University of Edinburgh

Cerebral Palsy and Visual Impairment in Children: Experience of Collaborative Practice in Scotland

Appendix III

Support from Technology

by Fionna Balfour

Generally when considering computer access technology for people with a visual impairment the combination offered consists of a screen reader or screen enlargement with a braille or standard keyboard. When considering those with an additional physical impairment then alternative keyboards and mousing devices or switches are likely to be the most suitable devices.

Although a wide range of hardware and software exists offering a choice for many users, it must be borne in mind that there is no one simple solution and often a number of methods and combinations need to be tried before finding the most suitable for an individual.

For those with sufficient control and dexterity, a standard keyboard may be used with optional large keyboard letters (stickies); perhaps a keyguard to help separate the keys and allow the hand(s) to rest without pressing extra keys; keyboards with larger keys and a better contrast may help; particularly useful for some is a one-handed keyboard (right or left) which offers all the keys on a standard keyboard but provides a fast input method.

If a standard keyboard is not suitable then an adapted or overlay keyboard may provide the best solution. These are flat programmable devices consisting of a grid of cells which can be programmed to offer any number of keys displayed as text, braille, graphics or which have tactile signifiers attached.

Those for whom a keyboard is inaccessible can choose from a range of switches which come in all shapes and sizes, can be operated by various parts of the body (head, hand, knee, mouth) and be used to operate an extensive range of programs. A switch box and some commercially available switches have sockets for attaching additional switches. Thus the userÍs own switch solution can be used to control the computer or operate a program. Switches can directly access programs set up to respond to one switch press or be more effectively used in conjunction with software providing visible and/or auditory scanning.

Often a simple magnification of the screen will be all thatÍs needed to enable access to programs. Many word processing packages offer a range of fonts and sizes for the user although menus and dialogue boxes are set at a standard size. Use of a commercial magnification program offers a better range of facilities including reversal of screen view, choice of pointer size and shape and more controlled movement around the screen, although some of these are provided with system software.

Auditory feedback is either a requirement or an additional support and can be achieved in a number of ways. Commercial screen readers, capable of reading any text, icons, menus and dialogue boxes on screen, generally give control of the mouse pointer to the numeric keypad and text is read out at the position of the pointer. Confusion can arise in a word processing package, however, as the text insertion bar is not necessarily at the same position as the mouse pointer, therefore a high level of cognitive awareness and concentration is required as well as the ability to operate the keypad in order to use this system. There is a limited range of packages on offer which vary in their suitability and ease of use for certain tasks. They require careful consideration and investigation before identifying the most suitable.

Alternatively a talking word processor or document reader can be used with more sophisticated versions offering a range of font, size and style, background and text colour, as well as a range of reading options (from single character to whole document) and an interesting choice of voices.

Software which provides switch users with key entry options can be programmed to offer a range of set-ups with any combination of standard keyboard keys as well as options to link to other programs and set-ups. Scanning can provide auditory cues and feedback as well as large text or graphic cells on screen - a very versatile tool opening up access to a wide range of commercial programs beyond the simple word processor. One commercial switch program offers the option of morse code entry which can greatly speed up the text entry process for a student requiring faster access than a standard auditory scanning set-up.

Access to the Internet and e-mail can similarly be made available through programming switch software, screen readers and document readers, although it has to be said this can be offered with various levels of support and independence, again catering for the individual.

A final comment must be added here for anyone with any influence! There is a wealth of commercial switch accessible materials and an extensive range of switch devices to enable all needs to be met. Unfortunately what there is not such a range of is programs with uncluttered screens, clear graphics with good use of colour and contrast and, most importantly, AUDITORY scanning. It seems such a pity that so much is now being invested in switch accessible educational and attainment programs which would only need an auditory cue to enable those with a visual or physical impairment to access them.