PC-users with Parkinson's disease? – Tips for appropriate adaptations

Today, technology is a key part of our everyday life. In spite of their general parkinsons disease (PD) ailments, people with PD want of course to continue living as normally as possible. This article presents possible alternative equipment when using a PC.

Story by: - 27.01.2009

We now try to summarize the results of the project Parkinsons Disease and ICT Challenges (PIKT) in terms of finding appropriate adaptations for ICT-users with PD. The project was founded by IT Funk/The Norwegian Research Council. A complete overview of the results are in PIKT project Sluttrapport (in Norwegian).

Particular problem areas for PC users with PD are inertia, muscle rigidity, problems with the use of the computer mouse, tremours and issues related to the keyboard and ergonomics.

The individual differences (symptoms) are quite different from person to person with PD. This hampers efforts to identify general recommendations.

Computer Mouse

Around 40 % og PC users with PD have significant challenges related to the use of the mouse. Very few of these have had any experience with possible alternative mice.

Many have used the touchpad, but few prefer this to the standard mouse. Generally, the touchpad and mouse stick do not contribute to a solution to serious mouse control issues for PC users with PD.

It seems many users with severe and serious problems may never have tried any alternative to the standard mouse solutions, and that a mouse solution more suitable for them, would improve their PC use.

With mouse control it is worth noting that the optimal solution is not necessarily to find one single mouse. Varying between different mice solutions - used for different purposes and / or for different health situations - could be beneficial.

The trackball mouse, filter for trembling/shaking (Parkinson mouse) and pen-on-pad mouse have received the most positive feedback from PC users with PD. The penn-on-pad mouse probably requires some user training (correct hand position) if it is to be used for OS/program control - and not only for drawing. 

For left handed mice and ergonomic mice the feedback varies, but many have found these types of mice to be beneficial.

The head mouse and foot mouse received a somewhat negative rating. Users often found more "common" mouse options that worked equally well, and preferred these. It is possible that foot- and head mouse solutions are alien to the users, and that testing how these solutions work over time is necessary to obtain a correct evaluation of them.

Software for mouse control (f.ex. MouseCage) has not been adequately tested.

Mouse Pointer control

When it comes to improving the control of the mouse pointer, the Trackball mouse seems very appropriate for people with PD - especially where trembling is the main problem.

The test shows that this type of mouse provides significantly increased mouse control, and many are very satisfied.

We have tested with the following Trackball mice:

• Kensington Orbit Optical Trackball (seems to fit those with larger hands).
  
• Logitech Marble Mouse (seems to fit nicely those with smaller hands).
  
• Orbit Kensington Expert Trackball (seems to fit those with larger hands)

These mice are shelfware, both cheap and easy to get hold of, and can easily be distributed to end-users. It is therefore regrettable that only 2% of respondents had ever tried such a mouse.

Also, rollermus and MouseTrapper seem promising in relation to mouse control, but these have so far not been adequately been tested.

Clicking the mouse 

Challenges in relation to clicking the mouse were a concern. Proper solutions for these issues are yet to be found.  

Many reported to liking joystick mouse solutions. The Anir joystick mouse was evaluated in our tests. The placement of the micebuttons are different on the Anir joystivk mouse compared to a standard mouse. It worked well for several of the testers, improving the clicking. On the other hand, it received some complaints for being too difficult and hard to manouver, thus giving poor mouse control, and were ergonomically poorly adapted for users with typical PD ailments.

As mentioned, the trackball mice works very well in relation to mouse control, but none of these provides solutions for issues relating to alternative ways of clicking. 

The issues related to mouse clicking are complex. Providing alternative ways of clicking the mouse is still a largely unresolved issue.

Keyboard

About 1/3 of PC-users with PD can be expected to have significant to serious challenges related to the use of the keyboard. Few have experience with alternative keyboard solutions. It seems many users with large and serious challenges have never tried any alternative to the standard keyboard. Assisting users in finding alternative keyboard equipment, as well as alternative computer mice, does therefore demand particular focus.

Because of the low level of experience with keyboard alternatives, it is difficult to state with certainty the general findings on keyboard solutions.

Many people with PD report good experiences with the mini keyboard.

Many say ergonomic keyboards also work well. Ergonomic and/or split keyboards seem appropriate to optimize for the touch method, and to reduce ergonomic stress, but do not necessarily resolve any specific challenges related to the use of keyboards.

Other keyboard options that might be appropriate to try out are: wireless keyboards, keyguards, and on-screen keyboards. Further, the "simpler life" keyboard provides clearly visible marking of keys, and X-keys and laser keyboard are also interesting solutions. Rubber keyboards received a slightly negative rating in the test.

Adjusting the settings in Windows Vista seems useful. Vista has several keyboard key settings that may be adjusted. Knowledge of these customizations should be distributed.

Ergonomics

Many people with PD are assumed to have large and significant ergonomic challenges in relation to the PC. About half of PC users with PD may be expected to have problems with inertia and muscle stiffness. Approximately 1/3 seems to have challenges related to trembling.

Different types of arm supporters and arm resters are very popular ergonomic adjustments, and should be tried out on an individual basis for people with ergonomic issues, together with appropriate keyboards and mice.

Other popular ergonomic solutions are electric tables that can be raised and lowered and ergonomic chairs, both which are used to facilitate ergonomic and variable working positions. 

A larger screen may also ease PC usage. For persons with impaired vision, a larger screen solved these challenges. Screen customizations and settings in the operating system are also beneficial.

Both ergonomic solutions and screen adaptations receive good feedback.

Knowledge about ergonomic solutions and screen adaptations seems relatively well disseminated among PC users with PD.

Slowness and Muscle Stiffness

Ergonomical and split keyboards may be appropriate for this user group, too help reduce clicking error rate and increase the speed of keyboard writing.

Keyguards have not been adequately tested, but may be beneficial.

Trembling

We recommend trying a trackball mouse where tremours related to mouse control are the main challenge. 

Also, arm supporters seem to work well as an aid for those struggling with trembling. 

The filter for trembling/shaking connected to the mouse (Parkinson mouse) is perceived as useful for some, perhaps especially to increase drawing and precision control, and generally receives a lukewarm positive rating. Often, medication is used to remove the main shaking of the hands/arms, and this is a possible cause of why the filter does not play a more important role in increasing mouse control.

It seems that finding the appropriate computer mouse for an individueal has greatest effect on solving the challenges related to trembling.

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