Office Makeover
How assistive technology saved my career

by Kathy Wechsler

Using the keyboard and mouse were becoming increasingly difficult for me. For a writer, that can spell the end of a career.

But does it have to?

I knew I needed to learn how to work more efficiently at my desk, so I saw my vocational rehabilitation (VR) counselor and explained my situation.

Specifically, coordination, strength and vision problems associated with Friedreich’s ataxia were causing:

• too-slow typing;
• difficulty reading words on the monitor;
• frequent “losing” of the cursor on the screen;
• difficulty reaching the mouse;
• difficulty keeping the mouse on the mouse pad;
• accidental clicking of the right mouse button;
• sliding around of the mouse pad, phone and keyboard; and
• discomfort due to an awkward typing position.

Occupational therapist Pat Trossman helps the author position her new keyboard.

Assessing the problems

Because people have their own sets of capabilities and limitations, what’s accessible for one may not be accessible for another, says Pat Trossman, an occupational therapist (OT) and director of professional services at TACT.

To make sure the desk and all its components meet the individual’s needs, it’s helpful to have an assessment by an assistive technology (AT) specialist or therapist trained in ergonomics.

Trossman, who is an AT specialist, prefers to see people at least twice, the first time at the Alliance for Technology Access center, where she has different types of adjustable furniture and technology available to try.

First, problems must be identified.  Typical barriers can be anything from seating and positioning problems to difficulty accessing computer equipment or office furniture, says Aaron Markovits, director of the Kern Assistive Technology Center in Bakersfield, Calif.

Next up in a professional assessment: Trying out new stuff.

For me, this fell into two general categories: better ways to use my computer (AT) and better ways to set up my physical space.

AT assessment

Trossman measures author’s eye-to-screen distance to improve her copy-reading ability.

An AT assessment enables people to try out new equipment and get their questions answered by an unbiased professional.

The first thing to be assessed is motivation. “In order to use any new technological equipment efficiently, there’s a learning curve, so the user has to be motivated and committed to learning how to use the equipment the way it was intended to be operated,” Markovits says.

Since my main concern was my typing speed, I tried Dragon Naturally Speaking speech-recognition software during my first visit to TACT. This software has a long upfront learning curve, so motivation is important. Before using the program, I had to train it to recognize my voice by dictating into a microphone.

Training the software became an even longer process when TACT’s microphone headset kept sliding off my head and I couldn’t reposition it myself. Finally, the problem was solved by attaching the headset to a baseball cap that I could put on and take off independently.

Being able to speak and have my words immediately transcribed really increased my typing speed. Because the speech-recognition software can open programs, select menus and follow other commands, it also lessened my dependence on the mouse, another major time-saver.

The softness and unevenness of my voice caused the software to be correct only 75 percent of the time, but Trossman said the program would continue to train itself to my voice and become more accurate.

While at TACT, I also tried the WordQ word-prediction program, a head-controlled mouse and a joystick mouse. I didn’t like the WordQ Word prediction program because it required too much use of the mouse, and the head-controlled mouse was far too sensitive for my ataxia, sending the cursor flying when I spoke. On the other hand, the joystick mouse had some potential.

Workstation assessment

Desk height is important for reaching the keyboard, mouse and phone with ease and maintaining good eye contact with the computer, says Lynnelle Milner, an OT who sees patients at the MDA Clinic at the University of Nevada School of Medicine, Las Vegas. If the desk is too high or too low, the individual will be overstretching, bending forward or thrown off balance, which can lead to poor posture.

“With clients who have neuromuscular disease, posture is key to keeping breathing open; avoiding repetitive stress injuries to eyes, shoulders, elbows and wrists; and most importantly, optimizing their work time so as to not fatigue or stress themselves, which can lead to exacerbation of their illness,” she says.

During my first visit to TACT, I tried out an electronic height-adjustable workstation and a keyboard arm and platform, both of which improve positioning at the desk.

Next, Trossman came to my office at MDA’s national headquarters to assess my existing workstation.

She measured my L-shaped desk and found it to be 29 inches high, a little tall for comfortable typing. We discussed whether to get an adjustable workstation like I’d tried at TACT.

Even though I’d be able to lower the desktop so the keyboard would be at a better level, we decided that for me, a height-adjustable desk would be a major expense ($1,000-$2,000) for a small gain, since the speech-recognition software will eliminate a lot of typing.

A keyboard arm and platform, which I also had tried at TACT, would put my keyboard in a better position. But it also would push me back from my desk and make it difficult to reach items on my desk, so we decided against it.

Trossman immediately decreased the problem I was having reading copy on my monitor simply by turning around the riser base on which the monitor rested. The base has a storage bin in front; turning it around brought the monitor 5 inches closer.

Despite the improvement, Trossman suggested replacing my 17-inch monitor with a 19-inch one; luckily for me, my office had a 22-inch monitor available.

Borrowing, buying, trying

Although trying out different products at TACT had been helpful, I needed more time to decide if a particular piece of equipment really would improve my efficiency. And sometimes you just get a better feel for a device if you can try it in your own office space.

Office accessories, such as this TaskMate monitor/keyboard lift, allow the computer screen and keyboard to be independently adjusted. The ErgoQuest Sit/Stand/Recline Workstation (right) has a single leg on one side, using a cantilever to support the monitor and tabletop.  It works equally well over a bed or recliner.

“I want people to have a chance to think about the equipment a little more and get over the initial excitement of seeing all these really fantastic things that are new to them,” Trossman says. New equipment may seem great at first, “but then reality sinks in.”

Because the joystick mouse seemed like it might work for me, Trossman put me in touch with the Arizona Technology Access Program (AzTAP), from which I borrowed two different joystick mice and two “jelly bean” switches to be plugged into the joystick for left and right clicking.

AzTAP is Arizona’s federally funded Assistive Technology Act Program. Available in every state (under different names), these programs provide short-term equipment loans for those who want to try before they buy. They also provide information about local funding sources. To find an AT program, visit www.resnaprojects.org/nattap/at/statecontacts.html.

After two weeks of practicing with the joystick mouse, I wasn’t convinced it was helping me work any more efficiently. It was difficult to get the cursor to land where I intended, and I ultimately decided it wasn’t for me.  

To solve my problem of inadvertently clicking the right-click mouse button, Trossman suggested a “one click” mouse like the Apple Pro Mouse, which will work on PCs. Because the mouse doesn’t have a right-click button, I’d have to use the Right Click key, which on my keyboard is located on the lower right next to the Control key. (My Right Click key has a line drawing of a drop-down menu with an arrow on it.)

Unfortunately, TACT didn’t have an Apple Pro Mouse available to try and Apple doesn’t even sell the “one click” mouse anymore, so I bought a refurbished one from Mac Pro Online for $16. This mouse solved the problem of accidentally clicking the right mouse button, saving me a lot of time and frustration.

TACT loaned me a couple of keyboards to try out. One, the Evoluent Mouse-Friendly Keyboard, has the numeric pad on the left side of the keyboard, leaving room on the right to place the mouse closer so it’s easier for me to reach. But I found the keys too small and crammed together, and the keyboard didn’t have a Right Click key.

I also borrowed a left-handed keyboard from TACT. This keyboard had a Right Click key and the numeric pad and Arrow keys on the left side, but it wouldn’t work well with my computer.

We finally decided on a Logitech diNovo Media Desktop Laser keyboard/numeric keypad and mouse combination for $200. It features a regular-sized keyboard with a Right Click key and allows the numeric keypad to be placed on the left, so I can bring the mouse closer.

Speech-recognition software

I liked the Dragon NaturallySpeaking speech-recognition software I tried at TACT, but to operate at its best, it requires a more powerful computer than I’m working on now, especially because I tend to keep a lot of documents open on the screen at once. To my surprise, I learned that both Microsoft Windows XP and the newer Microsoft Vista operating systems have speech recognition capabilities.

Although my office computer uses Windows XP, the IT department loaned me a laptop computer with Vista to try out at home. I found Vista’s speech- recognition program to be better than Windows XP, offering better accuracy and more features that are easier to use. But experts say Dragon NaturallySpeaking has them both beat.

However, the upcoming Windows 7 operating system (to be released October 22) is supposed to have even better speech recognition capabilities than Vista and is being favorably compared to Dragon NaturallySpeaking. After discussions with Trossman and my employer, it was decided not to wait for Windows 7 to be released and then installed on MDA computers. We went ahead and ordered Dragon, getting a great deal ($85!) from an Amazon.com sale. 

I’m still wearing a baseball cap with a microphone headset attached to it. But once I become more proficient with speech recognition, Trossman suggests switching to a gooseneck microphone that clamps to the desk, so I won’t have to remove it when I answer the phone or leave my office. I’ve borrowed a gooseneck microphone from AzTAP to try it out.

Low-tech solutions

The author dictates commands to her computer using speech-recognition software. The ball cap helps keep the microphone in place.

A lot of times simple, low-tech solutions work best.

To keep my keyboard, mouse pad and phone from sliding out of reach, I bought a roll of matted drawer-liners for $5.

From Amazon.com, I purchased an extra-large mouse pad for $10. This eased my frustration because the mouse didn’t fall off or get stuck on the edge of the mouse pad anymore.

Another big frustration was spending minutes looking for the “darn pointer” when my vision and coordination problems caused me to lose track of the cursor on the computer screen. Trossman showed me how to get into my computer control panel and turn on the pointer finder feature built into Windows XP, which puts a bull’s-eye ring around the pointer when the Control key is pressed. She also suggested changing the size and color of the pointer to make it stand out. Not only did this solve the problem, but it was totally free and had been available on my computer the whole time.

Trossman also showed me the “abbreviation expansions” shortcut in Microsoft Word. By going to Insert and clicking on AutoText and then AutoCorrect, Word can be set up to replace a chosen abbreviation with a certain word or phrase. For example, I set mine up to replace “xmda” with “Muscular Dystrophy Association.”

These simple changes ended up improving my computer efficiency, and best of all, they were very inexpensive or totally free.

The assessment at TACT gave me many immediate solutions, as well as some ideas to help me down the road, putting me well on my way to working more efficiently at my desk. This progress gives me more peace of mind and job security as a writer.

Now, if they could just do something about writer’s block …

My Accessible Workspace
Opening the door to function and efficiency

by Scott R. Bennett

The author uses a multipurpose pointer stick mounted on his wheelchair to operate his office door.

Making a workspace accessible means different things to different people, from someone with back pain who needs ergonomically designed desks and chairs, to someone with carpal tunnel syndrome who needs voice-recognition software for operating a computer, to someone in a wheelchair with limited arm mobility who needs adaptive equipment to access the entire workspace and perform a job. 

For me — a 45-year-old software development engineer with Duchenne muscular dystrophy (DMD) who has very limited mobility and is ventilator-dependent — “workspace accessibility” means using specialized software to make my computer more versatile and fully accessible to me, and a variety of other details, large and small, that all add up to a workspace that enables me to be independent, efficient and productive. 

Here’s a brief tour of my accessible home and work offices, and the kinds of equipment and resources I find valuable.

My computer

Without voice recognition software, it would be extremely difficult for me to work as a software engineer. The software (Dragon NaturallySpeaking Professional Edition by Nuance), gives me full access to my computer, including all software applications, the mouse and the Internet.  Because I use the professional edition, I’m able to create specialized voice commands for the software-development applications I use in my job. 

In conjunction with the voice recognition software, I use both a wired microphone and a wireless microphone to operate the computer (the wired microphone is used when the wireless microphone needs to be recharged).  The wireless CS50 USB microphone by Plantronics allows me to be more mobile by not having to sit right in front of the computer. 

The Microsoft accessibility tool Sticky Keys, which comes with the Microsoft Windows XP operating system, gives me the ability to type combination keyboard commands like Ctrl-Alt-Delete one key at a time rather than all at once. The Mouse Keys tool allows me to use the numeric keypad on the keyboard as a mouse.  These keyboard accessibility tools come in very handy on the few occasions when the voice recognition software crashes, a common problem with PC applications.

My office telephone has a serial port connection that I’ve connected to the serial port of my computer, allowing me to use telephone software combined with my voice recognition software to dial my telephone via voice command.

Details, details

Just as important as the computer and computer assistive technology are the small details that make my workspace accessible for me. 

Software engineer Scott Bennett at his workstation.

For example, I have a permanent microphone stand for mounting my wired microphone, and an earpiece holder is mounted on my wheelchair for using the wireless microphone.  I have a pointer stick mounted on my wheelchair that I sometimes use to press buttons on the telephone and/or keyboard, and I had stands made for the telephone and keyboard to hold them stationary and in the right position, so I can use the pointer stick effectively. 

I hire assistants from among my co-workers to help me during lunchtime, and I’ve had a bench set up in my office that’s at the right height for my assistant to help me use the urinal. (I need the bench because I get out of my wheelchair for that task.)

Other important details include:

• a table/desk at the correct height for me;
• a cup holder mounted on a gooseneck stand so I can drink water during the day;
• an automatic door opener mounted on my office door;
• a heater on a timer that turns on when I’m in the office, as I get cold easily; and
• motion sensors to turn on the lights in my office.

Working with your employer

Your employer is an important resource in making your workspace accessible.  When starting a new job or when changes are needed to your workspace due to changes in your disability, you and your employer should work together to make sure that you have the assistive technology and accommodations needed to make your workspace accessible.  (Note: see “"The ADA, employment and assistive technology.")

Bennett’s ergonomically designed workspace includes thoughtful touches such as the adjustable water bottle holder at right.

I work closely with my department managers and the people in the human resources and health services departments. They make sure I have all the assistive technology, accommodations and services I need to do my job and support my particular health care needs. 

The people in the safety and security office continually help me to ensure that my emergency evacuation plan and contact information is up-to-date. They periodically set up meetings for me to train security staff on my specific emergency needs.

My company’s maintenance staff has been very helpful creating the microphone, telephone and keyboard stands; making sure my desk/computer table and bench are at the right height for me; installing the secondary heating source and thermostat with a timer in my office; installing the automatic door opener on my office door; and ensuring that the sidewalk ramps and automatic door openers at the entrances are maintained properly. 

If your company isn’t large enough to have all of these departments and resources available, work with your direct managers to obtain the resources you need.  Working closely with your employer and co-workers is very important in ensuring your workspace is accessible.

DIY Interior Design There are many floor-plan creation programs available to purchase, but if you simply want to rethink a single room, you may not want to invest in a full-blown design application. A Web site called Floorplanner allows use of its rather sophisticated digital design tools to help you visualize your current space as an efficient, ergonomic workspace. Best of all, it’s fun. Basically, Floorplanner is drag-and-drop designing: First, working in the top-view mode, you outline your workspace floor plan to scale on the on-screen graph paper. Next, you drag and drop any doors and windows onto the walls. These openings can then be precisely resized. Once your room and its openings are defined, furnish it from a library of myriad furnishings and objects, organized under categories such as Office, Living Room, Bedroom, Kitchen, Plants and People (there’s even a person in a wheelchair). Simply drag and drop the items into your floor plan, then resize them to suit your purpose. If you want to move or resize these items later, no problem. There’s also a text tool to label your workplace design. Here’s the really fun part: Click on the 3D button and the two-dimensional top-view fades out and is replaced with a three-dimensional rendering of your design that allows a complete 360-degree view. Its perspective can be infinitely varied with your pointer tool.

Workspace at home

Flexible work schedules and telecommuting are benefits many companies provide that help people with disabilities work modified schedules and/or work from home. 

My company offers both of these benefits, enabling me to work six hours a day, five days a week.  I’m able to work from home as many days a week as I need, which I usually do about three days a week. 

Working from home requires making another workspace accessible. I’ve replicated at home all the workspace accessibility features at my office, including an accessible desk; wired and wireless microphones; stands for the microphone, telephone and keyboard; cup holder; etc. 

I have a secure connection directly to my office computer and the internal network of my company with access to e-mail, office printers and other company computers.  And with the meeting and conference software that my company uses, I attend meetings with my colleagues directly from home.  Thanks to these accommodations, I’m able to work at home as effectively as I am at the office. 

To enhance my home workspace, I’ve connected my computer to an environmental control unit, the Cintex4 by Nanopac, with programmable infrared control for operating devices using infrared remotes.  This allows me to use the voice recognition software on my computer to operate the television, stereo, lights and other devices, giving me full control of my home office environment by voice command.

Getting started

There are many resources available to you and your employer, such as your state rehabilitation commission, local independent living center, local MDA office and wheelchair/rehabilitation equipment company.  You also may want to talk to your primary care physician about setting up an appointment with an occupational therapist or rehabilitation specialist.  And there are many online resources for assistive technology and workspace adaptations. 

With all of my workspace modifications, the assistive technology that I use and the assistance of my co-workers, I’m able to perform my job as productively as my co-workers.  As a result, they don’t see me as a disabled employee but as another colleague.  Working independently and productively gives me a sense of accomplishment and feeling that I’m giving something back to society.

Scott Bennett, who has Duchenne muscular dystrophy, works for The MITRE Corporation in Bedford, Mass.  He lives independently in his own home in East Taunton, Mass., with support from longtime close friends/PCAs, family and loyal pet puggle “Peanut.”  Scott enjoys reading, playing chess, science and sports. Go Red Sox!

Tips from the Organizing Pros
Making home offices more accessible

by Barbara & Jim Twardowski

Professional organizer Angela Cody-Roguet prides herself on “thinking outside the box.”  When she tackled the home office of Chanda Hinton of Aurora, Colo., who uses a wheelchair, owns a service dog and has limited use of her hands, the challenge was finding affordable and accessible solutions that would allow Hinton to better utilize her space. 

Surprisingly, the first item to be removed was Hinton’s desk.  Cody-Roguet measured Hinton’s reach and discovered she only used the first 12 inches of her desk. The remaining 2 feet was a wasteland of unreachable papers and office supplies. 

The solution was to install a 1-foot-wide shelf along the entire 8 feet of the wall, set at desk height. Precise measurements were taken to ensure the wheelchair arms did not hit the shelf. Once the shelf was up, a printer/fax, inbox, outbox, binders and files were strategically arranged. 

“Before I reorganized and redesigned Hinton’s office, she had to wait for an attendant, her sister or her boyfriend to do numerous administrative tasks because she couldn’t reach or access the many things she needed during the day.  Now she has 100 percent autonomy,” says Cody-Roguet, whose Highlands Ranch, Colo., business is called Major Mom.

A professional organizer provides an outsider’s perspective to finding achievable and sustainable solutions. “Relying on an expert can save individuals from buying the wrong furniture, organizing systems, etc.,” says Cody-Roguet. “But most importantly, we can give people the freedom and joy that they never knew possible because we’re experts in creating functionality with beauty.” 

Lisa Alishio, a professional organizer and licensed certified occupational therapist assistant, believes an organized home office is good for your health.

“Remove the clutter and create a functional space — it’s uplifting. And you’ll waste less time and energy by working in a well-designed space,” she advises.  Constantly hunting for missing items is exhausting; trying to accomplish tasks in a mess is stressful.  When a desk is neat, you can immediately begin a project.

Alishio’s business, Clarity Home Consulting, has several clients with special needs.  “Every one is an individual. The first step to creating an ideal home office is to determine exactly what tasks the client wishes to accomplish in the space.”  Perhaps it’s letter writing or paying bills or surfing the Internet.  Whatever tools are needed at least 80 percent of the time are the ones that need to be within easy reach. 

The right office product, such as these clear plastic interlocking bins by OXO, will help you clean up your desktop clutter.

Alishio offers simple solutions for saving energy, improving efficiency and making your space look better.

For example, place pens in a pretty container rather than a drawer, which takes more time to open and close.  

Rather than using a cell phone as a calendar, which requires effort to check and so often gets overlooked, Alishio prefers large wall-mounted dry-erase calendars that can be read with just a glance.

Picture frames are easily knocked over and require dusting. Alishio uses cork blocks that can be placed in any configuration.  “Pin the photos to the cork and add a block as your photo collection grows.” 

Open baskets are Alishio’s favorite container.  They’re pretty and require little effort to use, having no lids to remove.

Use a label maker to identify the contents of all containers and drawers, enabling the friends, family members and aides who assist you to be more helpful.

Professional organizer Connie Hansen, owner of Organizers Elite in Mandeville, La., enjoys introducing her clients to tools that make the home office run smoother. 

Among her favorite finds are the OXO Good Grips office products (available only at Staples) and OXO home care products that are perfect for people with less hand dexterity or strength. For example, push pin heads are larger than typical, making them easier to grasp.

Hansen frequently shops for office accessories online; one of her favorite sites is The Container Store (containerstore.com). 

Finding a professional organizer is as easy as opening your phonebook or checking the Web site of the National Association of Professional Organizers (napo.net). 

Take the time to explain your needs and be sure to ask for references and contact the local Better Business Bureau.  It’s important that you’re comfortable allowing this individual access to your home and personal files. 

Barbara and Jim Twardowski, Mandeville, La., are frequent Quest contributors.  Barb has Charcot-Marie-Tooth disease.

For professional organizing resources, see InfoQuest.