ࡱ> sur7 ebjbjUU "~7|7|^%l 8D.H(D"ffL.......&1 F3~.6N44..P...*]-. P!$~@-.l.0..33. 1/23/2001 A Prompting System for the Cognitively Disabled A proposal for a project by Stefan Carmien My goal for a masters project is to implement a small testable device or system that acts as a cognitive prosthesis for cognitively disabled individuals. Towards this goal I conducted interviews with experts in the field, read books and journals, searched the web and had discussions with fellow students in the Center for Lifelong Learning and Design group who were working on similar goals. My research has been aided by guidance from my advisor Gerhard Fischer, the director of the Center for Lifelong Learning and Design (L3D), and the project director of the Cognitive Lever Project. Interviews I interviewed four people, experts in various fields in academia and an assistive technology developer. My goals here were to develop understanding of cognitive disabilities and to ask workers in the areas what works and is needed that computers and assistive technology could provide. My first interview was with Professor Richard Olsen, an expert in dyslexia at CU, from him came insights into learned helplessness and the need for exactly appropriate tools, that help just enough and do not prevent personal adaptation to ones handicap. We also discussed the interactive, negatively synergistic effects of one handicap upon other systems i.e. sensory defects can potentate cognitive problems. Professor Olsen also pointed out the unique role that computers can provide in repetition drills, freeing helpers to do more complex work, and inspiring motivation for use of adaptive technology. Next I talked with Professor Christine Yoshinaga-Itano, a speech pathology expert. She added a third type of disability to sensory and cognitive- motoric (which affects balance and fine motor functions), Motoric and speech disabled individuals sometimes require tools designed at the highest levels of the assisted technology, almost a new language system. This led me to the field of ACC (Augmentative and alternative communications). I next meet with Bill Baesman, the designer of the Visions system for enabling independent living by moderate to severely cognitively disabled individuals. Mr. Baesman, by profession a lawyer, has a cognitively disabled daughter and solved his and her problem from the inside, so to speak. His design, the Visions system, was a solution specifically tailored for her set of abilities and needs and then extrapolated out to produce a generalized tool. From our discussions I developed several design rationales that are needed to create tools for the cognitively disabled: use concrete images rather than abstract icons, use simple tools cleverly rather than a large complex system, design for individuals then generalize. I also learned of the role and importance of prompting for cognitively disabled. A surprising insight about these tools is the importance of intended consequences, like the result of a greeting card purchasing and mailing module both increasing independence and (and perhaps more importantly) mitigating the increasing social disconnection of the newly independent living handicapped person. Similarly there are social dimensions of design that need to be considered, like using a voce for prompts that is not a family member, so as not to bring family issues into the process. Finally I interviewed Professor Emily Richardson, an expert on the psychology of aging, memory loss and dementia. From her I learned of the importance of logging system events and timely feedback of events not taken (i.e. did not take pill from medicine closet). The space program effect (high technology spillover) was discussed in the areas of memory, aging and dementia my design should have this as an incidental aspect. She reiterated the importance of an easy and transparent user interface and configuration. Readings My reading sources came from two general areas: library research and journals. The texts fell into two categories: descriptive, like Cultivating Minds and tool books like Assistive Technology: Essential Human Factors. The descriptive books gave a broad view of how technology can interact with cognitively disabled individuals. Cultivating minds demonstrated how, by not naively applying tools, individuals with cognitive handicaps can experience and act in the world in far richer ways. Cultivating minds introduced the idea of use of the computer as an information prosthesis aids the handicapped person by bringing such a person into an information Society and the notion of trapped intelligence. The book Teaching Children with Autism to Mindread gives a good example of the possibility of computers taking up much of the repetitive tasks that cognitive rehabilitation entails. While both of these examples do not bear directly on my project they provided me with insights into this very different world of constructing tools for the cognitively disabled. Texts that I call tool-books such as Computer Resources For People With Disabilities by the The Alliance For Technology Access and Assistive Technology Essential Human Factors by Thomas W. King provided lists of tools and guides for their use. Computer Resources is primarily a hardware tool book but the discussion of what affordance is appropriate for specific problems, similar to the list that Anje Kintsch worked with Rogerio DePaula in our L3D group will inform the specifics of the design. Assistive technology focused on the design rationale that is needed for successful AT (Assistive technology) devices; success being defined, in a broad way, as being in wide use and having demonstrated effectiveness in providing or assisting the ability to accomplish tasks that were previously difficult or impossible to accomplish without help. The specifics from these books are reflected in the Design Rationale section below. Other sources Web sources, shared contacts, and the group meetings we had in the last year account for the balance of my research. One interesting source was a packet sent to me by AbleLink, a Colorado Springs company that has been doing research into tools for cognitive prosthesis for several years. Their literature said: Although every software application has different requirements, AbleLink Technologies consistently uses a variety of proven design and development methodologies to make software more accessible to individuals with cognitive challenges. Here are a few: Use of clear, uncluttered screens; Appropriate sequencing and pacing; Opportunities for repetition and positive practice; Graphics and animation that contribute to, rather than distract finch learning. Frequent audio feedback, both for error correction and positive reinforcers Combined use of pictures and audio Prompts for navigation; Linear designs of software operation; Use of Error minimization features, such as removing buttons from the screen at times when use is inappropriate; Consistent commands and features from screen to screen: A complete set of customization options that allow professionals to adapt the software to the unique needs of a variety of end-users; A database management system to allow for tracking of progress; Considerations for enjoyable, motivational and age-appropriate software; A research-based process for determining system requirements Interestingly most of these design rules were identical to the ones that I had developed in my research. Another interesting source for design rules and insight into cognitively handicapped is the Isaac project (http://www.certec/ith/se/English/Isaac/index.html). The Isaac project is/was (the documents say it is ongoing but the last update is early 1999) a Swedish designed Personal Digital Assistant For The Differently Abled created jointly by a team of computer scientists and social workers specializing in working with the cognitively handicapped. I have just been told of this project, by members of the CL team, this week and have only cursorily examined the copious documentation and project notes, but there is much to be learned here. Isaac consisted of a Newton with a camera and cel phone attached (and not adding much bulk) that was connected by an umbilical cable to largish purse like bag with a handmade PC (a 486 this was in 94), a second celphone data connection and a GPS. The total idea of Isaac is quite revolutionary with Isaac and a centrally located helper the cognitively disabled were to be able to go where they wanted, when they needed (it has a scheduling and alarm function), be found if lost, ask for guidance and get it instantaneously and use the camera for sharing their world. From a small book, Technology and Differently Abled People, that the Isaac team published, the section on Natural intelligence discusses how to appropriately work with complex chains of events, interfaces with incremental scales (i.e. not discrete), and memory (in the user) issues; all with insight producing specific examples from the daily world of the cognitively handicapped. I will be doing a review/digest in the near future for the CL team. The Visions System The visions system was the springboard for my projected project. Visions is a multimedia scripted application that consists of a networked PC running win95 with two monitors (one in the system closet with the CPU, one a 15 touch screen display in the kitchen) and a soundcard providing input to a amplifier and switching system controlled by the PC. The switch is connected to (up to) seven speakers and can be controlled by software to divert the soundcard out put to any one or set of the speakers. The speakers are currently in the kitchen, living room, bathroom and two bedrooms, placed on wall close to the ceiling. Software: The system runs on the MS Windows 95 platform. It is written in Astound! ( HYPERLINK "http://www.astoundinc.com/products2/astound/astound.html" http://www.astoundinc.com/products2/astound/astound.html), a power point-like scripting language. The Astound! Script is modifiable at the system console or thru another networked machine with astound! loaded. The Astound! script provides the touch screen interaction, and the Windows 95 event scheduler and the driver application for the audio switch provide the independent audio prompts for the system. Physical tools: The users are supplied a set of photo albums, one for each activity. The images for these albums and for the touch screen are actual photos of the items, activities and users, this degree of customization allows, the staff member demonstrating the system felt, the user to be more comfortable and accurate in using the system. On our tour we looked at the kitchen set, but there were others for activities like going out, videos etc. The kitchen set comprised a system of meal planning, food purchasing and meal preparation. The user started at the beginning of the week with the meal planning set, which had, in each picture pouch, a picture of the meal and individual pictures of the ingredients of the meal, all of which were identified on the back so as to facilitate putting back after the week had passed. The entire packet was moved to the weekly meal preparation book as it was chosen. After choosing the meals for the week, the ingredient cards from the weekly meal preparation book are pulled and visually compared with the kitchen inventory (note not by writing, visually this constrains the user to particular brands but allows for a much wider range of abilitied users). The cards that correspond to existing stock are replaced in the meal-planning book and the remaining cards (with pictures of the ingredients) are used for the shopping book. Shopping is handled by matching pictures to items at the local Albertsons where the user has a charge account. Similar scenarios exist for other kinds of activities. The first impression was that an amazing amount of leverage can be created for this kind of handicap with very simple tools. This thing worked - the staff at the facilty we toured said that he could use more of these. He also said that it was applicable for a fairly narrow range of disfuctionality not quite a unique problem requiring a unique solution but not for everyone in his care and not without proper setup. There are some real problems with ongoing administrative setup, but once in place the Visions system acts as a genuine cognitive prosthesis, allowing cognitively disabled individuals the ability to live on their own and interact in a meaningful way with their surrounding neighborhood. The Project itself Initially the project will be creating a prompting system on a palm sized touch screen device that will be capable of displaying and vocalizing a series of steps to accomplish a task. This prompting can be elicited by a menu or triggered by a timer (or possibly remotely via Rf). The initial task that the system will solve will be replacing the card system for shopping for weekly groceries in the Visions system. The system will be linear in the sense of one picture and prompt will follow sequentially after another, but will allow restarting and backsteping. There will be several levels of logging, from the ability to trace steps not taken on an immediate basis to long term logging for diagnostic analysis. From this point further elaborations in the design could be interactivity with other smart things like bus stops that inform the user that the bus they wanted had just left or would arrive in 10 minutes. Other interactions could be panic situations, here a GPS system could inform helpers of a lost client or simple ACC functionality to allow interactions with sales clerks and systems like the EDC.  The interfaces for the initial installer and ongoing changes would be targeted at non-computer professionals, and be simple and intuitive. Doing this part right is, from the perspective of adoption of the device, as important as the user interface. Target population The target population for this device would be cognitively disabled individuals. From one of Anjes handouts this would be trainable Mentally Handicapped IQ 55-72 and the upper range of Severely Mentally Handicapped IQ >55. Rather than use diagnostic language it might be more to the point to discuss that the user target population cannot do: They cannot read They have significant memory issues They cannot use abstractions (i.e. symbols have no extensible meaning) Their language is very minimal What they must be able to do: They work well with prompting techniques They are socialized enough to be out in commercial establishments without having/causing problems They have fine enough motor coordination to use a palm pilot sized touch pad (and perhaps the set of keys below). They are sufficiently capable to not lose or damage a palm pilot device There may be other populations that could benefit from the device, as an ACC tool, and the design should keep that in mind but this would be best another project. Similarly the space effort effect in terms of spillover into aging and memory loss areas should be kept in mind as a use for the device. There are two other target populations that the devices interface needs to be designed to: the installer and the eventual re-configure. These users need an intuitive and interface that is scaled to their level of skills with computers. They will be assumed to be able to compose a letter on a word processor but not much more. Design rationale This project has several axes that all need to be satisfied. It must be an adequate learning project, be academically oriented, it must be a tool that will be useable and used by several target communities the cognitively handicapped, their ongoing staff, the assistive technology professional that initially setup the tool, and the larger research community. The initial parameters and basis of the project should be a result of a research-based process for determining system requirements. Each part of the project will be intentionally part of a hypothesis an example might be the interaction of the touch screen, the image and auditory information can be determined in the context of studies of various types of cognitively handicapped individuals. The device chosen as a platform for the project needs to be easy to carry and the image and sound quality must be high enough quality to be experienced as a picture rather than an icon. The device needs to be robust, both as a software platform and as hardware, to minimize focus on the tool and maximize the use of the tool. The affordances of the platform must be clunky enough for not so finely coordinated fingers, and provide positive feedback of visual or auditory nature to indicate that they have been activated. The palm platform, i.e. the Palm OS on various hardware platforms, especially the Handspring Visor, with snap in modules, fulfills the requirements, with a minimum of excess. To succeed on a bare human level the device must have clear, uncluttered screens and controls that are not immediately needed should be removed from the screen. The interface needs to map intuitively, to be as similar to existing controls and information sources as possible. An example might be to map familiar radio or television controls to the controls of the device. There should be a simple way to backtrack or start over to allow for mistakes in using it, in general it should be a very forgiving interface, to reduce anxiety over failure in using it. Similarly, to confirm to the user, any activation of a control or change of state should have an accompanying auditory indication. The interface should be uniform in each mode (i.e. setup screens all the same look and feel, etc.) to minimize cognitive load. Each step of the use process must be appropriately passed and sized (the right size of jump from the last step), so that the user does not get lost in the cognitive mapping of step to next step in the process. Beyond the bare minimum of hardware and software the issue of adoption needs to be addressed. The device needs to look and feel cool not dorky or handicappy studies have shown that devices that look retarded stand a much lower chance of being adopted, particularly by young adults. The other users needs need to be properly addressed. The device and its PC configuration software must be simple enough to get used immediately and deep enough so that many different tasks could be configured. The initial configurer needs a good tutorial and sufficient explanation of the operations and theory of the system so that the initial programming is not a by the book exercise, which often comes to a standstill when the unexpected occurs. As much as possible the device should be intuitive to configure, with help from wizard setup tools, similar to the successful Microsoft applications. The over arching design concern here is that if the device is hard or too time-consuming or not robust enough, the tool will never get used in the first place. I will want to match the Visions system closely, and infact it might be useful to get a copy of it and create a software bridge between the handheld and various activities, so that the system is integrated for ease of use and setup. The device needs to have logging, short-term immediate feedback to aid the assistive technologist / helper in evaluating the setup of the tool and appropriateness to the user; long term for further research. As much as possible the possible extension of the device for other purposes as ACC, as a GPS platform, or for personalizing input via IR into an EDC like environment should be kept in mind during the design. Decisions to be made Hardware there are several small enough devices in the marketplace that would work. They range from custom-built devices to the ubiquitous palm pilot to various flavors and sizes (in physical measurements and capabilities) of PDAs. The overarching design principle here is that I want to prove my concept not ancillary questions about affordability and availability. The choices here seemed to be (beyond building my own): Palm pilot OS devices The Palm pilot IIIc or VII The handspring device (with attachable modules) Others Palm computers (Intel based) Windows CE Linux Are there other hardware/OS options? What minimally the project requires: Touch screen Display images Timer to alert Speech Recorder Synthesizer PC docking station Ir (For EDC & talk to each other) Research to be done I need to research existing literature on prompting (in contrast and as part of guidance) systems (especially for cognitively handicapped). I want to look into the body research on image recognition, use of icons and abstract visual representations with respect to cognitive disabilitys. I will be doing reading and research into the cognitive psychology aspects of these issues, about which I am so ignorant that I do not even know what I do not know. I want to look into usability studies with the cognitively handicapped, and analysis of cases where there were rapid adoption of a device and where the device was promising but never widely used. I need to do more work with just getting to know the target population like the work that Leo Burd and Rodgerio DePaula are doing. And finally I need to talk to people like Cathy Bodine and the AbleLink team to gain insights into existing developments and the real world development process. How I evaluate the product Evaluation needs to be done at different stages in the design and with the different target populations. Initially I will want to do a sort of usability study with the bare idea and both disabled users and experts in the field. As Leo Burd has pointed out in his presentation this October, evaluation with the cognitively disabled becomes very difficult in both objective terms and getting help with what the user wants. The process of evaluation could itself be a promising and useful project for CL. As the design becomes more solid usability studies with the installation and configuration population will need to be done. Finally when the project is complete I will want to do some analysis as to the usefulness of the device: this will be the hard to do in a non-trivial manner. I will probably assemble a team for the design and testing comprising colleagues, experts, family members and, of course, some of the actual intended users. Another possible resource/ collaborators might be the AbleLink team and Cathy Bodine, as their current projects seem similar to this one. There is some question if I want to involve the Visions designers in the project and if so at what point. My impression, gathered from my interview, is that this needs to be carefully approached so as to be seen as a friendly helping extension of their work rather than as a threat to their project. References Books & articles: Cultivating minds Cultivating Minds - A LOGO Casebook (part one of two parts) S. Weir, Harper & Row, 1987 Teaching Children with Autism to Mindread, A practical Guide P. Howland, S. Baron-Cohen, & J. Hadwin, John Wiley & Sons, England, 1999. Computer Resources For People With Disabilities, The Alliance For Technology Access, Hunter House, Alameda,CA, 1994. There is a later version that the CL project has in its library Assistive Technology Essential Human Factors by Thomas W. King Allyn & Bacon 1999 Technology and Differently Abled People a document on the Issac website People: University of Colorado at Boulder Faculty: Professor Richard Olsen Professor Christine Yoshinaga-Itano Professor Emily Richardson Bill Baesman, the inventor of the Visions system The CLever project (CL): (http://www.cs.colorado.edu/~l3d/clever/people/index.html) Anje Kintsch an assistive technology expert with the boulder valley school district Rogerio DePaula Leo Burd Center for LifeLong Learning and Design (L3D) (the group that the CL project grew out of : (http://www.cs.colorado.edu/~l3d/) Isaac project ( HYPERLINK "http://www.certec/ith/se/English/Isaac/index.html" http://www.certec/ith/se/English/Isaac/index.html) Ablelink Technologes http://www.ablelinktech.com PAGE  PAGE 13 PAGE \# "'Page: '#' '" Add bibliog. ref here (GF) PAGE \# "'Page: '#' '"  GF- develop a Dynagloss reference for this // GF write an essay about this PAGE \# "'Page: '#' '"  Need a definition of successful here GF PAGE \# "'Page: '#' '"  Need a glossary section added at the end to explain also to clear up refs to Leo & rogerio etc PAGE \# "'Page: '#' '" I think this is a cool area of research. Id love to talk to you about this some more. 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