C-TOC Literature Review

This page is in need of thematic re-ordering into a logical hierarchy of topic areas. Until then, it's separated into CPSC 544 topic presentation research areas, clinical psychology, and ongoing research.

HCI Universal Usability

References

[Moffat 10] - Karyn's thesis

K.A. Moffatt, "Addressing Age-Related Pen-Based Target Acquisition Difficulties," Ph.D thesis, 2010.

[Zhai 04] - from Karyn Moffatt's thesis

S. Zhai, J. Kong, and X. Ren, "Speed-accuracy trade-off in Fitts' law tasks — On the equivalency of actual and nominal pointing precision," International Journal of Human-Computer Studies, vol. 61, 2004, pp. 823-856.''

• comment: documents user performance differences between five wordings of speed/accuracy task instructions for a Fitt's-like task.

[Goodman 03]

J. Goodman, A. Syme, and R. Eisma, "Older Adults' Use of Computers. A Survey," Proceedings of HCI 2003, 2003, pp. 12-15.

• survey of 353 participants over 50.y.o. - highlights importance of simplicity and application's perceived usefulness;
• method: assessed reasons for using a computer, types of computer applications used, freq. with which they were used;
• for those with computers at home, 28% were obtained second-hand, older models, mostly PCs; when asked to provide details about their computer, only vague information given; majority rely on friends and family to choose computers for them;
• reasons for use: shopping, family research / correspondence, internet: information access, research, shopping, email, word-processing;
  • from most to least popular in terms of application use: word-proc, internet, email, spreadsheets, databases, games, photos, music, other
  • games played by 47% of respondents (Solitaire)
• how they learned to use computer, aside from computer classes: courses, work, self-taught, relative/friend;
  • self-teaching most common in USA, % of self-taught users increases w/ age
• problems w/ computer use: documentation (too much jargon, inadequate support);
  • computer-literate population may not in general have a great deal of technical knowledge - complaints about complexity and jargon
• use of internet and email decline w/ age, among internet users, popularity of email increases with age in some surveys
• what do older people want in computer applications? most applications have obvious practical purpose; many participants motivated by perceived practical use of computer applications;

[Ball 02]

K. Ball, D.B. Bersch, K.F. Helmers, J.B. Jobe, M.D. Leveck, M. Marsiske, J.N. Morris, G.W. Rebok, D.M. Smith, S.L. Tennstedt, F.W. Unverzagt, and S.L. Willis, "Effect of cognitive training interventions with older adults," Journal of the American Medical Association, vol. 288, 2002, pp. 2271-2281.

[Owen 10]

A.M. Owen, A. Hampshire, J.A. Grahn, R. Stenton, S. Dajani, A.S. Burns, R.J. Howard, and C.G. Ballard, "Putting brain training to the test," Nature, 2010, pp. 1-5.

[Dickinson 07]

A. Dickinson, J. Arnott, and S. Prior, "Methods for human - computer interaction research with older people," Behaviour & Information Technology, vol. 26, 2007, pp. 343-352.

• comment: Rock sent this article - a journal paper on working with older adults

• HCI research rarely reflects demographic reality; important to offer techniques to researchers for attracting, retaining, and working w/ older adults; few guidelines exist to support researchers in devising appropriate methods for carrying out usability studies;
• lifestyle:
  • wider range of educational levels, low literacy levels, many w/ no formal educational qualifications
  • cannot be assumed older adults are familiar w/ experimental techniques; silence and concentration are expected; language in consent forms, info sheets, exp. instructions must be straightforward and free of jargon; time estimates for reading must be generous, offer verbal instructions;
  • consider varying amounts of free time among older people - range of activity levels, may influence cognitive function (i.e. bereaved partners)
  • many have never used the internet; little or no direct experience w/ computers and internet;
• sensory / cognitive changes
  • visual and auditory perception, fine motor control, memory and cognition may be affected;
  • superior social skills - likely to involve experimenter
• mobility issues - temporary or permanent
• experimental design and methodologies
  • provide more time, explanation, reassurance than typical HCI experiment would allow;
  • may have uncertainty about appropriate behaviours; companions should not interfere / interrupt; participants may try to involve experimenter
  • wary about cognitive testing - age-related memory deficits - useful in ensuring equivalence between experimental groups - participants must be aware that failure is normal and expected; stress and worry can have a very negative effect on subsequent performance; hearing loss also likely to confuse, difficult to hear instructions; experimenters should not adopt stereotypical expectations about older adults' cognition
• self-reporting: age-related processing capacity can reduce this technique with older users - confusion is often general, poorly articulated, and non-specific; inexperienced older participants may perceive difficulties as related to the keyboard; concept of alternative interfaces not easily understood;
• thinking aloud - difficult in lab settings w/ older users - those w/ cog. impairments struggle w/ unfamiliar interfaces - thinking aloud interferes w/ completion of exp. task; diversity of older participants: some provide excellent data when thinking aloud;
  • retrospective think aloud also limited (memory issues); think aloud description w/ re-presentation of the stimuli must be considered as contributing to user learning, therefor potentially confounding experimental results;
  • "tell-me-what-you-did" also limited - processing and memory difficulties - little remembered of recent procedures; older participants hardly remembered processes accurately until they had repeated them several times;
• user diaries...

[Additional references to follow-up on]

Possible IDRG papers?

On designing technology for older users

• J. Birnholtz and M. Jones-Rounds, "Independence and Interaction: Understanding Seniors' Privacy and Awareness Needs For Aging in Place," Proceedings of the 28th international conference on Human factors in computing systems - CHI '10, 2010, p. 143.

On designing technology to address users w/ cognitive/memory impairments

• R.M. Baecker, "Designing technology to aid cognition," Proceedings of the 10th international ACM SIGACCESS conference on Computers and accessibility - Assets '08, vol. 2020, 2008, p. 1.

• M. Balaam, A.M. Hughes, S. Rennick-Egglestone, and T. Nind, "Rehabilitation Centred Design," CHI 2010, Atlanta: 2009, pp. 1-4.

• J. Bauchet, H. Pigot, S. Giroux, D. Lussier-Desrochers, Y. Lachapelle, and M. Mokhtari, "Designing judicious interactions for cognitive assistance," Proceeding of the eleventh international ACM SIGACCESS conference on Computers and accessibility - ASSETS '09, 2009, p. 11.

• M.L. Lee and A.K. Dey, "Providing good memory cues for people with episodic memory impairment," Proceedings of the 9th international ACM SIGACCESS conference on Computers and accessibility - Assets '07, 2007, p. 131.

• J. Sevilla, G. Herrera, B. Martínez, and F. Alcantud, "Web accessibility for individuals with cognitive deficits," ACM Transactions on Computer-Human Interaction, vol. 14, 2007, pp. 12-es.

On designing technology to address users w/ dementia

• A. Mihailidis, J. Boger, M. Canido, and J. Hoey, "The Use of an Intelligent Prompting System Seniors," interactions, 2007, pp. 34-37.

• J. Wherton and A. Monk, "Technological opportunities for supporting people with dementia who are living at home," International Journal of Human-Computer Studies, vol. 66, 2008, pp. 571-586.

• J. Wherton and A. Monk, "Choosing the right knob," Proceedings of the 27th international conference extended abstracts on Human factors in computing systems - CHI EA '09, 2009, p. 3631.

• J. Wherton and A. Monk, "Designing cognitive supports for dementia," ACM SIGACCESS Accessibility and Computing, 2006, pp. 28-31.

On task interruption + resumption

• D.D. Salvucci, "On reconstruction of task context after interruption," Proceedings of the 28th international conference on Human factors in computing systems - CHI '10, 2010, p. 89.

• D.D. Salvucci, N.A. Taatgen, and J.P. Borst, "Toward a unified theory of the multitasking continuum: From concurrent performance to task switching, interruption, and resumption," CHI 2009, 2009, pp. 1819-1828.

CPSC 544 Topic Presentation & Paper: Universal Usability - Healthy Older Adults (10/13/09)

• 544_Presentation_Universal_Usability_Health.pdf: CPSC 544 Research Topic Presentation

• 544_A1_brehmer.pdf: CPSC 544 Research Topic Paper

References

The following references were presented during a research area presentation on universal usability: healthy older adults Oct. 13, 2009.

[Abeele 06]

Abeele V, Van Rompaey V. Introducing Human-Centered Research to Game Design : Designing Game Concepts for and with Senior Citizens. In: CHI'06 extended abstracts on Human factors in computing systems. ACM; 2006:1474. Available at: http://portal.acm.org/citation.cfm?id=1125451.1125721.

• Abstract: UCD for non-traditional player groups such as senior citizens result in inspiring and creative game concepts based on the passions of elderly individuals.

• passion model: core activity + connect, cultivate, contribute - model of passions in elderly life
• focus on more than gameplay - cultivating personal growth, contributing to society, connecting people (ensure meaningful play)
• co-design of game concepts for passions and desires of seniors
• UCD in games - non-traditional player group - assessing playability in social games - incorporating ethnography and participatory design
• PD: brainstorm around a conceptual story and passions - co-designed into paper prototype + concept
• less important: playing cards, puzzles, TV
• passions: people, event planning, visiting/travel, dinner, walking, cultivating knowledge, attending guest lectures, reading non-fiction, attending workshops, watching grandchildren, organising and visiting isolated/non-mobile people

[Dix 04]

Dix, A., Finlay, J., Abowd, G. D., & Beale, R. Human-Computer Interaction (3 ed.). Peason Education Limited, Essex, UK (2004). 390-391.

• Abstract: Chapter on designing for diversity, section on designing for different age groups. Some high-level design guidelines and practices for designing for older users.

• no evidence of technophobia among older users
• more leisure time, disposable income, more independence in recent years (improved elder health)
• familiarity an issue - terminology may have different meanings
• make use of redundancy, accessibility
• clear, simple, forgiving or errors, sympathetic and relevant training

[Eisma 03]

Eisma R, Dickinson A, Goodman J, et al. Mutual inspiration in the development of new technology for older people. In: Proceedings of Include.Vol 7. Citeseer; 2003. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.107.5588&rep=rep1&type=pdf.

• Abstract: Presents design guidelines for working with older users and concept of mutual inspiration. Discusses value of hand-on activities.

• early involvement, common ground, encourage discussion, focus group atmosphere, hands-on activities / workshops - build confidence, social support
• more general than participatory design
• address the worries and fears of older users, but do not patronise

[Eisma 04]

Eisma R, Dickinson A, Goodman J, et al. Early user involvement in the development of information technology-related products for older people. Universal Access in the Information Society. 2004;3(2):131-140. Available at: http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s10209-004-0092-z.

• Abstract: Methodology for early user involvement; generation of seminars regarding older users for industry.

• communicating with industry - lack of interest - reluctant to consider older users, treated them as homogenous group - no subdivision of the demographic
• HCI/UCD does not address problems for eliciting requirements for ICT for older users; HCI methods focus on req's for specific products / projects, but not when product has not yet been developed
• contacting older users possible through charity orgs, educational establishments, community orgs, sheltered housing, church groups, social clubs, day centres - maintain and extend relationship - personal visits and newsletters
• use carefully worded questionnaires, standardised UCD process
• allow for a focus-group atmosphere (aids in individuals' lack of confidence)
• social workshops - incorporate games, chatting, group interviews

[Harley 09]

Harley DA, Kurniawan SH, Fitzpatrick G, Vetere F. Age Matters : Bridging the Generation Gap through Technology-Mediated Interaction. In: Proceedings of the 27th international conference extended abstracts on Human factors in computing systems. ACM; 2009:4799–4802. Available at: http://portal.acm.org/citation.cfm?id=1520744.

• Abstract: Workshop dedicated to exploring the opportunities and obstacles faced for the design of intergenerational communication. Poses questions as a means to define the current state-of-the-art and what design/accessibility/social issues factor into design for internet/mobile/pervasive technology.

• Q: problems facing elderly people (non-health related)
• A: social isolation, social support + companionship, loss of loved ones and peers due due death / loss of mobility, families growing distant, economic migration, existing intergenerational communication tools (familiarity issues)
• considering intergenerational context for design
• social isolation, social support + companionship, greater social networks - protective influence against mortality
• decline in mobility - families distant due to economic migration
• fastest growing user group online

[Kurniawan 06]

Kurniawan SH. An exploratory study of how older women use mobile phones. UbiComp 2006: Ubiquitous Computing. 2006:105-147;122. Available at: http://www.springerlink.com/index/R7G4V0145304J187.pdf.

• Abstract: Guidleines established by group of senior users HCI experts. Senior-targeted websites reviewed using heuristic evaluation and new guidelines. A review of new guidelines with senior web-users.

• older users using the web more: socialisation, new skill acquisition, special interests, news, personal finances, online companionship, shopping, communicating, assisting the homebound or otherwise disabled
• categories of guidelines: vision, psychomotor, attention, memory and learning, intelligence and expertise
• 38 guidelines under 11 headings: target design, graphics, navigation, browser features, layout of control, links, user cognitive design, colour and background text design, search engine feedback,
• user evaluation of guidelines + website rating
• conclusions: guidelines too general, not specific enough, but nevertheless implications for web developers

[Massimi 07]

Massimi M, Baecker RM, Wu M. Using participatory activities with seniors to critique, build, and evaluate mobile phones. Proceedings of the 9th international ACM SIGACCESS conference on Computers and accessibility - Assets '07. 2007;6185:155. Available at: http://portal.acm.org/citation.cfm?doid=1296843.1296871.

• Abstract: Presentation paper. Presents list of considerations for design of mobile phones for older users. Also presents considerations for participatory design for ICT with seniors.

• participants want a variety of functions and applications - hardware often frustrating
• by 2050, 21% of population > 60
• "senior-friendly" - decreased sensorimotor skills, reduction in complexity and functionality (oversimplified - appropriate for dementia)
• discourage hasty, single-function, re-purposed solutions
• applications: way-finding, memory aids, keyboard/mouse alternatives
• implications for legibility - macular degeneration a reality
• guided participatory activities - software design (needs analysis, requirements engineering, paper prototypes), needs analysis (mobile phone critiques, scenario-based design)
• critical comments on form factor, interaction styles, aesthetics, undesirable features
• personal organiser and memory aid - develop own phone software / main-menu redesign
• results: function areas: calendar, address book, notebook, how-to-use-this-phone, reminder alarm, games, emergency
• results: hardware: large buttons, screen/text size + brightness, grip, selection mechanism, jog wheel, weight, hearing aid compatibility
• user tests / deployment: placing / receiving calls, notes, calendar, contacts, photographs, voice recorder
• participatory design considerations: provide alternative activities, subgroups to level out individual differences and deficits, minimise cross-talk, participation as an institutional affair, activity structure, speed up / slow down as necessary, blend individual + group sessions
• design considerations: eliminate side/rear buttons, avoid soft keys - form appropriate mental models, home state button, human support networks, several input modalities, avoid modifiers, personal data structures, no slide-out, naming conventions,
• discussion: design for "us" rather than for "me" or "them" - less homogenous
• limitations: may not generalise well, not guidelines but considerations - need more testing, seniors are better critics, hardware design, accessible software, lack of creativity during design (learning rather than creating)
• conclusion: support memory to promote autonomous living

[Zajicek 04]

Zajicek M. Successful and available: interface design exemplars for older users. Interacting with Computers. 2004;16(3):411-430. Available at: http://linkinghub.elsevier.com/retrieve/pii/S0953543804000402.

• Abstract: Discusses usefulness of a pattern language in interaction design for older users, with an example in the domain of voice input/output web kiosk. Generalizes to all interfaces used by older users.

• web voice kiosk case study
• pattern language for message types
• web applications - 1st source of info: bus schedules, council collections, doctor/hospital appts.
• diversity among older users - variability w/ age - dynamic diversity
• older people ineffective when contributing to new technologies - unaware or possibilities
• design patterns for older users - pattern language - message types: confirmatory / default / explanation
• case study / limitations of guidelines - voice output web browser - mixed mode text + speech - evaluate usefulness of spoken instructions (voice help) - confirmatory messages to build confidence / conceptual models; what is optimal message length?
• guidelines:
  • keep messages as short as possible
  • reduce choice whenever possible
  • use mnemonic letters to indicate key press menu selections
  • insert confirmatory statements whenever possible
• web accessibility exemplifies dilemma inherent in use of guidelines
• task artefact theory + claims / patterns - claims preserve info surrounding a guideline essential elements of good interface in terms of task to be completed, artefact/system or claim based on experiment or theory - encapsulate design knowledge into patterns - describing an element of design + how/why it is used - used together to enhance effectiveness; memory-supporting patterns
• features specially designed to make interaction easier for older people will be useful for everybody - greater universal usability - user sensitive inclusive design
• types of messages: menu choice, confirmatory, default input, context-sensitive help, talk-through, explanation, error recovery, partitioned input

Additional References (not presented)

The following references were not presented during the topic presentation, but included in the initial research survey.

[Davis 08]

Davis H, Vetere F, Francis P, Gibbs M, Howard S. “I Wish We Could Get Together�: Exploring Intergenerational Play Across a Distance via a 'Magic Box'. Journal of Intergenerational Relationships. 2008;6(2):191-210. Available at: http://www.informaworld.com/openurl?genre=article&doi=10.1080/15350770801955321&magic=crossref||D404A21C5BB053405B1A640AFFD44AE3.

[Ellis 00]

Ellis RD, Kurniawan SH. Increasing the Usability of Online Information for Older Users: A Case Study in Participatory Design. Computer Law. 2000;16(3):180-186.

[Goodman 04]

Goodman J, Dickinson A, Syme A. Gathering Requirements for Mobile Devices using Focus Groups with Older People. In: Designing a More Inclusive World, Proceedings of the 2nd Cambridge Workshop on Universal Access and Assistive Technology (CWUAAT), Springer. Citeseer; 2004:1-10. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.130.7025&rep=rep1&type=pdf.

[Kurniawan 05]

Kurniawan SH, Zaphiris P. Research-derived web design guidelines for older people. In: Proceedings of the 7th international ACM SIGACCESS conference on Computers and accessibility. ACM; 2005:135. Available at: http://portal.acm.org/citation.cfm?id=1090810.

[Rosson 02]

Rosson M, Carroll J, Seals C, Lewis T. Community design of community simulations. In: Proceedings of the 4th conference on Designing interactive systems: processes, practices, methods, and techniques. ACM; 2002:75–83. Available at: http://portal.acm.org/citation.cfm?id=778726.

Utopia Conference [Brewster 02]

Brewster, S., & Zajicek, M. A new research agenda for older adults. Worksop held at HCI2002, South Bank University (2002). http://www.dcs.gla.ac.uk/~stephen/workshops/utopia/index.shtml (accessed Oct 2009).

• Abstract: A workshop to establish research questions and consideration when designing ICT for older adults.
• motivation: increased life expectancy in developed nations: 2021 - 78 M / 83 F, 2050 - 79 M / 84 F
• topics: social inclusion, lifestyle, user group, modelling, system design paradigm, unifying strands in interfaces / applications, age-related impairments, design guidelines, differences from universal design

Contains a link to all papers submitted:

• 1. Dickinson A, Eisma R, Syme A, Gregor P. Utopia: Usable Technology For Older People: Inclusive and Appropriate. A New Research Agenda for Older Adults, BCS HCI, London. 2002:38-39. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Utopia:+Usable+Technology+For+Older+People:+Inclusive+and+Appropriate#0.

• 2. Dong H, Keates S, Clarkson P. Accommodating older users' functional capabilities. Group. 2002;2:10-12. Available at: http://publications.eng.cam.ac.uk/8393/.

• 3. Goodman J, Brewster SA, Gray P. Memory aids for older people. In: Proceedings.Vol 2.; 2002:32-33. Available at: http://www.dcs.gla.ac.uk/~joy/research/2002_pos_paper/position_paper_hci02.pdf.

• 4. Hanson VL. Making the Web Usable By Seniors. :10-12.

• 5. Jensen BR, Laursen B, Sandfeld J. The effect of aging on performance and muscle activity during computer use . :8-9.

• 6. Keates S, Clarkson PJ, Robinson P. Providing Access to E-Information for Older Adults. Group. 2002:19-20. Available at: http://publications.eng.cam.ac.uk/10449/.

• 7. King A, Kurniawan SH, Evans DG, Blenkhorn P. The Design and Evaluation of A Joystick-Operated Screen Magnifier. Group. 2002:10-12.

• 8. Coleman R, Cassim J, Hamlyn H. It's CHI Jim, but not as we know it! Design.:34-35.

• 9. Lines L, Hone KS. Research methods for older adults. Research Agenda for Older Adults, BCS HCI, London. 2002;(September):10-12. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Research+Methods+for+Older+Adults#8.

• 10. Monk AF, Baxter G. Would you trust a computer to run your home? Dependability issues in smart homes for older adults. Brewster, S. and Zaijicek, M. A New Research Agenda for Older Adults. British HCI, London, UK. 2002:21-22. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Would+You+Trust+a+Computer+to+Run+your+Home?+Dependibility+Issues+in+Smart+Homes+for+Older+Adults#0.

• 11. Morrissey W. What's Stopping Silver Surfers? The Triumphs & Challenges of Older Adults Surfing the Web. Group. 2002:14-15.

• 12. Reed D. Towards dependability of technology assessment in the delivery of care to the elderly: a case study. Brewster, S. and Zaijicek, M. A New Research Agenda for Older Adults. British HCI, London, UK. 2002:23-24. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Towards+Dependibility+of+Technology+Assessment+in+the+Delivery+of+Care+to+the+Elderly#0.

• 13. Wales RJ. It's a Person Issue Before a Technology Issue. Group. 2002:10-12.

• 14. Whitney G. The Navigation of Older People with a Range of Disabilities in Complex Pedestrian Environments. :6-7.

• 15. Wilmes B, Vogel M. Web-/kiosk-based health information on falls delivered to older people in tower hamlets. Methodology.:10-13.

• 16. Zajicek M, Lee A. Voice XML for Older Adults' Web Access. Group.:10-12.

• 17. Zaphiris P. Quantitative Models for Older Adults’ Hierarchical Structure Browsing. Group. 2002:10-12.

CPSC 544 - Human Computer Interaction - Universal Usability

Topic Paper References

Research papers discussed and presented during the CPSC 544 lectures.

[Shneiderman 00] - Universal Usability (General)

Shneiderman B. Universal usability. Communications of the ACM. 2000;43(5). Available at: http://portal.acm.org/citation.cfm?id=332833.332843&dl=GUIDE&dl=ACM&idx=332833&part=periodical&WantType=periodical&title=Communications of the ACM.

• Comment: This article's contribution to the field is far-reaching and addresses many forms of usability concerns. In the past 10 years, we have seen the rise of broadband internet access, the One-Laptop-Per-Child initiative (i.e. the XO-1 laptop), and the creation of many diverse online communities cited in the article. In addition, we cannot forget the rise of Web 2.0 and social networking, which have undoubtedly adhered to principles of universal usability. However, with the technical divide shrinking, a set of universal usability problems still persist today, such as concerns regarding net neutrality.

[Ho-Ching 03] - Auditory Impairments

Ho-Ching FW, Mankoff J, Landay JA. Can you see what i hear?: the design and evaluation of a peripheral sound display for the deaf. In: Proceedings of the SIGCHI conference on Human factors in computing systems. ACM New York, NY, USA; 2003:161–168. Available at: http://portal.acm.org/citation.cfm?id=642641.

• Comment: I expect that efficient wireless microphone arrays, especially those requiring little calibration, could eventually fall within a reasonable cost range, thus enabling users to use sound visualization systems such as the Ripple display. On the other hand, I expect that ubiquitous ambient detection and notification devices may prove to be more viable, and enjoy greater use among both hearing and non-hearing users. For example, imagine a kettle equipped with the capability to send a notification over a local network to a desktop or mobile device, informing the user that water has boiled. Alternatively, sensors under doormats or inside a door detect and notify when a person approaches. If we consider Moore's law and the decreasing costs of such devices, I wouldn't doubt the possibility of a house or office containing many devices with detection and notification abilities.

[Wobbrock 03] - Motor Impairments

Wobbrock JO, Myers BA, Kembel JA. EdgeWrite: a Stylus-Based Text Entry Method Designed for High Accuracy and Stability of Motion. In: Proceedings of the 16th annual ACM symposium on User interface software and technology.Vol 5. ACM; 2003:70. Available at: http://portal.acm.org/citation.cfm?id=964696.964703.

• Comment: I curious as to whether a similar system exists that will support non-Roman alphabets; the Chinese alphabet for instance contains thousands of unique characters. From my understanding of written Chinese, many characters can be divided into halves or quarters (left and right, top and bottom), with more simplified glyphs in each half or corner. Perhaps an variation of EdgeWrite with a 2 x 2 grid of adjacent writing squares could facilitate input for Chinese and other languages.

Topic: Cognitive Impairments - References

Zoltan Foley-Fisher, Presenter

[Back 01]

Back M, Szymanski MH. The AirBook: force-free interaction with dynamic text in an assistive reading device. In: CHI'01 extended abstracts on Human factors in computing systems. ACM; 2001:251–252. Available at: http://portal.acm.org/citation.cfm?id=634216.

[Dawe 06]

Dawe M. Desperately seeking simplicity: how young adults with cognitive disabilities and their families adopt assistive technologies. In: Proceedings of the SIGCHI conference on Human Factors in computing systems. ACM; 2006:1152. Available at: http://portal.acm.org/citation.cfm?id=1124772.1124943.

[Lee 08]

Lee ML, Dey AK. Lifelogging memory appliance for people with episodic memory impairment. Proceedings of the 10th international conference on Ubiquitous computing - UbiComp '08. 2008:44. Available at: http://portal.acm.org/citation.cfm?doid=1409635.1409643.

[LoPresti 04]

LoPresti EF, Mihailidis A, Kirsch N. Assistive technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation. 2004;14(1):5–39. Available at: http://www.informaworld.com/index/789064993.pdf.

[Wu 08]

Wu M, Birnholtz J, Richards B, Baecker RM, Massimi M. Collaborating to Remember: A Distributed Cognition Account of Families Coping with Memory Impairments. Memory. 2008:825-834.

• Comment: Given the design considerations documented in this article, it appears as though many of them can be satisfied with existing services and technology. Google calendars allows users to share, set owner and group rights, and edit calendars from the web or on a mobile device. A group with Windows Mobile-equipped devices can synchronize their Exchange calendars and set reminders for individuals or for the entire group. The cost of large displays (and potentially even large wall-mounted touch displays) will come down in eventually come down and facilitate editing of synchronized shared calendars at home. One component of this solution that is currently missing is ubiquitous or wearable computers with synchronous capabilities, but I suspect that even these forms of technology are not far from being realized.

Topic: Visual Impairments - References

Mohan Raj, Presenter

[Emery 02]

Emery VK, Edwards PJ, Jacko JA, et al. Toward achieving universal usability for older adults through multimodal feedback. ACM SIGCAPH Computers and the Physically Handicapped. 2002;(73-74):53. Available at: http://portal.acm.org/citation.cfm?id=957214.

[Jacko 03]

Jacko JA, Scott IU, Sainfort F, et al. Older Adults and Visual Impairment: What Do Exposure Times and Accuracy Tell Us About Performance Gains Associated with Multimodal Feedback? CHI. 2003;(5):33-40.

• Comment: It is no surprise to me that redundantly coding feedback across multiple modalities for drag-and-drop interactions is beneficial to all types of users (normal vision and impaired vision) - redundancy encoding has also been discussed at length in CPSC 533C (Information Visualization). Inspired by what was learned in that course, I am curious as to how visually impaired individuals (i.e. those with AMD) respond to animation as a form of redundant feedback. For instance, during a drag-and-drop operation of a file to a folder, it is typical for a small animation (i.e. the folder opening) to occur when the file icon is placed over the target folder. Could animations such as this, or easily-detectable animation such as a flashing icon be justifiably added to multi-modal feedback patterns for visually-impaired users?

Clinical Psychology References

Clinical Conditions and Diagnoses - Review Papers

[Feldman 05]

H.H. Feldman and C. Jacova, "Mild Cognitive Impairment," American Journal of Geriatric Psychiatry, vol. 13, 2005, pp. 645-655.

• MCI - cog. func. below normal levels, yet not dementia;
• subtypes - AAMI (age-assoc. memory imp.), AACD (age-assoc. cog. decline), MCIa (amnestic MCI), CIND (cog. impair not dementia)
• etiological (def): the cause, set of causes, or manner of causation of a disease or condition; the causation of diseases and disorders as a subject of investigation.
• is MCI prelude to dementia; what is earliest stage of definable dementia; are there benign forms of MCI?
• nosology (def): the branch of medical science dealing with the classification of diseases.
• AAMI - defined psychometrically by scores on mem. tests 1SD below norms; other cog. func. unimpaired; not caused by specific neurological, psychiatric, medical cond.; most overlap w/ normal ageing.
• AACD - cog. effects of ageing beyond mem. domain - learning, memory, attention, thinking, language, visuospatial func.; onset over at least 6 mo. w/ requisite for confirmatory collateral history from reliable informant; 1SD below norms on tests of one of these cog. domains; insufficient to meet diagnostic criteria for dementia, not accounted for by systemic, neurological, psychiatric disorders;
• MCIa - memory complaints, generally 1.5SD below norms on psychometric tests; cog func. otherwise normal with ADL: activities of daily living; clinical dementia rating of 0.5; possible extension alteration to MCI multiple-domain and MCI single non-memory domain
• CIND - no consensus to date on operational definitions of the condition and whether there should be specified psychometric norms applied
• MCI (criteria) - neither demented nor normal - report of cog. decline supported by impairment on objective cog. tasks, evidence of decline over time; syndrome associated within a widely heterogenous group of diseases / disorders, from medical to neurological to psychiatric - assessed etiologically, promote appropriate medical mgmt;
• prevalence rates: higher in referral-based samples likely because of spectrum bias - indvls presenting to dementia clinic are more likely to have AD (alzheimer's) at the MCI stage than indvls in primary care or volunteer community settings; suggestion that AACD captures a broader range of cog. impairments;
  • avg. 10% annual rate of progression from MCI to dementia - varied considerably across MCI subtypes and settings; rates of progression from AACI to dementia are reported to be lower than AACD to dementia;
  • rates of reversion or recovery to normal from MCI differs for subtypes and settings - evidence is accruing on incidence rates within these subtypes as well as on their different dementia outcomes;
• screening: early MCI recognition can allow necessary diagnostic work-up to be undertaken, reversible etiologies and risk factors to be treated, counselling to be provided, therapy to be initiated; need to develop valid screening tools that can discriminate between normal and MCI and identify MCI individuals most likely to progress to dementia; no widely accepted screening tests for MCI;
  • MMSE - mini-mental state exam
  • Neurotrax mindstreams - computerised test
  • diagnostically validated tests likely to have utility in general practise because they are capable to detecting MCI, alerting the practitioner to seek and treat reversible etiologies, guiding the need for specific referral;
• study designs in which diagnoses have been made clinically and independently of psychometric tests have more validity than studies in which the psychometric tests were part of the diagnostic algorithm;
  • studies have consistently identified episodic memory deficits as being predictive of later progression to dementia; semantic memory/language deficits are predictive of dementia; highest risk of dementia still belongs to group with disproportionate memory impairment; episodic memory impairment is feature of abnormal, clinically relevant, cognitive functioning that may herald the onset of dementia
  • reliability of clinical judgment must still be demonstrated, w/ consideration to speciality and expertise of the clinician
• neuroimaging: extent to which the neuroimaging findings from these highly selective studies generalise to MCI population that presented to dementia clinics and general practice is unknown; further studies: determine diagnostic usefulness of MRI and PET in real-world patients.
• prevention: no successful pharmacological interventions to slow/reduce incident rates of MCI from normal;
• caveats: predictive validity around various definitions of MCI that are in use have not been fully determined; generalizability of findings from highly specified samples to general MCI population will require additional study;

[Feldman 08]

H.H. Feldman, C. Jacova, A. Robillard, A. Gracia, T. Chow, M. Borrie, H.M. Schipper, M. Blair, A. Kertesz, and H. Chertkow, "Diagnosis and treatment of dementia: 2. Diagnosis," Canadian Medical Association Journal, vol. 178, 2008, pp. 825-836.

• abstract: dementia can now be accurately diagnosed through clinical evaluation, cog. screening, laboratory eval, structural imaging; 32 recommendations related to diagnosis of dementia; insufficient evidence to recommend routine functional imaging, measurement of biomarkers, neuropsychological testing
• cog. impairment and dementia present in about 20% of elderly population and are consistently rated among top 3 concerns of elderly people;
• better cog. screening tools and more specific/expensive means of diagnosing Alzheimer's disease
• approach to diagnosis: clinical diagnosis, logical search for cause, identification of treatable comorbid (def: the simultaneous presence of two chronic diseases or conditions in a patient)conditions and other contributing factors, such as degree of cerebrovascular disease;
• diagnostic in 6 steps: patient history, interviewing caregiver/family, phys. exam, brief cog. tests, laboratory tests, structural imaging for patients meeting certain criteria; last 3 usually restricted to specialist practice
• recommendations for diagnosis of dementia:
  • range of brief cog. tests for discriminating between dementia and normal state - insufficient evidence to recommend one test over the others; not developed to differentiate between dementia subtypes;
  • diagnosis of dementia remains clinical - must retain diagnostic criteria currently in use, continued use of NINCDS-ADRDA criteria (Alzheimer's); mild Alzheimer's can be diagnosed with a high degree of specificity;
  • genetic testing;
  • neuropsychological testing - distinction between normal ageing, mild cog. impairment, or cog. impairment without dementia, early dementia; risk of progression from mild impairment or cognitive impairment without dementia to dementia or Alzheimer disease; differential diagnosis of dementia and other syndromes of cog. impairment;
• clinical eval - brief cog. tests - serve to determine presence of overall severity of memory and cognitive deficits and can be recommended for both primary care and specialty practice;
  • MMSE remains most widely used; score of 18-26 of 30 = mild dementia, 10-18 = moderate dementia, less than 10 = severe dementia - focuses on memory, attention, construction, orientation; Modified MMSE includes delayed recall
  • clock-drawing also used - may lack sensitivity for the diagnosis of early or mild dementia;
  • newer tests have been shown to be more accurate than the MMSE in discriminating between dementia and normal cognition, particularly in cases of mild dementia
    • coverage makes these tests more accurate in detecting dementia in heterogeneous populations
    • lack clear knowledge of advantages of one test over the others; recommends routine use;
  • some without dementia can score low on MMSE, w/ dementia < 20; dementia is even possible with scores > 26; language barriers, advanced age, low education can confound results and provide false positives
  • no brief cog/ test can differentiate betwen subtypes of dementia
• important to exclude delirium - condition that is transient, reversible, acute confusional state
• diagnostic criteria for dementia - acquired impairment in memory, associated with impairment in one or more of cog. domains: executive thinking, language, praxis, gnosis; impairments in cognition must be severe enough to interfere with work, usual social activities, relationships with others;
• neuropsychological testing routinely requires 2-4 hrs of patient's time, costs between 600$ and 1500$, not covered by prov. health plans; w/ expert interpretation it has shown utility in distinguishing early or mild dementia from mild cog. impairment or cog. impairment without dementia and from normal cog. function; contribute to determining likelihood of future dementia in at-risk groups, utility in distinguishing between dementia subtypes; considerable specificity, far greater than brief cog. testing; expensive, not ready in family practices;
• knowledge gaps: clinical definitions have a historical basis rather than empirical one; lack proof that the definition of dementia is superior to alternative ones, or the definition of cog. domains is optimal;
• hurdles to diagnosing dementia: physicians lack of familiarity w/ cog. screening; complexity of diagnosing process, pressures of time, lack of general conviction that an accurate diagnosis of dementia warrants the requisite effort;
• non-Alzheimer dementias: frontotemporal dementia - prominent behavioural changes and language impairment; dementia associated w/ Lewy bodies or Parkinson's - neuropsychiatric features includes visual hallucinations and fluctuations in disease course; vascular dementia - stepwise fashion, dysexecutive syndrome, focal neurological findings;

[Dubois 07]

B. Dubois, H.H. Feldman, C. Jacova, S.T. DeKosky, P. Barberger-Gateau, J. Cummings, A. Delacourte, D. Galasko, S. Gauthier, and G. Jicha, "Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria," The Lancet Neurology, vol. 6, 2007, pp. 734-746.

• abstract:
  • new techniques prevailing: distinctive and reliable biomarkers of AD; structural MRI; molecular neuroimaging with PET; cerebrospinal fluid analysis;
  • framework to capture both earliest stages, before full-blown dementia; new criteria centred on clinical core of early and significant episodic memory impairment
  • validation studies needed to advance these criteria and optimise their sensitivity, specificity, accuracy;
• criteria of DSM-IV-TR: statistical manual of mental disorders, 4.ed, NINCDS-ADRDA;
• prodromal (def.): relating to or denoting the period between the appearance of initial symptoms and the full development of a rash or fever.
• specification that onset of AD is insidious and there is lack of other systemic or brain diseases that may account for the progressive memory and other cog. deficits; more refined definition of AD is still needed to reliably identify the disease at its earliest stages;
• distinction between MCI (mild cog. impairment, amnestic mild cognitive impairment, preclinical AD: long asymptomatic period between first brain lesions and first appearance of symptoms, prodromal AD: symptomatic predementia phase of AD (generally MCI), AD dementia;
• improved recognition of non-AD dementia - operational definition and characterisation of non-AD dementia has improved; criteria developed that aim for high specificity; progress of clinical defn. of non-AD dementia improves sensitivity of currently accepted diagnostic criteria for AD by reducing level of uncertainty; improved defn. of AD phenotype, need to test early intervention;
• problems w. defn. of MCI: potential usefulness for clinical trials directed at delaying time to onset of AD - to address recognised clinical and pathological heterogeneity, subtyping MCI may be useful; 70% of those w. MCIa progressed to dementia actually met neuropathological AD; most accurate determination that indvl. had prodromal AD is critical;
• special care will be needed to limit toxic therapies to those w/ prodromal AD and those destined to develop non-AD dementia;
• revised criteria to eliminate MCI construct, bypassing binary outcome in clinical categorisation process associated with it as well as problems w/ reliability;
• objective: developing a diagnostic framework for AD that would include prodromal stages and integration of biomarkers and to validate framework
• core diagnostic criterion - early episodic memory impairment:
  • gradual and progressive change in mem. function at disease onset reported by patients/informants for period > 6 mo.
  • objective evidence of sig. impaired episodic mem. on testing
  • ep. mem. impairment can be isolated or associated w/ other cog. changes at onset of AD - exec. function (abstract thinking, working memory, mental set, language (naming, comprehension), praxis (imitation, production, gesture recog.), gnosis (recog. of objects/faces)
• core diagnostic criteria for AD: three above criterion + one or more supportive features: medial temporal lobe atrophy, abnormal cerebrospinal fluid biomarker, specific metabolic pattern on functional neuroimaging w/ PET, proven AD autosomal dominant mutation w/in immediate family
  • exclusion criteria: sudden onset, focal neurological findings, sensory loss, other clinical / medical disorders (i.e. major depression), delusions, apathy; - seizures, gait disturbances, extrapyramidal signs: relating to or denoting nerves concerned with motor activity that descend from the cortex to the spine and are not part of the pyramidal system, fluctuations in REM sleep, cerebrovascular disease, Lewy bodies, presence of delirium, toxic metabolic cause (altered state of consciousness)
  • evidence of early and previous episodic memory deficit as mandatory req. for AD diagnosis
  • criteria for definite AD: both clinical and histopathological evidence, both clinical and genetic evidence
• ep. mem testing: delayed recall suffers worse than immediate recall; genuine deficits in encoding and storage that are characteristic for AD must be distinguished from non-AD deficits that can also affect delayed recall, incl. attentional difficulties that may be present in depression, inefficient retrieval strategies assoc. w/ ageing, frontotemporal dementia, subcortical-frontal dementias;
• measures of sensitivity to semantic cueing can successfully differentiate patients w/ AD from healthy controls, even when patients are equated to controls on MMSI scores or when disease severity is very mild;
• patients w/ very mild AD also have a measurable reduction in sensitivity to cueing, reliably identifies prodromal AD;
• neurobiological imperative to identify AD before the point of disease where irreversible pathological injury would prevent effective intervention, proposed criteria should allow an earlier and more specific AD diagnosis;
• more balanced approach because clinical phenotype of AD is better known than its biological phenotype; time for assigning different weightings to its supportive features or recommending combinations of features, or alternatively requiring presence of all; other combinations may prove to have greater diagnostic accuracy or new features may be introduced;
• criteria represent a cultural shift req. more biologically focused work-up than prev. approaches;
• if non-AD is suspected, must be ruled out carefully on case-by-case basis by applying in parallel the diagnostic criteria for the other disorders;
• criteria still require decisions around how they are to be put into practice; not yet defined a magnitude of deficit or the comparative norms that should be used; no specification of the amount of atrophy that is optimally diagnostic of AD; foresee that technically less demanding criteria for clinical settings might develop from the more technically challenging research criteria once these are validated;