When David Pogue was diagnosed in 1996 with wrist synovitis -- a painful, largely untreatable inflammation of the lining of the wrist joint -- his doctor recommended he quit writing and playing the piano to relieve the pain.

That wasn't acceptable to the patient. "I only do two things in life," said Pogue, who writes a weekly New York Times column on consumer technology and pumps out several books a year -- on topics as diverse as opera and Macintosh computers. "I write and I play the piano."

While Pogue cut back on the latter, he looked for another writing solution. He tried dictating to a stenographer. "It was fine for laying down the text," he said, but polishing his work proved a nightmare for both him and his assistant.

Ultimately, the Connecticut-based scribe found an answer in what was then only an emerging technology: computer software that transforms speech into electronic text. Pogue suffered through several generations of primitive programs that required him to speak slowly and haltingly into his computer. But he adapted, and the technology improved. Today, Pogue said, voice recognition software allows him to turn out clean and error-free copy at nearly twice the speed the typical person types.

"It freaks people out," said Pogue, who has no financial ties to the software firms. "No one knows that a tool like this exists. It's absolutely jaw-dropping."

To be fair, Pogue's work as a tech reporter gives him an advantage over many people in terms of adaptability. Still, the coming of age of voice recognition products is good news, particularly for those worried that an injury -- even a temporary one, like a broken arm or a sprained wrist -- could cost them their jobs by keeping them from their keyboards. Should a hand-related injury or a motor-skills problem cramp your style, a new generation of moderately priced, user-friendly devices may get you back to your computer sooner than you -- or your boss -- thought possible.

Look, Ma, No Hands

Since the mid-1980s, high-tech devices that "hear" what a user says and turn the spoken word into electronic text have held out promise to amputees, upper-body paraplegics and others unable to type or manipulate a mouse, according to Kristine Neuber, an assistive technology specialist and director of George Mason University's Helen A. Kellar Institute for Human Disabilities in Fairfax. The institute provides training and technical assistance to students with disabilities and their teachers. Like Pogue, Neuber said the early programs' reputation for intractability was well-deserved.

Not only did they require users to speak at an unnatural pace, they also turned out documents riddled with errors -- for instance, typing "ice cream" when the user said, "I scream." By and large, only people with the most severe disabilities -- and few other options -- were willing to put up with the glitches, Neuber says.

The software also was prohibitively costly.

Today, much of that has changed. Voice recognition software packages priced at $10,000 and up a decade ago can now be purchased for less than $200. And they no longer require users to speak as though a listener were jotting their words in longhand.

While most of the off-the-shelf products were not designed specifically for people with disabilities, they can be a boon to anyone struggling to use traditional computer equipment, according to Michael Young, manager of the Computer/Electronic Accommodations Program, a free Defense Department service that matches people with specialized equipment needs to the appropriate assistive technology.

Juliette Rizzo, communications director of the Office of Special Education and Rehabilitation Services at the U.S. Department of Education, agrees. Five years ago, she began using a voice recognition program that allows her to continue working when her arthritis flares up and typing becomes painful.

"People in the office enjoy watching me use it," she said. "They see how easy it is and wish they had it on their computers."

Karen Jacobs, a Boston-based occupational therapist and a spokeswoman for the American Occupational Therapy Association, said the learning period for speech recognition software is short enough that it's become a practical option even for those with short-term impairments.

"People hurt their hands all the time," said Jacobs, who, like many in her field, is seeing an increase in patients with hand-related injuries stemming from computer overuse. (The retractable leashes many people use to walk their dog are another notable culprit, since they can strain a user's index finger and twist the wrist, she said.) "For people who take the time to do the training -- and we're talking about a half-hour or an hour -- [voice recognition software] is fantastic," she said.

Consumers can choose among voice recognition products that can be downloaded onto a standard laptop or desktop computer. But most accessibility experts, including Neuber and Jacobs, strongly favor several products made by ScanSoft.

ScanSoft's Dragon NaturallySpeaking Preferred -- boasts a 99 percent accuracy rate and an ability to take dictation at up to 160 words per minute. It sells for about $200.

Young said he prefers NaturallySpeaking Professional Solutions 7, which costs several hundred dollars more. This version can respond to more-sophisticated voice-activated commands, like moving through fields in databases and forms.

According to the ScanSoft's specifications, NaturallySpeaking requires a 500 MHz processor and 128 MB of RAM. But Neuber recommends a more powerful computer -- an 800 MHz processor with at least 512 MB RAM -- for optimal performance. The program is available only for Windows.

Speak Easy

Setting up NaturallySpeaking, like any other program, requires some manual dexterity. In addition to opening the box and sliding the CD into the computer -- tasks easier said than done for someone wearing a cast, brace or sling -- a user must "train" the computer to understand his voice and speech patterns. This requires attaching a microphone (one comes with the software) to the computer.

The remaining prep work is hands-free, requiring only that the user read a short series of passages aloud into the mike. After about five minutes, the system will have processed the particulars of the user's voice and be ready to obey voice-activated formatting commands, take dictation and even follow directions for accessing e-mail and surfing the Web. (Earlier generations required nearly an hour of voice training.)

The program, unlike many people, will learn from its mistakes -- once it's told what it's done wrong. The system works hard to make sense of words that are not familiar to it. Thus, Ihad to retrain my computer during a demonstration not to "hear" my name, Rita Zeidner, as "read a wider."

But users may also learn from the software. Young maintains it's helped him become a better and more prepared speaker.

"I've learned to think ahead of what I say. If I don't, that software is going to type everything I say, whether I want it to or not."

(Users can easily direct the program to delete unwanted words and speech mannerisms, such as "um.")

Today, about 25 percent of NaturallySpeaking's customers rely on the product "for some type of assistive purpose," according to Robert Weideman, ScanSoft's senior vice president for marketing. Several users have multiple sclerosis and use the software to work around muscle spasms and tremors that get in the way of typing. Others use the software to stave off repetitive-motion injuries such as carpal tunnel syndrome or to prevent an existing condition from getting worse, he said. (The majority of customers, he said, simply don't want to type or rely on a stenographer.)

Nevertheless, most techies agree that despite dramatic improvements over the last decade, voice recognition may not be ready for the masses, and vice versa.

"There's very definitely a learning curve," said Pogue. "I made it work because I absolutely had no choice."

Mike Ebert, an Arlington-based technology policy consultant, said he learned about the limitations of voice recognition programs the hard way. After he broke several bones in his right hand during a kayaking mishap last summer, he hoped the off-the-shelf package he chose -- IBM's ViaVoice -- would make working at his computer easier while his hand healed in a cast. But he was disappointed when the software didn't respond to his commands. After giving it his best shot, he shelved it permanently.

"I found the technology was more frustrating than putting up with trying to type," he said.

Other Options

Struggling to use a standard keyboard or mouse, but don't like the idea of talking into a computer? Here are a few other low-cost alternatives:

* Check what you already have on hand.

The "Accessibility Wizard" housed within Windows is one of Microsoft's best-kept secrets, said Young. This feature offers options to users who find it difficult to hold down multiple keys at once (such as Control, Alt and Delete). The Wizard also permits computers to be set to ignore repeated keystrokes, a helpful feature for people with hand tremors. In addition, users can change their mouse from the traditional right-handed set-up, which relies on the left click to move the cursor, to its left-handed mirror image. Or they can do away with the mouse altogether and perform all mouse functions on the keyboard. The accessibility program is housed in the Accessories section of Windows. Price: Free with Windows software.

* Keyboard options

Oversized keyboards provide a solution for many with hand tremors or sensory defects; undersized keyboards with keys spaced close together allow someone with a small range of motion or use of only one hand to access all the keys. Some specialized keyboards include filters that allow commonly used words and phrases to be entered in a single keystroke. Price: $185 and up. Some products are available at office supply stores, but a wider selection is sold through specialty vendors. Contact the Alliance for Technology Access for a listing of products and sellers: 707-778-3011 (voice), 707-778-3015 (TTY); www.ataccess.org.

Specialty keyboards do have their detractors, however. Lilly Waters, a California-based motivational speaker who lost part of a hand in a childhood accident, said they draw attention to a disability -- the last thing many people, particularly children, want. As an alternative, she designed a system for speedy one-handed-typing she hawks over the Internet (www.aboutonehandtyping.com).

* Mouse options

Various styles of mice ease hand strain and may be easier for some with hand or arm difficulties. Trackballs work like upside-down mouse units and minimize the need for hand or arm movement by allowing the user to manipulate the cursor with a movable ball. Joysticks move the cursor with a lever-like device usually operated by the hand or feet. Flat mouse touchpads require only a light touch to move the cursor. Rizzo, whose fingers don't bend easily around a standard mouse, relies on a pen-shaped mouse she can hold in her hand and operate entirely with her thumb. Price: $50 and up at office supply stores and through specialty vendors.

* Low-tech options

Plexiglass keyboard covers that slip over the keys can prevent users from pressing more than one key at a time. Armrests that attach to a desk or chair stabilize the arm and wrist while typing. Price: $50 and up through specialty vendors. And don't overlook simple options like changing the angle of your keyboard by propping up the front or the back with a notepad or a book.


* The Computer/Electronic Accommodations Program (CAP) Housed in the Pentagon, the program provides needs assessments, training and equipment to federal employees; its staff will also provide free needs assessments to the general public. Teleconferencing equipment allows people outside the Washington area to receive guidance. Call for an appointment: 703-693-5160; TTY 703-693-6189.

* Helen A. Kellar Institute for Human Disabilities Located at George Mason University in Fairfax, the institute lets individuals try out the latest in assistive technology. Call for an appointment: 703-993-3670; http://kihd.gse.gmu.edu.

* University Legal Services Assistive Technology Program for the District of Columbia The program provides free training and information to expand awareness about assistive technology. The center also has an equipment lending program. 202-547-0198; TTY 202-547-2667; www.atpdc.org.

* Target Center The center, managed by the U.S. Department of Agriculture, provides free needs assessments, equipment demonstrations, training and assistance for federal employees. Check out the center's online newsletter on ergonomic safety. 202-720-2600; www.usda.gov/oo/target/ontarget.html.

Juliette Rizzo, in the U.S. Education Department's Office of Special Education and Rehabilitation Services, uses voice recognition software to do computer work despite arthritis. Cheaper, better technology makes it easier for the injured to stay connected. Many accessibility experts recommend products made by ScanSoft, such as Dragon NaturallySpeaking Preferred, a voice recognition program that boasts a 99 percent accuracy rate and an ability to take dictation at up to 160 words per minute. The product sells for about $200. A more expensive version can respond to more sophisticated voice commands.Oversized keyboards, like this one by IntelliTools, can make typing easier for children lacking in fine motor coordination or people with hand tremors. Price: about $395.Closer-spaced keys of the Magic Wand keyboard permit use by those with a small range of motion or only one hand to access the keys. Prices: from about $1,400 to $1,900. ZoomText, by Ai Squared, magnifies the display on a computer monitor so it can be easily seen by someone with low vision. Two versions, one a magnifer and the other a magnifier/screen reader, sell for about $500 and $700.Above left, a monitor display without magnfication. Above right, the display as magnified by ZoomText.ZoomText computer toolbars show magnification and voice capabilities.Juliette Rizzo uses a voice recognition program to work at the Education Department.