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MAPS: PDA scaffolding for independence for persons with cognitive impairments

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MAPS: PDA scaffolding for independence for persons with cognitive impairments
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  S. Carmien HCIC 2002 CLever Project / L 3 D MAPS: PDA scaffolding forindependence for persons withcognitive impairments Stefan Carmien Center for LifeLong Learning and DesignUniversity of Colorado at BoulderP.O. Box 430Boulder, CO 80309 USA+1 303 444 4830carmien@cs.colorado.edu Keyword:  PDA, assistive technology,disabilities, technology abandonment,technology adoption, prompting systems,scaffolding systems Abstract:  Individuals with cognitivedisabilities are often unable to live on their ownbecause of deficiencies in memory, attention,and executive functionalities, leading to aninability to consistently perform daily tasks.Computationally enhanced prompting systemscan provide a necessary bridge to independentliving. High levels of assistive technologyabandonment are driven, in part, by poor userinterfaces for the configuration of these devices.MAPS ( M emory  A iding  P rompting  S ystem)provides a simple effective prompting systemwith an interface for caregivers designed toeffect high rates of integration into daily life. 1. Introduction Cognitively impaired individuals are oftenunable to live on their own because of deficiencies in memory, attention, and executivefunctionalities. These deficits can create inabilityto consistently perform normal domestic taskslike cooking, taking medications, performingpersonal hygiene and taking publictransportation. Prompting systems consist of breaking down a task into constituent parts andcreating prompts, consisting of pairs of imagesand verbal instructions, for each step. Aprompting script is a set of prompts that make upa task. A common way of transitioning fromassisted living (or living with ones family) toindependent or semi-independent living is thruthe use of prompting systems. 2. Cognitive Disabilities In the U.S. alone, there are approximately 20million persons, or 7%, of the U.S. generalpopulation, who are afflicted with cognitivedisabilities costing over $100 billion per year inmaintenance, long term care, and lostproductivity [Coleman 01]. Computationallyenhanced prompting systems can provide abridge to independence for many persons withcognitive disabilities. Prompting systems providea learning tool to acquire skills and ‘scaffolding’for daily life, as well as supporting mobility andemployment. A portable tool that providesmulti-modal prompting and allows easy creationof new scripts extends and adds additionalfunctionality to current one-on-one promptingsystems.  S. Carmien HCIC 2002 2 Several computer based prompting systems havebeen created for home living, with some success.Transition professionals, assisting cognitivelyimpaired young adults in the change from specialeducation school environments to independentliving, identified these four broad areas whereprompting can be of use [Byrd 01]: • Community • Recreation • Vocational • Domestic Device rejection is the fate of a large percentageof purchased Assistive technology [King 99].Users (caregivers) report difficulties inconfiguring and modifying configurations inassistive technology that often lead toabandonment [Kintsch 02]. Some expertsestimate that as much as 75% of all such devicesand systems are purchased and not used over thelong run [Reimer-Reiss 00] .The MAPS projectis primarily driven by (and will be measured as asuccess in the context of) the extraordinarily lowadoption and retention rates in existing complexassistive technological systems. Secondarily,research [Fischer 00] and interviews havedemonstrated that complex, multifunctionalsystems are the most vulnerable to thischallenge, therefore the initial goal will be of asimple system that does one (or few) things verywell for a large range of users/caregivers. Byviewing the configuration and other caregivertasks as a separate and equally importantinterface, and applying techniques such as task-oriented design [Lewis 94], this abandonmentproblem could be mitigated.Additionally, there is a lack of small granularityinformation (i.e. at the level of individual events)about the actual use of assistive technologydevices that would assist in adjustingconfiguration, long-term evaluation of theuser/device/configuration match and provide afoundation for longitudinal research. 2.1 Target population The target population for MAPS would becognitively disabled individuals. Using standardnotation [AAMR 92] this would be “trainableMentally Handicapped’ IQ 55-72 and the upperrange of ‘Severely Mentally Handicapped” IQ>55. Rather than use diagnostic language it ismore to the point to discuss what the user targetpopulation cannot do: • they cannot read; • they have significant memory issues; • they cannot use abstractions (i.e. symbols haveno extensible meaning); and • their language is very minimal What they must be able to do: • They work well with prompting techniques • They are socialized enough to use commercialestablishments without having/causingproblems • They have fine enough motor coordination touse a palm pilot sized touch pad (and perhapsthe set of keys below). • They are sufficiently capable to not lose ordamage a PDA as well as use it consistently There may be other populations that couldbenefit from the device, as an augmentative andalternative communication device; and thedesign should keep this in mind. Similarly thepossible curb cut effect 1 of spillover into agingand memory loss areas should be kept in mind asan extended use for the device. Figure 1MAPS interface user population There are two other target populations that thedevice’s interface needs to be designed for: theinstaller (often a trained assistive technologist)and the caregiver (often a family member) whowould eventually re-configure the system. Theseusers need an intuitive interface that is scaled totheir level of skills with computers. They will beassumed to be able to compose a letter on a wordprocessor but not much more. 2.2 Existing research There is a small body of literature concerning thedesign and implementation issues for assistivetechnology and augmentative and alternative 1 Curb cuts were originally developed forwheelchairs, but they have a broader usefulness forbaby strollers and shopping carts.  S. Carmien HCIC 2002 3 communication devices, including Thomas King[King 99] for general AT design guidelines andBeukelman [Beukelman 98] for issues specificto augmentative and alternative communicationdevice implementation. The proceedings of theASSETS conferences [ASSETS 00] and several journals [JHTR 02] [AJMR 02] [JCR 02] havebeen useful.Prompting by independent living transitionprofessionals with and without cards is anestablished technique used for both learning andperforming a task by cognitively impaired adultsand older children. In meeting with the Adam 12high school to adult life transition group [Byrd01], prompting was presented as a primary toolfor both training in new tasks and as scaffoldingenabling ongoing task completion.Prompting studies provide a (meager)background for design and study of computationally based prompting systems - therehave been several papers on the topic of computerized prompting and individuals withcognitive impairments by a European researchgroup [Lancioni 99] [Lancioni 00] and severalothers [Lynch 95] [Kim 00].Existing computer based prompting toolsprovide more information to base design andtheoretical inferences. Of special interest is theVisions System [Baseman 00], a stationaryprompting and scheduling system based on PC’susing speakers and stationary touch screens toprompt thru complex domestic tasks likecooking; sets of cards assist away-from-the-system tasks like grocery shopping. The AbleLink team [Ablelink 02] with a product called‘Pocket Coach’ that gives a series of vocalprompts running on a PDA using WinCE, andthe PEAT [PEAT 02] systems are of interest.A more complete visualization of the role of PDA’s in support of individuals with cognitiveimpairments was the Swedish Isaac project[Isaac 97], which did much initial exploration of PDA’s for cognitively disabled. Isaac utilized amodified Apple Newton connected to a custommade PC with practically every add-on that iscurrently being discussed. Additionally researchwas carried out into issues of data representation(i.e. time) tailored for the cognitively challengedindividual.Underlying much of the proposed system areconcepts, basic to the Center for LifeLongLearning and Design (L 3 D) [L3D 02], such asaiding communities of practice, developing enduser modifiable tools rather than simply artifacts,personalization, presentation of the rightknowledge at the right time, and an emphasis onan active engagement with the design andevolution of the system by all stakeholders 3. MAPS project MAPS is a part of the CLever project [Clever02]. The mission of CLever is to providecomputationally enhanced environments to assistpeople with a wide range of cognitive disabilities(including their support communities andcaregivers) and elderly people. It addressesparticularly the following problems:1. People with disabilities form “a universe of one” requiring research in personalization,user modeling, and adaptation.2. Different learning paths are needed to matchindividual needs and learning styles.3. Individuals with special needs and verydifferent cognitive abilities offer a uniquewindow into understanding the humanthought processes in general, which willrequire research in new collaborativehuman-computer systems.4. Mobile computational systems must mediatebetween the unique needs and capabilities of the user and the situational context of theworld. The challenge is to build a systemdynamic enough to recognize when simple,direct instructions are necessary (e.g., theperson is in danger; the situation isconfusing; the person is on a tight schedule;etc.) while also understanding when moreopen-ended choices are possible (e.g.,choices are relevant to the person’s needsand the person is capable of understandingthe choices; it is possible to “recover” if amistake is made; etc.).MAPS uses a PDA platform to display verbaland pictorial prompts in a sequence thatcomprise a script. The PDA providesbacktracking, restarting and ‘panic button’functionality (via wireless connectivity). As ascript is played a timer logs the events andprovides logging information for scriptrefinement and analysis as well as immediatealternate prompts for breakdown situations.Concrete images are gathered using a built indigital camera  S. Carmien HCIC 2002 4Figure 2 MAPS Architecture A PC based application provides tools for scriptcreation, modification and sharing with otherusers via a web-based repository of scripts. Theweb repository has a browser based search,storage, and retrieval engine facilitating sharingand building of a body of successful scriptsThere will be several levels of logging, from theability to trace steps not taken on an immediatebasis to long term logging for diagnosticanalysis.The interfaces for the initial installer andongoing changes are targeted at non-computerprofessionals, and will be simple and intuitive.Doing this part right is, from the perspective of adoption of the device, as important as the userinterface. 4. Scenarios Following are several scenarios that illustrate thepossible uses and delineate functionality of theMAPS system. 4.1 Shopping Jim is a 26 year old with a level of cognitivedisability that would allow him to use the MAPSsystem. He has lived with a system like Visions[Baseman 00] for the last year and worked wellwith it. He has had MAPS for the last month andit fits well with Jim’s level of functioning as wellas his life in his own apartment.Jim has been reminded by his apartment basedprompter that, since it was Saturday, todaywould be a good day to go shopping for theweeks groceries. Jim’s mother has programmedthe stationary system with his favorite meals, andthe system walks him thru selecting meals for theupcoming week. After Jim has selected hismenus using the touch screen, the speaker in thekitchen (where he does most of his interactionwith his house based prompting system) willthen ask him to place his PDA into it’s cradle.His stationary system then calculates Jim’s netneed for groceries (based on a combination of arolling tally and an earlier inventory of Jim’spantry that it had ‘walked’ Jim thru as part of themenu planning process). It then creates aprompting script for Jim to use at the market,that lists exactly what Jim needs to buy.When Jim arrives at the supermarket, his PDA’sfirst prompt directs him to the produce sectionthen prompts him to put a head of lettuce into hiscart (fig. 3). The verbal prompts are generatedfrom a list of appropriate words and spoken byhis mothers voice; the images that go with theprompts are color photos of the actual items,taken in this store. As each prompt issuccessfully followed, Jim presses the PDAtouch screen to step to the next prompt, one afteranother till he reaches the last prompt that directshim to the checkout line with a picture of hisfamiliar checkout clerk – the one he always talksto. In the process of following the script, if Jimbecomes distracted, he may back step thru theprompts till he reaches a prompt that he knowshe did correctly.Jim is confident in his use of his PDA because heknows that if he gets confused or lost he canalways press the panic button on his PDA and hewill get appropriate instructions to do (usually  S. Carmien HCIC 2002 5  just to wait where he is) while the wirelessconnectivity of his device reaches out to his on-call caregiver and informs her of Jim’s situation.If Jim took too long at a given prompt (a timetied to a specific step in a given script) a secondprompt would have popped up with relevantinstructions, in the case of Jim being ‘stuck’.When Jim next loads a prompting script into hisPDA, the PC will upload the log from the lastprompting session on the PDA and write it intothe data structure of the last script that was run,for caregiver evaluation and perhaps adaptive‘collapsing’ of several steps into a single step inpreparation for the next run of that script. 4.2 Bus trip Megan decides that today would be a good dayto visit her grandmother. She goes to her home-helper screen and puts her palm pilot into itslittle cradle. She pushes the picture of hergrandmother, on the monitor attached to the PC,and then pushes the bus picture (rather than thephone or greeting card picture). Her helperbeeps and shows a picture of her front yard whenit’s finished getting ready for her trip. Megantakes the palm pilot out of the cradle and puttingon her coat and picking up her backpack leavesthe house. She knows that she must go to the busstop across the street because the picture on thepalm pilot shows  that   bus stop and the voiceprompt tells her to cross the street to get to it.She crosses the street and as she reaches the busstop she touches the bus stop picture on the pilot.The pilot says “Good Megan, now let’s makesure this is the right one! Wait a bit while I see if it is ”In a few seconds the screen on her device showsa swirly pattern the reassures Megan that theyare ‘talking’ about what she wants to do andwhat is the best plan. Megan then sees the swirlypattern has changed to a series of progressivelylarger dots (the Isaac duration indicator – see theIsaac project), and a voice says “Megan, this isthe right bus stop and the bus you want willarrive soon” Megan waits patiently for her busoccasionally looking at the changing dot patternon her pilot, and, when a bus pulls up, looking ather pilot and still seeing the changing dots,continuing to wait patiently. Just as the last dotturns almost completely white a bus pulls up andMegan walks up the steps. Megan’s palm brieflygoes swirly and the bus driver looks at a LEDdisplay located above the entrance door. Thedriver says ”Going to Riverside, mam? This isthe right bus.” Megan goes all the way in and sitsin the seat right behind the driver. The bus pullsout………. 5. MAPS Design MAPS is a system, consisting of severalhardware parts (the PC and the PDA) and severaldifferent interfaces (for the user, installer, andreconfigurer) By designing a  System  - includingeasy to create and modify prompting scripts,small ‘atomic’ groups could be connected thruthe medium of sharing and modifying scripts in repositories  of scripts. This could provide animmediate cause for the creation of a forum of users, caregivers and designers that would assistin overcoming the insulated life that theseproblems often produce. Figure 3 The MAPS PDA prompter 5.1 Design rationale This project has several dimensions which allneed to be satisfied. It must be an adequatelearning project and it must be a tool that will beuseable and used by several target communities:the cognitively impaired, their ongoing staff, theassistive technology professional that initiallysets up the tool, and the larger researchcommunity.The initial parameters and basis of the projectshould be a result of a research-based process fordetermining system requirements. Each part of the project will be intentionally part of ahypothesis; an example might be the interactionof the touch screen, the image and auditoryinformation can be determined in the context of studies of various types of cognitivelychallenged individuals.The device chosen as a platform for the projectneeds to: • be easy to carry; • display an image of high enough quality to beexperienced as a ‘picture’ rather than an icon;
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