Scenario 5 - Arranging equipment for different pupils

In this scenario, the computer is set up for use by our Red and Blue groups.

Red group is working on early literacy skills. The computer is set up on a height-adjustable trolley. Sarah is using a Big Keys keyboard because she can locate the larger keys more easily, and a KidTrac rollerball because she finds it physically and visually better than a mouse.

The Big Keys and standard keyboard are connected together using a dual keyboard adaptor. The rollerball and standard mouse are connected to the computer through a Mouser dual mouse adaptor / switch interface.

Blue Group are working at an earlier level, using a range of switch-operated software, including some of the SwitchIt! series. They are using Jelly Bean switches to operate the programs. The switches are Velcroed to a Maxess tray and plugged into the Mouser to operate in place of the mouse buttons.

The keyboards and pointing devices are set to one side while Blue group uses switch access software. The Maxess tray with switches can be lifted straight onto the pupil’s wheelchair tray.

The teacher has devised a set of crib sheets to help others set up the equipment for individuals. These are kept with the computer.

Key skills and equipment

The key skills for the above example are the ability to:

• obtain, install and use special access devices and other equipment, for particular pupils
• adjust software settings for the equipment
• use a word processor (and digital camera, if available) to create crib sheets to support use of the equipment

The key equipment is:

• computer workstation
• BigKeys keyboard and Co-Pilot dual keyboard adaptor
• KidTrac (or other rollerball) and Mouser adaptor / switch interface
• Maxess tray
• Jelly Bean switches

Seating and positioning

Seating and positioning is enormously important for all computer and technology users, but especially for children with physical, sensory and / or learning difficulties. If a pupil is having difficulty accessing a keyboard (or any other access device) the first thing to look at is seating and positioning. There is little point in investigating all sorts of adaptations and specialized hardware and software unless the basic positioning of the keyboard, computer and screen are correct, and the user is seated in a stable, comfortable position. Good seating and positioning is a prerequisite for the use of technology (Gray, 1988; Cook & Hussey, 1995).

The basic ergonomic position for keyboard use is given here. Look in your computer manuals for advice on ergonomics and good keyboard technique, and consult an occupational or physiotherapist. The figure illustrates the ergonomics of using a computer; but the same principles apply to other tools, whether they are pencil and jotter or voice output communication aid.

Seating

Ensure that the pupil has sufficient support for pelvis, trunk, shoulders and arms, if necessary. Consult a seating specialist if the pupil has particular seating requirements.

If the user’s feet are dangling from a seat that is too high it will be hard to maintain sitting balance and achieve good hand or limb control. Foot rests with adjustable height and angle are available from computer and office equipment suppliers.

Tables and trolleys

Finding a suitable trolley, table or surface on which to place equipment often seems harder than you feel it should be. If a trolley is to be purchased, is it going to have to moved out of the classroom? If so, the width of the trolley should fit through the doorway. If a number of pupils are going to be using the same computer are they seated at different heights? A height-adjustable trolley may be necessary – but make sure it is one that can be altered with all the equipment set up on it.

A wide range of computer tables and workstations are available from school and office equipment suppliers. Many schools buy a ‘standard’ type of computer trolley from educational suppliers and these are often unsuitable for users with special needs.

The surface may be too high and not adjustable so that the keyboard is difficult to reach; the monitor shelves are often too high for primary school pupils sitting in low chairs, with the result that the children have difficulty seeing the display. The overall area may be too small to take expanded or overlay keyboards, together with mouse, pointing devices and interfaces, and still leave space for paper materials.

Check that the screen is tilted towards the pupil – staff often tilt monitors up so they can see it when standing, and may then forget to tilt it back down for the pupil. If the table or trolley cannot correctly position the display, investigate monitor arms.

Consider the height of the table surface. Some suppliers sell trolleys where the height can be set by inserting dowels or pins through the legs to hold the plinth at the correct height. These are satisfactory if the table does not need to be adjusted very often (for example, if one user is always seated in the same chair and always performing the same task), but they are difficult or dangerous to adjust when fully loaded with equipment.

Specialist trolleys, such as the Varitech, have a handle which lets you adjust the height easily and precisely even when the trolley is loaded with equipment. They also have plenty of space underneath to allow a wheelchair to be pushed in under it and have a larger than standard top surface to accommodate special keyboards and resources. Also, versions are available with surfaces that can be angled upwards.

Fully adjustable tables are expensive. If space and funding is restricted, there may be no choice but to try to adapt a standard table or trolley. If the keyboard is too high or otherwise not accessible, one option is to locate it on the user’s wheelchair tray (if there is one, and if it is big enough). Or, put the screen on the table and the access devices on a lower table in front (see below).

There are also keyboard shelves and monitor arms that can be attached to a table and then swung out and adjusted to the correct height for a wheelchair user (see below). The Disability Information Trust book, ‘Communication and Access to Computer Technology’ (Barrett & Herriotts, 1995) has detailed descriptions of adjustable tables, foot rests, arm supports and other positioning equipment. Office equipment suppliers such as Neat Ideas and Global Direct sell the more common ergonomic items such as wrist and foot rests and adjustable keyboard and monitor supports; companies will provide catalogues on request. The special educational needs technology suppliers (such as Inclusive Technology and Semerc) sell tables and rests designed for school use.

Keyboard, mouse and monitor supports

When setting up equipment, especially on a trolley where there is restricted space, it is essential that the items making up the user’s system are sensibly placed. Is there enough room for the keyboard, pointing device or other access device? Make sure that the monitor is not too high, or at an incorrect angle for the user. Also, check the lighting – sun shining onto a screen may make it impossible to see.

It is important that the keyboard and / or other input devices are within easy reach and at the correct height. If an input device is too far away, or too high up, any physical or sensory difficulties will be amplified. If the keyboard, mouse or switch cables will not reach close enough to the pupil (for example, onto a wheelchair tray), buy extension cables or a wireless keyboard / mouse / switch interface.

Some pupils, perhaps with arthritis or muscle weakness, can use a keyboard or pointing device but experience pain or fatigue. Wrist rests support the hand so that there is less strain on the wrist; arm supports support the arm yet still permit free movement. A wrist rest is suitable where relatively small amounts of movement are involved, while the arm supports are more adjustable and give greater range and support.

Some children find it much easier to access a keyboard when it is held up at an angle (particularly if they are using a hand or head pointer) rather than flat on the desk. Sloped keyboards stands are available from several suppliers, or you may be able to have one made for you. Secondary school technical departments are another useful source of help if you need this type of adaptation.

If the pupil is working with paper worksheets or books at the computer, a copyholder is useful to minimize the effort to shift attention between the screen and the worksheet.

Arm supports

Arm supports take the weight of the arm(s) yet allow the user to move freely, with little effort, across the keyboard to access the keys or other input device. They are particularly useful for people with muscle weakness who get tired typing. The supports can be attached to a table, to a wheelchair or to a chair armrest.

Grab bars and restraints

Some pupils with athetoid cerebral palsy benefit from a grab bar fixed across the table or tray. When the bar is grasped using one hand, it stabilizes and reduces uncontrollable movement, and so improves control in the other. Grab bars can be bought from OT and therapy suppliers such as Nottingham Rehab, or home-made – the Augmentative Communication Assessment Resource (Goossens & Crain, 1986) gives advice and instructions for making grab bars.

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