Reading and writing are difficult for patients with AT obviously because of neuromotor consequences on the control of the arms and eyes movements. Using a computer can partly solve this problem.

But the reality is not as simple as typing on a keyboard requires fine motor skills (even if it is less than for writing) and generally many round trips of sight between the keyboard and the screen. This causes inconvenience to patients' eyes and can quickly discourage them.

Fortunately, advances in computer technology and increased power and capabilities of computers make available a number of very useful functions and software. But one must always keep in mind that a computer is a tool: it has to adapt to the user, and not the opposite.

There are now very correct equipment, laptop or office ones and meeting the criteria developed in this chapter, for about 300-400€/$. It is important to begin initiating the child with AT early: On trouve aujourd'hui des matériels très corrects, portables ou de bureaux et répondant aux critères développés dans ce chapitre, pour environ 400 EUR. Il est important de commencer l'initiation très tôt chez l'enfant AT pour :

• Familiarize him with the tool and develop some automation such as the instinctive knowledge of the position of letters on the keyboard
• Take advantage of the time when the disease is still not too present to master the hardware and softwares
• Be prepared to use it as a learning tool in his life at home or at school as soon as his physical abilities affect his ability to learn

With these objectives and with an occupationnal therapist, the computer must be part of a customed school project.

physician helvetica,sans-serif;">As with any tool, there is a good position to use a computer and lots of bad.

And a good posture determines the level of fatigue after several working hours. This is true in general and even more for patients with AT for whom stability is required and a guarantee of performance. To do this, they should:

• Snap their back and keep the trunk on the seat, by using braces or a belt if necessary
• Use armrests at the right height or carved U-shaped tablet in order to support the elbows
• Get the elbows at an angle of 90 °
• Ensure to have the front at the same height as the top of the screen which should be at a distance of about 70 cm.
• Use a wrist rest to stabilize their hands on the keyboard

The size of the keyboard

For a person with AT, the first problem using a keyboard is the size of the keys: for example it will be easier to type on the keyboard of a desktop computer rather than on a laptop.

There are on the market larger keyboards, some of them designed for children to learn computing, with big buttons, using colors to distinguish letters from numbers or even vowels and consonants distributed in toy stores for general public at a low price.

Other specific keyboards have been developed for children with disabilities, for example with an alphabetical order of letters instead of the QWERTY order. But they have limited value and are not intended in any case to people who already have experience with computers.

Simultaneous keys

The second problem is that you often need to press two buttons simultaneously for a character or a function.

Again, the advantage of the desktop is that it has on his keyboard a separate numeric keypad compared to the laptop. On the latter however, one can connect an additional pad.

But the simplest solution is to set the correct operating system (Windows, Mac OS, Linux). All propose to use StickyKeys: for a given function, instead of simultaneously press a key combination, you just have to make this combination a key after the other. It is certainly a little longer, but it's very effective. It's just the principle of the "uppercase" key: once pressed, all the letters you type are uppercase, which is not the case if you've used the keys "shift + letter".

Key repetition

A third difficulty is the time of key repetition: if you push too long on a key, the corresponding letter appears more than once.

Again, the solution is in the settings of the operating system where you can adjust the keyboard settings and the repetition time between each letter.

Virtual Keyboard

Using the virtual keyboard, the one that appears on the screen and is offered by all operating systems, is not a good alternative method: using the pointing device which presents difficulties for the person with AT increases the operating time, so the fatigue.

Keyboard and sound

Finally, it is very useful for patients with AT to associate the listening of the character to the touch as the confirmation of it or the activation of a function. This way, there is no need to look up at the screen to verify that the action is correct.

Again, these settings are available in the Control Panel of the operating system. Windows from Vista, you must look for the "Narrator" in the accessories. It will also read every kind of text provided it is pointed out.

Some other specialized softwares can also read the character hit and / or the entire sentence with less "robotic" voices and more flexibility in the configuration. But they can be expensive.

Recommndations

To sum up, for the choice of a keyboard, the recommendations are:

• As long as the child has the ability, use a standard keyboard for learning the place of keys. A bit like a typist who no longer looks the keyboard but the screen, this will allow later the child to work without considerable research efforts of each letter on the keyboard
• When motor difficulties appear, the computer should be equipped with a keyboard with larger keys.
• When visual difficulties appear, use a keyboard with enlarged letters using a special keyboard or simply by pasting stickers on the keys
• The position of the keys can be standard if the computer has already been approached. If not, you can try the alphabetical arrangement
• Use the parameters of the operating system to resolve problems due to simultaneous touches and repetition rate
• Enable, still in the operating system or by a other program, reading the letters along with the touch.

link helvetica, search sans-serif; text-align: justify;">The vast majority of screens available on the market now are LCD screens (Liquid Cristal Display) with so numerous advantages over CRT cathode screens that one should not hesitate to take the plunge:

• People with AT are going to need increase the size of the font for easy reading: a large screen reduces the line breaks and thus the eye research movements
• An LCD screen is much less tiring to look at than a CRT screen. The first e-book go even further by using a display technique which does not emit light: eye strain is the same as for paper reading!
• Regarding the same screen size, LCD screen is much less bulky than a CRT: imagine the volume and weight of a 24-inch CRT!
• Touch screens must be also considered, but with some restrictions

Finally, there are glasses or helmet with integrated display, at reasonable prices again, which have the advantage of following the movements of the head of the wearer, but the disadvantage of blurred vision when looking for a letter on the keyboard for example.

The mouse

treatment helvetica, cialis sans-serif; text-align: justify;">The most famous pointing device is obviously the mouse, but it is not without flaws. It requires precision and a lot of control when one needs to:

• Keep the pointer on the targeted object and then click on it with the same hand
• Double-click: it is also a problem because you have to do in a short time twice the same operation
• Move an object on the screen with a button pressed simultaneously: the "drag and drop" so common

Over time, with the upgrades, the operating systems offer basically many settings that allow people with disabilities to use them. For the mouse alike the keyboard, we can, in the control panel, set:

• The size, color and speed of the pointer and show its trajectory
• for the double click, increase the time between clicks, or even remove it to launch applications at the first click
• for drag and drop, lock the click: after clicking an object, you can release the button, move the object to the desired position and click again to confirm its position
• the function of automatic positioning of the cursor on the default button of dialog boxes
• The programming of the mouse buttons. Some have more keys than the standard model, which allows for example to set one for a automatic double-click

The trackball

But other pointing devices can also be very interesting, first and foremost the trackball, a sort of upside down mouse with a ball moving on the surface that you turn to direct the pointer. As the base is fixed, the system is less sensitive to parasitic movements than the mouse while ensuring accuracy.
In addition, it can be used with two hands: one hand for handling the ball, the other can operate the buttons.

The touchpad

The touchpad is the little touch square that is at the bottom of the laptop keyboard to move the cursor on the screen. There can be also separate in the manner of a mouse.
Its advantages are the same as the trackball either because it is not mobile: arm and hand of the user are snugly while the only movements are those of the fingers and slightly of the wrist .

The joystick

The joystick is an alternative that has the same advantages as the trackball: the cursor control is done with the whole hand thus it requires less finesse in movement while maintaining high accuracy.

The keyboard

The keyboard can also be set up very well to replace the mouse:

• arrows to direct the pointer
• space bar to click
• other keys for more advanced functions ...

In addition, you do not change tool when typing or pointing, which avoids unnecessary movement. It also gains in stability as you act on one direction at a time. But reaching its target is more tedious ...

Touch screen

The large touch screen installed vertically on a desk in front of the user are not recommended for patients with AT because they require movements of large amplitude which can lead to imbalances and thus increase their fatigue more quickly.
This disadvantage disappears if these screens are used horizontally, as the table "Surface" of Microsoft, and for small touch screens on tablet PCs, for example, electronic wizards or smartphones. The advantages of the touch screen may be then very interesting. They can:

• to gather information and action in the same place: much of the coordination efforts between vision and motion are reduced. Example: imagine the efforts of a child with AT in class having to copy and respond in writing to a work on the blackboard; then just imagine now those of the same child using a touch pad that magnifies the text of his exrcice and proposes multiple answers he can choose just by touching them ... this is what the technique is promissing today. Applications are missing....but coming with devices like the iPad of Apple.
• to use the incredible possibilities of the computer in terms of presenting information to facilitate action. One can for example set up a simple and intuitive visual interface to command the house with a touch remote that can be a simple smartphone. The touch screen is the ideal interface for maintaining the independence of AT patients.

With the advent of the iPhone and Windows 7 that take all the advantages of touch screens, the next few years will see an ergonomic revolution that will undoubtedly benefit many people with disabilities. The touch pads like the Ipad are also media that we will have to look very closely. To be continued ..

As stated earlier, the first software to set for a person with AT is the operating system of the computer: Windows, Mac OS, Linux.

Operating Systems

Indeed, from one version to the next one, they have considerably increased over time the number of possible settings and functions dedicated to computer access for the disabled.
Thus, there are many settings on the mouse and the screen, a lens, a virtual keyboard with high contrast, features of voice recognition and synthesis, etc.. To get there:

• On Windows, you must go to the Control Panel under "accessibility" or "Ease of Access center" depending on the version, or go directly to the "accessories". You will find a full description of features depending on the Windows operating system by going to the Microsoft website. For this, the easiest way is to type "Microsoft + accessibility" in your language on your search engine.
• Mac OS-X seems to be very efficient and friendly in terms of accessibility options. In the same way as above, type in search "Apple + accessibility" in your language brings about a complete description of features. Note: For computer skilled people, it is possible to install the Apple operating system on a machine originally planned for Windows. 
• On Linux, the problem is slightly different in that there is no standardized version of the operating system but rather several versions of this system. All offer basic accessibility features such as magnification.
  For more advanced features, add-ons can be downloaded. For here is the principle of Linux: all applications are free but it is counterbalanced by the fact that it is a modular system where everyone adds the application that suits him. It is very flexible for some, complex for others. It should be noted however that it is possible to run most Windows applications on Linux. For starters, the Ubuntu version of Linux seems the most appropriate and easiest to access.

optical character recognition: OCR

The OCR software can also be very useful for reading: by scanning a text and keeping the formatting, they can afford to get on the computer screen magnification, a change of contrast as well as speech synthesis. The scanned text can also be used for personal work.

Some software are commercial while some can be found for free (from Wikipedia ):

• Open source softwares: GOCR (Unix, Windows), OCRopus (Unix), Tesseract (Unix, Windows)
• Freewares: Moredata, freeware using Tessnet (Windows), MoredataFast (Windows), FreeOCR, ...
• Commercial softwares:Readiris (Unix, Windows, Mac OS), FineReader (Unix, Windows), Scansoft Omnipage (Windows), BIT-Alpha (Windows), Neoptec (Windows, Mac OS, Unix), Adobe Acrobat Professional (Windows, Mac OS),...

Voice recognition

They are used to dictate either text or commands to control the computer or even through it to command your home for example.

Windows Vista and Seven incorporate such a software with acceptable performance, as well as Apple's VoiceOver on its iPhone iPad and iPod. But one of the best software in this area pays off: Dragon NaturallySpeaking, the market leader.

One may question the relevance of such software for use by people with ataxia telangiectasia since speech problems can occur. It is to be evaluated case by case.

Speech synthesizers

This kind of software is very useful for people with sight problems. They can read with synthetic but more and more natural voices the content of the active window on the screen.

Microsoft and Apple have incorporated that in their options of ergonomics, with an advantage of fluidity for Apple. Activation:

• For Windows, you must go to the Control Panel to find these options, or go through the "accessories" and look for the "narrator".
• For Mac, you must activate the "VoiceOver".
• Linux is a little behind with "Orca".

Note that Windows does not offer other voices than in English. The procedure for obtaining a voice in an other language is to install a program you find on the internet. Some charities may have information and downloads available. It is different from a country to an other.