Navigating The Technical Maze to Achieve Independent Living

RESNA 28th Annual Conference - Atlanta, Georgia

Ka Lun Tam, P.Eng.; Cynthia Tam, B.Sc.O.T., M.Sc.; Jerzy Antczak, P.Eng

Bloorview MacMillan Children’s Centre


When implementing solutions for independent living, it is not sufficient to combine multiple technologies together in the hopes that they will solve the issues they are each individually designed to address. Instead, the interactions between different solutions must be considered when designing an integrated system. This paper describes challenges in the provision of integrated technology to support independent living to one individual. Compatibility issues that arose, and the solutions that materialized, when implementing independent access to reading, writing and EADL’s through a single computer system are discussed.

KEYWORDS : Independent Living; Computer Access; Technology Integration;

With the advances in modern technology, independent living is now within reach for people with disabilities. However, it is not sufficient to implement multiple technologies together in the hopes that they will combine to solve the issues they are each individually designed to address. Instead, the interactions between different solutions must be considered when designing an integrated system. This paper describes the challenges and issues in provision of integrated technology to support independent living to one individual.

Royce was a 24-year-old young man. He had no functional control of his upper or lower extremities because of cerebral palsy. Royce had a dysarthric speech but a familiar listener could understand him quite well. Royce also had reduced vision, which affected his ability to read the display on a computer screen. He relied mainly on auditory information to read the display. Royce had completed high school education at a life skill level. He was living independently in an attendant-care apartment.

During the technology assessment, Royce identified the need for communicating with his family through email and for controlling devices around his home. What he liked to access immediately included his TV, telephone, electric door openers and his music, while future desires included access to other entertainment devices. Royce drove an Invacare Storm series power wheelchair using a proportional joystick. However he was not able to move the joystick from one direction to another quickly and accurately. The COM module on the chair enabled him to use the joystick as 8 separate switches. The best control movement to use as a switch site was pulling the joystick towards the body. Using the joystick as control switches was physically the least demanding and the most reliable. Royce used a switch positioned next to his joystick to toggle between driving and using the joystick as switches.

Royce had a Windows 98 computer that was upgraded to Windows XP. His main word-processor was Clicker4 (1), a software package that enabled a user with a single switch to enter text and/or speak the entered text. Royce accessed Clicker4 by pulling his joystick backward. A wireless switch transmitter sent the switch signal to the Crick USB Switch Interface on the computer. Clicker4 was chosen because it was, at the time, the only software available that provided auditory scanning option.

CrossScanner (2), a single-switch-activated mousing software, was used to provide mouse control. Royce moved his joystick to the left to activate CrossScanner. To help Royce with his incoming emails, ZoomText (3) was provided to read text that was displayed on the screen. These two pieces of software, when used in combination with Clicker4, were to have solved all of Royce’s computer access needs: the ability to read, the ability to write, and the ability to perform mousing functions. Unfortunately, there were technical and usability issues that prevented this combination from being successfully implemented.

Because of Royce’s reduced vision, he was unable to see the mouse cursor on the screen or the icons that he was trying to select when he was using CrossScanner. In addition, Royce had never seen the computer desktop before, and trying to learn the concept of moving and selecting icons on the screen proved to be too high of a cognitive load for him.

ZoomText’s voice output also interfered with Clicker4’s auditory scanning, and caused a system crash if both were used simultaneously. As a result, only one of the two programs could be active at any given time. When switching from ZoomText to Clicker4, however, the system was unable to automatically bring Clicker4 to the system foreground as the active window. The end result was that Royce could turn off ZoomText, but would be unable to subsequently access Clicker4.

The issue of active windows also surfaced while selecting an email software package. When Clicker4 attempted to interface with certain software programs, it was not always able to ascertain which window had focus, and hence which program should receive the keystrokes it sent. Often when a dialogue box was demanding a response, Clicker4 directed its outputs to a different window. As a result, Royce was no longer able to proceed with his task, and in fact was often unable to proceed with any task at all. This problem was particularly important to consider in the choice of email software for Royce.

In addition to software issues, a hardware issue also existed in the Crick USB Switch Interface. The Switch Interface was consistently unrecognized by the computer when it was first turned on. The Interface needed to be disconnected and reconnected. Royce was not able to perform this task himself. His attendants were not comfortable working with technology. Fortunately, Clicker4 also worked with certain keyboard keys, and an appropriate solution for future implementations of similar systems would be to provide a custom keyboard interface in place of the Crick Switch Box.

Compounding the problem was the fact that Royce needed to use the computer for multiple functions: writing email, playing music and controlling his television. Having considered all of Royce’s needs and abilities, plus the compatibility issues, some sacrifices were made in order to design an integrated system that focused on functions. Since, Clicker4 supported multiple grids, had a built-in talking word-processor and could be used to execute commands, it was chosen as the interface tool that provided control to all the above listed functions. ZoomText and CrossScanner were both removed. This design was much simpler as it allowed Royce to deal with one program and one access method.

When the computer was turned on, the Clicker4 front page presented Royce with choices for controlling one of the required functions. If emailing was desired, a task-specific grid provided Royce with commands that enabled him to compose and send emails using the Eudora Email (4) software. Clicker4 also interfaced with Speak To Me (5), a shareware, to read incoming emails out loud. These two programs were chosen because of their ease of interfacing with Clicker4 and the support for Clicker4 to constantly stay as the front-end controller. For selection of music, a choice on the front page brought Royce to another grid designed to interface with Windows Media Player, and Royce could play a selection of songs pre-loaded onto his computer. The scanning speed on Clicker4 was initially set to a slow speed while Royce was getting accustomed to it, but the speed was increased over time as his comfort level increased.

To control his television and a DVD player, Clicker4 interfaced with HAL2000 (6) software. This was a voice-activated EADL software that normally received commands from an external microphone. On Royce's system, however, HAL2000 received its voice commands from Clicker4's voice output. Because the voice output from Clicker4 was a consistent computer generated voice, recognition by HAL2000 was perfect.

When Royce was finished performing his desired tasks, he could disable Clicker4’s auditory feedback by opening a grid where this feedback was silenced. This grid was a quiet resting spot for Clicker4’s scanning, allowing Royce to enjoy his music or his television show without the interruption of Clicker4’s constant audio scanning. This page had only one action cell that activated the front control page.

As work progressed toward resolving the many compatibility issues on the computer, Royce’s needs to control other electronic devices at home were also addressed. The goal was to keep all of the controls on Royce’s wheelchair. The switch functions on the wheelchair joystick were used to open the door to his apartment building and to his suite. Royce's door openers were connected to a time delay circuit, which kept the doors from opening until 10 seconds after he moved the joystick. This gave Royce enough time to return his chair to driving mode, and move through the doorway before the door closed.

Royce's telephone access was provided through the Ameriphone RC200 (7). This was a scanning speakerphone that Royce could use to dial up to 20 pre-programmed telephone numbers, or to answer incoming calls. He could also use the RC200 to unlock the building doors for his visitors. Royce again used one of his joystick switches to activate the RC200. When Royce was in bed, he could access the RC200 through a single switch mounted on the wall next to his bed.

While a successful system was eventually implemented for Royce, much time and effort was expended to ensure that the final pieces did not interfere with one another. Less important tasks, such as the ability to control the mouse cursor, had to be eliminated in order to ensure the success of the primary objectives. Ultimately, the success of an integrated system requires a compromise between the best technologies and the most compatible ones, while keeping a constant eye on the overall goals.


  1. Clicker4, Version 4.1.92, Crick Software,
  2. CrossScanner, March 2003, RJ Cooper & Associates,
  3. ZoomText, Version 7.1, Ai Squared Inc.,
  4. Eudora Email, Version 6.1, QUALCOMM Incorporated,
  5. Speak To Me, 1995
  6. HAL2000, Version 2.0.66, Home Automated Living Inc.,
  7. Ameriphone RC200, Clarity – a division of Plantronics Inc.,


Ka Lun Tam, P.Eng.
416-425-6220 x3525
Bloorview MacMillan Children’s Centre
150 Kilgour Rd.
Toronto, Ontario, M4G 1R8, CANADA