TECH


Assistive Technology I’ve Used

This page gives an overview of the assistive technology I’ve used over the years as a high-level quadriplegic. These tools have helped me control computers, play games, and stay connected with the world.

Introduction to Accessible Technology

My introduction to assistive technology began in 2005, when my dad took me to C.A.R.T. (Center for Applied Rehabilitation Technology) at Rancho Los Amigos.
Before my injury, it was almost a badge of honor not to use technology—I didn’t want a pager,
a cell phone, or a computer. After my injury, technology became the place my mind could go during the
many years I spent in bed.

At C.A.R.T. I tried several devices, but the one that stuck was SmartNAV by NaturalPoint. It allowed me to put the cursor anywhere on the screen by moving my head. Paired with a sip-and-puff switch for clicking, it opened up the computer world to me.

You can learn more about C.A.R.T. here: Center for Applied Rehabilitation Technology (C.A.R.T.) at Rancho .

My first personal computer was a Dell desktop running Windows 7 with (if memory serves) an 80 GB hard drive. The SmartNAV device plugged into USB, and the sip-and-puff switch plugged into a 3.5 mm jack on the SmartNAV. With those tools and an on-screen keyboard, I could navigate most of what I wanted on either a PC or an iMac.

Today I no longer need SmartNAV because Head Pointer is built into macOS (starting with Catalina and beyond). I’m now on macOS Sequoia 15.7.

Pointing & Clicking Systems

SmartNAV by NaturalPoint

  • Platform: Originally for PC, later made Mac-compatible with RJ Cooper’s software.
  • Placement: Sits on top of the computer monitor, angled downward at your head.
  • How it works: I wore glasses with a reflective dot in the middle; moving my head moved the cursor.

Even after many years, my original SmartNAV device still works—proof that some hardware can really go the distance.

Sip-and-Puff Switch

My sip-and-puff switch was custom made by Ken Y. (RIP). Tubing was fashioned from a cut-up nasal cannula.

  • Sip – Left click
  • Puff – Right click
  • Long sip – Drag and drop

The switch plugged directly into the side of the SmartNAV unit. This combination gave me full mouse control
with just head movement and breath.

Important safety note: If you have anything touching your face or in your mouth—like tubing for sip-and-puff—be sure
it’s non-toxic and that you’re not allergic to the material.

QuadControl

QuadControl was another device created by Ken Y.. It was designed as a controller
for PlayStation and Xbox. Sadly, it’s no longer available, but it was an important stepping stone in my
journey into adaptive gaming.

QuadStick

The QuadStick, created by Fred Davison, took the ideas behind QuadControl
and improved on them significantly.

  • Compatibility: PC, Mac, PlayStation, Xbox
  • Approximate cost: $549 USD
  • Functions:
    • Controls PC and Mac cursor, mouse, and keyboard
    • Can be used as a controller on Xbox (with an adapter) and on PlayStation (no adapter needed)
    • Highly programmable with a deep configuration system (powerful, but can be complex)

The price may seem high, but considering everything it can do across multiple platforms,
it’s absolutely worth it for many people.

There are some high-level quadriplegics doing amazing things with the QuadStick in video games.
You can watch examples here: QuadStick Videos.

Apple iMac & macOS Accessibility

Since 2006 I’ve used three different iMacs, all of which have worked well for my needs.
The most recent one finally has the built-in accessibility features that let me do almost anything I want
on a computer without external pointing devices.

Current iMac Setup

  • Model: 2024 24-inch iMac
  • Processor: Apple M4 chip
  • OS: macOS Sequoia 15.7.2

I plan to purchase an adapter so I can bring my sip-and-puff switch back into the mix,
but I’ll still rely heavily on Voice Control and the Dwell Panel.

Accessibility Features I Currently Use

  • Voice Control – Helps with navigation and dictation.
  • Head Pointer – Controls the cursor using head movement. Requires decent neck range of motion.
  • On-screen keyboard – Allows manual typing and access to the Dwell Panel.
  • Panel Editor – Used to build custom keyboards and accessibility panels.
  • Dwell Panel – Extremely powerful when combined with Head Pointer for left/right click, drag & drop, and scrolling.
  • Facial Expressions – Lets you assign actions to specific facial movements and choose sensitivity: slight, default, or exaggerated.

Facial Expression Settings (macOS)

Path: System Settings > Accessibility > Pointer Control > Alternate Control Methods > Head Pointer.
Then click the little circled “i” icon > Camera Options.

Here’s how I currently have my facial expressions mapped:

  • Pucker Lips Left – Unassigned
  • Smile – Unassigned
  • Pucker Lips Right – Unassigned
  • Pucker Lips Outward – Drag and Drop
  • Eye Blink – Right click
  • Raise Eyebrows – Double click
  • Scrunch Nose – Unassigned
  • Open Mouth – Left click
  • Stick Out Tongue – Pause or Resume Head Pointer

This combination of head movement, voice commands, and facial expressions lets me use the Mac in ways that previously required external
hardware like SmartNAV.

Amazon Echo & Voice-Controlled Home Devices

We have three Amazon Echo devices in the house. They’re far from perfect, but they’re
a nice luxury for someone who depends on everything except being able to speak and chew food independently.

Echo in My Room

The Echo in my room allows me to:

  • Set timers
  • Listen to music and audiobooks
  • Get weather updates
  • Turn on lights, the ceiling fan, and an oscillating fan
  • Control the TV:
    • Turn it on
    • Choose apps (YouTube TV, YouTube, Plex, Netflix, Prime Video)
    • Play, pause, fast forward, skip, and adjust volume

When it works, the TV and volume control are really nice. It’s not consistently great
with blinds and some of the TV options, but when it behaves, it’s a game changer.

Echo in the Front Room

There’s another Echo in the front room where my parents spend much of their time. If they can’t hear me
yell from my room, I’ll use the “Drop In” feature as an intercom to get their attention.

Echo on the Back Patio

We also have an Echo on the backyard patio so Shawn can spend his mornings outside without disturbing me.
When I wake up, I simply “Drop In” on him through the Echo to check in or chat.

Physical Setups Over the Years

Hospital Tray Setup

For many years I used a hospital tray as my primary workspace, computing while lying in bed.
I rarely used the computer while in my wheelchair.

Hoyer Lift as a Tech Rig

Around 2017, Shawn and I built a setup that mounted two monitors and a speaker system onto a modified Hoyer lift. It looked a bit like a sci-fi rig:

  • The electronics were suspended above me on the lift arm.
  • I often worried the metal might snap and impale me.

With my most recent iMac, we updated the setup. We reused the Hoyer lift with a different dual-monitor mount, and Shawn:

  • Unhooked the hydraulic lift cylinder
  • Flipped the top bar over for a lower center of gravity
  • Made the whole rig more maneuverable

The new system still isn’t perfect, but now if something breaks, it’s more likely to give me a broken nose than a serious injury. I’ve got more ideas for improving it, because
like most accessibility setups, it evolves over time.

Closing Thoughts

Assistive technology—whether it’s SmartNAV, a sip-and-puff switch, QuadStick, macOS accessibility features, or a few well-placed Amazon Echo devices—has given my mind somewhere to go and something to do.
Each tool has its quirks, but together they give me real independence and a way to participate in
digital life on my own terms.