Depending on their physical abilities and needs, a person can control a computer or a communication aid using a slight movement of their foot, blinking an eye or moving their head. These various ways of controlling an AAC device are called access methods.

A person with complex physical difficulties may be dependent on technology to manage their life and access education and recreation. Some people use the same access method to control a computer, to operate a Voice Output Communication Aid (VOCA), and to control a powered wheelchair.

However, someone who uses a joystick well enough to drive their wheelchair safely, may still find it difficult to use joystick access to a communication aid or computer. In a wheelchair, the delay between moving the joystick and movement of the wheelchair tends to iron out tremor and jerks. Moving a cursor through letters, words and symbols requires much more control. So, some people use different access methods for different activities, for example: a joystick for mobility and a switch for computer and VOCA.


We are all familiar with the direct method of access: pointing at a picture, tapping a keyboard to type a message, or dialling a telephone number. Some people who use an AAC system to communicate may have enough physical ability to do these too. Instead of pointing or typing with a finger, others may to use a different part of their body such as a fist or toes, or maybe use a technique called eye pointing.


We all use eye-gaze from time to time. Looking hard at a person or an object can be more subtle than actually pointing with a finger. For people with very little control over their bodies, eye-gaze can be a very quick and efficient method of communicating. If they are looking at a cup of coffee on the table, it might mean they want their drink … now! Some people are able to use eye-gaze at a very advanced level to look at special symbols, words or letters printed on a card or other display. See the section on Eye-gaze Systems.

Pointing Devices

There are a range of different pointing devices for computers and some hi-tech communication that some people can use. Computers are so commonplace now that almost everyone is familiar with using a mouse to point at icons and text on a screen. Some people with physical difficulties find it hard to grasp a standard mouse or move it over the surface of a table. A trackerball (sometimes called a rollerball) may be more helpful.

Lightpointers and infrared pointing devices can be used with some communication aids and computers. They are worn on the head and transmit a beam of light to the equipment being controlled. The computer or communication aid responds to the light beam as if the keyboard has been touched. These are especially useful when someone has good head control but finds other types of movement difficult. See the section on Pointers.

Adapting the Keyboard

Sometimes, the simplest option is adapting a keyboard for someone who has difficulty communicating. Some basic adjustments can give the person direct access to their computer or communication aid. These can include:

  • Adjusting the keyboard settings
  • Putting a keyguard over the keys
  • Substituting a special keyboard for the standard one

Most computers and many communication aids have an option to adjust the keyboard response time. This improves accuracy for the user. A keyguard can help them use a standard keyboard without accidentally hitting the wrong keys. This is usually a sheet of perspex or metal that is fixed over the keyboard. It has holes drilled in it that correspond to the keys underneath.

Consider choosing a different type of keyboard.

  • Expanded keyboard – has larger, more widely spaced keys
  • Miniaturised keyboard – can be suitable for people with a very reduced range of movement but with good fine motor control
  • Ergonomic keyboard – easier to use for people using only one hand or a head pointer.

See the section on Keyboards.


Indirect access methods such as scanning with a switch may be the best option for a person who has severe physical limitations as well as a communication difficulty. Switch scanning works by connecting one or more switches to a communication aid or computer. These must be able to accept switch input, perhaps via a special interface box. The user needs to be able to activate the switch using whatever part of their body they can control with ease. This could be their head, foot, knee or hand. They then select what they want to say by activating the switch to control a moving cursor on the screen.

Scanning is a difficult skill to learn and most people will need a period of training and practice. They have to learn when to press the switch, when to release it, how to undo a wrong selection, and so on. See the section on Switch Scanning.

Switches for Scanning

There are many different types of switches. Some are better for controlling scanning devices than others. Some people may find a particular switch is the best one for them. Consider using a switch that makes a beep or click to let the user know it has been activated. This kind of feedback can be helpful, even if only while the person is learning to use the switch.

Some switches require only the lightest of touch to activate them – these are useful for someone who has weak or very restricted movement. Others need considerable pressure before they work – these may be better for someone with a lot of uncontrolled, strong movements. See the section on Switches.


It is very important to assess a person’s needs for special access techniques or technology, and to review their needs on a regular basis. Someone’s method of access may change over time as their physical abilities alter. New technology may become available, offering more options. Physical position can also affect the success of an access method – this could be lying in bed or sitting up in a chair). The type of seating can also make a difference , whether it’s an armchair, a special supportive seat or a stool. The assessment should ideally be done by a multi-disciplinary team including the person themselves. The assessment team could include an occupational therapist, physiotherapist, a teacher/educationalist, and a speech and language therapist.


Improving accessibility at home

When you use a wheelchair, making your home fully accessible can be an extensive and expensive project. If you have to move, there are many complications. You can’t find a place you like, and just move in. Your choice of home will be limited by space and layout. You will need to make adaptations. Even if you buy a house that has already been adapted, you may still need to make your own adjustments. But now, you can use smart technologies to make a “smart home”. A smart home gives you greater control over your living space, both inside and outside. Smart technologies can’t change the physical features – they can’t make your doorways wider, for example. But they can change how you interact with your surroundings.

Making your home more accessible with smart technology

Most smart homes are controlled through apps on a smartphone, meaning you can manage tasks from absolutely anywhere. Smart home technology has benefits for everyone, but if you use a wheelchair, it offers an increasing level of freedom. When you control your house with your phone, you don’t need to move around it as much. And if you have little or no speech, smart technology is even more beneficial, providing a level of independence that you could not otherwise enjoy.

Here are some options that are already possible.

  • Control your heating without having to go to the thermostat
  • Switch your lights on
  • Turn your oven on before you leave work, and come home to a cooked meal
  • Switch your TV on while on holiday, to give the illusion that you’re at home

You can get your smartphone to automate a task when you’re within a certain radius. For example, you can program the oven to switch on when you’re three miles from home, or the heating to come on just after you leave work. You can use your smartphone to:

  • open the curtains without moving from your bed
  • start the process of cooking breakfast while you’re still styling your hair
  • run a bath as you finish dinner, without even leaving the table

You can also use your phone to help with physical navigation. At the push of a button, a ramp can drop down from your front door. There are no limitations, thanks to the ever-increasing range of smart products on the market.

Why is smart home technology so valuable?

One of the most beautiful things about smart home technology is that it is fully customisable. You only need to install the features that you’ll actually use. Better yet, smart technology improves accessibility without you needing a certain wheelchair. Manual, electric, brand new ones or older – wheelchairs are all the same as far as smart tech is concerned. The wheelchair is not the important bit – all that matters is that you can use your phone while you’re in it. Some wheelchair users will need wheelchairs that feature all the latest technologies in-built. For others, a smartphone, or tablet, and connected devices are enough to make dramatic lifestyle changes. What would you like to be able to control using just your phone or tablet?

Many suppliers help with accessible technology for the home and mobility.


In eye-gaze systems, you look at the required item on the screen and then select it by either pressing a switch or holding their gaze for a preset length of time.

These systems are relatively expensive. Several systems are available; all have different characteristics and vary in their tolerance of head movement.

An assessment and a trial with a system are imperative before you consider a purchase.

Tobii C12

Alea Intelligaze

Pointers are mice, trackerballs and joysticks

There are many different versions of each of these. Someone who can’t use a standard mouse may find it easier to use an adaptation, such as a one click-mouse or miniature mouse. The position of the buttons on a mouse also varies. Trackerballs are available with different sizes of ball, in different locations. An assessment where you can explore the full range available is valuable.

If you can control the position of the pointer but not press the selection switch, you can add an additional “select” switch. If the program has a dwell facility (the ability to pause time), you can hold the pointer over the symbol/word/letter for a given, but changeable, time. The program will then automatically accept your selection without you having to press a switch. Not all programs offer this dwell facility – you can install add-on software to enable dwelling.

Using a pointer can also be made easier by modifying the cursor. You can change its colour, size and shape as well as the colour of the background. You can generally change the cursor’s speed of movement acceleration using the computer control panel.

Traxsys Roller Joystick Plus

MicroTrac Finger Mouse

Keyboards are available in different sizes, shapes and layouts. Some keyboards also have keyguards that minimise the risk of hitting an unintended key. Computers and communication aids offer facilities to slow down the repeat rate of keys, minimize repeated hits of a key (tremor) and enable making capital letters and other multi-key combinations (sticky keys).

Advice and the opportunity to explore the many different options are critical to success. You can make various adjustments to make it easier to use the keyboard. You can make the keys larger or smaller. You can add a keyguard to reduce unwanted activations. Some devices allow you to adjust the sensitivity of keys – to set a time for how long you must hold a key down to activate it, and/or an elapse time before you activate the next key. Some people find it helpful to select keys with a tool such as a “prodder” or a head pointer. Fine tuning the position, orientation and pressure you need to operate a device can get rid of a lot of frustration.

Big Keys keyboard with keyguard

Ultra Compact keyboard with keyguard

Single switch scanning

In theory, single switch scanning is the simplest. You use an indicator (highlight, cursor or light) to move through all the options, one at a time, at your desired preset speed. When the required item is highlighted, you press the switch to select it. If you can always hit the switch on your required item, this is a quick and easy selection method. However, single switch scanning demands considerable concentration and physical control.

There are two common problems. You may find you either tense up as you approach the required location and then can’t activate the switch, or get so excited that you hit the location before or after you require it. Slowing the scan rate may cause you to lose concentration or interest.

Two-switch scanning

There are many variations on two-switch scanning, but basically pressing one switch progresses the indicator systematically through the options available. When the required item is highlighted, you press the second switch to select it. Simply, one switch is the “move” switch and the other is the “select” switch.

This method puts you in total control and helps eliminate any tension around stopping the scan in the correct place.

Row-column scanning

Row-column scanning is much quicker than sequential scanning. Items to be scanned (the keys or cells) are arranged in a grid. Each row is indicated one at a time. When the row containing the desired item is highlighted, you press a switch. The indicator then moves along the row, key by key. When the desired item is highlighted, you press to select again.

You can use one or two switches for row-column scanning.

(Other scanning methods involve three or four switches, but these are rarely used.)

Switches come in different sizes, shapes and colours. Some allow you to adjust how much pressure to activate the switch. You activate a simple switch by pressing down on the top with a part of your body, such as your hand, head or knee.

If you can’t reliably activate a simple switch, check out the wide range of commercially available alternatives. These include mercury tilt switches, eye blink switches, muscle movement detectors, and sip/ puff switches.

You must secure and mount switches in the required position to stop them moving or falling out of reach. Switching also becomes automatic when the switch in a consistent position. The less you have  to think about the switching action, the better you can concentrate on what you actually want to do. Assessment by a qualified professional is essential to identify the best combination of switch type and switch mounting.


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