If you find it tricky to logoff/shutdown Vista using the Start button because accessibility issues, here’s a solution. Press ALT + F4 and you’ll get a Shut Down Windows dialog box, then TAB repeatedly until the focus is on the listbox, then use the UP and DOWN arrow keys to select the action you want to perform such as Shut Down, Log Off, Restart, Switch User, or Sleep.
Want to know more about Vista internals and how to administer Vista in enterprise environments? Get the Windows Vista Resource Kit, Second Edition from Microsoft Press.