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best for them according to their goals, and get trained in their use. If returning to an existing job is a priority, access to adaptive technologies in rehab can move that process along much more quickly.
    Computers contribute in four areas.
     

    Control of mobility. Power wheelchairs have evolved in quality and flexibility. Speed and acceleration can be finely controlled. Voice-controlled wheelchairs are not far off. Digital controls for vans are also making driving an option for more quadriplegics.

    Control of the environment. Commercial products allow remote control of doors, lights, telephones, or almost any electrical device from the wheelchair. The remote controller might be a keypad similar to the television remote control or a puff-and-sip device for people with limited arm use.

    Communication. The Internet connects people to the world. It has discussion groups and is a powerful resource and research tool. For those with limited ability to get out of the home—however temporary—the Internet can become a place of community and support. It can extend the rehab process by helping people discover possibilities they didn’t know existed.

    Vocational possibilities. Research has shown that computer skills erase the pay gap that people with disabilities otherwise experience in the job market. Adaptive keyboards and voice control systems provide full computer access and thus access to jobs that have nothing to do with physical labor. Many rehab centers with fully equipped computer labs include computer training during the inpatient rehab experience.
    Nontraumatic Disabilities
     
    Someone in an accident who acquires a spinal cord or brain injury will find himself in a medical facility and will generally be transferred to a rehabilitation services program. But what of people with a condition from birth, such as muscular dystrophy or spina bifida, or with a progressive condition that appears later, such as multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS)? How are they helped to adapt to a disability, particularly when the progressive nature of a condition demands continuing adjustment?
    Organizations dedicated to specific disabilities sponsor services at major medical centers or sometimes finance their own facilities. The National Multiple Sclerosis Society is very active in making support available nationwide, as are the Muscular Dystrophy Association, American Syringomyelia Alliance Project, United Cerebral Palsy, and the Spina Bifida Association, among others. If you are facing a late-onset progressive disability, your doctor should refer you to such sources. However, doctors are not always well informed about what options are available for you. You might need to research such programs on your own. These groups and services may be able to help you adapt to the condition in ways that your present doctor might be unaware of, and may possibly even reduce the progression or impact of the condition by informing you of recent advances in research.
    For example, Shepherd Center in Atlanta has established an MS center—one of 32 in the US—that provides both inpatient and outpatient services. Shepherd Center is a medical unit with staff members who are capable of diagnosis and treatment and who participate in research and clinical drug trials, at the option of the client. A study published in the
Archives of Physical Medicine and Rehabilitation
found clear benefits to a period of inpatient rehabilitation for people with MS. People in the group with intensive treatment learned greater degrees of adaptive skill and came out with better attitudes about their ability to function with MS than did the group who came as outpatients. 1
    People with MS or ALS typically establish a working relationship with a neurologist. However, if the neurologist is attending to many people with other conditions, she might not gain the same detailed experience as someone working in rehab who spends her time with people with a given