A tangible tabletop game supporting therapy of children with Cerebral Palsy – Thoughts and Summary

Summary:

The purpose of this study was to develop a tangible table-top game supporting the rehabilitation of children with Cerebral Palsy (CP). Their aim was to provide some of the rehabilitation services provided by therapists to children affected with CP using table-top technology. They mentioned that therapists use different toys and techniques in their training sessions to do exercises like finger extensions, princer grasp, elbow extension, and supination. The experience several problems while teaching these exercises: the children were used to the same exercises and it was no longer a challenge for then, they started to compensate for their lack of movement by using their other arm/hands, they were not motivated, and since training was personal, they lacked social interaction.

The intent of their game was to design an avenue where the children could practice these same exercises while having fun, and staying motivated. They involved therapists in their design, and the therapists provided feedback which helped them to improve their design. The final game was implemented was a table-top playing surface what lit up in different LED lights, and the children had to color match several physical objects like blocks and hammers to the lights on the surface to turn them off.

Their results were mixed –  although the children enjoyed playing the game, they also experienced some of the problems the therapists experienced like compensation with their good arm, and because they were in their therapy rooms, they had some fore-knowledge of the arm movements they were supposed to make.

Thoughts:

I wish the results were more successful than they were. It seems like the children faced some of the same problems with therapists; however, the children having fun in their therapy session is certainly a step in the right direction. I feel like the paper was somewhat premature, and hoped that they would have performed some more iterations of the design before the study was published. They also mentioned that the design was an iterative and participatory process, but it wasn’t mentioned anywhere they took the design preferences of the children in the design process. It seems like they only took into account feedback from the therapists, which may vary widely from what would work very successfully for the children.

Design of an Exergaming Station for Children with Cerebral Palsy – Thoughts and Summary

Summary:

The purpose of this study was to develop an exercise video game for children with Cerebral Palsy (CP) to keep them physically active. They developed this video game with the help of medical professionals, game designers, computer scientists, kinesiologists, physical therapists and eight children with CP. The game combines a physical platform to allow pedaling motion by the children, an Xbox 360 controller, and algorithms to take input from the user pedaling to make the gaming experience smoother. Gaming systems like this allow children with CP to exercise while having fun – they mentioned that most other research studies in this area are heavily focused on rehabilitation therapy, and not many are focused on maintaining physical fitness (which is equally as important). Their game also allowed for playing with other children over a network, providing social contact – and the game can be installed and played at home without occupying too much space.

Their resulting design was highly successful – and seven of eight children could play unassisted using the final version. The children were able to exercise at levels that would lead to health benefits. One of the main things they discovered was that it is really difficult to predict the needs and preferences of children with CP if you don’t have the condition – designs that they expected to work at first were quite unsuccessful. After several iterations and designs, they ended up settling on a racer chair where the arm rests are flush with the seats.

Thoughts:

Overall, I really liked this paper. I really enjoyed their approach, their iterative design process, and I feel like they gave us an end to end picture of their research. It was also very smart of them to focus on an area that was lacking (maintaining physical fitness), as some of the problems of people with CP is as a result of lack of use of the muscle groups. Maintaining physical fitness will certainly help to keep their muscles active, and help them live easier lives.

Electronic Dementia Guide for Excellence – Summary and Thoughts

Summary

The purpose of the EDGE ( Electronic Dementia Guide for Excellence) document is to serve as an electronic guide on how to care for Dementia patients in nursing homes. Its goal is to have long-term practical use, be user-friendly, improve quality of life for Dementia patients, make best practices accessible without being intimidating, and be based on state of the art research and practices. This guide was developed to address all the needs of the Dementia patients including their health, physical, and emotional needs. It was taken through a rigorous development, testing and piloting phase, and they continuously gathered feedback from the practitioners that cared for Dementia patients. Even though this guide was conceived when the internet was not so popular in hospitals,  they knew that the internet was getting very popular and they wanted to deploy the information through a channel where everyone could access it, and the information would be updated as new information became available.

The implementation of this guide was very successful. Practitioners started to feel better about going to work and caring for their patients and patients with Dementia felt and were treated like regular human beings.

The guide went online in 1998 can be accessed by anyone at www.dementiasolutions.com

Thoughts

I tried to go to the link above, and was redirected to a “NorthEast Health Employee Login Portal”.. Perhaps, the link has been changed, or is no longer active?

This guide is a great example of patient centered research and care. They put the patients first and achieved great results. They had the foresight of deploying the information over the internet by anticipating that the internet was going to be the information portal of the future and it was a very smart strategy. I think it’s a great example of how care guides for other health conditions should be researched and deployed. Just like in HCI (putting users at the center of design), putting patients needs at the center of their care always produces quality products.

Understanding Pointing Problems in Real World Computing Environments – Summary and Thoughts

Summary:

The researchers in this article developed software and an analysis tool to collect and analyze real world pointing performance, which was used to investigate the variance in performance of 6 individuals with a range on pointing abilities. Performance pointing research is generally done in a very controlled environment (usually a lab) where the users are instructed on exactly what to do. However, this method ignores a plethora of useful data that can be gathered if gathered in a real world scenario (like users clicking links mistakenly, and going back immediately). They focused mostly on the following types of pointing errors

  • Too many buttons: When a user accidently clicks both the left and the right mouse buttons together
  • Accidental click: When the user clicks when they didn’t intend to.
  • Double click speed: When the user does not click twice fast enough – instead of a double click, it is registered as two single clicks.
  • Movement during a single click (slipping): When the user moves the mouse cursor while clicking a button.

The research study also collects data on the direction changes of the mouse pointer and the excess distance travelled (ratio of actual distance travelled by pointer vs straight line distance from mouse pointer to target). Their software tool was based on (and extends) the DART tool which is a suite of system monitoring components that run in the background to log pointing, keyboard and window events.

Overall, they were able to gather real world data that was more detailed than data gathered in a controlled environment as the users had the liberty to use the test computers when and how they wanted. They found that most of the participants did not know/were not willing to adjust the pointing settings in order to make their experience easier.

Thoughts

Overall, I think it was a nicely written paper. Although they talk about the reasons for studying pointing performance like measuring pointing variances between individuals of various abilities, and studying performance across various pointing devices, it was not clear what the real world use of the data could be. Can this data help them design better pointing devices? Can they use this data to recommend/design different pointing devices to people with diferent disabilities? I couldn’t really deduce from the paper, what some real world uses of the data was, and based on their analysis, I could only imagine that their data could produce better real world design than “lab-gathered” data – I just couldn’t tell exactly how it was going to accomplish that.

TiltText – Summary and Thoughts

Summary:

—  Technique for entering text into 9-key mobile phone

  • Standard 9 key phone + low-cost tilt sensor
  • Uses combination of tilting phone (left, forward, right, back)
  • Pressing button to enter text
  • ‘Zero’ button to reset position
  • Press button without tilt for numbers

—  Related Research

  • Multi-tap: Multi tap to select key, wait for time out or button –  Disadvantages: Slow, time-out wait time
  • Two-Key disambiguation: Select key group, then key position (1-4) – Disadvantages: Never gained popularity
  • Linguistic Disambiguation: E.g T9 – Disadvantages: Two words same sequence, need to look at screen, non-english words

—  Study

  • 10 participants
  • 2 techniques (MultiTap and TiltText)
  • 2 sessions per technique
  • 640 total phrases each

—  Results

  • Initial learning curve – TiltText started slower
  • After learning curve: 23% faster than MultiTap
  • Higher error rate than MultiTap (11% vs 3%) due to tilt errors (mostly back tilt 36% for ‘s’ and ‘z’)

—  Advantages

  • Faster than MultiTap
  • Isn’t dependent on language

Personal Thoughts:

As a big fan of physical keys, this may have been frustrating for me to use, but I have to admit that this is a pretty nifty tool. I wonder why this techniques never became mainstream (at least not to my knowledge). What is the additional cost of including the sensors in the phones? Are there any health implications to having the tilt sensors close to the body? What are the longterm effects on the wrists from the continuous tilting? Does this technique allow people with disabilities in the hands or even arthritis of the wrists to use it?

Chapter 5 (pages 338-348) – Summary and Thoughts

This reading describes the cognitive skills that are critical to functional performance, and some cognitive disorders that impede these skills. It also addresses how we can use assistive technologies to augument the cognitive skills of people with cognitive disabilities. The cognitive skills described in the chapter include:

  • Perception: How we interprete sensations that we receive from the environment.
  • Memory: How we store information, and retrieve it when we need it
  • Orientation: Our basic awareness of our identities, environment, people and things around us etc
  • Knowledge representation: The ways, patterns, and methods we use to store information including grouping and sequencing information, sorting, and how we store facts.
  • Problem Solving: How we use things that we know to deduce things that we don’t know.
  • Language: Any system of communication using sounds, symbols, thoughts, objects gestures etc

There are several cognitive disorders described in this reading – congenital disorders (disorders that occur at birth) and acquired disorders (those that occur after birth).

The congenital disabilities include:

  • Intellectual or Developmental disabilities: Functional skills including communication, language, problem solving, and memory are limited.
  • Learning Disabilities: People affected by this disorder have average mental abilities, but have difficulty comprehending material including language, math, reading etc
  • Attention Deficit Hyperactivity Disorder (ADHD) – Difficulty paying attention to anything, very often distracted, disorganized and fidgety.
  • Autism Spectrum Disorder: Limitations in or lack of communication and social skills, but they may able to concentrate for long periods of time and often excel in math, music and science.

The acquired disabilities include:

  • Dementia: Syndrome characterized by a decline in day to day functioning, and impairment in several cognitive skills.
  • Traumatic Brain Injury: Generally occurs as a result when the head or brain is struck by a strong external force, and often results in a loss of several cognitive skills.
  • Cerebral Vascular Accidents (CVA or Stroke): May occur from a lack of blood flow or from ruptured blood vessels in the brain, which causes an interruption in brain function. People with this condition can often recover and return home after some time in the hospital.

I’m especially interested in learning more about ADHD and CVA, as I know many people that have been diagnosed with these conditions. Are there ways to prevent/treat them permanently?

 

Chapter 3.4 (pages 65 – 78) – Thoughts

This reading analyzes the role of cognitive development in the design of assistive technology. It cites the work of several researchers that classify different stages of development by different age groups. All these age groups have different developmental needs, and these unique needs need to be taken into account when designing assistive technologies for them. For individuals with developmental diabilities, it is not enough to classify them according to the different developmental stages according to their age; neither is it enough to classify them into another developmental stage as a result of their disabilities since they can be developed in one area, but deficient in another. In order to design for individuals with specials needs, their individual needs and capabilities need to be taken into consideration for the proper design of assistice technologies to suit their needs. This reading analyzes all these other factors in relation to cognitive development and assistive technology design:

  • Memory: It covers the different types of memory (sensory, short-term, and long-term), their characteristics, and things to consider when designing assistive technologies for them.
  • Language: It describes the five elements of language (phonology, morphology, syntax, semantics and pragmatics), and how language develops in children with and without cognitive deficits.
  • Problem Solving and Decision Making: It describes these terms, and how they can vary across different developmental stages, and people with different cognitive abilities.

Finally, it looks into the psychosocial function as it is related to the use of assistive technologies and how factors like identity and self-protection, motivation, individual beliefs, and individual experience can impact the way humans ineract with asistive technologies.

Overall, it a good body of knowledge of the factors that affect asistive technology design. I wish it went into more depth or presented more case studies on individuals with cognitive impairments, and proven factors to consider in the design of assistive technologies for them.