Computer Access and Adaptations

Ed Hitchcock, OTR/L , Rehabilitation Institute of Chicago, LIFE CENTER
Computer Access and Adaptations

Anyone considering the use of a computer adaptation should contact an assistive technology center for evaluation by a qualified occupational therapist. These professionals can help determine specifically which equipment would be most appropriate.

Many types of adaptations are available to help people with disabilities use a computer.
For example:

  • Standard keyboard with specialized software or hardware.
  • Enlarged keyboard or on screen keyboard operated by a mouse.
  • Trackball
  • Head operated mouse.
  • Switch access.
  • Speech recognition.
  • Text to speech programs.

Keyboard Adaptations

  • Keyguards - coverings for the keyboard to prevent hitting the wrong keys.
  • Accessibility Options, Ease of Access (Windows); Easy Access (Mac) - increase keyboarding and mouse function to improve accuracy.

Alternate Keyboards

Small or Large Size

  • Mini keyboard - operated with a finger, hand-held pointer, head pointer or mouth stick. May increase efficiency over standard keyboard.
  • Magic Wand - miniature, light touch keyboard operated with wand-shaped stylus.
  • Big Keys - standard sized keyboard with oversized keys, available in QWERTY or alphabetical arrangement with brightly colored or white keys.

Programmable Keyboards

  • Intellikeys - enlarged keyboard with overlays.
  • Discover: Board - large keyboard with overlays allows key input and cursor/mouse functions.

Ergonomic or One Handed

  • Comfort Keyboard - adjustable, sectional keyboard adjusts to user’s functional hand and wrist postures.
  • BAT Personal Keyboard - one handed keyboard requires only downward pressure without lateral movements. It has seven keys; each letter is typed by entering a combination of keys, referred to as a chord.
  • FrogPad - one-handed keyboard designed for fast data entry. The fifteen most commonly used letters are placed in the most efficient positions, eliminating unnecessary shoulder and elbow movement. Both left and right handed designs are available.
  • Half-QWERTY Keyboard - specially programmed keyboard for one handed typing. The functional hand assumes the same "home" keys as before (a,s,d,f or j,k,l). To type letters on the other side, the space bar is held down. This then “flips” the keyboard, turning the Q into a P and so on. This also prevents rotation of the shoulder and stretching of the hand across the keyboard. Half-QWERTY allows the keyboard to still be used for two-handed typing without interference.


On-Screen Keyboards - operated with mouse clicks or alternative devices. On screen keyboard size can be adjusted for visual and motor needs.
Examples: WiVik, SofType, Screen Doors, EZKeys, Discover Screen, Onscreen, Windows Onscreen keyboard, Click n' Type.

Mouse Alternatives

  • Touch Pad - mouse device with flat, touch-sensitive surface. Individuals with upper limb or hand disability can press on the touch pad with a finger, eraser tip or typing splint. Examples: Glidepoint, US Logic, Cirque.
  • Kensington Expert Mouse Trackball - large, gliding ball with four easy-to- click buttons allows users with minimal hand function to perform various functions.
  • Mini Trackball - small (1/2") ball is held in the hand and moved by the thumb and index finger.
  • Palm Mouse - small mouse is held in the palm of the hand and moved by pressure on a disk.
  • Quill Mouse - mouse is controlled by laying the hand inside of a trough, then sliding the mouse on the table; clicking is activated by two light touch buttons.
  • Felix 440 - specially designed handle comfortably accommodates fingers. Handle slides; click buttons are on the top of the handle and are easy to use.
  • Mouse Interface 5 or R.A.T. - switches control all mouse functions.
  • SAM Mouse and Joystick or Switch Port - standard trackball or joystick with switch adaptations. A switch port works with the mouse but uses a switch for the click function only.
  • Tablet Input Devices - uses a stylus, held like a pencil and dragged on the tablet. The stylus can be inserted into a vertical holder or splint for a person without hand function. Designed for entering graphic or highly detailed information.
  • Touch Screen/Touch Computer - finger touch on the screen makes selections, using a touch pad mounted on the monitor.
  • Dwell Software - user holds a mouse in position over the target for a preset length of time, activating a mouse click. Best for situations where the mouse motion can be accomplished but clicking is impaired.
    Examples: Point n' Click, Dragger, Magic Cursor.

Speech Input

  • Dragon NaturallySpeaking - speech recognition system transcribes spoken words into text for people with an inability to use their hands well enough for computer access. Several editions are available with various functions. Used with Windows operating system only.
  • iListen - speech recognition for Mac systems.
  • Windows Vista Speech Recognition - speech recognition for dictation and command and control embedded in Windows Vista.

Alternative Input Methods

  • REACH - uses an onscreen keyboard modified by size, color, shape and arrangement. Options and features allow for a flexible access method. This can also be combined with Scanbuddy which activates mouse control through a single switch; and/or SmartKeys which customizes keys and creates Smart Lists, a word prediction system.
  • Discover Suite - uses a customized keyboard, switch scanning software or switch access. Any switch, alternative keyboard or mouse device can be combined with standard or custom setups. Several options and features are available.
  • Intellikeys USB - programmable customizable keyboard that can also act as a switch port.
  • DARCI USB - offers control over all computer functions using switches with Morse code, joysticks and pointing devices.
  • EZ Keys for Windows - offers full computer access using an on-screen keyboard with word prediction, mouse capabilities via Radar Mouse and communication software.
  • New Abilities UCS 1000 - uses tongue activation via a device that fits into the mouth.
  • Head Operated Mouse - uses a pointing device, placed on the forehead or glasses, and a sensor, replacing the standard mouse for people who cannot use their hands. The mouse pointer moves in response to head movement, but requires controlled head movements. Works with Dwell software or alternate switches.
    Examples: Tracker One, HeadMouse Extreme, Smart NAV.



  • LOMAK (Light Operated Mouse and Keyboard) - head or hand held laser is pointed at a keyboard and the user selects a letter or mouse function by pointing the laser at the appropriate spot. This is generally better for people with shaky movement than the Head Operated Mouse (above).
  • Mouth Operated Mouse - uses the lips and or tongue to operate a joystick. Clicking is accomplished through sip or puff on the device.
    Examples: Jouse, Quadjoy, Tetra Mouse.
  • Eyegaze Systems - uses a digital camera pointed at the eyeball. As the eye moves to different points on the computer screen, a mouse or selection method follows it. Clicking is activated by blinking or dwelling. These devices are often combined with other technology.
    Examples: Quick Glance, ERICA, My Tobii.
  • Cyberlink - uses brain waves and brain activity for movement of the cursor or activation of a switch. This system is harder to learn than others and requires good cognitive skills.
  • Scanning Software for the Mouse - uses a switch to control movement of the mouse cursor. A single or dual switch will allow the mouse to be placed through scanning on the screen.
    Examples: CrossScanner. Scanbuddy.

Vision Alternatives

  • Screen Magnifiers - available through both Windows and Macintosh operating systems.
  • Narrator - Windows system reads typed characters.
  • Macintosh Voiceover - provides auditory feedback.
  • Zoomtext Xtra Magnifyer/Reader 9 - low-vision software with magnification, screen reading and scanning. It provides complete access to Windows programs and printed materials.
  • JAWS - screen reading program allows the user to listen to each keystroke, word or sentence as it is typed, as well as listen to menu items and Windows navigational tools.
  • Biggy - large, animated, high contrast cursors also provide auditory feedback when moved.

Reading Alternatives

  • What You Need Now (WYNN) and Kurzweil 3000 - software programs convert books, articles or text from the internet into read-aloud format.
  • Premier Programming - products include text read back, changes to visual presentation, word prediction and auditory dictionaries, which can be purchased as a suite or separately, allowing for features to be used for very specific needs.
  • Word Prediction - programs suggest words after user types the first two to three letters. For example, typing "he" produces a list of words: "he, hello, helicopter" etc. The user then selects the correct choice to insert into the document. Auditory feedback of the potential choices is also available. Examples: WordQ, Soothsayer.
  • Abbreviation Expansion - programs allow the user to input two or more letters as a preset abbreviation, which is then entered as the full word or phrase.
    Examples: AutoCorrect, QuickCorrect
  • Macros - user-defined commands for the computer, these can be used to decrease keystrokes or other functions.

The content of this handout is for informational purposes only. It does not replace the advice of a physician or other health care professionals. Copyright 2007 Rehabilitation Institute of Chicago.

Copyright 2008 Rehabilitation Institute of Chicago, LIFE Center, reprinted with permission.

Posted on BrainLine October 7, 2008

Copyright 2008 Rehabilitation Institute of Chicago, LIFE Center, reprinted with permission.


I find that the Opera web browser has been a great help for me, since my 2nd TBI, where I was in a coma for over a month. I've learned to customize it, it has voice capability, so it will speak web pages: good for when my eyes are tired etc, and can also be driven by speaking to it. Very easy to use, and has some fantastic features. Rob

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