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Preserving Dreams: Inventive Rehabilitation Counselor Enables Patients to Gain Back Their Independence

REDMOND, Wash. — Dec. 6, 2007 — For more than a decade, Curt Johnson has served as a rehabilitation counselor with the UW Medical Center—a nationally recognized U.S. hospital housed on the University of Washington campus in Seattle. Johnson, who likes problem-solving and mechanical tinkering, brings a unique set of skills to a challenging job.

"Honey, I love you. Tell my girls I love them too." Simple phrases, uttered a thousand times a day, by thousands of people—effortlessly. But, what if you're suddenly a 35-year old mother-of-three who has no control of any bodily movement below your nose? Your cognition is perfectly intact but you're trapped within your body. How do you communicate? How do you take back your life?

[image: Photo of Curt Johnson demonstrating one of the many switches available to help people with disabilities access computers without relying on a mouse or standard keyboard.]
Curt Johnson demonstrates one of the many switches available to help people with disabilities access computers without relying on a mouse or standard keyboard.

These are the kinds of things Curt Johnson thinks about every day. Johnson's job is to help patients—many of whom have experienced catastrophic injuries and illness—regain their independence and the ability to communicate.

On an unusually sunny and warm day in Seattle, Johnson enthusiastically guides a tour of his hospital workplace and passionately talks about the types of assistive technology he employs every day to help the patients he serves. Gadgets and spare parts fill his office and patients greet him warmly.

Computers—Regaining Control

About 30 percent of Johnson's cases involve catastrophic injury or illness, such as spinal cord injuries, multiple sclerosis, or, as in the case of the mother described above, brain stem stroke.

Again and again Johnson has found that a key element of rehabilitation for many of his patients—and possibly more so his catastrophic injury cases—is learning, or relearning, how to use computers. Johnson explains the positive impact computers have on his patients, "In a lot of cases of catastrophic injury, the patient has no independence. They're lying in bed and have everyone doing everything for them. What they want most is independence—the ability to do things for themselves, by themselves.

"When computers are made available to patients, instead of sitting and watching TV, or thinking about their disability and getting more and more depressed, they become active—and proactive. They begin researching areas that interest them, therapies they think might help them, or medications. Computers make a huge difference in how patients accept and cope with their current issues, how they participate in therapies and, ultimately, how they go on with their lives."

Embracing Technology—Key Step on Road to Recovery

Due to the severe impairments of many patients, however, a standard computer set-up is not enough. Many patients need assistive or "adaptive" technology too. This includes both hardware and software.

[image: Photo of Curt Johnson pointing to a computer screen with an image of a person using assistive technology to access a computer from his wheelchair.]
Curt Johnson discusses some of the commercially available and specially made assistive technology he's used to give his patients access to computers.

"We have patients who are motivated to communicate via computers and to use them as a tool to reach out of their hospital room, but often they are not able to use the standard keyboard and mouse," Johnson says.

Over the years Johnson has built lots of useful AT himself—utilizing his ingenuity, mechanical skills, and parts and materials he's picked up from local hardware stores. For many people with, for example, limited dexterity, they just need a simple solution—sometimes a very inexpensive one," he says.

"If you can set up a simple switch with some sort of selection software such as an on-screen keyboard—they can use a computer quite effectively. If they can use a computer, they can gain back some of the control of their lives their injuries have taken away. They can communicate with their loved ones. They can keep in contact with their workplace. They can go out in the world and explore—do research, and grow. They can work. They can go to school."

When he needs more sophisticated tools Johnson turns to another UW program he calls "invaluable"—the Washington Assistive Technology Act Program (WATAP).

"WATAP is a federally funded program," Johnson explains, "and one of the things they do is purchase all kinds of new assistive technology that's on the market. They bring it in and let people try it and see if it works for them. WATAP has been a tremendous resource for me. I've learned a great deal from them and their expertise has helped many of my patients."

Windows Built-in Accessibility Features Help Too

"There is a lot of wonderful assistive technology out there," Johnson says. "Screen readers, voice recognition software, on-screen keyboards.

"But, some solutions require no additional hardware or software at all—they come with the computer," Johnson says. Built-in features in Windows-PCs such as Sticky Keys (that allow key combinations to be entered sequentially rather than simultaneously), and Filter Keys (that tell the computer to ignore inadvertent keystrokes), and Repeat Keys (that tells the computer how long to wait before entering a repeat keystroke) are all many people need to be able to use the standard keyboard effectively.

[image: Photo of Curt Johnson demonstrating one of the switches he constructed from readily available materials at the local hardware store. The switch lets people with a limited range of motion input mouse clicks.]
Curt Johnson demonstrates one of the switches he constructed from readily available materials at the local hardware store. The switch lets people with a limited range of motion input "mouse clicks."

"For people who need more sophisticated assistive technology like screen readers and voice recognition systems, or learning and cognition tools such as word prediction programs—there are great products out there," Johnson says. "We can help introduce patients to these products and later, if the patient needs help getting the product permanently—to return to work, or to find new work—help is available."

An important organization Johnson works closely with is the Washington State Division of Vocational Rehabilitation. A division of the Department of Social and Health Services, DVR's mission is to "empower individuals with disabilities to achieve greater quality of life by obtaining and maintaining employment." Often that includes securing assistive technology and training. Johnson helps patients find out about such resources.

Gratifying Work

In the case of the 35 year old mother of three, Johnson was able to set her up with a computer and on-screen keyboard program that would allow her to select programs, and commands, and to run Microsoft Word all via a selection switch placed above her eyebrow. She activated the switch by raising her eyebrow to make a selection. Her message to her husband and children was the first communication beyond yes/no answers she was able to give following her stroke.

"I love my job," Johnson says, "because I feel like I can help preserve dreams—help people keep their dreams alive. Our team brings them ideas and helps them solve access problems, and they do the hard work. We show them the possibilities and our reward is seeing their hope return."

Curt Johnson's educational background is vocational rehabilitation and he holds a master's degree from the University of Arizona, and a bachelor's from the University of Wisconsin-Stout. He has concerned himself with vocational rehabilitation and rehabilitation counseling since the mid-1960s.

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[image: Curt Johnson photo]
"I love my job," Johnson says, "because I feel like I can help preserve dreams—help people keep their dreams alive. Our team brings them ideas and helps them solve access problems, and they do the hard work. We show them the possibilities and our reward is seeing their hope return."


Curt Johnson
Rehabilitation Counselor
UW Medical Center

UW Medical Center ranks 11th among America's best hospitals in U.S. News & World Report's 2007 honor roll and is a Magnet Hospital for nursing. It is renowned for its programs in solid organ transplantation, cancer treatment, heart care, high-risk pregnancy and neonatal intensive care, rehabilitation, and specialized orthopedic surgery.

Washington State Division of Vocational Rehabilitation has offices statewide to help meet the employment needs of people with disabilities and of employers. Find vocational rehabilitation services in your state.


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