Computer Access and Adaptations

AbilityLab, 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 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
  • On screen keyboard operated by a mouse
  • Enlarged keyboard or smaller keyboards
  • Trackball
  • Head operated mouse
  • Eyegaze
  • 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); Universal 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.
  • Big Keys – standard sized keyboard with oversized keys, available in QWERTY or alphabetical arrangement with brightly colored or white keys.

Programmable Keyboard

  • X Keys

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.
  • 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. Screen keyboard size can be adjusted for visual and motor needs. Examples: WiVik, Windows Onscreen, Click n' Type.

Mouse Alternatives

  • Touch pad – 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.
  • Aerobic mouse –controlled by laying the hand inside of a trough, then sliding the mouse on the table; clicking is activated by two light touch buttons.
  • 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.
  • iPad/iTouch/iPhone/Android – various devices allow for access to many computer type functions through touch screen, but limited external mouse, keyboard or switch access.
  • 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, Dwell Clicker.

Speech Input

  • Dragon Naturally Speaking – speech recognition system transcribes spoken words into text for people unable to use their hands well enough for computer access. Several editions are available with various functions. Used with Windows operating system only.
  • Dragon for Mac – speech recognition for Mac systems.
  • Windows speech recognition – speech recognition for dictation, command and control embedded in Windows and Mac operating systems.
  • Tablet/Smartphone Speech Recognition

Alternative Input Methods

  • REACH – uses an onscreen keyboard modified by size, color, shape and arrangement. Options and features allow for a flexible access method.
  • 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.
  • 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 Pro, HeadMouse Extreme, Smart NAV .
  • Mouth operated mouse – uses the lips or tongue to operate a joystick. Clicking is accomplished through sip or puff on the device. Examples: Jouse, Quadjoy, Tetra mouse, Integra mouse
  • Eyegaze systems – use 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, Eyetech, My Tobii .
  • 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 – low–vision software with magnification, screen reading and scanning 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.
  • 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.

Choosing adaptive equipment is a highly individualized procedure. Please consult with an assistive technology professional on how to acquire any of the tools described above.

Posted on BrainLine December 12, 2016

© 2016 Shirley Ryan AbilityLab (formerly 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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