Supporting effective alternative access for individuals with physical disabilities: state of the science, emerging technologies, and future research directions.

The review focused mainly on typing speed and accuracy, not comfort, ease of use, satisfaction, psychosocial impact, goal attainment, or AAC usage. Group averages hide very wide individual ranges, so a method's average speed may not predict one patient's performance. Touchscreen typing data came from only 2 studies, so the comparison with standard keyboards needs more data. Multimodal evidence is limited: of 34 studies, only 5 collected data from people with physical disabilities, and many were laboratory feasibility tests. When access methods were combined, the review did not show which component was responsible. The fastest brain-computer interface results came from implanted research devices that require neurosurgery and are not publicly available. Assessment evidence is emerging: few studies evaluated outcomes of different models, and many models do not specify or measure outcomes. The review did not address equity, funding, or availability of access methods and support. Some tools may be too time-intensive for routine practice, such as a switch access measure requiring at least 13 hours of training.

No author conflicts of interest or funding declaration is included in the supplied text. The publication types list research support, non-U.S. Gov't.

Do not choose an access method from group averages alone. The review found wide individual ranges, and many multimodal and brain-computer interface options were tested only in laboratory settings.