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Computer-Related Assistive Technology: Satisfactionand Experiences Among Users With DisabilitiesMary Burton MS a , Els R. Nieuwenhuijsen PhD and MPH and OTR b & Marcy J. Epstein PhD ba Department of Physical Medicine and Rehabilitation , University of Michigan Hospitals andHealth System , Ann Arbor, Michiganb Advanced Rehabilitation Research Training Center, National Institute on DisabilityRehabilitation and Research, University of Michigan Hospitals and Health System,Department of Physical Medicine and Rehabilitation , Ann Arbor, MichiganPublished online: 22 Oct 2010.

To cite this article: Mary Burton MS , Els R. Nieuwenhuijsen PhD and MPH and OTR & Marcy J. Epstein PhD (2008) Computer-Related Assistive Technology: Satisfaction and Experiences Among Users With Disabilities, Assistive Technology: The OfficialJournal of RESNA, 20:2, 99-106, DOI: 10.1080/10400435.2008.10131936

To link to this article: http://dx.doi.org/10.1080/10400435.2008.10131936

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APPLIED RESEARCHAsst Techno l 2008;20:99- 106

© 2008 RESNA

Computer-Related Assistive Technology: Satisfactionand Experiences Among Users With Disabilities

*Mary Burton, MS , t Els R. Nieuwenhuijsen, PhD, MPH, OTR, and t Marcy J. Epstein, PhD

"Department of Physical Medicine and Rehabil itation, University of Michigan Hospital s and Health System,Ann Arb or, Michigan;tAdvanced Rehabil itation Research Train ing Center, National In st itute on Disabil ity Rehabilitation and Research,Department of Physical Medicine and Rehabil itat ion, Universi ty of Michigan Hospitals and Health System,Ann Arbor, Michigan

Many people with disabilities use assistive technol­ogy d evices (ATDs) for computer access. The specificfo cus of this exploratory study was (a) to assess theexperiences, opinions, and satisfaction levels of 24 in­dividuals with disabilities using computer-relatedATDsj (b ) to inve stigate their awareness of health riskfactors related to computer usagej and (c) to examinethe psychosocial impact of computer-related ATDs onusers. Data were collected via telephone interviewswith 24 individuals with physical disabilities who hadexp e r ie nce using one or more ATDs. The Quebec UserEvaluation with Assistive Technology instrument wasused to evaluate users' satisfaction with ATDs in a num­ber of dimensions, including their physical attributes.The Psychosocial Impact of Assistive Devices Scalemeasured the psychosocial impact (i. e., independence,competence, and adequacy) of an ATD on users. Ad­ditional questions were posed to gather informationabout user's opinions and experiences. Training ap­p eared to be an important component for ATD users,many o f whom preferred a setting to tryout devicesrather than group or individual training. Respondentswith visua l impairments revealed a higher level ofadaptability versus those with o ut visual impairments(P = .00 I) . Additional research is needed to developspeci fic s ur vey items focused on users of computer­r elated ATDs and the evaluation of the psychosocialimpact of ATDs on computer users.

Key Words: Computer training-Behavior change­Acc essib ili ty- Ad ap tab ili ty.

Dr. Epstein is now with Baker College, Flint , Michigan .Address corre spond ence and reprin t requests to Mary J .Burton,

Departmen t of Physica l Medicine and Rehabilit at ion, Universi tyof Michiga n Hospitals and Health System, 325 E. Eisenh owerPkwy, Rm. 303 1, Ann Arbor, MI 48108-5744.

BACKGROUND

Rapid changes in information technology andbetter access to computers, more specifically, theInternet, have created many positive opportunitiesfor people with disabilities. These opportunities re­late to employment, education, communication, in­dependent living, and leisure (Cook, 2002; Fichten,Barile, & Asuncion, 2003 ; Ritchie & Blanck, 2003 ).Computer-related assistive technology devices(ATDs) are used as a means to an end so that peo­ple with disabilities can perform the tasks theywant to accompli sh (Hoppestad, 2006). Individualswith impaired vision, learning disabilities , limitedhand control, and other functional limitations inparticular can most likely benefit from computer­related ATDs. More kn owledge regarding training,access, and other factors from ATD users them­selves may shape and enhance serv ices and inter­ventions provided by rehabilitation specialists .

Computer-related ATDs were defined in fourcategories: (a) input devices such as keyboardswith large keys , adjustable spl it keyboards, keyguards, mouse , sticky keys , and special head orhand pointer sticks; (b) output devices, such as ascreen magnifier that enlarges text; (c) softwareprograms such as Jaws, Kurzweil, Dragon Natu­rally Speaking, or other voice-activation programs;and (d) all other accommodations. Thi s lattergroup included books on compact disc, a monocu­lar, raised hard drives , special stools, and manyothers. Some of these were not included in thedata, as the definition of computer-related ATDswas made more specific.

In general, it is crucial for providers (e.g., occu-

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pationalJphysical therapists and rehab engineers)to have an appropriate evaluation tool that canmeasure a user's opinion about the technology andhis or her level ofsatisfaction with its performance.A lack of such instruments can result in a consum­er's receiving ATDs unsuited to his or her needs orgoals and even abandonment of a device. A trial­and-error approach to ATDs can be time-consum­ing and costly. Among the tested and validated as­sessment measures for ATDs are the Quebec UserEvaluation with Assistive Technology, (QUEST),which measures an individual's satisfaction withan ATD's attributes, such as its weight, ease andcomfort of use, and effectiveness, among others.The Psychosocial Impact of Assistive Devices Scale(PIADS) is another validated tool that measuresthe psychosocial impact of a device on the user (Ju­tai & Day, 2002).

Regarding computer-related ATDs, less studyhas been done. Recently, Hoppestad (2006) inves­tigated criteria essential for a comprehensive as­sessment tool for people with severe disabilitiesusing computer-related ATDs. Thirty-three ex­perts in the field (including physical and occupa­tional therapists and speech pathologists) partici­pated in a Delphi process and identified a list ofintrinsic and extrinsic elements that should beconsidered when evaluating a person with a severedisability and computer-related ATDs. The intrin­sic elements, however, were mainly focused on aperson's medical issues (impairment level) ratherthan a person's functional abilities (e.g., problemsolving, learning, sitting, hand and arm use, reach­ing, lifting, carrying). The extrinsic elements in­cluded levels of support, goals , and certain envi­ronmental elements. Although useful, the conclu­sions of this and another study conducted by De­rosier and Farber (2005) underscored the need formore research targeting consumers' levels of sat­isfaction and experience in this area.

The National Task Force on Technology and Dis­ability (2004), as well as Microsoft Corporation(Forrester Research, 2004 identified certain topicsas most relevant and in need of further investiga­tion: consumer, health care provider, and business;awareness of ATDs; effective training and educa­tion in ATDs; affordability; and the need for fur­ther innovations to enhance ATDs for individualswith physical and cognitive disabilities. Other in­formation from J . A. Lenker (Personal communi­cation, 2004 ) concerning the understudied areas inthe field of computer-related ATDs led the authorsto construct survey questions regarding user sat­isfaction, training, and health behavior for this ex­ploratory project.

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A growing concern reported in the literature forboth those with and those without disabilities isthe potential health impact of computer overuse.Poor posture, long hours of computer use, and/orprolonged sitting can lead to negative health con­sequences, either physical (i.e., tendonitis or car­pal tunnel syndrome) or psychosocial in nature, in­cluding isolation or decreased social participation(Kraut et aI., 1998; Marcoux, Krause, & Nieuwen­huijsen, 2000; Nieuwenhuijsen, 2004).

This study explored the applicability oftwo stan­dardized survey tools, the PIADS and QUEST, inassessing users' opinions regarding computer-re­lated ATDs. The following research questions werethe specific focus of this pilot study. (a ) What arethe experiences, particularly in terms of training,funding, satisfaction, and other characteristics, ofadults with physical disabilities using computer­related ATDs? (2) What are the health behaviorsand practices of adults with physical disabilitiesregarding computer use? (c) What is the psycho­social impact of computer-related ATDs on users interms of adaptability, competence, and self-es­teem?

The initial assumption was that individualswith a variety of mobility impairments would par­ticipate in the study and would share their expe­riences with devices such as custom-made ATDs(head and/or hand pointers, adjustable split key­boards, etc.) . Furthermore, the authors' hypothesiswas that training in computer-related ATDs wasimportant to users and that those who receivedtraining would be more likely to engage in healthybehaviors (e.g., be aware of health risk factors dueto overuse and the value of proper posture).

METHOD

The methods, recruitment materials, and surveyinstruments were approved by the InstitutionalReview Board at the University of Michigan. Theproject was carried out in partnership with theAnn Arbor Center for Independent Living in thesummer of 2004. This study was cross sectional indesign using a structured telephone interview. Re­cruitment took place through flyers, e-mail mes­sages, personal contacts, and announcements inconsumer newsletters. Interested individuals wereinvited to contact the principal investigator by e­mail. Each participant completed a consent form,and a telephone interview was scheduled.

The prerequisite criteria for study participationincluded being at least 18 years of age , having aphysical disability (a sensory or mobility impair­ment), and experience using a computer-related

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ATD device for at least 6 months. In one case, theparticipant was not abl e to communicate by phone,and a caregiver as sisted in communicating que s­tions and answers. Two trained interviewers con­ducted the telephone surveys after completing ahands-on training session using a training guide(Nieuwenhuijsen & Morefield, 2004). At the com­pletion of the interview, each participant receiveda $15 stipend.

Thirty-six people were screened, and 24 quali­fied for the study. Reasons for disqualification in­cluded not having 6 months of experience using anATD, not using a device that accommodated a dis­ability fitting the definition of computer-relatedATD, or lacking a disability as defined by a limi­tation in functioning in terms of body func tions,body structure, activities , and/or participation re­strictions (World Health Organization, 2001).

The 45-minute telephone survey que stions con­sisted of 117 items, presented in 5 different sec­tions is contained in the online Appendix availableonline at www.resna.org. These sections were (a)general questions on computer-related ATDs(type, purpose, training, funding), (b) health anddisability status (including perceived health sta­tus , type of disability, functional abilities, andawareness of computer-related health risk factorsand health behaviors), (c) level of satisfaction withthe ATD (QUEST vers ion 2.0), (d) the psychosocialimpact of the ATD (PIADS), and (e) demographicinform ation (including age , rac e, work status, etc .).Expert input from leaders in the field of ATD, in­cluding rehabilitation engineering , assisted instructuring the survey.

The QUEST is a 12-item que stionnaire used toassess an individual's level of satisfaction, on a 5­point scale, with a wide variety of ATDs. The scaleranges from 1 (not satis fied at all) to 5 (very sat­is fied ). The QUEST measures satisfaction with theuse of the ATD (comfort, weight, durability, sim­plicity), the device its elf (dime nsions , effecti ve­ness, usability, safety), and services received(Brown-Triolo, 2002 ; Demers, Weiss-Lambrou, &Ska, 2002). According to the literature review, lim­ited applications have used the QUEST as a mea­surement of satisfaction with computer-relatedATDs (Derosier & Farber, 2005 ).

The PIADS was applied earlier as a clinical toolwit h compute r-related ATD users (Lim & Lenker,2003). For the PIADS, participants were asked toselect just one of the most important ATDs theyused. The overall goal of the PIADS is to describethe impact of an ATD on a person' s functional in­dependence, well-being, and quality oflife. The in­strument consists of 26 items that fall into three

COMPUTER-RELATED ASSISTIVE TECHNOLOGY

subscales: competence (subjective feelings of com­petence, productivity, usefulness, etc .), adaptabil­ity (the subjective willingness to take a chance, trynew things, and take advantage of new opportu­nities), and self-esteem (including security, senseof power and control, and self-confidence; Jutai &Day, 2002 ). The PIADS was designed as a paper­and-pencil measure that can also be administeredby phone, and interviewers used a script in thePIADS Manual (J utai & Day, 2002 ). Possible re­sponses were scored on a scale ranging from - 3(very much worse) to 0 (no impact) to +3 (muchbetter ) concerning each characteristic.

To supplement these instruments, additionalque stions were posed (see the online Appendixavailable at www.resna.org). These included thetypes of computer-related ATDs the participanthad used , the importance of training, the frequen­cy of the participant's computer use, and health­and functioning-related items. Several open-endedquestions were asked to elicit opinions, for exam­ple , "What have been the biggest keys to your suc­cess (or lack of success) with computer ATDs?"Quantitative and qualitative data were analyzedusing SPSS 12.0 and included descriptive , chi­square, one-way analysis of variance (ANOVA) forcomparison of means and narrative analysis. Thestatist ics used were tho se most appropriate for thesmall size of the sample. Because of the nature ofthe data, which included nominal, ordinal, andopen-ended que stions, restricted statist ical analy­sis was conducted.

Participants

Thirteen women and 11 men participated in thisstudy. All re sided in Michigan, with the exceptionof one person from Ohio. The ir ages ranged from19 to 71 years, with 10 of the participants being 30years of age or younger, reflecting a large numberof university students (see Table 1). Seventeenpeople identified as Caucasian, four as AfricanAmerican, two as Asian American, and one as oth­er.

Seventeen of 24 study participants had post­high school education, and six of those possessed apostgraduate degree. In terms of work status, 11individuals were working full- or part-time, sixwere college students , six were not employed ,three were retired, and one was a volunteer .

The disability characteristics of the participantsincluded 12 who had visual impairments: 3 withmu sculoskeletal impairments, 7 with nervous sys­tem impairments (including cerebral pal sy, mul­tiple sclerosis, and postpolio syndrome), and 2 with

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TABLE 1. Demographic information (N = 24)

n

TABLE 2. Participant's impairment and assistivetechnology devices (ATDs) used

RESULTS

All participants had experience with 1 or morecomputer-related ATDs: software programs, in­cluding speech recognition and screen readers (n =17); mouse (n = 8); special keyboards and key­board alternatives (n = 5); large monitors andclosed-circuit TV (n = 4); and telephone headsetstn = 7). Three participants reported experiencewith one ATD (a software program); all others in­dicated using more than one ATD.

When asked to select one key ATD for furtherevaluation prior to the QUEST instrument, 17 re-

other impairments (including learning disabili­ties). The age of onset varied: Most of those withvisual impairments reported the onset took placeat less than 10 years of age; for others, the datevaried between birth and 44 years of age. In ad­dition to their primary disability, four respondentsreported that they were also diagnosed with re­petitive strain injuries.

All but 1 of the 12 individuals with a visual im­pairment was using speech-recognition software.Other examples of the participants, their disabilitycharacteristics, and specific ATDs used are illus­trated in Table 2.

spondents identified software (including JAWS ®and speech-recognition software) as their ATD toevaluate. The first five questions of the QUESTwere not applicable to assessing software, so thata significant portion of the QUEST data were notrelevant for these ATDs. However, up to six ele­ments of the QUEST can be missing and the toolwill still retain validity (Demers et al. , 2000).

On the question regarding how easy the identi­fied ATD was to use, software users (n = 17) weresignificantly less satisfied with the ease of usingthis type of accommodation. One software user'srating was more than 2.5 standard deviations fromthe mean ofthe group, so this outlier was removed.Software users (n = 16) had a mean satisfactionrating of 4.1 ± 0.8, whereas those who used otherATDs (n = 7) had a mean of 4.9 ± 0.4, where 1 =not satisfied at all and 5 = very satisfied when an­alyzed with the ANOVA (p = .02).

When asked about their ATD and feelings re­garding productivity, 12 of the 17 software usersindicated that their ATD made them feel muchmore productive, as did 5 of the remaining 7 par­ticipants who had used other devices .

Overall, participants reported medium to highsatisfaction with their ATDs via their QUEST re­sponses (see Table 3), which suggested a measur­able improvement in major areas of their livessince acquiring their new computer-related tech­nology. When asked how much their ATD hadhelped to increase their computer use, 21 of the 24participants said that it had helped "a lot," where-

Examples of computer­related ATDs

Voice-recognition software(J AWS and Kurzweil),enlarged monitor, closed­circuit television, telephoneheadset, screen reader,scanner for data input,talking checkbook

Headset, pointer, st icky keys,voice-activating software

Keyboard, headset, pointer,adapted mouse , micro­phone, enlarged monitor,wireless keyboard, chinstick

Voice-activating software,headset

Visual impairment

Disability

Learning disability

Musculoskeletalimpairment

Neuromuscularimpairment

74751

10653

1123611

17421

Age (years)

19-3031-4344-5657 and older

Race

Caucasian AmericanAfrican AmericanAsian AmericanOther/multiple race

Employment status

Employed full- or part-timeNot employedRetiredStudentVolunteerMissing

Education level

High school diploma/GEDTechnical/trade schoolBachelor's degreeMaster's degreeDoctoral/professional degree

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TABLE 3. Psychosocial impact of computer-relat­ed assistive technology devices among people with

visual impairments versus other impairments

TABLE 4. User's preferences for training

Type of training

Mean scores

* Significance (two ta iled) .001. ** p = .001.

Compe- Adapt. Self­tence ability esteem

as 3 other users chose "somewhat" as their re­sponse.

Regarding the importance of training in the useof ATDs, 12 of24 users felt training was extremelyto somewhat important. One person commented, "Irely on other people knowing about computer func­tion to help me use my ATD." Five participantswere neutral, and the remaining seven partici­pants believed training was not important at all.

An additional question was asked about the typeof training that would work best: one-on-one train­ing, group training, or having a setting in whichparticipants were able to tryout different devices(see Table 4). Choices for responses as to how wella type of training would work were 1 = not verywell, 2 = somewhat, or 3 = very well. Participantspreferred a setting to try out different devices ontheir own; 18 of the 24 said that type of trainingwould work very well , three believed this wouldwork somewhat, and three others answered "notvery well." A participant commented on this topic,stating, "I am willing to investigate and play withmy ATDs, to get comfortable with them." Anothersa id, "I got trained with help from a multidisci­plinary university laboratory and used the publiclibrary for additional training."

Building on previous work conducted by one ofthe authors (Nieuwenhuijsen, 2003 , 2004), threequestions were asked to examine people 's knowl­edge of potential health risks from computer us­age. In her earlier work, Nieuwenhuijsen devel­oped a pattern of health behavior change andfound that a multicomponent intervention, overtime, did result in about 60% of behavior change ina positive direction among the participants (40 of­fice workers employed in an administrative officein Michigan). A computer-related health behaviorchange (HBC) index score was created by combin­ing three questions: (a) How much are you awareof health-related risk factors while using the com­puter, such as repetitive strain injury, carpal tun-

No trainingbut access to asetting whereI can tryoutdifferent de­vices and ask

questionsGroup

trainingOne-on-one

training

How would these types of training work for you?

Not very well 4 6 3Somewhat 12 14 3Very well 8 4 18

Total (n) 24 24 24

nel syndrome, or eyestrain? (b) In general, whileyou are working at the computer, how often do youtake a special effort to change your posture? and(c) When you are working at your computer, howoften do you make a special effort to stretch yourmuscles? The internal consistency index score ofthis new HBC variable was .80 (Cronbach's alpha)based on the previous work of one of the authors(Nieuwenhuijsen, 2004).

In this study, the independent-samples t testcomparing the mean HBC scores of those who re­ceived and did not receive funding for ATD train­ing revealed a mean of 8.2 among those who re­ceived funding (n = 14), versus a mean score of6.4among those who did not receive funding (n = 10).These results, however, are not significantly dif­ferent (p = .064). However, the small number ofrespondents precluded meaningful statisticalanalysis.

In terms of the psychosocial impact of computer­related ATD on consumers (n = 24), for the firstPIADS subscale related to competence, the meanvalue and standard deviation for all participantswas 2.32 ± 0.6. On the subscale regarding adapt­ability, the mean was 1.77 ± 0.9, and for partici­pant self-esteem, the mean was 1.67 ± 0.8. APIADS response of 1 and 3, respectively, stood for"a little better for you" and "much better for you ,"with the score of 2 representing a ranking some­where in between. On the PIADS , the higher thenumber, the more positively a user rated theATD's effect on his or her quality oflife. When com­paring the respondents with (n = 12) and withoutvisual impairments (n = 12), a significant differ­ence in PIADS adaptability was found , with ahigher score of 2.29 among those with visual im­pairments versus a score of 1.15 among those with­out visual impairments (p = .001; see Table 3).

2.29* 1.68

1.15** 1.66

Consumers with low vision orblind 2.49

Consumers with otherimpairments 2.17

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DISCUSSION

Among the observations made in this study wasthe need for increased awareness, training, and re­sources to procure ATDs. Fifty percent of partici­pants felt that training was important, and therewas a consensus among software users that train­ing in the use of ATDs is important for optimal andconsistent use of the device and is a pressing issue.Several interviewees described how training hadchanged the course of their lives.

When asked how new users should learn moreabout ATDs, many participants mentioned visitinga Center for Independent Living (CIL) or a reha­bilitation center. As rehabilitation centers requireinsurance coverage or other payment for serviceswhereas CILs have more flexibility regardingcosts, the latter could offer ATD-related services.The results of this study suggest that CILs couldplay an important role in educating people withdisabilities regarding the availability and use ofATDs. Given sufficient financial resources andstaff, CILs would be a logical provider of services,including group training on ATDs, a setting inwhich people could try out ATDs and matching ofusers to appropriate technology. Other local re­sources could playa role, such as the library for theblind, public libraries, and university-based assis­tive technology labs. A critical point, however, isthat a person who provides the resources and thetraining should have expertise in the field of assis­tive technology.

With regard to the question, "What have beenthe biggest keys to your success (or lack of success)with computer ATDs?" one user commented, "It'sabout being .. . motivated and self-confident, tak­ing recommendations from other very importantfolks, and trying new things."

Training might include instruction not only ingeneral ATD use-specific adaptations of the ATDto an individual user-but also in the safe use ofthe ATD. The inclusion of health-related questionsin ATD assessment tools could influence the re­spondent's behavior or at least could spark the per­son's interest in that area, as has been found in be­havioral studies (Marcoux et al., 2000). Preventionand early intervention of health problems is criti­cal, in particular among a population already atrisk for developing secondary health conditions(De-Jong, 1997).

For those who use the computer for prolongedperiods of time, a constellation of risk factorsemerge that can lead to eyestrain, neck and shoul­der pain, and wrist and hand problems, a compli­cation covered in a separate publication (Nieuwen-

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huijsen, 2003). The participants in this study whoappeared most aware of risk factors and appliedhealthy behaviors were those previously diagnosedwith repetitive strain injury, although the relationof these injuries to computer (overluse was un­known.

Throughout the narratives from users, issues ofaffording, obtaining, and learning to use ATDsdominated the focus of the open-ended questions,such that the energies and attention of the samplewere directed away from risk factors and healthycomputer use. Although the results from this pro­ject regarding the extent of computer-relatedhealth problems among people with disabilitieswas very limited, additional survey items aboutthis topic would help identify potentially un­healthy behaviors and enhance overall awarenessof risk factors .

Another noteworthy finding concerns the differ­ences in adaptability scores ofATD users who wereblind or visually impaired versus those who werenot. Perhaps these individuals, many of whomhave had their disability since birth, have learnedto create unique strategies for accomplishing dailytasks. Possibly using their ATD enhanced thisquality of adaptability. One theory is that peoplewith nonvisual (and more recently acquired) im­pairments are still developing their skills andlearning to live with their disability and thus feelless adaptable overall. It would be valuable tolearn if these differences in adaptability are foundwith a larger sample of participants and, if so,what is the cause of the reported differences inadaptability when using ATDs.

The two instruments used in this study, theQUEST and the PIADS , were identified as mostapplicable based on the review of the literature.The authors anticipated a much larger number ofparticipants. Because of the exploratory nature ofthis study, the nonrandomized selection of cases,and the small sample size, the findings must be in­terpreted with caution.

In addition, the initial prediction was that indi­viduals with a variety of mobility impairments(e.g., limited upper extremity function) would vol­unteer for this study and would have experienceusing devices such as keyboard and mouse accom­modations and custom-made adaptations (e.g.,head or hand pointer), as these types of ATDs weremore suitable for the QUEST instrument. How­ever, fully half of the volunteers had visual im­pairments and chose software (JAWS®and others)as their ATD to evaluate, as did several individu­als who had other disabilities. As a result, severalQUEST items were not applicable for software,

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su ch as the dimension, weight, safety, and dura­bility of the device .

The PIADS, in contrast, was found to be moreuseful , and most PIADS questions were answeredby all respondents. One advantage of this tool isthat it concerns the feelings and attitudes about allcomputer-related ATDs, whereas for the QUEST,the respondent had to select just one device, evenif he or she were using a combination of devices.One drawback of the PIADS was its length, andnot all items were relevant in terms of computer­related ATD.

There appeared to be a modest difference in theuser's ratings for ease of ATD for software versusother products. Again, the nature and size of thegroup mean that further study is needed to ex­amine this difference. It would be important to seeif lowered satisfaction among software users isfound in larger samples and if the type of softwareplays a role. Perhaps voice-activation software pos­es many more difficulties for users than othertypes of programs.

One comment from a participant regarding us­ing voice-activation software in our study was "myATD doesn 't work well with numbers data." Soft­ware users, as discovered by DeRosier, commentedon the length of time it took to train the software,it s inaccuracy, its failure to recognize their voices,and other issues. As these aspects of software werenot accurately evaluated with the QUEST, addi­tional questions and items specifically focused onand designed for computer-related ATDs couldmeasure other aspects of such technology.

Many users' narrative comments emphasizedthe need for consumers to learn about computer­related ATDs. One said, "More needs to be readilyavai lable for people with disabilities to improveour lives. We don't know ATDs are out there." An­othe r remarked that there is a lack of knowledgein the workplace about available technology.

RECOMMENDATIONS AND CONCLUSION

Because computer users with disabilities arefaced with both general health risks related tocompute r (over ruse and complexities of computeruse related to their disabilities, the measures usedto document their experiences with ATDs must re­flect a broader spectrum of issues and concernsvoiced by this population. Specifically, the resultsof our pilot study demonstrate that adaptabilityand availability may most affect the optimal use ofcomputer-related ATDs, including the awarenessof best user practice and unhealthy computer prac­tices. The instruments currently used to measure

COMPUTER-RELATED ASSISTIVE TECHNOLOGY

issues and concerns about computer-related tech­nologies among the disabled community clearlyare inadequate.

The PIADS requires the simplification of theadaptive schema needed by individuals with dis­abilities into the assessment of the use of theirATDs, whereas the QUEST assesses one ATD (e.g.,the technological availability of the physical com­puter/hardware) by people with disabilities. Yetthe QUEST accounts in it s construct neither forthe full range of adaptations nor for the relevanceof nearly halfof its items for the availability of soft­ware and other cybernetic ATDs used by many us­ers with disabilities.

Thus. one of the recommendations derived fromthis pilot study is the need for survey items spe­cifically applicable to computer-related ATDs. Arevised version of the QUEST may better capturethe level of satisfaction or users' opinions regard­ing the limitations of computer-related ATDs, inparticular software programs. Some examples ofthese items might include the level of satisfactionwith the program, ease of its installation, effec­tiveness of the program, ease of learning the ap­plications, and usefulness of instructional materi­al.

In regard to the PIADS , we agree with Lim andLenker (2003) that the PIADS could benefit froma more user-friendly 5-point Likert-type ratingscale instead of the current scale. In conjunctionwith the overall satisfaction data attained throughthe QUEST, the PIADS measure helped gatherquantifiable information that confirm s qualitativereports by the ATD users themselves.

The prevalence and awareness of computer-re­lated health conditions need to be further de­scribed, as does education and other factors thatlead to healthier behavior and practices.

Effective and practical computer-related ATDsare essential technologies for people with disabil­ities to maximize productivity, enhance quality oflife, and improve employment, health, and socialparticipation outcomes. Researchers conclude thatadditional investigation is needed in these areas:whether training can change the occurrence ofATD abandonment, which factors affect satisfac­tion levels with ATDs, and how best to enable peo­ple to avoid negative health outcomes while usingcomputer ATDs. Studies conducted with muchlarger numbers of participants who have a varietyof disabilities and use a wide range of computerATDs would be optimal to better understand thisarea of assistive technology.

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SUMMARY

An increasing number of people with disabilityexperience use computers and ATDs to meet theirspecial functional needs. Computer-relatedATD inthis article was defined as any device that enablesa person to access computer input and/or output.

More knowledge in the level of satisfaction withthese devices, types of training, and other concernsis needed to enhance service delivery and programdevelopment. The overall purpose of this studywas to interview 24 users for their individual per­spectives on ATD issues and concerns, interpretdata collected from a telephone interview, and an­alyze the psychosocial impact of computer-relatedATD. More specifically, the goal ofthis article wasto investigate the experiences of users with dis­ability and computer-related ATDs-the type ofdevices they use, their experiences with training,and the impact of ATD on the users' quality oflife-and to explore the applicability of two stan­dardized questionnaires, the QUEST and thePIADS. The authors provided a quantitative andqualitative analysis of their findings and recom­mendations for future research.

Acknowledgments: We want to acknowledge theparticipants in this study who shared their knowl­edge, experience, and comments about computer­related ATD. Thanks go also to the Ann Arbor Cen­ter for Independent Living and the Disability Net­work in Flint, both in Michigan, for their provisionof invaluable support through use of facilities andadministration. This study was made possible byGrant H133P990014 from the National Institutefor Disability Research and Rehabilitation and theDepartment of Physical Medicine and Rehabilita­tion in the University of Michigan Health System.

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