We’ve been looking at methods of computer access for a young boy (age 7) with athetoid cerebral palsy, and he’s evaluated quite a few options. The most promising method was an old Interface Designs switched joystick connected via a USB Mouse Mover interface, which he controls with his right hand. He clicks with a head switch. ‘Billy’ (not his real name) has been using this in school since January 2009 and he is now an expert: he can write using Clicker (both with a word bank and an on-screen keyboard); he can draw and paint with 2Simple Paint; he can access the internet; he can get navigate folders, use the Start menu to start programs, choose menu items, and adjust settings. I'm not quite sure how he manages it, but he does, and very quickly and accurately too.

The problem with this joystick is it’s no longer made, so I wanted to find an alternative that we could actually buy. Most joysticks are not like this one though - most are smaller, analogue (i.e. the more you push the stick, the faster the mouse pointer moves), and ungated.

So why does this stick work for him compared to, say, a Roller Joystick, which doesn’t, at all? I think there are three reasons:

• The joystick is large and clunky with a ‘gate’ – slots for forward, back, left and right. Billy has difficulty with fine motor control which means the Roller Joystick is almost impossible, whereas he can push the Interface Designs stick in the correct approximate direction and then the gate guides it into place.
• The stick has a long handle which he manages with relatively gross movements.
• The Mousemover interface has adjustable acceleration, which means the longer Billy pushes the stick, the faster the mouse pointer moves. This gives him really very good accuracy by pushing the stick for a short time and then releasing it, yet also quick movement around the screen by holding the stick on.

A few weeks ago I made a plastic gate for a Roller Joystick and Billy tried it out. It was much, much better than an ungated Roller Joystick but still not quite as fast and accurate as the Interface Designs/MouseMover combination – mainly I think because there is no control over acceleration (the Roller moves at full speed because Billy can’t do anything other than push it all the way).

I’ve been involved with lots of people like Billy over the years who can successfully control a gated stick but who struggle with an ungated, standard analogue stick and so this blog is to remind us all that Gates are Good (and could manufacturers please offer gates for their joysticks and/or come up with something similar to the Interface Designs device.)