Background: Luke is an individual who, due to a congenital condition, uses his lower extremity (LE) over his upper extremity to type with his feet (a toe-touch typing method). Even with proper seating and a personalized computer system, visual observation of his typing speed is too slow for an individual who wishes to go to college. Current literature does not provide evidence-based instructions on facilitating efficiency with speed and accuracy for toe-typing individuals. Based on the case above, what OT interventions can increase Luke’s typing performance?

Objective: This project aims to identify appropriate Occupational Therapy (OT) interventions to increase an individual’s lower extremities (LE) (hips/legs/feet/toes) typing performance to a college level, observe and facilitate other activities of daily living (ADLs) (tasks) performed using the LE, and, from these interventions, create a guide for providers and similar individuals to facilitate LE ADL performance.

ACOTE Area: The ACOTE areas are in the “Clinical” and “Research” Areas.

Methods: After informal interviewing, acquiring a designed custom chair by Biomedical Engineering students, and researching & acquiring a better computer system through an OT Independent Study, this mixed-method, single-subject study evaluated the impact of a modified typing program from Typing.com and standard Occupational Therapy interventions to improve typing performance using the lower extremities. The participant was recruited via email and provided verbal consent in person. The study occurred in the participant’s home. Typing performance was tracked using Typing.com across 34 lessons, and the intervention’s effectiveness was measured using a 5-minute typing test, Pre-Post Test. The participant signed an AV Release for videography, which would be turned into 2D figures to describe the individual’s positioning without identifying him. After the intervention period, quantitative data were analyzed using Excel, and qualitative data from SOAP notes were summarized and synthesized to find the most effective interventions to increase his toe-touch typing speed.

Results: Over 8 Weeks, Luke’s typing speed increased by 300%, and typing accuracy increased by 16.25%. Luke finished 76.8% of lessons. Typing.com data showed consistent improvement in performance. Most typing errors occurred due to his non-dominant left lower extremity, likely due to no previous bilateral lower extremity task-based interventions provided.

Conclusions and Relevance: With the introduction of a new protocol, this pilot study highlights the impact of occupational therapy interventions on lower extremity task performance. With a 300% increase in typing speed, the case demonstrates the following: a greater sense of urgency to develop a creative client-centered intervention with documentation when a presentation is not reflected in given protocols or scope of practice, a reminder for Occupational Therapists to maintain lower extremity and global biomechanical, clinical competency for treating physical dysfunction, emphasizes the value of interprofessional collaboration (OTs, PTs, and BMEs), the need for continued further research to uncover more this population to create remedial, adaptive, client-centered interventions for all LE performers, and established how a single case study can become the pilot study to broaden a provider’s scope of practice dramatically.