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Today we'll be talking about technical
solutions that can accommodate
people with MS and ALS
in the workplace.
So, without further ado, let's begin.
First, I want to highlight why we at CAP
care about this issue.
CAP stands for the Computer/Electronic
Accommodations Program and we're
a part of the Department of
Defense, and our mission is to provide
equal access to information and
opportunities in the Federal government.
We do this by helping to identify
appropriate solutions for each
individual based on their job
and the limitations they're experiencing
and providing these solutions to
Federal employees with disabilities, and
Active Duty wounded Service members.
For this reason, we will be focusing on
workplace accommodations during our
discussion today.
To start, I'd like to take a moment to
discuss each of these conditions,
starting with ALS. ALS stands for
Amyotrophic Lateral Sclerosis
which is often referred to as
Lou Gherig's Disease.
It is a progressive neurodegenerative
disease that attacks the nerve cells
responsible for controlling
voluntary muscle movement.
Essentially, as these motor neurons
degenerate and die, there is a
disruption of the signal from the brain
to the muscles, and it eventually leads
to the loss of the brain's ability to
control those muscle movements.
Early symptoms often include increasing
muscle weakness, especially involving
the arms or the legs, but it can eventually
get to where it effects speech,
swallowing or even breathing.
Most commonly, it's diagnosed in people
between 40 and 60 years old, so the
symptoms typically present around the
same time as other causes may, including
acquired disabilities, or symptoms simply
attributed to the aging work force.
Multiple sclerosis, which is commonly
abbreviated as MS, is a chronic disease of
the central nervous system.
It causes the destruction of myelin
which surrounds and protects nerve fibers
located in the central nervous system.
Signals traveling through the nerve fibers
are then interrupted or delayed,
and they cause neurological symptoms
in various parts of the body.
Symptoms can range in severity,
but often the first symptom is
blurred or double vision, but it can also
result in pain or loss of vision because
of the inflammation of the optic nerve.
Other symptoms may include muscle
weakness, tightness in the limbs, spasticity,
which is a tightness or stiffness of the
muscles, loss of coordination,
muscle cramps, or even paralysis.
Additionally, roughly half of individuals
diagnosed with MS experience cognitive
impairment, such as difficulty with
concentration, attention, or memory.
However, these symptoms are usually mild
and often go overlooked.
Usually the first symptoms of MS present
themselves between the ages of 20 to 40.
So now that we have an understanding of
what may be experienced by an individual
diagnosed with MS or ALS, we'd like to look
at some assistive technology options for
people with these symptoms that they can
utilize in the workplace.
To go over that with us,
we have Erin Sanderson.
Erin works in CAP's
Technology Evaluation Center in the
Pentagon, which showcases
this type of technology. Erin?
Erin: Thanks, John.
So as John mentioned, I'm going to review
some common assistive technologies for
individuals with MS or ALS.
First, it's important to start with a
good ergonomic work station.
This is the foundation for an accessible
work environment.
Tools that will allow for a proper
ergonomic work station can include a
number of different solutions.
One of which are alternating pointing
devices. These are an alternative
to a standard mouse.
So to use a standard mouse,
a person must
reach laterally while moving their arm
and wrist to control the mouse.
For some individuals with MS or ALS,
these are difficult and sometimes
impossible to use. So, alternative
mice may be an option.
A couple of these different types
of mice include a track ball mice -
I'm sorry, track ball mouse.
These are set up like
upside-down mouse with an
exposed protruding ball.
The user can roll the ball with
their thumb, fingers or the palm
of their hand to control the mouse.
Vertical mice. These are very
similar to a standard mouse
but the controls are on the side.
This is designed to keep the user's
hand in a natural position.
And finally, roller mice.
Now, this is a bar that's located in front of
the keyboard where all of the features
are located. It's controlled using a
rotating cylinder, and this mouse
completely eliminates the need to reach
laterally to control the mouse.
Like the standard mouse, the standard
keyboard may also be difficult for
someone with MS or ALS to use.
This could be due to shaking,
numbness, or loss of coordination.
So alternative keyboards
may help, and there are many on the
market with different features.
So a few different options include a
keyboard with larger keys, a keyboard
with a keyguard to prevent the wrong
keys from being pressed and
ergonomic keyboards which would
allow the individual to keep their arms,
wrists and hands in a natural position
when keyboarding.
Perhaps a person's limitations are so
significant that using a keyboard and
mouse are not possible.
For ALS, this could be the result of
muscle weakness, and for MS, this
could be the result of numbness in
the limbs, loss of coordination, muscle
weakness, tightness and tremors.
So in this case, speech recognition
software may be appropriate.
Speech recognition software would allow
the user to control the computer using
their voice.
Virtually anything that can be done with
a keyboard and mouse can be done
using verbal commands.
This includes creating documents, writing
e-mails and browsing the web.
And finally, as an individual with ALS or
MS finds it difficult to sit or stand for
long periods of time due to muscle
weakness, numbness or pain,
sit-to-stand equipment may
allow them to work for longer
periods of timely by allowing
them to change positions
throughout the day.
Now, there are many options
sit-to-stand options available on the
market. Some of these are adjustable
desks, attachments to desks,
or their own unit that sits on
the desk surface.
They are also available with the
ability to adjust the height both manually
or using a motorized unit.
John: And, with the way these conditions
effect muscle movement, it is completely
understandable why tools that assist with
the physical interactions of the job are
most prevalent, but do you think could
touch on technology that could also
benefit an individual experiencing
some of the other potential symptoms?
Erin: Sure. So, for MS, one of the
common symptoms is
visual difficulties.
If a person is experiencing problems with
their vision, tools such as screen
magnification software or desk top or
portable closed circuit televisions, or
CCTVs may be helpful.
Screen magnification software
would allow the user
to increase the size of the information on
the screen, adjust the color contrast to
reduce the glare in their eyes, customize
the pointer and cursor to make them
easier to see, and
even has a feature which will read the
information on the computer aloud.
CCTVs are used to magnify hard copy
documents or objects with small print.
They also have features that can
adjust color contrast and brightness.
Now, these can be a large unit the
size of a computer that sits on the desk
surface, or small portable devices that
can be taken to meetings or trainings.
For both ALS and MS, speech can
often be effected so if creating
the necessary volume is an issue,
voice amplification devices would
allow the individual
to adjust the volume of their speech to
ensure that they are communicating
effectively and can be heard.
These can help amplify the user's voice
in person but there are also devices
available to help amplify the user's
voice over the phone.
For some individuals, verbal
communication may not be possible.
So for them, augmentative communication
devices would allow them to
communicate in other ways.
So for some, it may be a communication
board, for others, systems may be created
to allow them to communicate using the
computer or other device.
Augmentive communication devices are
individualized products that are are
unique to each person, and how it is best
for them to interact with it depending on
their motor skills.
These can be controlled using their
fingers, their hands, or even their eyes.
As John mentioned, for MS, cognitive
functions may be impaired, so to help
with this, memory and cueing devices
would allow the individual to process
information easier, remind them of tasks
and deadlines, stay organized, and
continue to be productive.
A couple of solutions that could help
include smart phones. Now, these
are tools that many people already have.
Smart phones feature tools such as voice
notes, reminders, task lists and
calendar features, and if needed, there
are even reference guides available to
teach a person how to make the best use
of the features that their phones already
have. Another solution may be a
recording pen. This would allow
an individual to capture
information in meetings, trainings, or
during courses without missing any
pertinent information.
And finally, some people may find it
easier to process information if they can
both see it and hear it simultaneously.
To help, there are software programs
available that will read everything on
the computer aloud.
John: That's great information, Erin,
and thank you for sharing.
As useful as it is to know an array
of items that can assist with different
types of difficulties that an individual
may be having in the workplace it can be
hard to match up the correct technology
with what they are experiencing to have
it be an effective solution.
For that, CAP uses a needs assessment
system where we focus on, one, the job;
two, the individual is, and three, the
solution.
As Erin just mentioned, we're only
highlighting a couple of things in a
broad category of assistive
technology. With so many products
available, there are so many symptoms
that may be experienced, this is how we
determine what the most effective tool
may be for an individual in their
specific situation.
To make this a little more practical,
Erin and I would like to give an example
of how this three-pronged approach can
assist people in identifying which of the
solutions just mentioned may
be best in their unique case.
Erin?
Erin: So as John mentioned, the first
thing we want to look at is the job.
In this scenario, the individual is a
Federal civilian employee who works as a
legal counsel for a government agency.
The position involves significant amounts
of reading, writing and telephone use.
The reading duties can be both electronic
documents or research, as well as hard
copy files.
And finally, this individual is required
to attend meetings.
Most meetings involve high level staff in
different locations and are conducted
over the phone or video teleconference.
John: Next we want to look at the
individual. When looking at the
individual, it is important to
understand that multiple
people may have the same diagnosis.
However, most people don't experience
that diagnosis in the same way.
People may have varying symptoms,
so it's really important to ask questions, and
understand exactly what each person
is experiencing, how it is affecting them,
and what the prognosis is.
In other words, "what do we anticipate
happening in the future?"
In this scenario, the individual was recently
diagnosed with MS.
The current symptoms include muscle
weakness, which was causing difficulty
completing computer tasks when typing and
using the mouse.
He also experienced a numbness in
fingers and toes which
constantly resulted in him pushing the
wrong key or double typing single letters.
He also had a difficulty speaking at a
volume that could be perceived by
others, both in person and on
the phone. And finally, he was
experiencing some decreased vision, which
makes it difficult to review hard copies
and electronic documents.
The final step when learning about the
individual is to know what their
prognosis is.
Symptoms may get better, it could stay
the same, or continue to deteriorate.
What works one day, may not work the
next, so knowing the prognosis will help
determine the most appropriate tools.
The prognosis for this individual is that
his muscle weakness would continue to get
worse most likely, but his voice and
vision were expected to stay
about the same.
Overall this employee wanted to
continue working as a lawyer, and asked
for some reasonable accommodations that
would assist him with the difficulties
he was having.
He was very comfortable with assistive
technology and was willing to try
anything that would bridge the gap
between his job functions
and his limitations.
So now that we know about the job and the
individual, I'll ask Erin to show how we
can use this information to
find the best solutions.
Erin: To find potential solutions, we
want to look for tools that can assist
with the limitations he's experiencing
as a result of MS.
To help with this, employee's muscle
weakness and numbness in their fingers,
there are a few tools that may help.
First, is speech recognition software.
This would allow the employee to
speak to control the computer
with his voice instead of having to
type or use a standard mouse.
Next is an alternative keyboard
and keyguard. This would prevent the
employee from accidentally hitting the
wrong keys when using the keyboard
for sensitive information he could not speak
out loud. These are things like passwords.
To help with difficulty speaking at a
volume that can be heard by others, two
types of voice amplifiers would help this
employee. First is an in-line
amplifier connected to his phone.
This would allow him to increase the volume
his voice over the phone so that
he can be heard by others
on those conference calls that he's on.
Second, is an in person amplifier.
Now, this would amplify the sound
of his voice to people he met with in person.
To pair the amplifier and the speech
recognition software, there is a
headset with a switch box.
Now a headset is needed for both the
speech recognition software, as well as
for the use of the voice amplifier.
A switch box would allow the employee to
use a single headset and switch from
dictating to his computer to speaking on
the phone without having to change
headsets or picking up and holding
a standard phone hand set.
The final limitation that the employee
experiences is decreased vision.
So for this, screen magnification would
allow him to manipulate the color
combination and the size of material
on his computer screen, and if his
eyes are fatigued, and he finds it easier
to have information read along to him,
the software has a reader tool which
will do just that.
Next is a closed circuit television.
This employee spends the majority of his
day seated at his desk.
Therefore, a desktop CCTV
would be the best option.
It would allow him to magnify and change
the color combination of hard copy
documents. It would also provide the ability
for him to complete the split the screen and view
electronic and hard copy documents in the
large size, and in best color combination as
possible, all on the same screen.
The final step in accommodating
this employee is verifying that all of
these tools will work on the network, and are
approved for use in his work environment.
Now, in this case, the local IT staff
confirmed that all of the software or
items presented to the employee are
allowed for use on the network
and if agreed by the customer,
coud be implemented as a solution.
These tools were allowed in the
environment, and allowed the individual
to bridge the gap between his job functions
and his limitations to allow him to
continue to work and to succeed.
John: Thank you so much, Erin.
And I think that's a great example of how
the CAP needs assessment process can
ensure the correct solutions are
identified for an individual based on
what they're experiencing.
And ensuring the best options are
presented from a sea of available
technology solutions.
Before we wrap up, I just want to
highlight a couple of resources for you,
especially in terms of assistive
technology and how it interacts
with the computer.
The first is CAPTEC.
This is our technology center in the
Pentagon where Erin works full-time,
and they can provide in-person
needs assessments,
distance-based assessments through
phones or video conference,
and be a resource for anyone look
for an assistive technology solution.
I'd encourage to you check out our website
as well, which is CAP.mil.
There are a lot of resources on the site
and you can browse assistive technology,
receive up to the date disability
employment information and
technology updates.
If you have a specific question, you're
always more than welcome to just e-mail
us directly at CAP@mail.mil.
I also encourage you to check out our
You Tube channel.
Not only are there assistive technology
videos that show demonstrations
of assistive technology that Erin highlighted,
but there are also testimonial videos, one of
which is is an individual named Judy
Summers-Gates, who is diagnosed with MS
and works for the Food and Drug
Administration.
So looking at the testimonial and the
technology videos, you can kind of see
how we utilize the process in her
specific instance to find tools that help
her in the workplace.
So feel free to check out any of those
videos at www.YouTube.com/theDoDCAP.
In closing, I just want to say thank you for
participating in today's webinar.
If you have any questions or need
additional information, feel free to
contact us by phone at 703-614-8416
or by e-mail.
If you're interested in viewing
previous webinar or or looking at a list
of upcoming topics, please visit the
Training and Outreach section of
our website at CAP.mil.
On behalf of myself and Erin Sanderson,
thank you for participating in today's webinar.