Page 218 - Handbook of Electronic Assistive Technology

206 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

which used switches with a smaller activation area to ensure that the switch operated con-
sistently wherever it was pressed. The switch mounting system also incorporated easily
adjustable points of articulation with handles to allow fine-tuning of the switch position
by Nikhil’s support team and the function to easily swing away and store the switches out
of the way behind the headrest when they were not in use. The use of column/row scan-
ning also guided clinicians in the layout of the selection set, with vocabulary organised
syntactically in columns – with pronouns, high-frequency verbs and articles/quantifiers
grouped together to increase the consistency in building sentences.
Martin’s Case Study (Adult)

Background
Martin has motor neuron disease, and lives at home with his wife. He is a keen user of
technology. Martin is using his speech, but is unintelligible to unfamiliar listeners. He has
noninvasive ventilation set up, which he uses with a nasal mask 24 h a day.
Martin was using a head mouse and an app on his Apple Mac computer to communicate.
He has also set up a system to access sound files recorded by others to say prerecorded phrases
to add to his range of vocabulary. Martin had an iPad to use with a switch to access an onscreen
keyboard to communicate when not sitting at his computer; his wife had attached this switch
onto the front of a book which had helped, but it was difficult for her to set this up in a position
which he could use with the residual strength in his left-hand middle finger flexors.
Martin was referred because his switch access was becoming unreliable and he was keen to
investigate alternatives to this and also positioning the iPad for when he was in his wheelchair
and away from his Mac. Martin was also finding that during group conversations he was get-
ting left behind during conversations as it takes a long time to spell things out using the iPad.

Assessment
Physical abilities: Martin has good head movement when his head is supported on the
wheelchair headrest and his powered wheelchair is tilted back. He has no active move-
ment in his right hand/arm or either lower limb. He has some flexion and extension in
his left-hand fingers, with the strongest movement in his middle finger, which he uses to
operate his switch.
Sensory: Martin has no hearing or visual impairment. He is able to see numerous small
tabs open on his Mac, and navigate in and out of programs and use the onscreen keyboard
at its smallest setting.
Cognition: Martin exhibited no evidence of cognitive impairment.
Language and literacy: Martin is literate and has no language difficulties.
Martin’s Goals
Martin was keen to look at alternative methods of access to access his iPad. He was also
keen to continue to use the sound files he had set up on his Mac as well as accessing his
environmental control functions, which he was primarily accessing through his Alexa
device.