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Table of Contents
Concurrent Visual and Physical Disabilities
Incidence of Vision Problems: Normal population
Incidence of Vision Problems: Cerebral Palsy
Incidence of Vision Problems: Developmental Delay
Incidence of Vision Problems: Downís Syndrome
Acquired Neurological Impairments
Acquired Neurological Impairments
Third Group- Lightening can strike twice
Difficult to fit population technically
Process to accommodate both areas of need
Quantitative Computer Access Eval
Using Alternative Computer Input with Vision Technology
Intellikeys and Screen Magnification Software
Intellikeys and Jaws for Windows
Meshing Technology:
Computer Access for Visual & Physical Disabilities
Linda Petty, OT
www.utoronto.ca/atrc This email address is being protected from spambots. You need JavaScript enabled to view it.
Introductions
University of Toronto Adaptive Technology Resource Centre and Centre for Academic Technology
Research & Development, Education and Services
Vision Technology Service
Regional Assessment Centre for provincial Ministry of Health for SE and SS High Tech Vision Aids
Employment Accommodation contracts, linked to local hospitals, schools, AT clinics
Funding
Province of Ontario funds equipment for schools under Min. of Ed., ìPersonalî equipment under Min. of Health. No funding or legislation mandating employment accommodation.
Personal equipment: assessment service funded and 20 hours of training
Range of software/hardware eligible
Equipment funding
Computer system and screen reading or magnification funded up to $4900
Scanner and OCR program OR CCTV funded to 75% or 100%
Personal Information Managers funded 75% or less
Alternative keyboard access funded through Writing Aids clinics up to 75 or 100%
The bleeding edgeÖ
Two very different groups of disabilities
- Different medical specialities, support systems, special educators
- Different access technologies from different vendors, developers
- Little support from a technical/design perspective for products that work together well
Concurrent Visual and Physical Disabilities
Congenital, Acquired and Dual Disabilities
Congenital
75 - 90% of children with severe impairments have a visual impairment
High Risk populations for visual impairment include: Cerebral Palsy, Premature births, Downís Syndrome, Hearing Impaired, Fetal Alcohol Syndrome
- Beukelman & Mirenda, 1992; Erhardt, 1990; Mirenda & Mathy-Laikko, 1989
PPT Slide
Impairments include: visual acuity loss, eye muscle imbalances, visual field deficits, visual perceptual skill delays and processing problems
Treatments focused on motor impairments- visual problems are often undiagnosed, not treated or poorly understood, esp. in clients with motor-speech or literacy impairments
Incidence of Vision Problems: Normal population
Refractive error :15-30%,
Strabismus: 2 - 4%
Total: 30-35%
Compared to vision problems associated with congenital conditions...
Incidence of Vision Problems: Cerebral Palsy
Refractive error : 21-76%,
Strabismus: 15 - 60%
Other problems: 1 - 25%
Total: 50 - 78%
Incidence of Vision Problems: Developmental Delay
Refractive error : 52%,
Strabismus: 16 - 40%
Other problems: 21%
Total: 50 - 80%
Incidence of Vision Problems: Downís Syndrome
Refractive error : 42-73%,
Strabismus: 30 - 57%
Other problems: 0%
Total: 60 - 85%
Acquired Neurological Impairments
High Level Spinal Cord Injury, Acquired and Traumatic Brain Injury, Neuro Muscular Skeletal disabilities, Amyotrophic Lateral Sclerosis, Multiple Sclerosis
The physical insult or disease process affects optic nerve pathways, occipital lobe processing or ocular motor control of eyes
Acquired Neurological Impairments
For example: Traumatic Brain Injury at the brainstem level
- in one client results in severe nystagmus, decreasing acuity, unable to read 12 point text on 15î monitor, speech loss, quadriplegia
- in another client causes inability to open the eyelids, move eyes for tracking, reading effectively, loss of speech, quadriparesis
Demographics of Vision Loss
Between 1% and 2% of western populations have conditions resulting in Low Vision- Diabetes Mellitus, Age Related Macular Degeneration, Cataracts, Glaucoma, Retinitis Pigmentosa
LV most prevalent among the elderly- 25% of over 65, and the % of elderly in popín ?
0.2% are ìlegallyî blind
Demographics of Vision Loss
From 1.7 to 2.8% report visual disabilities in surveys from US, UK and Canada
Clients may present as needing high technology equipment but could be corrected with conventional medical or optometric intervention- need sequential assessment: Ophthamological, low tech, then high tech
Third Group- Lightening can strike twice
People with existing blindness and low vision conditions can acquire physical disabilities: e.g.
- blindness from RP: acquires head injury, hemiplegia through water skiing accident
- glaucoma and arthritis
- Retinitis Pigmentosa and Multiple Sclerosis
- Cerebral Palsy and Multiple Sclerosis
Difficult to fit population technically
Computer access methods for physical disabilities rely heavily on vision
High tech aids for visual disabilities rely on multiple keystrokes from whole keyboard, esp. numeric keypad, and are memory intensive
Conflict between timing and representation of alternative input device and vision aid
Process to accommodate both areas of need
Thorough identification of needs and problems- physical and visual- in personal, productivity and leisure reading and writing
Quantitative computer access evaluation to establish optimal computer access method
Application of computer access to control of visual access software, computer system and application software
Quantitative Computer Access Eval
- Seating and positioning and the influencing reflexes, muscle tone and posture
- Upper extremity range of reach (ROM), target size and accuracy and speed of sequencing, amount of pressure applied, grasp/release skills
- Head control for active movement, jaw and mouth movement and voice control
Lower extremity control and range of movement, if reliable and adequate upper extremity or head/voice control have not been found
Lower extremity control and range of movement, if reliable and adequate upper extremity or head/voice control have not been found
Visual skills in peripheral vision, tracking, scanning and eye-hand co-ordination
Determine the Movements, body sites, interfaces and positions for best access
Equipment Trials
Conduct a series of trials with each Movement/site/interface/position, collecting data on accuracy and speed, making modifications to improve performance as needed
Finalise on best configuration for the technology use or need
Training required on both visual and physical access technology
Using Alternative Computer Input with Vision Technology
Main target technology of screen enlargement, screen reading and OCR software
Keyboard Modifications
Sticky keys, filter keys in Win 95/8 work with screen enlargement software
With screen reading have to confer with manufacturer, often use non-keypad layout for laptop system, as Sticky keys will not hold down a numeric keypad Insert
Many clients can use filter keys instead of keyguard, which blocks view of keyboard
Mice and trackballs
Variety of mouse/trackball devices
Look for those with reliable drivers and right mouse button function
Match with strength ROM, coordination
Alternative Keyboards
Provide full text entry and function keys
Incorporate mouse emulation
- Tash Mini and King
- Magic Wand
Increased visual and cognitive load, keystrokes
Alternative Keyboards
Hardware miniature or expanded keyboards work well for text entry, but do not offer extensive control of vision software unless hot keys of vision software are re-configured or in laptop configuration
Usually do not have numeric keypad
Can be used in conjunction with a mouse to minimise some extra keystrokes
Big Keys Keyboard
Available in ABC or QWERTY large target keys, durable
Can get large black letters on tan background for adult users
www.bigkeys.com
Intellikeys Keyboard
Have used Overlay Maker extensively to develop large print overlays with keys to operate functions of screen enlargement/reading/OCR software
Overlays are customised
- for clientís visual requirements for colour, contrast, label size
- for physical targeting skills and range of motion
Modifying Overlays
Can increase contrast of background/ foreground
Can use puff paints for tactile feedback, or Braille labels on overlay
Web Browser Overlay
For client with needs for large target areas, large font and literacy support
Intellikeys and Screen Magnification Software
Can create custom overlays for visual needs and with macros to operate screen enlargement software
Re-configure ZoomText Extra Hotkeys and map under 5 overlay keys- Magnify plus and minus, ZT on/off and DocReader On
Can also use standard QWERTY or ABC overlay and re-label hot keys for in-frequently used keys
Intellikeys and Jaws for Windows
With Jaws for Windows have used Intellikeys with a high contrast overlay and laptop layout.
Will leave a ìJî keystroke when using insert key
OCR software
Minimise the amount of buttons needed with OCR, etc. by mapping most used keys- New, Open, Scan, Read, etc.
Can put reading controls on same overlay as writing control if space is available- other wise create separate reading overlays if support for changing overlays is in place
Sources of Overlays
www.Intellitools.com has an Activity Exchange section
Can search the database of overlays for those designed for low vision, also for various grade levels and subject areas, Mac or PC
On-Screen Keyboards
Compatible with Screen enlargement- need to make sure the focus alternates properly from the keyboard to the document
Ensure that the client can visually scan keyboard for selections
Usually need 21 inch monitor due to the amount of screen real-estate needed
Switch Scanning
Pre-programmed (EZKeys) or customizable (Discover Ke:nx, Discover Switch)
Switch access of on-screen keyboard: ie. WiViK
Switch access for mouse emulation only from Words+, Gus, Madenta, RJCooper
Customized Scanning Arrays
Best option for single switch specific application access
Can add text-to-speech support for visual or literacy needs
- Ke:nx setups included with product
- Switch Clicker Plus
- Discover Switch
- CAT: el.net/CAT/matrix.html
Switch Access
At present have not found a program which provides non-letter based scanning arrays for single switch scanning which can communicate with screen reading or enlargement programs.
- Switch Clicker Plus and Discover Ke:nx will not operate LPWindows and ZoomText Extra; Does not give commands at a level the program could interpret.
Morse Code
System of inputting text and commands/mouse movements through 1,2,or 3 switches through hardware switch box with or without software
Only alternative computer input method that does not rely on vision- use auditory tones to identify codes, text echoing/ reading programs to review what is written.
Hardware Morse Code devices
Attaches to keyboard port - MiniMorse or PCMCIA card- Darci
Does not offer faceto face communication support, instant phrases, etc.
Does not conflict with other software- screen reading/magnification
Voice Recognition
Continuous speech voice products can run in conjunction with screen enlargement; for speech feedback/ editing of what is written is best to use document reading from the enlargement program
Likewise, can run JFW and Naturally Speaking for non-hands free voice in-out
Jawbone available for JFW, NS and DD
Web Browsers
Opera is a ìnimbleî shareware browser with zoom features and complete control from the keyboard
Can download in 3 - 5 minutes, carry on a floppy
Available at www.opera.nt.nl
Support software
Help Read program from Hawaii literacy program at www.pixi.com~reader1
Shareware/freeware linked to Trace site at http://trace.wisc.edu/world/computer_access/multi/shareware.htm
Electronic text - links from SNOW site: http://snow.utoronto.ca
Resources
Adaptive Technology Resource Centre, Univ. of Toronto
Library of Papers with Conference presentations
- www.utoronto.ca/atrc
Barrier Free Education site from Georgia Tech at
- http://barrier-free.arch.gatech.edu
Service Requirements
Multidisciplinary team with occupational therapists & technologists experienced in alternative computer access
A range of computer access devices and mounting/positioning aids
Access to individuals support team for seating adjustments, training support
General recommendations
Encourage manufacturers/developers to consider each otherís products, develop scripts/set files, etc.
Need to test each configuration of alternative access software/hardware with the screen reading/magnification/OCR software to ensure compatibility
Document what works and share it!