Office Makeover

How assistive technology saved my career

Article Highlights:
  • Occupational therapist Pat Trossman advises author Kathy Wechsler on computer equipment and ways to improve her workstation to compensate for progressive muscle weakness.
  • A professional assessment of your workstation by vocational rehabilitation experts can lead to low- and high-tech solutions.
  • Short-term equipment loans (try before you buy) are available through Assistive Technology Act programs in each state.
by Kathy Wechsler on October 1, 2009 - 10:12am

QUEST Vol. 16, No. 4

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?

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

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.

My VR counselor sent me to the Technology Access Center of Tucson (TACT) for an assessment. During my two visits to TACT, I learned that the problems I was having could be solved by changing the way my desk is set up and using alternate methods of accessing the computer.

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

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 NaturallySpeaking 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.

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

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.

The ErgoQuest Sit/Stand/Recline Workstation 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.

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.

Office accessories, such as this TaskMate monitor/keyboard lift, allow the computer screen and keyboard to be independently adjusted.

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.

“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

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 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

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.

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

From, 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.

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