Gaming with ALS

For my sins, I am afflicted with Amyotrophic Lateral Sclerosis (ALS) or Motor Neurone Disease (MND) as we call it on this side of the pond. We like to be different. Stephen Hawking is probably the best known sufferer of this condition. He has the form of the disease which allows you to breathe and eat after you are paralyzed. That's not the kind that I have.

Still, one thing that we have in common is that we don't wish the disease to define us. Hawking has said that he's not very interested in his disease, and I'm not either. He likes pondering on the deep questions of the universe, I like playing games. Gaming is a good pastime for the disabled. Pondering doesn't need much specialist equipment, though, whilst most gamers never shut up about theirs. So here's a discussion about mine.

My Current Limitations

At present. I can move a mouse, but I can't click it easily as my fingers are too clumsy. I can use a keyboard only with great difficulty. I can move my legs and head. My speech is slow but mostly comprehensible.

Hardware

USB footswitch with 3 foot pedals. I got mine off eBay for about a tenner.

This is useful because I can still move my feet and even though feet aren't very dexterous (by definition) they are fine for pressing pedals. I use this to simulate mouse clicks.

Software for controlling games

The footswitch can be bound to various keys depending on the application, so you can have different bindings for each game. You can do this with the supplied application, but it's a bit limited, not to mention Chinese. What I have done is to simply bind the pedals to mouse buttons 1, 2, and 3 as you can see in the screenshot below (this is binding pedal 1).

The ability to bind the pedals flexibly comes from a free application called X-Mouse Button Control, which will intercept mouse clicks and map them to any keyboard keys I choose. So far I've stuck to pedals 1 and 2 as left and right mouse clicks. But the third pedal is more interesting. By default I have that pedal bound to Page Down, so that I can read eBooks and surf the web easily, but in games or other applications I have it available.

Software for communication 

This is in a separate section because not all games need it, but if you're playing online, especially MMO's then communication is important.

For text input, I use Dasher, another piece of free software, which allows you to input text by navigating through words just using the mouse. With practice you can get up to 30 words per minute. There's a Google TechTalks video showing why it's such an efficient method of text entry here. However, it's awkward for corrections and the function keys so I use the onscreen keyboard as well.

I don't currently play any games in which I use voice comms,and my voice is still comprehensible, but if necessary, Dasher can be set to speak the text I've written, which could in turn be routed to a microphone. I haven't tried it yet though.

Future Plans

Since mine is a progressive condition, I need to consider the end game, namely how I'll control games when I'm completely paralyzed. MND doesn't usually affect the eyes, so I should be able to use eye gaze to move the mouse. However, eye gaze is not ideal for making quick selections. Normally eye gaze systems use dwell clicking, where you need to hold your gaze over the area for a second or two before it clicks. That's a bit slow for MMO's, though it might be okay for strategy games.

So I'll need a better means of clicking. It's likely that I'll have a few muscles working which can be attached to input switches, but if not, I'll still have my brain. I have an Emotiv Epoc, which is a commercially available brainwave reader. It allows up to 4 different brain states to be mapped to keystrokes via the supplied Emokey application. Then, I can use X-Mouse button Control as at present. Moving with my eyes and clicking with my brain. Sorted.

Game Reviews

I'm going to give brief reviews for the games that I've played. I'm not going to review the games themselves, only how easy I have found them to play using this setup. Games are rated out of 5, losing a point for each major infelicity that I come across.