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Running head: ADAPTIVE TECHNOLOGY

Adaptive Technology: Foot-Operated Keyboard


Jared Hansen
Touro University Nevada

ADAPTIVE TECHNOLOGY

Client
Ms. G. is a 38-year-old mother of two children. She describes herself as determined,
stubborn, and friendly. Following an electrical injury in her childhood, she required a right
shoulder disarticulation amputation and a left interscapular thoracic amputation. She reported
being independent in her daily life activities using her feet. After trying to use prostheses for
years she decided they were too uncomfortable and burdensome for her, and that it was easier to
use her feet to achieve the tasks she needed to accomplish. She said that she had to learn to use
her feet and become self-reliant at an early age. As a single mother she runs her own business
from home spending a large amount of time on the computer typing with her feet. Having gone
through a recent divorce, she mentions that it is difficult to participate in many of the activities
that she enjoys doing in her spare time. With less time spent participating in her leisure and
recreation, and more time spent focused on her business, she is starting to develop knee, foot,
and toe problems. Some specific recognizable problems that are beginning to be observed
include contracted toes (hammer toe) and swelling in her knee, with pain in her knee, feet and
toes. These problems are directly related to poor biomechanics while typing on her laptop
computer.
Ms. G. enjoys shopping, swimming, singing karaoke, fitness training, and maintaining
her blog. She says she is a great swimmer and tries to keep up on her exercising and fitness
because she knows it is important for her health. Ms. G. has girl friends that support her by
making it possible for her to participate in her hobbies. She says that they are always there for
her when she needs them. She values the time she can spend with her two children as well as the
opportunities she has to spend time with her friends. In the past she would travel with her

ADAPTIVE TECHNOLOGY

friends, but with children and a business she doesnt travel as often. When using her computer
she currently types with her toes with the computer at the same level as the surface she is sitting
on. This has been her mode of typing for years, but she says it has never really been very
comfortable. One of her desires is to decrease or fix the problems she is having with her knees,
feet, and toes. The problems are decreasing her ability to work efficiently and she would like to
find a way to increase her efficiency as well. She did mention that she has a few gadgets that
make some of her activities easier.
Device Description
Inspiration for the device came from personal knowledge of pianos and organs. When
observing an individual playing an organ, the thought came that there might be a possibility of an
individual typing with their feet similar to an organist playing the foot keys of an organ. After
contemplating the idea of a foot-operated keyboard and deciding it would be a possibility, I
thought of designs for an ergonomic and efficient device to meet the needs of Ms. G. This footoperated keyboard, which I called the Footey Keyboard, was made using two boards of wood
that were cut and glued together creating a keyboard face at a 45 degree angle. A three by four
keypad design was used in the center of the board with areas off to each side of the keypad to
rest the feet, with eight additional keys on the lateral sides of the rest areas. Push buttons were
used as keys to allow for ease of use by the feet without causing strain on the toes or muscles.
See Appendix A for a detailed cost analysis and Appendix B for a figure of the Footey Keyboard.
By designing an ergonomic foot-operated keyboard that could be used by Ms. G., foot
abnormalities, including contracted toes, and knee, foot, and toe pain would be reduced or
eliminated. According to Kwon, Tuttle, Johnson, and Mueller (2009) muscle imbalances and
reduced ankle joint RoM [range of motion] were associated with hammer toe deformity (p.

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673). This device will allow her to operate a computer for business and leisure pursuits in an
efficient and ergonomically correct way, and be a cost effective alternative to other available
hand-free technologies.
Performance Benefit
Benefits that will come to Ms. G. from using the Footey Keyboard include continued
independence in using her feet to complete her daily activities. The ability to remain
independent in using her feet is important for Ms. G. because she no longer uses prostheses.
Having a foot-operated keyboard allows her to perform this task as she is already accustomed to
using a computer. She also needs something that is cost effective. When looking into alternative
options, she found that the cost was beyond her financial means, with devices and programs at
times being thousands of dollars. Another benefit includes decreased pain, discomfort, and
fatigue with routine use. While Ms. G. would use her laptop computer each day her knee, foot,
and toe pain would increase. By having an ergonomically designed option, this pain from poor
body mechanics will decrease. A final benefit of a foot-operated keyboard includes increased
efficiency in computer processing allowing for increased participation in leisure pursuits.
According to Yu, Zhang, Liu, and Chen (2006) cortical reorganization due to neural plasticity of
the motor cortex allows for foot movements to become similar to finger movements. By
increasing the efficiency of working on the computer, and decreasing the pain and fatigue
previously mentioned, there is a possibility that fewer rest breaks will be needed by Ms. G. while
working from home when using the Footey Keyboard. This increased efficiency would also
allow her to participate in her desired leisure activities, including updating her blog, more
frequently.

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Similar Devices

No similar foot-operated keyboards were found to be available for sale. When searching
for similar devices, one foot-operated keyboard was found reported on by a photojournalism
company in Indonesia. They mentioned that a foot-operated keyboard had been created by Gajah
Mada University, and they posted four pictures, but the article could not be verified by any other
means. A patented design for a foot-operated keyboard was found, but the device is not known
to have been created (U.S. Patent No. 5,889,510). Other options include an eye-tracking device,
which is approximately $2,000, or speech recognition software, which is approximately $200
and has a steep learning curve, requires dedication to learn, and has problems with accessing the
internet.
Literature Review
Individuals experiencing upper-extremity amputations, particularly bilateral amputations,
usually have many adjustments to make throughout their lives, in addition to the many personal,
social, cultural, and psychosocial changes and adjustments that occur following an amputation.
In addition to these adjustments, use of adaptive equipment, devices or techniques are common,
including using feet for tasks commonly completed with the hands. In an article by Yu, Zhang,
Liu, and Chen (2006) the ability to skillfully use feet for tasks by individuals with amputations
was investigated. They looked at the structural and functional reorganization of the primary
motor cortex of individuals with bilateral upper-extremity amputations. In this study the
researchers had individuals perform motor tasks during a functional MRI, comparing those with
the amputations to individuals without amputations. Results showed that after constant foot
movement practice, the human brain has replace the hand with the foot (Yu, Zhang, Liu, and

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Chen, 2006, p. 50). This study suggests that cortical reorganization from neural plasticity of the
motor cortex leads to the feet functioning like the hands.
In an article by Kwon, Tuttle, Johnson, and Mueller (2009) aspects of hammer toe
deformity were researched. Toe muscle strength, including flexion and extension, was measured
in individuals with and without hammer toe deformity. Researchers found that individuals with
hammer toe deformity had significantly increased muscle strength in the toes. A correlation
existed between toe muscle strength and metatarsophalangeal joint angle, which pointed to risk
factors for developing hammer toe deformity.
Conclusion
Individuals with bilateral upper-extremity amputations experience many adjustments that
need to be made throughout their lives. As one of these individuals, Ms. G. is adjusting to pain,
fatigue, and deformity in her knees, feet and toes that limit her participation in her desired
occupations, including work and leisure. By developing a foot-operated keyboard, called the
Footey Keyboard, Ms. G. will have the opportunity to continue to engage in her activities in a
manner she desires.

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References

Klarlund, N. (1999). U.S. Patent No. 5,889,510. Washington, DC: U.S. Patent and Trademark
Office.
Kwon, O. Y., Tuttle, L. J., Johnson, J. E., & Mueller, M. J. (2009). Muscle imbalance and
reduced ankle joint motion in people with hammer toe deformity. Clinical Biomechanics,
24(8), 670-675. doi: http://dx.doi.org/10.1016/j.clinbiomech.2009.05.010
Yu, X., Zhang, S., Liu, H., & Chen, Y. (2006). The activation of the cortical hand area by toe
tapping in two bilateral upper-extremities amputees with extraordinary foot movement
skill. Magnetic Resonance Imaging, 24(1), 45-50. doi: 10.1016/j.mri.2005.10.024

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Appendix A
Cost Analysis

Table 1
Cost Analysis

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Item
Acrylic lettering
Circuit board
Glue
LEDs
Paint
Push buttons
Solder
Wire
Wood
Total

Cost
$ 0.16
$ 23.99 (donated)
$ 0.20
$ 3.77
$ 0.50
$ 10.85
$ 0.05
$ 0.25
$ 4.17
$ 19.95
Appendix B
Figures

Figure 1. Footey Keyboard

Figure 1. Face of Footey Keyboard representing push button layout with foot rest areas.

Figure 2. Patent

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Figure 2. Design of U.S. Patent No. 5,889,510.

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