Pain-Free Living

Easier Computing

by Janet Hopkins

There is no getting around the fact that computers are an integral part of life for many of us. Whether we love them or despise them, computers help us to connect with others, find information, accomplish tasks more efficiently, and entertain ourselves. People with arthritis sometimes find using the computer a challenge, because pain, limited dexterity, and mobility problems can make sitting at a desk and operating a standard mouse and keyboard difficult or impossible. Fortunately, awareness of problems like these continues to grow, and there are now a number of different assistive technology devices that can help.

What is an assistive technology device? As defined in the Assistive Technology Act of 1998, it is “any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” Assistive technology includes low-tech devices such as pads to rest the hands on when typing as well as high-tech computer hardware and software. A growing selection of assistive devices is available to help people with varying degrees of impairment use computers with greater ease. This article explores some assistive technologies that can help people with arthritis.

Workplace assistance

For those who work in front of a computer for much of the day, stiff and achy joints present a serious difficulty. For these people (and their employers), the U.S. Department of Labor provides guidance on designing computer workstations to minimize stress on the body. Log on here for useful checklists and information on proper posture and desk height, as well as workstation components that can ease stress on the joints.

Through the Job Accommodation Network (JAN), the Department of Labor’s Office of Disability Employment Policy provides information to help employers accommodate people with disabilities in compliance with current laws. The online document “Employees with Arthritis” has advice for accommodating workers with arthritis. JAN also offers a Searchable Online Accommodation Resource (SOAR). Click the “search” button on this site to find multiple research options, including a link for arthritis and a link to products for people with mobility impairments. Go here for more from JAN about arthritis. For even more Web sites with information on assistive technology, see Resources.

Keyboard and mouse­ alternatives

The standard keyboard and mouse are the most common devices for “inputting” information into the computer. But while they may be fine for most computer users, they are not the only options. There are a variety of alternatives that include custom keyboards and mice, on-screen keyboards, and voice recognition software that can allow people with arthritis to operate a computer with greater ease.

For those who cannot type easily on a standard keyboard, customized keyboards may make the task easier. These include larger and smaller keyboard models, one-handed keyboards, tented keyboards, and split keyboards. Tented keyboards are divided in the middle and slope down to each side, like a tent. A split keyboard is split into two separated parts. In addition to these, there are many other types of keyboards that are curved, contoured, and padded in various ways. Alternative keyboards such as these have been shown to promote neutral wrist posture. But according to the National Institute for Occupational Safety and Health, there is no scientific evidence to conclude that the keyboards reduce the risk of discomfort or injury. Also, switching to a new keyboard layout is going to feel awkward at first and will require an adjustment period. It makes sense to try out any alternative keyboard for a couple of weeks before deciding on a final purchase.

Similarly, the standard mouse is not the only tool for navigating the computer screen and making selections. Mouse alternatives include a trackball, joy stick, touch pad, foot mouse (operated with the feet), and switch mouse (operated with a switch, or easy-to-press button). A touch screen on a computer’s monitor allows you to navigate the screen and make selections using your finger.

An on-screen keyboard is a good option for people who can use a standard mouse, mouse alternative (such as a trackball), or a touch screen but have trouble using a keyboard. An on-screen keyboard is simply a virtual keyboard that is displayed on the screen. If you have a touch screen, you type by touching the “keys” with your finger. If you’re using a mouse or mouse alternative, you type by pointing the cursor at and clicking on the “keys.” For those who have trouble clicking a mouse, some on-screen keyboards allow users to type by simply holding the cursor over the desired keys. You can find discussions of on-screen keyboards here. You can access the on-screen keyboard that is built into Windows XP and Windows ME by clicking “Start,” then “Programs,” “Accessories,” and finally “Accessibility.” For Windows Vista, click “Start,” “Control Panel,” “Ease of Access,” “Ease of Access Center,” and “Quick Access to Common Tools.” Go here for information on accessing the on-screen keyboard for Macs. Other free on-screen keyboards available are Click-N-Type and RapidKeys. There is also the Point-N-Click virtual mouse, which is the companion product to Click-N-Type. Point-N-Click is for people who can move a mouse or mouse-like device but who have trouble clicking it.
If moving and clicking the mouse or working with a laptop’s touch pad is a problem but working on the keyboard isn’t, consider using the keyboard to navigate the screen, open documents, and perform other functions. It takes time to learn keyboard navigation tools, but there are resources available to teach you. Keyboarding shortcuts for Microsoft products are laid out here, and the shortcuts for Macs are laid out here. Shortcuts for the Firefox browser are available here. Google Chrome, Internet Explorer, and Safari all have accessibility pages.

For people who find it difficult to operate both a keyboard and a mouse, there is widely available speech recognition software, such as Dragon speech recognition software by Nuance. To use this software, you simply speak commands into the computer. Over the years, speech recognition software has developed into a reliable method of hands-free computing for some users. However, speech recognition software is not an appropriate alternative for people with speaking difficulties or without the cognitive ability to use the software. As well, speech recognition software is not an appropriate option where confidential content could be overheard and/or when spoken commands and dictation are likely to disrupt other people using the workspace or classroom.

Another option for people unable to use their hands is software that uses the movement of the head or face to operate the computer. The Nouse Perceptual Vision Interface is hands-free computing software for the Microsoft operating system. Nouse must be used with a USB camera or a built in webcam. As the name hints, the user’s nose becomes the mouse and its movements are tracked by the camera to enable mouse and keyboard functions.

For more information on mouse and keyboard alternatives, check out the following resources:

• Microsoft’s “Resource Guide for Individuals with Dexterity Difficulties and Impairments” has tips to help people with dexterity problems use Windows, Word, Outlook, and Internet Explorer.
• Microsoft’s “Ten Tips for the Awkward Age of Computing” has tips for customizing Windows Vista and Windows XP to help people who have problems with sight, hearing, and dexterity. These include instructions for activating and using MouseKeys (which allows you to control the mouse with a keyboard), StickyKeys (which allows you to press only one key for commands that usually require multiple keys), and FilterKeys (which allows the computer to automatically correct for accidental keystrokes caused by stiffness or a tremor).
• AbilityNet has many fact sheets. Fact sheets that may be helpful to people with arthritis include “Keyboard and Mouse Adaptations,” “Keyboard Shortcuts,” “Keyboard: Single Handed Use,” “Rheumatoid Arthritis and Computing,” and “Voice Recognition: An Overview.”

Reducing keystrokes

Some people find themselves typing the same text over and over again. However, there are ways to reduce the number of keystrokes and thereby reduce fatigue and stress on the joints. One way to reduce keystrokes is to use macros, which are individualized shortcuts for inputting text on Microsoft Word. For example, you can write a macro to automatically insert your name and address on Microsoft Word documents. Instead of typing out four or five lines every time you enter your name and address, you can simply press ALT + F8 (or go to “Macro” under the “Tools” menu on a Mac) to open the macro box, select the recorded macro, and click “Run.” The recorded information is automatically inserted in the document.

The AutoText feature of Microsoft Word is similar to the macro feature. It allows you to program your computer to remember frequently typed long words or phrases. To start adding words or phrases, select the text you would like to save, go on the “Insert” tab to the “Quick Parts” menu and highlight “AutoText.” Scroll to the bottom and select “Save Selection to AutoText Gallery.” For example, if you add a four-word university or school name to AutoText, it will pop up as a suggestion whenever you type the first four letters. Once the suggestion pops up, all you have to do is press the “enter” key to automatically insert the full name. You can find more information about macros and AutoText by clicking the “Help” button on Microsoft Word or by searching the Microsoft Web site for product-specific tutorials.

Software that can reduce keystrokes is also available. You can download a free program for Windows called AutoHotKey. The software allows you to program your computer to perform functions or enter text with only a couple of keystrokes. The quick-start tutorial discusses how macros and hotkeys are created. AutoHotKeys will generally be more useful for more experienced computer users. ShortKeys Lite is a similar free program available for Windows. FastFox Typing Expander is another low-cost product that allows people to insert text with a couple of keystrokes.

Word prediction software. Another keystroke-saving tool is word prediction software. Word prediction programs predict what word you want to use before you have finished typing it. When you type the first letter of the word, a list of possible words is displayed. Each new letter added to the word causes the list to be updated. When you see the desired word on the screen, you select it, thereby potentially saving several keystrokes. Various companies have developed word prediction software. The Assistive Technology Research Institute at Misericordia University conducted a study on the use of this type of software in conjunction with an on-screen keyboard. The study found that word prediction software may help on-screen keyboard users increase their typing speed. However, the study also noted that word prediction software does not increase typing speed when you use it with a standard keyboard. This may be because word prediction software requires you to look away from the copy in order to select a word from the choices offered on the computer screen. On the other hand, word prediction software may make typing more comfortable and less tiring for people with dexterity problems. It’s also possible that word prediction software would improve typing speed for people who do not work from copy pages and therefore do not have to take their eyes off the screen.

You can purchase commercial word prediction software products as stand-alone utilities, but word prediction is often only one part of a feature-rich literacy support software product. Some of these products are mobile, meaning that you can use them on different computers. For a list of word prediction software, see Resources.

Switches and games

When using the computer proves too difficult for tasks such as writing e-mail and word processing, it can still be a source of entertainment. People with very limited mobility frequently use switches, or simple buttons that are easy to press, to operate computer software. You can make a switch work with your computer by connecting it to a switch interface device attached to the computer or by plugging it into a switch-adapted mouse. You can use just one switch or several at the same time. You can also partner switches with scanning software that moves through selection options on the screen, allowing you to make a selection when the desired field is highlighted. You can find an overview of switch and scanning systems here. Information about scanning is available through this tutorial. For switch-operated games available online, see Resources.

Making decisions

The assistive technology selection available today can make the decision-making process a bit overwhelming. To help customers make an informed choice, some companies allow people to test their assistive devices for a period of time before committing to a purchase. In the same way, a great deal of online software can be downloaded for a free trial period. Take advantage of these opportunities to find the most suitable product.

Furthermore, there are computer accessibility centers across the country that can assist people with their computer accessibility needs. For example, you can locate Microsoft Accessibility Resource Centers here. A list of state programs set up by the Assistive Technology Act is also available. The Alliance for Technology Access lists its centers on its Web site. And the Job Accommodation Network offers free consulting services and provides comprehensive information on its Web site.

Last Reviewed February 19, 2015

Janet Hopkins, author of Assistive Technology: An Introductory Guide for K-12 Library Media Specialists (Linworth Publishing, 2004), can be contacted at [email protected]

Get the latest arthritis news and the most useful self-management tips delivered to your inbox twice a month! Sign up for our free e-mail newsletter today.

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.