I.T. Systems to Support People with Parkinson’s Disease

Parkinson.org describes how the disease progresses so we can start to consider I.T. requirements

Parkinson’s affects everyone differently.  The symptoms someone might have and how quickly the condition develops will differ from one person to the next.  For many people, the condition can take years to progress to a point where it has a real impact on daily life. So having a plan on maintaining IT independence and enabling continual connectivity can seriously help people stay connected and support the mental health of a person with Parkinson’s disease.

This condition means that a person’s ability to use I.T and the need for different approaches through time will change.

How do symptoms progress and how does this impact the persons ability to use IT?

The most common symptoms of Parkinson’s are tremors, rigidity (stiffness) and slowness of movement.

An I.T Perspective:  In the early phases the use of a normal keyboard and mouse can still be possible and the best option for operating your computer.  But as the condition progresses and if the tremors or involuntary movement increases, a high level of frustration can pursue due to wrong keyboard strokes or being unable to align the mouse with part of the screen you are targeting.

Operating systems now have a lot of accessibility features ranging from mouse pointer size to the speed and responsiveness of the mouse movement. These features can seriously improve a person’s ability without additional cost.

Top 10 Windows accessibility Features

Options and setup for accessibility for MAC OS

Some of the more common settings for Windows and MAC that can support people with Parkinson’s

Features for keyboards such as

  • Sticky Keys that allow you to press one key at a time for shortcuts where pressing multiple keys at once is difficult or not possible due to dexterity issues.
  • Filter keys that ignore or slow down brief or repeated keystrokes and slow down the keyboard repeat rate.

Features for Mice such as

  • Pointer size – we all lose the mouse pointer occasionally, now you can permanently increase the size of the pointer.
  • Pointer color make the pointer higher visibility.
  • Mouse cursor speed and responsiveness, this can help give more control over the mouse.

Not everyone with Parkinson’s experiences the same combination of symptoms – they vary from person to person.

Also, how Parkinson’s affects someone can change from day to day, and even from hour to hour. Symptoms that may be noticeable one day may not be a problem the next.

As conditions progress the adaptability or granularity of the built in controls can become less effective and of course it doesn’t deal with a person’s physical requirements. This is when assistive technology comes in.

Older gent with comp
Lady with tablet
old gamers

Assistive Technology

What Device should we use? 

This is always going to be a personal choice. I always work on a device lasting for a minimum of 3 years. So depending on where in the lifecycle of Parkinson’s disease or how quickly the condition is progressing will effect your choice.  Of course, what you are going to use the device for is also important.

Is this going to be used in a work context where documents and colleague interaction is the focus?

Is the device going to be used for recreational activities such as using social media and staying in touch with friends and family?

Are you a gamer and want to enjoy your favorite racing or strategy game?

Of course, the answer to this will slightly differ depending on your answer.

Portable devices and potential considerations.

Everyone loves the idea of a laptop or tablet. They are flexible, highly portable and configurable.  But they can limit what is possible and becomes more of a fixed screen in certain progressions of the disease. Especially if a lot of assistive devices are going to be attached to it.

So considering how important the mobility of the device is essential. My father-in-law, for instance, loved the idea of a laptop to enable usage in different parts of the house.  But in reality he sat in his favorite chair to use the computer.

This wasn’t a problem as we could give him a different mouse and keyboard as his condition progressed but it limited the screen size and actually after a short time was not so useful.

Gone are the days of large towers and ultra compact computers. The Dell or the IMAC are a good example of this.  But remember if this is on a movable table we recommend that it needs to be secured.

Dell ultra compact PC

Of course, the decision between the two above is cost, accessibility integration, size requirements and touch screen ability.  The software you plan to run is also a consideration as not all software will run on each system.

Tablets

Tablets are also a good choice. They are lightweight and come with the ability to be fitted with different cases allowing better grip and control of the device when in hand.  Especially as you can get 12.9″ IPads for instance. Also with the accessibility options and other 3rd party software they can be setup with large icons etc to enable easier control for someone with Parkinson’s.  Software will be covered later in this page.

But they do rely on either being held by a stand or arm or in the hand itself. This can eventually become difficult for prolonged use.  Again, cost is a big factor here, but they do provide longevity so considering a larger tablet from the beginning, if your budget will allow, is a good investment.

We are not going to cover mobile phones in too much detail here as we found that even with big button mobile phones a high level of dexterity was needed, making them frustrating.  Especially as the condition progressed. But they are reasonably priced for a basic phone circa £25 – £45.  Phones that have voice assistants are good and with a headset can enable easy calling e.g. Siri or Alexa especially if the user can wear a headset for instance and doesn’t cause discomfort.

Big mobileAndrea bluetooth headset

Keyboards

Selecting the right keyboard is always going to be a personal choice but a separate keyboard certainly gives you a lot of options.  From standard full size keyboards, ergonomic 3D keyboards through to High Visibility, large keys.  To protect against tremors and accidental adjacent key presses there are special key guards available.

This added to the accessibility capabilities built into the modern operating systems can certainly maintain IT accessibility for people with Parkinson’s.  This is one area that laptops can fall short on as the keyboards on laptops are designed for compactness and lightness in most conditions and this can all go against effective use with somebody that has a condition such as Parkinson’s. Minimal travel keys of laptops also don’t have the tactileness or feedback of a full keyboard which helps with feel and control.

Monster 2 Keyboard Multicoloured Upper CaseKeyguard and keyboard

But there are now starting to be customizable keyboards such as the Chronker Keys keyboard setup to enable online video conferencing and calls easier.  The buttons are also programmable to allow for different functions and controls.  As we discuss this a Kick starter campaign is ongoing for these.

 

As well as this you can also have different assistive buttons to compliment a standard keyboard to allow for specific key presses to launch applications or Carry out specific functions.  These buttons range from 2 cms (1″) to 12.5cm + (aprox 5″)

PikoButton 30 Ability SwitchAssistive Switch

Mice and pointing devices

Mice or a pointing device is an area that we focussed a lot on and the requirement changed over the years.  As mentioned a normal mouse was fine, but as control of the hands became more difficult so did using a standard mouse.  We finally ended up with a big trackball mouse, but in retrospect had we known some of the following may have been more appropriate.

The Trackball was good as the arm movement was reduced that helped and with the Kingston mouse the level of configurability for the buttons and the mouse control really helped.  Click the picture below to see the device and the configuration options.

Vertical mice such as the penguin can allow a more natural grip similar to a joystick and this can help put the wrist and hand in a more comfortable position.

Penguin vertical mouse

for people who want a more relaxed position there are some ergonomic mice that provide a Lot more hand support such as the Hand shoe mouse or the Aerobic 2 mouse

left hand shoe

 

Tremor or involuntary movement control

The one challenge that all of these mice and trackballs can suffer from is if you have a sudden tremor or you suffer from continual tremors.  Using the mouse and keeping it on track can be both difficult and incredibly frustrating.  As with all technology wonders there are ways to filter this out electronically.  One such device is the AMAneo Assistive Tremor Mouse Adapter.  This device can be setup to filter out the sudden tremors of the person and can be altered daily given the symptoms on the day.  This can help remove frustration and allow someone to continue using mice to a certain extent as normal.

AMAneo Tremour 1

Posture and support

All of this technology is great, but if you don’t have the right support or its not comfortable it is nearly useless.  Support the arm during use of keyboards and mice can really help and in some instances also compensate for some of the physical elements just through proper support and being in a more relaxed position.  This is where items designed for Repetitive stress injury comes in, or at least this is where we started to find elements.

wrist-and-arm-support

 

Both above solutions enable motion but provide good support for the forearm and wrist.  but of course not forgetting simple Gel wrist rests for keyboards or mice.

I find the Gel ones are better as they remain cool when in use compared to some of the cheaper rubber based.

Text to speech

Tiredness is something that my father in-law suffered from generally due to the concentration of moving, when you have dictation software this makes it easy, but if people send you a document or you want to review a document sent to you a text to speech program can make this seamless.  Texthelp for instance is a feature packed application that does more than just read you a document.  Its a very powerful collaboration and creative suite, that allows for not only converting the text into speech but also allowing you to review and comment through voice.  This tool also has a powerful solution that can help with typo’s, grammar and spelling through its built in check it feature looking for confusable word errors, such as their or there your or you’re for example.  With full compatibility with voice dictation software (Covered next)  you can maintain full productivity while helping to reduce fatigue from using I.T.

Read and write 2

Dictation Software

We are all getting more used to talking to our devices. The introduction of the virtual assistants such as Siri, Alexa and Cortana certainly makes life easier for common functions.  Although they are good, they lack the conformability needed for someone who wants to do more either in the work place or at home.  Nuance Dragon has been around since the early 90s and pioneered the voice dictation abilities of computers.  For all the wannabe start trek fans the ability to speak to your computer is more accurate than ever.  With dragon you can Launch applications, select menu items, press keys, switch between windows, search the Web, create and send emails and more all by voice, if you wish.  Click the image below to see a demonstration of writing a document.

Click the link below to see how Dragon works.