ALBERTSON, N.Y. - At the National Center for Disability Services, a consumer's choice of input device is based on more than comfort. A properly positioned input device may mean the difference between using or not using a computer. It may be the means of allowing that person to be fully productive, to obtain or keep a job, or to gain an education. Carol Fuhrer, an occupational therapist, and Sandy Berman, a rehabilitation technology specialist, work with individuals with disabilities at Tech-Reach, a grant funded program in the National Center for Disability Services on Long Island. TechReach is a demonstration center of high- and low-tech adapted products that are adapted for use by disabled individuals. It is a free service that allows the public to try various adaptive products. For a fee the therapists also perform evaluations for people with disabilities who cannot use a standard keyboard or input device and makes recommendations on what devices would improve their productivity on a computer - or allow them to use a computer for the first time.

The consumers who are evaluated usually have been in the workforce, but due to a disability or traumatic injury cannot return to their job or cannot perform their job tasks in the same way. If they had previously used a computer for example, they may no longer be able to use the same equipment in the standard way because of a decreased range of motion or strength in their arms or hands.

Partial Tech-Reach funding is provided by the TRAID program with the Office of the Advocate for Persons with Disabilities, which was started by the Technology-Related Assistance for Individuals with Disabilities Act of 1988 (Tech Act). The Tech Act has recently been reauthorized and states that anyone with a disability is entitled to assistive technology devices and equal access. About 40 states provide adaptive equipment through the Tech Act program. The New York TRAID project has established seven regional technology centers. Consumers with disabilities often turn to technology devices to help them increase productivity at work or accomplish an educational goal. For example, a college student with a disability might find that he has an increasing demand to write papers and will seek an evaluation and technology assistance from Tech-Reach to help accommodate the writing load. Fuhrer and Berman recently completed evaluations for three people who have limited hand function - one due to a spinal cord injury, one with multiple sclerosis and one because of a congenital birth defect. For their individual needs, she recommended the MOUSE-TRAK from ITAC Systems Inc. (Dallas), a pointing device that is a hybrid between a mouse and trackball. The MOUSE-TRAK eliminates wasteful and tiring arm and wrist movements by using a design incorporating a padded area that supports the hand and keeps the wrist above the hard work surface. The user's fingertips manipulate three input keys and a polished phenolic ball for moving the cursor around the screen. Tests have shown that the MOUSE-TRAK alleviates much of the hand and wrist strain caused by hours of point-and-click movements necessary with many of today's GUI-based software applications.

"Each evaluation is very individualized, and our recommendations depend on the need and the function of the consumer. One of our mouse alternatives - actually the best mouse alternative we're finding - is the MOUSE-TRAK," Fuhrer said.

Tech-Reach has been demonstrating the MOUSE-TRAK since the project's inception. Computer technology is a relatively new branch of occupational therapy, so most occupational therapists had no previous experience working with computers. Upon joining Tech-Reach, Fuhrer began learning about various adaptations to standard peripherals and began using the MOUSE-TRAK herself.

"I happen to use the MOUSE-TRAK, too, because I find it to be a lot more comfortable. However, with the consumers that I work with, it's not a matter of comfort. It's the only way they can have mouse functionality," she said.

In addition to input devices, Tech-Reach demonstrates different types of keyboards, wrist rests, workstations and copy holders. Positioning is key to optimizing a person's function, no matter how limited. The height of the workstation table may be adjusted or placed at a different angle, or the keyboard may be positioned differently.

"A lot of it has to do with positioning. If a disabled person is put in the optimal position to maximize his existing range of motion and strength, we sometimes do not need to further customize a peripheral product," Fuhrer said.

Sometimes, in addition to correctly positioning the consumer at the workstation area, the product that the therapists recommend may still require adaptation. For example, in cases of severe physical disability, the MOUSE-TRAK may maximize a person's existing strength, but it may need to be placed on a wedge for optimal productivity.

While not the standard definition of ergonomics - proper positioning to prevent injury - ergonomics is a guiding force during the evaluations. Many of the products are so easily adaptable for optimal use because they were ergonomically designed. "A lot of the products we recommend are ergonomically designed. Others are just adaptations of standard keyboards or standard input devices that will allow somebody to function at the computer," Fuhrer said.

She added that the MOUSE-TRAK's suitability for her consumers is due to a combination of both cognitive and physical issues. From the cognitive perspective, many new mouse users have difficulties comprehending how their physical movement of the mouse corresponds with the cursor's movement on the screen.

"The MOUSE-TRAK remains in one position, which makes it more cognitively acceptable," she said. "I don't know if you remember what it's like to be a new mouse user, but sometimes some of the consumers do have some cognitive problems, and a standard mouse is a bit difficult for them to get used to."

The other issue is physical. Many of the consumers physically cannot move the mouse. Performing two simultaneous hand movements, such as a drag and click, is out of the question - the click and drag functions are consecutive as opposed to simultaneous. The consumer keeps his hand stationary, rolls the trackball, and then clicks with his fingers. The MOUSE-TRAK can be set up so different buttons will allow the user to perform the "drag" function to move items on the screen without physically moving his hand Fuhrer and Berman demonstrate a wide variety of products that they think will meet the needs of consumers. However, recommendations are only made during an evaluation, not a demonstration.

"Within the period of the evaluation, if the person manipulates the product successfully and there's an improvement in either speed or comfort, they will go with that product," she said. Fuhrer does not often have the opportunity to follow up with consumers on the productivity improvements that resulted from her recommendations, but in one of the three recent cases, the consumer told her he has experienced pronounced productivity improvements with the MOUSE-TRAK.

"The individual I worked with who has multiple sclerosis happens to be in a program in the same building, and he loves the MOUSE-TRAK. It really is allowing him to do things on the computer with much more ease than with a standard mouse. He can use a mouse, but it's much harder for him," she said.

At the adjoining Henry Viscardi School, occupational therapists have been using the MOUSE-TRAK to help students with severe disabilities access computers, sometimes with the aid of mouth or head sticks. The partially state-funded school has facilities for students with physical disabilities from pre-school through high school. MOUSE-TRAK is used with 386 PCs to access menus, painting programs, and a variety of graphical software residing on the network. "We have a number of children who have such physical disabilities that they really need alternate switch input, or who don't have fine isolation of their fingers and are not able to use the standard pieces of equipment. For these students, we've had to look at alternate means of input, and one of them is the MOUSE-TRAK," said Ginette Howard, senior occupational therapist at the Henry Viscardi School.

Not all of the students are able to use their hands to manipulate the trackball. These students have found that by using a mouth or head stick to manipulate the MOUSE-TRAK, they can not only perform drag movements, but they can access Wivik, a Windows-based on-screen keyboard from Prentke Romich (Wooster, OH) that allows them to type. MOUSE-TRAK improves productivity for disabled consumers.

"We have a number of children who have difficulty using their hands to operate different keyboards, and who have difficulty operating a mouse because they can't pick up or reposition a mouse - that's where the MOUSE-TRAK works best for them," Howard said. "But we also have children who have no hand use whatsoever and have to use a mouth stick or a head stick to operate the trackball. One great feature of the MOUSE-TRAK is that it allows dragging to occur with only one finger, so they don't have to hold down a button simultaneously while they're dragging the ball."

Howard said the MOUSE-TRAK is easier to control than a standard mouse for children with a limited range of motion. The school has a very large population of children with muscular dystrophy who become progressively weaker as they advance to secondary school. "What we find is that they can't use the standard keyboard with much ease. But the MOUSE-TRAK allows them to easily access the different cells of an on-screen keyboard. We use it with a number of children who are extremely weak and who may have only very little movement of one or two fingers.

"We start students on computers very early - as early as pre-school. Computer proficiency is a must for students with physical disabilities to enter the job market," Howard said.