ALS From Both Sides
Care of an ALS Patient
By Diane Huberty, Retired RN, Certified Neuro Nurse
...and ALS Patient
Choosing a Van
My Computer Desk
Low Cost Ways to Keep Computing
Being able to use a computer has been such a positive aspect of my life with ALS that I want to share the tricks and tools I use to keep computing.
Step One: The Right Computer Desk
The first thought in computer access for the disabled is usually about finding hardware and software, but accessibility has to begin with even more basic problem solving; finding a desk that will allow you to use your computer!
Over the years I have been through any number of rigged up computer setups as I fought to keep ahead of my ever-increasing weakness. Every setup turned out to be temporary -- and looked it! I finally had enough of crappy looking desks and set out to find a workable, adaptable, computer work center that looked like furniture. The desk I came up with is made from Sauder furniture and is the one I should have started out with because it is adaptable through many stages of disability. I was already in a power wheel chair when I came up with the idea for the desk so it was built to wheelchair height, but could be made at standard desk height and elevated later using leftover, matching wood to maintain its good looks.
The first requirement of a desk is support for weak arms. It amazes me that very, very few computer desks for wheelchair users have this feature! My arm support is cheap, easy to make, uncomplicated, and roomy. I use a piece of plywood with a deep cutout so that it wraps around my waist and extends far enough back to support my elbows. This tray slides out from under the desktop and rests on my wheelchair arm rests, providing support at just the right height for shoulder comfort. At the time I designed this desk, I was still able to reach the tray and pull it out, as well as use the keyboard. I can't do either of those things now, but the pull out tray is easy for my caregivers. (I have to rotate the joystick for my wheelchair a bit to fit under the tray.)
For diagrams and building information, go to
I also have a portable tray made exactly like my desk tray. It is held onto my chair with two short bungee cords (the blue straps) that hook through two small holes drilled into the back edge of the tray and then down to hook on the wheelchair frame. It is a really inexpensive, quick to set up, roomy solution for computing anywhere I go, but requires assistance to set up even if you have arm strength.
Arm supports recommended by Occupational Therapists are from medical/rehabilitation suppliers and are very expensive and industrial looking. They attach to the wheelchair which can be a real nuisance for transfers. The one advantage of this type is that they are available with springs or large rubber bands to help you raise your arms to feed yourself. This feature isn't needed for computer access though.
Commercial arm support devices available with the most affordable types found on web sites selling ergonomic devices for computer users. Besides being inexpensive, they are generally made to clamp onto the desk and have a finished look. Some combine the arm support with an attached mouse pad support. Perhaps the most affordable desk to use with arm supports is an adjustable height drafting table. These can be found for as low as $110. In addition to being inexpensive, they are small enough for cramped quarters, require minimal assembly, and adapt to any wheelchair height. The downside is that they have no space for a printer and other peripherals.
Step Two: Tame the Mouse
Before making the switch from mouse to some type of eye gaze cursor controller, there are some things that can be done to prolong your mousing ability:
Reduce the need to click the mouse.
can be set to automatically left click whenever you place your cursor over a clickable item. That alone saves a gazillion clicks but isn't the only option. You can quickly (and without clicking) switch back and forth to right click, double click, click and drag, select multiple items from a list, and more. It doesn't clutter your view of whatever is up on your monitor. It hides off to the side of the screen and the control buttons are made visible by putting the cursor on the little edge that remains on the screen. I use this freebie constantly!
Change your mouse pad.
I use an oversized pad so that I don't can't push the mouse over the edge and have to struggle to get it back on the pad.
XTracPads Ripper XL™ v2
is fantastic! It is 14 x 17 3/4 wide and has a friction free smooth cloth surface that maximizes the strength I have left.
Free up your elbows.
For quite a while I used a Moving Men pad to allow smoother elbow turning, pushing, and pulling the mouse. More recently I came up with an elbow roller that works even better. Get 4 small rolling casters from
. Cut about a 4X6 piece of thin wood or non-flexing plastic. (It could be smaller but I found that the small size cut off circulation and made my arm go to sleep.) Attach the rollers with small screws or glue. Add a pad of cushioning foam and your mouse will skate easily!
Dress appropriately for your office.
Avoid bulky clothing and rough fabrics that limit arm movement.
Get the right mouse and stick to it.
I use a simple optical mouse and prefer one without a scroll button which just gets in the way, but they are hard to find. A wireless mouse is just too heavy to push around. I have had to switch to my left hand, and need help to lift my fingers up onto the mouse. When the humidity is low or my hands are cold and stiff, a piece of tape helps hold my fingers on the mouse. Velcro tabs on the right and left buttons keep my fingers in place.
Nail that tail.
I have found that the mouse cord hanging down will quickly pull the mouse sideways so the cord is tucked under the keyboard or taped to the desktop to hold it in place.
And now the Critical Step!
My arm weakness is so severe that even with all those tricks, I don't have the strength to move the mouse enough to get the cursor to the sides and corners of the screen where all the buttons are! Big screen monitors offer big views but increase the distance you need to move the mouse to get across the screen. A simple solution is to reduce the resolution of your monitor display. How you do this depends on your computer. It will take a few tries to find a size that is small enough to get your cursor across the screen without being too tight a view.
Additional distance can be achieved an incredible, inexpensive, ergonomic software program called
. It cuts the distance you have to move the mouse in order to move the cursor in half! Without it, I need to move the mouse about 3 inches to cross the screen with the cursor. With
, I can do it with 1 1/2 inches. This is
the same as adjusting your mouse speed. It adjusts something called "mouse throw".
seemed to have disappeared from the Internet a few years ago. Although a search would give you a link to download it, the links would all come up as “file not found”. Recently, however, it has reappeared. You can download a time limited trial version and purchase it for $29. I can't recommend it highly enough. It is the primary accessibility tool that has delayed my need for an expensive head mouse or eye gaze system! The weaker your arms, the more valuable
is. When you first turn it on, it may seem to make little difference if your arm weakness is only moderate. Use it for a half hour, turn it off, and you will be able to tell the difference!
***A newer alternative to Intellipointer is to try a gamers' mouse. These have settings to reduce the mouse throw. The correct terminology is to reduce the CPI (count per inch) that controls how far the cursor moves in response to mouse movement. Intellipointer worked so well for me, but recently it became just too hard to push the cursor to the corners and sides of the monitor. I bought a moderately priced SteelSeries Rival 300 gaming mouse. It solved the reaching problem entirely but has made it a little more difficult to hit a specific spot on the screen on the first try. That is well worth the small aiming adjustments in exchange for the struggle to move the cursor long distances. ***
Step Three: Ditch the Keyboard
You don't need to be able to use a keyboard to use your computer, and you don't need to buy any software! The software programs you need are
. Before you assume that purchased programs would be better, consider the fact that this website is done using these freebies. I also do photo editing and have a website for that,
Free Photo Fix Magic
So what are these great programs?
The first program I rely on is a free onscreen keyboard called
. It puts a keyboard on the screen and as you move the cursor over the keys, it types for you -- or lets you control your computer with any keyboard command (Control/Shift, F4, etc.). You never need to struggle with your keyboard again!
Several great features make this freebie indispensable:
You don't have to click the mouse for each letter. Just set it on auto click and it will click as you pause the cursor over a key.
You can set it with Macros that type frequently used words, phrases, or sentences with just two clicks.
It offers a standard Qwerty layout as well as an alphabetical one, and even allows you to design your own. I have created custom layouts to speed up typing, code html, or use just the number keys. The one shown here groups the alphabet in the center rather than in two long lines, making it faster to find the desired letter. The most often used letters are centered, making it even faster. Having a couple of the blank spaces lets you pause in your typing without leaving the program.
It has Word Prediction to speed up typing.
The only drawback to using
is that is hard to type with any real speed as it is essentially hunt and peck. When I want to compose an email or a bit of literary genius, I Use
, another freeware program.
is like playing a race car game -- you just drive the cursor, pointing it down the road to the next letter you want to type. With just a little practice you can move at speeds nearing that of ordinary typing. The speed allows you to work at composing, not just plunking out letters! I find that setting the View/Orientation at Bottom to Top works best.
Step Four: Move the Monitor
Even the slightest amount of neck weakness can make using the computer an effort. Neck muscles tire quickly if not supported, but leaning back to use a head rest changes the angle of view, causing eye strain. I thought I needed new glasses when I couldn't read anything but the largest type. Then I discovered that all I need was a booster seat for the monitor! By raising my desktop monitor up about 5 inches, I can rest my head and still see the screen at the right angle. I expect that at some point I will have to find a way to compensate for a more reclined position by both raising the monitor and tilting it forward. But for now, my monitor is on a study plastic tool case awaiting the day when someone gets around to building a nice shelf for it. My laptop required a much higher boost to bring it up to a comfortable eye level and a collapsible, completely adjustable for both height and angle monitor stand has been terrific. Easy to adjust, more and taller heights possible, stable without clamps or bolts, and the laptop doesn't need to be attached to it. Several brands are available. Here is a link to one online seller.
The End Result...
Me, happily at my computer, surrounded by my adaptive equipment!
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