For people with ALS with severe hand and arm weakness, using a conventional keyboard can be difficult and frustrating. For them, an on-screen keyboard might be a more viable option to assist in maintaining communication and computer access.
On-screen, or virtual, keyboards provide an image of a keyboard on the computer screen that allows the user to select keys with a mouse, touch screen, trackball, joystick, switch, head-operated mouse or eye-tracking system. The software for on-screen keyboards can usually be accessed through switches and scanning.
Most such software programs enable the user to customize the size of the keys, as well as the color, labels, font and number of keys on the keyboard.
Amy Roman, a certified speech-language pathologist at the Forbes Norris MDA/ALS Research Center in San Francisco, said, “This permits a keyboard to be constructed that best matches the visual, physical, cognitive, language and communication needs of the user.”
On-screen keyboard software typically falls between $200 and $500, and most companies allow users to download a free demonstration. Most on-screen keyboards provide access to any application in the latest Windows operating systems, and software also is available for Macintosh systems.
|SofType keyboard by Origin Instruments
Jodi Bales, an occupational therapist at the Forbes Norris Center, explained that the use of on-screen keyboards can help people with ALS conserve energy.
“I think on-screen keyboards are an excellent option for all people who have hand and arm weakness,” Bales said. “Particularly when a person can ‘split the effort’ by using their hands and arms for some tasks and the on-screen keyboard for others or when they fatigue.”
Here are some important on-screen keyboard features to consider that can improve access to all computer functions:
- word prediction — the on-screen keyboard offers a word or list of words beginning with the letter that is selected;
- vocabulary (abbreviation) expansion — short codes represent whole messages that are spoken or written by the computer;
- instant message generation — a user can organize and store whole phrases under labeled on-screen keys;
- dwell selection — the user can select a key by “dwelling” on the key for a set period of time.
|MadenTec Limited's ScreenDoors 2000 keyboard
MadenTec Limited’s ScreenDoors 2000 software for Windows is suited for people with ALS who are using a mouse alternative like a trackball or head pointer. The software, which costs $295, features full-keyboard emulation that floats above any window, self-learning word predictor and dwell selection for people who can’t use a mouse or a switch.
“Since it’s something they’ve been familiar with, it’s very easy to launch and extremely easy to use,” said Mary Senger, international sales manager for Madentec.
ScreenDoors 2000 also can be used with any computer-based augmentative alternative communication (AAC) device. The software can be operated using switch access or scanning.
Origin Instruments’ SofType 4.2 program, $295, can be used with all standard Windows applications. The software features integrated AutoClick and Dragger for dwell selection, multiple keyboard layouts, word prediction/completion and abbreviation expansion. With AutoClick, clicking functions are performed by “dwelling” for a programmable length of time. Dragger allows AutoClick and single-switch users to perform all of the clicking functions of a two-button mouse. SofType software works with integrated AAC devices.
Edie Moore, a representative for Origin Instruments, explained, “The features are beneficial to people with ALS because it has a built-in dwell selection that allows you to perform clicking functions by holding the pointer still. They don’t have to use any form of a switch.”
|Prentke Romich's WiVik software
Prentke Romich’s WiVik software, released in 1991, is based on a Windows platform and can be used on any PC-based communication device. The software, $350, provides access using dwell selection or switch-based scanning, plus WordQ word prediction and abbreviation expansion. It also has speaking capabilities and can play back digitized speech.
Fraser Schein, a senior rehab engineer at Bloorview MacMillan Children’s Centre and assistant professor at the University of Toronto who helped develop WiVik, said, “One of the key features is that we have many different ways that you can access it, from pointing devices to a single switch. It’s really ideal for someone with ALS with changing conditions. They might start off using a mouse, and then move to head control or a single switch once they no longer have the use of their hands.”
Lake Software offers computer users the free download of the Click-N-Type virtual on-screen keyboard. It’s appropriate for people who can’t type but still can use a pointing device. The application, available at www.lakefolks.org/cnt, requires Windows 95 or later.
Microsoft has included an on-screen keyboard that’s available on all Windows operating software as part of its accessibility feature. However, the keyboard is basic and can’t be adapted to the user’s needs.
Roman added that on-screen keyboards aren’t the ideal option for everyone who has difficulty using a manual keyboard. She explained that some people with ALS find voice recognition software to be a better alternative if their speech is clear, while others find a switch system using Morse code to be less fatiguing and faster than direct selection or scanning associated with on-screen keyboards.