
wheel chair 16 hours/day.
Mr. J has C-4,5,6 level quadriplegia. He has limited arm movement for reaching overhead but is able to reach forward. Mr. J indicated that no involuntary movements exist that hinder the client's control. He has no active finger movement, so he cannot grasp objects easily with his hands. His fingers are slightly contracted into flexion. He is able to power his wheelchair with joystick control, and can feed himself with utensil adaptations. Mr. J requires maximum assistance in the rest of his self-care including dressing, bathing, and toileting. Mr. J has excellent respiratory control and a clear voice.
Mr. J works from his computer in his room. He works part time, and is paid by the hour doing a variety tasks which require him to access the internet, word processing, graphic design, advertising, and record keeping. He is required to use the Internet and his art stylus to complete his job. He also wishes to design a web page in the near future in order to promote a private business.
Mr. J currently uses an IBM compatible 50 MHz, 486 AST-Premmia personal computer with standard keyboard, trackball, and art pad. He has an external 14.4 modem, 3.5 inch floppy, CD ROM, tape backup drive, 13 inch color monitor, and a dot matrix color printer.
Due to the level of injury and resultant hand function, Mr. J has difficulty accessing a standard keyboard. He also has difficulty with his pointing device and art pad, which he needs in order to do graphic design and general desktop navigation. Mr. J is not able to operate a standard mouse. He has difficulty with the dual task of guiding the mouse, holding it steady, and then activating the mouse clicks. As stated earlier, he has difficulty seeing the monitor clearly and reports he can't identify the icons well on the screen. Mr. J also needs to be able to load in CD ROMs, 3.5" floppy disks, and tapes for his back up drive which he has difficulty with. He requires assistance from the center's staff to help gather needed discs and CDs. They also are required to help him rip off paper and load it into his printer. Mr. J. has a desk in his room where he keeps everything he needs, and it is cluttered with many various home appliances, computer hardware devices, books, etc.
Because of his functional limitations, Mr. J uses a trackball with much greater ease than a mouse. Using programmable buttons, he is able to separate many of the actions like double clicking, and dragging.
In order for Mr. J to complete his graphic art using his computer, he needs to use a drawing pad that traces an image onto the computer. A special stylus is used to input the information on the drawing pad, which is usually held like a pen or pencil. Mr. J has had difficulty drawing well, and needs greater control with this device.
Mr. J has been using a modified stylus with a Velcro strap, which he pulls over his hand using the attached D-ring. He still has difficulty controlling the stylus this way. Mr. J has previously used chin control to do a variety of art including computer graphic design, and plate painting. He is confident in his ability to use his chin accurately. How could you modify the stylus for chin control?
Currently, Mr. J uses a standard keyboard. He is able to type on this keyboard with a "two finer" approach using typing sticks with universal cuffs in each hand. He can currently type about 20-30 wpm via this access method, and can type for up to 4 to 5 hours. At this time, his eyes usually give out, and force him to quit. He also has difficulty orienting his hands into a neutral forearm position, which is needed to use the typing sticks. A more natural or resting position for him is to hold his arms in a more pronated position.
An adjustable-split keyboard with the ability to position the two halves of the keyboard into 45-degree positions would be helpful for Mr. J as he will be able to access the keys with his hands in a more natural or resting position for him. This positioning will help to keep his arms and hands from tiring and allow for greater endurance with keyboarding.
Although many potential solutions exist, Mr. J has opted (along with his OT) to purchase a 17 inch monitor. Since Mr. J's monitor is old, and has limited graphical output, he needs a new one anyway. By ordering a larger monitor, it is hoped that this will increase the size of icons and text. A larger monitor will require less strain on his eyes, and he will be able to work at the computer for longer periods. This combined with a combination of tweaking the screen settings in WIN 95 control panels, and using some additional software to zoom the display would make a big improvement.
Mr. J is requesting a Dell computer for support services (he has done this research on his own). He requires at least a 300 MHz processor, and a very large hard drive to work with and store large graphic files. He needs a quicker modem, as his is outdated. He also needs a trackball, an adjustable-split keyboard, tape back up, and a drawing pad.
Consider that Mr. J needs to access all these computer devices in addition to all his appliances like phone, TV, stereo, VCR, lights, etc. all in his little bedroom. He also needs to be able to access CD ROMs, floppy disks, books, tapes, and the like. It is therefore important that Mr. J's environment is laid out in a way that maximizes his function.
