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Computers and electronics are essential to modern life, impacting everything from communication and work to entertainment and healthcare. Although ALS symptoms like hand weakness can impair their use, changes in technique and a range of adaptive devices can help users continue to operate these technologies.
Typing will become difficult as the intrinsic muscles in the hand weaken. Hunt-and-peck will remain possible as long as the arms are able to be lifted up such that the hands can be held above the keyboard.
Keyboards which have tall buttons are the easiest to use for hunt-and-peck. The tops of the keys can catch the fingernail which simplifies indexing on the key cap.
Key combinations, such as using the shift key along with a letter, or control-alt-delete are the most difficult keyboard tasks. Key mapping software can be used to map frequent combinations to simpler ones. Rarely-used keys can be sacrificed for this purpose, or if the key mapping software supports it, a second keyboard could be provisioned.
An alternate input device will be required once hand and upper limb weakness have reached a point where it is no longer possible to hold the hands above the keyboard. Such devices include:
On-screen keyboards can be quite tedious to use due to the amount of clicking required. To streamline the process, frequently entered text—like names or addresses—can be added as custom buttons. Additionally, common key combinations such as cut, copy, and paste are excellent options for assignment to these custom buttons.
Using a mouse becomes increasingly challenging as muscle weakness and atrophy in the hand worsen. While the specific sequence of difficulties experienced can vary from person to person, the following provides a general estimate from earliest onset to latest:
Purchasing adaptive pointing devices can potentially be avoided for a very long time by making the following adaptations:
Difficulty clicking the primary button with the index finger can be mitigated by flipping the role of the buttons on the mouse, and instead using the middle and ring finger as a primary click. It is possible to get used to this change within a few hours.
Difficulty double clicking quickly enough can be mitigated by reducing the double click time interval in the operating system's pointing device settings.
Accidental clicks when placing the hand on the mouse can be mitigated by moving the mouse to a region of the screen where the accidental click will have no consequences.
Trackballs will be difficult for anyone that has mobility issues with their thumbs. With ALS, such issues are often one of the earliest symptoms.
Trackballs are of limited use to someone with ALS.
Voice dictation can be used in place of a hardware input device for typing. Its use requires relatively clear speech to work well.
Voice dictation software is not particularly good at interpreting terms which are specialized in nature, such as medical or engineering terms. They may need to be spelled out.
Punctuation is often stated by naming the punctuation mark itself. This creates ambiguity when trying to state a word which coincides with the name of a punctuation mark. Voice dictation software attempts to distinguish the intent by measuring the intonation and speed of the speech.
Desired Text | Speech Required Using macOS Dictation |
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Hello, it is nice to see you today. | “Hello COMMA it is nice to see you today PERIOD” |
The comma and period are common punctuation marks. | “The comma and period are common punctuation marks PERIOD.” |
Voice dictation may accept other commands, such as a command to begin a new line or new paragraph.
As the muscles in the fingers atrophy, the fingernails will tend to contact touchscreens and prevent screen touches from registering. This can be minimized by keeping nails short.
iPhone and iPad devices offer a broad range of accessibility features. For individuals with ALS, mobility or motor-related accessibility options are particularly relevant and beneficial.
Apple Pencil is not considered to be an adaptive device, however, it may bring utility to someone with impaired mobility in their hands for quite some time.
An Apple Pencil can be used by wedging it between the fingers with an iPad, though it is not specifically designed as an accessibility device. By enabling the accessibility button and customizing its menu to include features such as the app switcher and volume controls, users can operate most of the device with just the pencil. However, unlocking the iPad and using Touch ID for authentication still require traditional methods. While using gestures with the Apple Pencil and the accessibility button can be cumbersome, it remains a reasonable option.
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Streaming media players, or set-top boxes, include video playback devices such as Roku, Amazon Fire TV, Nvidia Shield, and Apple TV.
Apple TV remote controls can be challenging for individuals with limited pinch strength since all buttons and the gesture area rely on thumb use. An alternative is to use the Apple TV Remote app on an iPhone or iPad. In the device's settings, users can configure the app to display distinct buttons for up, down, left, and right, and adjust other settings to enhance usability.
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