AT Assessment for Computer Access



AT Assessment for Computer Access

(based on de-identified sample case by Karen Parecki, Palo Alto VAMC)

Date of Evaluation: 12/16/2010

CLIENT/CAREGIVER GOALS:

Primary Goals/ Expectations: "Be able to get on the computer and type, although

not sure if that is possible." Pt seen by AT SLP for communication device and

asked for assistance with computer access, thus this writer and SLP

worked with patient on computer access during this session.

Additional Goals for Computer Use:

-Self Care/Higher Level Living Skills

Leisure time activity development: Playing Poker on the computer

-Psychosocial

Relationships

E-mailing

-Other

Work

Motivation to learn and use new strategies and technology:

Pt initially resistive to trialing assistive technology as he stated he did not

want to "look like Frankenstein", however as technology was introduced, client

became excited and stated that the service and technology is "wonderful".

CLIENT BACKGROUND

Date of Birth:

Age: 63

Sex: Male

Email:

Phone:

Diagnosis: ALS

Onset: 9/2009

Medical Background: History was obtained primarily from CPRS chart review. Pt is

a 63 year old male SC veteran, diagnosed with ALS in September 2009, after

onset of symptoms (gait/imbalance and fasciculations) in 4/09. Pt established

care at the VA in 12/09. Prior medical history is also significant for

bradycardia, PTSD, and depression.

Referral Source: Pt seen by AT SLP who identified need for computer access

assessment.

Living Situation: Pt lives with wife in a 2-story home. Pt has several

caregivers throughout the day. Second floor of home is predominate living

space and, per pt, is an open floor plan. Pt has several home modification

allowing him access (ramps, stair lift).

Participants in evaluation: OTR/L, ATP and SLP, ATP.

Pt and 2 of his care-givers present. One caregiver was educated on

recommendations and has good computer skills.

Job Title / School Major: Pt owns and operates an estate jewelry business.

Years: 18

Job Duties / Classes: Oversees business, has caregivers who work at the store

and assist with the daily duties of operation.

Leisure Interests: Plays Poker on computer, travels to Maui.

Previous or Current Rehab Services: Pt is followed by SCI home care service for

mobility and home care needs.

Wheelchair Information: Pt using an Invacare FDX with power tilt and recline.

Pt also has a manual chair for travel use. Pt reports he has recently purchased

a portable power chair that will be able to be used in his home as the Invacare

is only used at work (home not accessible for this chair).

AAC Information: Pt provided with voice amplifier during this visit, please

refer to Assistive Technology SLP note on this date for further details.

EADL Information: Pt currently does not have any EADL's in place per report. He

states he is still able to operate his TV and his caregivers help with anything

else he needs.

EXISTING DEVICES:

Existing Computer Information:

Own A Computer yes

Type of computer: Toshiba Laptop

Have Access Through: Work and home

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Computer Specs:

Operating System: Pt not sure if it is Vista or Windows 7, reports computer is

fairly new. Pt unsure of speed, RAM, monitor size. Standard keyboard and mouse.

Current adaptive hardware/software: None, pt asks his wife do type for him.

Current ergonomic adaptations (home, work, school, etc) and/or wheelchair

mounting solution: Pt would benefit from a desk that is adjustable height to

allow desk use with the power wheelchair. Pt currently uses computer on his

lap.

Can current devices be used? Current device can be used with alternative input

for keyboarding.

Is the client comfortable with computer technology? Pt has basic computer

proficiency and reports his caregiver is very skilled in computer technology. Pt

states he uses the computer for emailing and playing poker. He states he will

continue to have his wife assist with long emails, but would like to be able to

type if possible.

Client preferences: PC based Laptop. Pt did mention that an Apple Mac book

would be nice since it is lighter weight.

Current rehab AT services: Pt being followed by SCI homecare services for rehab,

home modification and DME and mobility needs.

Standardized Outcome Measures (Baseline): Quebec User Evaluation of Satisfaction

with Assistive Technology administered based on current methods of access. Pt

reported Durability, Ease of use, and Comfort as the most important satisfaction

items when choosing a device.

BODY SYSTEMS

Behavioral Observations (setting, compliance): Pt with appropriate affect,

friendly and cooperative. Able to actively participate in assessment.

Physical (gross/fine motor): Impaired fine and gross motor skills bilaterally,

significant hand and UE weakness.

Sensory (visual acuity, light sensitivity, contrast issues, tracking abilities,

hearing, tactile): Pt wears glasses for reading, otherwise vision grossly

intact. Pt appears to have functional hearing.

Cognitive: (psycho-social, speech, reading, ability to learn directions and

commands): Cognition grossly WFL.

ACTIVITY:

Demonstrates difficulty in the following areas: Typing, pointing/mousing

Due to pt's decreased function of UEs, fine motor skill, and weakness he is

unable to successfully type on a standard keyboard and mouse.

ENVIRONMENTS for AT use: work / home / social

Pt using a laptop computer at this time which is portable and can be used in

various settings (work, home, vacation home). Pt also has a desktop computer at

work which he does not access and has no accessible office furniture to allow

him to access the desktop computer. Pt prefers the laptop placed on his lap for

ease of reach and use. Pt has good support (full time) for computer use by wife

and caregivers. They will be able to provide assistance with set-up and

troubleshooting technical issues (per pt report).

TRIAL:

Devices Trialed, Observations and Outcomes:

-Computer: Pt trialed with use of HP laptop (AT Center assessment computer), as

he forgot to bring his Toshiba laptop to the work site on day of assessment.

-Pointing (i.e. mouse use): Pt trialed with mini trackball and was unable to

successfully hold it in his hand and place thumb or fingers for trackball

use. Pt trialed with external touchpad mouse that could be placed or mounted

near right hand but felt that the positioning with this device was not

optimal. Trialed and able to use touchpad/trackpad that was integrated into

laptop to move mouse cursor and used tap to click on the touchpad to open or

activate programs. Pt also trialed with Headmouse Extreme with which he

demonstrated good success for cursor movement, selection, and text entry. Pt

will need practice and dwell time adjusted as he improves with this method of

access.

-Text Entry: Pt trialed with basic typing stick (he was initially resistant to

other technologies) and was unable to successfully reach all the keys due to

lack of strength and ROM. Pt trialed with both a vertically and horizontally

positioned typing aid. He did request one that goes horizontally on the hand

and wants to see if he can adjust it with heat to make it more useful. This

was not a successful means for text entry at this time. Pt then trialed with

onscreen keyboard and use of touchpad. He was able to successfully type and

use word prediction features of on-screen keyboard, although felt this was a

slow means of text entry. Pt finally trialed using a Headmouse Extreme with

on-screen keyboard and demonstrated good success. As pt's hand function

decreases, this will be his best option of access longer term.

-Software: Wivik on-screen keyboard and free downloadable on-screen keyboard,

pt demonstrated ability to work with either keyboard with alternative

mousing.

SUMMARY/ IMPRESSIONS: Pt will benefit from alternative computer access due to

decreased function of bilateral UE's. Due to progressive nature of disease, pt

will benefit from issuance and use of a head mouse with his current laptop and

an on screen keyboard. Head mouse will also be compatible with AAC devices if

that becomes necessary in the near future. Additionally, this can be integrated

with EADL controls.

PATIENT EDUCATION:

Patient trained on recommended device(s)

Patient educated on safe and appropriate use of recommended equipment

Patient demonstrates understanding of recommendation and approves of

recommendation

Patient informed that Prosthetics has final decision on equipment to provide,

and timeframe for delivery of equipment if approved

Patient informed of how/when to contact Prosthetics if needed

Patient informed of maintenance and repair procedures

Patient is aware of his/her responsibility for recurring utility charges (e.g.

home Internet access)

Patient aware to contact therapist if needs arise

RECOMMENDATIONS: Headmouse Extreme (compatible with several AAC devices should

the need arise), on-screen keyboard with word prediction, typing aid for simple,

short text input when not fatigued. Recommend setting touchpad to tap to click

mode (caregiver aware of how to make this change).

Consult to prosthetics placed on this date: 12/17/2010

PLAN: Mailed typing aid to patient to use while awaiting Headmouse. Also

recommended to patient and his caregiver to set touchpad to tap to click mode

and download a free on-screen keyboard or use Windows 7 onscreen keyboard if available.

This writer will contact patient when Headmouse arrives and will arrange to see

patient for installation and training at that time. Pt aware of how to contact

this writer should further needs arise prior to next meeting.

Further Assistive Technology Services: Training on Headmouse use. May need AAC

or EADL services as disease progresses.

Treatment Goals:

Pt will be able to enter text for emailing and access his on-line poker games

after caregiver set-up.

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