Cane Users Research Articles

Drop-off detection with the long cane: effect of cane shaft weight and rigidity on performance

Most travellers who are blind rely on a long cane to detect drop-offs on their walking paths. We examined how different cane shaft materials affect drop-off detection performance through providing different vibrotactile and proprioceptive feedbacks to the cane user. Results of the study showed a significant interaction between cane shaft weight and how the cane is used. A heavier cane was advantageous for detecting drop-offs when the individual used the ‘constant contact technique’ – cane tip stays in contact with the walking surface at all times – but not when he used the ‘two-point touch technique’ – cane tip is rhythmically tapped on the surface. In addition, a more flexible cane was advantageous for detecting drop-offs when the two-point touch technique was used but not when the constant contact technique was used. It is recommended that, when blind individuals select a cane shaft material, they consider which long cane technique they use more often.Practitioner Summary: Long cane shaft material affects how well a blind individual can detect drop-offs. A heavier shaft was advantageous when using the constant contact technique (cane tip stays in continuous contact with the surface), while a more flexible shaft was better when using the two-point touch technique (cane tip rhythmically taps the surface).

An initial field trial of a haptic navigation system for persons with a visual impairment

Purpose – The purpose of this paper is to describe conceptions of feasibility of a haptic navigation system for persons with a visual impairment (VI). Design/methodology/approach – Six persons with a VI who were white cane users were tasked with traversing a predetermined route in a corridor environment using the haptic navigation system. To see whether white cane experience translated to using the system, the participants received no prior training. The procedures were video-recorded, and the participants were interviewed about their conceptions of using the system. The interviews were analyzed using content analysis, where inductively generated codes that emerged from the data were clustered together and formulated into categories. Findings – The participants quickly figured out how to use the system, and soon adopted their own usage technique. Despite this, locating objects was difficult. The interviews highlighted the desire to be able to feel at a distance, with several scenarios presented to illustrate current problems. The participants noted that their previous white cane experience helped, but that it nevertheless would take a lot of practice to master using this system. The potential for the device to increase security in unfamiliar environments was mentioned. Practical problems with the prototype were also discussed, notably the lack of auditory feedback. Originality/value – One novel aspect of this field trial is the way it was carried out. Prior training was intentionally not provided, which means that the findings reflect immediate user experiences. The findings confirm the value of being able to perceive things beyond the range of the white cane; at the same time, the participants expressed concerns about that ability. Another key feature is that the prototype should be seen as a navigation aid rather than an obstacle avoidance device, despite the interaction similarities with the white cane. As such, the intent is not to replace the white cane as a primary means of detecting obstacles.

Differences in the Limits of Stability Between Older Rolling Walker Users and Older Single-Tip-Cane Users - A Preliminary Study.

To identify the differences in the limits of stability (LOS) between older rolling walker and single-tip-cane users. This was a matched paired t-test design with repeated measure. Eighteen older subjects were matched based on age, gender, and functional level. The subjects were assessed using the multidirectional reach test initially and 5-month later in four directions: forward, backward, leftward, and rightward. Initially, there were no differences between cane users and rolling walker users in the LOS in all directions. However, 5-month later, the cane users who held their canes in their right hand had significantly better stability in forward and rightward reach than the walker users (p < .05). Further, the walker users demonstrated significantly decreased functional reach in forward reach (p < .05). Cane users might have better stability than walker users in the forward direction and in the direction toward the side holding the cane. This study may provide guide for clinicians including nurses for selecting appropriate rehabilitative interventions for older adults using walkers and canes.

Identification of Vibrotactile Patterns Encoding Obstacle Distance Information.

Delivering distance information of nearby obstacles from sensors embedded in a white cane-in addition to the intrinsic mechanical feedback from the cane-can aid the visually impaired in ambulating independently. Haptics is a common modality for conveying such information to cane users, typically in the form of vibrotactile signals. In this context, we investigated the effect of tactile rendering methods, tactile feedback configurations and directions of tactile flow on the identification of obstacle distance. Three tactile rendering methods with temporal variation only, spatio-temporal variation and spatial/temporal/intensity variation were investigated for two vibration feedback configurations. Results showed a significant interaction between tactile rendering method and feedback configuration. Spatio-temporal variation generally resulted in high correct identification rates for both feedback configurations. In the case of the four-finger vibration, tactile rendering with spatial/temporal/intensity variation also resulted in high distance identification rate. Further, participants expressed their preference for the four-finger vibration over the single-finger vibration in a survey. Both preferred rendering methods with spatio-temporal variation and spatial/temporal/intensity variation for the four-finger vibration could convey obstacle distance information with low workload. Overall, the presented findings provide valuable insights and guidance for the design of haptic displays for electronic travel aids for the visually impaired.

The effect of cane length and step height on muscle strength and body balance of elderly people in a stairway environment.

BackgroundIt has been reported that 75% of stairway accidents occur while descending stairs. Using a cane can help to prevent older people and those with limited mobility from falling. However, studies have shown that two-thirds of older cane users use a cane that is longer than the recommended length, which may cause unnecessary muscular loads. This study aims to assess balance and muscular load in older people descending different height steps with different cane lengths.MethodsNine participants (5 males and 4 females) aged over 65 years participated in this study. Cane length and stair height were independent variables. Electromyography signals were recorded from the biceps brachii of the arm that usually held the cane and from both gastrocnemius muscles. In addition, the center of pressure (CoP) was assessed as an indicator of balance in older people descending a step.ResultsDescending from higher steps resulted in the use of greater arm and leg strength at the time of first foot contact. However, cane length did not affect any of the root mean square values. In addition, the CoP Stabilometric Parameters showed that mean distance, antero-posterior mean distance, total excursions, antero-posterior total excursions, mean velocity, and antero-posterior mean velocity were significantly affected by step height, but not by cane length.ConclusionsIf cane length is within the currently suggested range, then it has little effect on the force load on the arm and legs when descending a step. Step height has a greater effect than cane length on the strategies used by older people to maintain stability.

Ambulation Aid Use and User Performance for Transit Vehicle Interior Design

Public transportation plays an important role in shaping urban quality of life. However, urban transportation design and policy-making lacks a strong human factors knowledge base for accommodating a functionally diverse ridership including the aging and mobility impaired. This study examines seating configurations in contemporary low-floor buses and user performance for mobility impaired passengers. Task times in sitting and rising were obtained in a laboratory study using a static full-scale low-floor bus mock-up from – cane users (n=10), walker users (n=22), persons with visual impairment (n=17), and without any impairments (n=17). Significant differences in sitting and rising times across longitudinal vs. transverse seats by user group are demonstrated along with regression estimates to facilitate design evaluations. Implications of these findings, recommendations for improved low-floor bus designs and the relevance of ergonomics methods for safety, usability, and efficiency are presented.

Effect of Cane Technique on Obstacle Detection with the Long Cane

Modern long cane (also known as the white cane) techniques have changed little since their development in the 1940s. The two-point touch and the constant-contact techniques are the two used most widely by travelers who are blind. Regardless of which technique is used, obstacle detection, a key component of preview offered by a long cane (Blasch, La Grow, & De l'Aune, 1996), is crucial for the safety of blind travelers. When obstacles such as construction cones or toys left on the sidewalk are missed, they may trip the cane user, resulting in falls and consequent fall-induced injuries. Several recent studies have examined how different factors affect drop-off detection with the long cane. Cane users detected drop-offs more reliably when they used the constant-contact technique than when they used the two-point touch technique, particularly if they were inexperienced cane users respectively (Kim, Wall Emerson, & Curtis, 2009; Kim, Wall Emerson, & Curtis, 2010a). Younger cane users and those with earlier-onset visual impairments detected drop-offs better than older cane users and those with later-onset visual impairments (Kim, Wall Emerson, & Curtis, 2010b). However, drop-off detection performance with a standard marshmallow tip was similar to that with a marshmallow roller tip (Kim, Wall Emerson, & Curtis, 2010c). In addition, a cane length difference of 10 inches did not result in a significant difference in drop-off detection (Kim & Wall Emerson, 2012). In respect to obstacle detection, La Grow, Blasch, and De l'Aune (1997a) reported that participants achieved the greatest detection distance for foot-level objects (those that are not higher than the ankle) when the hand holding the cane was held at the midline and positioned below the waist. In another study, La Grow, Blasch, and De l'Aune (1997b) also documented that the two-point touch technique did not provide consistent surface previewing for four of seven participants. Wall and Ashmead (2002) found that pivoting the wrist when swinging the cane resulted in better body coverage than did moving the whole arm. The reliability of traditional cane techniques for detecting obstacles is of particular interest because some of the previous studies reported path coverage rates that were inadequately low (61-69%) when the participants used the two-point touch technique (Uslan, 1978; Wall & Ashmead, 2002). Although one orientation and mobility (OM La Grow & Long, 2011). What is of additional interest is whether the constant-contact technique indeed has an advantage over the two-point touch technique in detecting low obstacles. Such claims have been made by many cane users based on the fact that the cane tip stays in contact with the walking surface at all times when the constant-contact technique is used. However, these claims have been solely based on anecdotes and have not been examined empirically. The purpose of the present study was to examine how reliable the traditional cane techniques are for detecting obstacles and whether the type of cane technique affects obstacle detection as it interacts with the height of the obstacles. [FIGURE 1 OMITTED] METHOD Study design and recruitment criteria A repeated-measures design with block randomization was used for the study. We recruited 14 sighted students (7 female and 7 male) aged 22 to 62 (median age = 26) from Western Michigan University's (WMU) O&M program. The participants were familiar with both the two-point touch and the constant-contact techniques and their cane use experience ranged from one month to four months (median experience = four months). …

Use of a cane for recovery from backward balance loss during treadmill walking

Purpose. To study whether a cane improved balance recovery after perturbation during walking.Method. This study was a crossover comparison comparing the effect of walking with and without a cane for balance recovery after perturbation during treadmill walking. Five normal young volunteers participated. The velocity and acceleration of a marker sited on the seventh cerebral vertebra (C7) and vertical hand motion were measured by a motion analysis system.Result. When using a cane, C7 backward velocity increased by approximately 15% (413 SD 95 mm/s with cane vs. 358 SD 88 mm/s without). In addition, C7 backward acceleration increased by approximately 23% (3.2 SD 0.7 m/s2 with cane vs. 2.6 SD 0.8 m/s2 without) and the vertical motion of the right hand decreased (187 SD 98 mm with cane vs. 372 SD 260 mm without). Additionally, no subject was able to use a cane to broaden their base of support.Conclusions. The ability to limit trunk extension is crucial for preventing falls. Therefore, using a cane jeopardizes recovery from backward balance loss. The results encourage further research on the risk of a cane on balance recovery for the elderly population and habitual cane users.

Effect of Cane Length on Drop-off Detection Performance

Although individuals who are blind have used a stick or a cane for their independent travel since the early years of human history, designs for modern long canes did not appear until World War II, when the systematic long cane techniques were developed by Hoover (1962). Ergonomic factors, such as the length of the cane, may affect how well a cane user can detect the presence of obstacles and changes in surface elevation, including drop-offs. Reliable drop-off detection with a long cane, an essential component of surface preview (Blasch, La Grow, & De l'Aune, 1996), is critical for the safety of travelers who are blind who use canes, since missing drop-offs or other changes in elevation in the walking surface may cause them to fall or accidentally stumble into the collision path of approaching vehicles. Kim, Wall Emerson, and Curtis (2009) found that cane users were able to detect drop-offs more reliably when they used the constant contact technique than when they used the two-point touch technique. The characteristics of cane users may also influence the users' performance in detecting drop-offs. In Kim, Wall Emerson, and Curtis's (2010a) study, younger users were able to detect drop-offs more reliably than were older cane users. Cane users who lost their vision early in life also detected drop-offs more reliably than did those who lost their vision later (Kim et al., 2010a). In addition, those who had regularly used a cane for at least two years performed better than did those who were less experienced (Kim, Wall Emerson, & Curtis, 2010c). Detecting drop-offs may also be influenced by ergonomic factors, such as the type of cane tip (Kim, Wall Emerson, & Curtis, 2010b) and length of the cane (Rodgers & Wall Emerson, 2005). How the length of a cane may affect the detection of drop-offs is of particular interest because there appear to be different opinions on this matter among cane users. According to the traditional method (called the method), a proper cane length is defined as the vertical distance from the ground to 2 inches above the xiphoid process (La Grow & Weessies, 1994). In a study conducted with 10 adult cane users who were visually impaired (that is, those who were blind or had low vision), Rodgers and Wall Emerson (2005) reported that the use of a standard-length cane, measured by the sternum method, allowed the users to detect drop-offs significantly better than with the canes that were either 5%-15% shorter or 10%-20% longer than the standard length. However, some cane travelers have advocated for a cane that is substantially longer than the standard length. For example, Willoughby and Monthei (1998) suggested that although a cane user' s stride, walking speed, and reflexes should be considered, a cane that reaches only to the sternum is not long enough to ensure safety for an average cane user. In addition, Kish (2009) suggested, on the basis of personal anecdotal experience, that children up to age 6 should use canes that are as long as their height and that adult travelers need to use canes that are about chin high. Given this controversy, we investigated whether the length of the cane affects the detection of drop-offs. We also examined whether there is an interaction between the length of a cane and the depth of a drop-off. METHOD A repeated-measures design with block randomization was used for the study. We recruited 15 sighted students (13 female and 2 male) aged 22 to 55 (median age = 34) from the orientation and mobility (O&M) program at Western Michigan University who were familiar with both the two-point touch and constant contact techniques. These students had received 1 month to 4 months (median = 1.4 months) of cane training. A 32-foot-long walkway with six carpeted plywood platforms (8 feet long, 4 feet wide, and 8 inches high) was used for the study. We placed two plywood boards (2 feet long and 4 feet wide) on top of braced rectangular frames (2 feet long, 4 feet wide, and 2 inches high) against the lengthwise end of the walkway to change the depth of the drop-off from trial to trial. …

The effect of cane use method on center of mass displacement during stair ascent

The aim of the study was to examine the effect of forward and lateral cane placement on displacement of whole body center of mass (COM) and spatial relationship between COM and the cane during stair ascent (SA) in healthy adults. The data were obtained using three-dimensional motion analysis while ascending stairs non-reciprocally with following methods: (1) dominant foot stepped up first, then the opposite foot without a cane (NC); (2) forward placement of a quadricane followed by the ipsilateral foot, then contralateral foot (FCI); (3) forward cane placement followed by the contralateral foot, then ipsilateral foot (FCC); (4) ipsilateral foot stepping up first, followed by the contralateral foot, then the cane (LCI); (5) contralateral foot stepping up, followed by the ipsilateral foot, then the cane (LCC). The results indicated that the cane placement had significant effect on the medial–lateral (ML) COM displacement and the kinematics of the trunk. Lateral cane placement requires greater trunk extension and side-flexion. The major differences between ipsilateral and contralateral cane use are the motions at frontal and transverse planes in which the COM displacement in ML direction is larger in ipsilateral cane use. The COM displacement in ML direction is larger in ipsilateral use of cane (LCI and FCI). The results of this study may help clinicians better understand the possible nature of balance control in patients who ascend stairs with a cane, and suggest that the method of cane placement should be taken into consideration by clinicians when teaching the cane user to ascend stairs.

Interaction Effects of the Amount of Practice, Preferred Cane Technique, and Type of Cane Technique Used on Drop-off Detection Performance

This study examined the interaction effects of the amount of practice and the cane technique used in drop-off detection with a sample of 32 adults who were blind. The advantage of the constant contact technique over the two-point touch technique was significantly greater for the less experienced cane users than for the more experienced ones.

Ergonomic Factors Related to Drop-Off Detection With the Long Cane: Effects of Cane Tips and Techniques

This study examined the effect of cane tips and cane techniques on drop-off detection with the long cane. Blind pedestrians depend on a long cane to detect drop-offs. Missing a drop-off may result in falls or collision with moving vehicles in the street. Although cane tips appear to affect a cane user's ability to detect drop-offs, few experimental studies have examined such effect. A repeated-measures design with block randomization was used for the study. Participants were 17 adults who were legally blind and had no other disabilities. Participants attempted to detect the drop-offs of varied depths using different cane tips and cane techniques. Drop-off detection rates were similar between the marshmallow tip (77.0%) and the marshmallow roller tip (79.4%) when both tips were used with the constant contact technique, p = .294. However, participants detected drop-offs at a significantly higher percentage when they used the constant contact technique with the marshmallow roller tip (79.4%) than when they used the two-point touch technique with the marshmallow tip (63.2%), p < .001. The constant contact technique used with a marshmallow roller tip (perceived as a less advantageous tip) was more effective than the two-point touch technique used with a marshmallow tip (perceived as a more advantageous tip) in detecting drop-offs. The findings of the study may help cane users and orientation and mobility specialists select appropriate cane techniques and cane tips in accordance with the cane user's characteristics and the nature of the travel environment.

Assessment of canes used by older adults in senior living communities

The purpose of this cross-sectional study is to provide basic but essential information about how older cane users obtain their canes and how they use these canes for their daily mobility, since there is still lack of information on these areas. Ninety-three older (≥65 years old) subjects who use canes for daily activities were recruited from four assisted living facilities and five retirement centers for this cross-sectional study. The assessment involved interviewing cane users with a questionnaire, examining their canes, and investigating how these canes were used by their owners during ambulation. The commonly used canes are (from most to least): adjustable single-tip, un-adjustable (wooden), small quad, and large quad. Five major problems from data analysis were identified: lack of medical consultation for device selection/use, incorrect cane height/maintenance, placement of cane in improper hand, inability to maintain the proper reciprocal gait pattern, and improper posture during ambulation. Only forward-leaning posture during ambulation might be associated with increased falls among the older cane users. Knowledge of these problems could assist health professionals to implement appropriate interventions in clinical settings and to provide community service to address all problems related to cane use.

Analysis of user characteristics related to drop-off detection with long cane

This study examined how user characteristics affect drop-off detection with the long cane. A mixed-measures design with block randomization was used for the study, in which 32 visually impaired adults attempted to detect the drop-offs using different cane techniques. Younger cane users detected drop-offs significantly more reliably (mean +/- standard deviation = 74.2% +/- 11.2% of the time) than older cane users (60.9% +/- 10.8%), p = 0.009. The drop-off detection threshold of the younger participants (5.2 +/- 2.1 cm) was also statistically significantly smaller than that of the older participants (7.9 +/- 2.2 cm), p = 0.007. Those with early-onset visual impairment (78.0% +/- 9.0%) also detected drop-offs significantly more reliably than those with later-onset visual impairment (67.3% +/- 12.4%), p = 0.01. No interaction occurred between examined user characteristics (age and age at onset of visual impairment) and the type of cane technique used in drop-off detection. The findings of the study may help orientation and mobility specialists select appropriate cane techniques in accordance with the cane user's age and onset of visual impairment.

Drop-off Detection with the Long Cane: Effects of Different Cane Techniques on Performance

This study compared the drop-off detection performance with the two-point touch and constant contact cane techniques using a repeated-measures design with a convenience sample of 15 cane users with visual impairments. The constant contact technique was superior to the two-point touch technique in the drop-off detection rate and the 50% detection threshold. The findings may help an orientation and mobility instructor select an appropriate technique for a particular client or training situation.

Biomechanical Analysis of the Effects of Canes of Different Length and Mass on Posture and Gait in Persons who are Blind

PURPOSE: The purpose of this study was to determine the effects of cane use of different lengths and masses on gait patterns in blind individuals (traditional (T) and non-traditional (NT) cane users) and sighted individuals (S). METHODS: Participants (n=30) volunteered for this study from the Lion's World Services in Little Rock, Arkansas, from Louisiana Center for the Blind in Ruston, and from Louisiana Tech University. A 2D Motion Capture System was used to record the motion and ground reaction forces of the participants during gait. Differences in the mean peak kinematic variables and kinetic variables were statistically analyzed (P<0.05) using a MANOVA. RESULTS: Significant differences in the gait patterns were found among S, NT and T with similar gait patterns found between the NT and S. Mean peak for the hip angle during the swing phase was significantly different between T (189 ± 6rad) and S (198 ± 9rad). Mean peaks for the elbow angle during swing phase and stance phase were significantly different between NT (77 ± 30rad and 111 ± 13rad) and S (145 ± 7rad and 167 ± 9rad). CONCLUSIONS: Traditional cane users exhibit a different control over foot placement, gait velocity, and trunk motion. A more upright posture was found between S and NT. The current study established that cane length has an effect on gait patterns. Additional research is necessary to determine if alterations in gait patterns due to cane length may predispose individuals to injury

Mobility Assistive Device Utilization in a Prospective Study of Patients With First-Ever Stroke

Jutai J, Coulson S, Teasell R, Bayley M, Garland J, Mayo N, Wood-Dauphinee S. Mobility assistive device utilization in a prospective study of patients with first-ever stroke. Objective To estimate the extent to which clinical and functional features of stroke were related to the use of mobility assistive technology devices. Design Longitudinal study of quality of life after stroke. Setting Hospitals, rehabilitation centers, and universities in Ontario and Quebec. Participants Subjects (N=316) with confirmed initial stroke were included in this analysis. Fifty-eight percent of the overall sample were men (n=184). The mean age of this sample at the time of the stroke ± standard deviation was 65.3±15.3 years (range, 19–96y). One hundred thirty-five patients received a mobility assistive device poststroke, and 181 did not. Intervention Assistive devices for mobility (canes, walkers, wheelchairs). Main Outcome Measures Assistive device use and mobility capacity. Results Mobility device nonusers were less physically disabled than device users on a variety of measures. Poor physical functioning but good cognition were reliably associated with mobility device use. Use of multiple mobility assistive devices was more often associated with poorer physical functioning than was single device use. For single device users, wheelchair use was predicted by cognition, functional independence, and stroke recovery. Cane users, compared with walker users, had better mobility and were less physically impaired by stroke. Conclusions Patients were well matched to device type based on their mobility capacity. The findings of this study suggest that assistive device prescription-outcome relationships in stroke can be effectively and meaningfully modeled.

Extended Multisensory Space in Blind Cane Users

In the present work, we investigated whether an auditory peripersonal space exists around the hand and whether such a space might be extended by a brief tool-use experience or by long-term experience using a tool in everyday life. To this end, we studied audio-tactile integration in the space around the hand and in far space, in blind subjects who regularly used a cane to navigate and in sighted subjects, before and after brief training with the cane. In sighted subjects, auditory peripersonal space was limited to around the hand before tool use, then expanded after tool use, and contracted backward after a resting period. In contrast, in blind subjects, peri-hand space was immediately expanded when they held the cane but was limited to around the hand when they held a short handle. These results suggest that long-term experience with the cane induces a durable extension of the peripersonal space.

'But i don't read text printed in braille font'...

The author works in Coventry University and has been engaged in tutoring a student with disabilities who had enrolled for a degree in Business and IT at Coventry University. To do this, the author drew upon previous experiences in the Further Education (FE) sector at a College in the Midlands, where she taught Information Technology (IT) to diverse groups of students who had varied abilities. The ages of the FE students ranged from pre-16, visiting the College from a local special school to attend "taster" sessions, to adults, some of whom were seniors, attending a day centre for disabled adults that had a special arrangement for College tutors to give classes. The degree student was a white cane user, read Braille and navigated the computer with screen reader software. During her time at University, she took on an ambassadorial role: she gave guided tours to prospective students around the University campus during open days! From time to time she would recount stories that she described as amusing but which clearly showed ignorance on the part of her tutors. The title of this presentation is taken from one of her anecdotes. The Degree course in Business and IT had several workshops in Computing including statistics where spreadsheets and specialist software were used. The author was asked to tutor the student for the IT workshops of a year-long module. This included translating the instructional handouts from mouse-based to keyboard-based, being aware of potential problems with specialist software and the quirks of the online learning system (WebCT) [1] and finding ways of working around them all. This poster shows some of the issues related to the student's stories, the creating and translating of instructions for keyboard use and navigating the keyboard using JAWS.

Is the shortcut the quickest way to go?

The author works in Coventry University and has been engaged in tutoring a student with disabilities who had enrolled for a degree in Business and IT at Coventry University. To do this, the author drew upon previous experiences in the Further Education (FE) sector at a College in the Midlands, where she taught Information Technology (IT) to diverse groups of students who had varied abilities. The ages of the FE students ranged from pre-16, visiting the College from a local special school to attend "taster" sessions, to adults, some of whom were seniors, attending a day centre for disabled adults that had a special arrangement for College tutors to give classes. The degree student was a white cane user, read Braille and navigated the computer with screen reader software. During her time at University, she took on an ambassadorial role: she gave guided tours to prospective students around the University campus during open days! From time to time she would recount stories that she described as amusing but which clearly showed ignorance on the part of her tutors. The Degree course in Business and IT had several workshops in Computing including statistics where spreadsheets and specialist software were used. The author was asked to tutor the student for the IT workshops of a year-long module. This included translating the instructional handouts from mouse-based to keyboard-based, being aware of potential problems with specialist software and the quirks of the online learning system (WebCT) [1] and finding ways of working around them all. This "tips and techniques" session gives an account of some of these issues around the student's stories, creating and translating instructions for keyboard use navigating the keyboard using JAWS, and includes proposed solutions.