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Manship, Sharon and Hatzidimitriadou, Eleni and Stein, Maria and Parkin, Claire and Raffray,Maxime and Gallien, Phillippe and Delestre, Charlotte (2019) A Literature Review of the ChallengesEncountered in the Adoption of Assistive Technology (AT) and Training of Healthcare Professionals. In: Special Thematic Session 15 Robotics and Virtual Worlds for wheelchair users – from

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Guest Editors:

Lorenzo Desideri, Luc de Witte, Rabih Chattat and

Evert-Jan Hoogerwerf

Organisers

TECHNOLOGY AND DISABILITY Volume 31, Supplement 1, 2019

Special Issue: AAATE 2019 Conference – Global Challenges in Assistive Technology:

Research, Policy & Practice, 27–30 August 2019, Bologna, Italy

Guest Editors: Lorenzo Desideri, Luc de Witte, Rabih Chattat and

Evert-Jan Hoogerwerf

CONTENTS

Foreword by AAATE President S1

Foreword by the Conference Chairs S3

Committees S5

Part 1: Special Thematic Sessions S7

Part 2: Aging S109

Part 3: Mobility S125

Part 4: Sport S133

Part 5: Communication S137

Part 6: Rehabilitation and Assistive Robotics S147

Part 7: Education, Learning and Intellectual Disability S155

Part 8: Service Delivery and Outcome Research S165

Part 9: Policy S177

Part 10: Digital Health S183

Part 11: User Participation S189

Part 12: Internet of Things S195

Part 13: (e)Accessibility S199

Part 14: Platform Speeches S203

Author Index Volume 31, Supplement 1 S207

Special Thematic Sessions:

1. Cognitive Accessibility of Digital Resources

2. User Participation in Software Development

3. Making STEM Accessible to Disabled People

4. Appropriate Wheelchairs a Global Challenge - Reflect, Review, Strategize/Revolutionize

5. Eye gaze technology: accessibility, usability and effect on participation and communication for persons with severe disabilities

6. Employing MOOCs and OERs in Teaching Digital Accessibility

7. AI and Inclusion – Exploring the issues as well as the successes

8. Creating a Match: Supporting student participation across the educational continuum with technology

9. Good Practices in AT Service Delivery

10. Play, Children with Disabilities, and Robotics. State of the Art and New Developments

11. Innovative Approaches in Building Inclusive Educational Environments with Technology

12. Developing Assistive Technology Together with End-users, Business, Healthcare and Knowledge Institutes - Challenges and Benefits

13. Challenges and Open Issues in Indoor and Outdoor Accessible Mobility

14. Pathological Speech Processing for Healthcare and Wellbeing

15. Robotics and Virtual Worlds for wheelchair users - from ideas to reality: Innovation, Training, and Roadmap to Market (The ADAPT project)

16. AT2030: A New Approach

17. Care Robotics in Europe and Asia; A Multicultural Perspective

18. Social Robotics for Assistive Technology

Technology and Disability 31 (2019) S1 S1DOI 10.3233/TAD-190001IOS Press

Foreword by AAATE President

The field of Assistive Technology (AT) is gettingmore and more attention, on global as well as lo-cal/national levels. After a period in which AT in manyEuropean countries almost disappeared from the polit-ical and policy radars, we are now seeing an increasedawareness of its relevance again. The GATE initiativeof the WHO that has led to the adoption of an impor-tant resolution on improving access to AT plays an im-portant role in that, and also the UN Convention on theRights of Persons with Disabilities (CRPD) is an im-portant driver. More ‘down to earth’ countries start torealise that AT can play a role in tackling the enormouschallenge to maintain high quality affordable healthand social care systems.

This growing attention for AT is a good thing. Tech-nology can be a powerful tool to enable people withdisabilities to live the life they want to live and makethem as independent of care and support as possible.And technology can indeed reduce the burden on ourhealthcare systems. But that does not happen as a mat-ter of course, because the same technology can alsobe a barrier to full inclusion of people with disabili-ties in society, and an extra complicating and costlyaddition to an already complex healthcare system ifnot properly used and implemented. Here lies a fan-tastic challenge for the international professional andresearch and development communities: how to makesure that AT is developed, used and implemented inthe best possible way, so that its potential is harnessedand contributes to full inclusion of people with disabil-ities. That is a global challenge; we know that in manycountries people with disabilities have very limited orno access to AT and that in many other countries thematch between needs and technologies is far from op-timal. So, there is work to be done!

The above explains why the motto of the AAATEconference in 2019 is “Global Challenges in AssistiveTechnology”. For the AAATE this conference is a keyelement in its activities. The aim is to bring expertsin the field of AT – professionals, researchers, devel-opers, teachers, policy-makers and users – together toexchange knowledge, discuss progress, develop ideasand challenge each other to deliver the best possiblecontribution to this important field.

The more than 200 contributions to this confer-ence clearly show the breadth of the field, the manychallenges, the great opportunities, interesting researchquestions, possible future directions, global collabo-ration and many more topics. The AAATE confer-ence is unique in its attempts to give a comprehensiveoverview of the ‘AT world’ crossing the boundariesof technology specialisations, user groups and stake-holder categories. The abstracts presented in these pro-ceedings together give a good overview of what is go-ing on and what will be future trends. This will help todefine research and policy agendas and stimulate newcollaborations and links.

Luc de WittePresident of AAATE

ISSN 1055-4181/19/$35.00 c© 2019 – IOS Press and the authors. All rights reserved

Technology and Disability 31 (2019) S3 S3DOI 10.3233/TAD-190002IOS Press

Foreword by the Conference Chairs

Dear colleagues,

It is a great pleasure to present the proceedings of the15th International Conference of the Association forthe Advancement of Assistive Technology in Europefor your appreciation. The conference, taking placein Bologna (Italy) at the end of August 2019, coversas usual a wide variety of themes having to do withthe relation between Technology and Disability. Be-side the more traditional areas of Assistive Technologythis includes Accessibility, Universal Design, Ambi-ent Assisted Living, Smart environments and Internetof Things, Robotics, Technologies for independent liv-ing and self-management, Rehabilitation technology,Technology for Ageing, Augmentative and AlternativeCommunication, etc. It is a precise choice of the con-ference organisers, fully in line with the mission andpositioning of AAATE as a European AT associationof reference, not to specialise in any of those fields, butto keep this broad perspective, adopting the standpointof those searching for effective assistive technologybased solutions for their empowerment and for whomall solutions are open, as long as they work well. Thisapproach makes the AAATE conference probably themost all-round AT conference in Europe and a bian-nual “must” for professionals supporting persons withdisabilities and older adults. As a matter of fact, read-ing through the selected abstracts brought together inthese Proceedings, the reader get a good picture of thebroadness of the field and the wealth of competencerepresented by the authors.

We would like to thank the Programme Committee,in particular Lorenzo Desideri of AIAS Bologna, andthe Scientific Committee Members for the work donein collecting, reviewing and selecting the abstracts herepresented. They form the main scientific heritage ofthis conference, together with other reports that willbe made from the educational sessions, the policy ses-sions and the product and prototype presentations. Fororganisational reasons it was not possible to include allthat material in these proceedings.

Finally we would like to thank the authors that havechosen the AAATE conference to present their work.We have appreciated your effort and congratulate youwith the high level of the work presented.

The Conference ChairsEvert-Jan Hoogerwerf (AIAS Bologna onlus)

Rabih Chattat (Alma Mater Studiorum University ofBologna)

Luc de Witte (AAATE)


Technology and Disability 31 (2019) S5–S6 S5DOI 10.3233/TAD-190003IOS Press

Committees

Program Committee

Rabih Chattat (Alma Mater Studiorum – Universityof Bologna)

Lorenzo Desideri (AIAS Bologna onlus)Ramon Daniels (Hogeschool Zuyd)Anna Kanto-Ronkanen (Kuopio University

Hospital)Katerina Mavrou (European University Cyprus)Luc de Witte (University of Sheffield)

Scientific Committee

Renzo Andrich (Fondazione Don Gnocchi, IT)Dominique Archambault (Université Paris 8, FR)Wim de Backer (Thomas More-Modem, BEL)Maya Balakrishnan (Indian Institute of Technology,

IND)David Banes (DavidBanesAccess, UK)Diana Bell (Stellenbosch University, SA)Maria Borgestig (Örebro University, SW)Christian Bühler (FTB, D)Maria Fernanda Cabrera (Universidad Politécnica

de Madrid, ESP)Roberta Caldin (Alma Mater Studiorum – Univer-

sity of Bologna, IT)Niccolò Casiddu (University of Genova, IT)Amedeo Cesta (ISTC-CNR, IT)Rabih Chattat (Alma Mater Studiorum – Università

di Bologna, IT)Lorenzo Chiari (Alma Mater Studiorum – Università

di Bologna, IT)Paolo Ciampolini (University of Parma, IT)Sara Comai (Politecnico di Milano, IT)Silvana Contepomi (Argentine Assistive Technol-

ogy Association, ARG)Alessandra Costanzo (Alma Mater Studiorum –

Università di Bologna, IT)Andre Coy (University of the West Indies, JAM)Gerald Craddock (National Disability Authority,

IRL)Peter Cudd (University of Sheffield, UK)

Ramon Daniels (Zuyd University of Applied Sci-ence, NL)

Angelo Davalli (INAIL, IT)Lorenzo Desideri (AIAS Bologna onlus, IT)John Dinsmore (Trinity College Dublin, IRL)Krzysztof Dobosz (Politechniki Slaskiej„ PL)E.A. Draffan (University of Southhampton, UK)Miguel Ángel Valero Duboy (CEAPAT, ESP)Pedro Encarnação (Catolica Lisbon, PT)Luca Fanucci (Università di Pisa, IT)Stefano Federici (Università di Perugia, IT)Christian Galinski (InfoTerm, AT)Rosemary Joan Gowran (University of Limerick,

IRL)Maurice Grinberg (Assist Foundation, BUL)Jeanne Heijkers (Zuyd University of Applied

Science, NL)Helena Hemmingsson (Stockholms University,

SWE)Marion Hersh (University of Glasgow, UK)Klaus Höckner (Accessible Media, A)Evert-Jan Hoogerwerf (AIAS Bologna onlus, IT)Takenobu Inoue (Nat. Rehabilitation Center for

Persons with Disabilities & RESJA, JAP)Safaa M. Issa (Menofia University, EGYPT)Abi James (University of Southhampton, UK)Simon Judge (Barnsley Hospital NHS Foundation

Trust & ISAAC, UK)Anna Kanto-Ronkanen (Kuopio University Hospi-

tal, FIN)Iosif Klironomos (FORTH, GR)Giulio Lancioni (Università di Bari, IT)Cecilia Sik Lanyi (University of Pannonia, HUN)Maria Larsson-Lund (Luleå University of Technol-

ogy, SWE)Natasha Layton (ARATA, AUS)Geraldine Leader (NUI Galway, IRL)Helene Lidstrom (Linköping University, SWE)Hille Maas (University of Tartu, EE)Riccardo Magni (GLIC Network, IT)Elena Malaguti (Alma Mater Studiorum – Univer-

sity of Bologna)Massimiliano Malavasi (AIAS Bologna onlus, IT)


S6 Committees

Donatella Mattia (Fondazione Santa Lucia, IT)Katerina Mavrou (European University Cyprus, CY)Veselin Medenica (The College of Social Work,

SRB)Klaus Miesenberger (Johannes Keppler Universi-

taet, AT)Orazio Miglino (Università degli Studi di Napoli

“Federico II”, IT)Alex Mihailidis (University of Toronto, CAN)Silvia Mirri (Alma Mater Studiorum – Università di

Bologna, IT)Inhyuk Moon (Dong-Eui University & RESKO,

KOR)Paulo Novais (Universidade do Minho, POR)Fiachra Ó Brolcháin (Institute of Ethics, Dublin City

University, IRL)Juan Pavón Mestras (Universidad Complutense de

Madrid, ESP)Marek Penhaker (VSB Technical University of

Ostrava, CZ)Chih-Wei Peng (Taipei Medical University &

TREATS,TWN)Renata Pinjatela (University of Zagreb, CRO)Margriet Pol (Amsterdam University of Applied

Sciences & COTEC, NL/EU)Catia Prandi (Alma Mater Studiorum – Università di

Bologna, IT)David Prendergast (Maynooth University, IRL)Åsa Larsson Ranada (Linköping University, SWE)P. V. Madhusudhan Rao (Indian Institute of Technol-

ogy, IND)

Francesco Rea (Italian Institute of Technology, IT)Angela Riccio (Fondazione Santa Lucia, IT)Uta Roentgen (Zuyd University of Applied Science,

NL)David Rusaw (Jönköping University, SWE)Fabio Salice (Politecnico di Milano, IT)Paola Salomoni (Alma Mater Studiorum – Univer-

sità di Bologna, IT)Marcia Scherer (MPT Institute, USA)Dusan Simsik (Technical University of Kosice, SK)Roger Smith (University of Wisconsin-Milwaukee,

USA)Rainer Stiefelhagen (Karlsruhe Institute of Technol-

ogy, D)María Luisa Toro Hernández (Universidad CES,

COL)Ivan Traina (NUI Galway, IRL)Gianni Vercelli (Università di Genova, IT)Nadine Vigouroux (Université Paul Sabatier –

Toulouse, F)Annalu Waller (University of Dundee & ISAAC,

UK)Petra Winkelmann (Institut der deutschen Wirtschaft

Köln, D)Luc de Witte (University of Sheffield, UK)Hongliu Yu (Shanghai Engineering Research Center

of Assistive Devices, PRC)Susan A. Zapf (Rocky Mountain University, USA)Jacopo Zenzeri (Italian Institute of Technology, IT)


Part 1: Special Thematic Sessions

Special Thematic Session 1Cognitive Accessibility of Digital Resources

The cognitive accessibility of digital resources is stilla major research topic and is insufficiently covered byexisting solutions and current accessibility guidelines.People with cognitive limitations can only use digitalresources to a limited extent or not at all because theydo not understand the available information or cannotorient themselves sufficiently on complex websites.The project Easy Reading tries to solve these problemsby creating an environment that allows to adapt the ac-cessibility of websites to the individual support needsof the users. The software framework developed withinthe scope of the project provides tools for adapting thelayout and structure of web pages, for enriching thecontent of web pages with symbols, images and videos,or for translating web content into a different languagelevel (e.g. plain language or simplified language). Inthis way, users with cognitive limitations as well asusers who have difficulties understanding the originalcontent due to their age, technical experience or mi-gration background can work with the original sourcesand access all information and services resources. TheEasy Reading framework is planned as a cloud based,open source and freely available support infrastructure.In this way, the framework supports the integration anduse of state-of-the-art and future research and devel-opment. It combines tools for individual user-centricannotation, customization, translation and personaliza-tion. In this Special Topic Session the motivation, theproject objectives and the current project results willbe presented and discussed. Further contributions fromsimilar research projects are also welcome.Chairs: Christian Bühler, Ingo Bosse, Susanne Dirks

GAP REDUCE. A Research & Development Proj-ect Aiming at Developing a Tool for PromotingQuality of Urban Life of People with Autism Spec-trum DisorderTanja Congiua,∗, Francesco Lubranob, Luca Pilosub,

Pietro Ruiub, Valentina Talua and Giulia TolaaaDADU, Department of Architecture, Design and Plan-ning of Alghero, University of SassaribLinks Foundation, Torino

Background: The paper reports the first results of atwo years ongoing research and development projectcalled “GAP REDUCE” aimed at promoting the pos-sibility of people with Autism Spectrum Disorder (pri-marily adult and high-functioning) of walking au-tonomously and safely across the city. The purpose isthe design and development of a Web App able to sup-port ASD people to plan, easily and in advance, an ur-ban itinerary towards possible daily destinations. Theproject is part of a wider research that investigates thespecific topic of the relationship between people withautism and the city with the aim of designing an inte-grated system of urban mobility policies, projects andtools for supporting the real opportunity for them to“use” the city every day. Some considerations moti-vated the research: the growing incidence of ASD, thealmost exclusive focus of existing studies and appli-cations concerning people with autism (mainly chil-dren) and space on the design of dedicated, separated,closed and private spaces, and the need of guaranteeeven during adulthood the actual opportunity to exer-cise the level of autonomy achieved during educationaland therapeutic paths.Method: The first part of the research dealt primar-ily on two distinct aspects: one regarding a cognitiveframework of autism directed to identify the urban spa-tial elements that can facilitate or hinder the possibilityof ASD people of walking together with the commu-nicative and educational tools to deal with problematicbehaviors; the second concerns the design and develop-ment of a digital tool, i.e. a Web App, that implementsthe requirements, assumptions and outputs achievedin the first phase. The App automatically generatesroutes using spatial elements as waypoints and evalu-ates these routes suggesting the most suitable path forASD users. The App is also equipped with a graphic


S8 Part 1: Special Thematic Sessions

user interface which permits to show visual instruc-tions on how to overcome situations considered crit-ical (e.g. encountering crowded places, crossing highvolume traffic intersections).A neighborhood in the city of Sassari (Italy) was se-lected as pilot study area.Key results: According to the methodological assump-tions, during the phases of data collection and first cal-ibration of the algorithm two needs became apparentand influenced the following steps: the necessity toclassify the urban spatial elements into two categories:positive and negative Points Of Interest acting as spa-tial facilitators or obstacles respectively and the need tocharacterise each POI through a set of attributes to beconsidered in the evaluation of the most suitable path.Thus three different types of elements have been iden-tified:a) POIs are the spatial features collected and mapped

with GIS;b) waypoints corresponding to the positive POIs that

are part of the calculated route;c) critical points corresponding to the negative POIs

along the route.The preferable route will be identified initially on thebasis of waypoints number and path length, then anevaluation procedure will consider the quality of POIsalong the route.By mean of marker functionality the app will provide agraphical representation of the POIs through texts andimages that support the user especially in critical cir-cumstances.Conclusion: Starting from these first results, a map-ping phase will be carried out in the pilot study areawith the aim of identifying the spatial elements corre-sponding to the waypoints and critical points and, in amore advanced stage of the project, a test phase will becarried out with a group of users with high functioningautism.The functional structure of GAP REDUCE makes it aflexible tool with possible further developments alsowith respect to the spatial needs of other groups of in-habitants (elderly, people with dementia, people withother sensory disabilities). Beside promoting the au-tonomy of movement in the city it can also supporturban planning processes towards the development ofmore inclusive and accessible environments for every-one.Keywords: City and People with Autism, Quality ofUrban Life, Urban Capabilities, Web App.∗Corresponding author. E-mail: [email protected]

Cognitive and Learning Disabilities work at W3Cand for the Easy Reading ProjectShadi Abou-Zahraa,∗ and Steve Leea,∗aW3C (MIT, ERCIM, Keio, Beihang)

Background: People with cognitive and learning dis-abilities face a broad range of accessibility barriers inwebsites and applications. While the W3C Web Con-tent Accessibility Guidelines (WCAG) standard in-cludes requirements (“Success Criteria”) that facili-tate accessibility for people with cognitive and learn-ing disabilities, the issues and their resolution are oftenless well understood by designers and developers. Fur-ther, many cognitive accessibility techniques requireadaptation or personalization by an Assistive Technol-ogy (AT), which are not yet well documented. Thus,there is a growing need for a larger corpus of explana-tory material and implementable techniques from theW3C Web Accessibility Initiative (WAI), to help min-imize these cognitive accessibility barriers.Method: The W3C Cognitive and Learning Disabili-ties Accessibility Task Force is developing resourcesthat provide background, requirements, gap analysis,and guidance on designing user interfaces (UI) andcontent for cognitive accessibility. These supplementthe techniques detailed in WCAG. The W3C Person-alization Task Force is developing resources for per-sonalized adaptation of content and user interfaces.This allows content marked up with alternative for-mats to be selected according to user preferences. TheEU Horizon 2020 project, Easy Reading, is develop-ing a new Assistive Technology (AT) Framework toprovide personalized adaptation for cognitive accessi-bility. This is will adapt to user preferences with real-time adjustments by monitoring user interactions. As aproject consortium partner, the W3C are ensuring har-monization between the project Framework and W3Cresources. Any new requirements or techniques uncov-ered during the project will be included in W3C’s re-sources to maximize impact. In addition, engagementduring the project’s technical development allows theproject’s deliverables to benefit from the knowledge al-ready encapsulated in W3C resources.Key results: The project’s Inclusive Participatory Ac-tion Research technique and Framework implementa-tion helped improve the W3C cognitive accessibilityand personalization resources. This enhanced knowl-edge may also lead to additional WCAG Success Cri-teria. The W3C’s corpus of cognitive accessibility andpersonalization knowledge supports sustainability ofthe project outputs and ensures further dissemination


through integration into existing international stan-dards and supporting guidance.The Easy Reading Framework is providing a requiredimplementation to validate the W3C techniques in areal world solution. Thus, the W3C guidelines are bothdistilling new project learnings and also informing thework.Conclusion: There is a growing awareness of cogni-tive accessibility user requirements and barriers alongwith the importance of addressing them at source.Thus, it’s an opportune time to be part of the EasyReading project and to enhance the W3C standardsand resources. The Easy Reading project’s personal-ized adaptation framework provides new understand-ing of user requirements and practical solutions, aswell as being as useful Assistive Technology in its ownright.There is now a useful introduction to requirements, en-hanced standards, guidelines and techniques that com-missioners, designers and developers can use to im-prove the experience of many.As a result, the experiences of people with cognitiveand learning disabilities can be improved by applica-tion of these internationally recognized resources. TheW3C operates an open consensus process so others areencouraged to collaborate to further improve cognitiveaccessibility.Keywords: Cognitive, personalization, adaptation.∗Corresponding authors. E-mail: [email protected];[email protected]

Inclusive Participatory Evaluation and Analysiswith Peer-Researchers with Cognitive Disabilites –an Innovative ApproachNadja Zaynela,∗, Katja Biekerb and Cordula EdlercaPIKSL Lab Duesseldorf, In der Gemeinde lebengGmbH (IGL), Ludwig-Erhard-Allee 14, 40227 Düs-seldorf, GermanybPIKSL Lab Duesseldorf, In der Gemeinde lebengGmbH (IGL), Ludwig-Erhard-Allee 14, 40227 Düs-seldorf, GermanycRehabilitation Science, Technical University Dort-mund, Emil-Figge-Str. 50, 44227 Dortmund, Germany

Background: The Project Easy Reading focuses onthe individual support needs of the users with cognitivedisability while going online. One of the main start-ing points is the fact that every person is different andtherefore needs different support browsing the internet.We believe that a person knows her or his own needsthe best and therefore consider people with cognitive

disability as experts for themselves They know the bar-riers they face, so they should be included in researchregarding software that is aimed to help people withcognitive disability.Method: The whole Project is based on a User-Centred-Design (UCD) Approach and includes the In-clusive Participatory Action Research (IPAR). One ofthe main goals of the project is the combination ofthese two approaches into one approach: the IPAR-UCD concept. IPAR-UCD describes that the users whowill in the end use the software are part of the develop-ment of the software.In the Project 16 Peer-Researchers with different levelsof understanding, different level of writing and readingand different level of attention and memory are work-ing in three different organisations taking part in theresearch process. All three organisations such as Pro-qualis, DART and PIKSL are participating as partnersin the Easy Reading Project. The Peer-Researcherswith a cognitive disability are integrated in the wholeprocess of the project.Key results: After giving a short introduction on themethods used in the project, we will concentrate onsome examples of the practical work with the Peer-Researchers: One big part of the project is the UserTesting of the Easy Reading Browser Plug-in. ThePeer-Researchers are the ones who will carry outthe User Testing. For valid and reliable testing, weare working with Test Cases. That means during theproject we have to find ways that people with cogni-tive disability who also cannot read or write are ableto work with the Test Cases. We will show the differ-ent states of the Test Cases and reflect on the how theywere developed in an inclusive team of researchers andpeer-researchers. We will outline the iterative way ofworking in detail and show how it is possible to workin an inclusive team.Conclusion: Working in an inclusive Team of Re-searchers and Peer-Researchers based on the IPAR-UCD approach is an innovative way of working inSoftware Development Projects. Including experts withan own cognitive disability during the developmentprocess rises the chances of the acceptance in the EndUser Group.Keywords: Inclusion, Participatory Research, Acces-sibility, Usability.∗Corresponding author. E-mail: [email protected]


Automated Adaptation of Content and Structure ofOriginal Web pagesAlan McCaigTexthelp, United Kingdom

Introduction: Creating a good user experience (UX)is key to obtaining and retaining visitors on the web.Countless studies show that for each second your pageis in an unusable, unreadable or unresponsive state thedrop off rate rises rapidly. Allot of time, effort andmoney goes into making sure that the UX of a modernwebsite is good, so why doesn’t this also always ap-ply to accessibility? One of the main issues with acces-sibility on the web is the lack of enforcement for ac-cessibility standards within websites. There are guide-lines set out by the W3C, such as the Web Content Ac-cessibility Guidelines (WCAG). The 3 levels of theseguidelines have only been made a lawful requirementfor the public, private or government sector in varyinglaws within each country, if at all. Even then, if theselaws were to apply to all sites it would be an enormoustask to enforce it. There are various tools available tocheck the accessibility of your website however it re-quires you to use them and then implement solutionsto address them.Methods: With this in mind, how can an accessibil-ity tool be created using a one size fits all solution? Itcan’t. Instead of fully relying on web standards to havebeen followed we can create engines and algorithms toread the underlying code and structure of a webpageand break this down into various sections. For exam-ple, take a typical news article website, we can assumethat this will be made up of 3 main sections – the navi-gation, the content and everything else (comments, ad-verts, etc.). The user would most likely be interested inthe content and navigation so we can use these scriptsto adapt this content more suitably for the user. TheEasyReading project incorporates peer researchers intoa somewhat iterative development process. This allowsus to see what areas the end users are having major is-sues in and adapt or improve the engines accordingly.Conclusion: Recent advances in technology may beable to help create a state of the art solution. Whilstthe development of the EasyReading framework andits engines is still underway, we are looking at how dif-ferent technologies can be used to automatically adaptand read the content and structure of web pages usingDocument Object Model (DOM) manipulation, script-ing and machine learning. Then look into how to makethis content accessible through translation, annotation,and adaption. These engines can then be used within

the EasyReading framework to customize a user’s ex-perience to their accessibility needs.Keywords: Accessibility, web, EasyReading, JavaScript, Machine Learning.∗Corresponding author. E-mail: [email protected]

Adaptive User Interface Concepts Supporting Peo-ple with Cognitive DisabilitiesPeter Heumaderra,∗, Klaus Miesenbergera, TomásMurillo Moralesa, Stefan Parkerb and BarbaraWakolbingerbaInsitut Integriert Studieren, Johannes Kepler Univer-sity Linz, Altenbergerstraße 69, 4040 Linz, AustriabCompetence Network Information Technology to Sup-port the Integration of People with Disabilities, Al-tenbergerstraße 69, 4040 Linz, Austria

Background: The concept of user interfaces support-ing means for automatic adaptation to the require-ments, skills or environment of the individual usersshows great potential towards enhanced usability andaccessibility. Systems that support different user in-terface concepts and different HCI paradigms enableusers with cognitive disabilities to operate them in a fa-miliar manner. This abstract describes how such adap-tive user interfaces and interface concepts are devel-oped and evaluated within EasyReading, a frameworkthat allows users to get personalized support for webcontent in real-time. Framework interfaces and the pro-duced adapted content are directly injected into theweb-page, enabling the user to work directly with theoriginal digital content of the page. The resulting ar-chitecture adapts to the users’ needs in the followingways:– Presentation of the user interface– HCI paradigms used to trigger framework functions– Functions for converting content into an alternative,

easier to understand, format– Presentation of the framework results to the end userAs the architecture is component based, new user inter-faces, HCI paradigms and functions can be added andadjusted for the individual user. This abstract shouldgive an overview on the benefits of such an adaptivesystem as well as its evaluation.Method: Development within the project is driven bythe principle “Nothing about us without us”. There-fore, the project cooperates closely with three end usergroups from Austria, Germany and Sweden that workas co-researchers in the project in an inclusive ap-


proach. Framework components such as user interfacesand widgets supporting different HCI paradigms aredeveloped together with a single user-group and thentested by the remaining user groups. Based on the out-comes of the testing, the components are refined andfurther developed until they are approved. Newly de-veloped components are then classified, so that theycan be later on matched with a user profile to createsolutions for the individual user.Key results: The first set of components was devel-oped using the aforementioned inclusive approach andthe first user tests are ongoing. First results of the on-going user tests show that there is a strong need foradaptability by the target group. As the abilities andpreferences of the user group are divergent, a one-size-fits all approach does not suit. For example, users re-quired different HCI paradigms to be supported whenparagraphs present on Web pages had to be adapted fortheir easier understanding. For some users it felt natu-ral to select the kind of help they would need and thenjust click on the paragraph, while others preferred toselect the text by marking it with the mouse and thenclicking a button that would enable the helping func-tionality.Conclusion: Adaptable user interface can greatly in-crease accessibility of systems as they are able to sup-port the different needs of the individual user.Keywords: accessibility, adaptive user interfaces, peo-ple with cognitive disabilities.∗Corresponding author. E-mail: [email protected]

Safety, Privacy and Ethical Considerations whenResearching With People with Cognitive Disabili-tiesSandra Derbringa,∗, Eva Holmqvista and MargretBuchholzaaDART Centre for AAC and AT, Sahlgrenska Univer-sity Hospital, Göteborg, Sweden

Background: For many people with cognitive disabil-ities, it’s difficult to access the web on equal terms withothers. The needs of those who has difficulties navigat-ing and understanding web content are often dependenton context, which makes it difficult to standardize so-lutions. In the project Easy Reading, peer researcherswith own experiences of cognitive disability work to-gether with developers to design a solution to personal-ize the experience on the web. The question of ethics isessential and concerns both the research process with

users and the privacy and security of the technology.The aim has been to produce guidelines on ethical con-siderations to support the work during the project andto perform a risk analysis to identify and assess ethicalrisks.Method: The framework of ethics within the projectconcerns issues like informed consent, design princi-ples, the role of an ombudsman and personal data. Ex-isting regulations and guidelines and previous researchresults on this were studied, and best practices on howto research and develop together with the target groupwere put together. To assess the risks, an ICT risk ma-trix from Queensland Government was used. It mea-sures how likely the risk is and how serious its im-pact is and results in a combined risk score, labeled infive steps. All documents will be used as a basis as theproject carries on.Key results: To make sure participants with cogni-tive disabilities understand the meaning of participat-ing, accessible information sheets and consent formsare important. Such forms were created written in sim-ple language with pictures to support the text.Basic principles for developing interfaces suitable forusers with cognitive disabilities were identified. Sys-tems should be easy to use and allow mistakes and theyshould be responsive and reliable. Users must be incontrol of their privacy and systems must comply withdata regulations. The role of ombudsman is importantto safeguard the safety of participants. It’s importantthat the ombudsman fulfils requirements such as beinglocated in the same area, being familiar with the tar-get group and have legal knowledge. The target groupis vulnerable when it comes to understanding and con-senting to data collection and their data might be sen-sitive. Therefore, it’s important to only collect the dataneeded, only keep the data for as long as necessaryand only give access to those who need it. The risk as-sessment includes risks related to the technology andto the research carried out with peer researchers andtesters.Checklists focused on the above areas were pro-vided to facilitate practical work.Conclusion: The question of ethics has to be presentwhere users are involved in the process, and par-ticularly where technology can capture so much in-formation. Data collection must consider the privacyand security aspects. Results from the work done inthis project’s ethics work package, including practicalguidelines and checklists as well as insights into com-mon risks, will be valuable for coming projects, appli-cation development processes and user testing withinthe field of assistive technology.


Keywords: Ethics, Privacy, Inclusive design, Peer re-searchers.∗Corresponding author. E-mail: [email protected]

New Approaches to Web User TrackingStefan Parkera,∗, Barbara Wakolbingera, GerhardNussbauma and Peter HeumaderbaCompetence Network Information Technology to Sup-port the Integration of People with Disabilities, Al-tenbergerstraße 69, 4040 Linz, AustriabJohannes Kepler University Linz, Altenbergerstraße69, 4040 Linz, Austria

Background: User tracking in the Easy Reading con-text differs from the usual understanding of the term asin website visitor tracking (with main focus on market-ing purposes). In Easy Reading the focus is on track-ing of a user’s cognitive load while actually viewinga webpage. Ideally a user needs to make sense of thepage on his or her first visit or it might be the last visit.So, in addition to page navigation data through mousemovements and clicks, it will be necessary to introduceadditional sensors which can expose certain data on auser’s cognitive state.Method: To solve the problem stated above, first thestate of the art in user tracking was analysed. Thencurrent approaches towards the detection of cognitiveload were investigated. With certain user-related re-quirements in mind, like unobtrusiveness, affordabil-ity, ease of use and reliability, certain interesting pa-rameters for user tracking in the Easy Reading contextwere defined.Key results: The sensors that have been consideredmost important for future work are eye trackers, fitnesstrackers and webcams. While the main purpose of eyetracking is to show the user’s present point of focus,also additional information can be derived from it. Fix-ations (200–300 ms or longer) can give an indicationof cognitive load when they are long, but come at a lowrate. The same applies for Micro-Saccades (fast move-ments of 30–80 ms in two directions) that come withhigh velocity and length. A further useful parameterwould be pupil dilation, which has long been knownto raise on cognitive load. Sadly this can only be mea-sured with professional eye trackers that come at a highprice, therefore being in conflict with the requirementof affordability. The purpose of the fitness tracker is todeliver heart rate data. This can be used in two ways:number one the pulse rate itself can help to detect stress

(does the pulse raise without the user getting up?) andnumber two, the Heart Rate Variability (HRV) can beused to measure activity of the autonomic nervous sys-tem. HRV is known to respond quickly to changes ina person’s cognitive state. Finally, the webcam can beused to detect the user’s blink rate, giving an addi-tional indication of the user’s state. Specifically wheneye blinks come at a low rate and with high latency, itcan be an indication of high cognitive load.Conclusion: All data mentioned above can only beseen as parts of a puzzle. While any isolated parame-ter will produce many false positives, it is assumed thatconsidered together they will give a more or less clearpicture of the user’s current cognitive state. This willhelp to present information in a more adequate way forthe individual user and therefore significantly push in-formation accessibility for people with cognitive dis-abilities, as well as people with other kinds of com-prehension problems, like people with a low level ofeducation or people facing a language barrier.Keywords: User tracking, cognitive load, eye tracking,HRV.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 2User Participation in Software Development

User participation in the development of products andservices is generally regarded as one of the key factorsfor sustainable development. In recent decades, userparticipation in software development has improvedsignificantly. During software development, users aretypically involved in the early stages of development,in requirements analysis and evaluation. Despite thisimprovement, however, there are still many develop-ment phases in which users are not involved due to costand time constraints, which in many cases leads to lim-ited usability and acceptance of the developed prod-ucts. Since it is often already difficult to include userswithout impairments in all phases of the software de-velopment cycle, the question arises how user partici-pation is realized in projects in which software prod-ucts are developed for people with impairments. In theworkshop described here, approaches and proceduresfor user participation of people with different impair-ments from various research projects, currently fundedby the EU, will be presented and discussed.Chairs: Christian Bühler, Ingo Bosse, Susanne Dirks


Participation of Users with Disabilities in SoftwareDevelopment ProjectsSusanne Dirksa,∗ and Christian BühleraaRehabilitation Technology, TU Dortmund University,Emil-Figge-Str, 50, 44227 Dortmund, Germany

Background: Without any doubt, every project man-ager in software development will confirm that highlyusable products can only be developed through activeuser participation in the development process. Userparticipation is one of the most important factors forproject success. In projects where the potential usersare involved in the product development, better soft-ware is developed and the satisfaction of developersand users with the work processes and the product de-velopment is higher. So much for theory – in real life,user participation in software development is some-what different, especially if the potential user groupconsists of people with disabilities or other particularlyvulnerable people. In addition to insufficient organiza-tional and financial resources, software projects oftenlack suitable methods and trained developers and inter-face designers to successfully integrate users with im-pairments into the development process. In the scopeof the presented work, opportunities and challenges ofparticipative software development with people withdisabilities were analyzed and discussed and solutionsto the most occurring challenges were developed.Method: In addition to the results of an extensiveliterature analysis, experiences from various softwaredevelopment projects of the authors were gatheredand analyzed, e.g. from the H2020-funded project‘Easy Reading’. Special problems of the differentuser groups using standard software products, differ-ent methodological approaches to user participationand processes of participatory software developmentprojects were analyzed. The systematized challengesand opportunities in participative development projectswere then categorized, prioritized and related to dif-ferent methodological approaches. Based on this, so-lutions for the most common problems in participativesoftware development with people with different dis-abilities were developed.Key results: Most of the common problems in par-ticipative software development projects could also befound for the user groups with impairments. How-ever, a number of other problems arose due to the par-ticular characteristics of the respective user groups.For people with motor and sensory impairments, themain problems were the configuration and accessibil-ity of working environments and materials. For people

with cognitive impairments, the identified problemswere primarily related to the communication within theproject, the design of the working materials and theinteraction between the project participants. Althoughagile software development contradicts user-centereddevelopment in some aspects, the agile approach withsome adaptations proved to be well suited for partici-patory software development with people with disabil-ities.Conclusion: For more effective involvement of userswith impairments in software development projects,suitable methods are lacking. The presented work hasshown that agile approaches form a good basis for par-ticipative software development if they are extendedby methods that address the particular requirements ofusers with impairments.Keywords: user participation, software engineering,accessibility, agile approaches.

Assistive Technology for People with Profound In-tellectual and Multiple DisabilitiesTeresa Sansour∗, Marlen Marzini, Meike Engelhardt,Torsten Krämer and Peter ZentelDepartment of Special Education, Heidelberg Univer-sity of Education, Germany

Background: People with profound intellectual andmultiple disabilities (PIMD) often communicate on apre-symbolic level and use unconventional behavioursignals (e.g. specific body movements or vocalizations)to express their needs. The number of those interac-tion partners who are capable of accurately perceivingand interpreting these specific and highly individualbehaviour signals is very limited in most cases. Thissignificantly restricts the participation of this group inall areas of life. INSENSION is an European projectfocusing on better understanding of the behaviour sig-nals by using the advances of unobtrusive technolog-ical recognition tools. Facilitating the communicationof and towards people with PIMD could contribute toimprove their participation and quality of life. This willbe realized by creating a technologically supported re-sponsive environment, which automatically analysesand interprets various behaviour signals against thebackground of the particular context.Method: The study has been started with assessing thebehaviour signals of six test persons by different me-thodical approaches:– based on renowned assessment tools, a comprehen-

sive assessment (questionnaire for their close rela-


tives as well as for direct support professionals) col-lects information on communication and inner states

– recordings of the test persons using state of the arttechnology combined with monitoring of physiolog-ical parameters by means of the Empatica E4 wrist-band to analyse facial expressions, gestures, vocal-izations and physiological signals

– focus group workshops with close relatives, directsupport professionals and IT specialists

Key results: In our presentation, we focus on prelimi-nary findings of the focus group workshops which tookplace in Poland and Germany moderated according tothe Walt-Disney-Method by Dilts (1991) and the addi-tional use of particular methods of the Design Thinkingapproach like the creation of personas to exemplify thetarget group. Within the scope of three workshops, theparticipants defined those situations within the life ofpeople with PIMD, which are most challenging for thetarget group itself as well as for their direct support per-sons. Based on the findings of the focus group work-shops and based on the collected data of the recordingsand the assessment, three applications have been deter-mined to provide technological support. The applica-tions focus on communication, the use of multimediaplayer and robotic assistance devices. Each applicationaims to provide remedy in challenging scenarios in or-der to increase the self-determination of people withPIMD and to improve the quality of their lives.Conclusion: After the implementation of the main IN-SENSION system in a specific environment, the designprocess of the determined application is envisaged.Therefore, the inclusion of later users represented bytheir direct support persons plays an important rolein terms of usability since their participation enablesan orientation towards the users particular needs andwishes.Keywords: People with profound intellectual and mul-tiple disabilities, assessment of communication, fo-cus group workshops, information and communica-tions technology.∗Corresponding author. E-mail: [email protected]

Usability Evaluation of Mobile Application for Per-sons with Disabilities: A Review of Available ToolsFabio SacchiaaDepartment of Human and Social Sciences, Univer-sity of Bergamo, IT, Bergamo

Background: The use of mobile applications is in-creasing among persons with disabilities (PwD) (Csapóet al., 2015). Apps and mobile devices can representan affordable assistive alternative to traditional expen-sive technologies in facing daily challenges (Brady etal., 2013). Therefore, the choice of accessible and us-able applications becomes fundamental and must takeinto consideration the users’ specific needs. However,the selection of suitable apps can be difficult, due totheir large number rapid growth and development, andbecause most of them “are untested and unregulated”(Moran, 2018: 10). This requires the identification ofspecific evaluation tools enabling PwD “to navigate inthis evolving app space” (Kim et al., 2018:1). Researchin the field has already brought to evidence some ofthese tools, which investigate the usability of mobileapplication for PwD (Harrison at al., 2013). Usability,in fact, is based on the user experience design and rep-resents “the extent to which a product can be used byspecific users to achieve specific goals with effective-ness, efficiency and satisfaction” (ISO, 1998). The sev-eral components of usability can be used to make deci-sions about the choice of a software (Goel et al., 2018).This study aims at reviewing existing research on toolsused for evaluating usability of applications designedfor PwD. This will enable the identification of the dif-ferent components of usability, in order to introducenew tools or guidelines for helping PwD in makingself-determined choices.Method: On 01-22-2019, a literature review was con-ducted on Science Direct, IEEExplore, ACM Digi-tal Library and Google Scholar to identify primarystudies, published from 1998 to 2019. The keywordswere “usability evaluation” AND “mobile application”AND “persons with disabilities”.Key results: Thirty prominent studies were found,from which five tools were identified, namelyPACMAD usability model (Harrison et al., 2013),Quality criteria assessment scale (Reynoldson et al.,2014), Mobile device app evaluation rubric (Ok et al.,2016), Subjective Usability Scale (Reeder et al., 2016),Health-ITUEM (Brown III et al., 2018). Each tool iscomposed of items, grouped in categories, correspond-ing to usability dimensions defined by the authors.They were applied to evaluate the usability of a certaingroup of apps (e.g. m-health) and addressed to a spe-cific disability. They are based on different methodolo-gies (yes/no scale, Likert scale, open-end answers) andthe assessment was performed predominantly by care-givers, therefore the tools did not directly record theuser experience.


Conclusion: This study identified different tools, re-lated to the diverse usability constructs adopted. Itemerged their low generalizability and a low involve-ment of PwD in their evaluation process. Instead, ausability tool that involves direct cooperation withPwD would provide a more insightful assessment. Thisstudy highlighted the need of a more thorough evalua-tion of the importance of the relationship between ac-cessibility and usability in establishing the quality ofPwD assistive software. The work also elucidated thenecessity to establish regulatory standards, in order toachieve higher quality applications and to promote auniversal attitude towards accessibility and inclusionpertaining to PwD.Keywords: mobile application, usability evaluation,self-determination.∗Corresponding author. E-mail: [email protected]

Inclusive Collaboration in R&D for Improved Cog-nitive AccessiblityCordula Edlera,∗, Klaus Miesenbergerb and IngoBosseaaTU Dortmund University, GermanybJohannes Kepler University Linz, Austria

Background: e-inclusion entails empowering peo-ple to participate independently in digital society in-cluding people with disabilities. Usability and User-Experience Design describe user-oriented or user-centered design processes (UCD). The knowledgeof UCD is scientifically established and proven forthe implementation of assistive technology and e-Accessibility for people with disabilities except forthose with cognitive disabilities. So far, there is no fullparticipation of the target group as researchers or ex-perts. Furthermore, there is a lack of methods and toolsto support communication and interaction in researchand development (R&D). Although there are inclusiveresearch approaches in social sciences, there is stillnone in the field of software-engineering. In the ongo-ing Easy Reading Project with the IPAR-UCD concept(a combination of Inclusive Participatory Action Re-search and User-Centred Design), we demonstrate thatadequate attention and the creativity of researchers anddevelopers, as well as the adaptation and (further) de-velopment of usability methods and tools, can lead tothe inclusion of potential users as peer researchers inuser-centered R&D processes.Method: Development and advancement of the inclu-sive IPAR-UCD concept are based on the “Design-

Based Research” approach. This approach is an in-dependent type of qualitative research methodology.IPAR-UCD was examined and further developed withpeer-researchers in the EU-funded Easy Reading proj-ect. These “interventions” allow for evaluation of howwell IPAR-UCD solutions work. The data analysisuses the iterative comparison cycles. These could beadapted and re-tested. During the project, academic re-searchers initially collaborate with the peer researchersas target group for a requirement analysis. The IPAR-UCD concept addresses peer researchers’ need for sup-port by helping software designers and developers tobetter understand and meet the requirements of userswith cognitive disabilities through the inclusive user-centered design process. Later, peer-researchers aloneor as group communicate their thoughts and experi-ences with the prototype. As input for a new softwaresystem, the feedback from users identifies useful fea-tures and problems. In this way, the developers receivefeedback directly from the future user. Ideas and de-velopments fit together or have to be further adaptedthus ensuring accuracy in the development process. Asfocus-groups the research teams use methods such asbrainstorming, card sorting and storytelling. As singleperson or as a research tandem, they use adapted user-testing or the cognitive walkthrough.Key results: People with cognitive, respective learningdisabilities are no longer objects of research but ratherparticipate jointly in the research. This concept suc-ceeds when research partners engage with each other,when information and materials for peer researchersare available in understandable language, when enoughtime for explanations and repetitions and personalcommunication and a common consent is found. In thefuture, the IPAR-UCD concept which addresses peerresearchers’ need for support, can help software de-signers and developers to better meet the requirementsof users with cognitive disabilities through an inclusiveuser-centered design process.Conclusion: Inclusive research challenges traditionalresearch. This design-based intervention has shownthat it is possible to involve people with cognitive dis-abilities in R&D as testers but also as developers andidea providers.Keywords: e-inclusion, people with cognitive disabil-ities, IPAR-UCD, inclusive R&D, software engineer-ing.∗Corresponding author. E-mail: [email protected]


“From Word to Sign”: Developing a Reading Ap-plication for Deaf and Hard of Hearing Israeli SignLanguage (ISL) UsersOrna Levia,∗ and Betty Shrieberb,∗aM.Ed program in Educational Technology, KibbutzimCollege, Tel-Aviv, IsraelbProgram Director M.Ed program in EducationalTechnology, Kibbutzim College, Tel-Aviv, Israel

Background: Reading is an integral part of our dailylife. For Deaf and Hard-of-Hearing people (DHH),they often face significant difficulties in this area (Con-vertino, Borgna, Marschark, & Durkin, 2014; Mitchell& Karchmer, 2011) As a result, this population oftenhas a higher number of individuals with developmentallanguage disorders (Luckner & Handly, 2008; Miller,2010). Crucially, an impairment in this basic skill leadsto negative impacts in other aspects of life (Trezek,Wang, & Paul, 2011). Numerous studies have demon-strated that access to a sign language for DHH individ-uals results in improved literacy skills generally, andto reading acquisition specifically (Dammeyer, 2014;van Berkel-van Hoof, Hermans, Knoors, & Verhoeven,2016). Research of this nature led me to develop “FromWord to Sign”, a reading app tailor-made to this pop-ulation, designed to improve reading skills for nativeusers of sign language. The premise for this app de-velopment is the assumption that an assistive technol-ogy using sign language may significantly improve thereading of this population.Rational: Developing “From Word to Sign” app:People with specific reading disorder can use read-ing software when they are confronted by an unclearword. However, for people who are deaf, this opportu-nity doesn’t exist (reading software is not available forthem). The “From Word to Sign” app enables them tocompensate of their reading disability: when they facean unclear word, they can touch the word in order tooperate the extension. Then they can see a short videoin the sign language of that specific word that they arerequired to comprehend.Test report: The application test session includedfive deaf immigrants aged 30–50 (three men and twowomen) which immigrated to Israel four years agofrom France, the Ukraine, and Sweden. They were re-cruited for this session study through personal acquain-tance with the author as their Hebrew teacher. Two-hour meetings were established with each participant,asking them to read a Hebrew text with the possibilityof “recitation” and translation of unfamiliar words us-ing Israeli Sign Language (ISL) with the app – which

presents the word, its sign, and denotation. After read-ing the text, I asked them to sign the text in ISL.Preliminary findings: Two participants in the pilotsuccessfully achieved complete reading comprehen-sion using the app while, in contrast, three achievedpartial comprehension. Moreover, a review of the datafrom the app revealed nine areas of difficulties facedby participants: new words, words with multiple ISLtranslations, multi-word terms, visually similar signswith different denotations, enunciation, high-registerwords seldom used in daily practice, conjugations,noun modifying verbs, and visual demonstration.Conclusion: The app should be examined and exposedto a larger group of deaf, native-born readers withoutadditional impairments. In addition, by setting a pilotteam of teachers, who teach DHH students, we willcollect a wide range of findings and conclusions, in or-der to optimize its development. The pilot team will beresponsible for updating online reading texts and willreport on the effectiveness and the difficulties in usingthe app.Keywords: Reading Application, Deaf and Hard-of-Hearing people (DHH), reading disorder.∗Corresponding authors. E-mail: [email protected]; [email protected]

Arches Project – Validation of Technological Out-comes of Gaming Software based on a ParticipativeResearch MethodologyHelena Garcia Carrizosaa,∗ and Simon HayhoebaSchool of Education, Open University, Stuart HallBuilding, Walton Hall, Milton Keynes, MK7 6AA,United KingdombDepartment of Education, University of Bath, Build-ing 1 West North, Bath BA2 7AY, United Kingdom

Background: This paper presents a case study of soft-ware gaming development that formed part of the Ac-cessible Resources for Cultural Heritage EcoSystems(ARCHES) Project. ARCHES is a three-year-long Eu-ropean Union Horizon 2020 funded project with part-ners within the heritage and technology sectors in fourEuropean countries. The project ends in December2019, and uses an innovative participatory research ap-proach to understand and address issues relating tocultural access within museums for people with sen-sory and learning access needs. ARCHES has threephases: Phase 1 involves developing new technologies;Phase 2 involves testing and redeveloping these tech-nologies; Phase 3 involves checking the new technolo-


gies are ready for others to use. The aim of the projectis to solve barriers to learning about cultural heritagethrough technological solutions built through researchgroups. The research groups are made up of peoplewith a range of different access preferences, are lo-cated in four cities in Europe London, Madrid, Oviedo(Spain) and Vienna – meeting on a fortnightly basis.Participants’ input is collected and fed back to the tech-nology partners, who develop and improve their cho-sen technology based on this information.Method: The project is based on participatory re-search, informed by a social model of disability, whichargues disability is a result of the way society is or-ganised. Data is collected through fortnightly meet-ings during which participants’ views are collected,collated and analysed with the help of the participantsthemselves. Therefore, the participants are treated asco-researchers. Data collection methods include voicerecordings of discussions, scribed notes created forpeople with hearing difficulties, photographs and datarecords of various alpha testing and beta testing of soft-ware, and meetings with the software developers them-selves.Key results: The proposed game was introduced to theparticipants in March 2017. The group was presentedwith a rough version that set out the different chal-lenges they were going to face. During the testing ofthe game three main interrelated tensions were discov-ered:1. Communication within the groups, museums and

technology partners, and also between each other.2. Previous experiences with participatory research,

disability, museums, games and technology.3. Institutional restrictions such as grant restrictions

and museum marketing restrictionsThese tensions were faced by all parties involved inthe development: participants, museum coordinators,academic researchers and technology developers.Conclusion: Although the project is ongoing and finalconclusions are yet to be made, it appears that the par-ticipatory practice has led to improvements in softwaredesign and development. However, the tensions felt be-tween partners indicates that the methodology needsfurther refinement.Our recommendation for participant research methoddevelopment is that participatory groups need to be in-volved in the conception of future games from the ear-liest possible stages, rather than being introduced to thegame once it has been designed in rough.Keywords: participatory research, software develop-ment, video games, different access needs and prefer-ences, heritage sites.

∗Corresponding author. E-mail: [email protected]

Participatory Methodology, Inclusive Control Sys-tems and Inclusive Technical Capital Developed byEngineering Undergraduates and Teenagers from aMarginalised Community in MexicoSimon Hayhoea,∗, Alejandra Díaz de Leónb, AzaelCapetillob, Briony Thomasc, Catherine Montgomerya,Cristina Reynagab, Fundación Insitu, Juan ManuelFernándezb and Nicole LotzdaUniversity of Bath, Claverton Down, Bath, UKbInstituto Tecnológico y de Estudios Superiores deMonterrey, Nuevo León,, Monterrey, MexicocUniversity of Leeds, Woodhouse Lane, Leeds, UKdOpen University, Walton Hall, Milton Keynes, UK

Background: This workshop reviews an educationproject in Monterrey, Mexico, which was designedto teach principles of algorithms and control systemsand promote inclusion and accessibility in systems de-sign – inclusive technology is defined in this projectas digital systems that provide ubiquitous accessibility,with knowledge of these systems’ use referred to in thiscontext as inclusive technical capital / inclusive capi-tal. The educational development was part of the Fa-bLab Campana project, which was designed to encour-age community innovation in Campagna, a marginal-ized district in Monterrey, Mexico.Method: The methodology used to develop the par-ticipatory teaching was Grounded Methodology (GM),an adapted form of Grounded Theory (GT), and wasstrongly influenced by participatory methods such asthose used in the EU H2020 ARCHES Project. GMencourages the evolution of interpretive deduced theo-ries that evolve through discourse, such as educationaldesign, the design of technology, literature searchesor observational research. Participatory methodologyis an emancipatory methodology, which includes allparticipants in the development, design and evaluationof their own inclusive practice, training and the edu-cational process. Although this was restricted by theshort time line and prescribed project proposal, the na-ture of participatory practice influenced the relation-ship with participants from Campana, whose voiceswere heard in the learning design. Phase 1 was teach-ing Tecnológico students and Campagna school stu-dents about the nature of inclusive technology andinclusive technical capital, and the use of accessiblefeatures and apps on iOS and Android. Phase 2 was


the development of discrete sessions and teaching ofinclusive control systems workshops by Tecnológicostudents, which were influenced by discussions withteenagers from Campana. Although the design of theeventual courses was implemented by Tecnológico stu-dents, the development process importantly includedthe opinions of the Campana school students as partof the participatory process. Phase 3 was the deliv-ery of the workshops to school children in Campana.Data was collected through observations of the schoolchildren, logging conversations and results recorded inwriting and passed on manually and on social mediafrom verbal feedback and recorded video and e-notes.Key results: Phase 1: During the initial workshops,awareness was raised about what disability was andhow it could be found in local households, especiallythe sensory impairment of elderly relatives. Some stu-dents discussed the disabilities of family members, andstudents also raised the issue of other forms of inclu-sion, including multi-culturalism and socio-economicdevelopment. Phase 2: The participants from Tec-nológico and Campana designed ambitious roboticprojects, but had to make their devices simpler to teachthe concepts of accessible STEM and inclusion. Even-tually, they developed colourful items with large piecesthat could be communicated through different modes.With feedback from the Campana children, teachingsessions also included elements of geometry, sensoryaccess needs, low-cost features to make the devices so-cially accessible, games and multi-culturalism. Phase3: After teaching the workshops, the Tecnológico stu-dents discovered that logical games and participatorypractice were particularly useful for teaching aspectsof inclusion, and found active objects such as robotsengaged children’s attention and enthusiasm.Conclusion: The long-term benefits of developing in-clusive technical capital with future systems designersis unknown given the time constraints of the project,however the students and school children engaged withthe notion of designing inclusive technologies, andrelated inclusion and control systems design. In ad-dition, through discussion and participation, studentsalso thought about other aspects of inclusion not con-sidered in phase 1, that could further develop their owndesign of inclusive systems technologies.Keywords: Control systems, education, inclusion, in-clusive capital, grounded methodology∗Corresponding author. E-mail: [email protected]

Starting on the Innovation Path for a Fatigue Man-agement App for People with Multiple Sclerosis

Peter Cudda,∗, Daisy Camb, Emma Casimird, SarahLaceyc, Abigail Millingsa, David Palingb and StevePickupdaCATCH, University of Sheffield, The Innovation Cen-tre, 217 Portobello, Sheffield, S1 4DP, UKbNeurology, Sheffield Teaching Hospital NHS Trust,Royal Hallamshire Hospital, Glossop Rd., Sheffield,S10 2JF, UKcThe Recovery College, South West Yorkshire Partner-ship NHS Trust, 33, Gawber Rd., Barnsley, S75 2AH,UKdHMA, 42 Sackville St., Barnsley S70 2DB, UK

Background: Fatigue is a common symptom of MS,affecting 75–95% of people, and is a major cause ofreduced quality of life. FACETS is an evidence-basedface to face course that combines energy conservationand cognitive behavioural approaches. It has a statisti-cally significant impact on fatigue severity and fatigueself-efficacy. However, people with MS aren’t alwaysable to attend the multiple sessions, and, they also of-ten have difficulty sustaining gains in the longer-term.The initial app conceptualisation came from researchand practice evidence that identify the main compo-nents and goals of the FACETS programme. The start-ing aim was to simply replicate or substitute these com-ponents and goals adopting an evidenced-based anduser-centred approach. The clinical goal is to makea usable app hence all users are being consulted viastakeholder groups to avoid users having to use poorlyconceived technology during evaluations or trials.Method: Three key steps were conducted in prepa-ration for development, each with a specific intendedoutput. Firstly, a systematic scoping review of litera-ture grounding FACETS. Also identifying key com-ponents, adaptations, and any currently missing el-ements of behavior change. Secondly, ideation withMS professionals to capture explicit experiences andknowledge which supports, contrasts, and extendsthe FACETS literature. Technologists also contributedtheir knowhow to help specify the app concept. Thirdly,review the concept of the app and it’s features in opendiscussion with stakeholders.Key results: Examination of FACETS and the litera-ture revealed: the core underlying theories include thecognitive behavioural model, social cognitive model,self-efficacy, and self-management theories; and,change in behaviour is facilitated by the use of en-ergy conservation strategies, which include rest, sleep,healthy lifestyle, activity adaptation, and goal setting.The ideation phase was a very efficient way to simul-taneously explore the design and content of the pro-


posed app. Maintaining FACETS as a facilitated coursein an app produces a text heavy and screen heavy app.The authors concluded a different approach for an appwas needed. One where the activities the users wouldengage in would still contribute to behavioral changefor managing fatigue by drawing on the underlyingaccepted theoretical models. Further adaptations weresuggested because for instance clinical practice sug-gests FACETS class members are resistant to the cog-nitive components and, opportunities to employ feed-back are missing. The ideation also established that theapp should be used with light touch service involve-ment and for self-management.Exploring the app concept and designs with users –professional (14) and people with MS (8) – confirmedthe desire for such an app. In addition to many aspi-rational features importantly it was found that profes-sionals and people with MS did not agree on some keyaspects.Conclusion: A combined clinical, academic and com-mercial developer team using evidence-based compo-nents to develop app content, and then consulting withstakeholder groups is effective to start innovation. De-spite work being preliminary, key app componentshave been identified which show potential to at leastsupplement the current delivery of the FACETS pro-gramme. Future evaluation of the app will be neededto establish evidence.Keywords: Multiple Sclerosis, fatigue, app, innova-tion, user-centred.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 3Making STEM Accessible to Disabled People

Science, technology, engineering and mathematics(STEM) can be considered to be at the basis of mod-ern society, making it essential that they are fully ac-cessible to disabled people. However, relatively limitedattention has been given to STEM accessibility com-pared to many other subjects and there are still signifi-cant barriers to be overcome. Particular issues include,but are not restricted to, difficulties in representing no-tation and formulae in an accessible format, readingimages and graphs and making both virtual and reallaboratories and field work accessible. Negative atti-tudes and misconceptions about what disabled peoplecannot do also act as barriers and concerns about healthand safety issues are sometimes used as a pretext to

exclude disabled people. There is also a need to avoidlearning aims which cause difficulties for some groupsof disabled people, such as being able to draw graphson paper rather than analyse the results of graphs pro-duced by software. This session will discuss the fullrange of issues associated with making STEM acces-sible, with a particular focus on the role of assistivetechnology and tools designed to support accessibility.Chairs: Marion Hersh and Barbara Leporini

Natural Language Processing for Non-visual Accessto DiagramsTomas Murillo-Morales∗ and Klaus MiesenbergerInstitut Integriert Studieren, Johannes Kepler Univer-sity Altenbergerstraße 69, 4040 Linz (Austria)

Background: Current accessible alternatives to dia-grams for blind persons pose many critical drawbackshindering their take-up, to the point where appropriateaccess to diagrams has been labeled as “the last frontierin accessibility”. Dialogue-based approaches to graph-ics, in which users communicate with the image viaspeech, are a novel area of research whose evaluationhas yielded very promising results in overall expressiv-ity and user satisfaction.Method: An accessible Web application prototypeimplementing a natural language processing (NLP)pipeline to semantically annotated diagrams has beendesigned. Diagrams are first given formal seman-tics via supporting ontologies that may be embeddedwithin the graphic itself by using SAI (Semantic Anno-tator for Inkscape), an authoring tool for semantically-enhanced graphics. The resulting ontologies may thenbe explored by a blind user by means of speechin a natural manner via queries in natural languageon a fully accessible Web application. The presentedmethod expands on previous publications by the au-thors by focusing on the specific NLP techniques em-ployed. Some of these techniques include:Automatic inference of analytical tasks and operandsfrom a user’s query in natural language throughontologically-motivated heuristics.Use of automatic clarification dialogues where usersare asked to interpret ambiguous or unknown elementsfound in their query.Presentation of the result or lack thereof to the user.Support for non-visual navigational tasks of graphicprimitives through speech commands.Bookmarking of graphic elements and other methodsthat contribute to preventing overloading the user’s


working memory while using the natural language in-terface (NLI).These techniques mostly stem from state-of-the art re-search in dialogue interfaces to ontologies that we haveexpanded and adapted for their use in accessibility.We also demonstrate the integration of techniques thatadapt the NLI to the specific needs of blind users, asmost current research on NLIs does not focus on ac-cessibility.Key results: This submission deals with the novel re-search question of how to enable dialogue-based ac-cess to diagrams, and it is the first of its kind we havebeen able to find in the literature. Heuristic evaluationof our methodology has shown that NLIs are a sat-isfactory approach to non-visual access to diagrams,their key advantage being the lack of necessary previ-ous training of the users and that it requires no extrasoftware or hardware besides what blind Web users areaccustomed to employ for surfing the Web.Conclusion: Our research shows how natural languageinterfaces are a promising novel approach to non-visual accessibility of diagrams. We hope that the pro-posed NLP pipeline will be exploited by other authorsfostering future research in accessibility to visuallydisplayed STEM materials.Keywords: Non-visual diagrams, natural language,accessibility.∗Corresponding author. E-mail: [email protected]

Technology Support for Inclusive STEM Laborato-ries: State-of-the-Art and Open ChallengesMarion Hersha,∗ and Barbara LeporinibaBiomedical Engineering, University of Glasgow,Glasgow G12 8LT, ScotlandbISTI-CNR, Via G. Moruzzi, 1, 56124 – Pisa, Italy

Background: This research is motivated by the im-portance of science, technology, engineering and math-ematics (STEM), including for many careers, under-standing increasingly important public debates andpolicy formulation on issues such as cybersecurity/privacy management and genetically modified organ-isms and for personal life e.g. budgeting. STEMaccessibility seems to have received less attentionthan that of other subjects. Particular areas of diffi-culty/exclusion are laboratories, fieldwork and accessto formulae. This presentation will focus on laborato-ries.Method: There are three main components:

1. A review of the literature.2. An examination of the authors’ previous work.3. An evaluation of the issues drawing on the authors’

experience as disabled people working in STEM.

Key results: The relatively limited literature datingback to at least the 1980s recognises that disabled stu-dents require similar laboratory experiences to otherstudents and that disabled people do not raise particularsafety issues despite the use of health and safety con-siderations as a pretext to exclude them. Both designfor all and adaptations for specific individuals and peo-ple with particular impairments are required. The for-mer includes an uncluttered layout, wide aisles, goodsignage, adjustable height tables and seating and com-monly used equipment close together. Demonstratorsand technicians should have training in working withdisabled students and staff and in supporting particu-lar disabled students.Both the increasing capabilities oftechnology and the role of assistants have been noted.However, technology can support a more independentlab experience. The use of remote computer controlledlabs and virtual simulations have been suggested, butshould not replace physical lab accessibility. Acces-sibility of this software can be improved by text la-bels, keyboard access, personalised settings and audi-tory feedback, which should have an ’on/off switch’.However, challenges are still available for working re-motely and effectively with certain experiments, suchas to get back information on what is happening, or onthe colour or reaction of particular substances. Talkinglab probes were introduced in the 1980s, but not massproduced due to cost. More recently, free script fileshave been developed to make Vernier lab probes com-patible with the JAWS and Window Eyes screenreadersto allow real time access to data by blind and dyslexicpeople. A handheld computer with screenreader hasbeen developed as a portable data collector. Light mi-croscopes have been made accessible to physically dis-abled users through a remote viewing web-based appli-cation. Mounting a video camera can avoid the need touse the eyepiece. A motorised microscope with an au-tomatic load slider can be used by physically disabledand low vision users. Low-tech adaptations, includingeasy-grip handles, lower seating and 3D tactile models,could benefit all laboratory users.Conclusion: Technology has considerable not fullytapped potential in improving lab accessibility. Initialwork could focus on:

– Developing a wide range of equipment with speechoutput and screenreader compatibility.


– Developing precision robot manipulators compati-ble with a range of equipment which can carry outmanual operations and be operated by various assis-tive devices.

– Using adjustable-height benches and equipment,easy-grip devices, tactile models.

Keywords: STEM, lab accessibility, accessible equip-ment, low tech adaptations, assistive devices.∗Corresponding author. E-mail: [email protected]

InftyReader Lite: Converting e-Born PDF into Var-ious Accessible FormatsKatsuhito Yamaguchia,∗ and Masakazu SuzukibaJunior College Funabashi Campus, Nihon University,7-24-1 Narashinodai, Funabashi, Chiba 274-8501,JapanbInstitute of Mathematics for Industry, Kyushu Uni-versity, 744, Motooka, Nishi-Ku, Fukuoka 819-0395,Japan

Background: One of the most serious problems indigitized STEM (science, technology, engineering andmathematics) contents, which are usually provided inPDF, is their poor accessibility. From the viewpoint ofcomputerized processing to convert PDF into an acces-sible form, PDF can be classified into two types. “E-born PDF” is produced originally from an electronicfile such as a document in Microsoft Word, LaTeX,Adobe InDesign, etc. (without copy protection). Werefer to all the others as “image PDFaoar. The mostsignificant advantage of e-born PDF is that the infor-mation on each character/symbol such as its charactercode, font type, coordinates on a page is embedded init.In ICCHP2016, we reported a method to recognizeSTEM contents in e-born PDF, in which characterinformation extracted directly from a document wascombined with analysis technologies of MathematicalOCR (optical character recognition). It was very effec-tive; however, in the inside of mathematical formulas,a font rectangular-area extracted from e-born PDF by aPDF parser often differs significantly from the graph-ical area of the original character image. Thus, it can-not be used for mathematical-structure analysis as itstands. To correct that, we still had to use OCR enginesin our STEM-OCR software, “InftyReader”.Method: We have recently adopted a new powerfulPDF parser that also provides us with “vector-imageinformation” for printing characters/symbols. Using

it, we can get the true graphical area of the originalcharacter image even in the inside of mathematicalformulas. It allows us to develop new software, “In-ftyReader Lite (IRL)” that does not need any commer-cial OCR engines for recognizing STEM contents in e-born PDF. Since its recognition process no longer de-pends on image OCR, accurate conversion into text andmathematical-structure analysis can been done even ifcharacters/symbols have color ornaments or a back-ground image.Key results: IRL can recognize just e-born PDF;however, IRL can convert it into various accessi-ble formats as same as the standard version of In-ftyReader. That is, a recognition result can be ex-ported in IML (the original xml in Infty software), La-TeX source, XHTML with MathML, MS Word, Mul-timedia DAISY (“Digital Accessible Information Sys-tem”: an international standard format for accessiblee-books), accessible EPUB3, “ChattyBookaoar, “PDFwith TeX”, etc. Here, ChattyBook is audio-embeddedHTML5 with JavaScript which can be read with a pop-ular browser on various platforms (Internet Explorer,Chrome, Fire Fox, Safari). ChattyBook has the almost-same functionality and operability as DAISY. In Japan,many multimedia-DAISY textbooks are now convertedinto ChattyBooks, and thousands of print-disabled stu-dents (mostly ones with developmental reading disor-der) use them. PDF with TeX is a new-type of acces-sible PDF, in which text information is embedded, inactual reading order, in the background of the original-PDF page image. Mathematical parts are representedin LaTeX, and it is totally accessible for print-disabledpeople to read STEM contents with a screen reader.Conclusion: IRL should be a good/low-cost solu-tion for print-disabled people to convert (inaccessible)STEM contents in e-born PDF automatically/easilyinto various accessible formats.Keywords: e-born PDF, accessibility, conversion,DAISY, STEM∗Corresponding author. E-mail: [email protected]

An Investigation into Pedagogical and OpportunityBarriers in STEM Education of Visually-ImpairedNigerians: Why Disabled People Must be InvolvedBamidele Chika AgbakuribeDepartment of Guidance and Counselling, Facultyof Education, University of Abuja, PMB 117, Abuja,Nigeria.


Background: Access to labs and field work are furtherbarriers to STEM. Health and safety considerations areoften unjustly used to exclude disabled people frompractical work. in Nigeria, a West-African country, theexclusion transcends industrial-hazards as visually im-paired individuals are denied access to STEM edu-cation and by extension laboratory and field-orientedprofessions. While unavailability of standardised no-tations, inappropriate resources, unsuitable teachingstrategies, and lack of visually impaired STEM pro-fessionals who could serve as role-models have beenfound as barriers to STEM career of visually impairedpersons, nonetheless, the exclusion remains unabated.It is against this background that the pedagogical andopportunity barriers in STEM education of visuallyimpaired learners were investigated. To achieve the ob-jectives of the study, the following research questionswere raised: What are the barriers to STEM educationof visually impaired learners? What opportunities dovisually impaired learners miss as a result of these bar-riers? And How can these barriers be eliminated?Method: Informed by the popular disability mantra“Nothing about us without us”, the researcher soughta true and general representation of actual experiencesof visually impaired persons. Ethical approval was ob-tained from executives of Light for the Blind People,Nigeria who helped in seeking their members’ con-sents to participate in the research. Descriptive surveydesign was adopted. Study population was made up ofvisually impaired students from 36 states of Nigeriaand the Federal Capital Territory. Using nonprobabilityor non-random sampling technique, a total of 401 par-ticipants who attended the annual meeting of the asso-ciation was conveniently and purposively selected forthe research. Out of the 401 copies of the closed-endedstructured questionnaire that were administered, only380 were found usable. Data collection and analysiswere conducted within three weeks. Four-type Likertscale was used, and mean scores were calculated fordata analysis.Key Results: The study revealed that: visually im-paired students face barriers to STEM education due tostereotypes revolving around their capabilities (2.93);barriers to STEM subjects limited their educationaland career opportunities (2.52); well-defined notationscan eliminate these barriers (3.14).Conclusion: Although, these results are specific toNigeria, in general, disabled people are misconceivedand excluded from practical-oriented education andprofessions in both developed and developing coun-tries. It is therefore concluded that a lot of work is re-

quired to change social negative attitudes towards visu-ally impaired persons as provision of standardised no-tations can only help in reducing the barriers. Recom-mendation was then made that further work is neededto remove the barriers that prevent disabled peoplefrom accessing laboratory and field works.Key words: Pedagogy, Barriers, STEM, Visually-Impaired-Persons, Nigeria.∗Corresponding author. E-mail: [email protected]

Robot-supported Inclusion and Learning: A CaseStudy on the KUBO Robot in Early Childhood Ed-ucationLykke Brogaard Bertela,∗, Eva Brooksa and SusanneDaubaAalborg UniversitybUniversity College Northern Denmark

Background: The presence of educational robots inpreschool and early primary school settings is get-ting stronger and has shown to have powerful playfulqualities and to support learning. Research within so-cially assistive robotics in education suggests embod-ied robotic technology may facilitate social engage-ment and support inclusion, however little research hasbeen conducted on whether the act of programming so-cial robots may play an important part in discoveringand designing for diversity in play and learning. Thispaper presents findings from a case study on the edu-cational robot KUBO in Denmark and proposes a par-ticipatory and practice-based approach to the designof robot-supported learning aimed at the transition be-tween preschool and primary school. The purpose isto support and empower children’s essential life skillsincluding imagination, collaboration and communica-tion skills and to provide pathways capable of detect-ing and including a diversity of children’s needs andskills in a more advanced way than currently offeredby traditional educational technology.Method used: Kubo is a mobile robot developed byDanish startup company Kubo Robot, designed to sup-port learning for children in early primary school invarious subjects such as coding, language, and mu-sic through a tangible coding language; TagTiles. Inthe case study, teachers and pedagogic professionalsco-developed robot-supported learning designs withKUBO and tested these in three different scenarios;math teaching in 2nd grade, play-based learning inkindergarten as well as a ‘transition’ experiment in


which 2nd grade students were teaching young chil-dren (age 5–6) how to code using KUBO. Data in-cluded four instances of participatory observations, in-terviews with the teacher and pedagogic professionalsas well as in-situ interviews with children.Key results: The case study provides valuable insightsinto inclusive practices applied when implementingrobot-supported learning designs (e.g. using a story-telling approach to facilitate computational thinkingand understanding of coding concepts or applyingpeer-to-peer learning to empower children with learn-ing disabilities), however, new potential inclusive prac-tices also emerged from experimenting with the robots.For instance, a child’s individual experimentation withprogramming in ways very different from his peers(e.g. applying engineering methods) turned out to re-veal different skills but also needs, which may supportmore diverse approaches not only to the technology,but to learning in general.Conclusion: Findings from the case study indicatethat the application of robot-supported learning de-signs may support the visibility of children’s diverseneeds, skills and interests and facilitate the emergenceof new inclusive practices. However, further research isneeded to develop systematic approaches to inclusiverobot-supported learning designs and to quantify itseffects in practice, particularly in transitions betweenpreschool and primary school.∗Corresponding author. E-mail: [email protected]

Automatic Support for Web Accessibility Evalua-tionFabio Paternòa,∗ and Francesca PulinaaaHuman Interfaces in Information Systems (HIIS) Lab-oratory, ISTI, CNR, Via G. Moruzzi 1, 56124 Pisa, Italy

Background: Designing for people with disabilities isbecoming an increasingly important topic for severalreasons. Accessibility has become necessary due to therapid growth of online information and interactive ser-vices provided by web and mobile applications. Therecent European Web Accessibility Directive (WAD)promotes the rights of disabled people and requiresconsistent monitoring of accessibility in public web-sites.Even if the accessibility validation process cannot befully automated, in order to support accessibility, it be-comes important to have validators able to check, au-tomatically or semi-automatically, the correspondencebetween the requirements of accessibility guidelines

and the characteristics of the Web pages under consid-eration. These tools are useful for those involved in de-veloping websites, as through them designers and de-velopers can easily and quickly check whether theirwork meets the considered accessibility requirements.Method: We have carried out an analysis of the stateof art in the area of accessibility validation toolsand elicited feedback of stakeholders working in pub-lic organizations with online surveys and interviews.We thus found some common issues. Expandabilityand upgradeability: newer technical guidelines get re-leased, and while there is one international standard(WCAG), some countries make modifications to it. Forthe developers of validators, extending the set of guide-lines supported by their tools can be a major undertak-ing. Alignment with the latest technology: in the everchanging panorama of technologies, the first genera-tion of validators often appears to be unable to effec-tively validate websites made with the most moderntechnologies. Limited effectiveness of the reports: peo-ple with different roles (developers, designers, publicofficers) need reports containing different informationfor improving the site.Key results: We have designed and implemented anew version of the MAUVE validator, available athttps://mauve.isti.cnr.it/, aiming to address the issuesidentified. Guidelines are specified through an XML-based language, and externally stored, so that they canbe easily updated to include new guidelines. There-fore, we have specified the new success criteria intro-duced with the WCAG 2.1 guidelines by using suchlanguage, so that the tool can support the validationagainst the latest standard. It has the ability to validatevarious device-specific versions of a website, and dy-namic websites validation through browsers’ plugins.It can provide the validation report in the EARL W3Cstandard format, ensuring consistent interpretation ofresults. It also provides developers-oriented report sys-tem, with indications of the accessibility problems di-rectly into web page source code. The public versionof the tool supports validation of web pages providedby URI or local files or direct HTML input. We havealso an internal version able to support the validation ofentire websites and providing a more graphical report,oriented to non-technical users.MAUVE will also be integrated in a large-scale acces-sibility assessment infrastructure (under developmentin the EU WADcher project), which includes advanceddecision support tools, and a web accessibility obser-vatory.Conclusion: Validators are fundamental in making thevalidation process more efficient, consistent, reliable


and cost-effective. We present an accessibility tool forthe main stakeholders (web commissioners, web devel-opers, . . . ) and discuss its potentialities.Keywords: accessibility, automatic accessibility eval-uation, WCAG 2.1, guideline specification.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 4Appropriate Wheelchairs, a Global Challenge– Reflect, Review, Strategize/Revolutionize

Appropriate wheelchair and seating assistive technol-ogy is often essential for people with mobility im-pairments’ health and wellbeing. While some progresshas been made, evidence suggests that despite theWorld Health Organization’s Guidelines on wheelchairprovision, training packages and other resources, get-ting ‘the right wheelchair’ remains a global challengewith provision being focused around just deliveringthe product instead of following an evidence-basedservice process. In addition, many governments havenot committed to national wheelchair provision poli-cies. Several authorities employ ad hoc, unsustain-able systems instead of providing accessible person-centered services, skilled personnel, quality products,maintenance, follow up and management. Sustainablewheelchair service provision infrastructure is requiredfrom a human rights perspective.In January 2018, USAID, World Learning and the In-ternational Society of Wheelchair Professionals(ISWP) facilitated a wheelchair stakeholders meetinghosted in Bangalore, by Mobility India. Bringing to-gether fifty six sector leaders to share perspectives andconsider future developments, the goal was to estab-lish key priorities for the next five years to strengthenwheelchair services through policies, trained person-nel and a range of appropriate wheelchairs. To achievethis goal, ten priority actions were identified to effectchange towards sustainable development.This session discusses global challenges faced and ac-tions needed from multiple viewpoints. The impor-tance of appropriate wheelchair provision will be illu-minated by real world accounts. Collectively reflect-ing on ten years of development in research, educa-tion, and service delivery, the panel will review thecurrent situation, progress made and discuss ways tobuild awareness towards action which will revolution-ize wheelchair provision globally.Chair: Rosemary Gowran

Wheelchair Stakeholders Meeting 2018 – Develop-ing a Global Wheelchair Sector Report with Prior-ity Actions Toward Sustainable Wheelchair Provi-sion: Appropriate Wheelchairs, a Global ChallengeMichael Allena, Rosemary Joan Gowranb,c,d,e, MaryGoldbergf,g and Jon Pearlmanf,gaAssistive Health Technologies, USAID, DCHA/DRG |Empowerment & Inclusion DivisionbSchool of Allied Health, Faculty of Education andHealth Sciences, North Campus University of Limer-ick, Limerick, Ireland, V94 T9PXcHealth Research Institute, University of Limerick,Limerick, IrelanddSchool of Health and Sport Science, University ofthe Sunshine Coast, Locked Bag 4, Maroochydore DC,QLD 4558, AustraliaeAssisting Living and Learning Institute (ALL),Maynooth University, Co. Kildare, IrelandfDepartment of Rehab Sciences & Technology, Univer-sity of Pittsburgh, Pittsburgh, PA, USAgInternational Society of Wheelchair Professionals

Background: Since 2002, USAID has invested in thewheelchair sector with the goal of improving mobil-ity and opportunities for people with mobility im-pairments in low and middle income countries. In-vestments have evolved over the years, from specificorganizational earmarks to country-based and globalinvestments in resources, policy promotion, procure-ment and standards. In 2006 USAID along with WHOand ISPO held the Wheelchair Consensus Confer-ence to identify best practices for improving access towheelchairs. As a result WHO published the Guide-lines on Providing Wheelchairs in 2008 which high-lights Design and Production, Service Delivery, Train-ing and Policy and Planning as fundamental elementsof the ecosystem. As a result of the Guidelines US-AID made several global investments. In 2012 US-AID along with World Learning (WL) and Manage-ment Sciences and Health (MSH) convened stakehold-ers to reflect on past learnings and identify sector pri-orities which were:– Create a global initiative for greater collaboration

and coordination to lead awareness raising, knowl-edge sharing, data collection and research, and en-sure appropriate wheelchair service provision;

– Engage governments and other partners to supportaccess for appropriate wheelchair service provisionand get wheelchairs and other mobility devices onessential medical device lists and framework forUniversal Health Coverage;


– Develop mechanisms to maintain quality standardsfor products, services, providers, and training inwheelchair service provision.

Acting upon the recommendations, USAID made sev-eral investments, including support for the develop-ment of the International Society of Wheelchair Pro-fessionals (ISWP); the Global Cooperation on Assis-tive Technologies (GATE) initiative; and the Consoli-dating Logistics for Assistive Technology Supply andProvision (CLASP) activity. In 2018 USAID alongwith ISWP and WHO brought together stakeholders toreflect on the three key investments identified in 2012and define key sector priorities for the next five years.Method: The main method was hosting a facilitatedmeeting to develop a challenge model. The challengemodel leads participants through a process to definekey challenges, strategic priorities, measurable results,obstacles and root causes and priority actions for theselected challenge.Key results: As a result of the meeting and a postmeeting advisory group Wheelchair Sector report wascompleted including a five-year Sector Goal and Prior-ity ActionsSECTOR GOALBy 2023, 10 countries have new or strengthenedevidence-based, adequately-resourced, integratedwheelchair services supported by policies, competentpersonnel, and a range of appropriate wheelchairs.PRIORITY ACTIONS

1. BUILD AWARENESS2. CONDUCT RESEARCH3. ESTABLISH GLOBAL SERVICE STANDARDS4. ESTABLISH PRODUCT STANDARDS5. FOSTER INNOVATION6. IMPROVE WHEELCHAIR SUPPLY7. PROMOTE POLICY8. STIMULATE COLLABORATION9. SUPPORT COMPETENCY DEVELOPMENT

10. SUPPORT GOOD PRACTICEConclusion: Utilizing the results identified USAIDalong with several donors have been making invest-ments to implement the priority actions related to im-proved wheelchair access and service were identified.Several of the priority actions are now in implemen-tation and others are being more thoroughly definedthrough an analysis by ATscale, a Global Partnershipfor Assistive Technology. Under this partnership in-vestable interventions are being defined for donorswhich build off the results of the stakeholder meeting.Additional interventions are being defined for hearingaids, eyeglasses and prosthetics.

Keywords: wheelchair, global, strategy, stakeholders,Bangalore, standards.*Corresponding author. E-mail: [email protected]

Personal, Public, Political Discourse IlluminatingContext Specific Experiences Enabling and Depriv-ing Individuals as Wheelchair Users in the Repub-lic of Ireland: Appropriate Wheelchairs a GlobalChallengeRosemary Joan Gowrana,b,c,d,∗, Amanda Clifforda,b,Ksenia Chebana, Amy Darcya and Andrea GallagheraaSchool of Allied Health, Faculty of Education andHealth Sciences, North Campus University of Limer-ick, Limerick, Ireland, V94 T9PXbHealth Research Institute, University of Limerick,Limerick, IrelandcSchool of Health and Sport Science, University ofthe Sunshine Coast Locked Bag 4, Maroochydore DC,QLD 4558, AustraliadAssisting Living and Learning Institute (ALL), May-nooth University, Co. Kildare, Ireland

Background: Providing an appropriate wheelchair iscomplex and challenging due to diversity of people,places, provision processes, personnel, procurementand the existence of relevant policies. An inappro-priate wheelchair can impact severely on a person’shealth and wellbeing. The importance of developingsustainable wheelchair services continues to be under-valued. This paper illuminates the perspectives and ex-periences of wheelchair users in Ireland, reflecting per-sonal, public and political discourse since the introduc-tion of the WHO guidelines on the provision of manualwheelchairs in less resourced settings in 2008.Method: Mixed methods were used: National onlinesurvey using SurveyMonkeyTM, exploring wheelchairservice user’s experiences and level of satisfaction withwheelchair and seating provision in the Republic ofIreland. Individual semi-structure interviews exploringwheelchair service user’s personal perspectives. Scop-ing review exploring the public and political discourseon wheelchair provision in the Republic of Irelandfrom 2008–2018.Key results: Survey results (n = 273) show highweightings of satisfaction across the service deliveryprocess, yet 38% of respondents (n = 105, 38.5%) didnot feel their wheelchair meet their needs. Results in-dicate ad hoc waiting times and funding streams, witha lack of uniformity at each stage of the process. Over30% of respondents reported receiving little or no ed-


ucation and training skills. Follow up within the firstsix months of receiving their wheelchair product waslimited (21% n = 48, of respondents n = 228); withonly 41% (n = 95) needing wheelchair repairs satis-fied with this service. Individual interviews (n = 18)reflect similar disparity. The importance and embod-ied nature of the wheelchair was clear, with poorlyprescribed wheelchairs affecting a person’s life, theirphysical (pressure injuries), mental (vulnerability andunderlying fear) and social (engaging in the commu-nity) health. The experience of service delivery wasinfluenced both positively and negatively by a per-son’s relationship with personnel, including occupa-tional therapists and sales/ vendor representatives, dis-puting the client centered nature of interactions andoutcomes. The provision system was hard to navigatewith a continuous fight to get the right wheelchair andfollow up services to support this.The Scoping review indicates a challenged wheelchairservice within the public and political domain, high-lighted in scientific published (n = 3), unpublished(n = 2) papers, questions to Minister of Health (n =22) and newspaper articles (n = 21). Four themesemerged: personal lived experience of wheelchairusers and their families, with stories relating to chil-dren predominant; political discourse reporting con-straints within the system and a call for national pol-icy; provision system processes were poor, with waittimes having an overwhelming effect on individuals;and place highlights inconstancies across the country,with Dublin, Cork and Limerick reported on most fre-quently.Conclusion: The significance of a wheelchair in per-son’s life cannot be denied, yet there is a lack ofclear transparent pathways, protocols and policy forwheelchair service provision to meet individual needs.Disparity exists throughout the wheelchair provisionprocess, with many clients left waiting or fighting fortheir wheelchair. This work strengthens the call for anational review of wheelchair services in Ireland, withgovernment commitment towards sustainable develop-ment as a matter of urgency.Keywords: Appropriate Wheelchair, Service Delivery,Experiences, (Irish Context), (Disparity).∗Corresponding author. E-mail: [email protected]

Global Wheelchair Service Provision CapacityBuilding: An Online Mentoring Feasibility StudyAlexandria Milesa and Mary Goldberga

aDepartment of Rehabilitation Science and Technol-

ogy, University of Pittsburgh School of Health and Re-habilitation Sciences, 6425 Penn Ave., Suite 400, Pitts-burgh, PA, USA

Background: Evidence highlights that a major factorassociated with inappropriate wheelchair distributionis the global shortage of wheelchair service provisioneducation and training. The World Health Organiza-tion Guidelines on the provision of manual wheelchairsin less-resourced settings (WHO Guidelines) recom-mend integrating wheelchair service provision con-tent into existing rehabilitation programs at academicinstitutions. . . However, a 2017 study reported lim-ited training time allocated to wheelchair service pro-vision in some professional rehabilitation programs inlow-middle- and high-income countries. To help as-sess the global training need, the International Soci-ety of Wheelchair Professionals (ISWP) developed andvalidated a Wheelchair Service Provision Basic Test(Basic Test) which aligns with the WHO Guidelines’eight (8) wheelchair service provision steps. Currently,in the majority of regions where the test has been ap-plied, less than half of test takers pass the test with 41%passing in Africa, 44% in Asia, 46% in Latin Amer-ica, 47% in Europe, 48% in Australia and Oceania,and 55% in North America, which confirms the over-whelming need to promote training and continued pro-fessional development and mentorship of wheelchairservice providers worldwide. Novel flexible capacitybuilding activities are needed to help address this need.Thus, this study addressed the following research ques-tion: Is it feasible to implement an online mentoringprogram for wheelchair service providers globally?Method used: Fourteen intermediate wheelchair ser-vice providers enrolled in a feasibility study of an 8-week online Intermediate Level Mentoring Interven-tion, led by 3 experienced mentors. The program con-sisted of 9 tutor sessions led by mentors focusing ontopics relevant to intermediate level wheelchair ser-vice provision, 5 case study sessions (mentees pre-sented real service provision case studies and receivedfeedback from mentors), and 3 individual meetingswith mentors to clarify concepts and provide individ-ual coaching. A goal attainment plan was created foreach mentee by the mentor-mentee pair. All interac-tions were hosted in the Adobe Connect platform. Pre-post self-efficacy measures in intermediate level seat-ing were taken by all mentees as well as a program sat-isfaction survey and focus group after participation.Key results: The project findings indicate adequateresults across all feasibility components (recruitment


(100%) and retention (50%) rates; perceived bene-fit (85% participant satisfaction); and adherence rate(71%). Improvements in clinical reasoning on casestudies were also observed by mentors. Pre-post im-provements in self-reported self-efficacy and goal at-tainment were noted. Satisfaction survey and focusgroup data showed overall satisfaction with the inter-vention and provided recommendations for improvingfuture program iterations.Conclusion: An online mentoring program for inter-mediate level wheelchair service provision is a feasi-ble intervention for a subset of intermediate wheelchairservice providers and may improve providers’ goal at-tainment and self-efficacy in intermediate levelwheelchair service provision. An experimentally con-trolled study is a recommended next step to determinehow an intermediate level wheelchair service provisiononline mentoring program improves providers’ compe-tency.Keywords: wheelchair service provision, mentoring,professional development, education, capacity build-ing∗Corresponding author e-mail: [email protected]

A Cross-Sectional Survey Investigating WheelchairSkills Training in Ireland: Appropriate Wheel-chairs, a Global ChallengeKimberly Mathisa and Rosemary Joan Gowrana,b,c,d,∗

aSchool of Allied Health, Faculty of Education andHealth Sciences, North Campus University of Limer-ick, Limerick, Ireland,V94 T9PXbHealth Research Institute, University of Limerick,Limerick, IrelandcSchool of Health and Sport Science, University ofthe Sunshine Coast, Locked Bag 4, Maroochydore DC,QLD 4558, AustraliadAssisting Living and Learning Institute (ALL), May-nooth University, Kildare, Ireland

Background: Wheelchair skills training is a vital as-pect of wheelchair service delivery, yet they are ar-guably overlooked in many contexts. Training cancontribute to the prevention of pressure injuries andfall-related injuries, empowering users and improvinghealth and wellbeing. The practice of wheelchair skillstraining provided to wheelchair users by Irish clini-cians is highly variable. This paper presents the resultsof a study exploring wheelchair skills training practiceamong Irish clinicians.

Method: A cross sectional survey was conducted us-ing SurveyMonkeyTM. Invitations were sent to asso-ciations and special interest groups known to employprofessionals involved in wheelchair service delivery(e.g. Occupational Therapists, Physiotherapists, Reha-bilitation Engineers). Questions related to wheelchairskills trainings offered to wheelchair service users,wheelchair skills components included and nature ofclinician’s education and training to provide trainingin wheelchair skills. 147 respondents opened the sur-vey and 91 responses were received from occupationaltherapists and one rehabilitation engineer. Quantitativedata were combined, and summary statistics were car-ried out, when appropriate, using SPSS Statistics (i.e.frequencies, proportions, and cross-tabulations). Qual-itative responses were inputted into an Excel spread-sheet and a content analysis was carried out.Key results: Consensus among respondents was thattraining is often provided to new users (n = 91, 89%),however, it is limited to mostly instruction in transfersand simple mobility techniques. Clinicians reportedthat advanced mobility skills were sometimes or nevertaught (n = 81, 72%). Clinician’s confidence instruct-ing various skills corresponded with the frequency ofinstruction. Clinicians reported that they would like tosee standardized training programs established in self-maintenance and advanced wheelchair skills.Conclusion: The results indicate a need to further de-velop wheelchair skills training delivered by occupa-tional therapists and others. Formalized education andtraining to improve Irish clinicians’ knowledge andconfidence to provide more advanced wheelchair train-ing is needed. More streamlined wheelchair skills pro-grammes would teach users about safer wheelchairuse, while enhancing health and wellbeing and greateroccupational participation.Keywords: Wheelchair skills, Wheelchair skills train-ings, Occupational Therapy.*Corresponding author. [email protected]

Improving Global Wheelchair Product QualityJon Pearlmana,b,∗ and Anand Mhatrea,baDepartment of Rehabilitation Science & Technology,University of Pittsburgh, Pittsburgh, PA, USAbInternational Society of Wheelchair Professionals

Background: In 2008, the World Health Organizationpublished Guidelines of the provision of Wheelchairsin Less Resourced Settings (LRS) which emphasizedthe need for all wheelchairs to meet standards pub-


lished by the International Standards Organization andfor the standards to be adapted to the adverse con-ditions common in LRS. This guidance was in re-sponse to the widespread distribution of poor-qualitywheelchairs in LRS that failed quickly and left the riderstranded and/or injured. In spite of the WHO’s author-ity and influence on global practices, wheelchair qual-ity has not improved significantly, nor has the ISO stan-dards been adapted. The work described here was tohelp implement WHO’s recommendations to improveoverall wheelchair quality globally and eliminate thedistribution of inferior quality wheelchairs.Method: A working group of wheelchair experts fa-miliar with ISO testing and wheelchair design for LRSwas established in 2015 by the International Societyof Wheelchair Professionals and was tasked with help-ing to implement WHO’s recommendations by identi-fying and prioritizing the tasks associated with improv-ing wheelchair product quality in LRS. Following thisactivity, the highest-priority tasks were carried out byworking group members.Key results: Working group members included indi-viduals from universities (University of Pittsburgh, Le-Tourneu University, Massachusetts Institute of Tech-nology) and non-governmental organizations andCharities (ShonaQuip, LDS Charities, MotivationCharitable Trust). Priorities identified by the group in-cluded (1) the need for a best-practices guideline onwheelchair design (2) the need for a caster durabil-ity test method, (3) the need for a rolling resistancetest method, and (4) the need for a whole wheelchairtesting system. All four of these priorities have beenaccomplished, leading to multiple publications, open-source materials to support improve wheelchair qual-ity, increased testing capacity, and test-results whichhave led to improved products.Conclusion: Through a global collaboration and coor-dination of the wheelchair sector, major progress hasbeen made toward implementing WHO’s recommen-dation. The outcome has led to tangible tools for thewheelchair sector to leverage to improve product qual-ity, and better collaboration across global partners tohelp implement WHO’s recommendations.Keywords: wheelchair, product standards, less re-sourced county∗Corresponding author. E-mail: [email protected]

On Tire Pressure and Comfort of ManualAttendant-Controlled WheelchairsShoichiro Fujisawaa,∗, Katsuya Satob, Shin-ichi Itob,

Katsuya Satob, Jyunji Kawataa, Jiro Morimotoa, Mi-neo Higuchia and Masayuki BookacaFaculty of Science and Engineering, Tokushima BunriUniversity, 1314-1 Shido, Sanuki, Kagawa 769-2193JapanbInstitute of Technology and Science, Tokushima Uni-versity, 2-1 Minamijosan-jima, Tokushima, Tokushima770-8506 JapancKochi Rehabilitering Center, 63-6 Uchinotani,Haruno-cho, Kochi 781-0312 Japan

Background: For physically impaired persons, thewheelchair is indispensable travel means. However,wheelchairs may cause motion sickness or discomfortand annoyance due to vibration when moving. In par-ticular, the tire pressure affects when traveling over alevel difference. The most commonly used English-style valve for wheelchairs can insert air into the tirebut cannot adjust the air pressure. Therefore, it is un-clear how the wheelchair tire pressure affects the vi-bration. This research evaluates the influence on vi-bration due to changes in tire pressure of the manualwheelchair, using a tire pressure indicator suitable tothe English valve.Method: A dummy heavy load was placed on the seatof a manual wheelchair to assist the vibration mea-suring device manufactured in this experiment, and atriaxial accelerometer was attached thereon. Also, anelectric wheelchair was run a road surface with irreg-ularities at constant speed and constant intervals. Atire pressure indicator manufactured for this study wasattached to both sides of the rear wheel of a manualwheelchair, and a 25 kg dummy heavy load was placedon the seat section. The tire air pressure was set to80 kPa, 160 kPa, 240 kPa, and 320 kPa. Next, a sensoryevaluation of riding comfort was carried out. Evalua-tion items were set to 4 items, in addition to the threeitems of comfortable feeling, comfortable feeling andseating comfort of the buttocks, and the strength ofthe shaking during traveling, both at rest and running.The experiment was conducted with the cooperationof 10 subjects. The average age of the subjects was21.9 years.Key results: FFT analysis was performed on the accel-eration data measured in the vertical direction. Fromthe results, comparison was made between each tirepressure and the maximum power spectrum of themanual assistant wheelchair and the frequency at themaximum power spectrum were compared. Experi-ment results revealed that the maximum power spec-trum increases as tire pressure increases. As a result


of the significant difference judgment, there was a sig-nificant difference between the maximum power spec-trum and the frequency at the maximum power spec-trum when the pressure of the tire air pressure was sep-arated by 160 kPa. Although there was no differencedue to the difference in air pressure between the seatingcomfort at rest and the security, it was found that lowertire pressure increases sitting comfort, which becomesworse at the higher air pressure. The result when trav-eling was that, for all items of comfort, seating comfortand the intensity of shaking, the tendency was higheras the tire pressure decreased. In particular, the threeitems of sitting comfort, sense of security and strengthof shaking showed strong significance levels.Conclusion: It became clear that the tire pressure andthe maximum power spectrum of the wheelchair, thefrequency at the maximum power spectrum, and the in-tegral value are proportional. A significant differencewas observed when the tire air pressure was 180 kPaaway from the maximum power spectrum and the fre-quency at the maximum power spectrum. When run-ning, the result that the ride comfort decreased as thetire air pressure increases, but in general, the drivingforce decreases as tire pressure increases, so there is atrade-off. In the stationary state, the lower the tire airpressure, the higher the comfort. In nursing homes andother facilities, it is suggested that air pressure is mustbe adjusted with someone sitting in a wheelchair for along time.Keywords: Wheelchair, Tire pressure, Traveling overa level difference, Vibration, sensory evaluation.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 5Eye gaze technology: accessibility, usabilityand effect on participation and communicationfor persons with severe disabilities

This session presents latest research findings andlessons learned from an international interventionsstudy and a total survey involving eye gaze technologyusers in all ages. The speakers, researchers and clin-ical practitioners, are from Sweden, Dubai and USA.First findings from a total survey study in Sweden re-porting on accessibility, usability and different aspectsof eye gaze technology usage in everyday life will bepresented. The users were in all ages, (171 users, 4–81 years) with diagnoses such as cerebral palsy, Amy-otrophic lateral sclerosis (ALS), Rett syndrome, and

multiple sclerosis (MS). Differences between childrenand adult users (diagnosis, accessibility, daily usage,and usability), and which users seem to benefit themost from eye gaze technology provision will be re-ported. Next, research findings and lessons learnedfrom an international intervention study will be pre-sented. Children with complex needs that were pro-vided with eye gaze technology were followed overtime and measured both with and without the assistivedevice. Active participation in activities, functional in-dependence in everyday life and communication be-havior with and without eye gaze technology as well asguidelines for clinical practice will be discussed. Thesession provides in-depth knowledge and outcomes ofhow eye gaze technology can contribute to everydaylife for people with severe disabilities. The session alsoincludes experiences in the application of eye gazetechnology in clinical practice. The audience will havethe opportunity to share experiences of eye gaze tech-nology and participate in a discussion of how researchfindings may benefit clinical practice.Chair: Helena Hemmingsson

Eye Gaze Controlled Computer: A Total Survey inSwedish ContextHelena Hemmingssona,∗ and Maria BorgestigbaDepartment of Special Education, Stockholm Univer-sity, SE-106 91, Stockholm, SwedenbFaculty of Medicine and Health, School of Health Sci-ences, Örebro University, 702 81 Örebro, Sweden

Background: Eye gaze controlled computer (EGCC)is an assistive device (AT) that provides people withprofound physical impairments opportunity to controla computer with eye gaze and by that communicateand participate in the digital world as well as in soci-ety. Few people have access to EGCC and existing re-search is scare, typically focus on a single diagnosis,either adults or children and include few persons. Thisresearch includes all EGCC users in Sweden in orderto investigate which groups that receives EGCC as anAT, in what activities it is used, the effectiveness of theAT and users’ perception of usability in everyday life.Method: Design: Total survey. Assistive technologycenters in Sweden identified all inhabitants with a pre-scribed EGCC and mailed them (if < 18 years old, theparents) a questionnaire. The questionnaire comprised1) person characteristics 2) eye gaze technology us-age (settings, activities, duration, frequency, effective-ness and efficiency) and 3) satisfaction with device and


related service. Descriptive statistics, non- parametricand parametric analyses were performed to describethe whole sample and to make comparisons betweenadults and children (< 18 years old).Key results: The questionnaire was answered by 111adults and 60 parents (child version), response rate42%. No significant differences between respondents(n = 171) and non-respondents (n = 232) were found.The participants’ ages ranged between 4 and 81 yearswith the majority in school or working age (mean40 years, sd 19.7), 49% were females. Most com-mon diagnosis was Cerebral palsy (CP) among chil-dren (76%) and ALS (26%) among adult users. Thetime for accessibility of EGCC ranged up to eight yearswith a mean time of 2.0 years (sd 1.7). For most (79%)eye gaze was the only option to control a computerand nearly all (93%) used Tobii products. Sixty-threepercent had daily usage of eye gaze technology whileabout one third had weekly usage (33%), or less often(4%). Overall, participants are quite satisfied with theeye gaze technology as an AT.More adults (45%) than children (18%) used EGCC2 hour or more/day during leisure (p < 0.01). Afew, three children (5%) and 17 adults (16%) had us-age for more than eight hours per day. Most children(82%) used EGCC in school and most common up to2 hours/day (57%). Adults, to a higher extent than chil-dren (p < 0.01) thought they could use the EGCC inas many activities as needed (59/31%) and as often asneeded (65%/38%) (p < 0.01). The activity repertoireby EGCC ranged up to 12 activities (m 4.8, SD 3.0).Most common activities for adults were to write (67%)and to ‘to talk’ (62%), while the most common ac-tivities among children were ‘play and games’ (74%)followed by ‘to talk’ (72%). EGCC was seldom usedfor environmental control by children although parentsrated it as very important.Conclusion: EGCC is used in all ages and both atschool/work and during leisure. Daily usage was mod-erate although very high for a few. Overall, adults hadhigher use and were more satisfied with their usagethan children. The full potential of applications in par-ticular for children can be improved.Keywords: Digital access, Children, Adults, Eye gaz-ing.∗Corresponding author. E-mail: [email protected]

Eye Gaze Technology for Children with SevereMultiple Disabilities: Parents and Professionals’Perception of Gains, Obstacles and PrerequisitesEva Holmqvista,b,, Gunilla Thunbergb and Marie PenyDahlstranda,caDepartment of Health and Rehabilitation, Institute ofNeuroscience and Physiology, Sahlgrenska Academy,University of Gothenburg, Göteborg, SwedenbDart Centre for AAC and AT, Sahlgrenska UniversityHospital, Göteborg, SwedencRegional Habilitation Centre, Sahlgrenska UniversityHospital, Göteborg, Sweden

Background: Children with severe multiple disabili-ties are a heterogeneous group. Their problems mayentail both motor and cognitive dysfunction and theytypically have difficulties within all areas of activitiesand depend on an adult to assist them in order to play,communicate and perform any other daily activities. Insome cases, eye movement is the only body movementa child can control voluntarily. As a common AACmethod for these children is eye pointing (the com-munication partner follows the child’s direction of eyegaze in order to understand his or her intention), use ofeye gaze technology is interesting. However, it is bothtime consuming and requires specific competence toassess and introduces eye gaze technology and to pre-pare functional software grids for children with com-plex communication needs, severe motor and cognitivedisorders. There is a need for more knowledge of howand for what the children use their systems, and factorsthat should be considered.The aim of this study was to explore parents’ and pro-fessionals’ thoughts of how a gaze-controlled com-puter can be beneficial to children with severe multi-ple disabilities. A further aim was to investigate factorsaffecting usability.Method: The participants were 11 parents and profes-sionals, each of whom had taken on the role of key per-son in the work with a child using eye gaze technol-ogy. The systems were provided primarily for symbol-based communication but were also used for other pur-poses such as play, leisure and school activities. An in-terview guide was designed with open questions con-cerning important factors facilitating use and problemsencountered, and also questions concerning what thechild was able to do with the technology. The inter-views were recorded and transcribed. The study wasanalysed with Content analysis, which is described asa flexible method for analysing text data.Key results: The analysis process resulted in three cat-egories and twelve subcategories. The children used


eye gaze technology for a variety of activities. Therewere gains for the children in terms of empowerment,social interaction, learning opportunities and efficientcomputer use. The informants mentioned that it in-creased the children’s ability to perform activities in-dependently, express themselves and show competen-cies. Inaccessibility, liability issues and technical fail-ure were seen as obstacles, while prerequisites in-cluded time, collaboration, stimulating content, know-how and opportunities.Conclusion: This study suggests that eye gaze tech-nology can provide children who have multiple dis-abilities with new opportunities to communicate, inter-act and perform activities independently, if conditionsare right. The results indicate that certain prerequisitessuch as time spent, expert support, collaboration withinthe closest circle of people around the child, and stim-ulating content are necessary to make the technologyuseful and sustainable. The validity of the study mightbe affected of the small number of informants. We didnot meet the children and a limitation is therefore lackof detailed information about the use. This is neededin further research. It is also of great importance to ex-plore the views of the children.Keywords: Augmentative and alternative communica-tion, Computer access, Pediatrics, Usability.∗Corresponding author. E-mail: [email protected]

Child and Environmental Factors Influencing Se-lection of Eye Gaze Technology for Trials andAdoption for Young Children: An InterprofessionalPilot StudySandra Masaykoa,∗ and Joy S. McGowana

aDepartment of Assistive Technology and Augmenta-tive Communication, Easterseals Southeastern Penn-sylvania, 3975 Conshohocken Ave., Philadelphia, PA19131 USA

Background: Little research is available about charac-teristics of preschool candidates for eye gaze technol-ogy and environmental influences (parental, staff andagency) contributing to selection of eye gaze technol-ogy for trials and adoption. Our goal was to determinefactors influencing selection of eye gaze or anothermethod for computer access for preschoolers with dis-abilities.Method: During 2015–17, we conducted a field studywith a convenience sample of twelve children, ages 3–6, attending special preschools. All children had ac-

cess to agency-funded or borrowed eye gaze technol-ogy for training; trial data of participation and accuracywere collected by speech pathologists. Children partic-ipated in trials 30–90 minutes per week. We reviewedchildren’s medical and educational records. Thirty-twoservice providers and 12 parents were interviewed orsurveyed about their knowledge of eye gaze technol-ogy and the children’s abilities.Key results: The children’s diagnoses included cere-bral palsy (10) and rare neuromuscular disorders (2).Other conditions included dysarthria (12), seizure dis-orders (5), hearing impairment (1), cortical visual im-pairment (2); nystagmus (1). All had significant postu-ral issues. All were transported in manual wheelchairsmost of the time. All had difficulty handling or couldnot handle objects. Using any means, four childrencould communicate with familiar partners; the restwere inconsistent or seldom effective with familiarpartners. Teams did not use cognitive scores as indi-cators of potential, but all children could demonstratepreferences and look at a screen.Parental, staff, AT Team and agency factors were asfollows: All parents consented to children’s trials, andhalf had home-based trials. In year one, only 5% ofmulti-disciplinary staff members reported having for-mal training in eye gaze technology. In year two, staffwith formal training increased to 70% through agencyworkshops. The staff cited these supports from theAT Team to be helpful in decision making: equipmentloans (96% cited), implementation strategies (75%),programming (62%), team meetings (62%), instruction(62%), funding proposals (50%). The agency fundedthe AT Team and devices; 90% of staff perceivedagency as supportive of technology.Teams recommended the following after each year ofimplementation:Year 1 – One child: Acquire insurance-funded eyegaze technology AAC; One child: Acquire insurance-funded touch-activated AAC; Three children: Continuetraining; Two children: Discontinue eye gaze technol-ogy.Year 2 – Four children: Acquire insurance-funded eyegaze technology AAC; One child: Acquire insurance-funded touch-activated AAC; Three children: Continuetraining.Conclusion: Preschool candidates for eye gaze tech-nology have complex conditions impeding occupa-tional performance. Difficulty communicating indi-cates widespread need for AAC in this group; seating,portability, mounting and transportation require con-sideration. Difficulty with manual selection of icons


on a device suggests that eye gaze be considered asan access method, but children’s skills may advanceand allow touch activation eventually. Children’s train-ing may extend over a year before recommendations.Some children may reject eye gaze technology. ATTeams cannot assume staff members’ knowledge; pro-fessional development can increase staff expertise. Val-ued AT Team support can consist of equipment, strate-gies, meetings, instruction and funding. Agency fund-ing may be critical to implementation. Parent partici-pation is necessary in decision-making.Keywords: Eye gaze technology, Preschool, Profes-sional Development, AT Team.∗Corresponding author. E-mail: [email protected]

Eye Gaze Technology’s Effect on Participation andFunctional IndependenceMaria Borgestiga,∗ and Helena Hemmingssonb,caFaculty of Medicine and Health, School of Health Sci-ences, Örebro University, 702 81 Örebro, SwedenbDepartment of Special Education, Stockholm Univer-sity, 106 91 Stockholm, SwedencDepartment of Social and Welfare Studies, Faculty ofHealth Sciences, Linköping University, 601 74 Nor-rköping, Sweden

Background: To actively participate in activities arechallenging for children with severe disabilities world-wide. Few assistive technology interventions have thepotential to support children in performing a variety ofactivities in everyday life. Eye gaze controlled com-puter (EGCC) is today a possible intervention for ser-vice providers around the world. Previous research inSweden showed increase in activities with EGCC af-ter 9 months intervention. To strengthen research morechildren should be followed in EGCC outcomes. Theaim was to investigate the impact from EGCC in dailylife on active participation in activities (type, frequencyand duration), functional independence, and commu-nicative behavior among pupils with severe disabili-ties.Method: A multicenter intervention study with re-peated measurements including 18 children (Sweden,USA, Dubai). Results for 8 pupils attending specialschool will be presented (Sweden n = 3, age: 3–7 y;Dubai n = 3, age: 17–23 y; USA n = 2, age: 5–6 y). All had severe physical disabilities (e.g. Rett syn-drome, cerebral palsy, Lesch-Nyhan disease, intellec-tual disabilities), dependent on assistance and with-out speech. Intervention consisted of EGCC in daily

life (Tobii I12+, I15 or Tobii PCEye Go) and services(Swe: 5–8 occasions; Dubai, USA: every week) dur-ing 6 months by an AT team to support implementa-tion in daily contexts. Data were collected four times;before intervention (no EGCC), at 3 and 6 monthsEGCC intervention, after the end of intervention (noEGCC). Active participation in daily activities weredocumented with diary protocols (all time points). Keypersons rated the impact from technology on func-tional independence and communicative behavior (at6 months intervention) using Psychosocial Impact ofAssistive Devices Scale (PIADS) and CommunicationMatrix.Key results: All pupils performed activities withEGCC at 3 and 6 months intervention; six pupilsin school and two both in school and at home. At6 months the activity repertoire with EGCC rangedfrom 1–6 activities (Swe: 1,3 or 4 activities, e.g. talk,play, skill training; Dubai: 1,5 or 6 activities, e.g. talk,skill training, story selection; USA: 2 or 4 activities,e.g. talk, play, circle time), compared to no computeractivities for seven pupils before intervention and forno one after intervention. Duration ranged from 12–323 minutes per userday (Swe: 12 m, 73 m, 75ad’m;Dubai: 60 m, 72 m, 73 m; USA: 40 m, 323 m). Activ-ities were performed between 36–100% of days (Swe:36%, 64%,100%; Dubai: 71%, 71%, 71%; USA: 64%,71%). Preliminary findings indicate that activities, du-ration and frequencies with EGCC were similar be-tween pupils with different diagnosis, nationalities andages. Using EGCC, functional independence (PIADS)showed positive values for all but one child in com-petence (median 1.21, range −0.08 −2.00), adaptabil-ity (median 1.3, range 0.17–2.50) and self-esteem (me-dian 0.8, range 0–1.88). Preliminary results indicateemerging communicative behavior for some childrenwith EGCC compared to without EGCC which will bediscussed at the session.Conclusion: The results for the first eight pupils indi-cate increase in active participation and functional in-dependence after 6 months EGCC intervention. Slowdevelopment in general among children with severedisabilities indicate improvements in daily life fromEGCC use. Our future investigations will answer re-search questions concerning changes in communica-tive behavior and degree of dependence with and with-out technology use.Keywords: Children with disabilities, Intervention,Assistive technology, Self-help devices.∗Corresponding author. E-mail: [email protected]


Facilitating Participation in Routines and Activitiesfor Individuals with Complex Challenges by Use ofEye Gaze Intervention in a Transdisciplinary Spe-cial Education SettingIsphana Al Khatiba and Deepika Gopalaraoa,∗aDepartment of Assistive Technology, Al Noor Train-ing Centre for Persons with Disabilities, Building No.1, Street No. 21, Al Barsha-1, Dubai, UAE

Background: For students with profound and mul-tiple disabilities, who are eye gaze users, it is chal-lenging to implement their IEPs through use of cus-tomized activities and resources in all school routines.This study highlights how eye gaze intervention hasbeen embedded in various routines and activities at AlNoor Center for Persons with Disabilities to ensureparticipation and learning for individuals with com-plex communication challenges. Two approaches thatconstitute the bedrock of the Center’s service deliv-ery process viz. trans-disciplinary approach to assess-ment/intervention and activity and routine-based inter-vention are described. The aim of this part of the semi-nar is to describe implementation of eye gaze technol-ogy in a transdisciplinary special educational settingfor students with severe challenges.Method: Five eye gaze users participated in the studyfrom Jan 2018 to Sept 2018. Trans-disciplinary inter-vention, training support to teachers, teaching assis-tants and therapists in the use of eye gaze technology,routine – based intervention and customization of re-sources etc. were used to ensure implementation of eyegaze training for each eye gaze user. Student – specificeye gaze equipment was made available through theschool day. Thrice weekly individualized skill-specifictraining in eye gaze was provided. This initiative wasguided and led by the Assistive Technology Special-ists.The IEP was implemented through appropriatelyplanned activities ensuring access to eye gaze equip-ment in every routine. The routines included– Communication (apps with text/ symbols)– Academics (e-books, PowerPoint slides)– Literacy (customized Communicator page-sets with

IEP goal-specific grids)– Music (accessible apps, software Beamz Music,

Eye-play Music)– Leisure (watching YouTube videos of their choice,

online radio page-sets, Tic Tac Toe, Makeup page-sets, HelpKidzLearn games)

– ICT (page-sets for making greeting cards, Look-ToLearn software, SenICT activities)

– Art (creative art software, online Mandala creator,digital painters, pixel drawing)

– Vocational training (designing merchandize), etc.Assessments such as Communication Matrix, Co passassessment, Psychosocial Impact of Assistive DevicesScale, Quebec User Evaluation of Satisfaction with As-sistive Technology were used to measure the usage andbenefits of eye gaze.Key results: Eye gaze usage within Al Noor’s struc-tured service delivery setup has provided opportunitiesto the students to access all routines, which otherwisewould not have been possible. Examples of participa-tion of eye gaze users in activities include in a mu-sic band, designing of merchandize for sale, access-ing YouTube videos for leisure etc. and in areas suchas communication, ICT, art, literacy etc. Learning out-comes were attained in specific skills of duration andfrequency of eye gazing. Desire to communicate andeagerness to participate were observed amongst the eyegaze users. Some students displayed fatigue to tasksrequiring complex and sustained eye gaze movements.This was addressed through task – breaks to overcomefatigue.Conclusion: Structured service delivery processes, in-tensive staff training, access to resources and equip-ment and providing appropriate opportunities withinroutines are some of the key factors that have influ-enced the outcomes of this study. This study illustratesthe need for service providers to integrate assistivetechnology devices and services into the core servicedelivery process to ensure participation and learningfor the intended beneficiaries.Keywords: eye gaze, trans-disciplinary intervention,routine-based intervention.∗Corresponding author. [email protected]

Combining P300-based Brain Computer Interfacewith an Eye-tracking System to Improve Commu-nication Efficacy for People with Ocular Motor Im-pairmentFrancesca Schettinia,∗, Angela Ricciob, EnricoGiraldib, Federica Cappalongac, Lisa Pelagallid, FeboCincottia,b,c and Donatella MattiabaServizio Ausilioteca per Riabilitazione Assistita conTecnologia (SARA-t), Fondazione Santa Lucia (IR-CCS), Rome, ItalybNeuroelectrical Imaging and BCI Lab, IRCCS Fon-dazione Santa Lucia, Rome, ItalycDepartment of Computer, Control, and ManagementEngineering Antonio Ruberti, “Sapienza” University


of Rome, Rome, ItalydDipartimento di Ingegneria Elettrica e dell’Informa-zione “Maurizio Scarano”, Università degli Studi diCassino e del Lazio Meridionale

Background: Brain computer interface (BCI) systemsallow people with severe motor disabilities interactwith the environment representing an alternative chan-nel to access assistive technologies for communicationdisorders. When eyes movement are preserved but userexperiences severe motor impairment, high technol-ogy aids as eye-trackers are efficient and effective so-lutions. However, eye-trackers performances decreasein case of oculomotor impairments such as nystagmus,gaze paralysis. On the contrary, P300-based BCIs donot rely on eye movements but on the subject ability toattend relevant stimuli. In this work we propose a hy-brid algorithm, based on both EEG data and eye-gazeposition, with the aim of improving efficiency and ef-fectivness of communication aids for people with ocu-lomotor impairments.Method used: The hybrid BCI is based on an iterativealgorithm, originally proposed by Kalika et al. 2017that computes the probability of each item to be tar-get as the combination of EEG and eye gaze positiona priori probabilities. When total probability reachesa specific threshold the algorithm provides a classifica-tion result, otherwise another iteration occurs. We as-sessed EEG score values using a stepwise linear dis-criminant analysis (SWLDA) and a priori EEG prob-ability was computed by linear interpolation of scoreson the distributions of target and non-target stimuli.To estimate a priori eye-gaze probability, we assumedequal and Gaussian distributions for each item, Gaus-sian mean was estimated by a least square linear re-gression (LSLR) and covariance as the maximum ofthe vertical and horizontal gaze coordinates variance.We introduced constraints on the classification thresh-old, introducing a threshold value on the EEG scoresand considering a dwelling time for the eye-gaze po-sition. We preliminary validated offline the proposedalgorithm on the data recorded from 10 healthy par-ticipants. Participants were required to carry out aP300 Speller session. Scalp potentials were collectedat 256 Hz with 16 EEG active channels. Eye-gaze po-sitions were recorded using a Tobii 4C eyetracker. TheP3-speller interface (5 × 6 matrix of alphabetic itemsrandomly flashing) was provided by BCI2000. We col-lected 8 runs of 5 characters each. In order to assessalgorithm efficacy we computed the written symbolrate (WSR-REF) and exploited different variance val-ues for eye-gaze data.

Key results: Because of low values of eye-gaze vari-ance (0.001) no statistical differences were identifiedin terms of WSR for the hybrid algorithm with respectto the solely eye-tracker (t = −0.19, p = 0.84). Ifeye-gaze variance increases (0.1) the hybrid algorithmshowed higher WSR values with respect to both eye-tracker (t = 6.57, p < 0.001) and EEG (t = 3.72, p <0.01). This confirms that with eye movements impair-ments, the combination of eye-tracker data and EEGdata allows for better performance.Conclusion: Hybrid control could represent a solu-tion to increase communication efficacy for peoplewith ocular motor impairments who experience a de-crease in performance with eye-trackers. As expected,with healthy subjects the classification algorithm ismainly driven by eye-gaze data, but offline simulationsshowed that EEG data improves classification perfor-mance when the reliability of eye-gaze data decreases.We will evaluate the algorithm with potential end usersto further verify our hypothesis.Keywords: Brain Computer Interface, Eye-tracker, as-sistive technology.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 6Employing MOOCs and OERs in TeachingDigital Accessibility

In 2016, the European MOOC Accessibility Partner-ship (MOOCAP) launched the first European MOOCon digital accessibility, on the FutureLearn platform.Since then, other MOOCs on specific subtopics of digi-tal accessibility have been released, by MOOCAP part-ners and by other parties. In Europe, there is an ur-gent need for education and training of students andprofessionals studying and working in areas involv-ing digital media. MOOCs and Open Educational Re-sources (OERs), optionally integrated with presencetime (“blended learning”), are deemed to be an ap-propriate means to satisfy this need. Initially startedby MOOCAP, there is a growing European commu-nity with a joint interest in harnessing MOOCs andOERs in teaching digital accessibility for a wide audi-ence, including students at universities and profession-als at work. It is imperative to join forces, learn fromeach other’s experiences and share best practices andOERs, since the field of digital accessibility is so wide,and experts are scarce and geographically distributed.The BEYOND-MOOCAP network will host this Spe-


cial Thematic Session to facilitate an exchange of bestpractices and a platform for sharing OERs to reuse andfor translation into local languages. All interested per-sons and parties are welcome to join us and contributeto this session.Chair: Gottfried Zimmermann

Designing a MOOC for “Training the Trainers”Christophe Strobbea,∗ and Gottfried ZimmermannaaResponsive Media Experience Research Group,Stuttgart Media University, Nobelstraße 10, 70569Stuttgart, Germany

Background: EU Directive 2016/2102, voted in Oc-tober 2016, requires that new public sector websitesin the EU need to conform European standard EN301 549 by 23 September 2019. Other public sectorwebsites and public sector apps will eventually alsoneed to comply. The European Accessibility Act, ap-proved by the European Parliament on 13 March 2019,will greatly expand the range of products and ser-vices that need to be accessible, including comput-ers, e-commerce websites and mobile apps. This cre-ates a greater need for training resources and coursesfor content authors and developers, among others.The MOOCAP project (2014–2017), co-ordinated byStuttgart Media University, created 10 online courses,including four MOOCs, on digital accessibility. The re-sources from these courses met WCAG 2.0 level AAand were all made available as open educational re-sources under the terms of the Creative Commons (CC-BY 4.0) licence.Method: The above-mentioned courses and resourcesare in English and many EU member states will needtraining resources and courses in other languages. In-formal discussions with representatives of German mu-nicipalities have taught us that a course on digital ac-cessibility should use materials in German. In Ger-many, Stuttgart Media University is creating a MOOCin German that is aimed at civil servants who will bein charge of leading accessibility projects and/or train-ing developers and content authors who will be in-volved in making websites and apps compliant withEuropean accessibility regulations. The target audi-ence also includes designers and developers of digi-tal systems in general. The course content will meetWCAG 2.1 level AA. The course will combine threeface-to-face meetings, and online course modules thatare spread over four months. Each online module willcontain required reading and practical tasks that will

be discussed in regular online meetings (typically on aweekly basis). The course will cover accessibility ba-sics, laws and regulations, multimedia, web accessibil-ity (WCAG 2.1), office documents (Word, PowerPointand PDF) and inclusive design processes.Key results: The course contents is being developed;the course itself is scheduled to start in October 2019.Conclusion: Since the course has not started yet, noconclusions can be drawn at this time.Keywords: accessibility, training, resources.∗Corresponding author. E-mail: [email protected]

Using MOOCAP Open Educational Resources tosupport Universal Design and Accessibility initia-tives in Computer Science programmes in Ireland’sfirst Technological UniversityJohn Gilligan∗

School of Computer Science, Technological UniversityDublin, City Campus, Kevin Street, Dublin 8, Ireland

Background: The recently completed Massive OpenOnline Course for Accessibility Partnership project(MOOCAP), funded by the ERASMUS+ Key Action2 (KA2) grant program of the European Union, hadthe twin aims of establishing a strategic partnershiparound the promotion of Universal Design and Acces-sibility for ICT professionals and of developing a suiteof Open Educational Resources(OERS) in this domain.This study considers how the MOOCAP OERS wereused in two different situations in undergraduate com-puter science programmes in the Technological Uni-versity of Dublin which both have digital accessibilityas a common learning goal. This reflects the reportedneed to promote accessibility considerations amongstICT professionals.Method: This research involves two case studies withanalysis using the Johns model of reflection. Some sur-veys have also provided reflective feedback. The firstcase study examines the role of OERs to modernize ac-cessibility topics in a Universal Design and AssistiveICT module and the second looks at how the OERS area valuable resource in developing a training programin the preparatory stage of a team project module. Theteam project uses an Agile Co-Design model with part-ners with Intellectual Disability. Fifteen students tookpart in the first case study. Twenty four students tookpart in the second case study. The results of these casestudies will be considered in comparison to already re-ported international use of the MOOCAP content.


Key results: Prior to engaging with these modules,there was little knowledge of accessibility among thestudents. Both modules increased awareness of the roleof the user in computer science. The Co-Design pro-cess was especially significant in this regard with stu-dent participants reflecting that it had changed theirperception of development. Requirements were typi-cally given to them in previous assignments. Now theyhave to find out what the users wanted. The OERSwere an interesting and helpful resource in meeting thelearning outcomes of the module. The team projectsneeded strong preparation and the OERS helped inachieving this. Feedback was also given that more ex-amples of best accessible applications should augmentthe OERs used.Conclusion: It is essential to promote accessibilityknowledge amongst the ICT developers of tomorrow.The role of the user in application development is cen-tral to this. The MOOCAP OERS are a valuable re-source in this regard. They can help achieve these out-comes in many different ways. A repository of best ac-cessible applications would be a useful addition.Keywords: Open educational Resources, MOOCs,Digital Accessibility, ICT Professionals.∗Corresponding author. E-mail: [email protected]

Harnessing MOOCs and OERs in teaching digitalaccessibility – experiences with a flipped classroomapproachWeiqin Chen∗

Department of Computer Science, Oslo MetropolitanUniversity, PO box 4, St. Olavs plass NO-0130 Oslo,Norway

Background: The past few years have seen a press-ing need for students and professionals in informa-tion technology (IT) to learn digital accessibility. Asa consequence, an increasing number of universitieshave started to include digital accessibility in their ITcurricula, alongside some open educational resources(OERs) and Massive Open Online Courses (MOOCs).Researches have also been carried out on pedagogiesand methods in teaching digital accessibility. A flippedclassroom is a pedagogical approach that promoteslearner-centered instruction and replaces the traditionaltransmissive lecture with active in-class tasks and pre-/post-class work. In this paper we share our experi-ences on teaching digital accessibility using the flippedclassroom approach and OERs and MOOCs created inthe EU erasmus+ funded “MOOCs for AccessibilityPartnership (MOOCAP)” project.

Method: The study was carried out in 3 runs of thesame course from 2016 and 2018. Each run lasted for6 weeks where the first 5 weeks were dedicated tocourse content and the last week were used for coursesummary and exam. The 5-week’s content was corre-spondent to the 5 weeks in the introductory MOOC fordigital accessibility created in the MOOCAP project.In the flipped classroom approach, we have used theOERs (in 2016) and the introductory MOOC (in 2017and 2018 ran in parallel with the course) as the pre-/post-class work. To prepare for the classroom activi-ties students were asked to read the text and watch thevideos in the OERs and the MOOC. For classroom ac-tivities, we focused on collaborative knowledge build-ing where students were first asked to share with eachother what they have learned from the reading, andthen discuss important issues related to digital accessi-bility. For example, what criteria can one use to selectusers in a user testing of web accessibility? What arethe challenges in developing an accessible web form?What are the accessibility barriers can an ATM haveon diverse user groups? In total, 70 students partici-pated in the 3 runs of the course. At the end of each runan online questionnaire was distributed to gather feed-back. In the questionnaire there were also fields wherestudents could write their opinions in free text.Key results: The feedbacks from students were in gen-eral positive. Most of the participants reported thatthey have enjoyed the flipped classroom approach andlearning materials in OERs and the MOOC. They alsothought that the materials were very useful. However, afew students reported that the approach did not fit wellwith their preferred learning method. They preferred tobe taught rather than self-study. When some studentsdid not prepare before class, it was difficult to organizeclassroom activities.Conclusion: Our experience shows that using a flippedclassroom approach to harness OERs and MOOCs inteaching digital accessibility is a promising approach.However, it is also important to take into considerationthe diverse preferences and abilities of students. Fur-ther research could replicate the study, gather more ev-idence and provide recommendations in using OERsand MOOCs in flipped classroom for teaching digitalaccessibility.Keywords: digital accessibility, MOOC, OER, flippedclassroom, education.∗Corresponding author. E-mail: [email protected]


Exploring the impact of the Digital AccessibilityMOOCE.A. Draffana,∗, Manuel León-Urrutiaa and MikeWalda

aECS, WAIS, University of Southampton, UniversityRoad, Southampton, SO17 1BJ UK

Background: Since 2016, the Erasmus+ Europeanproject “MOOCs for Accessibility Partnership”(MOOCAP) has hosted their introductory five-weekdigital accessibility massive open online course(MOOC) four times. The eight partner universities pro-vided multimedia resources and links to a wide rangeof topics about assistive technologies and accessibledesign in ICT. The MOOC aimed to help participatinglearners understand how those with sensory, physicaland cognitive impairments may be disabled by barriersencountered when using digital technologies. By usingthe FutureLearn platform there were plenty of chancesto discuss content, make comments as well as reflecton what had been learnt. These interactions providedthe partnership with a greater understanding about theimpact the MOOC had on some learners and this paperaims to explore six case studies that illustrate particularoutcomes in the workplace.Method: By examining the data collected from theFutureLearn statistics for the four Digital Accessibil-ity MOOCs from October 2016–2018 it was foundthat 11186 learners signed up. 6670 engaged with thecourses in one way or another and 1127 completedthe courses with 1667 interacting by posting com-ments about the subjects discussed. On average learn-ers commented around 13 times over the course of eachMOOC. This amount of interaction was shown to beabove the normal range for this type of online learn-ing. The authors asked certain participants, who had adocumented web presence, if they could explore theirinteractions further. The resulting six case studies werealso chosen from participants with very different areasof expertise and how they shared their experiences dur-ing their interactions online.Key results: As the case studies were collated, it be-came clear that the participants were not only activelearners but also engaged with the majority of the con-tent, links and formative assessments. They appearedto have a high number of comments that were ‘liked’by other participants, and discussed topics with thetutors or mentors. Most interestingly when analyzingtheir reflective comments at the end of the first week,it appeared all six had professed that they intended totake what they were learning into their workplace.

Conclusion: The learners came from across the worldand were based in research and educational institutes,designing user experiences for the elderly or tutoringdyslexic adults, working as a digital learning consul-tant or leading on accessibility in large well-knowncompanies. Despite the different employment settings,all acknowledged that the course had provided themwith the confidence to expand on their work in thisarea. Moreover, they said it had allowed them to pro-vide support to others on the subject of digital accessi-bility and in most cases, this was evident in their webpresence after the MOOCs took place.Keywords: Digital Accessibility, MOOCs, Disability,Case Studies, Learners.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 7AI and Inclusion – Exploring the issues as wellas the successes

Artificial Intelligence and Inclusion’ is a subject thathas been debated in terms of ethics and a lack of bigdata for machine learning when thinking about inclu-sive design for those with disabilities. The challengesare to overcome these difficulties and to develop tech-nologies to remove the many different barriers to ac-cess. Those working in the world of assistive technolo-gies, and digital accessibility are innovating and ex-ploring this field in participation with those who havedisabilities. This special theme aims to explore someof the innovations that are appearing and to discuss theissues that have been arising as well as the successes.Chair: E.A. Draffan

AI and Inclusion: A Roadmap for Research and De-velopmentE.A. Draffana,∗, Mike Walda and Chaohai Dinga

aECS, WAIS, University of Southampton, UniversityRoad, Southampton, SO17 1BJ, UK

Background: Artificial Intelligence (AI) was a termcoined in the 1950s based on the work of Alan Turingand other machine-learning experts. The term tends tocover the use of data collections, algorithms and mod-els that can augment or assist humans in their decisionsand tasks, but there is a deepening awareness that notall data collections are inclusive or algorithms trans-parent. Ethical issues arise where this occurs and inclu-sion depends a lack of bias and fairness within the sys-


tems. This abstract presents a roadmap for digital ac-cessibility research and development using AI to sup-port those with disabilities with examples where strate-gies can help prevent barriers to inclusion.Method: A gap analysis has been undertaken to inves-tigate where issues might be arising for those who arerecognized as having ‘protected’ characteristics’, fo-cusing on those with disabilities. The process includedreviews of EU, government, academic and commercialreports, papers. The review used five AI driven searchengines, combining the terms artificial intelligence, in-clusion, accessibility and disability. An online reposi-tory of the findings was developed and as the gaps ap-peared more in depth investigations undertaken, meet-ing experts in the subject to evaluate how examples ofinnovative developments in particular areas, could re-move barriers to enhance digital accessibility and in-clusion.Key results: Around 1,782 academic papers werefound using the aforementioned terms. Much has al-ready been written about the ethical issues arising frombias and the exclusion of data relating to vulnerablegroups within society so papers with ‘ethics’ in the ti-tle were left out of the review. At the time, only 50 pa-pers were considered appropriate with government anddisability organization reports tending to highlight theissues arising, rather than offering solutions. The re-ports ’that included ‘disability’ appeared to consider itas a homogeneous concept that could lead one to be-lieve that one solution would fit all if it was provided.AI and inclusion appeared to be poorly defined, whenthinking about disability, with many papers consider-ing medical issues and not accessibility or design forall. Authors described using AI to support assessment,diagnosis and support for diseases and health condi-tions, smart living, homes and cities. Some were aboutassistive apps to support specific disabilities, but rarelyabout equity of access. It still seems that those withdisabilities are expected to use additional AT without aguarantee of accessibility to the digital and built envi-ronment.Conclusion: Successful inclusion of all vulnerablegroups within the AI research and development arenaremains patchy, in particular when considering strate-gies for access to aid those benefiting from a widerange of technologies. However, when exploring bothpolicy and machine learning applications catering forthe heterogeneity in disability (where barriers are re-moved), there are a variety of strategies that enhancedigital accessibility. These may include personaliza-tion, localization, risk assessments, anomaly detection,

and prediction or recommendation systems. Outcomescan be biased against particular needs, but if there isan awareness of these issues and algorithms are de-signed to cater for inclusion, enhanced digital accessi-bility can be achieved.Keywords: Artificial Intelligence, Inclusion, Accessi-bility, Disability, Design for all.∗Corresponding author. E-mail: [email protected]

The four idols of AI for health and wellbeingStephen Potter∗, Peter Cudd and Luc de WitteCentre for Assistive Technology and Connected Heal-thcare, The University of Sheffield, 217 Portobello,Sheffield, S1 4DP, UK

Background: In the last decade or so, increased com-puter processing and storage capabilities, along withthe availability of big data sets, have stimulated the de-velopment of more elaborate inductive machine learn-ing algorithms and architectures. These have deliveredimpressive results in tasks such as natural languageprocessing and image recognition, so much so that incontemporary usage AI has become practically syn-onymous with inductive machine learning and, morespecifically, with deep learning.Moreover, these results have, quite naturally, raised ex-pectations that, with just the right amount of effort,these results will be repeated across a range of do-mains, automating all sorts of mundane (and not somundane) tasks. The expectations – and accompany-ing hype – are such that AI now consistently appears inpolicy documents as a key driver of innovative servicesand products, of productivity gains, and of wealth andjob creation across all sectors of developed economies.The health and social care sector, with its escalatingneeds and straitened budgets, seems particularly sus-ceptible to the claims of proponents of this new AI.However, the degree of faith placed in AI to deliverthe imagined gains is not yet borne out by evidence.There are a number of reasons to believe that the gains,while by no means negligible, will be more limited andwill be more difficult and take longer to achieve anddisseminate into everyday care practice and assistivetechnology.Method: This discussion paper draws on the authors’experience of working with and around AI and healthand wellbeing applications. Its theoretical inspirationis drawn from the work of the British philosopher Fran-cis Bacon, one of the progenitors of modern inductivemethod, who in his Novum Organum (1620) identified


four ‘idols of the mind’, that is, types of common falla-cies or biases that divert reasoning from the acquisitionof ‘true’ inductive knowledge.Key results: We propose “the four idols of AI forhealth and wellbeing”, which apply equally to assistivetechnology; these are:– The idols of the tribe, or fallacies that emerge

from the conviction that there is, of necessity, ‘true’knowledge inherent in data;

– The idols of the cave, or mistakes that derive fromour ignorance, wilful or otherwise, of the limitationsof the methods and means at our disposal;

– The idols of the marketplace, or the constraintswhich human commerce places on our endeavours;

– The idols of the theatre, or the failings that arisefrom incorrect, ill-considered or improper use of AI.

As we show, consideration of these idols allows theadoption of strategies and practices to mitigate theireffects.Conclusion: A contribution is made to a critical ap-praisal of the use of inductive machine learning, par-ticularly deep learning, in care contexts. When consid-ering the application of machine learning for assistivetechnology an awareness of the pitfalls should help toallocate scant resources to those tasks most likely tobenefit end users.Keywords: Artificial Intelligence, data, machine learn-ing.∗Corresponding author. E-mail: [email protected]

AI Bias in Gender Recognition of Face Images:Study on the Impact of the IBM AI Fairness 360ToolkitGottfried Zimmermanna,∗, Patrick Brennera andNiklas Janssena

aStuttgart Media University, Responsive Media Expe-rience Research Group, Nobelstr. 10, 70569 Stuttgart,Germany

Background: Artificial Intelligence (AI) has great po-tentials, but also comes with risks. In particular, the“AI bias” has been described as a phenomenon thatcan marginalize persons with disabilities or classify asoutliers. This would potentially exclude those personsfrom fair access to important services such as healthinsurance and loan programs, or at least significantlyhamper them. The IBM Fairness 360 Open SourceToolkit (AIF360) addresses this problem. Its goal is to“examine, report and mitigate discrimination and bias

in machine learning models”. It was developed by IBMand announced in September 2018. The toolkit con-tains 10 algorithms to mitigate bias in AI systems. Oneof them is “reweighing” which is suitable for imagerecognition. So far, there has been little research on theimpact of AIF360 regarding its ability on mitigating AIbias, and its applicability on various problem domainsthat are typical for the application of AI algorithms.Method: We conducted a small study on the impactof AIF360’s reweighing algorithm on the accuracy ofgender recognition for face images of persons with andwithout Down Syndrome (DS). We used the genderrecognition algorithm and a training set of 20.000 im-ages from the UTKFace dataset which is included inthe AIF360 package. These images were tagged withthe gender of the person, but not with any informa-tion on DS. Also, we collected 30 images from pub-lic domain sources on which persons with DS weredisplayed; and 30 images from the same sources withpersons without DS. The study consisted of two partswhich differed in the set of training images. In part(1), we trained the system with random 16.000 im-ages from UTKFace. In part (2), we trained the sys-tem with random 15.984 images from UTKFace plus16 images of persons with DS (from public domainsources) – a proportion of 0,1% which is roughly theproportion of persons with DS in the German popula-tion. In both parts, we tested with images from publicdomain sources: 30 persons without DS and 30 personswith DS, in two modes: default algorithm and reweigh-ing algorithm.Key results: We found no evidence for a manifestationof the AI bias under this configuration. Gender recog-nition accuracy with the default algorithm was a low70% for persons without DS and 80% for persons withDS in part (1); and 70% for persons without DS and73,3% for persons with DS in part (2). However, whenusing the reweighing algorithm in part (2), there wasa slight improvement from 73,3% to 83,3% accuracy.However, the sample size was too small to claim a rep-resentative assessment for this algorithm.Conclusion: The AIF360 toolkit is a candidate instru-ment for the mitigation of AI bias. According to ourstudy, the reweighing algorithm has the potential to im-prove the gender classification accuracy, but researchwith a larger sample needs to be conducted to confirmthis.Keywords: AI bias, Down syndrome, reweighing al-gorithm, gender recognition∗Corresponding author. E-mail: [email protected]


Machine Learning: Design by Exclusion or Exclu-sion by Design?John Gilligan∗

School of Computer Science, Technological UniversityDublin, City Campus, Kevin Street, Dublin 8, Ireland

Background: Many applications, from image recog-nition to providing credit ratings for loan applicantsuse Artificial Intelligence (AI) and Machine Learning(ML). They have become major technologies in every-day life. However, commentators such as the ObamaWhite House and the World Economic Forum havenoted the potential of these technologies to excludeand discriminate. This discrimination typically startswith datasets that exclude or underrepresent particu-lar groups of people, including people with disabilities.This exclusion propagates through the Machine Learn-ing algorithms, used in these technologies. In otherwords, these algorithms have developed from a designprocess tainted by exclusion. How does this exclusionoccur in the datasets? Is it deliberate, i.e. exclusion bydesign or are there other reasons?Method: This study involves a comparative analysisof four case studies from the domains of education,speech recognition, fall prediction, and credit card riskassessment. These all have important resonance forpeople with disabilities. Comparison is across the di-mensions of:– origin and characteristics of the dataset,– whether exclusion is manifest or not in the dataset,– if this exclusion is deliberate,– what preprocessing occurs on the data set and– implications for people with disability.Key results: The key finding is that there is exclusionof certain groups of people in datasets used for ma-chine learning applications. This exclusion can haveserious consequences for the people who are discrim-inated. Education and job opportunities can be lost.A creditor may refuse a loan because the applicant iswrongly classified.How has this exclusion happened? It may be down toignorance. It may have been deliberate but motivatedby good intentions with respect to privacy or safety orethical concerns. It may simply be that this dataset isthe only one available regardless of its flaws. Howeverall is not lost and there may be remedial processes, es-pecially in the pre-processing phase, which can pro-vide some redress. Oversampling and under-samplingare of particular importanceConclusion: It is especially important to develop in-clusive datasets across many applications for underrep-

resented groups in machine learning. Inclusive datasetprotocols and techniques, which respect ethics, privacyand safety, need to be developed. The efficacy of inclu-sive pre-processing techniques such as oversamplingneeds exploration.Keywords: Machine Learning, Artificial Intelligence,Exclusion, Datasets, Disability.∗Corresponding author. E-mail: [email protected]

Accessibility and Stigma: Designing for Users withInvisible DisabilitiesMaria K. Woltersa,b,∗aA Journal Centre for Design Informatics, School ofInformatics, University of Edinburgh, EH8 9AB Edin-burgh, UKbThe Alan Turing Institute for Data Science and Arti-ficial Intelligence, London, UK

Background: While chronic pain due to overuse (e.g.,Repetitive Strain Injury, some types of back pain) isoften discussed in the ergonomics and accessibility lit-erature, there are many invisible conditions such as fi-bromyalgia that are characterised by complex, chronicpatterns of pain and fatigue. People living with thoseconditions often find that the number of tasks they cancomplete in a day is severely limited. This can be asignificant barrier to fulfilling even basic needs suchas self-care. At the same time, people with chronicpain are often stigmatized as “lazy”, because there areoften no visible signs or clear causes of their condi-tion. Physiologically, pain affects mobility and dexter-ity, and un-ergonomic technology can create or exacer-bate chronic pain. In this paper, we examine the extentto which these issues are acknowledged and discussedin the literature on providing healthcare or assistivetechnology for people who live with chronic pain.Method: Searches covered the ACM digital library(ACM publications) and PubMed. The keyword forthe ACM digital library was “chronic pain”. PubMedwas searched for “chronic pain” and “technologyuse”/“accessibility”/“usability”. In addition, five keyjournals in the field, Technology and Disability, Jour-nal of Enabling Technologies, Disability and Rehabili-tation Technology, Assistive Technology, and the Jour-nal of Rehabilitation and Assistive Technologies, weresearched for the term “chronic pain”. Chronic pain wasused as the umbrella term for relevant conditions be-cause it is a defining feature and likely to occur in theabstract, key words, or full text.Key results: The papers retrieved are mostly con-cerned with eHealth solutions for chronic pain man-


agement and self-management. There is almost noconsideration of ergonomic aspects. Within the healthfield, interventions are mostly evaluated for effective-ness and acceptability, some for usability. When acces-sibility issues were evaluated, the focus was on acces-sibility for visually impaired users, not on impairmentsof mobility and dexterity. There was also very little in-depth consideration of the work and effort required tointegrate technology into the daily life of somebodywith chronic pain. A few papers highlighted that peo-ple with chronic pain were particularly affected by thedigital divide.Conclusion: Chronic pain affects mobility, dexterity,and people’s ability to do the work required to use andlook after their technology. These aspects are mostlyneglected in the HCI, eHealth, and assistive technologyliterature on designing for people with chronic pain.We need to determine the relevant accessibility issuesbefore we can begin to leverage AI meaningfully toaddress them.Keywords: chronic pain, accessibility, stigma, inclu-sion∗Corresponding author. E-mail: [email protected]

AI and AAC: Linking Open Symbol Sets – A GlobalApproachE.A. Draffana,∗, David Banesb, Mike Walda, ChaohaiDinga and Russell NewmanaaECS, WAIS, University of Southampton, UniversityRoad, Southampton, SO17 1BJ, UKbDavid Banes Associates, Milton Keynes, Bucking-hamshire, MK12 5AU, UK

Background: Artificial Intelligence depends on bigdata sets to provide successful outputs from algorith-mic modelling. However, in the world of augmenta-tive and alternative forms of communication (AAC),where individuals with complex communication needsmay use symbols, data is scarce. This means that non-speaking symbol users have restricted choices, depend-ing on symbol to text when communicating online withlittle text to symbol translation. The conversions arefraught with complications due to the different types oflinguistic concepts, imagery and languages. At present,there is limited harmonization or standardization ofsymbol sets, so users find it hard to access suitablelocalized imagery to fit their present systems, unlessmanual modifications are made. This paper shows howsymbol sets can be linked with multilingual options

and how plans to use image recognition and more de-tailed metadata could improve outcomesMethod: The last ten years has seen studies examiningthe possible harmonization of different AAC symbolsets. These offered users the chance to communicatewith their preferred symbols in phrases and sentencesthat were transcribed into text and then converted intoanother set of symbols from a different symbol set andinto another language. The conversions used a conceptcoding framework with symbol sets such as Blisssym-bolics and ARASAAC using European languages. Thisidea has been extended with the use of ConceptNet(a semantic network) and additional metadata with awider range of languages to allow for the linking of aninfinite number of symbol sets. It is proposed that theuse of machine learning and image recognition couldfurther enhance the process with a diverse range ofsymbols that have free to use licenses and are appropri-ate for AAC users across the world. This would resultin ease of access to more pictographic based commu-nication that could be personalized, localized and be-come increasingly culturally suitable for globalization.Key results: So far it has been possible to automat-ically link five multilingual and multicultural openAAC symbol sets, providing a repository that can besearched or filtered using categories such as language,concept, label, category and parts of speech. Lan-guages vary from Hindi to Spanish, Marathi to Arabicwith the symbol sets ranging from those suitable foradults to Blissymbolics with its own grammar. All canbe used with communication chart builders using anopen board format (obf) for digital, online and paperbased communication systems.Conclusion: There may be challenges ahead for thosewishing to explore open symbol set development toprovide users with choices adaptable for personalizedcommunication. However, a global symbols’ model of-fers avenues into literacy and understanding of symbolto text based content. The addition of symbols for on-line informational content has already been consideredby the Web Content Accessibility Guideline cognitiveand learning disabilities task force and Easy to ReadEU project teams. Nevertheless, without harmoniza-tion it will remain hard for AAC users to express theirideas, share thoughts and comprehend content acrossour digitally networked world.Keywords: Artificial Intelligence, Augmentative andAlternative Communication, Symbols, Multilingual,ConceptNet.∗Corresponding author. E-mail: [email protected]


IoT-Based Observation Technology for Assessmentof Motor and Cognitive Conditions in Childrenwith Severe Multiple DisabilitiesMamoru Iwabuchia,∗, Kenryu Nakamurab, HiromiAkamatsub, Syoudai Sanoc, Takamitsu Aokid andMark MizukoeaSchool of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192,JapanbRCAST, the University of Tokyo, 4-6-1 Komaba, Me-guro, Tokyo 153-8904, JapancTakamatsu Special Education School, 1098-1 Tamu-racho, Takamatsu, Kagawa 761-8057, JapandNational Institute of Special Needs Education, 5-1-1Nobi, Yokosuka, Kanagawa 239-8585, JapaneDepartment of Communication Sciences & Disorders,University of Minnesota Duluth, 197 Chester Park, 31W College Street, Duluth, MN 55812, USA

Background: Medical advancement has increased thesurvival rates of newly born babies with multiple dis-abilities, which has increased the number of non-speaking children with limited responses during inter-actions. In order to provide good support to and inter-action with them, it is urgently needed to achieve anobjective means that helps to assess their motor andcognitive conditions. In this study, IoT-based observa-tion technology was developed, which helps to recordand evaluate the responses of those children while var-ious stimuli are presented. The usefulness of the sys-tem in assessing their motor and cognitive conditionswas investigated.Method: The following two applications were devel-oped, which support the observation of the responsesof children with severe multiple disabilities. The firstapp, TEAK (Team Entry Assessment Kit), was de-signed to navigate the user, e.g., the children’s parentsand teachers, with the instructions of how the stim-uli are presented during the observation. The app asksthe user about the child’s response toward the stimuliand choose a number from a five-level scale that as-sociates with their body movement. The observed dataare stored on the server and can be graphically pre-sented with potentially related information, such as en-vironmental information, which is collected over theInternet. The second app, OAK (Observation and Ac-cess with Kinect), was developed in our former studyand visualizes the location and amount of the body mo-tion using the camera of the smartphone/tablet. Thisapp creates images in a heat map format with a six-color scale based on the frequency of the brightness

change, which corresponds to the motion of the user,in each pixel of the captured video. New observationfunction including the automatic presentation of vi-sual, auditory, and tactile stimuli using IoT technologywas additionally implemented to OAK. There were 33participants, 10 parents and 23 special education teach-ers, in the experiment. Each participant observed a cou-ple of children with severe multiple disabilities usingone of the apps, and there were 27 children in total. Theparticipants were interviewed after the observations.Key results: TEAK successfully navigated the partic-ipants to conduct controlled observation and helpedto find previously unnoticed motor or cognitive abili-ties of several children. Meanwhile, many of the par-ticipants requested a simpler technology than the app.This led to a new feature that enables the user tosave the observed information via voice using smartspeakers (Amazon Echo) or by activating IoT devices(AWS IoT Button). OAK observation also successfullyhelped to conduct more precise assessment. For exam-ple, a non-speaking child’s slow voluntary response to-ward auditory stimulus was identified.Conclusion: In this study, two IoT-based observationapps were developed, which records and helps to eval-uate the responses of children with severe multiple dis-abilities toward various stimuli presented. The experi-ments showed that the apps helped to find previouslyunnoticed responses and gave more precise informa-tion of motor and cognitive conditions of the children.The details of each case and how IoT-based technologycan contribute to have more effective interactions withthem will be discussed at the presentation.Keywords: IoT, Assessment, Severe Multiple Disabil-ities, OAK, TEAK.∗Corresponding author. E-mail: [email protected]

IoT-Based Continuous Lifestyle Monitoring: TheNOAH ConceptNiccolò Moraa, Federico Cocconcellia, GuidoMatrellaa, Alessandro Riccominib, Dominic Kristalyc,Sorin Moraruc and Paolo Ciampolinia,∗aDip. Ingegneria e Architettura, Università di Parma,Parco Area delle Scienze 181/A, 43124 Parma, ItalybAicod S.R.L., via Emilia Est, 216/a, 43123 Parma,ItalycDepartment Automatica si Tehn. Informatiei, Univer-sitatea Transilvania din Brasov, str. M. Viteazul 5,Brasov, Romania


Background: Among most demanding societal chal-lenges, population ageing is stressing the need for“active” ageing, preserving chances of independentliving in the older age. Rescue services, fall detec-tion, telemedicine already proved their effectivenessin increasing self-reliance of older adults living alone:Internet of Things (IoT) technology, providing dis-tributed home intelligence at low costs and low in-trusiveness, may open further opportunities. Conven-tionally, remote clinical parameter monitoring is per-formed by using specific medical devices; this, how-ever, require schedule compliance and skill and, in thelonger perspective, outcomes can be jeopardized bycarelessness and boredom. Complementarily, informa-tion about meaningful changes in health and wellbeingcan be obtained by indirect observation. Many medicalconditions, in fact, manifest themselves with behav-ioral symptoms (e.g., unusual sleeping patterns, or re-duced physical activity) which, in turn, can be inferredby tracking home activity, without any action requiredto the user. This relieves the user from demanding mea-surement schedules and is suitable for users having noactual skill (e.g., cognitively impaired persons). Inher-ent challenges come from the need of recognizing rel-evant features within a continuous flow of unspecificdata. User-specific knowledge is needed, which in turncalls for adaptive approaches.Method: In the NOAH project (funded in the frame-work of AAL-JP programme), continuous monitoringis introduced, based on a new generation of IoT dailylife activity sensors that detect routines as bed patterns,toilet usage, room presence, and others. Such devicesexploit the Wi-Fi communication protocol, connectingdirectly to the Internet, with no need of home hubs.This makes the approach extremely flexible and sim-ple to deal with, supporting personalization and self-management. A suite of cloud-based analytics tools(ranging from statistical analysis to deep-learning tech-niques) is available to extract meaningful information,such as behavioral trends (either slow or abrupt) andanomalies. Unsupervised analytics is based on the ac-quisition of user-specific behavioral profile, so thatrelative changes are assessed, with respect to learnedhabits. Multivariate clustering techniques are exploitedto work out multi-modal profiles, in which multiplecustomary activity patterns can be accounted for (e.g.,related to the weekday, climate or mood). Deviationsfrom such patterns trigger communication with theend-user or his caregiver, by means of simple smart-phone apps.Key results: The NOAH system is being deployed atseveral users’ homes (up to 60 at the end of recruit-

ment phase), in three European countries (Italy, Roma-nia, Belgium). A co-creation process, involving end-users and stakeholders, has been exploited to devisemain system features. A large dataset is being col-lected, onto which the analytics engine continuouslyperforms trend and anomaly detection. Through peri-odic evaluation (involving questionnaires), effective-ness of the approach, as perceived by caregivers, willbe assessed.Conclusion: The NOAH system aims at continuousmonitoring of daily living patterns, based on dis-tributed sensing through innovative WiFi-based de-vices. Cloud-based analysis tools, based on machine-learning techniques, are exploited to sift through rawdata, providing caregivers with meaningful health-related insights. The approach is being field-validatedto evaluate its impact in fostering better knowledge,and thus better care.Keywords: Internet of Things (IoT), Behavioral Anal-ysis, Active and Healthy Ageing (AAL), Sensor Net-works.∗Corresponding author. E-mail: [email protected]

Field-based innovation methodology and its imple-mentation on development of an information sup-port robot system for the elderlyTakenobu Inouea,∗ and Minoru KamatabaNational Rehabilitation Center for Persons with Dis-abilities, 4-1, Namiki, Tokorozawa, Saitama, JapanbDepartment of Human and Engineered Environmen-tal Studies, The University of Tokyo, 5-1-5 Kashi-wanoha, Kashiwa, Chiba, Japan

Background: Assistive products with cutting-edgetechnologies are expected for promoting autonomyand independence of persons with disabilities. In or-der to improve these developments, conventional de-sign methodologies; e.g. human centered design, de-sign thinking and system thinking; are useful. How-ever, specific development methodologies are some-times needed especially for non-professionals on assis-tive product space who have high potential and manytechnological knowledges. Inoue et.al. proposed field-based development method for assistive products withthe 6 steps1). This paper describes establishment ofa field-based innovation methodology, which is ex-panded beyond the field-based development method.Then, development of an information support robotsystem is introduced as an example of an implementa-tion.


Method: Based on the AT development flamework,field-based AT development method1) and non-func-tional requirement perspective, 7 principles was estab-lished as a part of the field-based innovation method-ology. Then, development project of information sup-port robot for older people with cognitive decline wasconducted, according to this methodology.Key results: Here shows the 7 principles that was es-tablished in this study as follows,

1. Set specific target user groups and clarify bodyfunction and level of impairment.

2. Collect users’ information about daily life and setthe use field and stakeholders.

3. Promote user and stakeholder participation into theinnovation process.

4. Select suitable human interface technologies basedon the users’ body function.

5. Measurement of body functions at the real field isrecommended for it. In addition, take into accounttwo non-functional requirement as follows,

a) Modularization and parameter changing func-tion in order to fit to each user.

b) Prevention against side effects.

6. Fix the AT’s concept after clarifying the settings oftheir use. In addition, take into account two non-functional requirement as follows

a) Governmental provision system, insurance andother reimbursement.

b) Market size. Many of ATs are estimated smallmarket.

7. Modify the AT’s concept according to the result ofthe field test using the prototype. Also, develop fit-ting methods and service systems related to the ATsfrom the result and knowledge from the field tests.

Based on the data aggregation of the older people’scharacteristics in the life fields, the robot’s functionswere identified; e.g. suitable frequency and speed ofrobot’s speech, suitable information transfer methodagainst the cognitive decline, On the other hand, theconcept of the robot system was established from theresults of group interviews with 124 older people and40 care professionals and workshop with 2 familiesand their stakeholders. The fixed concept of the robotsystem was to indicate important information withindaily life e.g. date, day, schedule, through the conversa-tion between users and the robot. Also, service modelfor the robot system was established. The results ofthe field tests for one month with 6 older people liv-ing in the olders’ apartments showed effectiveness on

the medication adherence, consolidation of their liferhythm.Conclusion: This study showed the field-based inno-vation methodology, and the development of the in-formation support robot system as an example. It waseffective on the establishment of useful concept withcomplicated users, stakeholders and use field.Acknowledgement: This research was supported byStrategic Promotion of Innovative Research and De-velopment Program of Japan Science and TechnologyAgency.Keywords: AT innovation, Robot system, Cognitivedecline, Older people.∗Corresponding author. E-mail: [email protected]

Patients experiences with commercially availableactivity trackers embedded in physiotherapy treat-ment: A qualitative studyDarcy Ummelsa,b,c,∗, Emmylou Beekmana,b,c, AlbineMosera,b, Susy M. Braunb,d and Anna J. Beurskensa,baResearch Centre for Autonomy and Participation ofPersons with a Chronic Illness, Zuyd University of Ap-plied Sciences, Heerlen, NetherlandsbCAPHRI School for Public Health and Primary Care,Maastricht University Medical Centre, Maastricht,NetherlandscParaMedisch Centrum Zuid, Physical Therapy Sec-tion in Multidisciplinary Centre, Sittard, NetherlandsdResearch Centre for Nutrition, Lifestyle and Exer-cise, Faculty of Health, Zuyd University of Applied Sci-ences, Heerlen, Netherlands

Background: Activity trackers show potential for usein health care settings, for example in patients with achronic disease. Guidelines for physiotherapists rec-ommend measuring the physical activity of patientswith a chronic disease. The most frequent used mea-surement tools are questionnaires and diaries, but theyhave a limited reliability and validity. Activity track-ers can overcome these limitations since they pro-vide an objective measurement and record data real-time. Moreover, activity trackers can increase self-management of the patient and eventually save timeand money. However, to implement activity trackers ina healthcare process, like physiotherapy, insight intothe feasibility from the patient’s perspective is needed.Therefore, the goal of this study was to collect experi-ences of patients with a chronic disease with commer-cially available activity trackers during physiotherapytreatment and daily life.


Method: In a qualitative study, 29 patients with achronic disease (COPD, diabetes mellitus, chronicpain, cancer or osteoarthritis) who were receivingphysiotherapy used an activity tracker at least twoweeks. The following eight activity trackers were se-lected: Activ8, Digi-Walker CW-700, Fitbit Flex, Lu-moBack, Moves, Fitbit One, UP24, and the WalkingStyle X. The participating physiotherapists receivedtraining for the possibilities of the activity trackers,and were free to use the activity tracker in any waythey thought was best suited for treatment. Experienceswere collected using semi-structured interviews andfocus group interviews. A framework was developedthat incorporated the most important concepts from theexperiences of patients by means of a framework anal-ysis. This framework was used to analyse the data fromthe interviews.Key results: Participants were between 22 and 78years old, and 41% of the participants were insuf-ficiently active. The developed framework includedseven categories: purchase, instruction, characteristics,correct functioning, sharing data, privacy, use, and,interest in feedback. Each category had several sub-categories. All categories were consistent with the lit-erature used, two new sub-categories were added andfour subcategories were removed. The activity track-ers motivated patients to increase their physical activ-ity levels and to reach their daily goals. However, par-ticipants experienced certain barriers such as high stan-dards goals set by the tracker (10.000 steps) and com-plexity of the tracker. The complexity decreased theirmotivation to use the tracker. Participants also missedclear instruction from their physiotherapist about theuse and goal of the tracker. Most of the participantsdid not discuss their data with their physiotherapists,because they placed higher value on the treatment de-livered by the physiotherapist. However, participantscould see the potential value of using an tracker duringtheir physiotherapy session.Conclusion: The developed framework gives insightinto all important concepts from the experiences withactivity trackers for patients with a chronic disease andcan be used in further research and practice. In general,patients with a chronic disease were positive regard-ing activity trackers. However, activity trackers shouldbe adapted to the needs and skills of people with achronic disease. When using activity trackers, physio-therapists should pay more attention to embedding thetracker in their treatment. Full article can be found:https://www.tandfonline.com/doi/full/10.1080/09638288.2019.1590470?scroll=top&needAccess=true.

Keywords: Activity Tracker, Chronic disease, Physio-therapy, Patient Perspective, Physical activity.∗Corresponding author. E-mail: [email protected]

Smartphone Apps to Support the Self-Manage-ment of Hypertension: Identification of the MostSuitable AppsTourkiah Alessaa,b, Mark S Hawley and Luc deWittea,∗aCentre for Assistive Technology and Connected Heal-thcare, School of Health and Related Research, Uni-versity of Sheffield, Sheffield, United Kingdom.bBiomedical Technology Department, College of Ap-plied Medical Sciences, King Saud University, Riyadh,Saudi Arabia

Background: Hypertension is a common chronic dis-ease in adults that requires effective patients’ self-management. Smartphone apps provide considerablepotential to play a key role in self-management, ev-ident in the huge number of apps that have becomeavailable over the past few years. However, the increas-ing number of different blood pressure (BP) apps avail-able on the market creates the urgent need for physi-cians and patients to be made aware of their effective-ness, and the levels of security and privacy that theyoffer. This will help to identify apps that are useful andsafe.Method: Two studies were conducted to evaluate appsfor supporting the self-management of hypertension.Firstly, a systematic review was conducted, includ-ing articles from the years 2008 to 2017 that investi-gated and assessed functionalities of hypertension self-management apps and their effectiveness. Secondly,in January 2018, a content analysis study was under-taken, scanning the most popular UK app stores (Ap-ple and Google Play stores) and describing all avail-able paid and free apps supporting hypertension self-management and examining their functionalities. Aprivacy and security assessment of potentially effectiveapps was also performed.Key results: The systematic review included a total of21 articles, evaluating 14 apps between them. This re-view indicated that apps have a generally positive ef-fect on controlling BP. Due to inconsistencies in thedesign and quality of the articles, there is no decisiveevidence about which of the functionality combina-tions are most effective. However, it is clear that appsare likely to be more effective when they have more


comprehensive functionalities. Most apps in this re-view were study-specific, that is, they were developedsolely for the purpose of the study. This is in contrast tothe scores of commercial apps available on app stores.Indeed, the content analysis study identified 186 suchapps. There was a lack of evidence in relation to allavailable apps regarding their usability, effectiveness,and the involvement of health professionals in the de-velopment process. Furthermore, only few apps pos-sessed comprehensive functionalities (n = 30). Mostof them did not meet current criteria regarding data pri-vacy and security and lacked a clear theoretical basis.These findings raise a serious issue for physicians andpatients attempting to find a suitable app for the self-management of hypertensions. Eight apps were identi-fied that appeared to be effective, whilst also meetingcurrent standards of security and privacy levels.Conclusion: Despite the wide availability of appsto support self-management of hypertensive patients,and a corresponding body of research into such apps,relatively few apps are effective in supporting self-management of hypertension and protecting users’ per-sonal data.Keywords: App, Smartphone, hypertension, bloodpressure, self-management.∗Corresponding author. E-mail: [email protected]

Developing an Intelligent Virtual Coach for Boccia:Design of a Virtual Boccia SimulatorAlexandre Caladoa, Simone Marcuttib,∗, GianniVercellib and Paulo NovaisaaAlgoritmi Research Centre, University of Minho,Campus de Azurém, 4800-058 Guimarães, PortugalbDepartment of Informatics, Bioengineering, Roboticsand Systems Engineering, University of Genova, ViaAll’Opera Pia, 15, 16145 Genova, Italy

Background: According to the World Health Orga-nization, approximately 15% of the worldwide popu-lation lives with some form of disability. The currenttrend indicates that these numbers will keep increas-ing during the following years. Having a disability canlead to social exclusion, therefore it is paramount toensure that every individual with a motor or cognitivedisability can be able to participate in society, to thelargest extent possible. Thus, it is necessary to designand implement innovative strategies in order to tacklethese issues by fighting segregation and promoting so-cial integration. Boccia is a precision, strategy-based

ball sport which has been part of the Paralympic gamessince 1984 and it is practiced in more than 50 countriesworldwide. Originally, it has been designed for indi-viduals with cerebral palsy, but the rules of the gamecan be easily adapted to individuals with other typesof motor or cognitive disabilities. Besides, Boccia is amultiplayer game, which further encourages the inter-action between the players.Method: This paper presents an intelligent virtualcoach for Boccia, which is currently a work in progress.This virtual coach will be able to provide tips to theuser by suggesting the best possible position in thecourt where he/she can place the ball and how to exe-cute the respective throwing movement. Furthermore,the suggested strategies are adapted to the current stateof the game. This tool will be used to encourage indi-viduals with different disabilities to learn how to playthe game and to help shortening the learning curve,thus promoting physical activity. Furthermore, moreindividuals will be able to participate in the game and,since Boccia is a team-based game, the interactionamongst players with different disabilities can promotesocial rehabilitation, thus contributing for inclusion.Moreover, different types of sensors will be used on theplayers in order to acquire various bio-signals, whichmay trigger different virtual coach actions/responses.This data will also be recorded, so that relevant healthindicators can be closely followed by a coach or a care-giver. The work developed so far focuses on the designof a Virtual Boccia Simulator, which allows to easilysimulate various game situations, thus facilitating thetraining of the virtual coach’s Artificial Intelligence al-gorithms.Key results: The Virtual Boccia Simulator was suc-cessfully developed in Unity 3D. The current imple-mentation allows the user to throw the Boccia ballsfrom each of the six court positions, with the desireddirection and force. Ball physics are also customizable.Of course, the setting of these parameters depends onthe disability and the associated level. Additionally, a“free-camera” mode was implemented, which allowsthe placement of Boccia balls anywhere inside thecourt and the taking of screenshots to be used for thetraining of Artificial Intelligence algorithms.Conclusion: Overall, this work in progress aims to en-courage the practice of physical activity on individu-als with disabilities by playing Boccia, independentlyof gender, race or religion. Furthermore, as Boccia is asocial game, it can be used as a platform for inclusion,empowerment and promotion of social interaction.Keywords: Boccia, Social Inclusion, Rehabilitation,Artificial Intelligence



Special Thematic Session 8Creating a Match: Supporting student partic-ipation across the educational continuum withtechnology

This special thematic session will be an interactiveand engaging discussion on examining the role of as-sistive technology (AT) including universal design forlearning (UDL) for students with impairments affect-ing their participation in educational-based activities.Research supports the use of AT for students with dis-abilities to access curriculum, enhance cognitive skills,improve communication and social skills, and to aidein independence with self-care and daily living skills.Students with disabilities that begin to use AT earlyin their educational learning can be more effective inaccomplishing their educational goals and transition-ing into post-secondary education with increased con-fidence and success than students being introduced toAT use later in their educational career. Universal de-sign involves a whole systems approach from policy toinfrastructure considerations to create a learning envi-ronment for all learners to achieve their dreams. Pre-senters will highlight the importance of addressing ATuse across the educational continuum and examine thefollowing areas: early intervention to support learningand child-family engagement, student success in mas-tering educational goals with a focus on outcome mea-sures, environmental context considerations to supportlearning, promoting vocational success-the importanceof addressing AT and UDL in transition planning forstudents. Presenters will use the Matching Person andTechnology, Ecosystems, and the International Classi-fication of Functioning, Disability, and Health (ICF)Frameworks to discuss the importance of addressingpersonal factors, environmental contexts, and featurematching of student and technology in the assessmentand implementation process. Case scenarios across theeducation continuum will be used to enhance partici-pant learning.Chair: Susan Zapf and Marcia Scherer

Universal Design as a Catalyst for TransformationAcross the Educational ContinuumGerald Craddocka,∗, Dónal Ricea, Cormac Doranb andLarry NcNuttc

aCentre for Excellence in Universal Design, NationalDisability Authority, 25 Clyde Road, Dublin 4. IrelandbHead at Centre for Higher Education Research, Pol-icy and Practice, TU Dublin – Blanchardstown Cam-pus, Blanchardstown, Dublin 15, IrelandcRegistrar, TU Dublin – Blanchardstown Campus.Blanchardstown, Dublin 15, Ireland

Background: A congress can represent many differentthings to many different people and as organizers ofthe Universal Design and Higher Education in Trans-formation Congress 2018 (UDHEIT 2018), our hopeswere to allow two communities of practice share aphysical space to discuss and debate the transformationof higher education. Each individual journey that theparticipants of the congress imparted, illustrated theimportance and value of a forum for generous think-ing – a critical ingredient in sparking innovation andchange. The purpose of this presentation is to providea joint reflection on the impact of this UDHEIT eventon our learning – and to present a review of currentthinking on how best to employ the principles of uni-versal design at a systems level in a higher educationcovering the three scales of macro, meso and micro.The overarching framework of the congress was builtaround a range of key themes capturing the researchinterests of the diverse communities of practice – fromthe built environment, digital systems including assis-tive technologies, urban design and planning, commu-nity engagement to curriculum planning and delivery.The key questions to be addressed were at (i) Macrolevel – how do you influence policy makers and changesociety for the benefit of all citizens? (ii) Meso levelwhat are the practicalities of developing and imple-menting policy within organizations and communities?(iii) Micro level how can individual actions and ini-tiatives make a difference? This presentation providesan overview of the research presented by 140 speak-ers from 30 countries around the world. It provides ev-idence of innovation, research and critical change thatis bringing about an inclusive educational experiencefor all learnersMethod: A thematic review of the papers presented atthe UDHEIT 2018 congress to demonstrate how uni-versal design is influencing transformational change inhigher education.Conclusion: Framing Universal Design from a sys-tems perspective enables diverse stakeholders to bridgethe “Know-Do” gap. As a vital part of systems changethe congress demonstrated, debated and discussed thethree critical ingredients for transformation of the edu-


cational environment at an ecosystem level. These in-gredients were new resources and materials, changingpractices and changing beliefs to ensure an enablingrather than disabling environment for a diverse rangeof learners.Keywords: Universal Design, Higher education, trans-formation, systems approach.∗Corresponding author. E-mail: [email protected]

Developing the Irish Matching Person with Tech-nology (IMPT) to a multimedia format through aUniversal Design processTrish Mackeogha, Karola Dillenburgerb and JohnDonovancaASSISTID Fellow at Technological University, andCentre for Behaviour Analysis, Queens University,Belfast, UKbProfessor at the School of Social Science, Education,& Social Work and Director of Centre for BehaviourAnalysis, Queens University, Belfast, UKcHead of Research, Technological University, Grange-gorman, Dublin 7, Ireland

Background: In Ireland a national study in 2017 com-missioned by the National Council for Special Educa-tion on the use of Assistive technology (AT) in edu-cation recommended that the AT assessment and thematching process should be developed based on theprinciples of universal design (UD) with an emphasison pupils with severe and more complex needs. Manychildren have their own unique abilities and unique un-derstanding of the world which standardised tests of-ten fail to recognise. Exploring the needs of childrenwith disabilities can mean traditional data collectiontechniques do not provide the framework necessary toinvestigate how technology and AT can support theirneeds. Most assessment tools use verbal or text basedtechniques to interview and assess, which can often po-sition the child as a passive object and do not fully un-derstand a child’s experiences or their multiplicity ofabilities and needs. This paper outlines the adaptationof the Irish Matching Person with Technology (IMPT)tool to a multi-modal (IMPT/MM) format through auniversal design process to provide altnerative inputs,and presents initial findings in a case study series ofchildren who have used the tool in a pre and post study.Method: A central element of universal design is un-derstanding through observation and ethnography, theexperiences of the people, their own perception of theirlives, their social interaction and their desired activi-

ties, interests, priorities and concerns. In this projectthe children and their parents were engaged in thewhole process through observation, group discussions,focus groups, face to face interviews and engagementwithin the children in the classroom This was an iter-ative process developed over 18 months broken downinto four stages based on the double diamond 4D de-sign process of discover, define, develop and deliver.Key results: Sixteen children with multiple disabilitiestook part in the project with a pre-assessment interviewusing the IMPT/MM, the children have multiple dis-abilities with significant learning difficulties. At pre as-sessment interview, through using the IMPT/MD tool,the children were able to self-identify activities whichcould be facilitated through AT use, however due tocritical problems with service delivery, long waitlists,poor funding and a lack of expertise in AT, just eightchildren secured assessment. While many of the chil-dren are being assessed for one functioning impair-ment, mainly mobillity, other functional impairmentsare ignored. This paper presents the findings based oneight case studies, outlining the critical service issues.Work is ongoing to validate the instrument with the re-maining 8 children and a further cohort of 10 children.Conclusion: The use of IMPT/MM enabled the chil-dren to self-identify their AT needs, however theproject has uncovered critical issues in the delivery ofAT service in Ireland which has caused unaccetable de-lays in the provision of AT and a final report with rec-ommendations will be submitted to the funding body.Acknowledgement: This research is part of the AS-SISTID programme, which is funded through a CO-FUND grant from European Union Marie Curie pro-gramme and the RESPECT charityKeywords: universal design, assistive technology,matching person with technology, AT service delivery.∗Corresponding author. E-mail: [email protected]

Exploring the Role of Assistive Technologist withina Special Education SettingChristopher S. Norriea,∗, Annalu Wallera and Eliza-beth F. S. Hannahb

aComputing, School of Science & Engineering, Uni-versity of Dundee, Perth Road, Dundee DD1 4HN,Scotland, UKbEducation, School of Education & Social Work, Uni-versity of Dundee, Perth Road, Dundee DD1 4HN,Scotland, UK


Background: High tech augmentative and alternativecommunication (AAC) aids remain underutilised andfrequently abandoned within special education (SE)schools. Yet there is compelling evidence of both thebenefits of early intervention and of the significant con-tribution these technologies can make towards improv-ing outcomes for emerging communicators with com-munication disabilities. This study builds upon ear-lier ethnographic research that identified the cross-disciplinary role of the Assistive Technologist (ATist)as a solution to issues of technical support for ped-agogy and co-ordination encountered in the field – atrained professional who might mitigate some of theproblems described above by innovating novel solu-tions, boosting evidence-based practice, and enhanc-ing cooperation between practitioners within the class-room environment. To date there had been no formalattempt to understand or define the ATist role in the SEclassroom and this study’s primary aim was to explorethe role as a precursor towards developing a definitiveframework.Method: Approval was granted from the UniversityEthics Committee and an ethnographic study was un-dertaken in a SE school, with the principle investi-gator (PI) – an experienced AAC practitioner – em-bedded for five months within a class of primaryschool age children identified as having profound andmultiple learning disabilities (PMLD). An exploratorymixed methods approach was adopted: A qualitativecase study (exploratory single-subject design); sup-plemented by end of study semi-structured interviewswith adult stakeholder participants and allied healthprofessionals (n = 6) comprising teachers, speechlanguage therapists, classroom assistants and one par-ent/carer. During the study, the PI worked as part ofthe team, adopting the role of the ATist, and actingresponsively as a mediator between the teacher, focalAAC user and their assistive technology device. Con-tent analysis was then undertaken of the collected data(field notes, transcripts).Key results: The embedded approach facilitated famil-iarisation and relationship building. Data yielded sup-port for insights attained in the earlier study, and – im-portantly – key empirical evidence was acquired, doc-umenting the positive influence of the ATist role as asignificant protagonist in coordinating, supporting andmeeting pedagogical goals for high tech AAC users.These results represent a major contribution toward theframework currently under development – a definitivedescription of the ATist’s role within a SE context.Conclusion: The presence of an ATist enabled dy-namic personalisation (eg. programming novel vocab-

ulary “just in time”) of the focal user’s AAC device,which – coupled with frequent, contextual aided lan-guage stimulation – created a richer and more respon-sive learning environment for the focal participant, andconcomitantly for staff and for other children in theclassroom. The ATist also supported educators in de-veloping tailored online learning activities, and ad-dressing technical issues as and when they arose – bothminimising disruption, and supporting a more holisticlearning experience for the pupils. For future work, it isintended to complete and evaluate the nascent frame-work defining the ATist’s role in a forthcoming studyby eliciting feedback from subject matter experts.Keywords: Human computer interaction, Augmenta-tive and alternative communication, Early intervention,Special education.∗Corresponding author. E-mail: [email protected]

Assistive Technology in the University, Is There Stilla Person-Technology Match?Thais Pousada Garcíaa,∗, Estíbaliz Jiménez Arberasb,Natividad Rodríguez Marcosc and Emiliano DíezVilloriacaUniversity of A Coruña, Faculty of Health Science,Research Group TALIONIS, SpainbFaculty of Padre Ossó, University of Oviedo, SpaincINICO, University of Salamanca, Spain

Background: The number of persons with disabilitywho study at a university in Spain represents 0.52%of the university’s students. That low prevalence is dueto several factors: lack of information about AssistiveTechnology (AT), the low commitment from teachers,deficient accessibility and the self-concept of studentswith a disability. In this paper, the authors discuss thelevel of matching student and technology and the pre-disposition to technology use by university studentswith a disability, in general, and with NeuromuscularDisorders (NMD) and deafness, in particular.Method: Results are presented from three studies donein different regions of Spain. The Survey of Technol-ogy Use (SOTU), and the Assistive Technology De-vice Predisposition Assessment (ATD PA) and Educa-tional Technology Device Predisposition Assessment(ET PA) were the measures used and are part of theMatching Person & Technology (MPT) portfolio ofassessments. The sample in first study consisted of155 students with and without a disability; the secondsample was comprised of 11 students affected by any


NMD and using wheelchair. In the third sample, 35participants were students with deafness or hearing im-pairment (6 prelocutives/prelingual and 29 postlocu-tives/postlingual).Key results: The use of specific instruments to mea-sure outcomes, such as those in the MPT model port-folio of measures, is rare in Spain. Just three docu-mented studies have used this tool. The percentage ofstudents with disability in Spanish universities is low,mainly due to lack of accessibility, adaptations, and theabsence of assistive technology. The predisposition totechnology use, in general, has been positive (numberof positive answers was higher than the negatives orneutral). In students with NMD, the scores regardingtheir match with their wheelchair had a mean of 44.17(out of 50) and a median of 46.5. Thus, the wheelchair,as an AT, is viewed as benefitting the participation ofpersons with NMD in their educational activities. Par-ticipants scores reflected physical inaccessibility as amain barrier to the optimal use of their AT. Deaf peo-ple have very good experiences with technology, espe-cially those with pre-lingual deafness. They rated thevideo call system as the best support.Conclusion: There aren’t significant differences be-tween students with and without disabilities in regardsto their preferences about the use of technology in gen-eral. Positive answers to SOTU questionnaire itemspredominate. The students with disabilities, in general,don’t use a large number of ATs during their schol-arly activities. The persons with NMD utilize theirwheelchair their match with it is positive.The application of the MPT model and its assessmentsin a population of 155 adult university students showedgood validity and feasibility. This research has allowedfor a translation and adaptation of the MPT instrumentsinto Spanish versions.Keywords: University, Education, Outcome measures,Assistive technology (AT), Matching person and tech-nology (MPT).∗Corresponding author. E-mail: [email protected]

Outcome Effectiveness of Assistive Technology inSupporting Students’ Mastery of Educational GoalsSusan A. Zapfa,∗, Marcia J. Schererb, Mary F. Baxterc

and Diana H. RintaladaPost-Professional Occupational Therapy Program,Rocky Mountain University of Health Professions,Provo, UT, USAbThe Institute for Matching Person and Technology,Webster, NY, USA

cTexas Woman’s University, Occupational TherapyProgram, Houston, TX, USAdDepartment of Physical Medicine and Rehabilitation,Baylor College of Medicine, Houston, TX, USA

Background: Assistive technology can be a catalystin supporting students with disabilities to be success-ful within their educational setting and should be con-sidered within each student’s educational plan. Thepurpose of this quasi-experimental pre-post-test, non-control group research design was to measure the ef-fectiveness of assistive technology tools used in theeducational setting to support student success throughquantitative analysis using the Student PerformanceProfile scores.Method: Twenty-three Assistive Technology TeamEvaluators using the MATCH-ACES Assessment eval-uated 35 students with disabilities for assistive tech-nology needs. Data was collected during the 2010 and2011 school years. Specific educational goals wereidentified for each student and the student’s perfor-mance pre-scores on these goals were collected. Therecommended assistive technology was provided tostudents with training and students used the technol-ogy for a four-six-month time period. Student perfor-mance post-scores on the targeted goals were collectedand data analyses on outcome effectiveness was com-pleted.Key results: A significant improvement in student per-formance was found for this cohort on their educa-tional goals one (p < 0.001) and two (p = 0.001).A large effect size was found indicating that partici-pants improved their performance on the educationalgoals related to assistive technology use (goal one [d =0.86], goal two [d = 0.97], indicating clinical sig-nificance. ANOVA analysis was used to determine ifthe level of AT use contributed to the student’s per-formance. A Friedman analysis of variance was useddue to parametric assumptions not being met (ordinaldata). Assistive technology was found to be a signifi-cant factor in contributing to the success of student per-formance (p < 0.001). The study was found to haveadequate power (power was set at β = 0.80, effect size:< 0.80).Conclusion: Assistive technology tools were found tosignificantly impact students’ progress on their educa-tional goals. When students are matched and trained touse assistive technology based on the student’s needsand preferences; assistive technology can aid studentsin making progress on their individualized educationalplans and support academic success.


Keywords: Assistive Technology, Students with dis-abilities, Matching Assistive Technology to Child(MATCH) Assessment, Special Education, AssistiveTechnology Services.∗Corresponding author. E-mail: [email protected]

Standardizing the Procedures, Improving ourListening to the Needs of the Individual UserStefano Federici∗

Department of Philosophy, Social & Human Sciencesand Education, University of Perugia, Perugia, Italy

Background: Knowing which elements could guidethe development of policies, systems, and service de-livery procedures is essential to develop an assistivetechnology (AT) provision standard, to connect ser-vices and outcomes, and compare data for AT in Eu-rope and across the world. As stated by the GREATconference in Geneva (Global Research, Innovationand Education in Assistive Technology) held in August2017 as part of the World Health Organization’s GATEinitiative, identifying what constitute the internationalframework for the provision of AT worldwide is an ur-gent WHO task (de Witte et al., 2018).Method: Developed in the light of the Matching Per-son and Technology (MPT) model (Scherer, 1998), anideal model of AT assessment process that gathers themost recent scientific developments in AT assessmentand provision is here presented, as it is described in thepopular text, Assistive Technology Assessment Hand-book, 2nd Edition (Federici and Scherer, 2018). TheMatching Person and Technology Model and accom-panying assessments have been found to have verygood psychometric properties and have been validatedby a number of studies. They have been translated intoeight languages. Several derivative measures have beendeveloped. In this presentation, we will outline howthe AT assessment process can be applied in practiceto re-conceptualize the phases of an AT delivery sys-tem according to the ICF’s biopsychosocial model ofdisability. The model provides reference guidelines forevidence-based practice, guiding both public and pri-vate centers that wish to compare, evaluate, and im-prove their ability to match a person with the cor-rect technology model. The present contribution to thisspecial thematic session can foster discussion amonghealth practitioners and technology providers (occupa-tional therapists, physiotherapists, rehabilitation engi-neers, speech-language pathologists), as well as under-graduate and graduate students in these areas.

Key results: Successful assistive technology servicedelivery outcomes highlighted well the effectivenessof the ideal model, here presented, of AT assessmentand delivery process, as demonstrated in several stud-ies (Federici et al., 2015). The environmental assess-ment procedure brings clarity to measures of accessi-bility, universal design, and sustainability, and captureswell the three perspectives on the interaction betweenthe person and AT in the user’s environments.Conclusion: This model can be used by profession-als to check the functioning and to (re-)conceptualizethe phases of an AT delivery system according to:(i) the ICF’s biopsychosocial model of disability; (ii)the seven steps mentioned by the AAATE as relevantand adequate for any service delivery process; and(iii) the MPT model that ensures that the provision isperson-centered and not product of service-centered.This model of service delivery, therefore, intends to ex-press, in an idealized and essential form, an assessmentprocess where persons and their environment are at thecore of process, products, personnel, and provision.Keywords: Assistive Technology Assessment pro-cess (ATA model), Matching Person and Technology(MPT) model, ICF.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 9Good Practices in AT Service Delivery

Since the publication of the 2012 AAATE/EASTINPosition Paper on AT service delivery, significant ad-vancements have been carried out in several Coun-tries to improve national policies and service deliverysystems. Several new challenges have been posed bythe recent changes in the political and socio-economiclandscape, as well as the fast technological advance-ment. The theme “AT policies, systems, service pro-vision models, best practices” has been recently indi-cated (2016) by the WHO (World Health Organization)among the five research priorities in the Global Prior-ity Research Agenda of the GATE initiative (GlobalCollaboration on Assistive Technology); it will also beamong the topics of the Global Report on Access to ATto be published in 2021 as mandated by the WHO Res-olution “Improving Access to Assistive Technology”Issued on May 24, 2016. Within this framework, workis in progress worldwide to develop service deliverymodels, requirements and standards, drawing on theanalysis of best practices either in countries with estab-


lished welfare systems or in developing countries. Thissession intends to give a feeling of this ongoing workand contribute to the debate by presenting some bestpractice examples from various Countries; by fosteringdiscussion on commonalities, differences and trends;by helping learn from each other and get inspiration forimprovements that can increase access to appropriateassistive technology for persons who need them.Chair: Renzo Andrich

Proposal for Collaborative Assistive TechnologyProvision with Digital FabricationTakashi Watanabea,∗, Mamoru Iwabuchib, NoriyukiTejimac and Hisatoshi UedadaDepartment of Human Care Engineering, NihonFukushi University, 26-2 Higashihaemi-cho, Handa,Aichi 475-0012, JapanbSchool of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192,JapancDepartment of Robotics, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga 525-8577, JapandGraduate School of Health Sciences, MorinomiyaUniversity of Medical Sciences, 1-26-16 Nankokita,Suminoe-ku, Osaka 559-8611, Japan

Background: Assistive technology (AT) services areessential for adapting assistive devices to the individualneeds of users with disabilities. The main AT serviceis selecting or adjusting devices. If neither selecting oradjusting assistive devices are suitable for individualneeds, production or remodeling methods can be ap-plied. However, AT services often depend on the em-pirical knowledge and experience-based skills of indi-viduals or the regional community. Meanwhile, three-dimensional (3D) printing technology is a well-knowntype of digital fabrication that is expected to result innew value creation. For AT services, we attempted toapply 3D printing technology to actual cases and pro-posed effective applications. Various case studies havereported the use of 3D printing for supporting specialneeds education, making self-help devices, and design-ing 3D printable prosthetics in rehabilitation facilities.Accordingly, human resources development that cantake advantage of digital fabrication is required to per-form better AT services in local communities whereusers with disabilities live. In this study, collaborativeAT service was proposed through the development ofan online database for sharing information about thetechniques and knowledge on providing assistive de-

vices to users and a training program for digital fabri-cation.Method: The Support System for Assistive Technol-ogy (SS-AT), an online database of assistive devicesproduced using a 3D printer, was created with a clouddatabase. Each record of the SS-AT contains not only3D printable files on assistive devices but also tips andempirical information from experts and user feedbackincluding users with disabilities, AT specialists, thera-pists, designers, and makers, etc. There are two kindsof 3D printable files: those for a parametric approachand an explicit approach. The parametric approach en-ables the redesign of the shapes of the device by modi-fying its parameters. The explicit approach enables thedesign of complex surface shapes to fit to the otherparts. The tips and empirical information help adjustparameters and provide suitable AT services. The con-tents of the training program to learn digital fabrica-tion for AT services were also planned and hands-onworkshops were conducted.Key results: In the SS-AT, various 3D printable fileswith tips and feedback have been uploaded: joysticksfor operating electric wheelchairs and pointing de-vices, straw clips, keyguards, self-help devices, andshapes of dishes. Although SS-AT access currentlyrequires registration, users can collaborate with eachother as well as download files. In the workshop, par-ticipants include physical and occupational therapists,special needs education teachers, social workers, care-givers, local volunteers, and AT users with disabili-ties. They experienced printing an assistive device us-ing 3D printers and designing assistive devices using3D CAD. Participants also brainstormed self-help de-vices and shared individual needs and opinions witheach other. The results were promising for the develop-ment of human resources who perform AT services byremodeling and producing for users with disabilities inlocal communities.Conclusion: This work has the good potential to in-crease AT services in local communities and help shareindividual experiences, knowledge, and techniques be-tween distant regional communities. It hopes to con-tribute to the creation of an AT service system usingdigital fabrication.Keywords: Digital Fabrication, 3D Printer, Commu-nity Welfare.∗Corresponding author. E-mail: [email protected]

Assistive Technology Service Delivery in Rehabili-tation Context


Claudia Salatino∗, Renzo Andrich and Lucia PiginiIRCCS Fondazione Don Carlo Gnocchi, Milano, Italy

Background: The Italian National Health Servicestructures the assistive technology (AT) service deliv-ery process in six steps: planning, prescription, au-thorisation, delivery, inspection and follow-up. Pre-scription, authorisation and delivery are strictly reg-ulated, under the responsibility – respectively – of aspecialized medical doctor, the Local Health Author-ity and the supplying company chosen by the user. Theway to carry out all other steps is left to the serviceproviders. Here we report on the service model imple-mented by the Fondazione Don Gnocchi (FDG) reha-bilitation Centres, according to the conceptual frame-work developed by the Italian GLIC network of ATCentres.Method used: This model is based on AT special-ized units called SIVA, where individual AT interven-tions are carried out in three steps: assessment (lead-ing to the prescription of the appropriate assistive so-lutions), verification (checking the correct implemen-tation of the solution provided) and follow-up (mea-suring its outcome in the long run). Each interven-tion is tracked through a purposely-developed comput-erized form (SIVA Form) and three validated instru-ments: KWAZO, IPPA and QUEST. Each SIVA has anAT showroom, a team of therapists specializing in AT,and can rely on engineering support by a central unitcalled SIVALab.Key results: Here we describe the model though anexample chosen from the database of the SIVA inter-ventions: Giorgia (fictitious name), a 30-years-old ladywith quadriplegia who resides in a residential care fa-cility. The assessment was aimed at finding a solutionto enable Giorgia to call assistance when lying in bedduring the night. The assessment team included a SIVAtherapist, a SIVALab engineer and a nurse of the resi-dence. It was found that some residual movements ofthe left hand and head could be used to operate re-mote controls. Different solutions were tried out untilidentifying the most appropriate one: a head-activatedpressure switch, positioned near the head through anarticulated arm fixed to the bed, and a cable adapterfor connecting the switch to the wall socket of the res-idence call system. An assessment report was com-piled through the SIVA Form to recommend this so-lution. Verification was carried out as soon the newsolution had been implemented by the care facility.The system had been purchased and installed as rec-ommended. Baseline data for outcome measurement

were collected through the KWAZO and IPPA-1 in-struments. Three months after, a follow-up interviewwas performed, administering the IPPA-2 and QUESTinstruments. Giorgia perceived the solution as very ef-fective (IPPA score +15, on a −20 to +20 scale), washappy with the assessment/provision service (KWAZOscore 4.29 on a 1–5 scale), and was very satisfied withthe devices (QUEST score 4.63 on a 1–5 scale). Thecost was borne by the residence (e 660).Conclusion: Giorgia is an example of how AT inter-ventions are carried out by the SIVA units, and moni-tored until measuring the outcome in real life situation.This model is used mostly for complex cases wheremulti-disciplinary work and significant case manage-ment effort are needed to ensure consistency of the ATsolution with the persons’ rehabilitation programme.Keywords: AT service delivery, AT assessment ser-vices, Good practices.∗Corresponding author. E-mail: [email protected]

International Classification of Functioning (ICF)and ISO 9999: 2016 Based Combined Evaluation-effectiveness and ReasoningHille Maasa,∗ and Pille-Riika LepikbaÉesti Töötukassa, EstoniabWorkability Assessment Department, Estonian Unem-ployment Insurance Fund, Lasnamäe 2, Tallinn, Esto-nia, 11412

Background: Selection of optimal assessment tool ofassistive technology has been talking point among theprofessionals for years. Standardized tools include of-ten evaluation of limited performance areas in Ac-tivity Daily Life skills. Looking for unique basementhow to get overview what activities the person witha health condition can do in a standard environmentand what they actually do in their usual environment,seems ICF and ISO 9999:2016 combined assessmentto be most resultful. State coordinated pilot project iscurrently in action in Estonia about combined ICF andISO 9999 assessment prototype development. Currentstudy highlights the results of Estonian version of com-bined ICF and ISO 9999 based functional assessment.The customer‘s capacity and performance expressed infollowing terms: structures (s-codes), functions impair-ments (b-codes) and activity-participation limitations(d-codes).Method: 10 persons at the age gap between 35–55 years with Sclerosis Multiplex were selected for


the study, 5 males and 5 females with disability af-fecting time average 6 years. All participants evaluatedas the persons with partial work ability, assessment isbased on ICF. Study participants expertise’s analyzedabout determined ICF codes. Based on work abilityassessments participants impairments of functions be-longed to the b2, b4, b5 and b7 domains. Activity lim-itations belonged to the domains d4–d8. All study par-ticipants used daily during walking activities lower ex-tremity assistive technology device L300 Go Ortho-sis, belonging to ISO subcategory 06.15. (Functionalneuromuscular stimulators and hybrid orthosis). Be-fore usage and after 3 months of using period of L300Go device assistive technology specialist assessed par-ticipant‘s motor capacity and performance by ICF andISO 9999:2016 combined prototype. Overlapping didnot exist in 2 ICF subdomains of functioning (b1, b3)and in 2 subdomains in activities (d1, d9). Based on thefindings assistive technology specialist created partic-ipant‘s ICF graphic profile with and without assistivetechnology device.Key results: ICF based work ability assessment andISO 9999:2016 based assistive technology assessmentare not entirely compatible. There were differences in 2domains of Functions and in 2 domains of Activity andParticipation. ICF and ISO 9999:2016 combination forassessment of person‘s participation restrictions andactivity limitations is most precise. The original ICFCore-Set enables to create functional and activity pro-file of customer. ICF and ISO 9999:2016 combined as-sessment enables to create holistic functional profile ofcustomer abilities with and without assistive technol-ogy device.Conclusion: International Classification of Function-ing and ISO 9999:2016 based combined assessment isbeneficial for setting goals and performing holistic re-habilitation as it enables to focus simultaneously to thecustomer‘s functional performance and capacity. Cus-tomers graphic profiles created by two-component as-sessment are valuable and synoptic data sets of cus-tomer‘s functional abilities and skills.Keywords: Functioning, Work ability, Performance,Capacity.∗Corresponding author. E-mail: [email protected]

Exploring SMART Technologies: The Value of Tai-lored SessionsDesleigh de Jongea,∗, Tammy Aplina and MatthewOsbornea

aSchool of Health and Rehabilitation Sciences, TheUniversity of Queensland, Brisbane, QLD 4072, Aus-tralia

Background: There is an ever-expanding range ofmainstream and dedicated technologies on the mar-ket. In particular, innovations such as SMART tech-nologies (Sensing, Monitoring and Automatically Re-sponding Technologies (SMART) provide increasingopportunities for older people and people with dis-abilities to manage and monitor their homes, maintainsafety and security, promote health, navigate throughenvironments, and remain connected to their commu-nities. However, it is often difficult to keep abreastof new developments and understand what these tech-nologies can offer. A qualitative study was undertakento examine the experiences of 12 people with a varietyof abilities who partnered with a health professionalto explore the opportunities afforded by SMART tech-nologies. This presentation reports on the experiencesof their individualized SMART technology explorationsession, including their awareness of these technolo-gies, motivations for acquisition, and perceived barri-ers and facilitators to the uptake and use of these tech-nologies.Method: Participants were provided with an individ-ualized session to explore SMART technologies andevaluate the opportunities these afforded them. Thesessions were audio recorded and transcribed verbatim.Following the session, participants were phoned andasked a series of questions relating to what worked /didn’t work well in the session in terms of understand-ing what was possible and what these technologiesmight offer. The participant’s awareness of SMARTtechnology, motivations for acquisition, and perceivedbarriers and facilitators to uptake and use were also ex-amined through a thematic analysis of the session andinterview transcripts.Key results: Twelve people with disabilities were in-volved in the study. The participants ranged in agefrom 12–74 years and had a variety of disabilities andhealth conditions including congenital (1) and degen-erative (4) neurological conditions; traumatic injuries(2); vision impairment (1); three other health condi-tions (4).Participants reported that a comprehensive overviewof SMART technologies presented in functional cate-gories helped them to understand what was possibleand the potential value of these technologies to theirlives. Expectations of how well things were currentlybeing managed often changed during the session, as


people were made aware of the contribution SMARTtechnologies could make. Participants reported thatdemonstrations of the technologies helped them under-stand the functions they offered. Tailoring informationto each individual’s specific requirements and circum-stances kept participants engaged and wanting to knowmore.The main influences on awareness and knowledge ofSMART technology were reported to be general levelof interest in technology and avenues for gaining infor-mation. Motivations for acquiring SMART technolo-gies included future planning, leisure participation andsocial interaction, portability, personal safety, and in-dependence. Barriers and facilitators to uptake and use,included reliability and durability, lifestyle fit, cost,learning to use SMART technology, ease of use andenvironment and contextual factors.Conclusion: Tailored SMART technology sessionswhich overview the range of technologies in functionalcategories extend an individual’s understanding of howthese technologies can enhance his or her life and cre-ate new opportunities. These sessions should also givedue consideration to people’s motivations for explor-ing these technologies and perceived barriers and facil-itators in order to promote uptake and use.Keywords: SMART technologies, tailored session,uptake and use.∗Corresponding author. E-mail: [email protected]

What are They Doing and What are They Mea-suring? A Scoping Review on the Technological In-terventions and Ageing in Place Outcomes AlliedHealth Professionals UseJacinta Borilovica,b,∗, Meryl Lovarinia, LindyClemsona,b and Kate O’Loughlina,baFaculty of Health Sciences, University of Sydney,Cumberland Campus C42, PO Box 170, Lidcombe,NSW 1825, AustraliabCentre of Excellence in Population Ageing Research(CEPAR)

Background: Technology is often recommended inthe scientific literature and by governments as a wayof supporting older adults to “age in place”. That is, tolive independently in a way of their choosing. Despitesuch emphasis on technologies, and the exponentialrate in technology development and availability, thereare still many gaps in the use of technologies within theaged care sector. Specifically, little is known about howallied health professionals working with older adults

deliver technology to facilitate their client’s indepen-dence, with the majority of research focusing on thedevelopment and accessibility of technologies ratherthan the impact on person-centred outcomes associatedwith ageing in place.The current study thus explores (1) how allied healthprofessionals are currently using technologies witholder adults, and (2) the outcome measures used to theassess the impact of technology on ageing in place.Method: A scoping review was conducted using reco-gnised methods. Studies were included if they useda quantitative design to evaluate the effect of a tech-nology which may be recommended by an allied pro-fessional and who’s outcome was to increase an olderadult’s independence, wellbeing, confidence or par-ticipation in everyday activities. 12 relevant healthdatabases were searched for peer reviewed, interven-tion studies, published between 2008 and 2018. Keysearch terms included, technology, older adult, com-munity, and their synonyms. Articles were indepen-dently screened and assessed for inclusion in the re-view. Key data were then extracted from each includedstudy, with the findings from each study compared forsimilarities and differences.Key results: Forty-seven studies were included in thereview. Many of the excluded studies focused solely onuptake and acceptability of the technology or on clini-cal outcomes, rather than improving outcomes relatedto ageing in place. Human interactions and social con-nections appear important, particularly in learning andusing a new technology. Most of the studies focused ona particular technology with few studies focusing onthe individual goals of the older person in relation toageing in place.Conclusion: Peer reviewed studies have been pub-lished evaluating the effect of technology on someageing in place outcomes. This study provides an in-sight into the current techniques and practices of alliedhealth professionals when using technology as an in-tervention, and the types of outcome measures used inrelation to ageing in place. These findings can informthe design of a meaningful and effective process for al-lied health professionals to use when considering tech-nological interventions for older adults. In practice itis important to work with a person-centred approach,matching technological interventions to suit the goalsof the older person and the context.Keywords: Aged, Technology, Health Professions,Community, Outcome Measures.∗Corresponding author. E-mail: [email protected]


Assistive Technology Provision in India: Challengesand solutionsGift Normana,∗, Gopal Sudhakara, Carol E. Georgea

and Luc de WittebaDivision of Community Health, Bangalore BaptistHospital, Hebbal, Bangalore-560024, Karnataka, In-diabThe Innovation Center, University of Sheffield, UK

Background: Provision of Assistive Technology (AT)to a country of 1.35 billion people; 70% of them spreadover 640,867 villages is an enormous challenge. Evenif just a third of the 26.8 million of the estimatednumber of persons with disability (PwDs) in Indianeeded AT, it is still 8–10 million people that haveto be reached. Despite mammoth efforts taken by thegovernment, complemented by private business enter-prises, not-for-profit and philanthropic organizations,AT provision in India is still fragmented and mostlyunregulated. Access to good quality, affordable AT, re-mains a dream to many of the persons with disability.The objective of this paper is to present the various ef-forts and programs developed by the government andthe private sector, its benefits and challenges and sug-gest a simpler model that could be effective and effi-cient to fill the gap of AT needs in India.Method: The different models of AT provision in In-dia was reviewed using a combination of a desk review,literature search and sharing of learning from being animplementer of the government District Disability Re-habilitation Centre over the past five years. This hasgiven the opportunity to gain rich insights on AT pro-vision through multiple interactions with PwDs, grassroot level rehabilitation workers, government officials,private sector and other organizations who are involvedin AT provision and rehabilitation.Key results: The Ministry of Social Justice and Em-powerment (SJ & E) proposed to establish the DistrictDisability Rehabilitation Centers (DDRCs) to serve as“Hubs for comprehensive rehabilitation” in all 640 dis-tricts in India. The provision/fitment of assistive de-vices, follow up/repair of assistive devices is an im-portant component of the DDRC. Besides the DDRC,most ATs have to be obtained through the Assistance toDisabled Persons (ADIP) Scheme. However, the pro-cess of procuring ATs through this scheme is extremelycomplex with extensive documentation, upfront pay-ment by NGOs, prolonged turnaround times, delaysin reimbursement and poor quality of ATs supplied.The Artificial Limbs Manufacturing Corporation of In-dia (ALIMCO) supplies assistive products that come is

standard sizes and are not “tailor made” to the needsof the disabled, leading to non-utilization and wasteof resources. The DDRCs themselves are plagued bylack of sufficient funds, adequately trained manpower,materials and poor co-ordination at various levels andsectors. The private sector on the other hand has con-tributed considerably in research and development ofvarious assistive products, but they are islands of ex-cellence in a sea of poverty and inaccessibility.Conclusion: AT provision through the DDRC modelcould be strengthened with more political will, infu-sion of more resources, improving the competency ofstaff, better monitoring, supervision and better col-laboration with the NGO/private sector. Simpler pro-cesses in obtaining ATs through the existing schemeswould improve access and affordable to the majorityof the PwDs. The social, economic, cultural diversity,poverty and inequity of India contribute to the complexchallenges in AT provision in India.Keywords: Assistive Technology, India, challenges,solutions, DDRC.∗Corresponding author. E-mail: [email protected]

Assessing the Outcome of Individual Assistive Tech-nology InterventionsLucia Piginia,∗ and Renzo Andricha

IRCCS Fondazione Don Carlo Gnocchi ONLUS, Piaz-zale Morandi 6, 20121, Milan, Italy

Background: Assistive Technology (AT) outcome isindicated by the World Health Organization among thefive top priorities in AT research. In recent years sev-eral measurement tools have been developed and val-idated in many languages. One of today’s key issuesis how to routinely include outcome measures withinthe service delivery process, in order to capture the ef-fectiveness of the intervention in a sustainable manner(i.e. compatible with organization, human resourcesand budgetary constraints) and detect possible cases ofineffectiveness that require further intake.Method: 57 persons (27 women, 30 men, age 5–88 average 59) – who had received AT solutions af-ter in-depth assessment in specialized AT units ofrehabilitation centres – were recruited to undergo averification/follow-up process. Each assistive solutionincluded a range of products and environmental adap-tations to facilitate mobility, communication and self-care in daily life at home, work or school. Overall 150products were provided, mainly manual or powered


wheelchairs, seating systems, walkers, hoists, com-puter access interfaces, bathroom devices and com-municators. Verification included: 1) inventory of theproducts composing the assistive solution; 2) techni-cal inspection to check proper installation/fitting; 3)KWAZO (Quality of AT Service Delivery Process)questionnaire about the user’s and the caregiver’s per-ceived quality of the assessment and provision service;4) IPPA (Individual Prioritised Problems Assesment)first interview to detect their expectations with the re-ceived AT solution and 5) WHODAS (WHO DisabilityAssessment Schedule) 12-item interview to detect theuser’s disability profile.A follow-up interview was carried out 3 to 6 monthsafter verification. It included 1) data on the product us-age; 2) possible problems occurred in usage; 3) IPPAsecond questionnaire to detect how far the user’s ex-pectations had been met; 4) QUEST (Quebec UserEvaluation of Satisfaction with AT) to detect the usersatisfaction with each product.Key results: Most persons had severe disability con-dition (WHODAS score 33–100%, mean 67%) espe-cially in the mobility area. All persons expressed highsatisfaction with the process (KWAZO user score 3–5,mean 4,75; caregivers score 4–5, mean 4,79; in a 1 to5 scale); most persons perceived their AT solution aseffective (IPPA user score −5,8 – +20, mean +8,45;caregiver score +0,83 – +16,43, mean +9,14; in a−20 to +20 scale); most person scored the products in-cluded in the AT solution as more than good (QUESTuser score: 2–5, mean 4,49; caregiver score 3–5, mean4,55; in a 1 to 5 scale). Three cases were found inef-fective (IPPA <= 0); the failure reasons being, respec-tively 1) unexpected worsening of clinical condition 2)changes in living environment and 3) technical inade-quacy of the provided products.Conclusion: This method proved effective in mea-suring the outcome of AT interventions, and distin-guishing among successful cases, unsuccessful cases(therefore needing to be looked after again) and “neu-tral” cases (where seemingly no improvement wasachieved). More cost-efficient tools should be designedfor the follow-up interview in order to make it sus-tainable within the service delivery process. Currently,work is in progress to routinely include this method inthe service protocol of these rehabilitation centres.Keywords: AT Assessment, AT service delivery, ATOutcome measurement.∗Corresponding author. E-mail: [email protected]

Assistive Technology Service Delivery models in theNetherlandsUta R. Roentgena,∗, Edith A.V. Hagedorena and Luc P.de WittebaResearch Centre Assistive Technology in Care, ZuydUniversity of Applied Sciences, Henri Dunantstraat 2,6419 PB, Heerlen, The NetherlandsbCentre for Assistive Technology and Connected Heal-thcare (CATCH), The Innovation Centre, The Univer-sity of Sheffield, 217 Portobello, Sheffield, S1 4DP, UK

Background: Since 2002, models to guide the As-sistive Technology Service Delivery (ATSD) in theNetherlands have been implemented with the aim toorganize the provision of AT in a more client-centeredway. Due to the fact that the funding of AT is regu-lated by different laws and statutory rules, ATSD isperceived as very fragmented and not easy to oversee.Not only the type of AT but also the individual situa-tion of the user and the setting of use determine whichlaw or rule is applicable. The objective of this paperis to present the developments, recent trends and cur-rent practice of ATSD in the Netherlands, including ad-vantages and disadvantages as identified by differentstakeholders involved.Method: A desk research was conducted by Internetsearch, with a focus on websites and documents of theDutch government, knowledge institutions, the Nether-lands Organization for Health Research and Develop-ment, and a large Dutch patient organization. Addi-tionally, an invitational conference was held and 60stakeholders representing experts in the field of ATSD,such as users, policymakers, researchers, suppliers,and practitioners with a variety of professional back-grounds were consulted, using a metaplan method.Key results: Four main laws and corresponding exec-utive authorities are involved in the provision of AT.On the one hand, the Social Support Act and the pro-vision of AT based on the ICF offer advantages com-pared to the previous situation in which a list of ATproducts existed that showed which products could befunded by indication. Now a person’s needs in func-tioning, desired activities and participation form thestarting-point to realize an optimal match between theperson and a specific product, based on a program ofrequirements. Stakeholders are provided with the pos-sibility of choice, and innovations in the field of AT arefacilitated. Current models of ATSD emphasize the im-portance of trying-out, instruction, training, and user-centered assessments during the evaluation and follow-up. On the other hand, AT services are delivered at dif-


ferent places with no coherence. This is problematicwhen it comes to transitions between different care-settings (e.g. from hospital to a rehabilitation ward of anursing home and finally, going back home) as differ-ent laws and regulations are involved. This renders theATSD quite complex and time consuming. The sameholds true for situations that demand a combinationof AT devices which are funded by different execut-ing authorities. An example is a dynamic arm supportmounted on a wheelchair. Furthermore, the potentialof AT is not used fully. One reason for that is a lackof awareness of the possible benefits of AT and differ-ent types of AT solutions, and missing objective infor-mation and protocols to guide their selection. Anotherreason is that the preventive or supportive use of AT by(in)formal caregivers is hindered by the conditionalityof the Social Support Act, with costs being decisive in-stead of AT’s added value.Conclusion: Despite the identified drawbacks anddeficits in daily practice the underlying user-centeredprinciples of currently used ATDS models could berecommended as good practice in ATSD.Keywords: Assistive Technology Service Delivery,ICF, user-centered.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 10Play, Children with Disabilities, and Robotics.State of the Art and New Developments

Play is the crucial activity through which children ac-quire psycho-motor, cognitive and social competences.Children with disabilities (CwD) may face many bar-riers to play, such as inaccessible environments andtoys or adult attitudes often prioritizing rehabilitationand/or educational goals rather than to exploit chil-dren’s ability to freely act and participate. Robotics haslong faced this topic by developing robotic toys, as-sistive technology to enable play, and social assistivetools for the play of CwD. Robots can support both theactivity of playing and the collection of data about theactivity of CwD, possibly offering to the caregivers orcompanions the chance to develop new playing activ-ities. Often, robots provide new opportunities of playthat could be exploited to obtain interesting achieve-ments. How robots can support play for CwD? Whatrobots can bring to play for CwD? What products areavailable andare being developed? Is accessibility ahot topic? What developments are awaited to radicalchange and support CwD’s play? The STS will show

the work of some prominent groups working in thefield, sharing the idea that CwD must have the op-portunity to play autonomously the type of play theycan/wish/need to grow up fully and happily. In partic-ular, it will present: prototypes of new toys, augmen-tative mobility and augmented manipulation enablingchildren’s autonomous play, experimentations of main-stream robots in school and in rehabilitation contexts,together with Guidelines on accessibility and usabilityof robotic toys. Inclusive contexts of play will be dis-cussed too, showing how robots could improve inclu-siveness.Chair: Serenella Besio

What Is Play in Robotics Today?Serenella Besio∗

Dipartimento di Scienze Umane e Sociali, Univer-sità degli Studi di Bergamo, Piazzale Sant’Agostino 2,24129 Bergamo, Italy

Background: Play is an innate, internally drivenand evolving activity, crucial for children to acquirepsycho-motor, cognitive and social competences. De-spite being a right, it is far from being achieved byChildren with Disabilities (CwD), who may face manybarriers to play, such as inaccessible environments andtoys or inadequate adult attitudes. Robotics has longfaced this topic, by developing toys, assistive tech-nology and social assistive tools for the CwD’s play;here, play is interpreted as an unavoidable mean to-wards health, rehabilitation, educational scopes. Dothese studies share a unique definition of play? Whatkind of awareness do they show on the different playtypes and characteristics and their relationships withthe different ages in life? Last, are these studies com-parable on a common basis, so that the field of play forCwD can steadily grow and acquire new knowledge?This presentation aims at giving an answer to thesequestions, according to the COST Action “LUDI –Play for CwD” (2014–2018) framework. Through thework of 100 European researchers and professionals,LUDI created a comprehensive theoretical backgroundon the theme of CwD (Besio et al., 2017; 2018; Encar-nção et al., 2018), to support further transdisciplinaryresearch. By analyzing the studies and products foundin the literature, it will be possible to propose some in-novative reflections on the possible roles of robots forthe CwD’ play, and on awaited developments to pro-duce a real advancement in the field.Method: The last ten years (2009–2019) Proceed-ings of six important international robotics conferences


(EPIROB, HRI, ICRA, IDC, IROS, ROMAN) havebeen searched with the keywords “child” AND “play”OR “game”, to know: a) the distribution of the relatedstudies along the years; b) how many studies are ad-dressed to children with disabilities (and what kind ofimpairment); c) what definition and/or theory of playis adopted, if any; d) what role is attributed to play andwhat system abilities are implemented for this purpose.Key results: After relevancy check, 112 studies werefound, with two peaks around the years 2013–14 and2016–17; 19.6% are devoted to CwD (half to autismspectrum disorders). ROMAN, IDC and HRI are themost represented; 3 keynote speeches have been de-voted to child’s play (one to CwD). About half of thearticles presents prototypes, the other ones adopt exist-ing robots in original experimentations. They mostlyaddress human-computer interaction aspects, mainlyemotional, on the two sides; implemented relationshipsinclude the robots as companions, tutors, tutees, co-players. No article proposes a definition of play, 3 referto play types. Health and educational topics are highlyrepresented, for children with and without disabilities.Unexpectedly, one keynote speech was devoted to playfor the sake of play.Conclusion: The need for the adoption of a sharedframework on child play, particularly for CwD, is tes-tified by these scattered studies facing the topic fromdifferent perspectives without taking advantage fromthe others’ results. By applying the LUDI approach,the presentation will show the most crucial deficienciesin the field and will advance some proposal for futureimplementation.Keywords: Play, Children with Disabilities, Robotics.∗Corresponding author. [email protected]

Simple Robots for Simple Play: Exploiting theResources in Real SituationsAndrea Bonarini∗

AI and Robotics Lab – Dipartimento di Elettronica, In-formazione e Bioingegneria, Politecnico di Milano, Pi-azza Leonardo da Vinci, 32, I-20133 Milano, Italy

Background: Play is a right and a tool for develop-ment for everybody (Besio, 2017). Physical, interac-tive objects, i.e. robots, can provide tools engaging theplayer in a pleasurable activity. Pleasure and engage-ment come from the right mix of challenge and re-ward (Csikszentmihalyi, 1997). Complex and expen-sive devices are not needed for this: well-designed de-vices exploiting appropriate sets of signals and cause-

effect relationships are enough to provide effective andinteresting play experiences. A key modality to ob-tain these devices is to co-design the robot, involv-ing players and their care-givers, which provide needsand desiderata, together with designers and techniciansthat can provide technological solutions. We devel-oped several robots to be used by people affected byNDD (http://playbot4all.polimi.it). As an example, wepresent here Scimmiottondo, a monkey plush, havingtwo metal hands. When touching both the hands therobot starts singing a typical Ring-around-the-roseysong. This can also be obtained when a set of peopleforms a circle including Scimmiottondo. In this way,it has been possible to include up to 10 people withdifferent NDD, together with normally developed peo-ple, and therapists in a play activity exploiting atten-tion, turn-taking, and physical contact. Scimmiottondoalso includes an accelerometer, and, if it is mistreatedin any phase of the game, it can start screaming. More-over, if it is caressed on he top of the head it can sing aspecial song.Method: The design of the robot was started by men-tioning to a psychologist some technical possibili-ties, recognized as potentially interesting, and then therobot was co-designed with a care center. The partic-ipants to the trials were recruited by their caregivers.Each session started by a free interaction with therobot, aimed at discovering its capabilities and expe-riencing cause-effect relationships. Then, it was intro-duced as a possible companion for the Ring-around-the-rosey game, and the players had their moments toautonomously try what happened when they formedthe complete circle or opened it, taking turns to ex-perience to obtain the desired effect (singing or stopsinging). Scimmiottondo was used in 10 sessions in-cluding 6–10 people with different NDD (mediumfunctionality, aging from 16 to 42), 2–3 therapists and1–3 normally developed people. Results were collectedby interview from therapists.Key results: Therapists reported the success of the ex-perience in activating the game and stimulating ap-propriate interaction even in subjects usually refusingphysical contact or having problems in managing turn-taking. Scimiottondo could focus the group activityalso in repeated sessions, thanks to its appropriate en-gaging level.Conclusion: Even very simple, cheap robots, such asthe ones we designed to implement simple cause-effectrelationships, can produce interesting experiences withpeople with different NDD. Critical issues include theperception of signals and the exploration of cause-


effect relationships; these call for the selection of ap-propriate signals, which should be reliably perceivedand properly produced by the robot. The basic func-tionalities can be discovered by free exploration andcan make also unexpected behaviors arising, a signthat NDD players can exploit their inventive power andshow their hidden abilities.Keywords: Play, Robot, Interactive system, Co-design,NDD.∗Corresponding author. E-mail: [email protected]

Play and Augmentative Mobility: the INMAC(INclusive Mobility for All Children) VehicleLuis AzevedoANDITEC, Alameda Roentgen, 9C, 1600-757 Lisboa,Portugal

Background: Children with Cerebral Palsy (CP) usu-ally do not have the possibility of fully engaging inPlay activities, mainly due to their functional limita-tions that lead to severe restrictions to perform manip-ulation and mobility events. For many years, activi-ties of independent/augmentative mobility in Childrenwith Disabilities (CwD) have been performed throughthe use of powered wheelchairs available in the mar-ket. However in the same markets, and with very fewexceptions, there wasn’t available any equipment tospecifically provide augmentative mobility with themain objective of allowing very young CwD to en-gage in Play activities, adequate and/or adapted to theirage levels. As a consequence, and in order to overtakesome of the functional limitations faced by childrenwith severe disabilities when they want to be involvedin Play/Mobility activities, a R&D Project was set-up with the main objective of providing independentmobility to CwD, with an emphasis on CP Children.As a result of the project, a special vehicle – INMACINdependent Mobility for All Children – was devel-oped and a few industrial prototypes of that vehiclewere produced.Method: INMAC is the practical outcome of an in-ternational R&D Project developed in order to fabri-cate a working prototype of a vehicle that could al-low any child aged from 1 to 6 years old, namelythose with severe disabilities, to engage in Play. IN-MAC is equipped with an array of ultrasonic sensorsthat not only avoid obstacles, but also provide feed-back to the enduser of the physical environment whereit is used. The vehicle can be totally controlled by the

child through a specifically developed console and/orany AT interface available in the market. Five levelsof use/activity can be setup, from a first level wherethe vehicle “takes over” the mobility tasks to be per-formed, until a fifth where it is the child that takes fullcontrol of the vehicle. Several prototypes were devel-oped and tested in Rehab Centres mainly with CP chil-dren, and finally an industrial prototype (ready to befabricated and go to the market) was developed, allow-ing any of the specific AT interfaces existing in themarket (direct or indirect selection) to be used. The ve-hicle comes with a specially developed software thatnot only allows five levels of use/activity to be setup,but also allows the acquisition of many important databoth from the vehicle as well from the specific inter-face used by the child. A protocol was developed forthe tests of the INMAC, that mainly took place at a spe-cialized rehab Centre for Cerebral Palsied Children, inLisbon, Portugal.Key results: Preliminary conclusions of the tests,showed that not only the children were able to be fullyengaged in play activities despite their severe func-tional limitations, but also it contributed to the acquisi-tion of psyco-motor, cognitive and social competencesto those children.Conclusion: Further tests are planned at an interna-tional level and with children with other disabilitiesthan only PC children. Possibility of fabrication ofmany more vehicles to be available in the internationalmarket, are one of the outcomes of this project, con-tributing for the availability in the overall market ofspecific AT solutions for independent mobility.Keywords: Children with Disabilities and Play, Aug-mentative Mobility, Independent Mobility.∗Corresponding author. [email protected]

Mainstream Traditional or Robotic Toys: Which ofThem Better Supports Playfulness in Children withDisabilities?Nicole Bianquina,∗ and Daniela BulgarellibaDepartment of Human and Social Sciences, Univer-sity of Aosta Valley, Aosta, ItalybDepartment of Psychology, University of Turin, Italy

Background: Play is the main drive for developmentand is fundamental for physical, cognitive and socialdevelopment (Piaget, 1945/1972; Vygotsky, 1976).Playfulness is the child’s ‘disposition to play’ (Bar-nett, 1991). Playfulness can allow to discriminate be-tween play for the sake of play and ‘play-like’ activi-


ties (Visalberghi, 1958), which occur when play is usedas a means to achieve ‘other’ purposes, such as learn-ing or skill improvements.Children with disabilities can experience limitationsand functional problems (intellectual and motor limi-tations, speech disorders, sensory disturbances, emo-tional and social difficulties; Tingle, 1990). For thesechildren, play can be limited because of environmentaland contextual barriers (Besio, 2017); moreover, playis often used as a means for rehabilitation or educa-tional purposes. Thus, children with disabilities are of-ten prevented from playing for the sake of play. Toys,and specifically robotic toys, can offer interesting so-lutions to overcome the limitations of play activitiesand to support Playfulness (Skär, 2002). The projectGioDi-1 (2014–2015) showed that robotic toys couldsupport play and playfulness in children with physi-cal impairments (Bulgarelli et al., 2018). The projectGioDi-2 (2017–2019) directly compared the impact ofsimilar classical vs robotic toys on the child’s play-fulness. The current study reports the first results ofGioDi-2. The hypothesis was that children would ob-tain higher Playfulness scores when using robotic toyscompared to classic toys.Method: The sample consisted in 10 children (7 girls,3 boys; mean age in years = 9.24, SD = 2.51; min =6.05 years, max = 12.73) with intellectual disabilities;three children had also physical impairments. Datawere collected in Fall 2018; each session was video-taped. Children were observed at school, in a separateroom, during three sessions, playing with an educatorwith six different toys: classic and robotic caterpillar,classic and robotic dragon, classic and electronic ball.Fifty-eight sessions were analysed (one child refusedto play with the robotic dragon, and one child with theclassic caterpillar). Two independent observers codedthe Test of Playfulness. Inter-rater agreement had beenmeasured and disagreements had been solved.Key results: The ToP scores varied from −2.40 to2.40 (mean score = 0.25, SD = 1.26). No signifi-cant differences in the Playfulness scores were ob-served comparing the use of classic and robotic toys(mean ToP score_classic = 0.29, SD = 1.32; meanToP score_robotic = 0.20 SD = 1.23, p > 0.70). Thedifferences between the Playfulness scores were alsoanalysed for: a) each child: one child only (male, age= 7.75, with intellectual and physical disabilities) ob-tained a higher Playfulness score when using classictoys than robotic toys; b) each toy: no significant dif-ferences were observed (all p > 0.05).Conclusion: First results showed that robotic toys didnot support playfulness more than classic toys. Future

analyses will deepen the association between the us-ability and accessibility of the toys and the severity andcharacteristics of the disabilities. Moreover, the playpartners’ competence in supporting play and playful-ness will be analysed as well.Keywords: Play, playfulness, robotic toys, intellectualdisabilities.∗Corresponding author. E-mail: [email protected]

Guidelines and Tools on Usability and Accessibilityof Toys and Technologies for Play for Children withDisabilities: Review and Proposal from the LUDIProjectRianne Jansensa and Andrea BonarinibaResearch Centre of Assistive Technology in Care,Zuyd University of Applied Sciences, Henri Dunants-traat 2, 6419 PB Heerlen The NetherlandsbAI & Robotics Lab Department of Electronics, Infor-mation, and Bioengineering, Politecnico di Milan, ViaPonzio 34/5, 20133 Milano, Italy

Background: Play is important for each child. Toys,games, apps, robots and other technological productscan elicit great play opportunities. Moreover they cancreate inclusive play and support children with disabil-ities often challenged among others in playing differ-ent play objects. However finding, choosing, evaluat-ing, designing or producing a toy or technology usablefor all children can be a struggle. Professionals work-ing with children with disabilities as well as designersand engineers might benefit from guidelines or toolson usability and accessibility of toys and technologies.Method: Within the LUDI project, COST actionTD1309, a scoping review was carried out to answerthe following questions (1) which guidelines and toolsregarding usability and accessibility of toys and tech-nologies for play for children with disabilities exist?(2) what is their possible use for different stakehold-ers involved in play for children with disabilities? and(3) what are the strengths and the weaknesses of theguidelines and tools? Four different sources were con-sulted: LUDI database (stored at: http://ludi.utad.pt/ ),collected sources of LUDI members, experts in thefield of play for children with disabilities, scientificdatabases and hand search.Key results: The search yielded 15 sources on us-ability and accessibility of toys and technologies forplay for children with disabilities. An in-depth reviewwith an adapted version of the AGREE II instrument


gained 10 suitable guidelines for designing, produc-ing, choosing or evaluating toys and technologies onusability and accessibility. Five of these had a focuson play. From these ten guidelines four were relatedto persons with disabilities. The topic of these guide-lines was: games/apps (6), toys (1), indoor playthingsand environment (1), generic principles (1), all kindof toys and technologies for play (1). Only guidelineswith recommendations for a specific stakeholder groupwith a specific play object (games or toys) were found.Tools such as assessments, checklists were not emerg-ing from this scoping review. No guideline neither atool about usability and accessibility of a robot for playfor children with disabilities emerged.Conclusion: Based on these results, it was decided todevelop a guideline for different stakeholders about us-ability and accessibility of toys and technologies forplay for children with disabilities. The choice for a fo-cus on stakeholders and not on a specific technologicalproduct, i.e. robots, was based on limited availabilityof research data about robots for play for children withdisabilities and the wish of stakeholders to address playobjects in general. The different guidelines reflect theexpertise of LUDI members including their network inpragmatic documents with reflective questions to sup-port the decision making process of the user. In thesenewly developed guidelines the results from the scop-ing review were incorporated. A small feasibility studygave an impression about first experiences and opin-ions of potential users of the guidelines in different Eu-ropean countries.Keywords: guidelines and tools, usability, accessibil-ity, toys and technologies, children with disabilities.∗Corresponding author. E-mail: [email protected]

Taking Integrated Augmentative Manipulation andCommunication Assistive Technologies to Daily In-tervention PracticePedro Encarnaçãoa,∗, Anabela Caiadob, Iolanda Gilb,Maria Inês Gândarac, Margarida Ribeirob and InêsPintobaCATÓLICA-LISBON School of Business & Econ-omics, Universidade Católica Portuguesa, Palma deCima, 1649-023 Lisbon, PortugalbCentro de Reabilitação de Paralisia Cerebral Calou-ste Gulbenkian, Santa Casa da Misericórdia de Lis-boa, Avenida Rainha D. Amélia, Lumiar, 1600-676 Lis-bon, PortugalcNOVA School of Science and Technology, Universi-

dade Nova de Lisboa, Campus da Caparica, 2829-516Caparica, Portugal

Background: Children with motor impairments mayhave difficulties in manipulating objects impactingtheir participation in play and academic activities,thus affecting their cognitive development. Lego R©

Mindstorms R© controlled through augmentative and al-ternative communication (AAC) devices has been usedto build integrated augmentative manipulation andcommunication assistive technologies (IAMCATs).IAMCATs allow children to communicate while us-ing the robotic tool for indirect manipulation, build-ing on their expertise with the AAC device and ac-cess method. They also provide a means for childrento demonstrate their abilities, opening a window intochildren’s skills. IAMCATs have been used to support:a) participation in free and directed play; b) participa-tion in mathematics, language, and science & socialstudies academic activities; c) training assistive tech-nology indirect access methods (scanning). This paperreports the first steps in taking IAMCATs to daily inter-vention practice at the Calouste Gulbenkian Rehabili-tation Center for Cerebral Palsy (CRPCCG) in Lisbon,Portugal. This center accumulates more than 45 yearsof experience providing rehabilitation services to chil-dren with disabilities, combining clinical practice withclinical research.Method: In order to define the requisites of anIAMCAT to be used in daily intervention with chil-dren with neuromotor impairments, a Research Assis-tant spent one month at the CRPCCG. The IAMCATdeveloped in a previous project was used to exemplifywhat may be the features of such a system. Through in-formal conversations with the center clinicians, possi-ble uses for the system were identified. Eight childrenwith neuromotor impairments aged 3–9 years trialedthe IAMCAT in semi-structured play activities in threelevels of difficulty.Key results: Clinicians at CRPCCG identified severalpossible interventions in which the IAMCAT could beuseful, including play, development of visual-spatialperception, anticipation and planning skills, increaseattention span, cause-and-effect and turn taking train-ing. Challenges mentioned include the need for hav-ing a) easy-to-follow operation instructions, b) a play-ful training protocol for children, c) different operationscenarios, and d) intervention protocols for the differ-ent intervention goals. Children were curious about theIAMCAT and willing to try it. Due to their ages and thelack of training on the use of the IAMCAT, participants


were only able to perform the simplest tasks. Five ofthem used trial-and-error strategies to perform level 1tasks (e.g., make the robot move). Three were able todrive the robot to a given location without obstacles(level 2 task). None was able to accomplish a level 3task (e.g., avoiding obstacles). Nevertheless, observa-tion of children using the IAMCAT confirmed the po-tential of the tool.Conclusion: An IAMCAT can be a useful tool in a re-habilitation center to help achieving different interven-tion goals. Challenges identified may be addressed byan appropriate translation of research results into pro-tocols that can be implemented in day-to-day interven-tions. Future work includes the deployment of a web-site containing detailed but easy-to-use operation in-structions and intervention protocols, and then system-atically follow their implementation in daily interven-tions at the CRPCCG. Properly documenting the inter-ventions will allow for more robust conclusions on theuse of IAMCATs in daily intervention practice.Keywords: Integrated augmentative manipulation andcommunication assistive technologies, robotic assis-tive technologies, neuromotor impairments.∗Corresponding author. E-mail: [email protected]

Playing with ZORA – Robot supported therapy andeducation for children with severe physical disabil-itiesRenée van den Heuvela,∗, Monique Lexisa and Luc deWittebaZuyd University of Applied Sciences, Research centrefor assistive technology in care, Nieuw Eyckholt 300,6419 DJ Heerlen, The NetherlandsbSchool of Health and Related Research, Centre forAssistive Technology and Connected Healthcare, Uni-versity of Sheffield, Sheffield, UK

Background: Play is of crucial importance for thedevelopment of a child. Especially children with se-vere physical disabilities may experience difficultiesin play and they often need assistance while playing.Play activities may be partially or entirely impossiblefor these children e.g. manipulation toys, or accessingplaygrounds. New developments in the field of tech-nology and ICT create new opportunities which mayimprove the play possibilities for these children. Thispaper presents the results of a study using robot ZORAfor children with severe physical disabilities in therapyand special education. The contribution of ZORA tothe achievement of therapeutic and educational goals

and the roles professionals attributed to ZORA wereexamined.Method: A mixed methods approach was used andwas conducted among children with severe physicaldisabilities, in multiple rehabilitation and special edu-cation environments. Over a period of six weeks, chil-dren played and practiced with ZORA six times in ei-ther individual or group sessions. Professionals (ther-apists and teachers) attended a ZORA training ses-sion, decided for which goals they would like to ap-ply ZORA and designed specific scenarios with theresearcher and IT expert. Previous research indicatedthat ZORA can contribute to goals within the domainsof movement skills, communication skills and cogni-tive skills, therefore professionals selected goals withinthese domains. The Individually Prioritized ProblemAssessment (IPPA) was used to assess to what extentthe individual goals were reached according to the pro-fessional. Furthermore, playfulness and the children’sexperience of the sessions were assessed using a visualanalogue playfulness scale (range 0–10) and smileys(like, neutral or dislike). Video-stimulated recall inter-views were used to gain insight into the different rolesof the robot during the sessions. The IPPA and playful-ness data was analyzed using descriptive statistics. Theinterviews were transcribed, labelled and coded.Key results: In total 33 children (11 girls, 22 boys)with physical disability participated in this study. Thechronological age of the children was 2 to 21 yearsold, and their developmental age was between 2 and8 years old. Twelve professionals took part by prepar-ing and leading the sessions and taking part in the in-terviews. A significant difference was found betweenIPPA before and after the intervention sessions (p =0.001), which indicates a positive contribution of theZORA-based intervention sessions to the achievementof goals. Looking at specific domains the largest con-tributions were found on the domains of movementcommunication skills. The average score of playful-ness of all sessions taken together was 7.5, indicat-ing that ZORA elicits play. Overall, the children likedplaying with ZORA, since they chose the ‘like’ smi-ley in 93% of the sessions. The most suitable roles ofZORA according to the professionals are the roles ofmotivator, rewarder and instructor.Conclusion: This study indicated that robot ZORAcan be an effective tool to be used in rehabilitation andspecial education to reach therapeutic and educationalgoals. ZORA in particular, and robots in general, mayoffer the next generation of play for children with se-vere physical disabilities.


Keywords: Robot, children, physical disabilities, play.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 11Innovative Approaches in Building InclusiveEducational Environments with Technology

Building inclusive education environments in the digi-tal era entails numerous opportunities as well as manychallenges. Additional aspects of integrating (assistive)technology in education are added towards the goalsof digital inclusion that need careful management andmonitoring. Digital literacy for all learners becomes asubstantial aspect of the use of technology in order tocreate inclusive learning communities, as this is alsodefined by the UN Convention for the Rights of Peo-ple with Disabilities. Recent research evidence, suchas the work of the ENTELIS network, yielded a num-ber of considerations but also highlighted a number ofopportunities for overcoming barriers and reducing thedigital divide. The discussion around digital divide, es-pecially for learners with disabilities, does not solelyconcentrate on the technological dimensions and lackof access to technology resources, but it is aligned withthe current conceptualization of inclusive education.Self-assessment, action research and reflective practiceare becoming renowned approaches for defining goalsand monitoring progress towards digital inclusive edu-cation. This special theme aims to explore some exam-ples of such approaches when using technology for in-clusion and to discuss considerations and opportunitiesinvolved.Chairs: Katerina Mavrou and Silvio Pagliara

“Nothing about Us without Us”: Next LevelAndrea Petz∗ and Klaus MiesenbergerInstitute Integriert Studieren, Johannes Kepler Univer-sity Linz, Altenbergerstraße 69, 4040 Linz, Austria

Background: Education is a prominent facilitator ofinclusion amongst up-to-date Information and Com-munication Technologies, Assistive Technologies and(e)Accessibility. While there is a most complete cor-pus of initiatives, guidelines and regulations in Europedealing with delivering education to children with dis-abilities in elementary and secondary education (irre-spective of the further process and if this educationtakes place in an inclusive or special educational con-

text), the number of initiatives, measures and regula-tions get scarce when it comes to Higher Education andfurther diminishes at doctorate level. This leads to alack of peers (people with severe disabilities) in further(university) research, project work, teaching and lastbut not least also policy making. It applies to all fieldsof university research (including disability studies andrehabilitation). What adds quality to state of the art inmodern management – implementing diversity – is lostat university.Method: In preparing for this endeavor and in order toevaluate the situation and possibilities in Austria, wefollowed a four-fold study path: (a) Preparatory desk-top research on legal regulations and numbers at Eu-ropean level, (b) expert interviews with students andresearchers (with and without disabilities) asking whatkeeps candidates from as well as in following a doc-torate in Austria, (c) observations from a similar ac-tion called PROMI in Germany and (d) setting up afield trial framework in Austria to be able to conductan accompanying study/work in progress activity forgraduates with disabilities in doctorate studies whileresearching the main facilitators and barriers as wellas get a sound understanding on numbers and targetgroup.Key results: Studies show that the number of mas-ters exiting university is about 8000 per year, about800 extra finish with a doctorate. An estimated ratioof 20% (people with any form and grade of disabilityamongst the Austrian population) would mean an out-put of about 1600 graduated with disability and conse-quently 160 doctors with disabilities, numbers that arecertainly not reached. But also if one only takes 10% ofthese mere estimations (as in Austria, data on “disabil-ity” and health require particular protection and are notpart of formal population census), the resulting num-ber – following support and counselling services forstudents with disabilities at all Austrian Universities –would be overestimated – leading to similar values andfindings in other European countries that have a similar“tertiary quota” amongst their labor force.Conclusion: In parallel to the Austrian field trial –installing and staffing (altogether 6) fully accessibleand fully funded 4 year positions for doctoral studentswith severe disabilities at all major Austrian universi-ties – we will present necessary research to be con-ducted these next 4 years – compiling a significantlyreliable corpus of data/numbers, researching facilitat-ing and detrimental factors (besides financial and ac-cessibility issues – for transferable structures prepar-ing this next level of inclusion: People with Disabili-


ties following a stable research and career path at uni-versity, enriching quality of life and research (not onlyin disability related studies) and bringing high impactresearch and development to the next, necessary level.Keywords: Research, Disability, University, Doctor-ate.∗Corresponding author. E-mail: [email protected]

Accessibility Evaluation of Computer Based TestsPawan Kumar Patel∗ and Amey KarkareComputer Science and Engineering, Indian Institute ofTechnology Kanpur, Kanpur – 208016 U.P. India

Background: The accommodations in exams (e.g.scribe, compensatory time and magnification) arewidely used for many years to accommodate visu-ally impaired persons (VIPs). Nowadays, most ofthe exams are conducted using computers and web-based technologies referred to as Computer-based tests(CBTs). These CBTs play an important role in the pro-fessional advancement of any individual, starting fromuniversity admissions, courses evaluation and grading,to the recruitment in almost all software companies.Barriers in accessing certain components of the CBTslimit the utilization of these technologies for VIPs. Inthis work, we evaluated the availability and effective-ness of common accommodations in CBTs. To the bestof our knowledge, this is the first attempt to systemati-cally study the effectiveness of these accommodations.Method: We used a questionnaire to evaluate the ac-cessibility barriers in the CBTs. 24 participants re-sponded until January 15th, 2019. These were VIPsfrom IIT Kanpur, IIT Delhi and registered participantsat the assistive technologies conference, Empower-2018. We analyzed the accessibility of CBT inter-faces, the effectiveness of accommodations provided toVIPs, the comparison between available and expectedaccommodations, and finally the preferences of VIPsfor various accommodations. Using this data, we haveproposed recommendations to adopt more technology-based accommodations in CBTs.Key results: Every VIP is unique and requires appro-priate accommodations in CBTs to overcome the ac-cessibility barriers. The data obtained from the sur-vey reveals that 6.9% (2/29) of VIPs preferred scribeover other accommodations. 27.3% (6/22) of thosewho used a scribe reported enhancement in their per-formance, rest of them reported either drop or no im-pact. Hence assistive technologies such as screen read-ers along with accessible formats of contents should

be used to accommodate VIPs. Compensatory timewas useful for almost everyone regardless of the extentof disability. The usefulness of magnification was re-ported by only 25% (3/12) of participants with 90% ormore disability, while others reported significant im-provement in reading speed. We analyzed the avail-ability and expectation of various accommodations inCBTs and found that scribe and compensatory timewere available while accommodations such as magnifi-cation of text, screen reader, option for choosing colourcontrast and bigger monitor setup were rarely avail-able during CBTs, although data reveals that 30%–50% VIPs preferred these accommodations.Conclusion: The results about the effectiveness andpreference of using a scribe in CBTs are contrary tothe beliefs. Our observations identified the needs fortechnology-based accommodations over scribe to a di-verse group of VIPs. We showed that the extent ofresidual vision in VIPs is one of the major factor in de-termining the type of preferred accommodations. CBTinterfaces can be personalized to fulfil the needs ofVIPs with the use of assistive technologies. In the fu-ture, we would like to extend our study for a greaternumber of people, other disabilities, different types ofCBTs and for more geographic locations. Moreover,similar studies can be conducted for the accessibilityof online programming competitions.Keywords: Visually Impaired Persons (VIPs), Ac-commodation, Computer Based Tests (CBTs).∗Corresponding author. E-mail: [email protected]/[email protected]

LernBAR [Learning based on Augmented Real-ity] – An inclusive Training Concept for Home Eco-nomicsLaura Wuttkea, Linda Becha, Christian Bühlera, Den-ise Maternaa and Yvonne SöffgenaaFachgebiet Rehabilitationstechnologie, Fakultät Re-habilitationswissenschaften der TU Dortmund, Emil-Figge-Str. 50, 44227 Dortmund, Germany

Background: LernBAR is a research and developmentproject for vocational training using digital technologyas a core element. The project examines augmented re-ality (AR) based vocational learning for people withcognitive impairments in home economics. Digital me-dia can facilitate vocational life and has great potentialfor challenged learners. One innovative digital learningmethod is AR-based learning. AR supplies additionalinformation e.g. videos/audio which is presented with


a mobile device (glasses/tablet) in the real environmentcomplementing the view of reality. At the workplacethe system can recognize objects or markers to callup environment-related digital artefacts. Learners aresupported individually through the learning process,providing motivation, allowing repetitions, etc. ARspecifically relates the learning experience to the actualworkplace in reality (Fehling 2017, 127ff, 129f). Dueto demographic and social development in Germanythe importance of home economics increases, howevertraining figures decreased over the years (BiBB Daten-report 2016, 35). A modernization could enhance theappeal and future sustainability of the vocational train-ing (Fehling 2017, 126). The project focuses on realiz-ing AR-based learning and establishing further learn-ing opportunities via an e-learning platform. There-fore, a new curriculum is being developed and tested.Since home economic services constitute a large partof vocational training for people with cognitive impair-ments the project examines the usability of AR for thistarget group. Therefore, three institutions that offer vo-cational training for the target group are supporting theproject as partners.Method: The project starts with analyses of litera-ture and interviews of partners. The curricula for voca-tional training in home economics are adjusted to in-clude digital learning (like AR). Therefore, the part-ners’ curricula are analysed and merged using docu-ment analyses (Mayring 2007, 31). Based on the out-comes of the interviews the learning scenarios are cre-ated. Work process analyses are conducted with thepartners, including observations, control videos, ex-pert interviews and interviews with trainees (Spöttl andWindelband 2006, 139). The material is used to cre-ate learning content. On the technical side an appli-cation for displaying the learning content on glassesand tablets is developed and an e-learning platform isadapted for the project. The developed contents aretested with the target group using observations and sur-veys on acceptance/usability. The results allow targetgroup specific adjustments. Various offers like work-shops, guides/manuals, etc. allow the implementation.The project has a duration from June 2018 to May 2021therefore not all steps have been completed.Key results: Desired results in practice include 30learning scenarios for AR and the e-learning platform.Goals in research are to gain practical research data onlearning and teaching with digital media/AR and in-sights on acceptance and usability for people with dis-abilities.Conclusion: AR technology is expected to have greatimpact on future work life (Peddie 2017, 27). The

project explores the suitability of AR-based voca-tional learning for people with cognitive impairmentsin home economics.Acknowledgement: The project LernBAR is fundedby the German Federal Ministry of Education and Re-search under the funding code 01PE18004B. Respon-sibility for the content of this publication lies with theauthor.Keywords: augmented reality, vocational training,cognitive impairment, (education), (home economics).∗Corresponding author. E-mail: [email protected]

Mainstream traditional or robotic toys: Which ofthem better supports playfulness in children withdisabilities?Nicole Bianquina,∗ and Daniela BulgarellibaDepartment of Human and Social Sciences, Univer-sity of Aosta Valley, Aosta, ItalybDepartmente of Psychology, University of Turin

Background: Play is the main drive for developmentand is fundamental for physical, cognitive and socialdevelopment (Piaget, 1945/1972; Vygotsky, 1976).Playfulness is the child’s ‘disposition to play’ (Bar-nett, 1991). Playfulness can allow to discriminate be-tween play for the sake of play and ‘play-like’ activi-ties (Visalberghi, 1958), which occur when play is usedas a means to achieve ‘other’ purposes, such as learn-ing or skill improvements.Children with disabilities can experience limitationsand functional problems (intellectual and motor limi-tations, speech disorders, sensory disturbances, emo-tional and social difficulties; Tingle, 1990). For thesechildren, play can be limited because of environmentaland contextual barriers (Besio, 2017); moreover, playis often used as a means for rehabilitation or educa-tional purposes. Thus, children with disabilities are of-ten prevented from playing for the sake of play. Toys,and specifically robotic toys, can offer interesting so-lutions to overcome the limitations of play activitiesand to support Playfulness (Skär, 2002). The projectGioDi-1 (2014–2015) showed that robotic toys couldsupport play and playfulness in children with physi-cal impairments (Bulgarelli et al., 2018). The projectGioDi-2 (2017–2019) directly compared the impact ofsimilar classical vs robotic toys on the child’s play-fulness. The current study reports the first results ofGioDi-2. The hypothesis was that children would ob-tain higher Playfulness scores when using robotic toyscompared to classic toys.


Method: The sample consisted in 10 children (7 girls,3 boys; mean age in years = 9.24, SD = 2.51; min =6.05 years, max = 12.73) with intellectual disabilities;three children had also physical impairments. Datawere collected in Fall 2018; each session was video-taped. Children were observed at school, in a separateroom, during three sessions, playing with an educatorwith six different toys: classic and robotic caterpillar,classic and robotic dragon, classic and electronic ball.Fifty-eight sessions were analysed (one child refusedto play with the robotic dragon, and one child with theclassic caterpillar). Two independent observers codedthe Test of Playfulness. Inter-rater agreement had beenmeasured and disagreements had been solved.Key results: The ToP scores varied from −2.40 to2.40 (mean score = 0.25, SD = 1.26). No signifi-cant differences in the Playfulness scores were ob-served comparing the use of classic and robotic toys(mean ToP score_classic = 0.29, SD = 1.32; meanToP score_robotic = 0.20 SD = 1.23, p > 0.70). Thedifferences between the Playfulness scores were alsoanalysed for: a) each child: one child only (male, age= 7.75, with intellectual and physical disabilities) ob-tained a higher Playfulness score when using classictoys than robotic toys; b) each toy: no significant dif-ferences were observed (all p > 0.05).Conclusion: First results showed that robotic toys didnot support playfulness more than classic toys. Futureanalyses will deepen the association between the us-ability and accessibility of the toys and the severity andcharacteristics of the disabilities. Moreover, the playpartners’ competence in supporting play and playful-ness will be analysed as well.Keywords: Play, playfulness, robotic toys, intellectualdisabilities.∗Corresponding author. E-mail: [email protected]

Meta-analysis on the Impact of Augmented Real-ity on the Learning Gains of Students with SpecialNeedsJuan Garzóna,∗, Silvia Baldirisb and Juan Pavónc

aUniversidad Católica de Oriente, Rionegro, Colom-biabUniversidad Internacional de la Rioja, Logroño,SpaincUniversidad Complutense de Madrid, Madrid, Spain

Background: Augmented Reality (AR) has becomean important technology to support learning processes.

Many literature reviews have shown the trends, advan-tages, opportunities, and challenges of this technologyin educational settings. These reviews report that oneof the most important challenges of AR in educationis the limited number of AR applications that considerthe special needs of students. However, although thereis a claim for the inclusion of accessibility character-istics to address the special needs of users, no studyhas been conducted to identify the impact of AR onthe learning gains of students with special needs. Thatis, no data show that using this technology benefitsthe learning process of students with special needs orunder what conditions AR should be used to comple-ment their education. Many studies have shown thatAR technologies offer unique advantages that enrichthe learning environment, advantages that could not beobtained without the help of technology. Consequently,we pose that these unique characteristics of AR havea large impact on special needs education. With theabove background, this study proposes to identify theeffect size of AR on the learning gains of students withspecial needs. Additionally, the study analyzes the in-fluence of moderating variables related to the designof the intervention such as learning method, learningenvironment, and intervention durationMethod: We conducted a meta-analysis to identify theimpact of AR on the learning gains of students withspecial needs. The meta-analysis included 12 empir-ical studies (N = 270) published between 2010 and2018 in scientific journals and conference proceedings.In this study, students with special needs refer to stu-dents who have some type of disability. Accordingly,we considered four types of disabilities, namely, vi-sion impairment, deaf or hard of hearing, intellectualdisabilities, and physical disabilities. The moderatinganalysis seeks to identify under what conditions stu-dents with special needs can obtain the best of thistechnology for their education.Key results: The overall effect size of AR on the learn-ing gains of students with special needs was foundto be d = 0.75, p < 0.001. Regarding the moderat-ing variables, the constructivist learning method wasfound to be the most beneficial for students with spe-cial needs (d = 0.81, p < 0.001). Likewise, AR appli-cations seem to be more effective when interventionsare carried out in informal settings outside the class-room (d = 0.79, p < 0.001). Finally, the results indi-cate that longitudinal studies were more positive (d =0.78, p < 0.001) than cross-sectional studies.Conclusion: The results indicate that AR has a posi-tive impact on the learning gains of students with spe-


cial needs. The effect size was found to be large forall the subcategories according to Cohen’s classifica-tion. However, despite the apparent multiple benefits,the use of AR in special needs education is still toolimited. Therefore, stakeholders have great opportuni-ties to develop new and better systems that include alltype learners.Keywords: Augmented Reality, Meta-analysis, Spe-cial needs education.Acknowledgements: This work has been partiallysupported by the project “RISE Women with disabil-ities In Social Engagement (RISEWISE)” under theHorizon 2020 programme (Grant Agreement: 690874).∗Corresponding author. E-mail: [email protected]

Augmenting Reading through Technology: The Liv-ing Book ProjectKaterina Mavroua,∗, Maria Meletiou-Mavrotherisa andConstadina CharalambousaaDepartment of Education Sciences, European Univer-sity Cyprus, 6, Diogenous Str, 2404 Engomi, NicosiaP.O. Box: 22006, 1516 Nicosia, Cyprus

Background: Reading literacy is nowadays a primaryskill allowing citizens to ‘be’ and live in a complexworld. The Living Book project aims to address theunder-achievement of students in reading and literacy,by developing an innovative approach and related re-sources with the use of technology to increase stu-dents’ motivation. The wide range of disabilities andthe educational services learners have access to, impactdifferently on individuals’ literacy skills and engage-ment to literacy activities. Thus, learners with disabil-ities are considered among the most high-risk groupsfor low literacy skills. This contribution aims to dis-cuss the theoretical aspects of the Living Book projectand the development of the corresponding conceptualframework for teachers’ education to support learnerswith disabilities.Method: The project aimed at designing and imple-menting an educators’ and other professionals’ devel-opment program grounded on various interrelated bod-ies of research, including inclusive education and dig-ital inclusion. The programme was pilot tested dur-ing Spring-Fall 2018 with a series of hands-on profes-sional development seminars. To evaluate the applica-bility and success of the training modules, participants(primary education teachers, special education teach-ers and librarians) will subsequently undertake a teach-ing experiment during Fall 2018 – Spring 2019, where

they activate Living Book learning paths. Presentationof evaluation and impact findings are out of the scopeof this contribution. However, for testing and validat-ing the conceptual framework, teachers’ and learners’experiences will be mapped across the framework’sblocks.Key results: In this paper key results refer to the de-velopment of a conceptual framework. With respect to(digital) inclusive education the project builds upon thefollowing theoretical perspectives: (i) Augmented re-ality and innovative technologies; (ii) Universal De-sign for Learning (iii) the SAMR model for technologyintegration in Education; (iv) Taxonomies of Assis-tive Technology and E-Inclusion. For targeting learnerswith disabilities, the different approaches developed inthe project are based on a framework that connects theSAMR model to the UDL principles and Abbot’s tax-onomy of Assistive Technology for e-inclusion. Oftenthe use of assistive technology in literacy developmentremains at the level of physical or content/informationaccessibility. In Living Book, augmented reading fordisabled learners is framed in the (re)definition of in-clusive education in the digital era. (Assistive) Tech-nology integration is expected to provide accessible butalso engaging literacy experiences. Hence innovativetechnology integration (e.g. the use of AR) elevatesfrom Substitution and Augmentation to Modificationand Redefinition of literacy activities. Substitution andAugmentation reflect the UDL representation and ac-tion & expression principles, which are aligned to Ab-bot’s Technology for ‘Practice’ and ‘Assist’ learning.However, ‘Enabling’ learning with assistive technol-ogy indicates Engagement and thus, calls for Modifi-cation and Redefinition of literacy activities. Mappingparticipants’ experiences to the conceptual frameworkis expected to yield discussions upon the desired shiftin the learning paradigm for increasing engagement.Conclusion: The use of assistive technology in educa-tion can go beyond physical access and accessibility. Ina digital era, assistive technology is a means to modifyand redefine the learning environment for creating dig-ital inclusion opportunities and cultures in schools byproblematizing the added value of technology integra-tion in disabled learners’ engagement and acknowledg-ing the multi-faced interaction between person, tech-nology and environment.Keywords: Augmented reading, UDL, SAMR, Aug-mented reality, Digital inclusion.∗Corresponding author. E-mail: [email protected]


Flipped Classroom for All in Primary Education:Using Technology for Differentiation and InclusionMaria Loizoua,∗ and Katerina MavroubaEducational Research Department, Lancaster Uni-versity, Bailrigg, Lancaster LA1 4YW, UKbDepartment of Education Sciences, European Uni-versity Cyprus, 6, Diogenous Str, 2404 Engomi, Nico-sia P.O. Box: 22006, 1516 Nicosia, Cyprus

Background: In this article, the results of a multi-case study will be presented which aimed to address animportant gap in current literature concerning instruc-tional practices using a Flipped Classroom (FC) model,implemented in line with universal design principles.There has been a limited research focus on the imple-mentation of the FC model within the primary educa-tion context despite its potential benefits for differenti-ation and inclusion, especially through the use of tech-nology.Method: The study is a collaborative action researchproject, during which the researcher, in collabora-tion with five primary school teacher participants, ex-plored the effective ways of universal implementa-tion of the FC model in primary school settings inCyprus. To achieve the aim, this study first devel-oped a pedagogical framework of (Inquiry Based) IB-FC which consists of universal design principles ofusing the FC model for IBL (Inquiry-Based Learn-ing) at a primary education level. The universal de-sign principles here include the specific pedagogicalstrategies to motivate and improve students’ learn-ing applicable for all primary school subjects, throughdifferentiation and inclusion. The model was imple-mented for a school year in five different primaryschools in Cyprus, engaging 77 students (lower andupper primary). The digital literacy competency ofthe participant students had been addressed by prepar-ing flips in diverse formats, e.g. video, presentations,games, online readings, webQuests etc. In addition, theflips and the inquiry-based activities in class were up-loaded and administered through a Moodle platform(http://protyposxoleio.com), specifically designed forthe research. Therefore, all students could access con-tent through any connected device with no compatibil-ity issues. Qualitative data has been selected throughclassroom investigations and student interviews andhas been analysed using NVivo11. The final themesarising were grouped into students’ experiences andperceptions.Key results: Students’ experiences and perceptions onthe IB-FC implementation have been used to revise the

initial instructional tools given to the teachers for de-veloping their lesson designs (e.g. the IB-FC Differen-tiation tool). This in turn lead to the extraction of sevenfinal universal design principals which could enhancedifferentiation and inclusion through FC learning, rec-ognizing the critical role of technology in achievingthis. These include: structure and flexibility, simplicityand accessibility, interconnectivity and community, dif-ferentiation and personalization, development and pro-gression, motivation and engagement and assessmentand evaluation.Conclusion: The final IB-FC framework proposed inthe findings of this multiple-case study illustrates howthe seven universal design principles for FC imple-mentation are connected to the ten instructional IB-FC tools developed: In-class, orchestration routines,engagement, differentiation, technology, in-flip, com-munity, IB-FC skills, assessment and evaluation, flipsand Bring Your Own Device. These tools mainly high-light the role of technology in freeing up classroomtime for more IBL inclusive activities, by enhancingpre-class understanding within the individual learningspace through the provision of flips in diverse formats.Hence, the contribution of this study within the ATfield focuses on these principles and instructional toolsas an attempt to guide FC implementation which ad-dresses the needs of all students, despite their learningtype, ability and skills.Keywords: flipped-learning, differentiation, inclusion,universal design principles.∗Corresponding author. E-mail: [email protected]

Project E-IDEAS: Empowerment of Youth withIntellectual Disabilities Through an IndividualizedTransition Program Including AT for AcquiringEmployment SkillsIvan TrainaDepartment of Psychology, National University of Ire-land, Galway, Ireland

Background: The project E-IDEAS is an on-going re-search funded in 2017 by Marie-Curie Action programand the charity RESPECT. It is implemented at the Na-tional University of Ireland in Galway and it is aimedto develop a transition program for allowing personswith Intellectual Disability (ID) to find paid job.The rational is represented by the high levels of unem-ployment and underemployment of youths with ID inIreland.


Considering that youths with ID have less favorabletransition outcomes than youths in the general popula-tion and that employment opportunities are even lesspromising the initial question was: How to bridge the“gap” between what youths with ID “can do” andwhat they really “are doing” in employment sector?Method: The project E-IDEAS uses a mixed methodthat incorporates participatory research approach withqualitative research methods.It addresses the current educational and career prepa-ration context for youths with ID in Ireland through atransition program composed by three main activities:

1. Delivery of an Employment Preparation Curricu-lum (EPCv), developed using a person-centered ap-proach.

2. Provision of an Individualized Internship, sup-ported by job coaches of local organization (Em-ployAbility Galway) that provides real-life workexperience.

3. Use of assistive technology (AT), including tabletsand app AVAIL a mobile solution based upon theprinciples of ABA (Applied Behavior Analysis) en-abling learners to develop life skills.

Five persons aged between 20–25 with mild to moder-ate ID (IQ 50–70) were recruited by a local organiza-tion (Ability West). The transition program started inJanuary 2019, it lasts for 4 months and it will be ex-tended until summer 2019.Key results: The analysis of results is currently on-going. A questionnaire on the quality of life (San Mar-tin’s scale) has been administered to participants at thebeginning of the transition program and it will be com-pared with the data collected at the end of the process.Initial findings already emerged are:

– The provision of EPCv concurrently delivered withthe internship reinforces learning and provide a safeenvironment where to discuss and ask questions.

– The adoption of AT leads to positive results thathelps to achieve a long-lasting acquisition of skillsto perform job-related tasks although it requires acontinuous support.

– A strong partnership between different local stake-holders guarantees an effective transition towardsjob experiences.

Conclusion: The main practical implication of the re-search is that through a specific curriculum deliveredconcurrently with an individualized internship realizedin real-work settings, it is possible to empower personswith ID for acquiring employment skills. Also, theadoption of AT reinforces what learned in classroom

as well as tasks’ execution during the internship. Inthis view, the research’s results affect the AT field pro-viding the opportunity to develop a technology learn-ing environment that facilitates acquisition and explo-ration of job-related skills. Future perspective in termsof short and long-term impacts are:– Improve employability for youth with ID.– Help service providers in Ireland expand their com-

munity services.– Definition of practical actions aimed at impacting on

mind-set and common beliefs with respect to dis-ability and employment.

Keywords: Empowerment, Intellectual Disabilities,Individualized Transition Program, Assistive Technol-ogy, Employment SkillsCorresponding author. E-mail: [email protected]; [email protected]

Special Thematic Session 12Developing Assistive Technology Together withEnd-users, Business, Healthcare and Knowl-edge Institutes – Challenges and Benefits

This thematic session focusses on the potential of liv-ing labs in supporting companies in further develop-ing assistive technology in order to develop an effec-tive, usable and sustainable solution of the real prob-lems in health care. What is the benefit o f coopera-tion between companies with AT, knowledge institutes and health care organizations? What is the contribu-tion of research institutes like universities and applied knowledge centers involved? And how do health care institutions themselves organize in order to improve the match between assistive technology developed and needs of in health care.Chair: Paulette Wauben-Penris

Designing End-user Adaptable Interactive Rehabil-itation TechnologyDaniel Tetteroo∗

Department of Industrial Design, Eindhoven Univer-sity of Technology, Postbus 513, 5600 MB, Eindhoven,The Netherlands

Background: Technology supported rehabilitationtraining after stroke has been a topic of interest formany years. While numerous solutions have been de-veloped and evaluated, most of these solutions pertainto a limited set of exercises, pathologies and use cases.


Providing personalized solutions, and adapting to newor changing patient demands, is difficult for such tech-nologies, since most of their functionality has been de-fined during a design phase that predates their actualuse. This calls for technology that facilitates adaptationand customization to patient needs, without demand-ing skill and knowledge typically associated with de-signing or implementing new technology.Method: In close collaboration with a clinical part-ner, we developed TagTrainer: an end-user adaptabletechnology for physical rehabilitation after stroke. Inan iterative, user-centered process, therapists were in-volved in the design and implementation of the tech-nology. TagTrainer consists of multiple interactive sur-faces that detect objects outfitted with RFID tags, andprovides visual and auditory feedback. The system isconnected to a computer on which therapists can mod-ify, expand or create exercises for individual patients.Any object of daily life can be integrated into an ex-ercise, simply by attaching an RFID tag to it. Tag-Trainer was evaluated in four field studies in rehabil-itation clinics for a total of 24 weeks. In all studies,we measured technology acceptance (UTAUT), inter-viewed therapists on their experiences in using Tag-Trainer, and analyzed the rehabilitation exercises thatwere created by the therapists.Key results: Technology acceptance was moderateover the four studies, remaining relatively stable overthe course of each study. Therapists created a totalof 37 new exercises for their patients, showing thatin principle they are able to adapt TagTrainer to theneeds of their patients. However, through the inter-views we also encountered several issues pertainingto the feasibility of implementing an end-user adapt-able technology such as TagTrainer in a clinical con-text. Amongst others, the organizational model of clin-ics does not facilitate therapists in engaging in activ-ities other than patient treatment. Additionally, thera-pists indicated that important efficiency benefits couldbe reaped from (partly) reusing existing exercises, butthat judging the usefulness of exercises created by col-leagues for a particular patient prevented them fromdoing so. Finally, the therapists voiced concerns aboutthe impossibility to validate the effectiveness of eachand every personalized exercise.Conclusion: While the principle of an end-user adapt-able technology for physical rehabilitation after strokeseems promising, deploying the technology in a clin-ical context has shown that there still are many chal-lenges to be overcome. Furthermore, the studies haveshown that even when clinical partners are involved

in the development of a technology, non-technical andpolicy issues might arise upon deployment.Keywords: End-user adaptable technology, physicalrehabilitation, stroke, deployment study.∗Corresponding author. E-mail: [email protected]

‘Sharing is Caring’: What are the Main Legaland Ethical Challenges to be Looked at when Co-designing Assistive Technologies?Elisabetta Biasin∗ and Erik Kamenjasevic∗

Centre for IT & IP Law, Faculty of Law, KU Leuven,Sint-Michielsstraat 6 box 3443, 3000 Leuven, Belgium

Background: The way in which assistive technolo-gies (ATs) are ideated and produced today has signifi-cantly evolved from the fashion in which they used tobe done in the past. Over the recent years, new forms ofbottom-up innovation and social collaboration for theco-creation of healthcare solutions have emerged. Suchinitiatives involve the interaction of a range of stake-holders, including designers, healthcare professionals,makers, fab labs, and end-users who – for different pur-poses or ideals – put together their efforts and knowl-edge in order to co-design and reproduce various typesof ATs. One notable example of this new paradigm isrepresented by Careables.org platform – an initiativeby the Made4You project. Its aim is to create an on-line platform to enable stakeholders possessing broadand diverse knowledge to share it for the subsequentco-creation and reproduction of customized healthcaresolutions. Examples of ATs created in such a man-ner include 3D-printable prosthetics hands, wheelchairmounted environment controllers, learning supports,assistive phone cases, open lights for wheelchairs, tomention but a few. While social effects concerning co-designing initiatives clearly appear to be beneficial –especially in cases where a given AT does not exist onthe market yet, it is too costly, or it has not been tailoredto meet the needs of an individual – the ethical andlegal requirements have only been partially addressedin the literature and have rarely been implemented inpractice by the aforementioned stakeholders.Method: Through this contribution we will outline themain legal and ethical requirements to be regardedwhen a healthcare practitioner, developer or an indi-vidual wishes to design, co-create or reproduce an ATthrough such a bottom-up approach. This contributionstems from a desktop research carried out within thecontext of the Made4You project by legal researchersof KU Leuven whose main focus was on the EU


primary and secondary legislation dealing with pri-vacy, data protection, intellectual property rights, opensource/hardware licensing, and medical devices regu-lation. Finally, the main ethical principles will be out-lined.Key results: With regard to the legal framework fol-lowing questions will be addressed: what is the appli-cable EU legal framework for co-designing ATs andwhat are the main legal requirements to be considered?The research has shown that as of primarily interestfor stakeholders are fundamental human rights (in par-ticular privacy and data protection), intellectual prop-erty rights and open source/hardware licensing, liabil-ity of ATs co-manufacturers, and qualification of a co-designed AT as a medical device. With regard to theethical framework the question that has been studiedis: what are the major ethical principles to be regardedwhen co-designing a new AT? Principles such as jus-tice, beneficence, and non-maleficence have been em-phasized as the most relevant in such a context.Conclusion: The findings to be presented through thiscontribution aim at providing a point of discussionabout the legal and ethical aspects for the co-designand co-creation of ATs. The research results are di-rected towards all stakeholders that may have an inter-est in undertaking co-designing activities in order toraise awareness of the crucial legal and ethical require-ments that should not be overlooked when applying thebottom-up approach for the development of ATs.Keywords: Intellectual property, open hardware li-censing, medical devices.∗Corresponding author. E-mail: [email protected]; [email protected]

Structural Collaboration Between Care Organiza-tions and UniversitiesRamon Daniëlsa,b,∗ and Sil AartsbaResearch Centre for Assistive Technology, Zuyd Uni-versity of Applied Sciences, Nieuw Eyckholt 300, 6400AN Heerlen, The NetherlandsbLiving Lab in Ageing & Long-Term Care, MaastrichtUniversity, Duboisdomein 30, 6229 GT Maastricht,The Netherlands

Background: Care technology is regarded as one ofthe solutions dealing with a growing demand for care.In the Netherlands, care professionals are often con-tacted by companies marketing their new products. Al-though long term care organizations are open to newtechnological developments (e.g. e-health, robots and

virtual reality), healthcare professionals dealing withtechnology implementation in long-term care, face anumber of challenges. Firstly, the technology doesn’t(always) fit the needs of clients and/or professionals.Secondly, research regarding the added value or fea-sibility of technological products is scarce; care or-ganizations often lack capabilities and time to eval-uate the technology at hand in a proper and concisemanner. Lastly, there is lack of structural implemen-tation of care technology within long term care or-ganizations, often resulting in ad-hoc decision mak-ing. Seven institutes for long-term care decided to joinan initiative started by the Living Lab in Ageing &Long-Term Care (Academische Werkplaats Ouderen-zorg Zuid-Limburg, AWO-ZL).Method: The collaboration named “AWO-ZL GroupCare Technology” started in September 2018. Our aimis two-folded:– Reaching more efficiency for care organizations by:∗ Collaborating in assessing the added value and

feasibility of care technology;∗ Sharing experiences and acquired knowledge re-

garding (test results of) care technology;∗ Involving researchers (supported by bachelor and

master students) in life-testing.– Contributing to the development of care technology

products by:∗ Providing feedback to entrepreneurs (on technol-

ogy in different stages of development) based ontheir pitches;

∗ Organizing and performing life-tests regardingthe technological products those entrepreneurshave developed.

Representatives of the seven care organizations, ZuydUniversity and Maastricht University agreed to meetbimonthly in order to invite technology companies. Inthese meetings new technologies are discussed even asmethods to evaluate them and outcomes of life-testswhen available. Each care organization agreed to per-form at least one life-test a year, supported by scientificresearchers at Zuyd University and Maastricht Univer-sity. Short interviews were held to capture the experi-ences of care professionals and entrepreneurs.Key results: Six meetings have taken place in which10 companies pitched their technological products; 4life-tests have been or are planned to be conducted.The first evaluations show positive experiences: careprofessionals realize they often deal with similar ques-tions: Does the technology work? Do we have (this)need for innovation? Does it fit our patients? Do our


healthcare professionals know how to use the technol-ogy at hand? Hence, there’s a lot to learn from the ex-periences and knowledge of other organizations. En-trepreneurs value the positive attitude displayed in themeetings; they feel it is beneficial to meet experts inde field of care technology in order to have thoroughdiscussions. For Zuyd University and Maastricht Uni-versity the collaboration is a good example of our liv-ing lab where practice, research and education inter-twine creating a valuable learning environment for allinvolved (incl. care professionals, researchers and stu-dents).Conclusion: Collaboration between care organizationsand universities for evaluating care technology seemsbeneficial in order to improve implementation of caretechnology in long-term care organizations.Keywords: Living Lab, Long-Term Care, AssistiveTechnology, Technology Implementation.∗Corresponding author. E-mail: [email protected]

Design and Implementation of a Multimodal Wear-able System for Functional Assessment in Rehabil-itation and WorkRoberto Sironia, Paolo Peregoa, Viviana Casaleggib,Emanuele Gruppionib, Angelo Davallib, RinaldoSacchettib and Giuseppe Andreonia,∗aDesign Department, Politecnico di Milano, Lab.TEDH-Sensibilab, Via G. Previati 1/C, 23900, Lecco,ItalybCentro Protesi Inail, INAIL, via Rabuina 14, 40054,Vigorso di Budrio, (Bo), Italy

Background: Nowadays, wearable systems offer a notintrusive ecological solution for people monitoring andfunctional assessment. These platforms represent anideal tool for evaluating the rehabilitation evolutionand job reintegration of people. To control physical andphysiological parameters during rehabilitation process,a multi-parametric system is mandatory, but currentsystems are bulky or not fully integrated. The aim ofthis project is to develop a modular textile sensing plat-form fitting different people and job situations.Method: Co-design mixed with technical analysis isthe adopted method. Three design iterations were car-ried out. In the first step, two Users focus groups par-ticipated by patients, caregivers and technologists werecarried out for the design of the basic requirements.A dedicated and ad-hoc created, questionnaire web-administered to 40 end-users provided the final def-

inition of the functional requirements of the system.The second step consisted in the technical analysis anddesign and its validation with a panel of users. An-thropometric analysis and wearability analysis wereconducted in parallel with textile materials analysisand technologies selection (for sensing, processing andtransmission); according to these outcomes, a prelimi-nary design was developed for aesthetical and comfortassessment only, by simulating hardware shapes andvolumes and weight through rapid prototyping tech-niques. A questionnaire for acceptability and usabilitybased on 5 questions (using Likert scale) confirmed thedesign.Key results: According to the results of user research,the main system requirements are: on one side, theneed to have a modular wearable system, which guar-antees high levels of comfort in terms of breathabil-ity, freedom of movement and wearability; on the otherside, the system has to guarantee an accurate and dedi-cated monitoring of the specific rehabilitation activity.In particular, the co-design process highlighted that allusers are firstly interested in evaluating the global mo-tor function or even of specific body segments, withcomparison of data from the contralateral body dis-tricts. Physiological parameters as single-lead electro-cardiogram, breathing rate and depth and muscular ac-tivity, are relevant in subjects with specific cardiovas-cular pathologies, e.g. post- strokes, when also a totalbody motor assessment could be useful to be achieved.According to these outcomes, the wearable system inits full configuration is being developed through theimplementation of 13 inertial sensors placed onto thebody segments in a network which is integrated withthe sensing platform composed of conductive fabricelectrodes and a dedicated device for ECG, heart ratefrequency and respiratory activity (and also EMG infuture configuration).Conclusion: The Multimodal Wearable system is de-signed to support monitoring of people during reha-bilitation and job reintegration in an ecological settingand in a truly integrated physio-physical approach. Thecomplete development and validation are still ongoingbut, the promising results about system accuracy in realsituations open new perspective for application of thesystem in work related pathology prevention and evenin sport performance assessment.Keywords: Wearable System, Multimodal monitoring,Co-Design, Ergonomics, Rehabilitation.∗Corresponding author. E-mail: [email protected]


Making Black Swans Free as a Bird: Freedom,Safety and Courage in Psychogeriatric CareSamuel Schrevela,∗, Ad Blomb, Dick Rijckena, Jan-neke Vervloeda and Erwin de VlugtaaResearch Group Technology for Health, The HagueUniversity of Applied Sciences, Johanna Westerdijk-plein 75, 2521 EN, Den Haag, The NetherlandsbPieter van Foreest Nursing and Care Homes,Raaigras 102, 2643 JJ, Pijnacker, The Netherlands

Background: Living Labs are public private partner-ships that aim to bring innovation closer to practiceand, in this study, make innovations more meaningfulfor healthcare practice. This Living Lab project wasconducted in a closed psychogeriatric unit in a health-care organization in the Netherlands. The facility ex-ists of units with three floors for six psychogeriatricclients on top of each other, which limits the space forclients to move around freely. Dementia patients some-times have the urge to walk and become restless if freemovement is not allowed. This restlessness negativelyinfluences the wellbeing of themselves and the otherresidents. This project aims to explore possibilities toincrease freedom for restless psychogeriatric residents,given the physical constraints of the facility and its lo-cation.Method: The project consisted of two phases. The firstphase was an in-depth exploration of the problem with-out focusing on possible (technological) solutions: in-terviews (n = 29) were conducted with various staffmembers, and four staff members were shadowed dur-ing both day and night shifts. Maximum variation sam-pling was used to ensure the inclusion of perspectivesand experiences of all relevant stakeholders concerningthe facility. The data were analyzed using open cod-ing to create a list of themes that were used for thesecond phase. Secondly, the project group, consistingof researchers and employees of the organization, re-flected on the central themes in three sessions follow-ing the method of frame innovation to formulate inno-vative solutions.Key results: Major emerging themes were freedomversus safety, risk staking, lack of contact with col-leagues, high work load and time constraints. Staffreported difficulties moving between the unit floors,and that unrest amongst residents negatively influencestheir ability to deliver person-centered care. Courage,the willingness to try new possibilities without know-ing what the possible outcomes and consequencesare, emerged as a necessity to deal with the prob-lems of the facility. Whilst deliberating courage, the

insight emerged that only a handful of known resi-dents (‘black swans’) become restless when their free-dom was restricted. If those individuals could be tem-porarily moved to a different location in the facility,which has a circular hallway, disturbances for all psy-chogeriatric residents may be avoided. This solutionemerged without focusing on technology as a startingpoint but, according to the participants, it will createa context wherein the use assistive technology has alarger chance of success.Conclusion: Even though this project did not take as-sistive technologies as a starting point, the findings ofthe project are relevant for innovators in technology.All participants came to agree that simply implement-ing new technologies would not have addressed theproblem of the facility. Due to the participatory natureof the research a truly innovative solution was foundwhich, additionally, may increase the chances of suc-cess for assistive technologies in reducing restlessnessfor the residents. From a socio-technical perspectivethis makes sense: healthcare contexts are systems inwhich people and technologies are closely interrelated.Only if social and technological innovation go handin hand, chances of success can be significantly in-creased.Keywords: psychogeriatric care, participatory rese-arch, socio-technical perspective.∗Corresponding author. E-mail: [email protected]

Stay@home with Dementia: Companies, Health-care, and Knowledge Institutions Challenged forUser-centered DesignRyanne Lemmensa,∗, Jorina Reekmansa, Steffi Rijsb,Claudia Tersteegb, Benjamin van der Smissenb andAnnemie SpoorenaaPXL University of Applied Sciences and Arts, Guf-fenslaan 39, 3500 Hasselt, BelgiumbVIVES University of Applied Sciences, Xaverianen-straat 10, 8200 Brugge, Belgium

Background: Assisted technology (AT) can supportthe growing number of patients with dementia andtheir caregivers in daily life, to improve independenceand safety. A mismatch between AT and the needs ofpersons with dementia might explain the limited useof AT. Pro-active involvement of clients and (informal)caregivers(s) in the design and implementation of ATwill maximize implementation and the likelihood oftechnology acceptance. In this project, AT for patientswith dementia were designed based on clients’ and


caregivers’ needs by bringing companies, healthcare-and knowledge institutions together. The aim of thisabstract is to address the design process and experi-enced difficulties.Method: Three teams consisting of 5 companies and 7healthcare institutions were created to design AT. Theknowledge institutions coordinated the collaboration.An iterative user-centered design approach was used inwhich the double diamond model was applied. Firstly,a needs assessment [Jorina Reekmans, Ryanne Lem-mens, Steffi Rijs, Annemie Spooren. Stay@home withdementia: from needs assessment to assistive technol-ogy, this volume] resulted the top-10 problem activi-ties and their barriers which were translated into func-tional requirements (= discover phase). Secondly, inthe define phase, the needs and requirements relevantfor the AT being developed were defined. Next, pro-totypes were developed during an iterative process bycompanies with input of healthcare professionals, re-peatedly checked for the functional requirements andtested multiple times with (informal) caregivers (= de-velop phase). In the near future, prototypes will betested with clients. At the end, an AT adapted to theneeds of clients will be delivered. Feedback on the pro-cess was gathered in an iterative way by observationand informal interviews. At the end, teams were inter-viewed about their experiences.Key results: A co-creation session was organized, in-cluding different methods encouraging user-centereddesign, to develop conceptual designs of AT. Basedon the problem activities ‘using appliances’ and ‘dis-orientation’, 3 prototypes were developed: 1) a sim-ple and adaptable TV remote with possibilities to linkwith a relax chair; 2) an AT to stimulate day struc-ture, making use of home automation and video mes-sages for clients; 3) a digital buddy in which infor-mal caregivers receive feedback about the actions ofthe client. Adaptations were made during the iterativeuser-centered process based on feedback received dur-ing tests with (informal) caregivers. In the first itera-tion the team members were uncertain about their roleand there were some difficulties with communicationand collaboration. However, at the end, all stakehold-ers indicated the added value of the complementaryexpertise and collaboration. Companies and healthcareinstitutions indicated they were not used to think outof the box with a focus on the problems and barri-ers. Knowledge institutions experienced difficulties re-garding how to translate user needs into technical re-quirements and some practical problems (i.e. bringingtogether the team, recruiting clients to test the proto-types). Results of the final interviews are ongoing.

Conclusion: This study gives an overview an iterativeused centered design process for AT for clients withdementia living at home. The conclusive enrichment ofthe process explains the added value of intensive inter-disciplinary collaboration between different stakehold-ers. However, during this process, difficulties regardingcollaboration and practical issues had to be overtaken.Keywords: assistive technology, dementia, user-centered design, collaboration between companieshealthcare organisations knowledge institutions.∗Corresponding author. E-mail: [email protected]

ARTHE: Development of an Upper Limb ActiveSmart weaRable Orthosis for Stroke THErapyRoy Sevita, Romy Selsa Stijn Bukenbergsa, LuizaMurarua and Veerle Creylmana

aMOBILAB & Care – Thomas More, Kleinhoefstraat4, 2440 Geel, Belgium

Background: Recovering from stroke is a long andintensive process for both patient and therapist. Sincethe rehabilitation process is limited in time, focusis primarily on regaining lower limb functionality.Non-functional upper limbs are consequently foundin 30%–66% of stroke patients, and only 5%–20%show complete recovery. To stimulate the brain mo-tor (re)learning process, therapy should include activeparticipation during repetitive, task-specific and moti-vational exercises. In this context, the use of assistiverobotic devices, complementary to conventional ther-apy, contributes to enhanced upper limb motor recov-ery. This abstract presents the development of an up-per limb exoskeleton “ARTHE” that enables patients toenhance their exercise routine.Method: An exoskeleton, assisting stroke patients dur-ing intended flexion and extension elbow movements,was developed based on field observation, literature re-view and co-creation sessions with both therapists andpatients. The device uses EMG sensors (biceps and tri-ceps) and a load cell (integrated in the distal part of theexoskeleton) to detect the user’s movement intention.Based on these signals the actuation unit provides mo-tor assistance according to exercise and patient specificrequirements. An actuation unit capable of delivering24 Nm continuous torque was selected. To keep the el-bow brace lightweight and comfortable, the proposedprototype transfers torque through a Bowden cable sys-tem, so the actuator module can be placed on a morestable surface or region (e.g. hip or table). This pro-


totype was tested on 10 healthy subjects and 9 strokepatients, performing therapeutic exercises in a clini-cal setting (two 30-minute sessions with 1-week in-terval). Healthy subjects, patients and their therapists(n = 2) that participated in the study answered a ques-tionnaire (based on the D-QUEST instrument) relatedto ease of use, quality of movement and qualitativeimprovements. Additionally, the interaction forces be-tween therapist and patient were measured during con-ventional therapy sessions (n = 8) to define the mini-mal necessary motor torque to be applied by the actu-ation unit.Key results: All 9 stroke patients reported a desire topractice more with the ARTHE device, while 8 out of 9found that ARTHE improved their impaired upper limbmovement quality. General concerns were the size ofthe device and usability in a home environment. Theoriginal anticipated continuous torque of 24 Nm wasfound to be too high for use in a therapeutic setting.The measurement of the interaction forces betweentherapist and stroke patients revealed that an actuationunit with a continuous torque range of 4–5 Nm and apeak torque of 16 Nm is sufficient, reducing the unitsignificantly in both size and weight. The force sensorproved to be a more reliable sensor for the stroke pa-tient population. It also increases the user-friendlinessby eliminating the need for specific sensor placement.Conclusion: A prototype of an upper limb robotic de-vice was developed. It received positive reactions frompatients that tested the device, since they perceivedan improvement in their movement quality. However,the device still needs to be downscaled and usabil-ity should be further improved. As input signal, forceproved to be more user-friendly compared to EMG.Keywords: Exoskeleton, Upper Limb, Elbow, Stroke,Rehabilitation.∗Corresponding author. E-mail: [email protected]

Combining Forces in Further Developing an Inno-vation for Incontinence CareL. van der Heidea,∗ and P. Waubena

aResearch Center for Technology in Care, Zuyd Uni-versity of Applied Sciences, Henri Dunantstraat 2,6419 PB, Heerlen, The Netherlands

Background: In the Netherlands 750.000 people haveto cope with the consequences of urine incontinence.High expenses of 149 million on a yearly basis arepartly due to the fact that often material is changed be-

fore saturation levels are reached. On the other handmaterial is regularly changed late resulting in discom-fort for clients and increased care tasks for staff due tochanging bed sheets and clothes and washing clients.The IncoSense Smart is an innovation developed byIncoSense bv that aims to contribute to solving ineffi-ciencies and discomfort in incontinent clients. The toolconsists of a sensor, a wearable that measures the satu-ration level of incontinence material, a notification sys-tem and a management dashboard. Aim of this studywas to assess the impact of the IncoSense Smart at thelevel of the client, care, and organization in a real lifesetting.Method: The study was conducted in a somatic and apsychogeriatric intramural elderly care facility in theNetherlands. Phase 1: the current state of the art andneeds with respect to incontinence care were investi-gated in one focus group session and two individualsemi-structured interviews with staff. Phase 2: techni-cal validation within one of the participating care facil-ities of the IncoSense Smart and investigation its im-pact. Technical validation was done in a one week testperiod. The impact of the IncoSense Smart was as-sessed among 10 somatic, 10 psychogeriatric patientsand their caregivers. Data on saturation of the materialwere collected in week 0, 1, 4 and 10. A focus groupwith staff and individual interviews with clients com-pleted the study. Outcome measures were: client andstaff experiences, saturation of incontinence materialwhen changed, accuracy changes (too early, late, ontime), extent to which clients wear material of appro-priate size, amount of incontinence material use.Key results: Seventeen clients completed the study.Average age of clients was 82 years (range: 67–96).People had been living in the care facility for on aver-age for 33 months (range 2–121). Practically, it was notalways to possible to detect saturation levels of incon-tinence material as clients took off the sensors, sensorswere thrown away with the material itself by staff, no-tifications were not sent or received to phones of staff.446 pieces of incontinence material were weighted inthe study period, which contained on average 358 mlof urine. The average saturation level was 40%.Conclusion: Testing in a real life setting gives essen-tial information for the (further) development of the In-cosense Smart. Not every incontinent client in a carefacility will benefit equally from the IncoSense Smart,so selection of the appropriate target group requires at-tention when implementing the system. Size of mate-rial used is often too large, an additional advantage ofthe IncoSense Smart appeared that it makes staff aware


of the need for using the appropriate sizes and applyingmaterial correctly. Adaptations were done to the designof the IncoSense Smart in the meantime and the devicehas been tested in a care facility in Belgium.Keywords: Incontinence, Elderly Care, Dementia,Sensor technology.∗Corresponding author. [email protected]

Special Thematic Session 13Challenges and Open Issues in Indoor andOutdoor Accessible Mobility

Mobility can be defined as “the ability to move orbe moved freely and easily”. Despite the advances inICT, where mobile devices and smart objects (includ-ing sensors and internet of things technologies) be-come even more pervasive and powerful, mobility, and,in particular, accessible mobility is still an issue diffi-cult to address, both in the indoor and outdoor envi-ronment. In fact, these two contexts let emerging dif-ferent structural problems impacting the mobility ofpeople with impairments under different aspects. Justto present some examples: architectural barriers canblock the mobility of people with mobility impair-ments and elderly people, both in the indoor and out-door spaces; missing accessible information can makehard enjoying a building or a urban path by vision im-paired people; people with cognitive disabilities canface difficulty in orienteering due to the difficulty inusing the wayfinding systems that can be perceived ascomplicated and unstructured. The goal of this specialthematic session is to create an opportunity to put to-gether experts investigating this topic of interest, and todiscuss challenges and open issues in providing acces-sible mobility, considering both limitations in the cur-rent technologies (such as Bluetooth Low Energy tech-nology accuracy for indoor context) and methodolo-gies (such as relying on voluntary crowdsourcing or,on the contrary, on official sources as unique sources ofinformation), and unexplored possibilities (such as in-novative low-cost and non-intrusive sensing technolo-gies).Chairs: Catia Prandi and Silvia Mirri

Indoor Navigation for People with Visual Impair-mentMostafa Elgendy,∗, Viktor Földing, Miklós Herpergerand Cecilia Sik-LanyiDepartment of Electrical Engineering and Information

Systems, University of Pannonia, 8200 Veszprém, Hun-gary

Background: People with Visual Impairment (PVI)have limitation in functions of the visual system. Itprevents them from seeing, communicating or doingdaily activities such as navigation and shopping. So,we have proposed a solution to help them in the shop-ping process using visual tags. In this solution, wehave implemented two applications for identifying PVIlocation and navigating indoor using QR codes andArUco markers. We compared both applications to se-lect which marker gives more accuracy and which onecan be detected from a long distance.Method: We have developed two applications. In thefirst application, QR codes are printed and installedin the environment at regular intervals. Each QR codestore information about the current location. Then, anindoor map has been built using a graph to connectamong all QR codes. In this graph, nodes represent QRcodes while edges are labelled with the direction andthe number of steps between nodes connected to them.This map is stored in a database to be used during nav-igation. When PVI use this application, they give theirtarget location to it using voice commands. Then, itopens the camera to capture photos until a QR codeis detected. The position details stored in the detectedQR Code is used as an initial location. After that, itcalculates the shortest path to the target location basedon the stored map. PVI start walking to the appropriatedirection using navigation commands. During naviga-tion, PVI try to detect QR codes to identify their cur-rent location and receive continuous navigation com-mands. This process is repeated until they reach theirdestination point. The second application is the sameas the first one, but it uses ArUco marker instead of QRcodes. Both of them use camera calibration to make lo-calization more accurate. We compared them to knowwhich one gives more accuracy and which can be de-tected from a long distance.Key results: We have tested the developed two appli-cations to measure precision for detecting QR codesand ArUco markers using different distances (1 m, 2 m,3 m and 4 m). The results show that ArUco markers canbe detected from all mentioned ranges while QR codescan be identified from a range up to 1 m. Moreover,ArUco markers can be detected faster than QR codesbecause PVI do not need to focus the camera in caseof ArUco. The results also show that QR codes cannotbe identified if the image is blurred. However, ArUcomarkers give better results as they can be identified if


the image is blurred from a range up to 4 m. The resultsalso show that QR codes and ArUco markers cannot bedetected when PVI are moving fast.Conclusion: We have presented two applicationswhich used a smartphone camera to identify PVI loca-tion using visual tags. We have compared both of them,and the results show that ArUco markers are more ac-curate for indoor navigation than QR codes.Acknowledgement: The authors thank the financialsupport of Széchenyi 2020 under the EFOP-3.6.1-16-2016-00015.Keywords: Smartphones, Visually impaired, Indoornavigation, Visual tags.∗Corresponding author. E-mail: [email protected]

Understanding Mobility Device Users’ Experiencesof Discrimination due to Physical Inaccessibility: AQualitative StudyCecilia Petterssona,∗ and Per-Olof HedvallbaSchool of Health Sciences, Örebro University, Fakul-tetsgatan 1, SE-701 82 Örebro, SwedenbDesign Sciences, Faculty of Engineering, Lund Uni-versity, Box 118, SE-221 00 Lund, Sweden

Background: By ratifying the United Nations Con-vention on the Rights of Persons with Disabilities(CRPD), Sweden has undertaken to implement therights recognized in the Convention. The ability tomove around in the community is an important part ofenabling participation. According to the CRPD, pub-lic buildings and places have to be made accessible formobility device users. In Sweden, physical inaccessi-bility is an often-occurring ground for discriminationin notifications to Equality Ombudsman (DO). Theoverall aim of this study was to generate new knowl-edge on how mobility device users experience discrim-ination due to inaccessibility, in what situations, andhow they describe their experiences of being discrimi-nated.Method: Applying a qualitative approach, this cross-sectional study involved perspectives from occupa-tional therapy and design/engineering. In order tounderstand mobility device users’ experiences aboutinaccessibility and discrimination, a unique mate-rial consisting of notifications to DO during 2015–2016 was used. A thematic analysis of 74 notifica-tions focusing on discrimination and use of rollators,wheelchairs (manual/powered), and powered scooterswas conducted.

Key results: The analysis resulted in three themes; 1)testing the regulations and hope for a change; 2) beingable to be treated and living like people without dis-abilities; 3) being able to participate and being inde-pendent in all environments. The results showed thatpersons who report discrimination due to physical in-accessibility take support in different laws and regu-lations, and some notifications revealed requests forcompensations. The notifications described how differ-ent regulations and conventions serve as basis for per-sons with disabilities to have access to different phys-ical environments on the same conditions as personswho don’t have disabilities. Some notifications showedthat persons who report discrimination ask how lawsare adhered to. Several notifications described howstaff at for example restaurants respond to guests inan undesirable manner, and situations where othersdo not understand their needs. The notifications de-scribed how mobility device users felt discriminated,and disadvantaged due to physical inaccessibility thatexcludes and makes them unable to live their lives asothers and being able to get to places in the same wayas others.Conclusion: Based on mobility device users’ own sto-ries in notifications, this study highlights how peopleexperience consequences of inaccessibility as discrim-ination. The study generates new knowledge on phys-ical inaccessibility as a basis for discrimination. Suchknowledge is important to clarify whether current stan-dards sufficiently cater to the use of different types ofmobility devices, and a contribution towards enhancingstandards and guidelines. In addition, this study con-tributes with important knowledge on inaccessibility tothe ongoing growth of Universal Design.Keywords: Mobility device, Participation, Inaccessi-bility, Discrimination, Universal design.∗Corresponding author. E-mail: [email protected]

MEP CROWD: Improving Mobility of Users withData and Images of High QualitySara Comaia, Emanuele De Bernardia, AndreaMasciadria and Fabio SaliceaaDipartimento di Elettronica, Informazione e Bioing-egneria, Politecnico di Milano, Via Ponzio 34/5, 20133Milan, Italy

Background: Mobile and web technologies allow peo-ple to actively participate in the enrichment of mapswith accessibility information consisting of reports


and/or images on barriers or points of interest (e.g.,Wheelmap, MEP App, mPASS, etc.): maps can dis-play geolocalized pictures of barriers or report infor-mation about accessibility of buildings/streets, typi-cally as non-accessible (often represented with a redicon/segment), accessible with some difficulties (yel-low), accessible (green). Data collected with the helpof users can improve their mobility, but one of the chal-lenges consists in validating the crowd-sensed data, topublish only correct and accurate information.Method: The proposed solution is based on a crowd-sourcing engine and on a mobile application – calledMEP Crowd – that allows users to visualize picturesof barriers reported by other users and answer somequestions created by the engine on the declared typeof obstacle (e.g., the user is reporting a narrow path),its criticality level (e.g., the user declares that it isnot accessible) and about the quality of the pictures;the same questions are distributed to several differ-ent users. They are invited to answer some simplequestions (e.g., “Does the picture show stairs?”), with“yes”, “no”, “I don’t know”. This allows to evaluateboth the reliability of the person who uploaded the re-port, and – by comparing the answers of the single in-dividuals with the answers provided by other users forthe same task – to evaluate also the reliability of theevaluator itself.Users of the MEP CROWD application are engagedwith mechanisms based on gamification techniques(e.g., scoring systems, achievements, badges, etc.); anotification system gives feedback to the user abouthis progress through an established schedule. For ques-tions related to possible explicit content, we apply animage recognition filter that discards those deemed tobe harmful a priori; to be compliant with GDPR, theapp MEP Crowd is PEGI 16.Key results: The approach has been applied to over3500 reports consisting of pictures and forms filledwith data about obstacles reported in a survey donewith middle school students accompanied by targetusers, and have been evaluated by people of differentage and sex. About 25% of the images and reports wereconsidered unclear: in case of single evaluations on thesame barrier, they were discarded; instead, in the caseswhere more than one report of the same obstacle typeexists in the same area, all reports can be merged intoa single report characterized by an overall evaluation,which improves the average quality; moreover, imagescan be ranked and only the images with highest qualityare shown to the final users.Conclusion: MEP Crowd is a system that exploitscrowdsourcing quality control techniques in an appli-

cation that is completely based on people’s reports: itidentifies and keeps only valid answers, ranks images;evaluates the reliability of both the users providing thereports and the MEP Crowd users themselves.Keywords: City Accessibility, Crowdsourcing, Mo-bile solutions.∗Corresponding author. E-mail: [email protected]

On Enhancing Campus Accessibility: AccessibleDigital Signage, Wayfinding, and NavigationGiovanni Delnevoa, Giacomo Mambellia, SilviaMirria,∗, Lorenzo Montia, Catia Prandia, VincenzoRubanob and Paola SalomonibaDepartment of Computer Science and Engineering,University of Bologna, Mura Anteo Zamboni 7, Bolog-na, ItalybMaster Degree in Computer Science, University ofBologna, Mura Anteo Zamboni 7, Bologna, Italy

Background: Moving across the urban environment(both outdoor and indoor) could represent a barrier forcitizens with disabilities. This is crucial in UniversityCampuses, where students with disabilities must besupported in independently moving across buildings,offices, classrooms, and labs. Even if several laws andacts aim to guarantee buildings accessibility, there isa general lack of tailored and accessible informationabout buildings structure (including barriers and facil-ities). In particular, traditional signage reports manylimitations in terms of: information, languages, ac-cessibility, and visibility. Digital signage could coverthis lack. Moreover, many studies are currently con-ducted to evaluate positioning technologies and al-gorithms, providing accessible wayfinding/navigationsystems (for instance: NavCog). Our aim is to studyand identify a system that integrates these two aspects.Method: Our main idea is to exploit technologiesfor indoor positioning and wayfinding/navigation, in-tegrating accessible digital signage, so as to computepersonalized paths and routes (avoiding barriers, in-cluding facilities), providing accessible interface andinteraction (by means of user’s mobile devices). Wehave tested several algorithms and tools and then wehave decided to use Beacon technology to identifyusers’ position (according to user’s proximity), whilesmartphone compass has been used to detect users’ di-rection. We mapped the building with a graph, wherethe beacons correspond to the nodes. Each pair of ad-jacent beacons has been connected with an arc. Eacharc can be marked as accessible, or not, with respect


to a specific disability (e.g., stairs are marked as inac-cessible for wheelchair users). Each point of interest(classrooms, labs, restrooms, offices, etc.) has been as-sociated with a beacon. We have designed and devel-oped a prototype of a mobile app, providing two mainapp usage modalities: (i) reaching a destination withinthe building, with an accessible path (tailored on thebasis of users’ needs and preferences); (ii) exploringpoints of interest in the proximity of user’s position.Once a user selects a destination, the prototype com-putes the shortest personalized path (Dijkstra’s algo-rithm) between the beacon of the starting point (auto-matically detected) and the beacon of the destination.The path is then visualized and updated whenever anew beacon is sensed. The system has been designedand developed by involving users with disabilities, in-cluding them in the development team. The prototypehas been designed for all: it provides an accessible in-terface and interaction for users with visual disabilitiesand it equipped wheelchairs users with tailored acces-sible paths within a building. The app prototype hasbeen developed with ReactNative and it has been testedwith iOS (with VoiceOver) and Android platforms.Key results: We have set up an experiment withina historical building of the University of Bologna(Palazzo Riario), as a real case study, and we have in-volved a group of five students with disabilities (visualand motor/mobility ones), who provided feedback en-riching the whole system, appreciating the potentialityof the involved technologies.Conclusion: The proposed approach can be exploitedin different contexts, integrated with outdoor systems,to support users with disabilities while autonomousmoving in a campus.Keywords: Accessible Wayfinding, Accessible DigitalSignage, Internet of Things.∗Corresponding author. E-mail: [email protected]

Making Tourism Services Accessible to VisuallyImpaired Users Through a Mobile AppCatia Prandia,∗, Chiara Ceccarinia and Silvia MirriaaDepartment of Computer Science, University ofBologna, Bologna, Italy

Background: Tourism, defined as the practice of trav-eling for recreation, is not always accessible to all thepeople. This is particularly true if considering peoplewith visual impairments who often experience difficul-ties in traveling and enjoying unknown destinations.For these reasons, different volunteers and associations

started to provide services to assist visually impairedusers while enjoying recreational activities.With this in mind, we designed and developed a mo-bile application to aggregate this kind of accessible andtrustworthy services and facilitate the meeting betweensupply and demand, exploiting innovative IT strate-gies.We designed the application in collaboration with theBlind Bat association (Forlì, Italy), that deals with theaccessibility of cultural and mobility services for thevisually impaired users.Method: The main idea behind this study is to createan accessible mobile application able to provide visu-ally impaired users with a marketplace where to matchsupply with demand and where providers can meet theconsumers’ needs. In particular, the main goal is toequip users with an accessible multilingual mobile ap-plication where is possible to:

– Set personal preferences related to the graphical userinterface (GUI) in term of colors and contrast, fontsize and family, on the basis of people with low vi-sions and color-blind users’ preferences;

– Discoverer touristic/cultural services provided byassociations and volunteers, based on:

∗ the proximity (exploiting the mobile devicesGPS);

∗ preferences (exploiting a recommendation systemtailored on the basis of the users’ needs and pref-erences, and previously enjoyed services);

– Rate and review enjoyed services, exploiting gamifi-cation to motivate users to contribute with feedback.

To design the application, we involved 100 users (49suffering from low vision and 51 blind users), rangingfrom 13 to 79 years old, in a questionnaire in orderto collect their insights to design such a mobile app.Moreover, we involved 15 users (7 blind users and 8suffering from low vision) in the evaluation of the ac-cessibility and usability of the app. Findings are pre-sented in the next section.Key results: The key findings emerged from the ques-tionnaire, considering information about traveling, are:

– the majority of users (28%) travels “more than oncea week”, the 20% “more than once a year”, the15.5% “once a year”, the 14.5% “once a month”(and so on);

– regarding the motivation behind the traveling, mostof the users (36.5%) answered tourism and the 20%for visiting family and friends;


– the 86% declared they would like to travel more of-ten, and, the same percentage claimed that havinga mobile application will support them in travelingmore.

After the developing of the mobile application (bothfor iPhone and Android OS), 15 users tested the ap-plication, to validate its accessibility and the providedfunctions. One interesting consideration that emergedduring the evaluation was related to the sharing feature,considered really relevant for users.Conclusion: Involving 115 users, we designed, de-veloped, and evaluated a mobile application to facili-tate the meeting between supply and demand, exploit-ing, personalized GUI, recommendation strategies, andgamification.Keywords: tourism for all, gamification, mobile appli-cation, recommendation strategies.∗Corresponding author. E-mail: [email protected]

Shared Control System of Electric Wheelchair forPersons with Severe Disabilities using Reinforce-ment Learning MethodLele Xi∗ and Motoki ShinoDepartment of Human and Engineered EnvironmentStudies, Graduate School of Frontier Sciences, TheUniversity of Tokyo (UT), Japan

Background: Persons with severe disabilities experi-ence difficulties in operating an Electric Wheelchair(EW) mainly due to two reasons. First, some personswith disabilities do not have proper input devices be-cause of their lack of muscle power and the deforma-tion of their hands. Second, even special input devicesare developed to meet their physical conditions, thereis no guarantee that they can operate the EW correctlyas they intend. For the first problem, we have madeinvestigations to understand their physical functions.The structures and parameters of the input devices arethen developed based on the quantitatively evaluationof their physical functions. The results show that al-most all stages of persons with disabilities can use thenovel input devices to give signals with their own op-eration. However, some of their operation is not accu-racy enough to drive an EW especially in some com-plicated cases such as turning left or right in a narrowcorridor even with the special designed input devices.This paper mainly focused on the second problem. Au-tomatic driving wheelchair can partly solve the secondproblem, however, it is not helpful to maintain their

residual physical functions. Therefore, it is necessaryto develop a shared control system which can adjust thecontrol weights between user and machine consideringthe characteristics of persons with disabilities.Method: Based on the results of the previous research,after analyzing their operating characteristics, a sharedcontrol system using reinforcement learning methodis proposed in this paper to adjust the control weightbetween user and machine to meet the requirementthat making full use of usersar operating abilities andgiving assistance when necessary. The reward for re-inforcement learning is designed considering usersaroperating burden, safety and comfort. The structureand the parameters of the reinforcement learning algo-rithms can also be designed to meet the different re-quirements from users such as less training times andthe way the machine side intervenes.Key results: Because the straight and yaw are two fun-damental movements for EW driving, three courses in-cluding going straight in a corridor, stopping beforean obstacle and turning left, are used in the simula-tion to verify the effectiveness of the method. Accord-ing to the user’s operating characteristics, two differ-ent situations are considered: users’ turning signal isinsufficient or users’ turning signal is oversteered. Thesimulation results show that the proposed shared con-trol system can gradually adjust the control weights be-tween the user and machine, making the movement ofthe EW safe and comfortable while ensuring makingfull use of userars control signals. The entire conver-gence process is basically within ten trails.Conclusion: A novel shared control system using re-inforcement learning method is proposed to adjust thecontrol weights between user and machine consider-ing the characteristics of persons with disabilities. Af-ter several trails, the weights between users and ma-chine can be adjusted to make full use of users’ oper-ating abilities and also make the movement of the EWsafe and comfortable.Keywords: Shared control, Electric wheelchair, Se-vere disabilities, Reinforcement learning∗Corresponding author. E-mail: [email protected]

The Effect of Footway Crossfall Gradient on onearm and leg drive wheelchairsTakao Yanagihara∗

Kinki University Faculty of Science and Engineering,3-4-1 Kowakae, Higashiosaka, Osaka, Japan


Background: The footway crossfall gradient is a bigbarrier for wheelchair users. In Japan, the Law forPromoting Barrier-free Transport and Facilities for theElderly and the Disabled and its guideline indicatethat the footway crossfall gradient should be recom-mended to be 1% or less and it might be allowed to beno greater than 2% when it is unavoidable. However,many footway crossfall gradients above the standardremain.Many people with stroke require manual wheelchairsfor mobility. They propel wheelchairs with both thesound arm and leg. It is necessary to clarify the evi-dence for these guidelines how changes in a crossfallgradient affect the accessibility and the physical loadof one arm and leg drive wheelchair users. And the ob-jective assessment of barrier-free road construction toimprove the accessibility of a wheelchair should be in-vestigated. The purpose of study is to clarify the effectof footway crossfall gradient on one arm and leg drivewheelchairs by the wheelchair propelling force.Method: The dynamic wheelchair propelling forcewas measured by using a torque meter equipped ona wheelchair (Kyowa Electronic Instruments) to ana-lyze the required force when propelling on the foot-way crossfall. I experimented two kinds of gradients of0.4% and 4% in actual footway.In this study, I measured the physical load of 4% gra-dient because many footway crossfall gradient abovethe standard and compared it of 4% gradient and flatgradient. Subjects were five healthy persons simulat-ing hemiplegia. They propelled wheelchairs with bothone arm and leg for 30 meters. In addition, I measuredhow much the wheelchair deviated from a center line.The torque propelling force was measured when sub-jects propelled the hand rim at upslope and downslopeside.Key results: When subjects propelled wheelchair us-ing an arm and a leg at the downslope side, the work-load of the 4% gradient was significantly larger thanthe 0.4% gradient. On the other hand, at the ups-lope side, there was no significant difference in work-load. However, in the 4% gradient, two subjects moveddown the slope up to 40 cm from center line whenthey propelled wheelchair using an arm and a leg atthe upslope side, and they applied a great deal of forcein the opposite direction to apply the brakes. Whenwheelchair users propel an arm and a leg, it is thoughtthat a greater force is applied to the leg than the arm.Conclusion: Previous research has shown that there isa difference of force between the upslope and downs-lope sides of a two-hand drive wheelchair. Similarly,

in this study, this difference of force can be achievedby applying a braking force to the upslope side of thewheelchair, and an increase in force on the downslopeside. However, some subjects were unable to keep thewheelchair straight line against the force by the cross-fall, it was found that the crossfll gradient was a signif-icant barrier for wheelchair user with single arm andleg.Keywords: Manual Wheelchair, Cross Slope, PhysicalLoad, hemiplegia.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 14Pathological Speech Processing for Healthcareand Wellbeing

There are an increasing number of people with debil-itating speech pathologies (e.g., due to stroke, Parkin-son’s, etc.). These groups face communication prob-lems that can lead to social exclusion. They are nowbeing further marginalised by a new wave of speechtechnology that is increasingly woven into everydaylife but which is not robust to atypical speech. This the-matic session will present research on the use of audioand speech processing for healthcare and wellbeing.In particular, we welcome papers on detecting, treat-ing and living with pathological speech and associatedconditions. It will bring together researchers from thefields of speech and language processing, medicine,psychology, as well as disciplines related health andaging and thus will contribute to the advancement ofcross-disciplinary speech and language research.Chairs: Heidi Christensen

Global Challenges in Pathological Speech Technol-ogyPhil GreenSPandH, Department of Computer Science, Universityof Sheffield, Portobello, S14DP, UK

Picking up on the theme of AAATE19, I present a crit-ical review of research and achievements in develop-ing speech technology for people whose speech is ab-normal. I will concentrate on what I know: how thingshave developed at the University of Sheffield, wherethis topic has been active for over 20 years. There havebeen notable successes: we have shown that


– It is possible to obtain good recognition results forpeople with severe dysarthria with very simple sta-tistical models if you can train for each individualspeaker.

– Speakers can improve their articulation given visualfeedback based on the closeness of what they say totheir best attempt so far.

– That such feedback can be used as the basis forspeech training aids, where the therapist devises ex-ercises for individual clients.

– That tailored speech recognition can be used as thebasis for a communication aid by using recognitionresults to drive a synthesiser that ‘speaks’ in a nor-mal voice.

– That the models used in statistical speech synthesiscan be adapted to produce a normal voice which cap-tures the characteristics of a client with disorderedspeech.

– That it is possible to restore the individual voiceof someone who can no longer speak at all by alearned transformation from articulatory sensor datato acoustics.

However, the impact of this work has been limited.It tends to produce good demonstrations, papers andPh.Ds but there is little which is deployed in real clin-ical applications. I will discuss why this is so andconclude with suggestions about how the communitymight work together to improve matters. In particular,

– A common problem is in finding enough data formachine learning. We need to automatically collectdata from systems which are already in use and, asfar as possible, to share this data.

– We need to work towards systems which adapt totheir users, rather than insisting that the users adaptto them.

Keywords: speech technology, disordered speech, im-pact.∗Corresponding author. E-mail: [email protected]

Acoustic Features to Support the Perceptual Evalu-ation of Accent Production in Dysarthric SpeechViviana Mendoza Ramosa,∗, Hector A. KairuzHernandez-Diazb, Maria E. Hernandez-Diaz Huicic,Heidi Martensd, Gwen Van Nuffelena,c,e and Marc DeBodta,c,eaDepartment of Otorhinolaryngology, Head and NeckSurgery and Communication Disorders, UniversityHospital of Antwerp, Wilrijkstraat 10, 2650 Edegem,

BelgiumbFaculty of Electrical Engineering, Central Univer-sity Marta Abreu of Las Villas, C. Camajuani km 5.5,50100 Santa Clara, CubacFaculty of Medicine and Health Sciences, AntwerpUniversity, Wilrijkstraat 10, 2650 Edegem, BelgiumdCVO Antwerp Adult Education Center, Distelvin-klaan 22, 2660 Hoboken, BelgiumeFaculty of Medicine and Social Health Sciences, Uni-versity of Ghent, De Pintelaan 185, 9000 Gent, Bel-gium

Background: Prosodic disorders are reported in a sig-nificant number of clinical conditions and have a neg-ative impact on speech intelligibility and comprehen-sibility. Research on acoustic features of prosody inpathological speech is rather scarce. Previous studieson sentence accent production correlate this prosodicfunction with movements of the fundamental fre-quency (F0), intensity and duration. However, it isunclear how differences between accented and non-accented syllables are objectively expressed and howthese changes in F0, intensity, and duration are re-lated with the sentence, and with the preceding seg-ment of the accent location. The goals of this researchare to identify relevant acoustic features of sentenceaccent production in Dutch, including derived featuresof F0, intensity, and duration, allowing the classifica-tion between accented or unaccented syllables in anaccent production task and to objectively demonstratethe similarities and differences between healthy andspeakers with dysarthria in sentence accent production.Method: Persons affected with dysarthria are the prin-cipal population in this study because in healthy speechthe strategies for accent production are more consis-tent, 80 adult speakers (30 healthy and 50 with speechimpairment) were asked to produce 3 pairs of sen-tences with different accent positions. Three expertsperformed perceptual judgments of the samples. Anacoustic analysis of all speech samples was performed,a set of 20 features was generated for each sentenceand was divided into three different groups, resultingin feature sets related to frequency, intensity, and dura-tion within the target syllable, in contrast with the pre-vious syllable and also in contrast with the entire sen-tence. These features were used as input for a LinearDiscriminant Analysis. A statistical analysis was per-formed (two-sample Kolmogorov-Smirnov test), aim-ing to find potential differences in the accentuationprocess of speakers with and without dysarthria.Key results: Outcomes of the analysis show the rel-evant acoustic features used to detect accented and


unaccented syllables and reveal that healthy speakersmainly rely on the following features to produce aperceptually detectable accent: a change in frequencywithin the target syllable with simultaneous increaseof intensity and contrast in frequency between the tar-get syllable and the previous syllable. Speakers withdysarthria mainly use the contrast in frequency and in-tensity between the target syllable and the previous syl-lable rather than the contrast with the rest of the sen-tence. They also use durational parameters as an ele-ment in prosodic accent production. Although in bothgroups some common features are used, they differ sig-nificantly (p < 0.01) in the accent production. Thelatter was established by means of newly developedacoustic features.Conclusion: The results of this study provided a lim-ited set of acoustic features to characterize sentenceaccent in a reliable way. This research allows a bet-ter understanding of accent production and the dif-ferent strategies used by healthy and speakers withdysarthria. It also opens an opportunity for the devel-opment of an objective and automatic tool to evaluatecontrastive stress tasks. This study could be inspiringfor speech-language pathologists looking for compen-satory strategies in patients with speech disorders andmore appropriate therapy methods.Keywords: Sentence accent, Dysarthria, Acoustic fea-tures, Prosody.∗Corresponding author. E-mail: [email protected]

Enabling Early Detection and Continuous Monitor-ing of Parkinson’s DiseaseChristopher Oatesa,∗, Andreas Triantafyllopoulosa andBjörn Schulera,b,caaudEERING GmbH, Gilching, GermanybZD.B Chair of Embedded Intelligence for HealthCare and Wellbeing, University of Augsburg,GermanycGLAM – Group on Language, Audio & Music, Impe-rial College London, UK

Background: Parkinson’s disease (PD) currently af-fects 6.3 million people worldwide, and with an ag-ing European population, this number is set to rise.People with this incurable disease suffer from weak-ness, tremor, and rigidity. Biomarkers of the diseasehave yet to be fully investigated, and so expensive andtime-consuming clinical assessments are required butall too often never carried out. Early detection of thedisease and continuous monitoring of its progression

can greatly aid in the application of therapies to delayfurther symptoms and help patients and family man-age it both mentally and physically. As symptoms ofPD manifest in the voice, we are working towards au-tomatic recognition and monitoring of Parkinson’s dis-ease directly from the voice. Through embedded sen-sors, PD tests can be carried out at ultra-low-cost,are highly scalable, do not require a visit to a clinic,and can generate high-frequency monitoring data. Ourstudy focuses on differentiating between healthy anddiseased individuals, and predicting the severity of apatient’s disease.Method: Using openSMILE, our large space featureextraction toolkit, we analysed audio samples collectedfrom a clinical trial featuring 20 patients in variousstages of the disease along with a control group of30 subjects of the same age range. We were also pro-vided with UPDRS Scores which denote the severity ofeach patient’s condition on a scale from 0–199 (worst).The audio samples contain extended vowel utterances“aah”, successive consonant-vowel utterances “pa-ta-ka”, read speech, and free speech. Several thousand di-rect and derived audio features were evaluated w.r.t.their correlation with the test subjects. Support vec-tor machine (SVM) classification models were usedto differentiate between patients and healthy subjects,and linear regression models were implemented to pre-dict the patients’ severity of the disease. For this partof the study, only the extended vowel and successiveconsonant-vowel utterances were utilized.Key results: Several audio features have been shownto correlate well with our binary classification tasks.In the case of extended vowel utterances, featureswhich showed strong correlation were MFCC coeffi-cients, Jitter, F0 and Harmonic-to-noise ratio. In par-ticular, F0 variations and discontinuities proved to bethe most useful. Our algorithms were able to provide aclean separation between healthy subjects and patientswith PD, with an average unweighted accuracy of 91%on subject independent folds using a combination ofconsonant-vowel and vowel sounds. In addition, theUPDRS scores were predicted with a Pearson correla-tion of 0.55 using only the successive consonant-vowelsounds.Conclusion: We have successfully integrated theopenSMILE technology in low-resource embeddedsystems like smartphones, but more importantly, inlow-energy wearable sensors such as smartwatches.This is crucial since it enables the continuous monitor-ing of a patient’s condition through a minimally inva-sive device placed on the patient themselves. This de-


vice would monitor the patient’s normal speech in ev-eryday life. More accurate measurements could be fre-quently obtained through structured voice tests (suchas extended vowel utterances), performed on a smart-phone by any health care assistant.Keywords: openSMILE, Parkinson’s disease, wear-able sensors.∗Corresponding author. E-mail: [email protected]

Apkinson: a Mobile Solution for Multimodal As-sessment of Patients with Parkinson’s DiseaseJ. C. Vasquez-Correaa,b,∗, T. Arias-Vergaraa,b,c, P.Klumppa, J. R. Orozco-Arroyaveb and E. Nötha

aPattern Recognition Lab., Friedrich-Alexander Uni-versity, Erlangen-Nürnberg, GermanybFaculty of Engineering. Universidad de AntioquiaUdeA, Calle 70 No. 52-21, Medellin, ColombiacDepartment of Otorhinolaryngology, Head and NeckSurgery. Ludwig-Maximilians-University, Munich,Germany

Background: Parkinson’s disease is a neurologicaldisorder that produces motor impairments in the pa-tients, including bradykinesia, resting tremor, and dif-ferent speech impairments. The motor symptoms prog-ress differently among patients, thus it is important tomonitor their symptoms individually and continuously.The continuous monitoring is not always possible formany patients, especially those with low accessibilityto healthcare services. There is a need for a system totrack the disease progression of the patients individu-ally. A smartphone application that combines speechand movement analysis could be a suitable mechanismto monitor the disease progression. Such applicationwill be beneficial for patients and caregivers to be in-formed about the current stage of the disease; and forclinicians to make timely decisions regarding the medi-cation and therapy of the patients. Various applicationshave been developed to monitor Parkinson’s patients.However, most of them only evaluate the upper andlower limbs symptoms using the inertial sensors fromthe smartphone. There are no applications to performa robust analysis of the speech state of the patients. Onthe other hand, related studies have shown that it is pos-sible to evaluate the speech impairments of Parkinson’spatients using signals captured with the smartphones.However, such studies only consider the smartphone torecord the speech data, without providing a feedbackmechanism to the patient about the current state of thedisease.

Method: We introduced a new application called Ap-kinson to evaluate continuously the speech and move-ment symptoms of Parkinson’s patients, providing afeedback mechanism about the current stage of thedisease. The patients are asked to do different speechand movement exercises every day, which are selectedfrom an exercise bank that contains a total of 35 ex-ercises. The speech exercises include the phonation ofsustained vowels, diadochokinetic utterances, severalsentences that the patient has to read, and the descrip-tion of images that appear in the screen. On the otherhand, movement exercises are captured using the iner-tial sensors of the smartphone to evaluate symptoms inthe upper and lower limbs, such as postural tremor, ki-netic tremor, finger tapping, gait deficits, among oth-ers. At the end of the exercise session, Apkinson eval-uates the performance of the patient, while it keepsa register of the results from previous sessions. Thisanalysis will allow the assessment of the progress ofthe disease of the patients.Key results: At the moment, a group of 20 patientsis testing the functionalities of Apkinson. They per-formed all the speech and movement exercises and re-ceived the proper feedback about their performance.The speech state is evaluated in terms of phonation, ar-ticulation, and prosody, while the assessment of move-ment deficits is evaluated according to the tremor am-plitude and the stability of the movements.Conclusion: We introduced Apkinson, a new smart-phone application designed to capture speech andmovement signals using the patient’s smartphoneswhen they perform different exercises. The patients re-ceive feedback about their performance after doing theexercises. Further releases of Apkinson will include ro-bust models to predict the neurological state of the pa-tients.Keywords: Parkinson’s disease, Mobile application,Speech assessment, Motor assessment.∗Corresponding author. E-mail: [email protected]

Generating Phonological Feedback for Evidence-based Speech TherapyShalini Parekh∗, Azarakhsh Jalalvand and KrisDemuynckIDLab, Ghent University – imec, Technologiepark-Zwijnaarde 122, B-9052 Ghent, Belgium

Background: The number of people with debilitat-ing speech pathologies due to stroke, Parkinson’s orother age-related diseases, is ever-increasing. Tools


to remedy the communication problems or otherwisesupport the patients thus have high social value. Themain points of attention for support are: detection,therapy and assisted living. Our research focuses onspeech therapy, specifically on improving the ASISTOe-health tool for training and evaluating pathologicalspeakers. Below, we briefly list the main propertiesof the existing tool and possibilities to make the e-therapy tool more accessible, more engaging, and moreindividually targeted. The current tool is designed forDutch speakers. Expanding to multiple languages willsignificantly extend the population that benefits fromthe tool. The current version covers a limited set ofpathologies, such as dysarthria and Laryngectomy. Amore versatile and robust model can be obtained bylearning commonalities across different pathologies.Providing detailed feedback, rather than intelligibility,based on phonological features is expected to make thee-therapy more effective.Method: Having access to more data in multiple lan-guages is a vital part of the solution to achieve theaforementioned objectives. To collect and aggregatethe data, we collaborate with clinical institutes (UMC-Utrecht, NKI-Amsterdam) and the industrial sector(EML-European Media Laboratory). 54,231 speakersfrom ASISTO and COPAS database are used, withrecordings of 1 minute/speaker and the target labelquality as follows:

Good Average BadASISTO 65.45% 23.64% 10.91%COPAS 89.61% 6.93% 3.46%

Key results: Pathological data is very diverse andsparse in nature. Handling the more diverse and largerdata-sets requires efficient and flexible training proce-dures to extract the phonological features from the au-dio. Switching from a Multi-Layer Perceptron (MLP)implemented in C to Pytorch was a first step to achievethe desired speedup and flexibility. As a result, trainingtime is now reduced with a factor of 20 without loss inperformance. To further improve the model, we focuson: Robustness: Robust machine learning paradigmson unseen data (e.g., Dropout, mini batch normaliza-tion, weight decay) will be adopted. To combat over-fitting even further, we aim for compact models thatincorporate constraints base on physiology. Exploit-ing commonalities across pathologies/languages: De-spite the differences in pathologies and exercise type,we expect that modified training algorithms could leadto a single overarching and multipronged model. Ex-

ploiting cross-language commonalities is due to theuse of phonological features straightforward. Detailedfeedback based on phonological features: Phonologi-cal features provide extra support to the therapists indiagnosing the main problems, tracking the progress ofthe patient and the efficacity of the exercises (evidence-based therapy). Patients benefit as well from more in-formative feedback.Conclusion: Learning commonalities across patholo-gies and across languages should make the ASISTOtool more versatile and more robust. Also employingphonological features provides a rich analysis of thespeech which is expected to benefit both the speechtherapists and the patient, hence making the e-therapytool more effective.Keywords: TAPAS, ASISTO, Pathological speechprocessing, e-Therapy, Phonological feedback.∗Corresponding author. E-mail: [email protected]

From VIVOCA to VocaTempo: development andevaluation of a voice-input voice-output communi-cation aid appMark S. Hawleya,b,∗, Kate Fryerab and Aejaz Zahida,b

aCentre for Assistive Technology and ConnectedHealthcare, ScHARR, 30 Regent Street, Sheffield S14DA, UKbBarnsley Assistive Technology Team, Barnsley Hos-pital NHS Foundation Trust, Gawber Road, BarnsleyS75 2EP, UK

Background: People with severe physical disabilitiesoften have difficulty accessing communication aids viacommonly available access methods. An alternativeapproach, using dysarthric speech recognition as an ac-cess method, was described at the AAATE conferencein 2007. The voice-input voice-output communicationaid (VIVOCA) was not developed for the commercialmarket at the time, partly due to the limitations of avail-able hardware. Subsequent widespread availability oftablet computers led to the further development of theVIVOCA concept, and a commercially available prod-uct, VocaTempo, has been released as a tablet-basedapp aimed at children and young people. This paper de-scribes the development and evaluation of VocaTempo.Methods: A two-stage collaborative R&D project in-volving a public-sector AT provider, a university re-search centre and company developing speech therapyand communication apps, took place over 18-months.Iterative design, development and evaluation resulted


in an app, which uses the (dysarthric) speech of indi-vidual users as an access method to produce clear syn-thetic speech output phrases. Two evaluation phaseswere carried out; the first was a proof of concept evalu-ation, to assess performance, usability and acceptabil-ity within a controlled environment, and to identifykey user requirements. The second was a ‘real life’evaluation, to the assess performance, usability and ac-ceptability, of an updated app (based on phase 1 find-ings), in everyday usage environments, and to evaluateits potential impact, including how VocaTempo maybe incorporated into usersar communication strategies.The evaluations used a mix of qualitative (observation,interviews with users and therapists) and quantitative(task completion, communication speed) methods.Results: The VIVOCA concept and speech recogni-tion technology were successfully incorporated into aprofessionally produced tablet-based app.First evaluation: Five individuals aged 19–22 years tri-alled VocaTempo. The app was shown to be highly us-able, reliable and easy to learn to use. For 4 out of 5participants, the app was faster than their current com-munication method. Average speech recognition ratewas 94%, ranging from 87.5% to 100%. The appars re-jection of vocalisations due to mis-timing of vocalisa-tions and background noise were issues which neededaddressing. All participants found the app to be accept-able and most wanted to continue to use the app in thefuture. A range of requirements for further develop-ment of the app were identified.Second evaluation: Eleven individuals aged 5–21 yearstrialled the re-developed app. The app recognised 75–100% of vocalisations in controlled conditions, andrecognition increased with use. Participants respondedpositively to the concept of the app and gave positivefeedback to the set up procedure. Qualitative data sug-gests the app was suitable for use in real life situations,and provided examples of how users may utilise theapp for different purposes and in different scenarios.We identified some feature and bug issues and devel-oped practice recommendations on mounting, access,use of external microphones, and user support.Conclusion: The development of the VIVOCA con-cept has resulted in a tablet-based app that successfullyuses speech recognition as a communication aid accessmethod. The app, VocaTempo, has potential benefitsfor a variety of children and young people.Keywords: Communication aid, speech recognition.*Corresponding author. E-mail: [email protected]

Special Thematic Session 15Robotics and Virtual Worlds for wheelchairusers – from ideas to reality: Innovation, Train-ing, and Roadmap to Market (The ADAPTproject)

Assistive Technologies (AT) in the form of SociallyAssistive Robotics (SARs) and smart Electric PoweredWheelchairs (EPWs) can be effective tools to empowerpeople with mobility disabilities and improve socialinteractions, independence and autonomy in everydaylife, leading to positive emotional wellbeing. However,driving an EPW safely can be challenging due to rangeof barriers and this leads to AT abandonment and socialisolation. Existing barriers in the uptake of AT solu-tions for EPW users include interdisciplinary commu-nication, standardization of technology, interoperabil-ity, limited involvement of users, lack of AT trainingfor healthcare professionals, and synergies between re-searchers and markets.In this Special Thematic Session, we will present pa-pers linked to a European collaborative project ‘Assis-tive Devices for empowering disAbled People throughrobotic Technologies’ (ADAPT). The ADAPT projectaims to tackle the above mentioned challenges in threeways. First, the project is adapting existing technol-ogy, and creating new innovative assistive technologiesbased on advances in robotics, namely an intelligentconnected wheelchair equipped with Driving Assis-tance (DA) technologies and a wheelchair driving sim-ulator based on Virtual Reality (VR), for the purposeof testing smart wheelchairs and training/rehabilitatingusers. Second, the project is filling the gap in the cur-rent healthcare workforce development and trainingby developing training materials and sessions to en-gage more efficiently the healthcare professionals withthe use of AT solutions. Third, the ADAPT partner-ship is developing a roadmap of relevant stakehold-ers and market events to promote the results of theproject and ensure the sustainability of the technologydeveloped. The partnership involves fifteen organisa-tions in UK and France, including Health Trusts, Uni-versities and AT companies, with teams of engineers,healthcare professionals and clinical scientists who arecollaborating to build interdisciplinary networks andapproaches to AT technology development, healthcareprofessional AT training, and transfer of knowledge tomarkets. The project is funded by Interreg VA France(Channel) England Programme and runs for 4 years(2017–2020).The papers presented in this session will discussproject progress in the respective areas of AT and so-


cially assistive robotics for wheelchair users, AT train-ing and professional development, and sustainability ofAT solutions in the health and social care sector.Chair: Eleni Hatzidimitriadou

ADAPT: An EU Multidisciplinary Project in Robo-tics Rehabilitation for Empowering People withDisabilitiesNicolas Ragot∗

Institut de recherche en systèmes électroniques em-barqués, Normandie Univ, UNIROUEN, ESIGELEC,IRSEEM, 76000 Rouen, France

Background: Ageing societies and the increase inchronic disabilities are irrevocable trends in the EU.Many people with complex disabilities face increasedisolation due to a loss of independent mobility. Sev-eral studies highlight the key role of innovative As-sistive Technologies and “smart” Electrical PoweredWheelchair as effective tools to empower disabled peo-ple and improve their social inclusion. Nevertheless,standardization, interoperability, limited involvementof users, lack of specialist training for health profes-sionals impede the uptake of such innovations. Thepurpose of this presentation is to give an overview ofthe European INTERREG VA FCE ADAPT project“Assistive Devices for empowering disAbled Peoplethrough robotic Technologies”1 which aims to develop,promote the undertaking of innovative assistive tech-nologies based on Robotics and Information & Com-munication Technologies for the benefit of disabledpeople.Method: A transdisciplinary consortium of French andEnglish partners formed the 4-year ADAPT project,starting in May 2017. The project aims to overcomethe barriers to the uptake of assistive technology by de-veloping:– Driving assistance technologies integrated into a

powered wheelchair to compensate for user disabil-ities and to monitor and report changes in users’health

– A virtual reality powered wheelchair simulator plat-form to give to the user an immersive experienceof driving a smart EPW. Professionals will assess

1The INTERREG FCE Programme is a European Territorial Co-operation programme that aims to fund high quality cooperationprojects in the Channel border region between France and England.The Programme is funded by the European Regional DevelopmentFund (ERDF).

the suitability of the EPW for particular patients andenvironments and gain understanding from the userperspective.

– Developing innovative assistive technologies train-ing programs to fill the current gap in the healthcaretraining programs about digital innovative technolo-gies in the field of health and disability

– Formalizing agreements between research institu-tions and companies to facilitate the uptake of theADAPT’s results by the market.

Key results: An overview of the ADAPT prelimi-nary results will be presented. A specific focus will bepointed out on:

– The virtual reality driving simulator system forwhich a preliminary study has been conducted withvolunteers to evaluate the benefice of the motionplatform regarding the kinestosis issues;

– The driving assistance systems integrated on thepowered wheelchair for which tests have been con-ducted in labs;

– The first units of training programs created for thehealthcare professionals;

– The first activities carried out in order to make theuptake of the ADAPT’s results easier by the market

Conclusion: The talk will give an overview of theADAPT project: context, challenges, methodology ofwork and preliminary results. This presentation willalso highlight the next stages of the project regardingthe development and tests of the technological systems,the next training programs to be developed and the ac-tions undertaken to favor the spreading to the ADAPTresults to the market.Keywords: Assistive technologies, Robotics, Virtualreality, Training, Market accessibility.∗Corresponding author. E-mail: [email protected]

Artificial Intelligence for Safe Assisted DrivingBased on User Head Movements in RoboticWheelchairsPaul Opreaa, Konstantinos Sirlantzisa,∗, SotiriosChatzidimitriadisa, Odysseas Doumasa and GarethHowellsaaSchool of Engineering and Digital Arts, University ofKent, Jennison Building, Canterbury, Kent, CT2 7NT,UK

Background: Wheelchair users do not always havethe ability to control a powered wheelchair using a


normal joystick due to factors that restrict the use oftheir arms and hands. For a certain number of theseindividuals, which still retain mobility of their head,alternative methods have been devised, such as chin-joysticks, head switches, or, sip-and-puff control. Suchsolutions can be bulky, cumbersome, unintuitive, or,simply uncomfortable and taxing for the user. Thiswork presents an alternative head-based drive-controlsystem for wheelchair users.Method: Using recent advancements in the field ofdeep-learning networks, we have developed a drive-control solution based on two popular neural networkmodels, which make use of a low-cost RGB camera totrack the user’s head and estimate its position and ori-entation. Head movements are translated to drive com-mands by which a user is able to control the speed anddirection of the wheelchair. This control system workson top of our collision avoidance algorithm whichadds an extra level of safety and prevents movementsthat could occur from any misinterpreted input. Head-tracking is achieved in two stages. The first stage usesthe popular YOLO deep-learning object detection al-gorithm which we have re-trained specifically for facedetection. The second stage uses a residual neural net-work (ResNet), re-trained specifically for estimatinghead pose. The YOLO network detects the user’s facefrom the camera stream in real time, which is then ex-tracted from the image. The face detected is subse-quently passed to the ResNet neural network, whichoutputs an estimation of the yaw and pitch of the head.These two outputs are translated into drive commands,forward-backward for pitch, and left-right for yaw. Thesystem runs under the ROS (Robot Operating System)framework, and all processing is achieved using a Jet-son TX2 board, an embedded AI computing devicewith a CUDA enabled NViDIA GPU which is poweredfrom the wheelchair batteries.Key results: Trials with twenty participants (not dis-abled) were conducted in a simulated environmentwith a joystick in-the-loop setup as baseline for eval-uation, and an RGB camera for head-tracking. Twosetups were tested: with, and without collision avoid-ance. With the exception of three expert users of thehead-tracking system, who completed the course with-out collisions, first-time users did not successfullypass the course. With the collision avoidance system,all participants completed the course without colli-sions, both using head-tracking and joystick. Averagetime to completion using head-tracking was 70.16%(± 25.78%) higher than using the standard joystickwithout collision avoidance. When driving with the

standard joystick, the collision avoidance system intro-duces an average 22.75% (± 14.56%) increase in com-pletion time.Conclusion: Our system demonstrates the practical-ity of using innovative deep-learning artificial intelli-gence coupled with a collision avoidance system forhead-controlled driving of powered wheelchairs. Thisapproach could prove preferable to currently availablesolutions because of its simplicity and efficiency. Addi-tionally, input from the head-tracking system could beredirected, in order to control a tablet or smartphone,or send commands to a smart home or other Internet ofThings (IoT) devices.Keywords: Artificial Intelligence, Robotic wheelchair,Head-tracking.∗Corresponding author. E-mail: [email protected]

A Simulator to Promote the Return to Work ofWheelchair UsersSara Arlatia,b,∗, Vera Colomboa,b, Matteo Malosioa,Stefano Motturaa, Simone Pizzagallia, Alessio Prinia,Emilia Biffic, Chiara Genovac, Gianluigi Renic andMarco SaccoaaInstitute of Intelligent Industrial Technologies andSystems for Advanced Manufacturing (STIIMA), Ital-ian National Research Council (CNR), 23900 Lecco,ItalybDepartment of Electronics, Information and Bioengi-neering (DEIB), Politecnico di Milano, 20133 Milano,ItalycScientific Institute, IRCCS E. Medea, BioengineeringLab, 23842 Bosisio Parini, Lecco, Italy

Background: Return to work and participation inthe community life have been recognized to improvewheelchair users (WUs) quality of life. Therefore, thedevelopment of strategies to help them recover theirautonomy in the activities of daily living (ADL) rep-resents a key challenge. Virtual Reality (VR) has re-cently emerged as a promising tool for providing endusers with a multi-sensory simulation of diverse sce-narios, in an interactive, controllable, repeatable andsafe environment, increasing the possibility to acquirenew skills. In this work, a VR-based simulator aimedat promoting the work reintegration for WUs has beendesigned and developed.Method: The needs of WUs, as well as the character-istics of current clinical practice in standard care, havebeen investigated to define the requirements of the VR-based wheelchair simulator. Three different scenarios


have been identified to properly address mobility andADL-related issues: (1) driving the wheelchair in anoutdoor environment, and moving around and accom-plish specific tasks (2) in the house and (3) at the work-place.Key results: Up to now, only the outdoor environmenthas been developed. It specifically addresses users’mobility limitations, thus it requires the WU to over-come different barriers, such as ramps or steps, and toavoid moving obstacles, i.e. pawns and cars. The firstprototype has been deployed to run on the GRAIL plat-form (Gait Real-time Analysis Interactive Lab). An ap-propriate seat – to be anchored on the GRAIL tread-mill, together with the two wheelchair’s rear wheels –has been designed in order to fit different anatomicalfeatures and thus to be usable by as many users as pos-sible. Specific modules were developed using GRAILcommercial software (D-Flow) to handle user’s navi-gation in the virtual scene, which is rendered in real-time by using OGRE rendering engine.The currently-developed application allows the simu-lation of both electronic and manual wheelchair; in theformer case, the user will have the chance of using ajoystick, controlled either with the hand or the chin. Inthe latter, markers placed on the wheelchair’s wheelsare used to determine the direction and the velocity ofthe user’s motion.Future Works: The deployed virtual environment willbe validated in the next months enrolling both un-experienced (n = 10) and experienced users (n =10, WST-Q > 80). Data regarding the whole users’experience will be collected and analyzed to assessthe system usability and acceptance, and thus the fea-sibility of a training program exploiting VR dedi-cated to WUs. The other two scenarios (i.e. house andworkplace-contextualized training) will be developedand validated as well. The final step foreseen in theproject is the development of a platform independentfrom the GRAIL. New functionalities will be imple-mented using Unity 3D as game engine to allow thenavigation in the scenes using a Head Mounted Dis-play: this should increase users’ immersion and en-gagement. The GRAIL treadmill will also be replacedwith a Steward platform, plus two motors acting onthe wheelchair’s wheels, for the correct perception ofvestibular and haptic feedbacks.Keywords: wheelchair user, virtual reality, training.∗Corresponding author. E-mail: [email protected]

A Literature Review of the Challenges Encounteredin the Adoption of Assistive Technology (AT) andTraining of Healthcare ProfessionalsSharon Manshipa,∗, Eleni Hatzidimitriadoua, MariaSteina, Claire Parkina, Maxime Raffrayb, PhilippeGallienb and Charlotte DelestrecaFaculty of Health and Wellbeing, Canterbury ChristChurch University, North Holmes Road, Canterbury,Kent, CT1 1QU, UKbRéseau Breizh Paralysie Cérébrale, 54 rue St Hélier,CS 74330, 35043 Rennes, FrancecRouen University Hospital, F-76000 Rouen, France

Background: Long-term disabilities often result inloss of autonomy and social interaction. Accordingly,there is a demand for Assistive Technology (AT) de-vices to enable individuals to live independently foras long as possible. However, many people experi-ence difficulties in obtaining and using AT. This pa-per presents findings from a narrative literature reviewundertaken as part of the development of AT trainingfor healthcare professionals, one of the work areas ofthe ADAPT project (Assistive Devices for Empower-ing Disabled People through Robotic Technologies),funded by EU INTERREG France (Channel) England.The results of the review informed the design of a sur-vey of healthcare professionals regarding their viewsand experiences of AT and the development of ATtraining.Method: The review sought to understand challengesencountered in the adoption and use of AT as well ashow training of healthcare professionals in AT takesplace. A narrative approach was adopted as the mostappropriate way to synthesise published literature onthis topic and describe its current state-of-art. Narrativereviews are considered an important educational tool incontinuing professional development. An initial searchwas conducted via databases in the UK and France, in-cluding CINAHL, Academic Search Index, Social Sci-ences Citation Index, BDSP (Base de données en SantéPublique), Documentation EHESP/MSSH (Ecole desHautes Etudes en Santé Publique/Maison des Sci-ences Sociales et Handicap), Cairn, Google Scholarand Pubmed. Inclusion criteria for the review included:covering issues relating to AT provision and train-ing, English or French language, and published from1990 onwards. Application of these criteria elicited 79sources, including journal papers (48), reports (11), on-line sources (11), books (6) and conference papers (3).Sources were thematically analysed to draw out keythemes.


Key results: The majority of papers were from USAand Canada (27), then UK (20) and France (19). Otherswere from Europe (7), Australia (3), country unknown(2), and one joint UK/France publication. The mainsource of literature was journal papers (48), of whichthe most common types were practice reports (18),evaluation surveys (10) and qualitative studies (9). Thereview uncovered a number of key challenges relatedto the adoption of devices, including: difficulty defin-ing AT across disciplines, lack of knowledge of health-care professionals and users, obtrusiveness and stigma-tisation AT users can experience when using devices,and shortfalls in communication amongst professionalgroups and between professionals and users. Theseissues can lead to abandonment of AT devices. Fur-thermore, substantial barriers to healthcare profession-als exist, including inconsistent provision and qualityof training, lack of evaluation of training, lack of re-sources and funding, shortage of qualified profession-als to teach, and the increasingly rapid development ofthe technologies.Conclusion: Support, training and education for pre-scribers, distributors, users, and their carers is vital inthe adoption and use of AT. Evidence indicates a needfor comprehensive education in the AT field, as well asongoing assessment, updates and evaluation which isembedded in programmes.Keywords: literature review, challenges adopting ATcare solutions, AT training of healthcare professionals∗Corresponding author. E-mail: [email protected]

A Survey of Assistive Technology (AT) Knowledgeand Experiences of Healthcare Professionals in theUK and France: Challenges and Opportunities forWorkforce DevelopmentClaire Parkina,∗, Eleni Hatzidimitriadoua, SharonManshipa, Maria Steina, Sophie Achille-Fauveaub,Julien Blotc, Deborah Lavalc and Charlotte DelestrecaFaculty of Health and Wellbeing, Canterbury ChristChurch University, North Holmes Road, Canterbury,Kent, CT1 1QU, UKbRéseau Breizh Paralysie Cérébrale, 54 rue St Hélier,CS 74330, 35043 Rennes, FrancecRouen University Hospital, F-76000 Rouen, France

Background: Assistive Technologies (AT) in health-care can increase independence and quality of lifefor users. Concurrently, new AT devices offer op-portunities for individualised care solutions. Nonethe-

less, AT remains under-utilised and is poorly inte-grated in practice by healthcare professionals (HCPs).Although occupational therapists (OTs), physiothera-pists and speech and language therapists (SLTs) con-sider that AT solutions can offer problem-solving ap-proaches to personalised care, they have a lesser under-standing of application of AT in their practice. In thispaper, we report findings of a survey on AT knowledgeand experiences of HCPs in UK and France. Trainingneeds also explored in the survey are presented in aseparate paper on development of online training forthe ADAPT project.Method: A survey of 37 closed/open questions was de-veloped in English and French by a team of healthcareresearchers. Content was informed by published sur-veys and studies. Email invitations were circulated tocontacts in Health Trusts in UK and France ADAPT re-gions and the survey was hosted on an online platform.Knowledge questions addressed AT understanding andviews of impact on user’s lives. Experience questionsfocussed on current practices, prescription, follow-up,abandonment and practice standards. 429 HCPs com-pleted the survey (UK = 167; FR = 262) between Juneand November 2018.Key results: Participants were mainly female (UK89.2%; FR 82.8%) and qualified 10+ years (UK66.5%; FR 62.2%). A key group in both countrieswere OTs (UK 34.1%; FR 46.6%), with more phys-iotherapists and SLTs in UK (16.8%, 16.8%; vs. FR6.5%, 2.3%), and more nurses in France (22.1% Vs.UK 10.8%). More HCPs were qualified to degree levelin France (75.2%; UK 48.5%, p < 0.001). In termsof knowledge, all HCPs agreed that AT helps peo-ple complete otherwise difficult or impossible tasks(UK 86.2%; FR 94.3%) and that successful AT adop-tion always depends on support from carers, familyand professionals (UK 52.7%; FR 66.2%). There weresome notable differences between countries that re-quire further exploration. For example, more FrenchHCPs thought that AT is provided by trial and error(84.7%, UK 45.5%, p < 0.001), while more UK HCPsbelieved that AT promotes autonomous living (93.4%;FR 42.8%, p < 0.001). Also, more French HCPs con-sidered that AT refers exclusively to technologically-advanced electronic devices (71.8%, UK 28.8%, p <0.001). In both countries, top AT prescribers were OTs,physiotherapists and SLTs. Respondents had little/noknowledge in comparing/choosing AT (UK 86.8%; FR76.7%) and stated they would benefit from interdisci-plinary clinical standards (UK 80.8%; FR 77.1%). Athird of HCPs did not know if AT users had access


to adequate resources/support (UK 34.1%; FR 27.5%)and rated themselves as capable to monitor continuedeffective use of AT (UK 38.9%; FR 34.8%).Conclusion: Knowledge and application of AT wasvaried between the two countries due to differencesin health care provision and support mechanisms. Sur-vey findings suggest that HCPs recognised the value ofAT for users’ improved care, but had low confidencein their ability to choose appropriate AT solutions andmonitor continued use, and would welcome AT inter-disciplinary clinical standards.Keywords: survey of AT knowledge and practice ex-periences, healthcare professionals, UK, France∗Corresponding author. E-mail: [email protected]

Training Needs and Development of Online ATTraining for Healthcare Professionals in UK andFranceEleni Hatzidimitriadoua,∗, Maria Steina, ClaireParkina, Sharon Manshipa, Philippe Gallienb and Deb-orah LavalcaFaculty of Health and Wellbeing, Canterbury ChristChurch University, North Holmes Road, Canterbury,Kent, CT1 1QU, UKbRéseau Breizh Paralysie Cérébrale, 54 rue St Hélier,CS 74330, 35043 Rennes, FrancecRouen University Hospital, F-76000 Rouen, France

Background: Assistive Technology (AT) solutions forpeople with disabilities has become part of mainstreamcare provision. Despite advantages of AT on offer,abandonment and non-compliance are challenges forhealthcare professionals (HCPs), introducing this tech-nology to clients. Studies of abandonment reveal that1/3 of all devices provided to service users end upstored unused. Key need is training to make informeddecisions about AT tailored to individual needs andcircumstances. In an online survey undertaken by theADAPT project, HPCs identified AT training needsand barriers. Currently, a programme is being devel-oped aimed at introducing AT concepts and enhancingpractices to a wide range of HCPs.Method: Survey questions explored gaps, availabil-ity, qualifications and barriers to AT training in Eng-land and France. A series of consultation meetingswith ADAPT partners took place. An advisory groupconsisting of longstanding AT users and their for-mal/informal carers and HCPs (occupational thera-pist, speech and language therapist, psychologist and

biomedical engineer) contributed to the discussions onsurvey findings, development and evaluation of ATtraining for HCPs, key content areas and means of de-livery.Key results: HCPs had no AT specific qualifica-tions (UK 94.6%; FR 81.3%) nor in-service AT train-ing (UK 65.1%; FR 66.4%). They either did notknow of AT courses (UK 63.3%) or knew that noneexisted (FR 72.5%). Barriers to AT training weremainly local training (UK 62.7%, FR 50%) and fund-ing (UK 62.7%, FR 55.7%). Some training prioritieswere clearer for French HCPs – overall knowledgeof AT devices (82.1%, UK 45.8%), customization ofAT (65.3%, UK 30.1%), assessing patient holistically(53.4%, UK 25.3%), educating patient/carers (56.5%,UK 28.3%) (p < 0.001). Variances may be due todiffering country-specific HCP education approach. Athird of both groups highlighted also abandonment,client follow-up, powered wheelchair training and pre-scribing AT.To bridge gaps in knowledge and identified train-ing needs of HCPs, the online interactive trainingprogramme starts by introducing foundations of AT,including definitions, types/uses of AT, legislation/policies and AT in practice. More specialist units buildand expand on specific areas, e.g. AT for mobility,communication, assessment and evidence-based prac-tice. The biopsychosocial model of Health and WorldHealth Organisation’s (WHO) International Classifica-tion of Functioning, Disability and Health (ICF) frame-work underpin development of content. ICF shifts fo-cus from disability to health and functioning, in linewith a social model of rehabilitation.E-learning comprises existing videos, AT textbookmaterial and bespoke animated presentations. Self-assessment and evaluation of training are embeddedand learners receive certificate of completion. Train-ing was piloted to a group of HCPs trainees and post-registration HCPs who commented on relevance of ATcontent, clarity, accessibility of presentation, and use-fulness. Users found training very useful, especiallylegislation/policies and AT literature.Conclusion: Overall, survey results suggest that bothUK and French HCPs’ training on AT solutions islimited and highly variable. There is need for cross-channel AT professional competencies, availability ofwork-based training and funding support. Develop-ment of online, interactive training aims to increaseprofessional confidence and competence in this area aswell as the evidence base for AT.


Keywords: AT training needs; healthcare profession-als; barriers to training; training priorities; develop-ment of online AT training∗Corresponding author. E-mail: [email protected]

Integrating Ride Dynamics Measurements andUser Comfort Assessment to Smart RoboticWheelchairsElhassan Mohameda, Jihad Diba, KonstantinosSirlantzisa,∗ and Gareth HowellsaaSchool of Engineering and Digital Arts, University ofKent, Jennison Building, Canterbury, Kent, CT2 7NT,UK

Background: Individuals relying on wheelchairs formobility are subject to risk of injury due to exposure towhole-body vibrations for prolonged time as per ISO2631-1. Our study evaluates the feasibility of integrat-ing ride dynamics measurements (i.e. vertical accel-erations) as expressions of user travel comfort assess-ment to smart robotic wheelchairs. This will also helpto mitigate injury risk and discomfort by using real-time electronic measurement systems to ensure adap-tation of wheelchair movement dynamics (accelerationand speed) to the type of ground surface.Method: The INVACARE Spectra XTR2 electricwheelchair, weighting 98 kgs, was used in seven dif-ferent surfaces, indoors and outdoors. It was drivenfor fifteen minutes by one of the authors (body mass88.6 kgs, height 185 cm) for 322 meters. The sur-faces were: Uneven Pavement Slab, Damaged TarmacRoad, Undamaged Tarmac Road, Pavement Bricks,Carpet Floor, Tiled Floor, and Inclined Concrete. Av-erage travel speed was 0.339 m/s. In-house designedsensor devices were placed on the metal frame ofthe wheelchair (location without suspension) and un-der the seat (location with suspension). Collected datawas filtered and analysed using MATLAB. For eachterrain type, the mean, standard deviation, minimum,and maximum of vertical accelerations were calcu-lated, along with Maximum Transient Vibration Value(MTVV). MTVV measures the maximum amplitudeof instantaneous frequency-weighted acceleration atmeasurement time. ISO 2631-1 and related literaturesuggest MTVV as one of the main indicators of injuryrisk and ride comfort.Key results: Results show, for both with and withoutsuspension measurements, Tiled Floor has the high-est MTVV, indicating it would be the most uncomfort-

able and, depending on the value obtained, the riskierto cause an injury if traversed for long time. Differenttypes of tiled floors would produce varied MTVV mea-surements. For this reason we propose that a continu-ous monitoring system is required to be integrated tosmart wheelchairs. In most cases, maximum accelera-tions and MTVV were higher when measured with sus-pension than without. Our hypothesis is that suspen-sion has dampening effects on vertical accelerationscaused by the unevenness of the terrain, but, it can, un-der certain conditions, attenuate also the overall ampli-tude. Thus, it is important to measure both affected andnot affected by suspension locations. Remaining testedsurfaces were ranked for discomfort as expected (us-ing MTVV and mean vertical acceleration statistics),with Pavement Bricks second and Damaged TarmacRoad third, while Undamaged Tarmac Road producedthe lowest values (i.e. less overall vibration).Conclusion: Different terrain types produce levels andtypes of vibrations which are not properly mitigatedby the usual wheelchair suspensions (typically basedon dual springs). This affects ride comfort (expressedby MTVV measurements) which should be consideredin smart wheelchair controller design to improve userexperience enhancing safety and wellbeing. Our elec-tronic controllers integrate real-time measurements toa shared-control assistive driving algorithm, based ona deep learning artificial intelligence training proce-dure. This leads to adjustments of wheelchair speedand acceleration obtained from the shared (user/AI-based) controller for better ride comfort and reducedinjury risk.Keywords: Maximum Transient Vibration Value(MTVV), Ride comfort assessment, Smart wheelchair,Artificial Intelligence shared-control algorithm.∗Corresponding author. E-mail: [email protected]

A Smart Posture Monitoring and Correction Sys-tem for Wheelchair UsersRania Kolaghassia, Konstantinos Sirlantzisa,∗ and PaulOpreaaaSchool of Engineering and Digital Arts, University ofKent, Jennison Building, Canterbury, Kent, CT2 7NT,UK

Background: Wheelchair users may experience dis-comfort and ulceration from continuous sitting. Seat-ing pressure distribution is typically assessed using ex-pensive multi-point measurement mats, not appropri-


ate for real-time posture assessment during everydayuse. Existing solutions include cushions inflating anddeflating alternate air chambers embedded in the cush-ion. These systems operate without user posture feed-back, leading to further ulceration. To address this, wepropose a smart monitoring system to continuously as-sess user posture and selectively adjust a cushion to al-leviate pressure and potentially correct posture orienta-tion. The proposed system measures pressure distribu-tion and adaptively controls air pressure in the cushionto automatically re-adjust posture. This aims to reducethe need of support from carers and reduce ulcers riskand general ride discomfort caused by posture changesresulting from collisions or vibrations.Method: First, we map pressure distribution to deter-mine areas of high interface pressure by low cost forcesensors (Force Sensitive Resistors – FSRs) placed onthe seat. Two types of FSRs are used; one square(4.5 cm × 4.5 cm), and one disc-shaped (2 cm di-ameter), placed at seven locations on the seating area,two at the front, two at the back, one in each side,and one in the middle of a 5 × 5 grid on the45 cm × 45 cm cushion. Five different posture incli-nations were tested (wheelchair at horizontal surface):straight, right, left, forward, backward leaning. Partic-ipants were instructed to lean approximately 20 de-grees from vertical. One further condition tested withthe wheelchair at 10 degrees inclination (17% surfacelateral rise). This represents riding on an inclined path-way (pavement drainage rise 2% to 5%). We tested twosubjects representing approximately the minimum andmaximum of mass and height for the wheelchair used:1) mass 110 kgs, height 185 cm, 2) mass 50 kgs, height165 cm. Tests were contacted on hard seating surface(no cushion) and on normal cushion. Each measure-ment lasted for 30 seconds taken as the mean of sam-pling at 500 ms intervals. Following pressure changesdetected, posture was adjusted using air supply to fourair chamber regions independently. Air pressure wasmeasured and controlled electronically by pneumaticvalves.Key results: Compared to XSENSOR mat (benchmarkbaseline) both types of FSR sensors provide consis-tent measurements for different inclinations (std ± 1%mean value). Measuring pressure using a cushion sub-strate provides more reliable data (no sensor data fail-ures). Also, for left, right leaning, pressure reduction inopposite side provided higher value indicators of corre-sponding inclination. Front and back sensors providedunreliable measurements due to differences in seatingcontact area resulting from footrest height. The cen-

tre of seating area sensor produced many failures (con-sistent with XSENSOR mat indicating low pressureat this location). Finally, small sensors (discs) gavehigher rates of change (−45% to −50%) than largerFSRs (−22% to −38%).Conclusion: Body posture or wheelchair inclinationcan be estimated reliably using disc shaped FSRs at ap-propriate wheelchair cushion locations. Measurementsare proportional to corresponding inclinations and canbe used to control our innovative electronic pressurecontrol for air tube-based cushions to correct at least12% of corresponding posture inclination, thus im-proving user ride comfort.Keywords: Seating posture monitoring, Posture cor-rection, Smart wheelchair.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 16AT2030: A New Approach

Globally, one in ten people who needs assistive prod-ucts and services to maintain or improve their lives hasaccess to them. This number is increasing whilst thegap between need and provision is growing.At the Global Disability Summit two initiatives –AT2030 and ATscale. ATscale is a new global partner-ship for AT which aims to accelerate access to AT andAT2030 is the first programme of ATscale. AT2030 hasbeen designed to be ‘fast start’ – it is an intentionallyflexible and exploratory programme, designed to test‘what works’ in getting life-changing Assistive Tech-nology (AT) to the people that need it the most.AT2030 is comprised of six programmes and our spe-cial session reports on key learnings and challengesfrom each programme. The six programmes are:1. Coordinate evidence and research – is developing

new models for return on investment and creating amarket shaping framework methodology.

2. Spark Innovation – is creating an Innovation Hub inKenya linked to a challenge fund and testing newinnovations in low resource settings.

3. Drive availability & Affordability – is testing mar-ket shaping methodologies, creating market shapingtools and pilot test market interventions.

4. Open-up Market Access – is developing new mod-els of integrated AT service provision.

5. Build Capacity and Participation – is working ininformal settlements in the global South. Scop-ing community-led solutions to AT, researchingcommunity-led practice and inclusive approaches.


6. Support ATscale the Global AT Partnership.We welcome debate on the future direction of AT2030and ATscale.Chair: Cathy Holloway

ATscale – Meeting the Global Need for AT Throughan Innovative Cross-sector PartnershipAlison End Fineberga,∗, Margaret Savageb, VictoriaAustinc, Frederic Seghersb, Catherine Hollowayc, SaraBoitend and Chapal KhasnabiseaATscale, the Global Partnership for Assistive Tech-nology, Geneva, SwitzerlandbClinton Health Access Initiative, 383 Dorchester Ave,Suite 400, Boston, MA 02127, USAcGlobal Disability Innovation Hub, UCL at Here East,8-9 East Bay Lane, London, UKdDepartment for International Development, 22 White-hall, Westminster, London SW1A 2EG, UKeWorld Health Organization, Geneva, Switzerland

Background: Today, over 1 billion people need at leastone form of assistive technology (AT), but 90% do nothave access to the AT they require. The number of peo-ple who need AT is expected to grow to more than 2billion people by 2050. Despite evidence and consen-sus around the huge unmet need for AT globally, re-search shows a wide range of systemic, underlying en-vironmental challenges and cross-cutting factors con-tributing to the challenge in matching appropriate sup-ply and demand for AT. While progress has been madein improving many aspects of AT delivery, the sec-tor has been fragmented and under-resourced for sometime. The environment is poised for change, as coun-tries begin recognising the necessity of AT coverage torealise commitments to the Sustainable DevelopmentGoals and the UN Convention on the Rights of Personswith Disabilities. To uphold these commitments andinfluence the complex systems for AT access, a broadset of stakeholders across sectors is needed to investin and coordinate a multi-faceted, systematic approachspanning market shaping, capacity development, andpolicy reform.Method: In early 2018, consultations and initial land-scape analyses were conducted to better understandthe barriers and scope of challenges to increasing ac-cess to appropriate, affordable AT, particularly in low-and middle-income countries. This included review ofpast interventions and approaches, as well as discus-sion about current barriers observed throughout the ATecosystem. Information gathered through this process

was considered in a series of meetings and workshopsto develop a framework for a new partnership modelwith the potential to address these gaps.Key results: An understanding that transformationalchange requires market shaping approaches to addresssupply and demand-side barriers, supported by an en-abling environment, emerged from the broad consulta-tion and analysis. Building this enabling environmentmust include galvanising political will, mobilising re-sources, increasing awareness, addressing policy, andstrengthening systems and service delivery. Accom-plishing this requires a cross-sector partnership act-ing as a catalyst for change, amplifying existing work,and coordinating and mobilising global stakeholders.In July 2018, this vision was realised with the launchof ATscale, the Global Partnership for Assistive Tech-nology, at the Global Disability Summit. Eleven organ-isations joined ATscale’s Forming Committee with agoal of reaching 500 million more people with life-changing AT by 2030. ATscale has established its ini-tial strategy and has set out to develop a long-term op-erating model. Several early interventions to supportthe ATscale strategy are being undertaken by AT2030,a UK aid funded programme.Conclusion: This Partnership will enable partnersworking in distinct sectors to collaborate with a uni-fied mission, facilitating complementary approaches,innovation, and capacity building. The coordinated ap-proach of convening a broad range of leading stake-holders across sectors will increase access to afford-able, appropriate, and high-quality AT products andservices, leveraging current and past work to addressthe entire AT ecosystem. The initial work, includingthe strategy overview, already reflects diverse perspec-tives and the opportunity provided by a collective ef-fort, supporting the global community to have an im-pact greater than the sum of its individual parts.Keywords: ATscale, Cross-sector, Partnership, Ac-cess.∗Corresponding author. E-mail: [email protected]

Increasing Access to Assistive Technology by Ad-dressing the Market Barriers: A Market ShapingApproach for WheelchairsMargaret Savagea,∗, Frederic Seghersa, Alison EndFinebergb and Novia AfdhilaaaClinton Health Access Initiative, 383 Dorchester Ave,Suite 400, Boston, MA 02127, USAbATscale, the Global Partnership for Assistive Tech-nology, Geneva, Switzerland


Background: Market barriers limit both supply anddemand of appropriate AT in low- and middle incomecountries (LMICs). Market shaping aims to break thevicious cycle of low supply, low private investment,limited competition, and high prices that perpetuateslow demand. Market shaping has proven successfulin increasing access to global health products includ-ing vaccines and antiretrovirals, leading to hypothesizethat these approaches could also be applied to AT mar-kets. ATscale, the Global Partnership for AT, aims tomobilise global stakeholders to shape markets in linewith a unified strategy. To inform this strategy, it is crit-ical to identify specific interventions required to shapemarkets and overcome barriers. Wheelchairs are thefirst assistive technology undergoing analysis, whichis being delivered by Clinton Health Access Initiativeunder the UK aid funded AT2030 programme. WHOestimates that 75 million people need an appropriatewheelchair and most lack access. The market for ap-propriate wheelchairs in LMICs is highly fragmentedand characterized by limited government engagement,limited investment, and low willingness-to-pay and isdominated by cheaper, low quality wheelchairs fail-ing to meet end-user needs. Non-governmental orga-nizations (NGOs) have attempted to fill the need forcontext-appropriate wheelchairs, but market uptake islimited. These initial findings led ATscale and AT2030partners to believe that market shaping could supportincreased access to appropriate wheelchairs.Method: To develop a robust understanding of themarket landscape and identify opportunities to increaseaccess to appropriate wheelchairs, a mixed-methodsapproach is used including a grey literature review,market data analysis, key informant interviews, andsite visits. The analysis outputs are captured in amarket shaping strategy document that incorporatesa market landscape, key barriers, and identificationof market shaping objectives, recommended interven-tions and outcomes. The authors have sought inputfrom experts, suppliers, and stakeholders throughoutthe drafting and stakeholders will provide feedback onproposed interventions through virtual roundtable dis-cussions prior to finalization.Key results: The process led to recommendationson marketing shaping interventions to increase ac-cess to wheelchairs. On the demand-side, incorporat-ing proven models for provision in the health sector inline with WHO Guidelines may stimulate appropriateprovision and increase predictable demand. Tools tosupport countries to develop roadmaps for integrationaround financing, policy, provision and procurement

will be important enablers. Pooling resources thoughinnovative financing, such as co-financing, may de-crease fragmentation of resources available and catal-yse demand. On the supply-side, the development andadoption of specifications and preferred product pro-files (PPP) may strengthen procurement for context ap-propriate wheelchairs, decrease market fragmentationand increase market transparency. Mechanisms to se-cure a reliable supply for a range of affordable ATmay require an approach combining technology trans-fer or licensing from manufacturers, regional distribu-tion systems, and local assembly (rather than manufac-turing).Conclusion: This work provides evidence to informATscale’s strategy and investments and will continueto inform the approach and reach of AT2030. Interven-tions may include additional evidence generation, de-velopment of tools to support decision-makers or pilot-ing models of financing, provision or supply. The sameprocess will be used for other priority AT.Keywords: Market Shaping, Wheelchairs, Access.∗Corresponding author. E-mail: [email protected]

AT2030 – Exploring Novel Approaches to Address-ing the Global Need for ATCatherine Hollowaya,b, Giulia Barbareschia,b, FelipeRamos-Barajasa,b, Lucy Pannell, Dafne Morgado-Ramireza,b, Richard Frosta, Iain McKinnona, Christo-pher Holmesa, Maria Kettc, Nora Grocec, MarkCarewd, Ola Abu Alghaibe, Emma Tebbuttf , EmilyKobayashig, Frederic Seghersg and Victoria AustinaGlobal Disability Innovation Hub, UCL Here East, 8-9 East Bay Lane, Queen Elizabeth Olympic Park Strat-ford, London E15 2GW, UKbUCL Interaction Centre, 66-72 Gower St, LondonWC1E 6EA, UKcUCL Institute of Epidemiology and Healthcare, Lon-don, UKdLeonard Cheshire Disability, London, UKeUN Partnership of Persons with Disabilities (UNDP),Houghton St, Holborn, London WC2A 2AE, UKfDepartment of Essential Medicines and Health Prod-ucts (EMP), World Health Organization (WHO),Geneva, SwitzerlandgClinton Health Access Initiative, 383 Dorchester Ave,Suite 400, Boston, MA 02127, USA

Background: It is well known that the provision of as-sistive technology (AT) is a ‘wicked’ problem and one


that requires new thinking to solve. AT2030 is a pro-gramme of investment which is part of a new globalmovement, to find new cross-sectoral approaches toAT provision and use. AT2030 was designed based ona scoping study into the barriers affecting AT provi-sion. The scoping study had the objective of answer-ing the following two questions:1) What are the bar-riers which prevent access to AT for the people whoneed it, with a focus on those living in low resource set-tings within the UK Department for International De-velopment (DFID) priority Global South countries? 2)How should DFID, in partnership with others (includ-ing particularly other donors), best direct its interven-tions toward overcoming these barriers?Method: The method used was flexible and iterativein nature. It sought to bring in expertise from acrossa diverse set of stakeholders and organisations. Theemerging ideas were tested through stakeholder inter-views and discussions and were refined though partnerworkshops and external events. The methodology wascharacterised by a participatory and consultative pro-cess, with clear objectives, and was both inclusive andtransparent. This provided an opportunity to reflect onthe applicability of evidence in different contexts andpromoted dialogue among different types of stakehold-ers. Due to its rigour, flexibility and appropriateness insummarizing relevant features of complex datasets in-cluding different sources, thematic analysis was cho-sen as the analysis method for this scoping research.In total 18 sets of field notes alongside transcripts of 23semi-structured interviews were analysed. These datasources had been collected during meetings with stake-holders such as funding agencies, research partners andAT providers. Interviewees worked in different devel-oping countries and were employed in various sectorsincluding academia, industry and NGOs. These weresupplemented with two deep-dive scoping exercisesconducted in Kenya and Uganda. This corpus of datawas analysed and coded using a hybrid deductive andinductive approach.Key results: Our work reveals differing levels of ATmarket development across countries. However, thekey barriers are common. Five broad areas to cate-gorise barriers, facilitators and opportunities for im-proving AT access in developing countries were identi-fied and prioritised according to the 5Ps model formu-lated by GATE: People, Products, Policies, Provision,Personnel.Conclusion: We found the challenge of AT provisionrepresents a complex web of market and systematicmarket failure, compounded by a lack of participation

from the communities that have the best knowledgeof the issues (users themselves). This results in a mis-match between supply and demand which affects al-most a billion people. This makes AT access one of themost pressing problems facing the global health sector.∗Corresponding author. E-mail: [email protected]

Innovate Now: Creating an Assistive TechnologyInnovation Ecosystem in NairobiGiulia Barbareschia,b,∗, Felipe Ramos Barajasb,Umesh Pandyab and Catherine Hollowaya,baUniversity College London Interaction Centre, 66-72Gower Street, London WC1E 6EA, UKbGlobal Disability Innovation Hub, 8–9 East Bay LaneQueen Elizabeth Olympic Park, E15 2GW, London,UK

Background: In Kenya there are at least 2 million peo-ple with disabilities and approximately 67% of themlive below the poverty line. Being able to access ap-propriate assistive technology (ATs) is fundamental toensuring people are able to improve their access to op-portunities for education, livelihoods and life gener-ally. Unfortunately, currently available ATs are ofteninadequate, too expensive and delivered through ser-vices which are unable to keep up with the demand.The Kenyan entrepreneurial spirit and technologicalcreativity are renowned across the world. This createsa potential fertile ground for AT innovation where newtechnologies and disruptive service delivery systemsare developed to increase access to AT, and to boosteconomic opportunities across the country. AlthoughAT innovation could represent a lucrative opportunityfor many tech entrepreneurs, only a few start-ups fo-cus their efforts in the area. This is partially due to alack of awareness, but it is also linked to the difficultyof bringing products to market in a field where ideasneed to be tested with hard-to-reach populations andcomplex regulatory systems need to be navigated.Method: Interviews with stakeholders were carried outto identify needs and difficulties of start-ups develop-ing products for the AT market in low resource settings.Interviews were conducted with entrepreneurs, expertsin the field of AT, accelerator and incubator managersand venture capitalists. Two scoping visits were alsoconducted to Kenya to map the innovation landscapeand understand the gaps within the services currentlyprovided to entrepreneurs. Negotiation meetings wereheld with potential partners to better define the roleof NGOs, government agencies and the private sectorwithin the innovation ecosystem.


Key results: Results from the interviews with stake-holders show that the barriers encountered by startupsin the field of AT are many and varied. Some of theneeds of AT startups are related to business planning,legal expertise marketing mentorship, which can be ad-dressed by traditional incubators and accelerators pro-grammes. However, AT startups also encounter diffi-culties in gaining access to environment where theycan test and develop their products, receive feedbackfrom people with disabilities and gather the strong ev-idence they need to secure funding from donors andventure capitalists. Reports from scoping visits demon-strate that Kenya has a wide network of incubators andaccelerators that could support the activity of AT star-tups. However, these organizations are often discon-nected from people with disabilities and NGOs whowork on the ground, which limits the impact of the ser-vices they can provide.Conclusion: To address the gap highlighted by ourinvestigation, the Global Disability Innovation Hubthanks to the support from the UK Department forInternational development, has created the InnovateNow ecosystem which aims to support entrepreneursthroughout their journey and help their products toreach the market more quickly. The Innovate NowEcosystem is funded through a network of partnershipsinvolving government, private businesses, NGOs andacademic institutions where each partner has a specificrole and provides contextual support and expertise tonew start-ups who have developed innovative ATs.Keywords: Innovation Ecosystem, Assistive Technol-ogy, Start-up, Incubator.∗Corresponding author. E-mail: [email protected]

Moulding a New Prosthetic Service Delivery Systemwith the Amparo Confidence SocketGiulia Barbareschia,∗, Wesley Teerlinkb, Lucas Paesde Melob and Catherine HollowayaaUniversity College London Interaction Centre, 66-72Gower Street, London WC1E 6EA, UKbAmparo GmbH, Lahnstrasse 17, 12055, Berlin, Ger-many

Background: Lower limb amputation is a major sur-gical procedure that can completely change a person’slife. Thanks to lower limbs prosthesis, amputees of-ten regain their independence, resuming their desiredroles in family and social life. Unfortunately, many am-putees who live in low and middle income countries

do not have access to the prosthetic services that theyneed. Without an appropriate prosthesis, amputees of-ten remain dependent on family and community andare unable to access basic rights such as food, shelter,education and work. One of the main factors respon-sible for the difficulty of providing appropriate lowerlimb prosthetics is the high cost associated with theirfabrication. In turn, this is mainly linked to the needto rely on specialized health care workers and expen-sive workshop equipment for most of the manufactur-ing process. Generally, making a lower limb prostheticis a highly individualised process and requires on av-erage 8 hours of work time from the healthcare profes-sional with two of these hours spent with the patient ontwo separate visits.Method: Amparo Gmbh has developed a new thermo-plastic pre-assembled socket that can be molded di-rectly on the residual limb of the amputee, thus drasti-cally reducing the time, tools and expertise needed tomanufacture lower limb prosthesis. The pre-assembledsocket is also fitted with the attachment point, allowingthe technicians to easily connect the socket with theterminal part of the prosthesis. The low-temperaturethermoplastic allows the socket to be remolded sev-eral times to accommodate changes in the residuallimb which are common after amputation. Finally, theequipment needed to manufacture a lower limb pros-thetic with the Amparo socket can easily be packed ina standard suitcase, making possible to adequately fitlower limb prosthesis within. To understand the ben-efits of the confidence socket we carried out observa-tions of during socket fitting procedures and informalinterviews with both prosthetic technicians and belowthe knee amputees who are currently using the product.Key results: The socket has received positive re-views from both amputees and healthcare profession-als. Technicians particularly appreciated the ease ofuse and how quickly they could fit the socket and testthe prosthesis with their patients. Amputees praised thecomfort of the socket and were impressed with the factthat the socket eliminates the need for multiple visitsand the waiting time when modifications have to bemade. Amparo is currently working with the GlobalDisability Innovation Hub and local partners to trial thethermoplastic socket in Kenya to assess the feasibilityand acceptability of the new technology with the localworkforce.Conclusion: To reducing the cost, time and skills re-quired to fit lower limb prosthetics. Its impact is po-tentially greater in low and middle income countrieswhere shortage of human and material resources make


providing appropriate prosthesis a particularly com-plex issue.Keywords: Lower Limb Prosthetics, Amputees, Pros-thetic Technicians.∗Corresponding author. E-mail: [email protected]

Developing Tablet Audiometry for Screening Chil-dren’s Hearing in TanzaniaTone Øderuda,∗, Cosmas Mnyanyib, Jon Øygardenc,d,Tore Christian Storholmena and Tron Vedul Tronstadd

aSINTEF Digital, P.O.Box 124, Blindern, 0314 Oslo,NorwaybThe Open University of Tanzania, P.O.Box 23409 Ki-nondoni, Dar es Salaam, TanzaniacNTNU, 7491 Trondheim, NorwaydSINTEF Digital, 7465 Trondheim, Norway

Background: WHO has estimated that there arearound 466 million people worldwide that have a dis-abling hearing loss, and 34 million of these are chil-dren. The majority of children with hearing impair-ment live in low-income countries, and in Sub-Saharancountries most children with hearing impairment re-main undiagnosed, untreated and without the provisionof adequate services and devices. The current provi-sion of hearing aids is inadequate across most low-and middle-income countries. For the individual child,hearing loss normally has a large impact on life be-cause the loss of hearing affects the development ofspeech, language and cognitive skills. Public aware-ness and attitudes towards childhood disability in low-and middle-income countries are often poor, and maylead to social isolation, stigmatization and exclusionfrom education and employment. The objective of theresearch has been to develop new appropriate tools forscreening children’s hearing in local communities inlow- and middle-income countries, and to assist chil-dren with hearing loss to attend school and participatein society. The research project specifically addressesthe topic of Inclusive Education and the UN Sustain-able Development Goals Nr 4 on Quality Education.Method: A participatory research design and co-design process characterised by user involvement anditerative design processes were selected. The iterativeprocess includes problem definition, identifying userneeds, defining system specifications, developing tech-nology, prototyping, testing and evaluation involvingusers and relevant stakeholders. The prototypes havebeen refined according to the knowledge gained in the

testing, before passing onto a new iteration. Qualitativeresearch methods have been applied for providing userneeds and a better understanding of the situation forchildren with hearing impairments and include individ-ual interviews, focus group interviews, questionnaires,field studies and observations involving children, par-ents, school teachers, hearing experts, authorities andNGOs.Key results: A new tool for community-based screen-ing of children’s hearing has been developed. Thescreening tool have been tested at primary schools inTanzania and the screening tool is based on the con-cept of gaming and consist of commercially availabletablets, headphones and dedicated software developedby the project. The game-based tablet audiometry hasbeen validated with reference to traditional audiome-try and tested. 407 children in primary school in Tan-zania have participated and been screened for hearingloss, measuring the hearing thresholds of 25 dB withtablet audiometry and traditional audiometry. The pa-per describes the development process and present theresults from testing and validating the tablet audiome-try at primary schools in Tanzania.Conclusion: The new screening tools using game-based tablet audiometry has the potential of facilitat-ing the development of local hearing services in low-and middle-income countries and screening children’shearing at local schools without expensive and spe-cialised equipment. Special teachers and school teach-ers will do the screening. Awareness and identifyingchildren with hearing impairments is the first step to-wards Inclusive Education and participation.Keywords: Children with hearing mpairment, Hearingloss, AT in low-and middle-income countries, Tabletaudiometry, Disability.∗Corresponding author. E-mail: [email protected]

Assistive Technology Services for School Childrenwith Disabilities in Tanzania: The Role of NGOsand the Need for Intersectoral CoordinationsG. Van den Bergha,∗ and D. Kakokob

aCentre for International Health, University of Bergen/Department of Health and Functioning, Western Nor-way University of Applied Sciences, Inndalsveien 28,5020 Bergen, NorwaybSchool of Public Health, Muhimbili University ofHealth and Allied Sciences, Directorate of Researchand Publications P.O. Box 65001, Dar es Salaam, Tan-zania


Background: According to UN, less than 1% ofschool-aged children with a disability in Tanzania areenrolled in school. Tanzania developed an InclusiveEducation Strategy to ensure equitable access to qual-ity education for all. Tanzania has no national proce-dures to assess the needs of children before enrolmentin school. District-level educational resource and as-sessment centres were suggested in 2013, includingscreening and referral for assistive technology (AT)provision. Yet, rehabilitation services and AT systemsfor children with impairments are poorly developedand often inaccessible or unaffordable in a countrywith 55 million inhabitants. The aim is to discuss howpublic-private collaboration, NGOs and intersectoralcoordination may contribute in fulfilling children withdisabilities’ rights in education and health, rehabilita-tion and AT provision.Method: The discussion is based on previous case-study research and recent data collected through multi-sited ethnographic fieldwork and visits in public andprivate rehabilitation- and education institutions andNGOs in rural/urban Tanzania since 2012, and experi-ence-based knowledge. Methods included documentand literature-review, participant observation and in-terviews of stakeholders in disability-related organiza-tions and parent associations.Key results: Public and private rehabilitation institu-tions providing AT have increased in number, in partic-ular in urban areas with specialised hospitals, for-profitenterprises and not-for-profit NGOs. For the growingmiddle-class, advanced AT (for ex. cochlear implants)is available, or can be purchased abroad. Yet manychildren with disabilities (CWD) who live in rural ar-eas may never access basic AT such as spectacles,crutches or wheelchairs. NGOs seem though to con-tribute significantly in rehabilitation and inclusive ed-ucation. In three decades, Comprehensive CommunityBased Rehabilitation (CCBRT) has become Tanzania’slargest provider of rehabilitation services, with a hos-pital, CBR units, AT production centres, and outreachthroughout the country. As a social enterprise servingthe most vulnerable, they collaborate across sectors,and invest in prevention, advocacy and training, pro-moting early identification and follow-up through in-novative ICT and “ambassadors”. Quality-services forchildren and the poor are increasingly financed by in-come generated through a private clinic.In the special education sector, privatisation has in-creased the number of schools. However, in publicschools, very few special education teachers, lack ofappropriate resources and rare specialised assessment

centres, with inadequate budgetary allocation, resultsin poor AT support. At the same time, some local andinternational NGOs collaborate with the Ministry ofEducation implementing district assessment centres,developing operational tools for identifying and docu-menting the needs of CWD, and providing and refer-ring them for services.Conclusion: In spite of policies affirming the right toeducation for all children in Tanzania, need-assessmentand AT provision is still random, with rare publicsupport to enable quality services. Some disability-NGOs apparently address children’s special health-and education needs early, also in marginalized loca-tions, increasing availability, accessibility and afford-ability of services, while investing in advocacy, com-munity empowerment and competence building, mo-bilizing funding, and pursuing sustainability. Govern-ment commitment and national coordination of AT ser-vices across health-, education and social sectors, andpublic-private collaboration may promote a more equi-table distribution of AT services, thus allowing educa-tion for all.Keywords: children with disabilities, assistive tech-nology systems, Tanzania, NGOs, inclusive education.∗Corresponding author. E-mail: [email protected]

Comprehensive Approach to Assistive Technologyin Low-income Country: A Case Study of CRPBangladeshDjenana Jalovcica,∗, Shamima Islam Nipab and S.J.M.Ummul AmbiabaDepartment of Health and Functioning, Western Nor-way University, Inndalsveien 28, 5020 Bergen, NorwaybDepartment of Rehabilitation Science, BangladeshHealth Professions Institute, Savar, Dhaka-1343,Bangladesh

Background: Assistive technologies (AT) encompassa wide range of technologies and devices that main-tain and improve individual’s functioning, indepen-dence and participation. Equal access to AT is includedin the Convention on the Rights of Persons with Dis-abilities. WHO estimates that only 5%–15% of peoplewho require AT in low- and middle-income countrieshave access to them, and this is true for Bangladeshas well. An estimated 1.6 million Bangladeshis need awheelchair and 800,000 need an orthotic device. Thereare no facilities for large scale production of ATs, noofficial distribution system, no financial support forprovision of AT for persons with disabilities, and no


planned approach to AT imports. Although imports in-crease AT availability, it is not known whether theyare fitted properly and what kinds of consequences thatmay have on psychological, social and physical func-tioning. There are very few qualified rehabilitation pro-fessionals who are trained to prescribe individualizedAT. Also, there are many environmental barriers thatprevent participation of persons with disabilities. TheCentre for the Rehabilitation of the Paralysed (CRP),a non-governmental organization, was established in1979 to offer services to people with spinal cord in-juries, children with cerebral palsy and adult neurologypatients. It has grown from a four-bed unit to a 140-bedhospital with 12 regional rehabilitation centers, andan accredited academic branch that offers 11 diploma,bachelor’s and master’s programs in physiotherapy, oc-cupational therapy, speech and language therapy, nurs-ing, prosthetic and orthotics and rehabilitation science.This case study aims to contribute knowledge on ATproduction and distribution in Bangladesh, through ex-amining promising CRP practices.Method: This qualitative case study documents an ap-proach to small scale production and distribution ofAT. It presents the results of the content analysis of therelevant documents, articles, case studies and artifactsthat were collected, reviewed, and complemented withobservations at CRP Bangladesh in January 2019.Key results: CRP has a comprehensive approach toAT production, distribution and follow-up for its pa-tients in community and hospital settings. Over time,CRP has developed specialized units dedicated to pro-duction of various types of AT: appropriate paper tech-nology, wheelchair and mobility devices workshops,special seating, hand therapy (splinting), and pros-thetic and orthotics. CRP’s approach to the provisionof AT is based on principles of availability, affordabil-ity, adequacy, acceptability, appropriateness and qual-ity (5As+Q). CRP increases AT availability by produc-ing low cost and affordable devices. AT adequacy is en-sured by individually fitting each device to meet user’sneeds, increasing the acceptance of the device by users.CRP ATs are made of locally available materials alsoconsidering the local environment and infrastructure.CRP AT services are of high quality, provided by qual-ified multidisciplinary rehabilitation teams with pro-fessionals trained at bachelor’s level. They assess, pre-scribe devices and follow-up patients using telehealth,phone, or home visits to ensure modifications are doneaccording to the changing needs of persons with dis-abilities.

Conclusion: The CRP’s 5As+Q approach that ensuresaccess to AT for its patients is context-sensitive and canbe replicated and scaled up.Keywords: Assistive technology, low income country,comprehensive approach, Centre for the Rehabilitationof the Paralysed, AT production in Bangladesh.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 17Care Robotics in Europe and Asia; A Multicul-tural Perspective

As ageing is a worldwide phenomenon internationalcollaboration is increasingly important. This sessionhighlights Care Robotics research and development inAsia and Europe. This is a fast developing field and themarket for care robotics is expected to grow rapidly.In Asia as well as in Europe much research and de-velopment work is being done. The aim of this sessionis to present an overview of this work and to discussdifferences and similarities between Europe and Asia,with a view on learning from each other and increasingthe applicability of robotic solutions across continents.The focus is on care robot devices to enhance the qual-ity of life of people with disabilities, elderly people andcaregivers. During the session there will be sufficienttime for discussion and input from the participants.Chair: Luc de Witte

Care Robotics Development: A European Perspec-tiveStephen Potter∗ and Luc de WitteCentre for Assistive Technology and Connected Heal-thcare, The University of Sheffield, 217 Portobello,Sheffield S1 4DP, UK

Background: Care robotics is an area of assistive tech-nology that promises much but has, as yet, deliveredlittle. Excluding the specialist area of surgical robots,and notwithstanding the hype around robotics, it seemsthat few care robots are currently to be found in useon a day-to-day basis anywhere in the world. The mostobvious reason for this would seem to be the relativeimmaturity of robot technology; however, there couldbe other causes: failings in the design and developmentprocesses, for instance, or structural deficiencies in theecosystem that sustains the care robotics economy. Theauthors have probed the current state of the European


care robot development community and the causes ofthe apparent lack of practical results; this paper reportstheir findings.Method: The authors conducted an internet-basedanalysis of care robotics companies worldwide, andperformed an assessment of the market positioningof each and the state of its robot offerings basedon current product and service availability, the evi-dence of peer-reviewed papers, its involvement in ex-ternally funded research programmes, and other sup-porting material. Focusing on the European experi-ence, a workshop with experts in the field explored theissues around care robot applications, and a follow-upquestionnaire was used to widen the scope to encom-pass other opinions.Key results: The study confirmed the impression that,within Europe, care robots use is limited to, at best,standardized, repeated, localized, non-critical and low-risk tasks that require little robot intelligence or auton-omy. In large part this is because the technology is notyet sophisticated enough; but also because the practicalissues of introducing robots into complex care contextsand, to a lesser extent, safety, legal and regulatory con-cerns have not been satisfactorily addressed. However,it also revealed that there are structural weaknesses ina European care robotics ecosystem that relies heav-ily on public funding (at a national and supranationallevel) and is populated by micro and small enterprises,and university research departments. Perversely, thismodel serves to incentivize the development of robotsthat secure subsequent public funding rather than thosethat address real end-user requirements. Furthermore,the lack of appropriate instruments for assessing theholistic cost-effectiveness of care robots alleviates the‘evolutionary pressure’ to develop better robots androbot services.Conclusion: In general care robotics is (probably) themost challenging area of robotics: it involves long-terminteractions with vulnerable people in complex, dy-namic environments, and as such the apparent immatu-rity of the field is hardly surprising. It is clear that mucheffort, perhaps driven by more commercially focuseddomains, is still required to develop the fundamentalrobot and AI technology and to improve interfaces, re-liability and safety. Moreover, we believe that the rateof development could be improved by the develop-ment of whole-lifecycle evaluation methodologies, bythe greater involvement of potential service users in thedesign process, and by incentives that reward a greaterwillingness to risk exposing care robotics to real users.Keywords: Artificial Intelligence, technology ecosys-tem, research and development, robotics.


Planning Care Robot Project in Korea Based onUser Centered Approach and its Future DirectionWon-Kyung Song∗, Myung-Joon Lim, Hyosun Kweonand Eun-Rae RoDepartment of Rehabilitation and Assistive Technol-ogy, National Rehabilitation Center, 58 Samgaksan-ro,Gangbuk-gu, Seoul, 01022, Korea

Background: Korea faces an aging population, andcare robot market is expected to grow rapidly. Thoughdevelopment and dissemination of care robot in Ko-rea has not been prepared yet, some countries are al-ready carrying out large-scaled national projects oncare robots. The objective of this abstract is to doc-ument the iterative procedure used to identify needs,selection, and planning of care robot project in Koreabased on user centered approach.Method: Based on literature review, field observationof real space and people, in-depth & focus group inter-views of various stakeholders, we identified the needsof care robot and selected care robot categories in Ko-rea. Also we set up and held “Care Robot NetworkForum (n = 49)” with various stakeholders includ-ing caregivers, care-receivers, researchers, companies,nursing homes and policy makers. Through this Fo-rum, we carried out care robot project planning in Ko-rea.Key results: The results of the study in care robotproject in Korea showed that there are 9 categoriesof requirements for care robots which is lifting, mov-ing, changing position on the bed, toileting, eating,bathing, exercising, communication and smart mon-itoring. The five primary strategies of care robotprojects are: 1) Intensive investment according tomatching needs and technology for care robot; 2)Achievement through translational research; 3) Real-ization of smart care through 4th industrial revolutiontechnology; 4) Personal-centered research with stake-holders; 5) Building a care robot ecosystem. Moreover,we need specific steps for care robot project in Korea.1) Planning 2) Development of care robotic devices 3)Translation Research 4) Development of service model5) Dissemination.Conclusion: We identified the needs & selections re-quired and planned the care robot project in Koreathrough this study based on user centered approach.Through this research project, we have started the first


period of Korea Caring Robot Project, which will beproceeded for four years from 2019. It is expected thatjoint research on the need for care robot and R&D di-rection considering various cultural differences will beneeded in the future.Keywords: Care Robot, Plan, Aging, Disability.∗Corresponding author. E-mail: [email protected]

What Should be Considered when Developing Carerobots According to their Types?Myung-Joon Lim, Eun-Rae Ro, Won-Kyung Song andHyosun Kweon∗

Department of Rehabilitation and Assistive Technol-ogy, National Rehabilitation Center, Seoul, 01022, Ko-rea

Background: The care robot project in Korea startedin 2019. It is important to predict and prepare for thedemands of the care robots. Based on 4P (public, pri-vate, people, partnership) approach, a questionnairesurvey was conducted to identify the caring needs andconsideration on the development of care robots.Method: The participants (n = 114) of the survey arecomposed of public section (n = 21; policy maker,nursing home owner), private section (n = 40; com-pany, researcher), informal caregiver (n = 32; fam-ily member) and care-receiver (n = 21) in Korea. Thesurvey was conducted through online, using a surveytool called Google Survey from Oct 15th to Dec 16th,2018. The online survey, composed primarily of check-ing boxes and comment fields, consisted of 38 ques-tions. The data was analyzed through MS office exceland atlas.ti 8.0.Key results: The results of the studies showed that thegroup with the greatest need for care robots is the infor-mal caregiver group. Barriers in introducing care robotto the field include safety issues, clinical trials, fielddemonstration, and public benefits. For each kind ofcare robots, the important considerations for technol-ogy development were different; ceiling typed lift (cur-rent environment friendly device), exo-skeleton typedlift (user friendly), moving (safety), changing positionon the bed (customized), toileting (hygiene), eating(customized), bathing (user friendly), exercising (cus-tomized), communication (Artificial Intelligence tech-nology) and smart monitoring (Information).Conclusion: The purpose of this study is to investi-gate the difficulty of caring and consideration of thedevelopment of care robots throughout the four groups.Through this study, we found that the main target of

care robot is the caregiver. In addition, it was found thatthe priorities of consideration in the technology devel-opment were different according to the types of carerobots. In order to supplement the limitations of thisstudy (small scale, online questionnaire), we need toperform usability test, user experience and technologydemand analysis in the future for care robots. It is ex-pected that this research will help to set the directionof care robot project in Korea.Keywords: Care robots, Questionnaire survey, Care-giver, Care robot project.∗Corresponding author. E-mail: [email protected]

Care Robotics in Europe and Asia; A MulticulturalPerspectiveSandra Bedafa,∗ and Luc de WittebaZuyd University of Applied Sciences, Research centrefor assistive technology in care, Nieuw Eyckholt 300,6419 DJ Heerlen, The NetherlandsbSchool of Health and Related Research, Centre forAssistive Technology and Connected Healthcare, Uni-versity of Sheffield, Sheffield, UK

Background: Service robots have the potential to sup-port older adults with executing problematic daily ac-tivities in order to maintain their independent living.However, stereotypes often suggest that older adultstend to be less open to the idea of living with a robot.Several multi-country studies that were conducted dur-ing the ACCOMPANY (Acceptable robotiCs COM-Panions for AgeiNg Years) project provide insight inthe acceptability of service robots by potential usersin three countries (i.e. older adults, informal caregiversand professional caregivers) and their view on how aservice robot should behave in a socially acceptablemanner when interacting with potential users (i.e. thepreferred characteristics of such a service robot).Method: An existing service robot, the Care-O-bot3, and different scenarios developed by the ACCOM-PANY consortium were used as concrete cases in thedifferent studies. These were discussed and analyzedduring different focus group sessions with older adults,informal caregivers and professional caregivers in theNetherlands (n = 97), France (n = 173) and theUnited Kingdom (n = 62). During these focus groupsessions various topics were explored. Detailed sum-maries of the qualitative results of the focus groups foreach country were composed from audio recordings.Key results: The results of the studies in the ACCOM-PANY project showed that older adults in all three


countries are open to the idea of having a service robotsupporting them in their daily life. It was even foundthat the older adults had a more positive attitude to-wards robots than their caregivers. Participants fromall three countries agreed that a service robot shouldalways have to obey the user. All participants alsowished and often even expected that a service robotcould be customized to the needs, wishes and prefer-ences of each individual user. However, no major dif-ferences could be found in the views recorded amongthe participants of the three different countries. Therewere some small differences, for example: in Francethe participants mentioned more issues concerning thecoordination of care and the role a service robot couldplay to improve this, while this was mentioned less inthe Netherlands and the United Kingdom.Conclusion: Only small differences could be found inthe views recorded among the participants of the threedifferent countries. However, this does not imply thatthere are no differences in the perception of care robotsin Europe as the participants agreed that one size doesnot fit all; the robot has to respond to individual pref-erences. This makes the development of service robotscomplex as it has to deal with variety between differ-ent individual users (e.g. their personal preferences andhome environments). In order for a service robot to dothis in an acceptable manner it would require a highlevel of intelligence, a level that is currently not possi-ble.Keywords: Service robots, older adults.∗Corresponding author. E-mail: [email protected]

Special Thematic Session 18Social Robotics for Assistive Technology

Social robots in the context of assistive technologyare specifically designed for social interaction with hu-mans. Such approach plays an important role with re-spect to health and psychological wellbeing of thosethat need assistance. Assistive social robots are demon-strated to be useful in wide range of assistance fromrobotic therapies for children to eldercare. Two fun-damental reasons are at the basis of the success ofthis approach: a functional and an affective motivation.Such robots are developed to function as an easy-to-interpret and immediate interface to digital technology,and, at the same time, to help increase the quality oflife by providing companionship. However, no com-prehensive review is yet performed to investigate theeffectiveness of such assistive social robots in the care.

Therefore, we systematically reviewed some success-ful stories in social robotics for assistive technologyand highlight the effects of assistive social robots forhumans that need assistance.Chairs: Francesco Rea and Riccardo Magni

Humanoid Robots: Advantages of Social Robots inthe Assistance of EldersFrancesco Reaa,∗ and Alessandra SciuttibaRobotics Brain and Cognitive Sciences, Istituto Ital-iano di Tecnologia, ItalybCOgNiTive Architecture for Collaborative Technolo-gies, Istituto Italiano di Tecnologia, Italy

Background: In our research, convinced by incontro-vertible evidences we propose different assistive tech-nologies based on the proactive intervention of hu-manoid robots. The humanoid robots and their easy-to-interpret behaviors give the opportunity to promote ac-ceptable assistance. Further the humanoid robot if cor-rectly designed is more likely to be accepted as com-panion in the activities of daily living. Our key hypoth-esis is that the acceptance of robot companion has adirect and positive outcome in the assistance.Method: With a multidisciplinary group of researchersaddressing the rehabilitation of ageing individuals withmild cognitive impairment, we proposed robotic tech-nology that proactively assist and promotes cognitiverehabilitation.Key results: Key result is that it is more complicatedto convince the traditional health care system of thebenefit of the proposed technology with respect to theageing individuals. They accept the novelty of roboticassistant more happily than predicted. The reason be-hind such high degree of acceptability stands in thepossibility of interfacing with the technology through acompanion that interacts according with known socialrules.Conclusion: The take home message is that in socialrobotics for assistance is important to involve the end-user user in the design in order to understand their so-cial needs. Thanks to such understanding, the assis-tance can be enriched with a social dimension that pro-motes the level of acceptability of the technology. Inthe near future such interesting consideration will beproposed to partnership of interested stakeholders inthe field of assistive technology.Keywords: Human Robot Interaction, Assistive Tech-nology, Ageing Population, Social Robotics, Huma-noid Robotics.


∗Corresponding author. E-mail: [email protected];[email protected]

A Communication and Monitoring Robot Systemfor Older People Living AloneYoshiyuki Takahashia,∗, Motoki Takagib and KaoruInouecaDepartment of Human Environment Design, ToyoUniversity, Saitama, JapanbBioscience and Engineering – Biomedical Engineer-ing Course, Shibaura Institute of Technology, Saitama,JapancDepartment of Occupational Therapy, Tokyo Metro-politan University, Tokyo, Japan

Background: The number of older people living aloneis dramatically increasing in Japan which in turn hasled to the rise in the number of solitary deaths. Thishas become a disturbing social problem. Therefore, theimportance of attentively monitoring older people whoare living alone has recently been acknowledged. Cur-rently, taking care and the monitoring of older peopleis undertaken by humans. However, due to the rapidlydecreasing birth rate in Japan leading to a reductionin the Japanese labor force in the very near future, thenumber of care staff for older people will likely de-crease. As a result, reducing the burden and work ofcare staff is urgently required. Therefore, we propose arobot system to assist and reduce care-staff workloadse.g. by monitoring and improving the quality of care.Our proposed system is mainly for the use of care staffof a community-based integrated care system in localcommunities.Method: We have developed a communication robotsystem – a physical robot for older people, which uti-lizes the cloud network, as well as having a terminalfor monitoring older people. The robots are able tospeak with the older people, and can communicate lo-cal community information such as news, give dailyroutine cues, hold casual conversations and so forth.The user’s speech is converted to plain text and an ap-propriate response message is found from the conver-sation database on the server (Cloud). The probabilityof the response message is calculated using Word2Vec.The robot also has physical motion functions and isinstalled with a three degrees of freedom motorizedmechanism. The terminal for the person monitoringuses a web browser as a web page and can monitortheir activity through the data from the robot. In con-sideration of ethical aspects, we have made it possible

to monitor only simple activity records e.g. talk time,the number of counts by the human motion sensor andso forth. Additionally, the robot has the function of en-abling it to make an emergency call and the monitoringpersons can send messages to the robot and in turn therobot can convey these messages to the older person.Finally, a communication log is compiled and it will beanalyzed and then used to evaluate the older person’sactivity levels.Key results: A Communication robot system for olderpeople who live alone has been developed to monitor,communicate and collect their activity data. Care staffbelonging to the community-based integrated care sys-tem can monitor the older people through the robot.The robot, it’s functions and the design of the termi-nal web page were checked by occupational therapistswho are familiar with taking care of older people espe-cially those with dementia. This advanced system hasobtained positive evaluations from occupational thera-pists.Conclusion: As a result of developing the communi-cation robot system for older people who live alone,the next step is to actually place the robots into single,older people’s homes.Keywords: Older People Living Alone, Communica-tion and Monitoring, Robot.∗Corresponding author. E-mail: [email protected]

Robot-assistive Joint Attention Training in AutismSpectrum DisordersDavide Ghiglinoa,∗, Pauline Chevaliera, FrancescaCiardoa, Federica Florisb and Agnieszka WykowskaaaSocial Cognition in Human-Robot Interaction, Isti-tuto Italiano di TecnologiabPiccolo Cottolengo Genovese di Don Orione

Background: The advent of new technologies allowsresearchers to investigate subtle features of the humanbehavior, by dissecting it and by creating well con-trolled experimental paradigms. A systematic investi-gation of such features is desirable in order to facilitatethe interaction between humans and artificial agents.Although numerous authors demonstrated the efficacyof assistive technologies in neurodevelopmental disor-ders, sample sizes and methods of previous studies de-termined dubious results. Based on previous literatureresults and limitations, we defined a robot-assistivejoint attention training tailored to autism spectrum dis-order. The training consists in a spatial attention gamewith the robot Cozmo, which interacts with objects lo-


cated in front of it, stimulating the child’s attention.Activities include a 15 minutes interactions with therobot during rehabilitation sessions, and will be carriedout twice a week for five weeks.Method: To test the efficacy of the planned training,38 children (29 males, age ranging from 3 to 7) andtheir families were involved in the activities. Prior tothe activities, children diagnosis was re-assessed us-ing the ADOS 2 and ESCS, to determine their func-tionality level. Clinicians and families involved in theprotocol were evaluated in terms of implicit and ex-plicit attitudes towards robots, using and Implicit asso-ciation test (IAT) combined with self-report question-naires (i.e. NARS, ROSAS, FSQ). An additional self-report questionnaire was created ad-hoc in order to as-sess the familiarity and the previous experience withthe robots along with the expectancies toward robotics(FITTER questionnaire). We trained clinicians to au-tonomously control the activity of the robot. 8 childrenwere excluded from the study after a two-week famil-iarization phase, due either to a lack of interest or im-possibility to carry out the activities. In order to al-low all children to interact with the robot, a cross-overdesign was adopted. The training is currently ongoingwith 30 children.Key results: Preliminary results based on question-naires administered to clinicians revealed a positivecorrelation between age and discomfort perceived to-wards the robots (r = 0.50, p = 0.03), anxiety towardsrobots (r = 0.50, p = 0.03) and reluctance towards in-teraction with robots (r = 0.49, p = 0.04). Previousexperience with the robots negatively correlated withperceived warmth during the interaction (r = −0.48,p = 0.04). Reaction times collected with IAT revealeda negative association between robots and mentalis-tic concepts (F = 157.45, p < 0.001). Qualitative re-ports collected from the clinicians after the familiariza-tion phase revealed a positive attitude towards the robotfrom the vast majority of the children. Children fromall functioning levels seem to be able to understand thetask, providing either verbal or non-verbal response.Post-training improvements will be assessed with theESCS and ADOS 2.Conclusion: Preliminary data suggest the existence ofa positive attitude towards robots both in the childrenand in the young clinicians involved in the activities.Despite the initial skepticism, the entire sample of clin-icians reported a positive experience with the robot af-ter the familiarization weeks. We expect the effects de-tected from the self-report questionnaires to change af-ter the training, due to the increase in the familiarityand expertise with assistive robotics.

Keywords: Assistive Robotics, Human-Robot Interac-tion, Autism, Social Cognition.∗Corresponding author. E-mail: [email protected]

Promoting the Use of Social Robots to Engage Stu-dents with Special Education Needs (SEN): Devel-opment of a Teacher-friendly AppLisa Cesario, Arianna Gherardini, MassimilianoMalavasi, Valentina Fiordelmondo, Chiara Lepore, andEvert-Jan Hoogerwerf and Lorenzo Desideri∗

AIAS Bologna onlus, Piazza della Pace, Piazza dellaPace 4/A, 40134, Bologna, Italy

Background: The use of social robots with studentswith special education needs (SEN) is gaining in-creased attention within research due to their ability toengage students in social activities. Anthropomorphicrobots, for example, have been proposed as ideal so-cial mediators encouraging engagement within studentgroups that find social skills difficult to develop, andby extension find traditional learning methods difficult.In addition, recent investigations have begun to showa positive impact that robots could have within SENteaching through encouraging engagement with learn-ing activities. Technological competence and lack ofeasy to use robotic platforms, however, may make theuse of the social robots for SEN students difficult, in-creasing the likelihood that the robots will not be usedin the future by potential stakeholders. In this view, thepresent contribution reports on the development of anapp to facilitate the development of robot-based edu-cational activities targeting SEN students and promotethe use of social robots in mainstream schools.Method: The design and development of the app fol-lowed a Living Lab (LL) approach. LL is a user-drivenopen innovation ecosystem which enables users to takean active part in the research, development and innova-tion process. In this study, a permanent panel of 5 SENteachers were involved in the conceptualization and de-sign of the app aimed at controlling a humanoid robot(Aldebaran NAO humanoid robot). Iterative group dis-cussions between the SEN teachers and the develop-ment team were organized to develop a first workingprototype interface running on an Apple iPad R©. Theprototype was pilot-tested with a student with DownSyndrome (age 8 years) and mild intellectual disabilityusing a AB case study design. Activities proposed withand without the social robot tapped language and mathskills.


Key results: The app developed allows SEN teachersto control the humanoid robot and activate learning ac-tivities without the need to connect further devices asin already available NAO controllers. The app was con-sidered usable and easy to understand, even if furtherrefinements are needed to ease the use of the applica-tion. The results from the case study revealed compara-ble results between the traditional and robot-based ap-proach to learning, thus suggesting that the introduc-tion of a humanoid robot is not detrimental for stu-dent’s learning achievement. On the contrary, accord-ing to the opinions of the teachers, it may open novellearning scenarios.

Conclusion: Social robots are increasingly used notonly ‘in education’ (e.g. as a support to teach techni-cal skills), but ‘for education’ – that is, as a medium toteach curricular subjects. In this view, robot-mediatededucation is opening new learning scenarios in whichthe student learns from – or together with – a robot thatis capable of asking questions, providing feedback andsuggestions, and in general to engage the student insocial interactions. More research is warranted to ex-plore whether the use of social robots may improve in-clusion in education of SEN students usually at risk ofmarginalization.Keywords: Social Robots, Special Education, Intellec-tual Disabilities.∗Corresponding author. E-mail: [email protected]


Part 2: Aging

Reducing Health Disparities in Older Peoplethrough Assistive TechnologyJeffrey W. Jutai∗

Faculty of Health Sciences and LIFE Research Insti-tute, University of Ottawa, Ottawa, Canada, K1N 6N5

Background: Health disparities are preventable dif-ferences in the opportunities to achieve optimal healththat are experienced by socially disadvantaged popula-tions. Older people are at a greater risk of experienc-ing health disparities than younger people. Technologyhas great potential for reducing disparities, particularlyas we improve our understanding of the role it playsin social processes of aging. The next generation ofassistive technologies should be informed by researchon how best to ensure that they can be easily and ef-fectively integrated with educational, health and socialservices, and that their benefits can be distributed equi-tably across all populations of persons who are ageing.Method: This author conducted a scoping review ofthe literature on the relationship between assistivetechnology and social determinants of healthy ageing.A search was conducted for journal publications oforiginal research studies and reviews in the Englishlanguage. Search engines included PubMed (Medline),CINAHL (Ebsco), PsycINFO and Web of Science, us-ing the following parameters: aging population (in-cluding elderly and seniors); assistive technology (in-cluding communication technology and health tech-nology); health disparities (including health inequities,social isolation, and social determinants of health).Key results: Two social constructs are central to socialrelationships and physical health in ageing: social sup-port and social integration. Social support refers to asocial network’s provision of psychological and mate-rial resources intended to benefit an individual’s abilityto cope with stress. Social integration is defined as par-ticipation in a broad range of social relationships. It is amultidimensional construct thought to include a behav-ioral component and a cognitive component. Assistivetechnology (AT) is capable of influencing both of these

components. Precisely how AT influences social sup-port and social integration, and thereby affects healthyageing, is unknown. Assistive technology, such as in-formation and communication technologies (ICTs) arepromising technologies for improving for social sup-port and social integration because they emphasize in-tervention in natural social networks. They are a meansof making changes in social relationships that one canrely on months and years beyond the period when theyare first introduced to an older person. ICTs can beused also to increase the availability of social supportwithin existing social networks by helping to improveindividual social skills or by building stronger ties toexisting network members. They increase social inte-gration by creating and nurturing close and peripheralties between an older person and their community.Conclusion: Assistive technology (AT) has the poten-tial to intervene successfully in all critical areas of in-fluence on social connectedness provided that three es-sential spheres of activity are optimally interacting: (1)Technology – the technology can demonstrably pro-duce the effects on social support and social integrationdescribed above; (2) Services – educational, health,and social services are available to help an older per-son exploit these functional benefits; (3) Policy - sub-populations of older persons (e.g. cultural or linguis-tic minorities, ID and DD populations who are ageing)are not excluded from the provision of AT supports andservices are treated equitably.∗Corresponding author: [email protected]

Assistive Social Care Technologies for Older Peo-ple: Let’s Talk More About ThisAlison Orrella,∗ and Fiona VeritybaSchool of Health Care Sciences, Room 317 FronHeulog, Bangor University, Bangor, Gwynedd, LL572DG, Wales, UKbCollege of Human and Health Sciences, Room 135Haldane Building, Swansea University, Swansea, SA28PP, Wales, UK


S110 Part 2: Aging

Background: Health and social care are facing un-precedented challenges due to the changing patterns ofdisease, the demanding expectations of service users,financial restrictions and an ever increasing ageingpopulation. The effect of these challenges are observedin the increases in demand for, and use of, health andsocial care, the cost of caring and the need for morequalified carers. Assistive technologies, in particulardigital technologies, are being heralded as part of thesolution to provide sustainable social care services.Human relationships are paramount in social careacross the life course and are important for the careworkforce as giving care often has value for the caregiver. Protecting autonomy and upholding the right tohuman relationships is integral to treating older socialcare users with dignity. If assistive technologies are tobe of benefit to future generations of people in needof assistance we posit that a broader community dis-cussion about the value, worth and place of assistivetechnologies in social care is required to help informand to realize policy ambitions and to meet the socialcare needs of older adults. The aim of this research wastherefore to identify key questions for future dialogue.Method: A systematic literature search with a narra-tive synthesis was undertaken to identify potential re-search questions for debate. Using free text terms, syn-onyms and subject headings relating to assistive tech-nology and social care, a systematic search of articlespublished in English between January 2000 and De-cember 2018 were sourced from Medline (EBSCO),CINAHL (EBSCO), PsychINFO (ProQuest), SocialScience Premium Collection (ProQuest), British Li-brary Social Welfare Portal and the EThOS databases.Policy documents and discussion pieces on digitaltechnology use in social care were also reviewed asthey demonstrate emergent thinking around societal,ethical and moral issues. Record titles and abstractswere assessed by research team members. After re-moving duplicates, 2473 records were identified for re-view. Sixty-seven full-text copies of items thought tomeet the review inclusion criteria were obtained andassessed against these criteria. Forty-two items ful-filled the inclusion criteria. Eligibility criteria were:items had to be written in English and had to describeand/or report on the use of assistive technology in a so-cial care setting for older people. Disagreements wereresolved by consensus within the research team.Key results: Three distinct questions emerged fromthe data for broader discussion: (1) What are the impli-cations of placing elders in a position where they are‘cared for’ by technology devices? (2) If assistive care

technologies fail to provide assistance as good as peo-ple, is it right that limited resources are invested in de-vices instead of the social care workforce? (3) Whoseinterests are being serviced: the people who are caring,the people who are being cared for or the market?Conclusion: To ensure that the promises and benefitsof assistive technologies in social care are realized aclearer understanding of the importance of relationalcare and people’s interdependence is required by en-gaging a wider audience in the discussion.Keywords: Assistive technology, Social care, Olderpeople, Human relationships.∗Corresponding author. E-mail: [email protected]

Experiences with the Use of Welfare Technologiesfor Elderly PersonsLisbet Gruta,∗, Mette Røhnea, Dag Ausena,b and ToneØderuda

aSINTEF Digital, P.O.Box 124, Blindern, 0314 Oslo,NorwaybImatis AS, Porselensvegen 14, 3920 Porsgrunn, Nor-way

Background: Western societies are facing challengesin health care due to the increasing number of el-derly persons, persons with dementia and persons withchronic diseases. The use of technology is expected tosupport active aging and independent living and to re-duce the need for specialised care at nursing homes.The term ‘welfare technology’ refer to technologiesthat may support persons safety, freedom and activeaging, while maintaining independence and autonomyat home and comprises terms such as assistive tech-nology, care technologies, telecare and technologiesfor health monitoring and medication support. The ob-jectives of the research studies are to document howelderly persons, persons with dementia and personswith chronic diseases, and their caregivers experiencethe use of safety alarms, localisation technologies andmedication dispensers. The article describes and dis-cusses how the use of these technologies contributes tophysical activity, safety, freedom and independent liv-ing.Method: Action research and a participatory innova-tive design were chosen in order to understand un-derlying causes and enabling future improvement anddevelopment. The inclusion criteria were elderly per-sons living at home aiming for independent and activeliving, persons experiencing orientational challengesor persons receiving medical assistance from home-

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based services. Professional caregivers assessed eachindividual users’ needs before inclusion and selectingthe appropriate welfare technology. Informed consentwas obtained from the participants or by proxy fromtheir relatives or professional caregivers. The study in-cluded 71 participants using Mobile Safety Alarms,208 participants using Localisation Technology (GPS)and 49 participants using Medication Dispensers. Itwas a four-year longitudinal study.Key results: For users of Mobile Safety alarms, mostusers (97%) reported that carrying the alarm and know-ing that they might activate the alarm-button and callfor help, if necessary, made them feel safe and theycould continue their outdoor activities. About half ofthe users (52%) reported that the alarm gave themmore freedom. Safety and the users’ freedom to walkoutdoor alone were also the most frequently reportedimpacts of using the GPS (90%), and this increasedthe users’ autonomy and physical activity. Most rel-atives and professional caregivers reported that theyfelt safe and less anxious, because the GPS enabledthem to locate and find the user, if necessary, and pos-sibly avoid further escalation and emergency situa-tions. 89% of the users reported that the medicine dis-penser increased their sense of mastery and indepen-dence enabling self-management of medications. Morethan one-third (39%) of the users of dispenser, reportedincreased freedom and mobility. The dispensers signif-icantly reduced the number of home visits by profes-sional caregivers to half of the users.Conclusion: The studies demonstrate that welfaretechnologies contribute to maintaining physical ac-tivity, safety, freedom and independent living for el-derly people, persons with dementia and persons withchronic diseases. These technologies facilitated theuser’s ability to continue living independent at home,and welfare technologies may have the potential to de-lay the need for transfer to nursing homes. Careful as-sessment of each users and close collaboration amongusers, relatives and professional caregivers were re-ported to be a prerequisite for successful implementa-tion.Keywords: AT for elderly persons, AT for personswith dementia, assistive technology, welfare tech-nology, mobile safety alarm, localisation technology,GPS, active aging.∗Corresponding author. E-mail: [email protected]

Assistive Products Use Among Oldest-Old People inJapan: Differences in Personal Attributes and Liv-ing SituationMisato Niheia,b∗, Ikuko Sugawarab, Nozomi Eharaa,Yasuyuki Gondoc, Yukie Masuid, Hiroki Inagakid,Takenobu Inouee, Malcolm MacLachlanf and EilishMcAuliffegaDepartment of Human and Engineered Environmen-tal Studies, The University of Tokyo, 5-1-5 Kashi-wanoha, Kashiwa, Chiba, JapanbInstitute of Gerontology, The University of Tokyo, 7-3-1 Hongo, Bunkyo Ward, Tokyo, JapancGraduate School of Human Sciences, Osaka Univer-sity, 1-2 Yamadaoka, Suita, Osaka, JapandTokyo Metropolitan Institute of Gerontology, 35-2Sakae, Itabashi Ward, Tokyo, JapaneResearch Institute of National Rehabilitation Centerfor the Persons with Disabilities, 4-1 Namiki, Toko-rozawa, Saitama, JapanfMaynooth University, Maynooth, Co Kildare, IrelandgUniversity College Dublin, Belfield, Dublin 4, Ireland

Background: Improvements in healthcare and life-styles have allowed more people to live longer thanever. Japan, for example, has approximately 67,000centenarians – the highest ratio per population in theworld. Increasing age, however, is associated with in-crease in frailty, cognitive decline, chronic illness, andother impairments, and the use of assistive products(AP) becomes essential to live comfortably and au-tonomously in one’s home. With the number of olderpeople worldwide forecast to increase substantially, theglobal demand for AP is sure to increase. The useof AP can reduce the effects of several types of im-pairment, allowing older people to live more comfort-ably at home and remain active and engaged membersof society. The very old population of Japan offers aunique source of information about the use of AP laterin life. In this study, we will conduct a survey of non-institutionalized individuals, 90 years old and above,about their experiences with AP. The aim is to provideimportant insights to service providers in Japan, andglobally, about strategies for the optimal provision ofAP to older populations.Method: Self-written or amanuensis questionnaireswere posted to 4,530 people (90+ years) from theKashiwa City resident basic ledger. We analyzed 1,602valid responses (35.4%). The mean age was 92.8 ±2.8 years old (484 males and 1,045 females); 45 per-sons were centenarians. The survey items are as fol-lows: (1) age, gender, person living with, etc.; (2) liv-

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ing functions (level of nursing care needed, IADL etc.);(3) services in use (support services, AP, etc.); and (4)inconvenience in daily life (free description). This re-search was conducted with the approval of the WHOand the ethics review committee of each affiliated in-stitution.Key results: Living situation was as follows: livingalone (17%), living with spouse (11%), living withother family members etc. (50%), and living in facili-ties (22%); 67% of respondents received some nationalcare support services, and 1,574 people (98.3%) are us-ing some kind of AP. The utilization rates of dentures(76.2%), eyeglasses (64.2%), handrails (41.9%), andcane (41.0%) are high rate. There were also users ofmultiple AP (10+ types). Differences were found de-pending on AP, such as a wheelchair, which increasesthe utilization rate due to aging, and other AP, whichdecrease (hearing aid and walker). There was also agender difference, and the utilization rate of walkingAP was significantly higher for women. In addition,the usage rate of information AP for personal com-puters and smartphones was significantly higher formales. After further analysis to determine the reasonsfor these gender differences, we found that oldest-oldfemales tended to have lower mobility than their malecounterparts resulting in the higher need for walkingAP.Conclusion: The diversity of living conditions of el-derly people including AP, nursing care services, andexpert support was revealed. Additionally, the utiliza-tion of AP has revealed the fact that various items suchas gender differences, degree of need for care, IADL,living together, etc., are involved.Acknowledgement: This research was supported bythe World Health Organization Centre for Health De-velopment (WHO Kobe Centre – WKC: K18005).Keywords: Assistive Product, Oldest-Old, Question-naire Survey.∗Corresponding author. E-mail: [email protected]

“Preferred” Light Color in Home Lighting Inter-ventions for People with Age-related Macular De-generation (ARDM)Claude Vincenta,c,∗, Nathalie Cimonb, Paule Vervilleb,Frédéric Dumontc and Julie BourassacaDepartment of rehabilitation, Université Laval, 1050av. de la Médecine, Quebec city, Quebec, G1V 0A6,CanadabLow vision program, Centre intégré universitaire de

santé et de services sociaux de la Capitale-Nationale –site de l’Institut de réadaptation en déficience physiquede Québec, 525 Boul. Hamel, Quebec city, Quebec,G1M 2S8, CanadacCenter of interdisciplinary research in rehabilitationand social integration, 525 Boul. Hamel, Quebec City,Quebec, G1M 2S8, Canada

Background: The level of brightness in the environ-ment (lux) has a significant impact on the visual po-tential for people with visual impairments, but littleis known about the impact of light colors (Kelvin).Only one descriptive study investigated the effect oflight colors on reading performance (n = 107). Itrevealed better near-vision, smaller readable charac-ter size, and increased reading speed when using amagnifying glass with the preferred color tempera-ture (2700K-4500K-6500K). Also, no publication wasfound to study the effect of ambient light colors on vi-sual comfort. Our research question focused on theevaluation of the preferred choice of ambient lightingcolor tested with a near-vision assessment in clinic andby using standardized tools to evaluate the impacts athome for people with age-related macular degenera-tion (ARMD).Method: An explanatory quasi-experimental designwas proposed with 4 evaluation times and 3 inter-ventions. A sample of 10 ARMD patients with vi-sual acuity between 6/21 and 6/48 was recruitedwithin the visual impairment program. The interven-tion lasted between 8 to 10 weeks for each patientand involved two visual impairment rehabilitation spe-cialists. Evaluations were done with the MinnesotaLow-Vision Reading Test (MN Read), the Interna-tional Reading Speed Texts (IReST) the visual com-fort scale (0–10), a digital Lux Meter-LX1330B andthe Home environment lighting assessment (HELA).During clinical interventions the following instru-ments were used : the LuxIQ (4500K-5000K-6500K),magnifying glasses (diopters-10-12-16-20-24-28-39-40), and standing models (Eschenbach R©-Optelec R©-Schweizer R©). Home lighting interventions consistedof: addition/modification of light bulbs (fluocompact-DEL-incandescent), rearrangement of lamps and glarereduction.Key results: Six women and one man of 83 ± 11 yearsold with ARDM completed the experiment. In allcases, the use of the LuxIQ and illuminating magni-fying glasses showed positive impacts in near visionto increase reading speed (49 to 58 words/min.) andvisual comfort (5/10 to 8/10). It also shows positive

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impacts in ambient vision after lightning interventionswith preferred color in kitchen (n = 3), living room(n = 3) and office (n = 1). The level of ambient light-ing at home was highly increased in all cases (249 to1295 lux). HELA satisfaction also increased (3/10 to8/10). In all cases, the preferred light color chosen innear vision was the same as the one used for ambientlighting. The cold color (5000–6500 K) was chosen 5times and once for the warm color (2700–3500 K) andthe white color (3500–4000 K).Conclusion: Our preliminary results should have animpact on visual impaired rehabilitation. So far, wehave demonstrated that by relying on the “visual” as-pect of color (cold, white and warm) and not just theselected Kelvin, the color of light is transferable fromthe near vision to the ambient lighting vision in a cho-sen room. The color of the “cold” light temperatureseems to be the preferred color of light in rooms whereactivities require precision. It would be interesting totest if the chosen temperature color (cold ± 5000 K)remained the same in a room designed for relaxing orresting activities. A multi-centric study could be a so-lution to realise more meaningful results at statisticallevel.Keywords: Low vision, Light color, Home interven-tion (kitchen), Reading∗Corresponding author. E-mail: [email protected]

Stay@home with Dementia: From Needs Assess-ment to Assistive TechnologyJorina Reekmansa,∗, Ryanne Lemmensa,∗, Steffi Rijsb

and Annemie SpoorenaaPXL University of Applied Sciences and Arts, Guf-fenslaan 39, 3500 Hasselt, BelgiumbVIVES University of Applied Sciences, Xaverianen-straat 10, 8200 Brugge, Belgium

Background: The number of patients with dementialiving at home (about 70%) is still increasing. Assistedtechnology (AT) can support patients with dementiaand their caregivers in daily life, to improve indepen-dence and safety. Despite the supply of AT, the use ofAT in daily practice is only limited. One of the reasonsis the fact that most AT is not adapted to the needs ofpersons with dementia. This study aims to investigatethe specific needs of persons with dementia and their(in)formal caregivers in relation with AT and aging inplace and to translate these needs into functional re-quirements.

Method used: To investigate the most important prob-lems patients with dementia experience, patients (n =18), informal caregivers (n = 72) and healthcare pro-fessionals (n = 93) filled in the FINAH and Amster-damse IADL questionnaire. Qualitative research usingfocus groups and semi-structured interviews with 6 in-formal caregivers and 20 healthcare professionals, pro-vided detailed information about the problem activi-ties, their barriers and requirements for AT.Key results: Based on the questionnaires and the fo-cus groups, the 10 most important problem activi-ties included: using appliances (e.g. household ap-pliances, TV remote, telephone), disorientation (intime/structure of the day and regarding location),household activities (e.g. preparing meals, doing gro-ceries, doing the laundry), administration (e.g. mak-ing payments, fill in forms, keep an appointment),personal care (e.g. washing oneself, toileting), tak-ing medicines, emotions and behaviour (e.g. being de-pressed, disinhibition, fear, aggression), social con-tacts/participation and taking care of their own health.Barriers within these problem activities were in the fol-lowing categories: insight/perception, structure, habits,behaviour/emotions, disorientation, complexity, recog-nition, preservation of independence, forgetfulness,learning new things, safety, not performing, social par-ticipation, co-morbidity, professional care and distrac-tion. These barriers were translated into functional re-quirements of assistive technology.Example:Problem activity: using appliances (TV remote)One of the barriers: complexity, i.e. too many but-tons, too many different remote controls, too many op-tions/functionalities, difficult operation.Functional requirements: use limited number of but-tons, reduce the number of steps to be taken to a mini-mum to operate the remote, make the remote adaptableto individual needs, make it impossible to disorganizethe apparatus.Additionally, some general requirements for assistedtechnology for persons with dementia were formu-lated in the following categories: Usage (e.g. user-friendliness, working autonomously, durability/sustainability, easily accessible, reliability), design(e.g. recognizable, (un)conspicuous, neutral, visual,integrated), flexibility (e.g. tailor-made, adaptable tostage of dementia, suitable for home situation), aimedeffect (e.g. safety, independence, reassurance, burdeninformal caregivers, social participation, communica-tion), privacy and security (e.g. data security, privacy),juristically, financial (e.g. price, leasing possibilities)

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and implementation (e.g. practicing with AT, timing,role (informal) caregiver, requirements home).Conclusion: This exploratory study gives an overviewof the most important problem activities for patientswith dementia, the barriers within these activities andthe requirements for assistive technology. The resultswere reported to companies specialized in assistivetechnology to support user-centred-design. In the sec-ond phase of this study, companies and healthcare pro-fessionals are working together in cocreation to de-velop/adapt products to create a user-centred solutionfor a problem activity identified in this study.Keywords: Assistive technology, dementia, needs as-sessment∗Corresponding author. E-mail: [email protected]

CRDL – Interactive Technology Eliciting Engage-ment in Elderly People with DementiaRenée van den Heuvel∗, Monique Lexis and RamonDaniëlsaZuyd University of Applied Sciences, Research centrefor assistive technology in care, Nieuw Eyckholt 300,6419 DJ Heerlen, The Netherlands

Background: People with an advanced stage of de-mentia encounter problems with communication andverbal interaction, leading to a decrease in participa-tion and social isolation. CRDL (Cradle) is an interac-tive instrument, specifically developed for people withdementia to stimulate communication and social in-teraction. Based on different types of touch, CRDLproduces sounds. Research on the effects of CRDL tostimulate engagement is lacking. The research ques-tions of this study were as follows:1. Which interventions using CRDL may contribute to

the stimulation of engagement for people with de-mentia?

2. What are the effects of these interventions in pro-moting engagement in people with dementia?

Method: The study consisted of two phases using amixed-methods design. First, two interventions withCRDL aiming at the promotion of engagement weredeveloped based on results of semi-structured individ-ual interviews with 9 professionals and a brainstormsession with 6 professionals from elderly care organi-zations in the Netherlands. Second, the interventionswere tested in daily practice in two nursing homeswith 30 clients following an ABB-design; phase A in-cludes one intervention session without CRDL; phase

B (B1 and B2) includes interventions with CRDL.The primary outcome ‘engagement’ was measuredwith the Positive Response Schedule (PRS), an instru-ment developed to score engagement based on video-observations. Moreover, interviews with participatingprofessionals were conducted to evaluate experiencesof using CRDL. PRS data were analyzed using theWilcoxon signed ranked test by comparing scores onthe individual items between sessions A-B1 and A-B2.Key results: The two interventions developed were1) ‘influencing behaviour’ and 2) ‘promotion of so-cial interaction’. The procedure on how to perform theinterventions was described in a manual. In phase 2of the study 30 clients with severe dementia (22 fe-male, 8 male) and six care professionals of two el-derly care organizations participated. The profession-als could choose intervention 1 or 2. For 10 clientsintervention 1 was selected and for 20 clients inter-vention 2. In the A-phase interventions without CRDLwere used. For the intervention ‘influencing behaviour’positive effects were found compared to interventionswithout CRDL on four items of the PRS, i.e. deliber-ate body movement (B1-A p = 0.051 and B2-A p =0.025), deliberate head movement (B1-A p = 0.017),focus on environment (B1-A p = 0.011 and B2-A p =0.091) and engagement (B1-A p = 0.059 and B2-Ap = 0.097). No differences were found on the PRSitems for the intervention ‘promotion of social inter-action’. Professionals all reported positive experiencesof using CRDL and expressed their willingness to pro-ceed working with CRDL.Conclusion: The study resulted in two meaningful in-terventions for application of CRDL in dementia carepractice and gave positive indications for effects ofCRDL to stimulate engagement. Future research on theeffects of these and other CRDL interventions amonga larger population and in other target populations,such as people with intellectual disabilities is recom-mended.Keywords: CRDL, technology, dementia, engagement∗Corresponding author. E-mail: [email protected]

Assistive Technologies for Older Persons with Intel-lectual Disabilities. A Preliminary Systematic Re-view for Future Research ImplementationMabel Giraldoa,∗, Serenella Besioa and Patrizia MartibaDepartment of Human and Social Sciences, Univer-sity of Bergamo, Piazzale S. Agostino 2, 24129 Berg-amo, Italy

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bDepartment of Social, Political and Cognitive Sci-ence, University of Siena, Via Roma 56, 53100 Siena,Italy

Background: The number of older persons, includ-ing those with disabilities, has increased substantiallyin most countries and it will accelerate in the nextdecades. Among this population, experts have estab-lished a conceptual and factual distinction between twodifferent phenomena: disability with aging (elderly in-curring into some kind of impairments) and aging withdisability (elderly who incurred into impairments dur-ing the developmental age). In both cases, assistivetechnologies (AT) can play an important role in sup-porting and stimulating elderly with disabilities in or-der to improve their quality of life and to support themin cognitive and social skills maintenance. In particu-lar, the present paper aims at mapping the state of theart in ATs developed in the last 5 years for older per-sons with intellectual disabilities (ID).Method: Adopting PRISMA checklist, a systematicreview was conducted in IEEE Digital Library, ACMDigital Library and Scopus databases using the fol-lowing keywords: a. assistive technology OR assistivedevices OR domotics; b. accessib*; c. disabil* olderpeople OR disab* elderly; d. intellectual disability ORmental retardation; period: 2014 to 2019. Inclusioncriteria were scientific papers, proceedings and bookchapters addressing the topic of interest. Studies thatdid not include older adults/elderly with ID and re-searches that did not focus on the use of ATs and re-lated devices (indoor/outdoor, embodied, etc.) for thesetarget-users were excluded.Key results: After an initial selection of 520 articles,61 were subjected to in-depth analysis leading to thefinal selection of 45 papers. The selected contribu-tions reflect a heterogeneous variety of ATs (proto-types, on-purpose/low cost/commercial devices, etc.)that can support the older persons with cognitive im-pairments: advanced sensors/networks (n.10); cogni-tive assistants (n.3); robots (n.3); wireless commu-nication systems (n.14); wearable technologies (n.6).Moreover, some papers (n.5) collect or combine dif-ferent kind of devices while a few (n.4) face the eco-nomic, ethical and legal issues connected to the useof ATs with older/disabled persons. In the majority ofthe studies, these ATs were developed for older per-sons who acquired some kind of cognitive impairments(e.g. dementia) in older age (n.18) or, according to theirdesigners, could be used both for age-related cogni-tive disorders and for older persons with life-long ID

(n.20). Only a few studies (n.7) focused on the use ofATs for persons aging with ID.Conclusion: The paper reports on the increasing num-ber of ATs designed to assist elderly with cognitive dis-abilities to meet their needs. Simultaneously, it high-lights that only few researches focus on AT devicesfor persons aging with ID. This confirms the lack oftheoretical/concrete integration between aging and dis-ability studies. These aspects, together with prematureaging (generally associated with ID), result in limitedunderstanding of how the experience of living with along-term disability influences the experience of ag-ing. Consequently, more attention to, and the develop-ment of ATs specifically designed for the aging pop-ulation with ID is needed. New challenges for futureresearches will be addressed and further possible ex-ploitation/application for supporting “successful agingwith disabilities” will be drawn.Keywords: Intellectual disabilities, Older person, Ag-ing with disability, Assistive Technologies.∗Corresponding author. E-mail: [email protected]

Virtual Garden for People with DementiaAnne-mie Sponseleea,∗ and Astrid DooremalenaaSchool of People and Health Studies, Fontys Univer-sity of Applied Sciences, Postbus 347, 5600 AH, Eind-hoven, The Netherlands

Background: SENSE-GARDENs will strengthen theawareness of older people with dementia by provid-ing stimuli to the different senses, such as sight, touch,hearing, balance and smell. In this study, several proto-types of the AAL-project were tested. For the Reality-Wall – a large screen showing film and photos, withsounds and music, and matching vibrations - the con-tent must be tuned to a person’s cultural background. Inthis study the desires and needs of Dutch older peoplewith dementia in relation to the Reality-Wall were re-searched, with the goal to have content for the Reality-Wall when implemented in the Netherlands. The Life-road/Cycling-Home consists of a stationary bicycle infront of a screen on which the environment of the cycleroute is presented. In this study, various technologicalset-ups were tested with the goal to increase the senseof immersion to improve the well-being of people withdementia.Method: In co-creation with nine people with de-mentia (phase CDR-2 and CDR-3) and their fam-ily, moodboards were created illustrating what kind

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of films, music, tv-shows, art, etcetera would fit peo-ples’ interests and bring up good memories. Basedupon these moodboards, a 24-minute film with 21fragments in four categories (TV; photo with sound;TV with music; photo) was created to test, usingparticipatory observations. Five people with demen-tia (phase CDR-2 and CDR-3) were shown the filmtwice (with and without a family member), while re-searchers measured the number of verbal/non-verbal,social/non-social behavior for each fragment, using theVerbal and Nonverbal Interaction Scale. For the Life-road/Cycling-Home twenty care-home residents withdementia were randomly attributed to two out of fourtest settings (Google Streetview (personal choice of en-vironment); 360-degrees video of the care-home en-vironment; Bikelabyrinth (commercially available in-teractive routes); ClubVirtual (commercially availablevirtual cycling routes). Participants were seated infront of a stationary bicycle and a television screen,and were cycling for three minutes per test setting. Tworesearchers made observations, using the DiscomfortScale – Dementia of Alzheimer Type (DS-DAT), usinga 5-point frequency scale.Key results: During the 24-minute film for the Reality-Wall, participants mainly showed non-verbal socialbehavior. TV fragments with music resulted in thestrongest reactions (F = 6.66, df = 3, p < 0.01). Incomparison to observations without a family member,participants showed more verbal social behavior (t =−2.54, df = 20, p < 0.05), more non-verbal socialbehavior (t = −2.22, df = 20, p < 0.05), and lessnon-verbal non-social behavior (t = 4.26, df = 20,p < 0.00), when a family member was present duringthe 24-minute film. For the Life-road/Cycling-Hometest, the 360 degrees video resulted in the lowest aver-age discomfort score (DS-DAT score: 7.2). The GoogleStreetview setting resulted in the highest discomfortwhen tested first (DS-DAT: 11.2), but the lowest dis-comfort when tested second (DS-DAT: 5.9; t = 2.10;df = 8; p < 0.10).Conclusion: All fragments resulted in more socialthan non-social behavior, some fragments strongerthan others. The presence of family members increasedverbal social behavior. The film seems suitable forresidents with dementia of Dutch care-homes. 360-Degrees videos are useful for the Life-road/Cycling-Home prototype. Participants experience no extra valuein interactive routes.Keywords: Dementia, Virtual Environment, Co-creation, Stimuli.∗Corresponding author. E-mail: [email protected]

Dementia Dogs and their Impact on Community-dwelling Persons with Mild to Moderate Dementiaand their Family CaregiversClaude Vincenta,b∗, Frédéric Dumontb, BertrandAchoub, Cary Brownc, Suzette Bremault-Phillipsc,Bernie Travisd, Annette Rivardc and Julie BourassabaDepartment of Rehabilitation, Université Laval, 1050av. de la Médecine, Quebec city, Quebec, G1V 0A6,CanadabCenter of interdisciplinary research in rehabilitationand social integration, 525 Boul. Hamel, Quebec City,Quebec, G1M 2S8, CanadacDepartment of Occupational Therapy, University ofAlberta, 116 St. and 85 Ave., Edmonton, AB, T6G 2R3,CanadadEarly Onset Dementia Alberta Foundation, Edmon-ton, Alberta, Canada

Background: Individuals with mild to moderate de-mentia, and their caregivers, may benefit from the sup-port of a dementia dog. It falls into the category ofcognitive aids (assistive technology for disabilities).It’s a dog trained to provide cues (and sometimes re-minders) and companionship, improve activity-levelsand wayfinding, and enhance well-being and connec-tion. There are very few schools that have a for-mal training program to train dementia dogs; we havefound one dog schools in USA, one in Scotland andone in Australia. Since there is no scientific evidenceaddressing the efficacy of dementia dogs, our studyproposes the following research objectives: 1-to exam-ine the impacts of canine assistance on both the personwith dementia and his/her caregiver (e.g., on engage-ment, socialization, well-being, activity levels, wan-dering, sense of meaning and purpose, quality of life,stress and health); 2-to conduct a cost-effectivenessanalysis associated with having a canine assistance inthe home of the person with dementia (e.g., costs re-lated to dog acquisition and community training, post-placement, costs savings; benefits measured in terms ofquality of life for caregivers and those with dementia);and 3-to examine the acceptance of canine assistancein public places in the prior 3 months from the care-givers’ point of view (e.g. approachability situationsand socialisation experiences).Method: A comparative analysis of 3 ‘cases’ is un-derway. Each case will be comprised of 20–40 dyadsof a caregiver, person with mild to moderate demen-tia, and either (1) a companion dog, (2) a certifiedsupport dog, or (3) no dog. Data collection will in-clude phone/Skype interviews with caregivers, a cost-

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effectiveness analysis and observation at dog trainingschools. Phone questionnaires used are the Concern forthe Care recipient’s Well-Being (CCWB) and the Im-pact on the Caregiver’s Social Life (ICSL) (two sub-scales of the Caregiver’s Burden Scale). Online ques-tionnaires used are the Adult social care outcomestoolkit (ASCOT), the Social care-related quality of life(SCRQoL), the ICEpop (Investigating Choice Exper-iments for the Preferences of Older People) and theCAPability measure for Older people (ICECAP-O). Aqualitative thematic analysis of interviews and compar-isons of the quantitative data across the 3 cases will beconducted.Key results: Preliminary results on canine assistancehas a positive impact on the lives of persons with de-mentia and their caregivers (supporting engagement,quality of life, well-being of the dyads, and enablingthe person with dementia to remain at home safely andthe caregiver remain or return at work).Conclusion: With more results about canine assis-tance, it may be possible to advocate for the establish-ment of new training programs for certificated demen-tia dogs across Canada. Furthermore, positive resultsfrom the cost-effectiveness analysis and acceptance ofthe dementia dogs in public places will inform policy-makers about the feasibility of funding certified dogsand to establish the associated public policies.Keywords: Cognitive aid, Emotional support dog,Alzheimer, Home support, Caregiver facilitator.∗Corresponding author. E-mail: [email protected]

Family Caregivers’ Experience of Care and Use ofAssistive TechnologiesFrançois Routhiera,b,∗, Maude Beaudoina,b, Oladele AAtoyebic, Claudine Augerd, Louise Demersd, AndrewWistere, Janet Fastf , Paula Rushtond, Josiane Lettrea,Michèle Planteg and W. Ben MortensoncaCentre for interdisciplinary research in rehabilitationand social integration, Centre intégré de santé et deservices sociaux de la Capitale-Nationale, 525 Hamelest, Québec, G1M 2S8, CanadabDepartment of rehabilitation, Université Laval,Québec, G1V 0A6, CanadacDepartment of Occupational Science and Occupa-tional Therapy, University of British Columbia, Van-couver, V6T 2B5, CanadadSchool of rehabilitation, Université de Montréal,Montréal, H3N 1X7, CanadaeDepartment of Gerontology, Simon Fraser University,

Vancouver, V6B 5K3, CanadafDepartment of Human Ecology, University of Alberta,Edmonton, T6G 2P5, CanadagResearch Centre, Institut universitaire de gériatrie deMontréal, Montréal, H3W 1W4, Canada

Background: Nearly half of the Canadians will befamily caregivers (individual who provides unpaid as-sistance to someone living with a chronic condition)at some point in their lives. Family caregivers provide75% of the care needed for individuals with disabil-ities to remain in their communities. Caregiving haspsychological, physical and financial consequences.Considering issues associated with caregiving, findingways to reduce caregiver burden is critical. Researchhas shown that the use of assistive technologies coulddecrease caregiver burden. However, it is essential toknow how caregivers experience care and use of assis-tive technologies. This knowledge would guide the de-velopment of assistive technologies that are appropri-ate to their situation. This study aimed to explore theexperience of caregiving for older adults, whether as-sistive technologies are currently integrated in the careand their perceived impacts.Method: This study draws on data from a larger multi-site, mixed-methods project on Canadian family care-givers. Sites of recruitment and data collection are Van-couver (English-speaking participants) and QuébecCity (French-speaking participants). To be recruited,family caregivers had to speak French or English, be atleast 19 years old and provide care to an older adult,or be an older adult providing care. Participants wereselected during recruitment to obtain a maximum theo-retical variation in terms of impairments of the personfor who care was provided (i.e., physical and/or cogni-tive), relationship with the care recipient (e.g. spouse,child, etc.), the amount of care provision and region inCanada. Between November 2015 and October 2017,59 family caregivers were recruited and participated inan individual semi-structured interview on their cur-rent caregiving situation and their use of assistive tech-nologies. Participants were informed that, when askedabout assistive technologies, they could talk about ser-vices (e.g. home care services), policies (e.g. care fund-ing) and assistive devices. A thematic content analysiswas conducted.Key results: Three main themes were identified fromthe interviews that describe family caregivers’ expe-riences of care. ‘Responsibilities of Caregiving’ de-scribed that caregivers assisted in all areas of their carerecipient’s life, but some factors modulated the specific

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activities for which help was provided and the typeof help. An example of a modulating factor was theircare recipients desire for autonomy. ‘Caregivers’ Chal-lenges and Rewards’ portrayed the daily challenges ex-perienced by caregivers, such as physical strain, men-tal difficulties, the need for external assistance, etc. butalso identified positive caregiving activities. ‘Strategiesto Address Responsibilities and Challenges’ illustratedthat caregivers use a variety of strategies to face theirdaily challenges, including the use of assistive tech-nologies, but some needs are not fully addressed.Conclusion: We developed a better understanding ofthe complexity of care provision, including daily chal-lenges and needs that are not fully addressed, whichmay be affected via appropriate access to and use of ef-fective assistive technologies. This study is a first steptoward user-centred design research to develop innova-tive assistive technology solutions and areas where ad-vocacy is needed to improve access to existing devicesand services.Keywords: assistive technology, caregiver, olderadults, needs, mixed-method, interview.∗Corresponding author. E-mail: [email protected]

Evaluation of an Assistive Technologies Bundle byInformal Carers of Older Adults. Results from a Pi-lot Trial in Austria and ItalyInes Simbriga,∗ and Judith Kathreinb

aInstitute for Public Management, Eurac Research,Viale Druso 1, 39100 Bolzano, ItalybInstitute for Strategic Management, Marketing andTourism, University of Innsbruck, Universitätsstraße15, 6020 Innsbruck, Austria

Background: There are many assistive and smarthome technologies, but a residential gateway that con-nects them and thus creates an interoperable and adapt-able technology bundle for older adults is still miss-ing. Within the project gAALaxy, funded by the Euro-pean AAL programme, such a bundle was developedand evaluated. The main research questions regardinginformal carers focused on the usability of the bundle,perceived effects on well-being and quality of life vari-ables, as well as different care aspects.Method: The technologies were evaluated in an ex-ploratory field study. Community-dwelling older adultsand their informal carers from Austria and Italy tested abundle, consisting of an emergency watch, a fall detec-tor and a smart home system, for six up to 18 months.

The trial period was conducted in two phases, with themiddleware of the bundle being improved before thesecond phase. Here, we present parts of the results, i.e.the analyses of a questionnaire filled in by 38 informalcarers. It measured attitudes towards technology, theperceived impact of the bundle on the older adults andthemselves, and the perceived usability and ease of useof the bundle. In pilot phase two we also asked partic-ipants about their willingness to pay for the technolo-gies.Key results: Statistical analyses showed that therewere virtually no significant differences between phase1 and 2 regarding the perceptions of informal carers.Surveying the impact of the bundle on different vari-ables across both phases, we found mostly positive val-ues though. The perceived effects on care quality, easeof use, peace of mind, comfort, safety, autonomy, andsocial interaction were all positive, with a total mean of1.14 (SD: 0.64, seven-point scale from −3 to +3). Themean perceived usability of the bundle was 1.63 (SD:0.89, seven-point scale from −3 to +3). The ability ofthe bundle to recognise emergencies quickly was ratedespecially positively (mean: 1.45, SD: 0.81, five-pointscale from −2 to +2). Only the perceived effort of us-ing the bundle as an informal carer was rated slightlynegatively (mean: −0.62, SD: 0.92, five-point scalefrom −2 to +2). 10 informal carers reported some fu-ture willingness to pay a monthly fee for the wholebundle including services, with a wide range of ac-ceptable monthly fees being stated (mean: 57.19e, SD:52.57e).Conclusion: The lack of differences between phase 1and 2 in terms of general technology attitude and eval-uation of the bundle is not surprising as the bundlechanged little over time from the end-users’ point ofview (the improvements were of a technical nature andhad no noteworthy effects). Even if there were no sta-tistically significant increases of the perceived qualityand effects of the technology bundle over time, we canstill state that the overall perception by the informalcarers was almost always positive in both phases. Theexploratory nature of the research design did not allowsophisticated statistical analysis methods. We there-fore consider the results as preparatory for bigger scaleprojects (e.g. i-evAALution, also funded by the AALprogramme).Keywords: Assistive Technologies, AAL, OlderAdults, Informal Carers∗Corresponding author. E-mail: [email protected]

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Evaluation of Daytime Activities at Home for El-derly Hemiplegic Patients and Development of Bedwith Standing up Function to Prevent Disuse Syn-dromeKatsuhiro Manabea, Tsutomu Hashizumeb, TaizoShiomib, Satoshi Miyasitab, Toru Maesonoc and Tsu-tomu AbedaFaculty of Medical Science Dept., Teikyo Univer-sity of Science, 2-2-1 Senjusakuragi, Adachi-ku Tokyo,JapanbFaculty of Medical Science Dept., Teikyo Universityof Science, Tokyo, JapancAgeo Central Medical Group, JapandRehabilitation Progressive Center-co, Japan

Background: The rehabilitation service of elderlyhemiplegics patients at home to prevent disuse syn-drome play an important role in Japan. However, theactual activity level of patients and the effectiveness ofthe rehabilitation are not clarified objectively. The pur-pose of this study is to evaluate their activities with Ac-tivity Monitoring Evaluation System (AMES) and todevelop the bed with standing up function to preventdisuse syndrome. The bed can take the forms of veryadjustable profile electrically, so that the patient is ableto achieve a standing position through a sitting positionfrom horizontal lying position.Method: We examined the activities of 30 hemiplegicpatients (71 ± 3.5 years, 22 males, 8 females) withAMES while 8 hours (9 am to 5 pm) for 2 days. AMEScould derive the activities such as walking, propellingwheelchair, standing, sitting, and lying position on bed.We evaluated total duration time, percentage and max-imum continuous time of each activity. In order to ver-ify the efficiency of the bed in almost bedridden an-other 2 hemiplegic patients (83 years male, 87 yearsfemale), to take standing position for 30 minutes wasperformed twice a day for 30 days.Key results: 1. Mean total duration time, standard de-viation were that walking: 55 ± 37min, propellingwheelchair: 33 ± 34 min, standing: 27 ± 21 min, sit-ting: 270 ± 100 min, lying position: 116 ± 119 min. 2.The mean percentage of each activity against to 8 hourswere that walking: 12%, propelling wheelchair: 7%,standing: 6%, sitting: 56%, lying position: 24%. 3.Mean maximum continuous duration time and max-imum time were that walking: 6 min (27 min), pro-pelling wheelchair: 49 seconds (1.5 min), standing:2 min (9 min), sitting: 43 min (2 h 14 min), lying po-sition: 43 min (2 h 40 min). 4. The standing up withthe bed increased serum proteins and hemoglobin that

indicated the improvement of anemia and nutritionalstate, and improved edema in the lower extremities andADL level. However, these results showed only slightimprovement, with no statistically significant differ-ences.Conclusion: The percentage of walking and standingis only 18%, whereas that of sitting and lying positionis about 80%. Nine subjects show that the percentageof walking is lower than 10%. The percentage of sit-ting time 56% shows that the subjects have been sittinghalf in a daytime. The mean percentage 24% of lyingposition indicates that some subjects are staying in bedthrough the daytime, and 9 subjects have been lyingfor over 3 hours. The results reveal that the amount ofdaily activities of the hemiplegic patients in a daytimeis unexpectedly low, and predict those patients may becaused a disuse syndrome. The standing up function ofthe bed is clinically useful, for selected patients whocould show good prognosis in ADL stage. However,the primary purpose of the bed is to facilitate a changefrom a supine position to a sitting position and to leadfrom a standing position to walk. So, further study toverify the effect of the multi adjustable forms bed withAMES for improving the activity level of hemiplegicpatients is required.Keywords: Elderly hemiplegia, Daytime activities,Rehabilitation service, Standing up bed, Disuse syn-drome.∗Corresponding author. E-mail: [email protected]

Detecting Social Interaction in a Smart Environ-mentAndrea Masciadria, Stefano Brusadellia, AndreaTocchettia, Sara Comaia,∗ and Fabio SaliceaaDipartimento di Elettronica, Informazione e Bioing-egneria, Politecnico di Milano, Via Francesco Anzani42, 22100 Como, Italy

Background: Over the last few decades, numerousarticles and studies have shown the relationship be-tween loneliness and its effects on people’s health, es-pecially in the case of senior citizens. Detecting lone-liness requires a meticulous and continuous observa-tion of the subject by clinicians. However, consider-ing the growth of the population over sixty, the hugedemand for health-care facilities, and the necessity tocontain the costs of hospitalization, the technology isnow called to support the activities of specialists. Anopen challenge is to measure the level of social inter-action among people, and to infer a personal “loneli-

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ness” index. We propose a system to identify the inter-actions among people who are sharing the dining tablein a smart environment.Method: This study refers to an experimental inves-tigation conducted in “Il paese ritrovato”, an innova-tive health-care facility located in Monza, Italy, that as-sists people affected by Alzheimer Disease. The sys-tem detects the patients who are sitting around a ta-ble and their position; this information is computed in-tegrating an environmental Bluetooth indoor localiza-tion system and an RFID module installed on the table.Moreover, the system detects the social interactions:a quad-microphone array expansion board for Rasp-berry Pi called ReSpeaker Mic 4-Array detects the di-rection from which someone is speaking. A dedicatedsoftware filters the data locally, and computes a “socialindex” among the people who are sitting around at thetable. The communication between the main moduleand the devices has been implemented using MQTT, apublish/subscribe mechanism.Key results: The experiment has been carried out in anindoor environment, by placing the system on a four-sided square table with four people, one for each seat.During the testing phase, the system has been testedunder three different environmental conditions: in ab-sence of noise and voices aside from the speaker, inpresence of noise and with other people speaking in thesurroundings of the system. Overall, the system showspromising results (precision: 84%, recall: 93%, accu-racy:79%) only, in presence of loud noise, the systemis still not able to identify with precision the peoplewho participate in the interaction. We strongly believethat the computed index constitutes a valuable sourceof knowledge for further data analysis modules (suchas the one installed in “Il paese ritrovato”) to monitorpatients.Conclusion: A novel system to identify the interac-tions among people who are sharing the dining table ina smart environment has been presented. Thanks to alocalization module based on both Bluetooth and RFIDtechnologies, and a microphone, this system is capableto measure the level of social interaction among peo-ple. As future work, we plan to investigate the possi-bility to extend the system to detect social interactionsin wide open spaces through the integration of a devicecapable of recognizing the speakers’ voiceprints.Keywords: Wellbeing assessment, Assistive Tech-nologies, Social interaction, Smart Environments, IoT.∗Corresponding author. E-mail: [email protected]

Continuous Ambient In-home Walking Speed Mon-itoring in Frail Older Adults: Results of a Feasibil-ity StudyPhil Joddrella,∗, Stephen Pottera, Luc P. de Wittea andMark HawleyaaCentre for Assistive Technology and Connected Heal-thcare, School of Health and Related Research, TheUniversity of Sheffield, 217 Portobello, Sheffield S14DP, UK

Background: Walking speed has been shown to bepredictive of important clinical outcomes in olderadults and has been labelled ‘the sixth vital sign’. Fur-thermore, it has particular value as one of the most sig-nificant indicators of frailty. Despite the clinical im-portance of walking speed measurement (and its in-clusion in guidelines regarding frailty, multi-morbidityetc.), measurement of walking speed is rarely carriedout. It is not feasible to carry out clinic-based walkingspeed measurements with sufficient frequency to cap-ture the rate of change of health in older people andas a result important heath deterioration is missed andhealth services end up reacting to crisis situations (e.g.falls). Our aim was to test whether it is feasible to mea-sure walking speed frequently and unobtrusively in thehome, using ambient technology that is easy to installand reliable (therefore usable in a health and social caresetting), low cost, and acceptable to older people.Method: A longitudinal feasibility study was con-ducted involving 20 older adults (aged 65 or above)living alone, identified as either frail or pre-frail bythe Rockwood Clinical Frailty Scale (score betweenfour and six). Self-selection sampling was employedwithin the populations of two supported-living servicesin Sheffield, UK. Sensors were installed in the partic-ipants’ homes for a period of three months to contin-uously measure their walking speed. The researchervisited each participant at four time points (baselineand monthly intervals) to conduct manual walkingspeed measurements, administer the Rockwood Clini-cal Frailty Scale and a brief health interview, and col-lect the data from the memory cards of each device.Qualitative interviews were also conducted at the endof the study to assess participants’ attitudes to the sen-sors and the concept of continuous in-home walkingspeed measurement.Key results: Eighteen participants completed thestudy, with two withdrawing, one due to personal pref-erence at month one and a second due to a changein living circumstances at month three. The numberof walking speed measurements recorded by the sen-

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sors varied significantly between participants (mean1159.39, range 4–3636); the number was determinedby the placement of the device within each home andtechnical disruptions to the sensor operation, as wellas the individual’s lifestyle and degree of mobility. Anear-normal distribution of speeds was evident for sev-eral participants for whom placement was good anddisruption was minimal. Qualitative interviews withthe participants indicated both acceptability of the de-vice within the home environment and of the conceptof measuring walking speed as an indicator of physicalhealth.Conclusion: This study has demonstrated the feasi-bility of continuous ambient in-home walking speedmonitoring in older adults. Further development of thewalking speed sensor is required to increase place-ment flexibility, improve accuracy and allow for wire-less integration with online services. This will leadto a device that can be used both to support self-management of frailty and monitoring of frailty byhealthcare providers.Keywords: Frailty, Walking speed, Ambient sensortechnology.∗Corresponding author. E-mail: [email protected]

Effectiveness of Sensor Monitoring in a Rehabili-tation Program for Older Patients After Hip Frac-ture: A Three-arm Stepped Wedge RandomizedTrialMargriet Pola,∗, Gerben ter Rietb, Margo van Harting-sveldta, Ben Krösec,d and Bianca M. Buurmana,eaACHIEVE, Centre of Applied Research, Faculty ofHealth, Amsterdam University of Applied Sciences,Amsterdam, The NetherlandsbDepartment General Practice, Amsterdam UMC,University of Amsterdam, The NetherlandscResearch Group Digital Life, Amsterdam Universityof Applied Sciences, University of Amsterdam, Amster-dam, The NetherlandsdInformatics Institute, University of Amsterdam, Ams-terdam, The NetherlandseSection of Geriatric Medicine, Department of InternalMedicine, Amsterdam UMC, University of Amsterdam,Amsterdam, The Netherlands

Background: The performance of activities of dailyliving (ADL) at home is important for the recovery ofolder persons after hip fracture. Fear of falling hin-ders older persons to perform ADLs. Sensor monitor-

ing can be used as a coaching tool to reduce fear offalling and increase daily functioning. However, as faras we know, sensor monitoring-based programs havenot yet been used in rehabilitation for older patients af-ter hip fracture. In this randomized trial, we tested theeffects of an intervention involving sensor monitoringinformed occupational therapy on top of a cognitivebehavioral treatment (CBT) based coaching programon patient- reported daily functioning in older patientsafter hip fracture.Method used: The study was a three-armed random-ized stepped wedge trial in six skilled nursing facili-ties, with assessments at baseline (during admission)and after one, four and six months (at home). Eligi-ble patients were hip fracture patients 65 years andolder. Patients received care as usual, CBT-based oc-cupational therapy or CBT-based occupational therapywith sensor monitoring. The sensor monitoring sys-tem comprises 1) a wearable physical activity moni-tor (PAM-sensor) that is worn on the hip; 2) a net-work of ambient sensors comprises (Benext )passiveinfrared motion sensors placed in the main spaces inthe patients’ house and 3) a gateway, that is a raspberryPi with a Z-wave shield for communication with theambient sensors, a Bluetooth adaptor for communica-tion with the PAM and a 4G dongle to make connec-tion with the remote server. Via a web-based applica-tion users can login to the server and see the visualiza-tions. Interventions comprised a weekly session duringinstitutionalization, followed by four home visits andfour telephone consultations over three months. Theprimary outcome was patient reported daily function-ing at six months, measured with the Canadian Occu-pational Performance Measure.Key results: A total of 240 patients (mean[SD] age,83.8[6.9] years were enrolled. At baseline, the meanCanadian Occupational Performance Measure scores(range 1–10) were 2.92 (SE 0.20) and 3.09 (SE 0.21)for the care as usual and CBT-based occupational ther-apy with sensor monitoring groups, respectively. Atsix months, these values were 6.42 (SE 0.47) and 7.59(SE 0.50). The mean patient-reported daily function-ing in the CBT-based occupational therapy with sen-sor monitoring group was larger than that in the care asusual group (difference 1.17 [95% CI (0.47–1.87) P =0.001]. We found no significant differences in dailyfunctioning between CBT-based occupational therapyand care as usual.Conclusion: Among older patients recovering fromhip fracture, a rehabilitation program of sensor mon-itoring-informed occupational therapy was more effec-

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tive in improving patient-reported daily functioning atsix months than to care as usual. The findings have im-portant implications for those active in the support ofolder patients after hip fracture. A successful imple-mentation of this intervention, requires the use of goalsetting and CBT-strategies to motivate patients to in-crease daily activities with the goal to recover. The ob-jective information of the sensors provides profession-als with more detailed information about daily activitypatterns, so they can more effectively discuss goals andcoach patients to recover.Key words: Geriatric rehabilitation, sensor monitor-ing, cognitive behavioral treatment∗Corresponding author. E-mail: [email protected]

HABITAT: A New Generation of Ambient AssistedLivingAlessandra Costanzoa,∗, Francesca Benassib, ElenaBorellic, Diego Masottib and Giacomo PaolinibaDEI “Guglielmo Marconi”, University of Bologna,Via dell’Università 50, 47522 FC, Cesena, ItalybDEI “Guglielmo Marconi”, University of Bologna,Viale del Risorgimento 2, 40136 BO, Bologna, ItalycCIRI SDV, University of Bologna, Via Tolara di Sopra41/E, 40064 BO, Ozzano dell’Emilia (Bologna), Italy

Background: Over the last years, due to the increas-ing median age of the world population, solutions de-voted to home living assistance are becoming a matterof urgency, enhancing interests throughout the scien-tific community. In particular, HABITAT (Home As-sistance Based on the Internet of Things for the AuTon-omy of Everybody) is a project addressed to families,caregivers, and to everyone who needs support in dailyactivities in order to guarantee increasing safety andto encourage the maintenance of a healthy lifestyle.The presented solution consists in a platform based onthe typical technologies of Internet of Things (IoT),namely RFID (Radio Frequency IDentification), Wear-able Electronics, Wireless Sensor Networks (WSN)and Artificial Intelligence, which allows to realize re-configurable assistive environments.Method: After an in-depth analysis of needs, carriedout through interviews and focus groups involving thereal users living in adult daycare centers, more than450 requests were collected; based on these wishes,everyday life objects have been enhanced with brandnew functionalities, with the aim of making them be-come “smart”. As an example, a common wall lampintegrates an innovative indoor localization system, an

armchair allows to detect the sitting posture and fi-nally a belt incorporates a mobile health system ableto perform an indoor and outdoor gait analysis. Con-cerning the indoor localization, a RFID reader (withmaximum read range of 5.50 m and angular apertureof ± 45◦) able to localize and track both people andobjects equipped with RFID tags, has been developed.Thanks to the limited thickness of the reader, this tech-nology is able to be inserted in any piece of furnitureinside the house, i.e. hung on the wall inside a frame.Furthermore, a small RFID tag completes the over-all system and can be worn by the users in a discreteway, like a brooch, a pendant, or with the antenna di-rectly integrated in the textile materials. After prelim-inary laboratory investigations, 40-minute tests havebeen performed on 19 subjects, including caregivers,self-sufficient and non-self-sufficient seniors, from 55to 83 years old, volunteers from a daycare facility onthe outskirts of Bologna (Italy).Key results: During the abovementioned tests, boththe technology of the smart objects and their accept-ability were validated and deeply investigated: with re-gards to the indoor localization, mean errors of about18 cm were detected within a room of 32 m2. Duringthe project, deep focus has been pointed towards theacceptability of the technology, together with the ob-ject design usability and their interaction with the finalusers.Conclusion: In this work, a new version of AAL (Am-bient Assisted Living) system addressed to elderly peo-ple living in their own houses or in daycare centershas been described; its future aims forecast improve-ments on the technology functionalities and on theuser-friendly designs of the smart objects.Keywords: Ambient Assisted Living, Elderly, Internetof Things, Assistive Technology.∗Corresponding author. E-mail: [email protected]

LivingHub: An interdisciplinary approach to de-signing an innovative AT laboratory for ageing pop-ulation by using simulation-based educationNiccolò Casiddua,∗, Marco Chiricob and ClaudiaPorfirioneaaDepartment of Architecture and Design, University ofGenova, ItalybUniversity of Genova, Simav, Italy

Background: Simulation-based education methodol-ogy, born in the military field, has since earned

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widespread recognition in many fields as a powerfultool to strengthen knowledge, improve team commu-nication and teach the skills of decision-making pro-cesses. Many Universities in the world have set up theirown simulation laboratories, teaching and researchcenters, predominantly in engineering and medical ar-eas. In particular, simulation based medical trainingenables students, physicians, nurses and other healthprofessionals to integrate cognitive learning with prac-tical experience, without posing risks to the patients.Today the use of simulation has surpassed militaryand medical applications and has allowed the devel-opment of transversal didactic teaching methods thatcould cover a wide range of new training needs.Devised from the confluence of transdisciplinary skills(medicine, engineering, computer science, architec-ture, design) according to the AAL (Ambient AssistedLiving) approach, this work presents the LivingHubproject: a smart prototype apartment (about 70 squaremeters) to simulate domestic environments for ageingpopulation integrated with systems of monitoring, con-trol and assistance.The LivingHub objective is to promote the spread ofa new home healthcare culture that passes throughsimulation-based education, designing suitable spacesand devices and developing specific professional skills.Furthermore, the LivingHub wants to provide a refer-ence model for new research and training opportunitiesin the field of interdisciplinary and interprofessionalskills, across different scientific areas.Method: Currently under construction, the LivingHubis being built as a movie set (folding triangular trusswith audio-video-light system) consisting of four mainrooms (bedroom, living room, bathroom, kitchen) anda control room.

The LivingHub is a home-laboratory (according to themodel of the MIT Living Labs: http://livinglab.mit.edu/) where different actors (coming from universities,companies, research centers, public institutions, citi-zens) have the chance to exchange ideas, following amultidisciplinary and user-centered approach able topromote innovation.Starting from the detection of users’ needs in carryingout daily activities, simulation training scenarios arebuilt with technological aids by formal and informalcaregivers, with particular attention to the concepts ofaccessibility and usability.Key results: The LivingHub aims to create a hub thatcombines various functions, such as an educationallaboratory for students and professionals, a showroomof technologies and services in AAL field, a researchand development laboratory for assistive technologiesand services.Conclusion: The LivingHub not only aims to educate,through simulation, future highly qualified care profes-sionals, but is also aimed at generating user-centeredecosystems, able to accelerate the large-scale adop-tion of assistive technologies and co-created serviceswith the users themselves. The LivingHub encouragesthe integration of domotic technologies into the do-mestic environment with monitoring and remote as-sistance systems (telemedicine, tele-monitoring, robotsfor telepresence, remote data processing. . .).Keywords: Simulation-based education, Interdiscip-linary approach, AAL laboratory.∗Corresponding author. E-mail: [email protected]


Part 3: Mobility

Travelers with Disabilities: Challenges and Assis-tive TechnologiesAlireza Darvishy*Institute of Information Technology, Zurich Univer-sity of Applied Sciences, Steinberggasse 13, 8400 Win-terthur, Switzerland

Background: This paper describes the preliminaryresults an ongoing project in the area of accessibletourism, which is currently being run by different uni-versities, industrial partners and selected hotels. Thefirst goal of the project is to systematically identify thebarriers that travelers with disabilities encounter todaywhen going on holidays. Another goal of this projectis to build so-called Hotel-Living-Labs (HLLs). Theseare hotel rooms that are generally accessible and whichare equipped with assistive technologies as well as as-sistive services. The HLLs serve as a test bed whereassistive technologies and services can be evaluated ina realistic holiday environment. The last goal is to it-eratively build an overall service for travelers with dis-abilities who wish to enjoy accessible holidays in acustomer-centered way, together with the different cus-tomer groups with disabilities and their accompanyingpersons.Method: Firstly, a literature review of potential bar-riers for travelers with disabilities and elderly travel-ers was performed, and assistive technologies/serviceswere proposed for overcoming these barriers. Theseidentified potential barriers are currently being veri-fied in a series of ongoing interviews, which are be-ing conducted with 25 individuals, separated into fourcategories: persons with vision impairments, personswith hearing impairments, wheelchair users, and el-derly persons. Each interview lasts 1 hour. The findingsfrom the interviews will be compared with the findingsof the literature review. The results will then be used todevelop a number of fully accessible “hotel living lab”rooms, where the travelers’ experiences will be evalu-ated via a questionnaire.Key results: The initial literature review revealed that,apart from facilities or services not being accessible

themselves, many of the identified potential barriersare related to information offered by missing, inacces-sible, outdated, inaccurate or inadequate informationoffered to the guests by the providers of assistive tech-nologies/services before and during the holiday stay.Conclusion: Accessible Tourism is an important goalto achieve in order to allow travelers with disabilitiesand elderly travelers to enjoy their holidays to the samedegree as anyone else. Because the preliminary resultsof this project have indicated that many of the existingbarriers occur because important information is miss-ing, inaccurate, or inaccessible at different steps of theholiday journey, the project will focus on applying dig-ital assistive technologies that allow this information tobe provided in an accessible manner.Keywords: Accessible tourism, interviews, assistivetechnologies∗Corresponding author. E-mail: [email protected]

People Moving in a Smart CityLaura Burzaglia,∗ and Pier Luigi EmilianiaaInstitute of Applied Phisics “Nello Carrara”, CNR,Via Madonna del Piano 10, 50019 Sesto Fiorentino,Florence, Italy

Background: In Italy, several projects for the deploy-ment of ICT infrastructures to support the smart cityconcept are active. One of the main components isthe control of the vehicles traffic. However, the needsof pedestrians should be considered, aiming to guidetheir navigation in the city and to offer support if theyhave problems. The system should be inclusive andpersonalized, including: (i) people without specific re-quirements (e.g. with context-based instructions andallowing requests in free format); (ii) fragile peopleas old people offering additional support (e.g. tellingthem where they are, if they are lost, and guiding themhome); (iii) people with activity limitations, with sup-ports based on their specific limitation (e.g. giving ac-cessible information about the environment).


S126 Part 3: Mobility

Method: An innovative structured procedure will beused, based on the identification of the functionali-ties necessary to support the activities listed in Chap-ter 4 of the WHO ICF classification, d450 Walking,d460 Moving around in different locations, d470 Us-ing transportation, d475 Driving, their organization inservices and the integration in social networks. Thisapproach has been tested in a system developed in ourlaboratory, which addresses Chp. 6 Domestic life, inparticular feeding and Chp. 7, Interpersonal interac-tions and relationship. It allows the choice of a recipe(with control of health problems), the automatic man-agement of the pantry and of the shopping list, the step-by-step assistance in the preparation of dishes. Whenpeople do not have the necessary abilities, AT is usedwhen suitable (e.g. for the interface adaptation) or spe-cial support is offered (for example simplification ofthe procedures for people with cognitive difficulties).Useful comments have been collected during the eval-uation though an (adapted) Pluralistic Usability Walk-through (PUW). Then, the knowledge acquired in theimplementation of a second system dealing with a psy-chological problem of people, who live alone, i.e. soli-tude, will integrated introducing elements of “intelli-gent” support for adaptation to people and situations.This system identifies the situation of people from theirbehavior and trough a learning component supportsthem with suggestions (not decisions). from the sys-tem itself and/or from the social network – An evalu-ation of the system is under preparation in a shelteredcondominium in Florence.Key results: The main result is the conceptual verifica-tion of the structured design procedure of support sys-tems, which starts from ICF and is based on the supportby technology, by connected people, and by artificialintelligent components to learn from their real use andto adapt them to the individual person. This implies thefunctionalities of a navigation system, the cooperationof people (in the social environment or in vicinity ofthe moving person), and intelligence in the system, tocollect information about the situation and reactions ofmoving people and their social environment, reasoningon these data to devise personalized suggestions.Conclusion: The above-cited results appear good start-ing points to be generalized to a more complex envi-ronment, together with the identification of the impacton assistive technology suitable for its use in a mobileand public environment.Keywords: Services, ICF, Mobility.∗Corresponding author. E-mail: [email protected]

Challenges in Indoor Navigation and AccessibilityVikas Upadhyaya, Neha Jadhavb,∗, Tigmanshu Bhat-nagarc, Pranayd, P.V.M Raoe and M. Balakrishnanfa,b,fSchool of Information Technology, IIT Delhi, Indiac,d,eDepartment of Design, IIT Delhi, India

Background: Independent mobility is a primary con-cern for inclusion of visually impaired (VI) people.Indoor mobility is challenging because of informa-tion unavailability, structural complexity, poor repre-sentation and lack of orientation and mobility training.Adoption of new technology including security con-cerns creates more complications in independent ac-cessibility. Some of the critical indoor facilities thatdemand accessibility includes hospitals, and transportterminal. This work is an effort to create a morereliable technological solution for accessible indoornavigation for VI. Current research like NavCog andSoundscape for supporting indoor and outdoor nav-igation focuses on improving localization accuracyand audio-based information delivery but have chal-lenges like reliability and cognitive load. Empiricallywe found, indoor navigation requires contextual local-ization accuracy and hierarchical information deliveryfor better non-visual cognitive mapping while most ofblind navigation methods do not include this. Our keymotivation here is to investigate how an indoor naviga-tion representation scheme works for VI and how tech-nology could play a role in inclusive navigation inter-face design.Method: Our approach is based on creation of infor-mation representation scheme influenced from sightednavigational cues (like decision point, progressive dis-closure and information reinforcement) from indoor.We have done a preliminary survey to understand in-door navigation cues for sighted. The indoor represen-tation scheme for navigation using regular signage (al-ready tested in a hospital) helps us to understand andannotate building maps with navigation and safety re-lated information (entry/exit, doors) and services (lifts,stairs, ramp, drinking water and washrooms) requiredby all the users. We include additional annotations likefloor surface change (e.g. small steps or ramps) andprotrusion in the corridors (e.g. fire extinguishers) toenhance accessibility and to generate a rich annotatedmap with additional meta-data. One important step weare examining to get scalability to other public build-ings is the possibility of extracting required annota-tions from videos. We use beacon and user input-basedcourse localization and audio-based feedback usingsmart-phone. We are now in the process of conducting


a study with VI users to test our system. It is expectedthat such representation scheme and associated inter-ventions can contribute to open standards for indoornavigation and accessibility.Key results: We have some key findings from our lim-ited trials in a public hospital in New Delhi, India.The emphasis has been on an inclusive solution due toa diverse demography of users and affordability thatinvolves effective utilization of existing infrastructureto make the solution cost-effective and scaleable. Ourstudy has shown that providing right information atright place can be very effective in indoor spaces. Tri-als have shown that prior information about upcom-ing landmarks within indoor spaces is helpful. Progres-sive disclosure of information and timely reinforce-ment can help in reducing cognitive load. Ongoing re-search states that non-visual cognitive mapping of en-vironment can enhance retention using such cues.Conclusion: This paper deals with problem of indoornavigation for VI. We found right information at righttime is a key to reliable indoor navigation. Our lim-ited trials suggest that an information representationscheme and contextual localization can handle the di-versity in user group and should be included in openstandards for indoor navigation and accessibility.Keywords: Accessibility, Indoor navigation, Mobility,Visually impaired, Cognitive map, Localization.∗Corresponding author. E-mail: [email protected]

An Affordable Concept to Produce Mobility De-vices in Low Resource SettingsValdis Kruminsa,∗, Luc de Witteb, Sapna Beharc andVarshapriya RadhakrishnancaAdvanced Manufacturing Research Centre, Univer-sity of Sheffield, Wallis Way, Catcliffe, Rotherham S605TZ, UKbCentre for Assistive Technology and ConnectedHealthcare, University of Sheffield, 217 Portobello,Sheffield S1 4DP, UKcIcarus Nova Discovery Pvt Ltd, No: 7 Rogers Road,Richard’s Town, Bangalore 560 005, India

Background: In many low resource settings even themost basic assistive devices are not available, and ifavailable, they are often not affordable for the peoplewho need them. Therefore the World Health Organisa-tion (WHO) has identified the development of afford-able high quality assistive devices as a global researchpriority. In this presentation we present the results of

a project in which we looked at the possibility of pro-ducing frequently used assistive devices in more effi-cient ways, and make them more suitable for the spe-cific context of low resource settings. We focused onmobility aids as listed in the WHO Priority AssistiveProducts List. With an international team of experts inmanufacturing technologies, product design, assistivetechnology provision and rehabilitation professionalsin India and the UK we developed an innovative con-cept for locally producing mobility devices.Method: The project consisted of three phases. In thefirst phase we studied the most urgent needs in twoareas in India, one in the city of Delhi and one in arural area near Bangalore, using a survey method. Ina second phase we made a technical analysis of theWHO Priority Assistive Products List from the per-spective of more efficient production methods, and or-ganized a multidisciplinary and international workshopto discuss the link between needs on the one hand andthe possibilities of more efficient production methodson the other. This led to three promising possibilities:Adaptation and modification of existing AT solutions,End-user involved modular assistive devices and As-sistive Technology App. In the third phase one of thesewas concretely developed into an innovative produc-tion concept by a team of product designers in the UKand India.Key results: The result is a concept for producingthree types of mobility devices (walking stick, crutchesand walker frame). During the presentation this con-cept will be demonstrated and the approach followed toreach this result discussed. The concept is easy to pro-duce at a low cost, devices can be generated locally ‘onthe spot’ and individualized for the user, parts can bere-used and repair is very easy using basic hand tools.The personalisation has been incorporated in the as-sembly process by cutting the tubular components to aspecific length for the particular end user. By remov-ing the assembly process from the centralised manu-facturer of the modular components and introducing itto local distribution centres the assembly costs are con-verted into jobs for the local community. A field trialin rural India with the new concept is being planned.Conclusion: This project shows that it is possible todevelop innovative concepts and methods that enablethe production and assemblage of affordable and highquality assistive products. Multidisciplinary and inter-national collaboration proved to be essential to achievethis. The resulting concept for mobility devices has thepotential to greatly contribute to better availability inlow resource settings.


Keywords: mobility, affordable, crutch, walker, pro-duced locally.∗Corresponding author. E-mail: [email protected]

User Acceptance of Augmented Reality Glasses forHand Exoskeleton ControlTobias Ableitnera,∗, Sandra Metzla, Surjo Soekadarb,c,Andreas Schillingd, Christophe Strobbea and GottfriedZimmermannaaResponsive Media Experience Research GroupStuttgart Media University, Nobelstraße 10, Stuttgart70569, GermanybClinical Neurotechnology Laboratory, NeuroscienceResearch Center (NWFZ) & Department of Psychia-try and Psychotherapy, Charité – University MedicineBerlin, Charitéplatz 1, Berlin 10117, GermanycApplied Neurotechnology Laboratory, UniversityHospital Tübingen, Calwerstraße 14, Tübingen 72076,GermanydWSI / GRIS, University of Tübingen, Sand 14, Tübin-gen 72076, Germany

Background: Every year about 260,000 people in Ger-many suffer a stroke, of which one third retain se-vere motor deficits. Particularly, loss of hand functionleads to a considerable loss of autonomy and qual-ity of life. We expect an actuated hand exoskeletonto provide them with daily life assistance and restoretheir hand function. However, hand exoskeleton con-trol poses a considerable challenge for human-machineinteraction. We follow up on Markovic et al. (2014)who have achieved promising results in hand prosthe-sis control using AR glasses.Method: In a preliminary study, we investigated whichAR glasses are suitable and acceptable by the users. Ingeneral, there are two types of AR glasses: (1) Largeglasses with a real AR experience (e.g. MicrosoftHoloLens); (2) Small glasses that resemble a head-updisplay (e.g. Epson BT-300, Google Glass). In order toinvestigate which type has higher user acceptance forcontrolling a hand exoskeleton, we implemented a pro-totypical assistance system without hand exoskeletonfor the HoloLens and the BT-300. We evaluated themwith 6 healthy test persons (age: M = 25.50 SD =7.71). They indicated on a Likert scale (1 = not at all,5 = definitely) whether they would use the respectiveAR glasses to control an assistance system for the fol-lowing application contexts: (C1) private, (C2) public,(C3) rehabilitation environment. We also asked themhow long they would comfortably use them in general.

Based on the results of the preliminary study, themain study was a questionnaire focusing exclusivelyon small AR glasses. We asked 15 patients (10 strokepatients, 5 tetraplegics, age: M = 54.33 SD = 13.45)about their experiences with AR glasses and their the-oretical acceptance for controlling a hand exoskeleton.All 15 patients had motor or sensory limitations in atleast one hand. 8 of them could not grasp any objectswith at least one hand and would benefit from a handexoskeleton. Again, we assessed the user acceptanceon a Likert scale. We also collected additional qualita-tive data.Key results: The preliminary study showed that thesubjects would wear the BT-300 (M = 48.10 min SD= 42.27 min) significantly longer than the HoloLens(M = 20.50 min SD = 15.00 min). Furthermore, theBT-300 (C1: M = 4.00 SD = 1.09, C2: M = 3.33 SD= 1.63 and C3: M = 4.00 SD = 1.55) has a higher useracceptance than the HoloLens (C1: M = 3.33 SD =1.03, C2: M = 2.00 SD = 0.89, C3: M = 3.17 SD =2.04).In the main study, the 15 patients showed a high useracceptance (C1: M = 4.28 SD = 1.44, C2: M = 2.93SD = 1.75, C3: M = 5.00 SD = 0.00) for small ARglasses to control the hand exoskeleton. However, 5 pa-tients indicated that they would not wear AR glassesfor at least one application context.Conclusion: This study shows that small AR glasseshave a high user acceptance for assistive system con-trol in private and clinical environments. This bringsabout novel interaction possibilities with assistive sys-tems. However, the results also show that – to date –many assistive system users do not want to wear ARglasses in public. Therefore, it is necessary that assis-tive systems such as hand exoskeletons can be operatedby other input and output devices, aside from glasses.Keywords: hand exoskeleton, augmented reality, as-sistive technology, user acceptance.∗Corresponding author. E-mail: [email protected]

Accuracy evaluation of an add-on acquisition sys-tem of operation log with inertial measurementunits for a mobility scooterShunsuke Kurokawaa,b, Jun Suzurikawab,∗, TakenobuInoueb and Kazunori HaseaaDepartment of Mechanical Systems Engineering,Tokyo Metropolitan University, 1-1, Minamiosawa,Hachioji-shi, Tokyo 192-0397, JapanbDepartment of Assistive Devices, National Reha-


bilitation Center for Persons with Disabilities, 4-1,Namiki, Tokorozawa-shi, Saitama 359-8555, Japan

Background: In recent years, a mobility scooterspreads in society as a mobility aid for elderly peopleand plays a considerable role in maintaining the qualityof life. Despite its convenience, severe accidents havehappened with increasing number of users. To reduceaccidents, appropriate measures of driving in daily usewill be a possible solution. Therefore we developed asimple and easy-to-install acquisition system of oper-ation log for detection of dangerous driving in dailyuse. The feature of this system is capability to quantifyand record operations of the mobility scooter by onlya few inertial measurement units (IMUs). The coordi-nate transformation of gravitational acceleration mea-sured by IMU attached on the steering tiller can es-timate two operation variables, i.e., the angles of thesteering handlebar and the accelerator lever. This studyaims to evaluate the estimation accuracy of these twovariables and to optimize the combination of IMUs onthe scooter body and the tiller.Method: [Estimation method] The acquisition systemis composed of two IMUs mounted on the body andthe accelerator lever of the mobility scooter and thedata logger on the front basket. The relation betweenthe two operation variables and the gravitational ac-celerations measured by the IMU on the lever can bedescribed by the coordinate transformation with rota-tion matrices. Solving this equation enables to convertthe measurement data into the two operation variables.The IMU on the scooter body is utilized to compensatefor the body inclination.[Accuracy evaluation] The estimation accuracy of theproposed system was examined by changing the num-bers of IMUs and axes (i.e. acceleration and/or angu-lar velocity) used for calculation. The true values ofthe angles were measured by wire displacement sen-sors. The test course included flat and sloped surfaces.The similarity between the estimated and the true val-ues was evaluated using the root mean square error(RMSE) and the correlation coefficient (CC).Key results: The number of IMUs used for calcula-tion mainly influenced the estimation accuracy with thepresence of terrain inclination. The inclination com-pensation by the IMU on the scooter body was effec-tive in the sloped surface with the inclination of over 7degree whereas the inclination-induced estimation er-ror was ignorable with flat surfaces. The use of angularvelocities measured by IMUs was another factor im-pacting on the estimation accuracy. In some cases, the

angle of the accelerator lever was estimated with betteraccuracy when the angular velocity was complemen-tally used with acceleration. The estimation accuracyof the steering angle, on the other hand, was the bestwhen estimated solely by acceleration measured withtwo IMUs. RMSE and CC with this estimation condi-tion were 3.18 degree and 0.99, respectively.Conclusion: The estimation accuracy of the operationvariables of the mobility scooter were compared withdifferent methods using acceleration and angular ve-locity. Consequently, we concluded that the combina-tion use of 3-axis acceleration values measured by twoIMUs is suitable for monitoring driving behavior indaily use.Keywords: IMU, Power wheelchair, Skills evaluation,Lifelog.∗Corresponding author. E-mail: [email protected]

A Semantic Decision Support System to foster Re-turn to Work of Novice Wheelchair UsersDaniele Spoladorea,∗, Sara Arlatia, MargheritaFossatib, Luca Negrib, Marco Saccoa and MarioCocchibaInstitute of Intelligent Industrial Technologies andSystems for Advanced Manufacturing, (STIIMA), Na-tional Research Council of Italy (CNR), 23900 Lecco,ItalybScientific Institute, IRCCS E. Medea, 23842 BosisioParini, Lecco, Italy

Background: This work presents a Decision SupportSystem (DSS) to foster return to work (RTW) of novicewheelchair users (NWU). The DSS is developed withinan ongoing research project financed by the Italian Na-tional Institute for Insurance against Accidents at Work(INAIL). Following accidents at work, many NWUsdecide not to come back to work, thus relying on theNational Institute of Welfare for disability pensions;however, long-term unemployment could have a neg-ative impact on NWU’s mental and physical health.Within this context, the DSS aims at easing the processof RTW for NWUs by supporting therapists and voca-tional personnel with technological means in discrimi-nating the still suitable jobs for each specific user.Method: The DSS leverages semantic representationsof the knowledge related to jobs and NWUs’ func-tional capacity evaluation; for the first representa-tion, O*NET (Occupational Information Network) vo-cabulary (the cross sections “Skills” and “Abilities”,


which are common to all the professions mapped inO*NET) was converted into an ontology. For the sec-ond, four comprehensive Core Sets from the Inter-national Classification of Functioning, Disability andHealth (ICF) – corresponding to the three primary con-ditions that force a person on a wheelchair: Spinal CordInjury, Traumatic Brain Injury, Stroke, plus the Voca-tional Rehabilitation Core Set to address work reinte-gration – were modelled into an ontology to describethe functioning of NWUs. Each O*NET skill and abil-ity describing a job was then translated into ICF, viaa consensus forum involving two psychologists andtwo biomedical engineers. Using ICF qualifiers andO*NET importance scores for each “Skills” and “Abil-ities”, the DSS leverages a set of rules to automati-cally match a NWU’s functional capacity evaluation,performed with ICF, to a list of jobs he/she can stillperform.Key results: Up to date, the DSS can model anyNWU’s condition with ICF and match him/her with alist of possible jobs; the DSS includes 10 professions(4 clericals, 4 physicals, 2 middle-management), but itsstructure allows to easily add more jobs. The outcomesderiving from the reasoning processes of the DSS canhighlight the skills and abilities in which the NWUmay face some difficulties, thus helping the vocationalpersonnel and therapists in deciding whether to suggestthe NWU to return to a specific job, perhaps with thesupport of some facilitators.Conclusion: The presented DSS, leveraging semanticweb technologies and ICF, provides a common lan-guage for clinical and vocational personnel and allowsthe involvement of non-clinical personnel (employers),with the aim of fostering work reintegration of NWUsand enhancing their quality of life, thus decreasingthe impact of work accident consequences in terms ofprivate and social costs. In the following months, thepresented DSS will be tested for technology accep-tance and usability (using respectively TAM 3 and SUSscales) by INAIL personnel.Keywords: wheelchair user, return to work, decisionsupport system, semantic web, ontology.∗Corresponding author. E-mail: [email protected]

Wheelchair Users’ Experiences with and Need ofActivity TrackersTina Hellea,∗ and Kirstine Rosenbeck GøegbaUniversity College of Norther Denmark, TIBS, SelmaLagerløfs Vej 2, 9220 Aalborg Øst, Denmark

bRosenbeck Informatics, Oluf Borchs vej 39, 9000 Aal-borg, Denmark

Background: The use of different kinds of activitytrackers, e.g. step counters, has become popular tomonitor one’s physical activity level. A typical goalfor users is to evaluate whether public health recom-mendations stated by health authorities are met. Givena sedentary lifestyle, wheelchair users are particularlychallenged when it comes to the performance of phys-ical activity. However, activity trackers on the mar-ket are not applicable for wheelchair users. Obviously,steps are not a valid measure, but research suggest thatother measures such as heart rate, wheel rotation andarm acceleration also have limitations. Yet, wheelchairusers still use activity trackers, and their experiencesare key to developing better technology.The aim was to investigate: What are the wheelchairusers’ experiences of using current technological de-vices for activity tracking and, what are their require-ments for future valid and meaningful activity track-ing?Method: A focus group interview was conducted, in-volving N = 7 wheelchair users; one woman and sevenmen in the age of 24–49. Participants were sampledthorough a wheelchair users basketball club. The focusgroup lasted for one hour. A semi-structured interviewguide was developed to guide the interview. A contentanalysis was performed by the authors, first separately,then together to reach consensus and validate the find-ings.Key results: Wheelchair users have some positive ex-periences with activity tracking using GPS-data e.g.some tracked whether the relationship between dis-tance and time improved. However, they experiencedthat distance and time are the only parameters thatare correctly measured, whereas calorie consumption,pulse, step and training intensity are not appropriatelymeasured. The wheelchair users especially noted thatsome activity trackers provide reminders that assumethat the user can walk, such as “it is time to get upand move around”, which they considered meaning-less. The wheelchair users experienced an un-met needto evaluate whether their overall physical activity wassufficient or whether they were too inactive, but noneof the technologies that they had utilized, could pro-vide this information, which includes exercise train-ing as well as daily household tasks. In addition, thewheelchair users suggested that it would be motivat-ing to compare current and previous achievements andcompete with oneself and others. A surprising finding


was that wheelchair users experienced a need of under-standing their own typical pulse alterations, to be ableto prevent dizziness related to performance of physi-cal activity. In addition, the wheelchair users were con-cerned that physical activity measures could be usedagainst them and become a barrier for granting assis-tive technology.Conclusion: Sound activity trackers are needed,specifically designed for wheelchair users. The bene-fits hereof are evident from a public health perspective,because we might identify wheelchair users with lowphysical activity levels. In an assistive technology per-spective, appropriate use of information provided byactivity trackers should be considered to avoid distrustamong wheelchair users. In summary, activity trackingmay be valuable for wheelchair users, health care andsociety at large. Future research should account for thelimitations of this study i.e. few participants limited tobasketball players.Keywords: activity tracking, wheelchair users.∗Corresponding author. E-mail: [email protected]

Addressing Communication Issue Among Care-givers and Wheelchair Users: Identifying DesignMetrics and Defining NeedsSantosh Mauryaa,∗, Daisuke Matsuuraa, TakahiroUeharab, Masato Kawabatab and Yukio TakedaaaDepartment of Mechanical Engineering, Tokyo Insti-tute of Technology, Tokyo, JapanbHirakata General Hospital for Developmental Disor-ders, Osaka, Japan

Background: Needs for designing assistive technol-ogy devices (ATDs) are directly affected by variationsin assistance required by the ATDs user, but peoplearound ATDs user also affect definition of design needsas they interact with users on daily basis. Thus, otherthan functional aspect of ATDs, social and psycholog-ical aspects also gain importance. Here, we addressthe issue of difficulties in face to face communica-tion during the process of assistance, among caregivers(CG) and wheelchair users (WU). Previous studies ad-dressing this issue present new technical tools like au-tonomous mobility systems or novel wheelchair con-trollers. However early on in the design phase, it isdifficult to assess nature of design problem requiredto be solved – whether in form of an original designor as new addons. In this work we narrow down thekey metrics within the requirement-space that establishgood correlations, focussing on improved communica-tion experience and reduced stress for CGs.

Method: We conducted an exploratory study with arehabilitation centre, and collected data in form of in-terviews and questionnaires with WU and CG (hos-pital staff and family members) as target participants.We designed a questionnaire targeting WU’s activities,CG’s workload, type of ATDs used, device handlingproblems, communication methods used and commu-nication limitations. The collected data was analysedto narrow down relations among defined metrics statis-tically and qualitatively. The first phase of data collec-tion and analysis lasted 1 month, establishing exhaus-tiveness of the designed questionnaire. 5 CG and 7 WU(5M, 7F) with mean age of 45.6 years (SD = 10.2) withmean experience of caregiving/receiving 4.58 (SD =1.16, on a scale of 0–5), participated at first phase. CGsreported to provide assistance to 15.08 (SD = 10.99)wheelchair users daily, approximately 8.9 times (SD =4.31) per day.Key results: Significant correlations among CG’s du-ration to get tired and frequency of assistance be-ing provided were observed, e.g. +0.967 for nighttime all week, +0.893 and +0.898 for weekday andweekend afternoon time. Using factor analysis (FA)we grouped WU’ activity and established differencesin three components: personal-amusement (watchingTV/reading, time with family), task-activities (go-ing to shopping/hospital, playing indoors) and daily-necessities (toothbrushing, changing clothes). Also,using FA we narrowed down device handling problemsto two components: mediated-non-mediated problem(passing through gates, static to dynamic) and device-usability problems (power needed, ease of rotation).Results pointed out communications among WU andCG happened mostly at start of the assistance activity(∼ 40%), where CG were dominant through speakingand touch. CG faced moderate difficulty with WU’svoice and head-movement, and high difficulty withCG’s bending their body for communication.Conclusion: The analytical study helps to narrowdown needs in form of correlated design metrics forWU-CG communication, and targets enhancing thecommunication experience. This serves as the first stepto establish novel concept designs to intangible prob-lems related to ATDs like wheelchair. The sample sizeneeds to be expanded further to generalise the findings.The future prospect for this work is to generate andanalyse design concepts, and evaluate them based onthe established co-related design metrics.Keywords: communication, caregivers, mobility,wheelchair users, design metrics.∗Corresponding author. E-mail: [email protected]


Usability Assessment of a Navigation Tool for Man-ual Wheelchair Users in Urban AreasFrançois Routhiera,b,∗, Camillle Lainesse-Morina,b,Mir Abolfazl Mostafavia,c and Luc Noreaua,baCentre for interdisciplinary research in rehabilitationand social integration, Centre intégré de santé et deservices sociaux de la Capitale-Nationale, 525 Hamelest, Québec, G1M 2S8, CanadabDepartment of rehabilitation, Université Laval,Québec, G1V 0A6, CanadacDepartment of geomatics sciences, Université Laval,Québec, G1V 0A6, Canada

Background: Manual wheelchair (MWC) users havemany challenges to overcome when traveling outdoors(slopes, thresholds, holes, sleepers, road works, etc.).They must experiment different paths to find the onethat suits them best. Currently navigation tools are notnecessarily adapted to the needs of MWC users. Thesetechnologies provide some information on the accessi-bility of service points such as stores, restaurants andetc. but not the accessibility of the road network. Thedevelopment of an innovative navigation technologycalled MobiliSIG (mobilisig.scg.ulaval.ca), based onthe wheelchair use confidence, made it possible to fillthis gap by proposing a mobile application that can beused on different types of smart devices. The objec-tive of this study is to assess the usability of MobiliSIGwith potential MWC users. Usability is the degree towhich a technology can be used to achieve specific ob-jectives with effectiveness, efficiency, and satisfaction.Method: Three men and three women (age: 26–52 years; MWC experience: 5–36 years; MWC skills:22–91%) participated in an experiment on two dis-tinct routes in a district of Quebec City (Canada).They were interviewed to evaluate MobiliSIG accord-ing to 25 usability criteria. They had to express theirresponses using a scale between 1 representing ‘not us-able at all’ and 5 ‘strongly usable’. Consistency be-tween the level of the accessibility of each segment

proposed by MobiliSIG and the objective evaluation ofthe participants (using a scale between 1–5 [1 repre-senting ’strongly disagree’ and 5 ‘strongly agreeing’])was also assessed. A quantitative and qualitative anal-ysis of the data highlighted the advantages, disadvan-tages of the functionalities of MobiliSIG and severalimprovements were proposed.Key results: The overall average of the ratings ob-tained for the usability criteria is high (4.1 ± 0.6/5).The top five criteria are: everyday vocabulary, ease oflearning, endurance, assistance and support, and timespent for waiting. The five lowest rated criteria are: ap-pearance, evidence of control, expected functionality,efficiency and effectiveness. The level of the accessi-bility of the segments according to MobiliSIG and thatperceived by the participants are coherent 57% of thetime (41 on 72 analysed segments of routes). For othersegments, the level of perceived difficulty was higherfor 20 segments and easier for 11 segments.Conclusion: MobiliSIG is a promising tool for MWCusers who want navigating in the City. This first itera-tion of MobiliSIG’s usability assessment was generallypositive. However, few points that will guide the futuredevelopments of this navigation tool were identified.Many technological challenges remain (e.g. improvedpositioning of the user, automation of the accessibil-ity information extraction, considering changes in theenvironment and improved assessment of the accessi-bility) and should be considered for future develop-ment. As other perspectives, MobiliSIG should also bedeveloped to include other profiles than MWC users,for instance, individuals who use other mobility de-vice, blinded persons, etc. It should also integrate othermodes of transportation for a complete trajectory, suchas public transportation (e.g. bus and tramway).Keywords: manual wheelchair, navigation, usability,effectiveness, efficiency, satisfaction.∗Corresponding author. E-mail: [email protected]


Part 4: Sport

Designing High-efficient and Easy-to-wear Ther-mal Interface for Cooling of Wheelchair AthletesDuring TrainingAmaike Kakerua,b, Jun Suzurikawaa,∗, KennyaKitagawaa,b, Atsushi Takashimaa, YoshinoriTeshimab, Takenobu Inouea and Toru OgataaaNational Rehabilitation Center for Persons with Dis-abilities, 4-1, Namiki, Tokorozawa-shi, Saitama 359-8555, JapanbChiba Institute of Technology, 2-17-1, Tsudanuma,Narashino-shi, Chiba 275-0016, Japan

Background: Heat accumulation is a well-known bot-tle neck of sport training for wheelchair athletes withcervical spinal cord injury (SCI), whose thermoregu-latory system has serious dysfunction. However, thereis no definitive method to continuously remove bodyheat during exercise on a wheelchair. The authors haveproposed a neck cooling belt that is wearable in a sit-ting position on a racer wheelchair. The belt has a tubu-lar structure made of flexible elastomer film, in whichcold water is circulated. Although the positive effect ofneck cooling during exercise was experimentally con-firmed, the structure of the belt has not been optimizedyet. In this study, two main components of the cool-ing belt, i.e. flow channel structure for water circula-tion and load-relief feature to reduce neck pressure dueto tubing, were designed and evaluated in order to im-prove the usability.Method: [Flow channel structure] For high-efficientheat transfer on the neck, the contact condition be-tween the belt and skin is a key factor. The flexibilityof the tubular belt changes depending on the film thick-ness, the pattern of heat seal and the inserts betweenthe films for anti-obstruction. The influence and extentof these three design parameters were characterized bymeasurement of heat absorption rate (HAR) betweenthe cooling belt and neck. [Load relief] Tubing from acoolant circulator hung on the wheelchair backrest tothe cooling belt can cause unpleasant pressure on theneck during propulsion. To relieve this load, a shoulder

strap was designed and prototyped. Considering us-ability for handling with paralyzed upper limbs, loop-less and one-side structures were tested with measure-ment of pressure between the belt and neck skin.Key results: [Flow channel structure] The comparisonamong elastomer films with the thickness of 100, 200,and 300 µm showed that the decrease of HAR wasmeasurable with 300-µm one. The decrease of HARwas also observed to be induced by the heat-sealingpattern at the middle of the interface, which reducesthe real contact area between the cooling belt and neckskin. Both patterned heat-sealing and the array of flowchannel inserts were effective for anti-obstruction ofcooling water when the belt was tightly worn for goodcontact to skin. With these results considered, the cool-ing belt made of the 200-µm film which has the insertarray achieved HAR of 20 W with the cooling waterof 18 ˚C in a hot environment of 31◦C. This HAR isalmost twice as high as that reported previously. [Loadrelief] The measurement of the contact pressure be-tween the cooling belt and neck skin showed the one-side shoulder strap caused unbalanced load on the neckdue to its asymmetricity. The loop-less structure on theshoulder successfully relieved the load on the neck.Conclusion: A neck cooling belt was designed andtested for thermoregulatory assist of wheelchair ath-letes. The parametric experiments quantified the rela-tionship between HAR and flow channel structures andthe effect of the loadrelief structure. The cooling beltwith the optimal design achieved HAR of 20 W in av-erage.Keywords: Thermoregulation, Heat transfer, Neckcooling.∗Corresponding author. E-mail: [email protected]

Thermal characterization and field trial of a wear-able coolant circulator for assist of thermoregula-tion in wheelchair athletesKennya Kitagawaa,b, Jun Suzurikawaa,∗, Kakeru


S134 Part 4: Sport

Amaikea,b, Atsushi Takashimaa, Toshiyo Tamurac,Yukiharu Higuchia, Yoshinori Teshimab, TakenobuInouea and Toru OgataaaNational Rehabilitation Center for Persons with Dis-abilities, 4-1, Namiki, Tokorozawa-shi, Saitama 359-8555, JapanbChiba Institute of Technology, 2-17-1, Tsudanuma,Narashino-shi, Chiba 275-0016, JapancWaseda University, 1-104, Totsukacho, Shinjuku-ku,Tokyo 169-8050, Japan

Background: Persons with spinal cord injury (SCI)have serious dysfunction in the thermoregulatory sys-tem. The loss of thermoregulatory responses in ahot environment, including sweating and vasodilation,sometimes leads to fatal incidents during intensive ex-ercise. To overcome this problem, we have developeda thermoregulation assist system for wheelchair ath-letes. In a laboratory setting, neck cooling with a tubu-lar belt in that cold water was circulated successfullysuppressed the increase of core temperature in the sub-jects with cervical SCI during arm cranking. However,the effect of neck cooling in a real outer environmenthas not been demonstrated. In this study, we designedand prototyped a wearable coolant circulator that canbe installed on a wheelchair. The thermal performanceof the system was, then, characterized with bench-marking. Lastly, the system was used by wheelchairmarathon athletes with cervical SCI under measure-ment of body temperatures.Method: [System design] The coolant circulator con-sists of a Peltier device (max. heat absorption rate =40 W), axial-flow pump, water reservoir, battery, andtubing to the neck belt. The size and weight of the sys-tem are 300 (W), 200 (H), 100 (D) mm and 2.9 kg,respectively. To reduce the system volume, the waterreservoir and the fitting components of tubing werespecially designed and made by a 3D printer.[Thermal characterization] The heat absorption fromthe neck belt and the environment into the coolant weremeasured by precise thermistors in an artificial cli-mate chamber of 31◦C. The power consumptions ofthe Peltier device and the pump were also monitored inorder to estimate the coefficient of performance (COP)of the system.[Field trial] Two wheelchair marathon athletes were re-cruited as subjects of the field test. During running onthe track on racer wheelchairs, the neck skin and coretemperatures were monitored with and without cool-ing. The procedure of this trial was approved by theIRB of the National Rehabilitation Center for Personswith Disabilities, Japan.

Key results: [Thermal characterization] The maxi-mum and average heat absorption rates at the neckwere 48 and 15 W, respectively. The heat loss out ofthe reservoir was 5 W, while that out of the tubingwas lower than the detection limit. Consequently, COPof the prototyped system was estimated at 40%. Thisvalue is as high as that of the previously reported wear-able cooling device.[Field trial] During the 45-minute trial with cooling,the temperature of the skin above the carotid arteryreached around 28.6◦C, and was 5.7 ˚C lower in aver-age than that in the non-cooling trial. The decrease ofthe core temperature by cooling was observed in onesubject.Conclusion: A wearable coolant circulator for neckcooling of wheelchair athletes was designed, proto-typed and evaluated. The system can be installed on aracer-type wheelchair, and showed COP of 40% withthe mean heat absorption rate of 15 W. Cooling withthe proposed system will be helpful for wheelchairusers in outdoor activities as well as wheelchair athleteengaged in various types of sports.Keywords: Neck cooling, Peltier device, Hot environ-ment, Spinal cord injury, Wearable equipment.∗ Corresponding author. E-mail: [email protected]

Automatic Production System for Sports Programwith Support InformationTsubasa Uchidaa,∗, Hideki Sumiyoshib, MakikoAzumaa, Naoto Katoa, Shuichi Umedaa, NobuyukiHirumab and Hiroyuki Kanekoa

aScience & Technology Research Laboratories, NHK(Japan Broadcasting Corporation), 1-10-11 Kinuta,Setagaya-ku, Tokyo, JapanbAdvanced Technology Development and Research Di-vision, NHK Engineering System, Inc., 1-10-11 Kinuta,Setagaya-ku, Tokyo, Japan

Background: For deaf and hard of hearing peopleviewing sports programs, commentary by JapaneseSign Language (JSL) helps them fully understand thesituation of the game. To produce sports program withJSL is required the expertise in each sport to translateJapanese into JSL, and multiple interpreters need tostand by because the game mostly lasts for hours. How-ever, the shortage of interpreters specialized in sportshave become a barrier to increase the number of sportsprogram with JSL. In order to solve these problem, wehave developed an automatic production system for on-

Part 4: Sport S135

line distribution. When the situation difficult to under-stand without audio information such as penalty oc-curred, the system provides the detailed commentaryby JSL computer graphics (CG) animation and subti-tles in real time.Method: The system automatically renders JSL CGanimation from prepared templates of JSL phrases cor-responding to fixed format match data distributed dur-ing sports game. Extracted items from match data suchas players’ names, scores, and penalties are insertedinto templates of JSL sentences. After this, JSL CGanimation is rendered automatically from completedsentences and JSL motion capture data that recordedphrase by phrase. The rendered JSL CG animation isoutputted with Japanese subtitles and score informa-tion to the screen for each event. That screen output isoverlapped with the game video sent over the InternetProtocol (IP) network and distributed as one stream-ing video. Finally, the live video stream is played on aweb browser. The video player on a web browser hasthe push notification function that pops up text mes-sage on the game video area to alert the penalty event.If user clicks the pop-up text, the JSL video explain-ing that penalty in detail is automatically played. Wealso developed a video on demand (VOD) player di-verting video generated by live streaming process. TheVOD player has a seekbar with event icons referringto time-series event list automatically generated formmatch data.Key results: We have confirmed that the system couldrender JSL CG animation and distribute overlappedvideo stream in real time. Compared with the previ-ous method that needed time required to generate MP4video files of JSL CG animation, about 30 secondsdelay time from event occurrence to JSL CG anima-tion display was decreased. Furthermore, the systemcould also adjust the synchronization between gamevideo and JSL CG animation by giving buffer time toIP game video stream. Although the user needed toseek the specific scene by themselves when using pre-vious VOD player, the new event timeline helped userto playback the scene for each event efficiently.Conclusion: To improve the viewing experience ofdeaf and hard of hearing people, we have developedan automatic production system. The system enables togenerate JSL CG animation, subtitles and score infor-mation automatically and distribute game video streamwith that support information. As a result, sports pro-grams with support information are produced withouthuman resources. We will verify the effective supportinformation and provision timing while applying oursystem to the various types of sports events.

Keywords: Japanese Sign Language, Computer Ani-mation, Sports.∗Corresponding author. E-mail: [email protected]

First Evaluation of Information Support of every-one by everyone for everyone TimeLine (ISeeeTL)applied to Deaf and Hard of Hearing People Watch-ing SportRumi Hiragaa,∗, Daisuke Wakatsukia, YuhkiShiraishia, Masayuki Inouea, Yuka Kogoa, YoshikiFukunagaa, Makoto Kobayashia, Manabi Miyagia,Takeaki Shionomeb, Jianwei, Zhangc and AtsuyukiMorishimadaTsukuba University of Technology, JapanbTeikyo University, JapancIwate University, JapandUniversity of Tsukuba, Japan

Background: Information support for deaf and hard ofhearing (DHH) people usually requires hearing peopleto provide support to DHH people. Information Sup-port of everyone by everyone for everyone (ISeee) isa project that uses crowdsourcing to generate informa-tion support in which the support-giving role is notfixed; DHH people provide information based on theirabilities and knowledge for hearing people and viceversa.We are developing an ISeeeTimeLine (ISeeeTL) sys-tem which uses crowdsourcing to make watching sportmore enjoyable. To find out what is required to en-joy watching sports (including parasports) with theISeeeTL, we conducted experiments in which bothhearing people and DHH people watched sports. Theresults focus on the DHH people because all the stu-dents we teach at a department of Tsukuba Universityof Technology are DHH.Method: The ISeeeTL is a website (rather than an ap-plication) for posting about sports rules, results, teams,etc. It bears a slight resemblance to SNS applicationslike WhatsApp, but the ISeeeTL allows the posting oftemporary comments besides posts. All the posts ap-pear quicker than those on Twitter.Fifty eight participants filled in questionnaires aftereach of the five games, 18 of whom were DHH peo-ple. There were 1852 posts, 349 of which were sub-mitted by DHH participants. It took 456 minutes towatch the games. For some questions, they rated fromone (strongly disagree) to 5 (strongly agree). We usedthe responses to find out whether there were any dif-ferences between the opinions of the two participant

S136 Part 4: Sport

groups (DHH people and hearing people) and howISeeeTL was appreciated when people were watchingsports.Key results: The questionnaires included three ratingquestions about reading the posts and four questionsabout writing the posts. We analyzed the answers tothose questions with a two-way analysis of variance(ANOVA) in which the factors were the two participantgroups and the questions.The responses to the questions about reading postsshowed there were significant differences between thegroups (p = 0.02) and the questions (p < 0.01). DHHpeople evaluated reading posts better (mean 3.74) tohearing people (mean 3.36). The multiple comparisonshowed that the difference lies between the questionon the usefulness of posts and the two questions on thequality and quantity of posts.The responses to the questions about writing postsshowed no difference between the two groups and

a significant difference between the four questions(p = 0.01). The multiple comparison showed that thedifference lies between the level of enjoyment fromposting and those of the other three questions on bur-den, achievement, and importance of posting.Conclusion: Though the current iteration of theISeeeTL has received a positive evaluation on readingand writing posts, closer investigation shows that postquality and quantity should be improved. We are cur-rently redesigning the ISeeeTL, and we are going toinvite sports specialists to post valuable information.The ISeeeTL has been officially approved as an infor-mation support system at some games of the NationalAthletics Meeting of Japan, including the wheelchairbasketball games in 2019.Keywords: Deaf and Hard of Hearing, InformationSupport, Sports Watching, TimeLine, crowdsourcing.∗Corresponding author. E-mail: [email protected]


Part 5: Communication

A Machine Learning Assistive Solution for Userswith DysarthriaDavide Mulfari∗, Gabriele Meoni, Marco Marini andLuca FanucciDepartment of Information Engineering, University ofPisa, Italy

Background: With the rapid advancement in virtualassistant technology, many human computer interfacesexploit automatic speech recognition (ASR) solutionsto get a verbal interaction with smart devices. Nowa-days, such interfaces meet the demands of users with-out speech disabilities, while those with dysarthria,i.e., a neuromotor speech disorder leading to a poorintelligibility of user’s speaking, cannot benefit fromthese services due to their communication disorders.Dysarthria condition is also characterized by an ex-treme variability of the speech (inter and intra speak-ers) and it occurs with severe motor disabilities. There-fore people with dysarthria and reduced motor skillsare unable to use their speaking to make easier their in-teraction with computing devices, for example in smarthome scenario.Method: To address the aforementioned issues, weemploy machine learning technology in order to rec-ognize speech commands (keywords spotting tasks) indysarthric speech. Our effort is to build ASR mod-els based on deep neural networks, we intend to col-laborate with people with communication disorderswho wish to share their utterances in order to trainsuch models. To this aim, we have developed a mo-bile app allowing end users to record their speakingwhile they pronounce given speech commands. Sev-eral application scenarios may benefit from our speechmodel. For instance, we currently work on an acces-sible smart home control especially designed for peo-ple with dysarthria, by integrating our custom key-words recognizer with openHAB, an open source soft-ware framework for smart home. With this solution,users with dysarthria can use personalized keywords toperform basic actions within their smart environments(such as controlling plugs or TV).

Key results: With the collaboration of four native Ital-ian speakers with dysarthria, an initial dataset for train-ing has been achieved including a small vocabulary(n.11 Italian keywords). By using Google’s Tensorflowrunning on a GPU-enabled machine, a convolutionalneural network model has been trained, it comes withtwo convolutional layers and a softmax classifier. Inthis early stage, we performed 18.000 training steps,and every 500 steps, we run a test on a validation-set.After the training stage, the same collaborators withdysarthria have been also involved into testing activi-ties, aimed at recognizing given keywords in their ut-terances: our model showed acceptable accuracy level(58%) for 11 labels. This method is not tied to a givenlanguage, we plan to extend it in a multi-language way.Conclusion: In the field of artificial intelligence, wepresent an ASR system for users with dysarthria. Themachine learning approach is designed for detectingjust a few number of predefined keywords within a re-duced vocabulary. Initial experiments showed promis-ing results thanks to a dedicated training procedurebased on TensorFlow framework. In future works, weplan to better investigate the proposed application withthe collaboration of many people with dysarthria whowish to share their utterances.Keywords: Automatic Speech Recognition, MachineLearning, Speech, Dysarthria, Smart Home.∗Corresponding author. E-mail: [email protected]

Development of controllable electrolarynx contro-lled by neck myoelectric signalKatsutoshi Oe∗, Sho Oda and Shoya UnoDepartment of Mechanical Systems Engineering, Fac-ulty of Engineering, Daiichi Institute of Technology, 1-10-2 Kokubu chuo, 899-4332, Kirishima, Japan

Background: Presently, there are many patients wholost their voice caused by laryngectomy, laryngeal in-jury and so on. The voice is very important commu-nication method for human, and when the voice was


S138 Part 5: Communication

lost, the patient often causes the mental distress. Forthese patients, the research about speech productionsubstitutes are implemented. However, they have prob-lems with regard of voice quality, articulation, and in-tonation. For example, the electrolarynx has good fea-tures of voice continuity, sound volume and acquisi-tion. However, it has poor voice articulation because ofits uncontrollable pitch frequency. To solve this prob-lem, many researches about the control method forelectrolarynx are being conducted. All of these tech-niques focused on controlling the pitch frequency. Ourresearch aims to realize the electrolarynx with high-level controllability. We focused on using the myoelec-tric signal of the sternohyoid muscle (SH) to controlthe electrolarynx. The SH has the function of vocalcords relaxation and activate during the utterance oflow-tone voice. Therefore, the pitch frequency of elec-trolarynx can be controlled using the myoelectric sig-nal of SH.Method: Our proposed controllable electrolarynx usesthe myoelectric signal measured by the myoelectricelectrode attached to human neck near the SH. To getthe stable signal, the grand electrode was attached tothe wrist of the test subject. The measured signal isprocessed by a computer and outputted as the controlsignal. The most important thing is the determinationof the parameter for conversion of myoelectric signalto control signal. From our previous research, it is con-firmed that the exponent and quadratic are better thanthat of linear function. To evaluate the controllabilityof pitch frequency control, the indication of the sub-ject’s will was compared to the calculated pitch fre-quency and the errors were counted and calculated theerror rate. The test subject indicated the indicators of“High”, “Mid” and “Low” by mouse pointer with hisintension. At the same time, he was conscious to gen-erate the myoelectric signal, and the height indicatorof pitch frequency lighted on according to the gener-ated myoelectric signal. The errors were counted fromcaptured video. The test subjects were 3 normal adultmales.Key results: From the averaged result of error rate, itwas clear that the error rate of the linear relationship(22%) and the quadratic relationship (21%) are higherthan that of the exponent relationship (13%). To eval-uate the control stability, the numbers that the subjectfailed to keep the constant tone was counted. From thisresult, the numbers of failures of exponent relationship(1) was the least of that of other two relationship func-tions (7 each). Therefore, it was clarified that the bestcontrol function was exponent.

Conclusion: In this report, we proposed the controlmethod for controllable electrolarynx using of neckmyoelectric signal. From the results, it was clarifiedthat there was an exponent relationship function be-tween the RMS value of myoelectric signal and pitchfrequency of vocalized sound. Using of this function,the controllability of electrolarynx was increased in theviewpoint of numbers of errors.Keywords: Speech production substitutes, Electrolar-ynx, Myoelectric signal, Sternohyoid muscle.∗Corresponding author. E-mail: [email protected]

How do We Provide Necessary Support to EnableRemote Communication for People with Communi-cation Difficulties?Margret Buchholza,b,∗, Ulrika Fermb and KristinaHolmgrenaaDepartment of Health and Rehabilitation, Institute ofNeuroscience and Physiology, Sahlgrenska Academy,University of Gothenburg, Göteborg, SwedenbDART Centre for AAC and AT, Queen Silvia Chil-dren’s Hospital, Sahlgrenska University Hospital,Göteborg, Sweden

Background: To participate in today’s society, oneneeds to be able to handle digital remote communi-cation (i.e., communication with someone who is notphysically in the same place). This includes phonecalls, texting, e-mail, chat, social media, and otheronline services for communication. Use of remotecommunication may facilitate social contacts, self-determination, and participation. Unintelligible speak,in combination with difficulties in reading and writingmakes remote communication difficult. Research haspointed out several obstacles to remote communicationaccess, and users’ right to communicate are not alwaysbeing met. There is a need for increased support, buthow this support should be administered has not beenresearched.Method: The purpose of this study was to explore theneed for necessary support to enable access to remotecommunication for people with communication diffi-culties. A qualitative design using focus group method-ology was used to understand support persons’ viewsand thoughts in their role of supporting users of remotecommunication. The participants were support personsto people with communicative and cognitive disabil-ities, which, at some level, interfered with using re-mote communication in daily life. They were family


members and/or staff who worked in sheltered hous-ing, schools or as personal assistants. Five focus groupswith 21 support persons in total were conducted. Thefocus groups were recorded and transcribed, and datawas analyzed qualitatively using focus group analysismethodology.Key results: The participants experienced a need forsupport for the users and their networks and identi-fied it to be crucial in enabling remote communicationfor people with communication difficulties. They de-scribed a need for increased support on several levels.The users need lifelong support and individual trainingon a long term basis. There is a need for higher compe-tency concerning remote communication among staffin the users’ daily lives. There is also a need for bettercoordination between all different professional effortsand interventions. The support persons lack access toinformation about remote communication and technol-ogy and access to expert advice. They also pointed outthat it would be useful to have all of the informationin one place, suggesting that there should be a digitalplatform to gather all information about remote com-munication for persons with disabilities. This platformmight contain instructional videos with tutorials, ex-amples, advice, and recommendations by experts, andmight also offer opportunities for people with com-municative and cognitive disabilities, support persons,and professionals to share experiences and “life hacks.”Further, it could also be a forum to connect with ex-perts for online consultation.Conclusion: Support is crucial in order to enable re-mote communication and participation in society forpeople with communication difficulties. Support needsto be provided on several levels; 1) Individual supportto the user, 2) information and training for staff, 3) co-ordination of services providing support, 4) access toexpert knowledge and sharing of knowledge. A digi-tal platform with all supportive functions gathered issuggested.Keywords: Remote communication, Social media,Communicative and cognitive disabilities, Training,Support.∗Corresponding author. E-mail: [email protected]

Let’s Stay in Touch! Remote Communication forPeople with Communicative and Cognitive Disabil-itiesMargret Buchholza,b,∗, Ulrika Fermb and KristinaHolmgrena

aDepartment of Health and Rehabilitation, Institute ofNeuroscience and Physiology, Sahlgrenska Academy,University of Gothenburg, Göteborg, SwedenbDART Centre for AAC and AT, Queen Silvia Chil-dren’s Hospital, Sahlgrenska University Hospital,Göteborg, Sweden

Background: Remote communication involves com-munication between people who are not physically inthe same place. Using everyday technology like smart-phones, tablets and computers, including services forcalls, messaging, video calls and social media are com-mon means of communication in contemporary soci-ety. Digital communication is increasing as a requiredmeans of social interaction, communication for inter-actions for daily activities, like contact with health-care, insurance or banks and, therefore, has becomea prerequisite for participation in society. Despite thiscommon use of the Internet and social media, severalgroups of people do not have access to remote commu-nication. Being able to use remote communication re-quires either functional speech (phone calls and videocalls) or the ability to read and write (texting, e-mailingor chatting). Several conditions, such as congenital, ac-quired and progressive disorders can affect commu-nication abilities. People with a combination of com-municative and cognitive disabilities may have lim-ited speech and comprehension abilities as well as re-stricted reading and writing skills, which means thatboth their spoken and written communication are af-fectedMethod: The aim was to explore and describe re-mote communication for people with communica-tive and cognitive disabilities in in relation to self-determination and participation from users’, profes-sionals’ and support persons’ perspectives. The re-search project is based on four studies: three qualitative(I, III, IV) and a mixed method (II). For study I, semi-structured interviews were used with seven profession-als after an intervention project on texting with pic-tures and speech synthesis. In study II, semi-structuredinterviews with 11 users on their experiences of re-mote communication using Talking Mats, a pictorialcommunication tool. Study III and IV involved fo-cus groups with 21 support persons on their experi-ences and views on remote communication for the tar-get group.Key results: Professionals described how text mes-saging with pictures and speech could increase inde-pendence and participation, and how individual assess-ments and user-friendly technology were important.


People with communicative and cognitive disabilitiesdescribed how remote communication related to self-determination. Having a choice between types of re-mote communication and levels of independence wasimportant, and technological limitations forced themto find their own communication strategies. Supportpersons discussed how remote communication enabledusers to have more control and feel safer while in-creasing self-determination and participation. The re-sults suggested communicative rights were not met,and there was a need for better provisions of technol-ogy and support.Conclusion: Access to remote communication is cru-cial for participation in today’s society where anincreasing part of human interaction is carried outthrough digital channels. Access to remote communi-cation can increase independence, self-determinationand participation in daily life for people with com-municative and cognitive disabilities. It can also af-fect health and safety. The findings suggest peoplewith communicative and cognitive disabilities may en-counter difficulties in accessing emergency calls and e-health services. There is a need for further technologydevelopment so that remote communication technol-ogy can be accessible for all. People with disabilitiesand their network need improved support.Keywords: Augmentative and alternative communi-cation, Assistive technology, Remote communication,Digital communication, Social media.∗Corresponding author. E-mail: [email protected]

Development of an AAC System for a Student withSpeech Impairment and Spastic QuadriplegiaFrancesco Carbonea,∗, Francesco Davide Casconea,Antonio Gloriab, Massimo Martorellia, Dan Natan-Robertsc and Antonio LanzottiaaDepartment of Industrial Engineering, Fraunhofer JLIdeas, University of Naples Federico II, Naples, ItalybInstitute of Polymers, Composites and Biomaterials,National Research Council of Italy, Naples, ItalycDepartment of Industrial & System Engineering, SanJose State University, San Jose, CA, USA

Background: In complex cases of disability, customAugmentative and Alternative Communication (AAC)Systems should be developed because existing stan-dardized commercial products often leave user require-ments unmet. AAC systems are personalized to reducethis mis-match between technology and user needs. A

semi-custom solution was developed by Departmentof Industrial Engineering of the University of NaplesFederico II, adapting commercial devices, 3d-printingmockups for evaluation and design new solution forassembly to wheelchairs. Several studies were con-ducted including: usability evaluation, learning curverate, software and hardware optimization and cognitiveassessment for actuators and layouts.Method used: A custom system was developed for astudent with complex communication needs caused bya traumatic injury that led to motor impairment anda speech disorder. A usability test and interface opti-mization are discussed to fix usability issues, highlightcritical areas for improvement and design new proto-types. Performance, specifically learnability curves ofthe product were found. Learnability can lead to a re-duction of design and product development times. Im-provements in communication rate, number of opera-tions per sentence, and errors were found. Additionalcentral topics include areas lacking in current productdevelopment and methods of eliminating barriers to ac-cess.Key results: A usability index was obtained from us-ability data. An Analytical Hierarchy Process and Mul-tiple Criteria Decision Analysis are used to identify,prioritize, and investigate the usability functions in theproduct that can be improved. A learnability curveshowing incremental of performance in a time of 8weeks was also found.Conclusion: Guidelines were developed through datacollection and through decision criteria. The guidelinesare generic and can be applied to usability heuristics.The main benefit of implementing Interaction Design(IxD), usability and ergonomics is the possibility toextend the results to other users through a paramet-ric approach and generate generic-purpose tools andmethodologies that can be applied more widely.Keywords: Augmentative and Alternative Communi-cation, User Needs, 3d-Printing Mockups.∗Corresponding author: [email protected]

Augmentative and Alternative Gesture Interface(AAGI): Multi Modular Gesture Interface for Peo-ple with Severe Motor DysfunctionIkushi Yodaa,∗, Tsuyoshi Nakayamab, Kazuyuki Itohb,Yuki Ariakec, Satoko Mihashic, Hiroyuki Awazawac

and Youko KobayashicaHuman Informatics Research Institute, National In-stitute of Advanced Industrial Science and Technology(AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8560,Japan


bResearch Institute, National Rehabilitation Center forPersons with Disabilities (NRCD), 4-1 Namiki, Toko-rozawa, Saitama 359-8555, JapancDepartment of Physical Rehabilitation Medicine, Na-tional Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawa-higashi-machi, Kodaira, Tokyo 187-8551,Japan

Background: Individuals with severe motor dysfunc-tion are unable to use existing computer interfaces dueto spasticity, involuntary movements, and the like. Theinterfaces these individuals can use, if any, are limitedto customized switch interfaces, which makes it diffi-cult to operate a computer with any degree of ease. Forindividuals who can use only simple switch-based de-vices, these more sophisticated operations are all butimpossible. It is very expensive to develop an interfaceable to respond to changes in an individual’s move-ments caused by physical deterioration, so the main re-quirement is that it involve technology that can easilybe customized for a diverse range of users at low cost.Method: We have developed a switch gesture interfacethat utilizes a commercially available RGB-D camera.The system software recognizes gestures from 2D and3D images, so the system can customize to each usereasily than hardware systems. Furthermore, the soft-ware is easier to apply both daily and long term thanhardware is. The 3D images can specify gestures byusing shape information, thus enabling application tomore varied environments and types of gesture thanonly using 2D images.We used the RGB-D camera to gather data on the typesof gestures that severely quadriplegic individuals wantto use in an interface. The data included both movingRGB images and depth (range) images. A total of 211gestures were collected from 55 individuals with motordysfunction and the voluntary movements were clas-sified on the basis of body part. We developed all al-gorithms for recognition in-house and used only a fewbasic camera libraries to obtain 2D and 3D images. Ifthe RGB-D camera is discontinued, we can transportall software to another camera easily.Key results: We developed seven recognition modulesbased on body part and two recognition modules inde-pendent of body part. Among the latter, the Front ob-ject module recognizes the closest region to the cameraand is useful for movements of hands, arms, and toes,and the Slight movement module recognizes slightmovement in the region of interest. We experimentedon five testers with four recognition modules (Finger,Head, Foot, and Slight movement) in a long-term ex-

periment (over three months). The user of the Footrecognition module is now using this system daily. Ouroriginal software and the RGB-D camera have been in-stalled in the user’s own PC, and he uses WORD andWEB browser by foot gesture every day.Conclusion: To enable a low-cost interface, we haveutilized commercially available RGB-D cameras anddeveloped a non-contact, non-constraint interface. Wecollected 211 gestures from 55 individuals with mo-tor dysfunction and classified voluntary movements onthe basis of body part. We developed seven recognitionmodules dependent on body parts along with two inde-pendent recognition modules and facilitated long-termexperiments with five users. For one user, we com-pletely succeeded in practical use by foot gestures.We call this software the Augmentative and AlternativeGesture Interface (AAGI) and will open it sequentially.All software will be supplied freely from our HP.Keywords: gesture interface, support for the disabled,3D image recognition, AAC, human sensing.∗Corresponding author. E-mail: [email protected]

Presentation Matters: A Design Study of DifferentKeyboard Layouts to Investigate the Use of Predic-tion for AACRolf Blacka,∗, Annalu Wallera and Conor McKillopaaSchool of Science and Engineering, University ofDundee, Perth Road, Dundee DD1 4HN, Scotland, UK

Background: Augmentative and Alternative Commu-nication (AAC) applications on mobile technology typ-ically use on-screen keyboards for text entry. AACusers with limited dexterity tend to use single fingertyping, leading to slow text entry rates. Although wordand phrase prediction have the potential to increaserates, users tend to keep typing rather than selectingpredictions. It is hypothesized that the need to scan listsof predicted words or phrases necessitates an undesiredshift of gaze, resulting in missed predictions.Method: We propose new ways for on-screen presen-tation of predicted words and phrases and report onearly results from a multiple single user study usingthree different keyboard layouts. Keyboard layout de-signs were informed by a literature review, an onlinequestionnaire and focus group activities with partici-pants who use AAC. Three on-screen keyboards wereimplemented on a touchscreen tablet – a standard key-board and two layouts which display predictions closerto where the user’s visual attention is already focused.The Standard Layout (SL) displays a row of 4 pre-


dicted words above the keyboard; the ‘Above TypedLayout’ (TL) displays up to four predicted words in a 2× 2 grid above the typed letter; while the ‘Above Pre-dicted Layout’ (PL) displays up to 4 predicted wordsabove the next predicted letters. Ten participants withneurological impairments affecting hand function wereinvited to copy type a number of short memorablephrases. All participants used single finger typing apartfrom one participant who used eye gaze with mousepointer control for access. Due to physical limitationswe were only able to record the gaze of four partic-ipants during their typing exercise using an eye gazetracker. A semi structured interview was conductedafter the activity. For the four participants with gazedata, we analysed text entry rate, error rate and per-sonal preference using videos of the typing interaction,screen captures with gaze plots and verbal feedback.Key results: Participants expressed different prefer-ences of keyboards after the experiment. These rangedfrom preference for the standard layout (SL) due tothe familiarity, to preference for PL due to perceivedaccommodation of finger and gaze movement. Entryrate was the highest using SL. Participants achievedthe highest keystroke savings with PL and significantlylower savings with TL. Participants missed predictionsusing all layouts. Interview feedback conflicted withobserved entry rates (e.g. preferring a slower keyboardlayout, perceiving this to have a faster entry rate).Conclusion: Preliminary results suggest that display-ing predictions closer to the next letter to be typed mayincrease the selection of predictions. Although text en-try rates were higher using SL, this may change withlonger use of PL. Further studies which include the in-tegration of phrase prediction into the PL keyboard andextended use are being undertaken.Keywords: AAC, prediction, keystroke savings, com-munication rate, eye gazeAcknowledgments: We thank Zulqarnain Rashid andShuai Li for their part in coding the prototypes, ChrisNorrie for data collection support, TobiiDynavox forsupplying eyegaze technology and most importantlythe participants of the study. This research is funded bythe Engineering and Physical Sciences Research Coun-cil, Grant Ref. EP/N014278/1.∗Corresponding author. E-mail: [email protected]

Communication Partners’ Perspective on the Use ofan AAC Application Oriented to Just-in-time Lan-guage AcquisitionTetsuya Hirotomi

Institute of Science and Engineering, Academic Assem-bly, Shimane University, 1060 Nishikawatsu-cho, Mat-sue, Shimane 690-8504, Japan

Background: Visual aids, such as pictorial symbolsand photographs, are widely used for exchanging mes-sages between children and their communication part-ners in augmentative and alternative communication(AAC). A variety of AAC apps have been developed,but in many cases, the vocabulary should be selectedprior to exposing the words to children. The selectedvocabulary is often insufficient to respond to children’sinterests, needs, and actions as they arise during inter-actions.Method: We developed a mobile application runningon Android OS, named STalk2. It was oriented to“just-in-time” language acquisition. In other words, itwas designed to increase the use of visual aids in thedynamic process of interaction between children andtheir communication partners. It is capable of recog-nizing voices and presenting visual aids stored in a lo-cal database and/or retrieved by an image search onthe web; it also monitors communication activities. Weconducted a longitudinal study (mean = 6 months, sd= 4 months) with 25 adults including parents, schoolteachers, and staff of after-school day service cen-ters, and thirteen children with complex communica-tion needs (CCN). In this study, the use of STalk2 ineveryday communication was evaluated. At the end ofthe study, the adults completed a questionnaire con-sisting of ten statements. These statements were orig-inally in Japanese, the native language of all partici-pants. A five-point scale ranging from “strongly dis-agree” to “strongly agree” and an open-ended ques-tion to provide the reason were used for each state-ment. One of the statements was related to the over-all satisfaction regarding whether needs were met us-ing STalk2. The Spearman correlation coefficient wasused to describe the relationships between the overallsatisfaction and the responses to other statements. Sta-tistical significance was set at p < 0.01.Key results: The percentage top-two-box score, cor-responding to those who agreed with the statement,for overall satisfaction was 50%. Responses to the fol-lowing statements have strong relationships with theoverall satisfaction: A) I thought the frequency of thechild exhibiting problem behavior was reduced be-cause he/she understood messages better (rs = 0.739),B) I thought the opportunities to present visual aidswith verbal messages to the child were increased (rs =0.660), C) I felt that the burden of communicating with


the child was reduced (rs = 0.576), and D) I thoughtthe communication on which the child focused his/herattention was increased” (rs = 0.572).Additional comments made by adults included, “the re-sponse time of the child for performing certain taskswas reduced and the child could express their ownwill,” “the child could accept rescheduling becausethey could use STalk2 to confirm the information bygenerated speech to reduce their anxiety,” and “STalk2enabled me to rapidly search for and present appropri-ate illustrations.”Conclusion: The results suggested that STalk2 re-duced difficulties for half of the communication part-ners of children with CCN by enabling visual aidsto be presented during their conversation. By usingSTalk2, the partners presented visual aids more fre-quently, children with CCN focused on their commu-nication and could understand messages better, and asa result, their problem behavior was reduced.Keywords: AAC App, Communication Partner, Just-in-time Language Acquisition.∗Corresponding author. E-mail: [email protected]

AsTeRICS Grid – a flexible web-based applica-tion for Alternative Communication (AAC), envi-ronmental and computer controlBenjamin Klausa,∗, Benjamin Aignera and ChristophVeiglaaResearch Group Embedded Systems, UAS TechnikumWien, Höchstädtplatz 6, 1200 Vienna, Austria

Background: In the field of Augmentative and Alter-native Communication (AAC), there are several toolsfor the creation of layered grids, which show wordsand symbols and provide speech output. While mostof these applications are designed for a single plat-form (e.g. iOS), in recent years also cross-platformweb-based solutions emerged. Next to AAC functions,environmental- or computer control capabilities can beuseful for the target audience of such systems. All cur-rently available applications are either restricted to asingle platform or miss extended capabilities beyondAAC. AsTeRICS Grid is a flexible system for the cre-ation of AAC grids, environmental control solutionsor alternative Human-Computer Interfaces, combiningthe advantages of existing web-based and native appli-cations.Method: The requirements for the communication-related features of AsTeRICS Grid were defined in co-

operation with an AAC expert. Subsequently, the appli-cation was developed in multiple iterations (Kanban-based methodology), considering feedback by theAAC expert and students who worked with the applica-tion in the course of academic projects. A user study isplanned for the near future. From a technical perspec-tive, AsTeRICS Grid is a single page web applicationusing various Javascript libraries. Native capabilitieslike environmental- and computer control can be addedusing bindings to the existing AsTeRICS framework(https://www.asterics.eu/get-started/Overview.html) asa backend. AsTeRICS Grid is hosted as OpenSourceproject on github.com (https://github.com/asterics/AsTeRICS-Grid).Key results: Compared to existing AAC solutions, As-TeRICS Grid provides the following unique character-istics: (1) grid layouts and element sizes are completelyflexible, (2) possibility of environmental- or computercontrol via the application, (3) platform agnostic web-application that is usable offline, automatically syn-chronizes the configuration across devices and at thesame time maintains perfect privacy. Environmental-or computer control capabilities are realized using theAsTeRICS framework as an optional backend. As-TeRICS includes different sensor- and actuator plug-ins which allow a wide range of interaction capabili-ties targeting the native platform, including emulationof keyboard or mouse functions or control of exter-nal devices via HTTP, infrared and home automationstandards. Selecting an element in the AsTeRICS Gridcan e.g. trigger an action on a remote tablet, switchon lights or change the channel of a TV. Although it’sa web application, AsTeRICS Grid can also be usedwithout internet connection. Once the website was vis-ited, the whole app is automatically stored locally us-ing modern browser technologies and afterwards is us-able offline. If users want to use AsTeRICS Grid onmultiple devices, all configuration data can be auto-matically synchronized using the cloud, while the ap-plication remains fully functional without internet con-nection on each device. Data protection is guaranteedby implementing end-to-end encryption of all configu-ration data.Conclusion: AsTeRICS Grid is a web-based tool forAAC that also provides environmental- and computercontrol capabilities and is usable across all major plat-forms. This facilitates new forms of usage which werenot possible before: users can easily switch their pre-ferred input device and control external appliancesfrom the AAC application. Future research will fo-cus on user-studies with persons who can benefit fromthese possibilities.


Keywords: AAC, Environmental Control, Web-based,Human-Computer Interface∗Corresponding author. E-mail: [email protected]

Attitudes and Usage of AAC in Bulgaria: A Surveyamong Special Education TeachersEvgeniya Hristovaa,b,∗ and Maurice Grinberga,baDeparment of Cognitive Science and Psychology,New Bulgarian University, Montevideo 21, Sofia 1618,BulgariabASSIST – Assistive Technologies Foundation, Razv-igor 3A, Sofia 1618, Bulgaria

Background: Modern technologies for augmentativeand alternative communication (AAC) form the ba-sis for effective intervention for children with com-plex communication needs – children with physicaldisabilities, e.g. related to cerebral palsy, Rett syn-drome, neuro-muscular dystrophies, but also childrenwith autistic spectrum disorders or with intellectualdisabilities. The knowledge and usage of AAC by theprofessionals working with these children is extremelyimportant for the development of their full potential,their capabilities for communication and participationin social life. As Bulgaria is an emerging AAC country,in the paper we are interested in studying two main top-ics: the attitudes to AAC and inclusive education andthe knowledge and usage of low-tech and high-techAAC among special education teachers in Bulgaria.Method: We developed a questionnaire consisting oftwo parts. The first part explores the attitudes towardsinclusive education and attitudes towards using AAC.This is done by providing descriptions of children with2 types of disabilities – severe forms of cerebral palsy(CP) and autism spectrum disorder (ASD). The secondpart of the questionnaire explores teachers’ knowledgeand usage of AAC (low-tech and high-tech) in theirwork with children with disabilities. The questionnaireis filled in by 88 special education teachers from Bul-garia. Data is collected anonymously using paper-and-pencil questionnaires.Key results: The results from the questionnaire showpositive attitudes towards using AAC by children withdisabilities. There are more positive attitudes towardslow-tech AAC compared to high-tech AAC. With re-gard to the attitudes towards inclusive education, theratings are not so positive. Also, special educationteachers rate specialized school as more appropriate(compared to inclusive education schools) for children

with severe forms of CP or ASD. The results howevershow very low rates of knowledge and usage of AAC.Forty-six percent of the special education teachers inBulgaria are not familiar with low-tech AAC methodsand only about 30% of them use low-tech AAC. For thehigh-tech AAC the results are the even more disturb-ing. More than 2/3 of the professionals have no knowl-edge about text-to-speech software and less than 10%use it when working with children with special educa-tion needs. Alternative access methods are unknown to85% of the special education teachers and only 2% usesuch assistive technologies for children with disabili-ties.Conclusion: The results of the survey show alarminglylow levels of knowledge and usage of AAC among spe-cial education teachers in Bulgaria. In the same time,the attitudes about using AAC are mainly positive. Theobtained results are used to formulate steps for over-coming the existing barriers in the usage of augmen-tative and alternative communication in Bulgaria: rais-ing the awareness about the benefits of AAC; provid-ing information about low-tech and high-tech AAC andtheir benefits for children with disabilities; provisionof training AAC courses for special education teach-ers both during their formal education and on-the-jobtraining courses.Keywords: AAC, attitudes towards AAC, AAC knowl-edge.∗Corresponding author. E-mail: [email protected]

Sign Language Recognition through MachineLearning by a New Linguistic FrameworkTsutomu Kimuraa,∗ and Kazuyuki KandabaNational Institute of Technology, Toyota College, 2-1Eiseicho, Toyota, Aichi, JapanbNational Museum of Ethnology, 10-1 Senri ExpoPark, Suita, Osaka, Japan

Background: We have developed Japanese Sign Lan-guage Dictionary System for several years. Becausemany Deaf are less intelligible to the written Japanese,when they want to find a proper sign for a Japanese en-try word through the present system, they have a prob-lem that the entry Japanese word is hard for them, incontradiction. They need a new system to solve theproblem in the way that a Deaf user signs in front ofthe camera, the system recognizes and automatically itshows the candidates for the target sign as a thesaurus,or a Japanese translation.


Method: Our system learns signs through Deep Learn-ing and it creates a learn model which constructs thesign recognition system. The model data collectedwere 101 signs in the vocabulary of Level 6 in JapaneseSign Language Proficiency Test which is widely ac-cepted in the country. The 12 deaf and hearing infor-mants of repeated the recording experiments for sev-eral times. The total number of the signing data was7,763. OpenPose, the Skelton Models detects and rep-resents human joints on single images. It acquires thevector data and all the data was filed by CSV for-mat of the trajectories at X and Y axes which wererecorded frame by frame. In the next the Neural Net-work Console (NNC) by SONY analyzes the data.Long Short Term Memory (LSTM) was also used.Briefly explained, the system analyzed the data of vec-tors through Deep Learning, being extracted from thesigning video by OpenPose, and the accuracy of signrecognition was about 75% as a result. The solution toraise the rate was discussed.Key results: Approximately 90% of the 7,763 signsdata were taken as learning data and the rest were toevaluate the neural network. As result of cross valida-tion, the average accuracy was about 75%. The falserecognitions were analyzed and found the cause bysimilarity of the signs, and the remarkable joints werefound.Conclusion: The recognition rate is insufficient forcomplete machine translation but is usable for a dic-tionary, because our dictionary offers some candidatelexis which are to be selected by the user. We willexpand the sign data in the future and we expect thehigher rate by deep learning. In our project, we alsopropose some new sign linguistic constituents becausewe need new concepts to apply for an electrical processof sign language in an analogy to applying acousticsfor phonology. We focused to the movements of sign-ing which would be physically indicated by the trajec-tories and speed of joints of a body. The remarkablejoints, an elbow and a wrist were found to behave animportant role.Keywords: Deep leaning, Machine learning, Sign lan-guage, Sign recognition, OpenPose.∗Corresponding author. E-mail: [email protected]

Access to Non-Verbal Aspects of Group Conversa-tions for Blind PersonsReinhard Koutnya,∗ and Klaus MiesenbergeraaInstitut Integriert Studieren, Johannes Kepler Univer-sity Linz, Altenberger Straße 69, 4040 Linz, Austria

Background: Communication between multiple peo-ple talking to each other in person, like during face-to-face business meetings, does not only consist of thespoken language and therefore requires more than theauditory channel to fully participate. Blind people whotake part in this kind of meetings rely on the otherparticipants to explicitly speak out any important non-verbal cues, like deictic gestures, which has proven tobe especially challenging in heated discussions as peo-ple tend to fall back to their usual behavior of usingnon-verbal communication (NVC) to support their ar-guments. Perceiving NVC is key to successfully followand contribute, particularly in these situations. Nowa-days, a quite large set of non-verbal information canbe captured using different means, including video andbody-worn-sensor based motion capturing. However,the bandwidth of how much information blind peoplecan perceive is limited in comparison to sighted peo-ple due to the lack of the visual channel. Therefore, acareful selection of relevant information is necessaryto avoid cognitively overloading the blind person.Method: This submission will outline NVC cuesfound to be helpful for blind people during face-to-face business meetings. Throughout the research mul-tiple meetings have and will be analyzed and inter-views with people from the target group have and willbe undertaken to iteratively develop an ontology ofthe relevant information space, clustering pieces of in-formation, modelling relations between them and helpto process this data in an effective and efficient wayto display a personalized stream of information to theblind user.Key results: Analyses of meetings and interviews withblind people show that NVC is crucial in conversa-tions, especially if more than two people are involved.Outcomes suggest that there is a disparity betweenNVC cues blind people think are helpful during a firstinterview and after exposure to additional NVC cues.Observations show that the set of NVC cues perceivedto be helpful is a very individual matter as well, point-ing out the necessity of a highly customizable stream ofinformation conveying NVC cues. Creating an ontol-ogy which describes the information space is a contin-uous process. At the time of writing, 15 cues groupedin 5 main clusters of information have being identi-fied covering verbal communication, non-verbal com-munication, visual artefacts, digital artefacts as well asspatial information of physical objects. Especially spa-tial aspects and non-verbal communication and theirrelations, like deictic gestures, show great potential ofenhancing a blind person’s overall understanding ofgroup conversations.


Conclusion: This research aims at identification of theinformation space relevant to blind people in groupconversations. Non-verbal communication, spatial in-formation and other subdomains linked to them showgreat potential to significantly improve the overall un-derstanding of group conversations for blind people,which is a crucial prerequisite for effective participa-tion. Furthermore, a highly customizable approach toaccess this kind of information according to observa-tion and interviews seems necessary as this is a very in-dividual concern and decisively varies from person toperson, depending on their capabilities and experiencewith this kind of information.Keywords: Face to face Communication, Non-verbalcommunication, Ontology, Blind People∗Corresponding author. E-mail: [email protected]

Selecting AAC Apps for Effective Communicationin a Mainstream Classroom Setting. A New Frame-work of Where to StartJames Northridgea,∗aCentre for the Integration of Research, Teaching andLearning (CIRTL), University College Cork, CollegeRd, Cork, Ireland

Background: Innovative technologies such as iPadsand other mobile devices are changing well-establishedareas of experience and practice, including medicine,business and education. The field of speech languagepathology is no exception. The accelerated rate of tech-nological advancement is also affecting AAC as anarea of study and practice. Current AAC assessmenttools are not designed to address criteria for differen-tiating between AAC apps, leading most families andpractitioners to download their selection without anyrobust guidance or assessment. This study looked toshift the focus from mere technology-orientated so-lutions to the key goal of enabling communication.Therefore, it is important to understand how these appsare initially recommended and obtained. It was neces-sary to gauge the impact this is having on students andthose who support them. The three-year project aimedto empower family members and practitioners to dif-ferentiate truly effective AAC apps from the many oth-ers that proliferate in today’s consumer-orientated mar-ket.

Method used: This project can be divided into keyareas; Key Area 1: An environmental scan of currentAAC assessment tools will be conducted to (1) eval-uate which one(s) should be used to develop a toolfor selecting among AAC apps and to (2) identify cur-rent barriers in app selection. Two online surveys wereused to collect data from educators and practitioners,N = 497. The surveys consisted of both qualitative andquantitative questions focused on identifying the cur-rent usage of AAC, selection criteria, technical supportrequirements, perceived benefits and challenges fromprior use of AAC. Four focus group sessions were fa-cilitated with two for professionals and two for parentsto gather further information and to gain an insight intohow they currently select AAC apps and experiencebarriers in the app selection process. Two focus groupsessions took place in the United States N = 12, andtwo in Ireland, with one for each group, professionalsand parents, N = 12. Key Area 2: A formative eval-uation of the results of Key Area 1 was conducted todevelop the criteria that was used to guide the designof a new AAC app selection model to fit the consumer-orientated model we now find ourselves in.Key results: The information gained was applied un-der Key Areas 1 and 2 to develop a consumer-friendlyapp selection tool that (a) helps potential users to iden-tify potentially effective ACC apps and (b) assist themin acquiring the knowledge needed to overcome orbypass challenges to their effective use. To gain in-sight concerning its effectiveness, a participant feed-back survey to obtain final feedback and directionfor future improvements for this early prototype AACapp selection model was developed. The new AACApp selection tool is now available for use online –www.SelectingApps.com and is free to use.Conclusion: Development of this new AAC App se-lection criteria will have fundamental and prevailingeffects on the lives of individuals with complex com-munication needs. Furthermore, it will empower AACusers to reach their full potential by maximising theircommunication ability and participation in day-to-daylife.Keywords: Augmentative and alternative communica-tion iPad Apps, AAC Selection, Communication Apps,(participation), (inclusion).∗Corresponding author. E-mail: [email protected]


Part 6: Rehabilitation and Assistive Robotics

A Custom Serious Games System with Forced-Bimanual Use can Improve Upper Limb Functionfor Children with Cerebral Palsy – Results from aRandomised Controlled TrialDavid A. Hobbsa,b,∗, Susan L. Hillierb, Remo N.Russoc,d and Karen J. ReynoldsaaMedical Device Research Institute, College of Sci-ence and Engineering, Flinders University, 1284 SouthRoad, Tonsley, SA 5042, AustraliabDivision of Health Sciences, University of South Aus-tralia, 108 North Terrace, SA 5001, AustraliacWomen’s and Children’s Health Network, Women’sand Children’s Hospital, 72 King William Road, NorthAdelaide, SA 5006, AustraliadCollege of Medicine and Public Health, Flinders Uni-versity, Sturt Road, Bedford Park, SA 5042, Australia

Background: Cerebral palsy (CP) is the most commoncause of physical disability in childhood, with the con-dition affecting both motor and sensory function. Mostchildren with CP favour their dominant upper limb dur-ing activities of daily living, resulting in a learned non-use phenomenon for their non-dominant (ND) limb,and consequently, decreased afferent inputs. The aimof this research was to design, develop, test and trial acustom serious gaming intervention to improve upperlimb function, addressing both motor and sensory as-pects of the limb, which was novel and had not been at-tempted before. The hypothesis was that sensory func-tion could be significantly improved through regularuse of a home-based haptic gaming system that re-quired coupled bimanual integrated hand use to suc-cessfully play the games.Method: The gaming system was developed using astage-gate product development process for the hard-ware and an agile scrum methodology for the software.Universal Design principles, focus groups with chil-dren aged 4–16 years old, short-term in-home trials,and a co-design philosophy were adopted to producethe prototype system in 2.5 years. The system, knownas OrbIT, is a standalone, self-logging, accessible andhaptic serious gaming system that features 15 differ-

ent games, which randomise game events to increaseplayer engagement.Eighteen children with CP (12 male; mean age: 10 yr8 mo ± 3 yr 4 mo; Manual Ability Classification Sys-tem Level: I(2), II(10), III(3), IV(3); CP type: hemi-plegia (n = 13), diplegia (n = 5)) trialled OrbITat home for 6 weeks. The experimental group (n =10) received afferent haptic vibration to their ND handvia the controller, whereas the haptic feature was dis-abled for the control group (n = 8). Primary outcomemeasures were tests of sensation (pressure sensitiv-ity, texture discrimination, distal proprioception, andstereognosis) and the Jebsen Taylor Hand FunctionTest (JFHFT). Assessments were conducted upon en-rolment (A1), immediately after the intervention (A2),and 4 weeks post-intervention (A3).Key results: All 18 children completed the trial, with2 children withdrawing post-trial. OrbIT was ratedhighly by families (7.4 ± 1.9 out of 10, median =8.0, n = 17) and overall average system usage was377 ± 267 mins, with no statistical difference in us-age between groups (p = 0.07). Statistical modellingrevealed a significant between group difference for theND hand for the test of stereognosis between A1 andA2 (p = 0.02) that did not persist at A3 (p = 0.41).When considered as a single cohort (n = 18), mod-elling revealed a strong statistically significant differ-ence for the ND hand for the JTHFT total time (p =0.001) between A1 and A3. However, a Type II errorcannot be ruled out. A post-hoc analysis revealed anestimated sample size of 55 children for 80% power.Conclusion: OrbIT proved to be an acceptable, feasi-ble, and robust technology for children with both uni-lateral and bilateral CP, when upper limb sensory andmotor impairments are present. Sensory improvementswere recorded for the intervention group, but did notpersist, whereas ND hand function improved signifi-cantly for all children post-trial. However, a larger andappropriately powered study needs to be conducted tovalidate the results of the trial.Keywords: Serious Games, Universal Design, co-design, cerebral palsy, sensation.


S148 Part 6: Rehabilitation and Assistive Robotics


Ciranda: A Floor Seat Positioning System and So-cial EnterpriseTulio Maximoa,∗ and Erika FoureauxbaSchool of Design, The Hong Kong Polytechnic Uni-versity, Jockey Club Innovation Tower, Hung Hom,Kowloon, Hong KongbInstituto Noisinho da Silva, Rua Conselheiro Dantas,183, Belo Horizonte, MG, Brazil

Background: One of the first challenges for manychildren with physical disabilities is to sit indepen-dently. A floor seating positioning system enables thismilestone, helping the child to maintain eye level withother children, play and learn on the floor, rectify theposture and, as a consequence, helps including thechild within its social spectrum. Ciranda is the firstcomprehensive floor seat solution to attend those needsin Brazil. The design aims to be safe, playful, af-fordable, and avoid negative connotations commonlyseen on floor seat solutions, such as ‘tightening’ thechild with straps or having an appearance of medi-cal equipment. Ciranda design, inspired on cartoons,has an innovative adjustable looping system that hugsthe child trunk to the backrest and a set of saddleson the seat that can adjust to different child’ bodysizes and shapes. The institute Noisinho da Silva, anon-government organisation, designed and producedthe Ciranda seat for Brazil market and also devel-oped the Oficina da Ciranda, a social enterprise ser-vice endorsed by UNICEF to accommodate the needsof parents in a vulnerable socio-economical situationby teaching them how to build their seat. These multi-awarded solutions had benefit more than a thousandchildren. Now, the institute is studying the applicabil-ity of the commercial solution within other marketsand the social enterprise within other contexts. This re-search will focus on structuring the Ciranda project asa model that can be replicated in different regions.Method: Ciranda and Oficina da Ciranda were de-veloped as a result of a co-design between differentstakeholders based on the principle of human-centreddesign. Anthropometric data were collected from 370children who cannot sit without support, often childrenwith cerebral palsy, myelomeningocele and multipledisabilities. The families of these children were visited,observed and interviewed. A project requirement wasdeveloped using the insights from the data, and a mul-

tidisciplinary team of collaborators were formed to co-design the solutions. For the social enterprise service,a model of collaboration was tested in a first workshopin 2007 and improved through the years. This researchaims to study and adapt this model aiming to replicatethe social enterprise in China and Hong Kong SpecialAdministrative Region.Key results: Oficina da Ciranda had already benefitedmore than 6000 people directly. This means that morethan 1000 children with disabilities had their floor seat-ing positioning system made by their community andfamily members, creating a network of people withsimilar values and struggles to support each other. TheCiranda commercial version was purchased by hun-dreds of families, contributing to promoting more Ofic-ina da Ciranda workshops with part of the sales profit.Conclusion: Ciranda project connects different stake-holders to form a community that supports each otherand to build a solution for one of the many challenges afamily with children with physical disabilities has. Themodel also unravels other challenges common to mostassistive technologies, such as access to a device andtraining for the use and maintenance of the device.Keywords: floor seat, positioning system, social enter-prise, assistive technology service, design.∗Corresponding author. E-mail: [email protected],[email protected]

Developing an Android Game for Restoring theMotor Functions of FingersCecilia Sik-Lanyia,∗, Patricia Szaboa and BarbaraBodoraaDepartment of Electrical Engineering and Informa-tion Systems, University of Pannonia, Egyetem u. 10.8200 Veszprem, Hungary

Background: Each year about 795 000 people expe-rience a new or recurrent stroke. The number of thepeople involved in it is very high, and this number hasincreased fast. The speed of treatment has a large ef-fect on the person’s chance of recovery. The conse-quence of a stroke is a really serious problem, and itcan make one’s life harder. This is the reason why thisapplication has been designed; to help people who suf-fered stroke to heal faster and go back to normal lifesooner. There are promising interventions that couldbe beneficial to improve the aspects of gait includingfitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also im-prove transfer functions. Occupational therapy can im-


prove activities of daily living. Several large trials ofrehabilitation practice and of novel therapies are under-way to inform future practice. There is a wide range ofmethods, that can help the patients e.g. serious gamesfor rehabilitation. The idea for developing a new re-habilitation game “Crafted Fingers” has been influ-enced by a game for children (http://www.fingers-in-motion.de/de/).Method: We studied the most relevant scientific litera-tures. Based on the new results and on our earlier expe-rience we have designed a new application for tablet,because we needed bigger surface and because of thetouching function it was a good opportunity to com-bine the technology with the therapy. We used one ofthe most popular programming languages, the Java andwe created the application for android platform. The“Crafted Fingers” application has 5 games: “Piano”,“Memory”, “Shopping-list”, “Fly away” and “Draw-ing”. All games need to be controlled by repetitivemovements with fingers on the tablet or on smartphonescreen. Every game has different difficulty levels. The“Crafted Fingers” have tested by therapists and elderlypeople. We measured the scores and time. The resultswill be shown at the conference.Key results Playing this game helps everyday tasks be-come as easy as they were once. The different gestureshelp differently:– Tweezer grip: help to pick up small objects,– Selective finger touch: help in the typing (for exam-

ple on the phone or on the computer),– Rotation in the wrist: strengthens the wrist,– Moving one finger: help the precision,– Selective finger circles: strengthens the forefinger.– Selective circles with the thumb: strengthens the

thumb.It will help more patients not just those who suffer fromstroke, but those as well who somehow have lost theirmotoric function in their fingers.Conclusion: This application will help to restore themotoric function of the fingers for those patients whouse it regularly. Even though it will be successful, thepatients need the traditional methods as well to achievethe best results during their rehabilitation.– Benefits: easy to use, exciting, sustaining the atten-

tion, improve different skills.– Disadvantages: It is not enough for the full recovery.

It is not fully suitable to strengthen the muscle of thefingers.

Acknowledgements: The authors thank the financialsupport of Széchenyi 2020 under the EFOP-3.6.1-16-2016-00015.

Keywords: Android, Game app., Stroke, Rehabilita-tion, Finger motion.∗Corresponding author. E-mail: [email protected]

Hand Function in Skills of Modern Day among El-derly IndividualsAlexandra Danial-Saada,∗, Lorenzo Chiarib, ShlomiLauferc, Mattia Corzanib and Michal Elboim-Gabyzond

aOccupational Therapy Department, Faculty of SocialWelfare and Health Sciences, University of Haifa &The Arab Academic College for Education in Israel,Haifa, IsraelbDepartment of Electrical, Electronic, and Informa-tion Engineering, University of Bologna, Bologna,ItalycFaculty of Industrial Engineering and Management,Technion Haifa, IsraeldPhysical Therapy Department, Faculty of Social Wel-fare and Health Sciences University of Haifa Haifa, Is-rael

Background: Elderly individuals in the modern-dayenvironment are obligated to interact with an ever-growing number of technological devices in order toparticipate in life activities and maintain their inde-pendence and quality of life. Operating such devices,such as touchscreens, requires the ability to performunique motor skills such as tapping, swiping and vir-tual pinching. Hand function is subject to age-relatedchange. Hence, studying the hand function abilities ofthe elderly during touchscreen manipulation is an im-portant new research direction. The objective of thisstudy was to characterize elderly hand function perfor-mance skills while operating a touchscreen.Method: The study was a field study conductedin a community center. Study population included28 community-dwelling elderly individuals (81.9 ±4.2 years old) and 16 middle aged (53.7± 6.2) adults.Data collected included subject’s characteristics (de-mographic information, health status). Cognitive statuswas determined by the Montreal Cognitive Assessmentquestionnaire. In addition, functional mobility and dy-namic balance was assessed by the “Time up and gotest”. Hand performance was assessed by a) Bilateralstrength of hand grip and thumb-finger pinch grips(tip to tip, and three fingers pad to pad) using a cal-ibrated JAMAR hand dynamometer; b) Manual dex-terity by Functional Dexterity Test. A software appli-


cation called Touchscreen-Assessment Tool (TATOO)was used to measure hand performance abilities neces-sary for operating a touchscreen. Temporal and accu-racy measures were collected while performing four ofTATOO’s tasks. Age effect was examined by compar-ing the performance of the two groups using the T test.P 6 0.05 was considered statistically significant.Key results: The elderly group were independent inbasic and instrumental activities of daily living, pre-senting high level of functional mobility and dynamicbalance as reflected in the TUG scores (10.3 ± 3.6) .However, the MoCA score for the elderly group (21.5± 4.3) revealed mild cognitive impairment of the in-dividuals. The middle age group had no cognitive im-pairment (MoCA score > 30), TUG scores typical totheir age (5.57 ± 0.95), and significantly lower than theelderly group. Significant age effects were observedin the grip strength, three fingers pad to pad pinchstrength, and in manual dexterity. In contrast, no agedifference was observed in tip to tip pinch strength.Touchscreen operating skills were significantly lowerin the elderly, as reflected by the temporal measuresand reduced accuracy in the TATOO’s task perfor-mance. Interestingly, no age difference was observedin the “Pinch ability” task.Conclusion: Significant differences were found inhand function performance of the elderly when com-pared to adults as reflected by traditional assessmenttools and by TATOO’s outcomes. However, the age-related changes are restricted to pinch skill, as shownin the tip to tip pinch strength and the “Pinch ability”task in TATOO that showed no significant differencebetween the groups. TATOO demonstrated the poten-tial of becoming an important novel supplement to thehand function assessment toolbox to clinical profes-sionals treating the elderly in the modern world. Futurestudies with larger samples are warranted in order toestablish a normative dataset for the full characteriza-tion of hand performance while conducting a variety oftouchscreen manipulations.Keywords: Touchscreen Assessment Tool (TATOO),assessment; hand function, elderly.∗Corresponding author. E-mail: [email protected]

Mobile Health Game Development to MotivateWalking for Hematopoietic Stem Cell TransplantPatientsCecilia Sik-Lanyia,∗, Arpad Kelemenb, FerencRevesza, Csaba Simona, Shannon Cerbasc, Barbara

van De Castlec, Gergo Proszenyaka, Adrian Arvaia

and Yulan LiangbaDepartment of Electrial Engineering and InformationSystems, University of Pannonia, Egyetem u. 10, 8200Veszprem, HungarybUniversity of Maryland, Baltimore 655 W. LombardSt., Baltimore, MD 21201, USAcSidney Kimmel Comprehensive Cancer Center atJohns Hopkins Hospita1, 800 Orleans St, Baltimore,MD 21287, USA

Background: Fatigue is one of the most commonly re-ported symptoms for patients going through a hemat-opoietic stem cell transplant (HSCT) process. Physicalactivity (PA) has been shown to improve symptoms offatigue in HSCT patients. The National Comprehen-sive Cancer Network Clinical Practice Guidelines forCancer-Related Fatigue advise starting PA slowly andincrementally progressing with distance and time. Theuse of mobile device applications (apps) promoting fit-ness may be helpful in increasing PA. Our purpose isto develop a new fitness app called Walking Warrior(WW) for HSCT patients to be used as a step counterand a game.Method: A game inspired by Candy Crush was ideatedand designed as a matching puzzle game with theunique feature of walking to unlock new levels. TheWW game play screen includes 10 different tiles, 6displayed as a cell type, 2 as boosts, and 2 as blocksthat make game play more challenging. Cell types in-clude red blood cells, white blood cells, neutrophils,platelets, stem cells, and nerve cells. Each difficultylevel has limited number of “moves” a player can maketo reach the goal. Each level also has a different goalthat the player must reach to get to the next level. Thegame contains bonuses for more points and obstaclesfor added challenge and diversity in game play expe-rience. The step counter app tracks steps as the userwalks. When the player reached the required numberof steps, the game gives them one token and they cancontinue to play. We developed an admin page witha MySQL database and stored it on a server. Adminsand authorized users can check how many tokens theuser has and how many steps they made. Evaluatingthe usability of a game is an essential step in game de-sign and development. Usability of WW and the stepcounter was assessed by domain experts (4 in gamedevelopment and 1 in bone marrow transplant nurs-ing). We designed and validated an item-response ex-pert heuristic questionnaire survey/instrument with 40items for evaluating and assessing usability of WW for


HSCT patients. Each evaluator rated the questions 1–5,where: 1 = strongly disagree, 5 = strongly agree.Key results: Reliability analysis: Cronbach’s alpha =0.933, which indicates high reliability of the instru-ment. The findings from the heuristics questionnairesuggest that the game’s assets of clarity, ease of use,appropriateness, quality, motivation, and mental effortwere moderately favorable (> 3). Comments from ex-perts propose that the game is causally fun, suitable forthe target audience, and that the overall concept of thegame is good with high potential.Conclusion: WW could help many people who arefighting not just with cancer, but any disease, wherephysical activity is an important part of their recovery.Nonetheless, the treatment could be very exhaustingfor the patients. They must keep fighting as real war-riors. Moreover, the game can be used by anyone whoenjoys puzzle games or need motivation to walk.Keywords: Serious game, Mobile game, HSCT pa-tient, Physical activity, Motivation.∗Corresponding author. E-mail: [email protected]

Experience Level and Usability Evaluation whileUsing “TATOO”, a Touchscreen Assessment ToolAlexandra Danial-Saada,∗, Mattia Corzanib CarloTacconib and Lorenzo ChiaribaOccupational Therapy Department, Faculty of SocialWelfare and Health Sciences, University of Haifa &The Arab Academic College for Education in Israel,Haifa, IsraelbDepartment of Electrical, Electronic, and Informa-tion Engineering University of Bologna, Bologna, Italy

Background: Touchscreen devices are widely used inmodern life therapy sessions. A touchscreen assess-ment tool (TATOO) was developed by Daniel-Saad andChiari to provide valid and reliable data regarding finemotor skills while operating these devices. This toolfits individuals of different ages and varying abilities.TATOO consists so far of six tasks, each of which pro-vides information on a functional component requiredwhen using a touchscreen, such as a tap, swipe, pinch,drag, and so on. A numeric and graphic report summa-rizes the performance of each task includes temporaland Kinematic aspects, touch pressure and accuracy.TATOO was intended to be used by clinicians and byclients who are mostly without professional computerknowledge. For that reason, testing its usability is ofparamount importance to predict the user’s acceptance

or rejection of the device and the degree of internalmotivation to use it.This paper reports a study that evaluated the usabilityof TATOO by both children with typical developmentand by clinicians. Furthermore, this paper shows thecorrelation between children’s usability feedback andtheir level of experience to use touchscreen devices andalso, the correlation between children’s usability feed-back and clinician’s usability scores.Method: Ten clinicians and 60 typical developmentchildren aged 4–10 have used this system in order toassess the usability of the tool. Clinicians were in-vited to the University of Haifa and given a three-hourpresentation introducing TATOO and how to use it.Each of the clinicians was asked to assess six childrenusing the TATOO application. After using TATOO,children evaluated their experience through the Short-Feedback-Questionnaire-Child (SFQ-Child), in whichemoticons are used to describe the experienced levelof difficulty. Usability Evaluation Questionnaire (SUS)and Semi-structured Interview were finally given tothe clinicians. A demographic questionnaire was de-veloped to gather data about the users.Key results: The SFQ-Child questionnaire reachedvery high indices of pleasure (SFQ = 4.8 of 5 ± 0.49),comfort (SFQ = 4.65 of 5 ± 0.92), the sense of success(SFQ = 4.9 of 5 ± 0.53), and ease of use (SFQ = 4.7 of5 ± 0.38). Clinicians rated TATOO’s usability as “verygood” (SUS = 85.5 ± 8.04, range = 70–97.5), whichreflected their satisfaction with the system’s usability.We found no correlation between the clinician usabil-ity scores and the SFQ-Child, which means that theclinician usability did not affect the children’s expe-rience. Furthermore, there is no correlation betweenSFQ-Child and the variable “experience using tabletor smartphone” in the demographic questions, whichmeans that children’s experience did not affect their us-ability feedback.Conclusion: TATOO will complement the 21st-century assessment needs, where the traditional finemotor assessment tools are not able to capture the skillsnecessary to operate a touch screen device. The pos-itive usability responses indicate that the new appli-cation has user-friendly characteristics and will likelyhave a successful use among the end users. Future stud-ies with larger samples in different ages and with vary-ing abilities are needed in order to update a new ver-sion with the universal design method.Keywords: Touchscreen Assessment Tool (TATOO),Usability Evaluation, Short-Feedback-Questionnaire-Child.



A Walking Assist Robot Which makes the PelvisMove More Easily and Assists in WalkingMasataka Ootania, Atsushi Nakaharaa, HiroshiTsutsuia, Kenji Yamadab, Jun Kuriharac and YukioHondaa,∗aRobotics Department, Osaka Institute of Technology,1-45, Chayamachi, Kita-ku, Osaka, 530-8568, JapanbDepartment of Electrical Systems Engineering, Hi-roshima Institute of Technology, 2-1-1 Miyake, Saeki-ku, Hiroshima 731-5193,JapancThe Canon Institute for Global Studies, 1-5-1Marunouchi,Chiyoda-ku,100-6511 Tokyo, Japan

Background: One of the problems of the aged soci-ety is an increase in elderly people who have weak-ened muscle power. The most effective exercise ther-apy to counter physical frailty is walking accompaniedby aerobic exercise. The walking assist robot in this re-search is designed not to rehabilitate frailty but to mit-igate frailty for those elders who can walk by them-selves. In other words, this walking assist robot doesnot improve the muscular strength of the leg, but is arobot that enables the person to walk faster.Method: Our idea is that the walking assist robot canmake the pelvis rotate more smoothly and to stimu-late the sacrum which in turn enables a faster walkingwith a longer stride. Since the sacrum is located in thecenter of gravity in the human body, the robot makesit easier to rotate the pelvis by stimulating the rightand left of the sacrum alternately according to the tim-ing of the swing of the legs. The walking assist robotis composed of a pushing mechanism to stimulate thesacrum having one motor. When the pre swing stageof the lower limb is detected by the acceleration sen-sor attached to the thigh, a pushing stimulus is givento the right and left of the sacrum. The walking exper-iment was carried out in an 11 m length walking pathby using a motion capture camera. We also conducteda SUS (System Usability Scale) questionnaire after theexperiments. For this preliminary study, five healthymale student subjects were selected and measurementswere done under the approval of the ethics committeeof Osaka Institute of Technology.Key results: Among the three prospective distances,i.e. 5 mm, 10 mm, and 15 mm, the best result was ob-tained in the case of the 15 mm distance. The high-est performance for the timing of stimulation was ob-

served at a time when the motor drive started stimu-lating while the leg was between pre swing and mid-dle swing. As a result of the measurements using themotion capture, by increasing the extrusion amount ofpressing stimulus, 3 of 5 showed an increase in walkingspeed, stride, pelvic rotation angle and the hip joint ro-tation angle. In the SUS questionnaire result of 6 items,the average was 59.5 points, which presents a problemconcerning the complexity of the device.Conclusion: It was our intention to develop a walkingassist robot which would make the pelvis move moreeasily and assist people in walking. This robot will as-sist a person to walk more quickly using his or her ownmuscular strength without changing the strength of theperson’s own muscles. We believe we have introduceda novel means of improving pelvic rotation by pushingstimulation of the sacrum. As a result of preliminaryexperiments using healthy subjects, we hope that theeffectiveness of this walking assist robot will lessen theeffect of physical frailty for people in the aging popu-lation.Keywords: Walking assist, Sarcopenia, Locomotivesyndrome, Rotation of the Pelvis, Stimulating thesacrum∗Corresponding author. E-mail: [email protected]

VIVO-Rehab: Coupling Humanoid Robots withMotion Sensing Devices to Support Upper LimbFunction Assessment of Children with Spinal Mus-cular Atrophy (SMA)Chiara Leporea, Lisa Cesarioa, MassimilianoMalavasia, Elisabetta Dondia, Lorenzo Desideria,∗,Annarosa Colonnab and Antonella CersosimobaAIAS Bologna onlus, Piazza della Pace, Piazza dellaPace 4/A, 40134 Bologna, ItalybMEDICINA RIABILITATIVA INFANTILE IRCCS –Istituto delle Scienze Neurologiche di Bologna, ViaSant’Isaia 90, 40123, Bologna, Italy

Background: Emerging off-the-shelf technologiessuch as motion sensing input devices and social robotsare increasingly used as assistive technologies (AT) notonly to compensate for people’s disabilities, but also tosupport health professionals in their daily activities inorder to develop more enjoyable rehabilitation scenar-ios. In this contribution we report on the developmentof VIVO-Rehab, a platform for the supervision, moni-toring, assistance and rehabilitation of users from theirhomes. VIVO-Rehab was pilot-tested involving threechildren with Spinal Muscular Atrophy (SMA) to doc-


ument the applicability of the platform in the evalua-tion of children’s upper limb functions.Method: VIVO-Rehab was designed to monitor pre-established parameters such as the analysis of move-ment for rehabilitation through the control of kine-matic, dynamic and other physiological signals. Thesystem integrates the Kinect device by Microsoft forMotion Capture and the humanoid robot NAO by Soft-bank Robotics. The NAO robot was used to instructand demonstrate exercises. In this view, a set of pre-defined upper-limb movements was developed in col-laboration with rehabilitation professionals involvingelbow and shoulder joint movements. The set of upper-limb movements was then pilot tested with three chil-dren with SMA3 and SMA2 who were asked to per-form movements shown by the Nao robot. Duringchild-robot interactions, the Kinect recorded the dataof the 25 joints. Subsequently these data were imple-mented in a Matlab program that allows the visualiza-tion of joints and segments during movement and al-lows the extraction of some parameters such as speed,acceleration and angles.Key results: Observational results from the pilot studyshow that the use of Nao robot allows a greater interac-tion with children. Furthermore, the use of the Kinectallows to obtain good performances for the MotionCapture and with the Matlab program it was possible toperform both motion evaluations and the comparisonbetween the movements.Conclusion: This system can be applied both in thehome and in the outpatient setting to perform contin-uous evaluations over time and monitor the improve-ment or deterioration of patients’ movements. Futureprospects see these devices implemented at home, use-ful for greater monitoring or home rehabilitation, sothat they can easily see the results of the exercises per-formed or the correctness of the movements.Keywords: movement detection, SMA, rehabilitation∗Corresponding author. E-mail: [email protected]

Socially Assistive Robots Influence for Elderly withCognitive Impairment Living in Nursing Facilities:Micro Observation and AnalysisToshiharu Igarashia, Misato Niheia,b,∗, MioNakamurab, Kazuko Obayashic,d,e, ShigeruMasuyamad,f and Minoru Kamataa,baDepartment of Human and Engineered Environmen-tal Studies, The University of Tokyo, 5-1-5 Kashi-wanoha, Kashiwa, Chiba, Japan

bInstitute of Gerontology, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba, JapancSocial Welfare Corporation Tokyo Seishin-kai, 2-16-25, Mukoudaicho, Nishitokyo, Tokyo, JapandUniversal Accessibility Evaluation Organization, 2-24-28, Hyakunincho, Shinjyuku, Tokyo, JapaneFaculty of Healthcare Management, Nihon FukushiUniversity, Mihama, Chitagun, Aichi JapanfTravellers Medical Center, Tokyo Medical University,6-7-1 Nishishinjyuku, Shinjyuku, Tokyo, Japan

Background: In recent times, the lifestyle of the el-derly in Japan has changed considerably. While previ-ously two or three households lived together, in gen-eral, now there is an increase in the number of lonelyand elderly couple households. Furthermore, accord-ing to a Japanese government report, the number of el-derly people with dementia, which was 4.62 million in2012, is estimated to increase to 7.3 million by 2025. Inthis social context, using assistive technology to sup-port the lives of the elderly can help them become moreindependent.Method: Therefore, to observe and analyze the influ-ence of social assistive robots on elderly people andnursing workers in a nursing care facility, a long-termintervention experiment was conducted from February5 to February 25, 2018 (35 days), on ten elderly per-sons. The subjects’ ages ranged from 81 to 97 years(Mean = 89.4, SD = 4.81). All the subjects (one male,nine female) could express their willingness to partic-ipate in the study, including those with mild cognitiveimpairment.Key results: The findings showed that the number ofdialogues and dialogue time vary depending on theircognitive function. While the average intervention was6.4 the 1st week, 13.0 the 2nd week, and 17.0 the 3rdweek in the group whose CDR <

= 1, the average inter-vention was 2.6, 7.2, and 12.8 in the 1st, 2nd, and 3rdweek, respectively, in the group with CDR >

= 2. Therewere significant differences between the two groups(p < 0.05). However, the average number of dialoguetimes increased gradually in both groups in the inter-vention period. Also, in the conversation content anal-ysis, it was found that the group with CDR <

= 1 usedmore different kinds of words than the group with CDR>= 2. In addition, the average interaction time was 439.4sec / week for the group with CDR <

= 1, whereas it was148.6 sec/week for the group with CDR >

= 2. There wasa significant difference between the two (p < 0.05).However, in the group with CDR <

= 1, the average dailyconversation time/week was almost the same, whereasit gradually increased in the group with CDR >

= 2.


Conclusion: This could be attributed to the soundquality, pitch, and information presentation method ofassistive robots using synthesized speech, making itdifficult for them to be understood by elderly peoplewith cognitive impairment. Therefore, correlating thefrequency of artificial speech voice and degree of com-prehension and cognitive levels is a future researchsubject.Keywords: Socially assistive robots, Assistive tech-nology, Elderly care, Human Computer Interaction,Sota,.Acknowledgement: This research was supported byAMED (Agency for Medical Research and Develop-ment). This research was approved by the ResearchEthics Committee of the University of Tokyo and So-cial Welfare Corporation Tokyo Seishin-kai.∗Corresponding author. E-mail: [email protected]

A Trial of a Communication Robot at Home for El-derly Living Alone Using Data from a telephone callbeginning with “How Are You?”Satoshi Tsujikawaa, Kazuhira Akamatsub, HiromitsuYokoyamab, Jun Kuriharac and Yukio Hondab,∗aTsujikawa ENT Clinic, 40-8 Ebata-cho, Kadoma,571-0012 Osaka, JapanbOsaka Institute of Technology, 1-45 Chayamachi,Kita-ku, 530-8568 Osaka, JapancThe Canon Institute for Global Studies, 1-5-1Marunouchi, Chiyoda-ku, 100-6511 Tokyo, Japan

Background: The declining birthrate and longevityhave become pressing issues in various countries in-cluding Japan. Effective sharing of health informa-tion regarding healthy elderly living alone is expectedto extend healthy longevity by their own preventivehealth management, leading to significant improve-ment of the sustainability of health and economicalsystems. We have made calls with 168 elderly livingalone for 8 years at regular intervals and collected theinformation which could be of use (CALL data), andsupported them by sharing the information. To con-tinue this activity, we planned a communication robotwith the Question-Answer-Response format(QAR) viabuttons. The aim of this study is to determine whetherthe robot can communicate with elderly people withfixed QAR without using the pattern matching technol-ogy.Method: Using CALL data, the subjects to be dis-cussed after many conversations was narrowed down

to 30 items and 979 QAR were made and classifiedinto three categories, namely, mundane topics (366QAR), physical topics (291 QAR) and mental top-ics (322 QAR). We adopted a push button answer-ing system for elders with feeble verbal communica-tion due to aging and/or disease. These questions in-clude ones related to day-to-day life as mundane top-ics, e.g. “How are you?”, being asked at first, andthen, problems associated with physical and/or men-tal topics, if any. Topics that they hoped for were in-vestigated by repeated inquiries via buttons and there-upon advice could be provided. We conducted thistwo-way communication with general mundane is-sues at first, and then with specific ones by repeat-ing QAR. Since the Profile of Mood States 2nd Edi-tion and Short Form is used worldwide to estimate thepsychological condition, our experiment is evaluatedusing POMS2-Adult Short. 13 participants (Averageage:79.3) of elderly living alone (9/13 were targetedfor “How are you?” calls) and tried the robot at homeon a one-to-two-month interval, and the abovemen-tioned information was examined to evaluate psycho-logical effects in pre- and post-trial, and the willing-ness to possibly extend at the end of the examination.Tension-Anxiety (TA), Depression-Dejection (DD),Anger-Hostility (AH), Vigor-Activity (VA), Fatigue-Inertia(FI) and Confusion-Bewilderment(CB) weremeasured before and after the experiment. The rate ofthe improvement of the mood status was performed us-ing paired t-study by TMD (Total Mood Disturbance(TA + DD + AH + FI + CB) – VA). Furthermore,their intention to extend use was investigated at the endof the experiment.Key results: 13 participants showed statistically sig-nificant improvement in mood status during the exper-iment and 9 participants wanted an extention of thetrial period. Furthermore, 13 participants were dividedinto two groups on the basis of the mean value of totalTMD percent improvements: good improvement group(7 participants) and insufficient group (6 participants).The average age (Mean ± SD:83.3 ± 3.9) in the GoodGroup was significantly older compared with that ofthe insufficient Group (Mean ± SD: 75.2 ± 3.9).Conclusion: The past eight years of our experimenthave demonstrated that we can clearly identify the con-dition of the elderly living alone by asking only thirtyquestions with the help of our experimental communi-cation robots.Keywords: Communication Robot, Elderly LivingAlone, Q&A Format, Chatbot, Tele-counseling data-base∗Corresponding author. E-mail: [email protected]


Part 7: Education, Learning and IntellectualDisability

Recommendations for Using Assistive Technologiesfor Inclusive Media Education in KindergartensSaša Stepanovica,∗, Veselin Medenicaa, Ivana Ristica

and Lidija IvanovicaaDeparment of Occupational Therapy, The College ofSocial Work, Terazije 34, Belgrade, Serbia

Background: The role of assistive technologies (AT)in inclusive media education is a rarely discussed topicbecause it is considered that the use of ATs in kinder-garten is premature. The potential of digital media forthe participation of children with disabilities is big, butthere is no data on how to use ATs and the media insuch a way as to increase accessibility for children withdisabilities in kindergarten. Therefore, we aim to iden-tify issues of accessibility of content according to the‘Doing Disability Concept’, to identify ways in whichidentified problems can be solved using ATs and ul-timately to give recommendation for use of ATs inkindergartens to solve identified problems.Method: A team of 3 experts, working with childrenin a kindergarten has been formed. It was composed bythe teacher, special educator, occupational therapist inorder to create recommendations for the creation anduse of ATs in the kindergarten. In Phase 1, team had todefine problems of accessibility to the content/ activi-ties. Seventy-two papers were reviewed, using the Do-ing Disability Checklist, for recording identified prob-lems. In Phase 2, it was necessary to review paperswhich explains the ways in which the ATs solve theproblems identified in Phase 1. Of the 92 papers re-viewed, 7 were identified that meet the above criterion.Based on the review, the experts completed a list ofrecommendations for use of AT in inclusive media ed-ucation in kindergartens.Key results: In Phase 1 problems of accessibility ofcontent are identified as: non-use or lack of adequatetechnologies to ensure accessibility; inadequate designof existing technologies used and digital divide; lack

of IT education for teachers; lack of practical ways forinclusion; lack of motivation for children with disabil-ities to get involved; rejection by the peers. The re-sults of Phase 2. indicated the positive role of ATs inaddressing the identified problems: 1. Impact on themotivation of the child for participation; 2. Compen-sation of developmental difficulties facilitates the in-clusion and prevention of digital divide; 3. Training isusually included when ATs are provided, which makesthe problem of lack of teachers education solved.Conclusion: Recommendations have been made forthe use of ATs in kindergartens: Pedagogical staffshould be technologically literate; When selectingATs, make sure that all children can be involved in in-teraction through technology not only those with dis-abilities; Choose ATs which stimulate attention andchild’s play; AT should play a role in stimulating thedevelopment of skills, not only compensation; If tech-nologies and media are not adapted for all children,make sure to use ATs or do not use technology at all.Include children in the design process of new ATs.Keywords: Assistive Technology, Kindergarten, In-clusive Education.∗Corresponding author. E-mail: [email protected]

Creating Appropriate Instuctional Applications forUsers with Intellectual DisabilityMarian McDonnell∗ and Irene ConnollyDepartment of Technology and Psychology, Instituteof Art, Design and Technology, Kill Avenue, DunLaoghaire, Co. Dublin, Ireland

Background: Despite the abundance of literature inthe area of human-computer interaction (HCI), there islimited HCI research about users with intellectual dis-ability (ID).This research project evaluates Let’s StopBullying, an eLearning application in development at


S156 Part 7: Education, Learning and Intellectual Disability

the Institute of Art, Design and Technology, Dublin,Ireland. This application aims to educate young adultswith mild to moderate intellectual disability about bul-lying and cyberbullying. Cyberbullying is bullying,when perpetrated through technology.Understandingour participants’ needs and observing their interaction,within a user-centred approach, this evaluation of aweb-based instructional application informed the it-erative process of development of an appropriate in-structional resource intervention to educate users withID. The aim was to design an accessible and user-friendly instructional resource to empower and edu-cate about bullying and cyberbullying. Using audio,picture-based interventions, game-based learning andscripts, this study explores the level of user engage-ment with the application and the preferred method oflearning for participants with ID.Method: Purposive sampling was used to recruit par-ticipants of unspecified levels of ID. Recruitment wasobtained in accordance with ethical standards of thePsychological Society of Ireland (PSI). Inclusion cri-teria specified an ability to communicate verbally andbeing over 18 years of age. These criteria were estab-lished due to lack of additional support from a speechand language therapist. Between five to eight userswith ID have been suggested to identify up to 80% ofinterface problems. However, twenty-two individualswith mild to moderate intellectual disability took partin our focus groups and laboratory sessions over a threeweek period. Seven tasks were created to explore theapplication, with progressing difficulty to accommo-date levels of ability through four modes of learning(game, video, audio, reading). The evaluation inves-tigated preferred learning modes and engagement forthis user group. The study employed a mixed-methodsdesign including observational and inquiry methods ofusability evaluation.Key results: The 22 participants (9 = male, 13 = fe-male), who took part in the study, were ranging in agefrom 19–34 years (M = 22, SD = 3.72). Their use ofcomputers included smartphone, iPad, laptop and PC.Students indicated using the computer everyday (n =14), once a week (n = 7), or once a month (n =1). All participants indicated using a computer (n =22) with varying frequency summarised below. Partic-ipants reported using the applications Snapchat, Face-book, WhatsApp, Skype, and Facetime. Of those thatuse Facebook (n = 12), 75% found it easy to remem-ber their password (n = 9). Adapted System UsabilityScale(SUS) self- report measures indicated that partic-ipants liked the Let’s Stop Bullying application. The

listening activity was the preferred learning modality,followed closely by the game activity. Indications arethat participants would like to see more games andvideos with people in the application. Observationalanalysis identified occurrences of positive and nega-tive emotional engagement. Results revealed more pos-itive emotional responses than negative emotional re-sponses.Conclusion: There is a lack of suitable instructionalapplications for users with ID. Understanding users’identified preferences informs the process of develop-ment to bridge this ditgital divide. This helps to createappropriate instructional interventions with value forusers with ID, engaging them with educational tech-nology.Keywords: Intellectual Disability, Instructional Tech-nology, Cyberbullying, Usability, User Engagement.∗Corresponding author. E-mail: [email protected]

The Contribution of iMovie Editing to ImproveStorytelling Skills of a Student with Deafness andADHDAvigail Provisora,∗ and Betty ShrieberbaM.Ed program in Educational Technology, KibbutzimCollege, Tel-Aviv, IsraelbProgram Director M.Ed program in EducationalTechnology, Kibbutzim College, Tel-Aviv, Israel

Background: This case study examined the contribu-tion of video modeling and processing it, via iMovieediting, to promote planning and organizational skillsin storytelling, of a student with deafness with At-tention Deficit Hyperactive Disorder (ADHD), whiledescribing his own personal experience in Sign Lan-guage. Deaf and Hard of Hearing (DHH) students withADHD show lower test scores in assignments that re-quire maximum utilization of executive skills, for ex-ample telling a personal story (Cannizzaro & Coelho,2013).In the past few years, researchers have been increas-ingly interested in the ability of DHH students to ex-press their narrative. It has been found that studentswith deafness show lesser ability than their hearingpeers in the structural aspect of the narrative discourse.Sometimes the difficulty stems from the differencesbetween sign language and written language (Rath-mann, Mann & Morgan, 2007).Method: Manny is a deaf student with attention deficitdisorder who studies in a special needs school. Dur-


ing a composition lesson, Manny was required to sharehis personal experiences with his classmates. This taskwas very difficult for him and his stories lacked in se-quence. The rest of the students found it difficult to un-derstand him and as a result their attention level de-creased. When Manny noticed this, he would give upand return to his place. This affected his sense of com-petence and the level of participation in the lesson.A qualitative approach to a case study was conducted.An intervention program was developed that integratesvideo modeling and video processing using the iMovieapplication. According to this method, Manny watchedhis video telling an experience story, then edited thevideo and finally watched it again so that he can learnwhat a correct narrative scheme is.Key results: The findings show that the video Model-ing served as a mirror for the student and reflected onhis conduct during storytelling of his personal experi-ence, to his classmates. In addition, as a result of theediting process, the student internalized the narrativescheme while maintains a temporal sequence and usingconnecters in a correct order. The processes indicatesimpressive progress of the student’s of executive con-trol of information and to his ability to initiate the edit-ing process without the teacher mediation. In additioniMovie was found as an intuitive app for the student. Itenabled him to implement the editing technique easily,thus facilitating the learning process of the narrativeschema.The findings did not show the contribution tothe student’s planning and flexibility skills, nor to theextension of his attention range.Conclusion: Children with deafness usually rely ontheir sight in order to absorb various experiences andinformation. Thus, watching his video before and afterthe editing process helped Manny to see easily wherehis difficulties lay and facilitated the learning process.Moreover, it helped him correct easily his errors, im-proving his control skill while internalizing the narra-tive schema. There is still a need for continuing prac-tice in order to enhance the level of the story that isbeing told.Keywords: Executive functions, Video modeling,Imovie, Storytelling, Deaf and Hard-of-Hearing peo-ple (DHH).∗Corresponding author. E-mail: [email protected]; [email protected]

Observation of HandiMathKey AppropriationPhase by Disabled Students in a Middle SchoolFrédéric Vellaa,∗, Nathalie Dubusb, Christine Gallardb,

Cécile Maletb, Véronique Adesb and NadineVigourouxaaIRIT, UMR CNRS 5505, Paul Sabatier University, 118Route de Narbonne, 31062 Toulouse Cedex 9, FrancebASEI, Jean Lagarde center, 1 Avenue Tolosane, 31520Ramonville-Saint-Agne, France

Background: The mathematical input in text editorsby disabled students is demanding both at the func-tional level (motor disorder) and at the cognitive level(attention, visual-spatial, memory) and generates fati-gability little productive and effective gain. To re-duce these demands, HandiMathKey, a mathematicalkeyboard software was designed by applying a user-centered method. The aim of paper is to report howdifferent disabled students have appropriated Handi-MathKey in a middle school by an observation carriedout by a multidisciplinary team. The hypothesis is thatHandiMathKey can be learned and used by all studentswith disabilities.Method: A team (one mathematics teacher, one oc-cupational therapy and one specialized education as-sistant) leads an interdisciplinary workshop to observehow the students accept and use HandiMathKey. Thisfield study has started since September 2018 at theJean Lagarde rehabilitation and education Center.TheHandiMathKey was proposed to 23 students (19 withhand motor impairment, 3 with visual impairment and1 other with dyspraxic and dysgraphic disorders) inthree classrooms of middle school. Two classrooms usethe HandiMathKey with the Microsoft Office editor,the third with the one Libre Office. Every three weeksfor each class, a workshop takes place during the classtime: the teacher introduces the HandiMathKey fea-tures corresponding to the mathematical concepts be-ing taught; then the students are invited to do mathe-matical exercises and the occupational therapist mayassist them in getting to grips with the HandiMathKey.During the workshop two types of data are recorded: 1)notes of teacher and occupational therapist within re-flection diary; 2) activity log of the use of HandiMath-Key. After five workshop sessions the students are in-vited to reply to answer a SUS (System Usability Scalequestionnaire).Key results: This study confirms the interest of hav-ing a multidisciplinary team for observation and as-sistance in the appropriation phase of HandiMatHKey.We report the five observations of 9 students with mo-tor impairment. The students were all volunteers butduring these workshops they did not seen the imme-diate interest of HandiMathKey. The students appro-


priate HandiMathKey due to the interface affordance.However, there is a need to learn how to use the Libre-Office text editor. The typing with HandiMathKey andLibreOffice is similar to reading the mathematical for-mula, which makes it more affordable for students withplanning and visual-spatial difficulties. As the sessionsprogressed there is a greater participation of students.Conclusion: This field study shows that the appropri-ation phase of HandiMathey is necessary for studentsto agree to use it as an assistive technology. Anotherperspective is to analyze the typing speed and the errorrate.Keywords: Mathematical Virtual Keyboard, Accept-ability, disabled students, observation, education.∗Corresponding author. E-mail: [email protected]

Digital Assistive Technology Education and Train-ingAnnalu Waller∗

Computing, School of Science & Engineering, Univer-sity of Dundee, Perth Road, Dundee DD1 4HN, Scot-land, UK

Background: Assistive Technology (AT) is, by its na-ture, interdisciplinary. However, education and train-ing in AT is usually delivered within specialist pro-grammes, e.g., in occupational therapy where AT is in-trinsic to the delivery of services which aim to supportindependence and inclusion of persons with disabili-ties. With the increase in digital AT, there is a needto equip a wider range of professionals with knowl-edge and skills to ensure effective use of such tech-nology. Training in digital AT and accessibility hasbeen embedded into both mainstream undergraduateand taught postgraduate degree programmes in Com-puter Science at Dundee University. This study wasconducted to identify the range and focus of AT train-ing as reported in the literature, compared to that beingoffered in Dundee.Method: A high sensitivity literature review was con-ducted to identify the nature and delivery of AT train-ing. The Web of Science bibliographic database wasused to identify published outputs using the terms: (as-sistive technology) AND (teaching OR learning OReducation OR training OR instruction OR “profes-sional development”). A total of 1,504 papers were re-turned. Examination of the paper titles revealed a focuson the teaching or instruction of users instead of pro-fessional education and training. The search was thusrefined by using the following terms: (assistive tech-

nology) AND (education OR “professional develop-ment”). On inspection, 32 papers describing a range ofAT education and training.Key results: The papers described a range of edu-cation and training of AT. Some programmes werespecifically designed to provide training to a multi-disciplinary cohort of students at post-graduate level.Such programmes tended to be Biomedical with ATas a component, while some have focused specificallyon AT, equipping students from both a technical and aclinical background to develop skills in the assessmentand provision of AT. Training and awareness of ATwas also provided within specialist professional train-ing, e.g., teacher training and occupational therapy, al-though there is evidence that special educational teach-ers and therapists lack sufficient exposure to AT.Conclusion: Most AT training and accreditation havea medical and healthcare focus. This may be appro-priate for traditional AT which is dependent on bio-mechanical and electronic engineers to provide accessto mobility (wheelchairs, prostheses, etc.) and aids fordaily living (hoists, kitchen appliances, etc.). However,computer science and software engineering are nowat the forefront of developing inclusive and accessi-ble technology. Accessible mainstream computing anddigital AT have the potential to enable people withcomplex physical and/or intellectual disabilities to ac-cess a wide range of activities including communica-tion, education, employment and recreation. In order toensure that the “digital economy” does not result in anever increasing “digital divide”, digital AT and acces-sibility must be embedded into mainstream softwareengineering curricula. It can be argued that instead ofviewing accessibility as an ‘optional extra’, this area oftechnological design and application should be embed-ded into mainstream degree programmes, thus equip-ping software engineers to meet the needs of any in-dividual, recognizing the natural diversity in all soci-eties.Keywords: Accessibility, Assistive Technology, Aug-mentative and Alternative Communication, Digital As-sistive Technology, Higher Education, Training.∗Corresponding author. E-mail: [email protected]

A special Needs Course in Undergraduate HealthProfessions: An Evaluation Using Mixed MethodsJoaquim Alvarelhãoa, Alexandra Queirósa, MargaridaCerqueirab, Anabela G. Silvab and Nelson P. Rochac,∗aSchool of Health Sciences, IEETA, University of


Aveiro, Campo Universitário de Santiago, 3810-193Aveiro, PortugalbSchool of Health Sciences, CINTESIS, University ofAveiro, Campo Universitário de Santiago, 3810-193Aveiro, PortugalcDepartment of Medical Sciences, IEETA, Universityof Aveiro, Campo Universitário de Santiago, 3810-193Aveiro, Portugal

Background: Assistive technology as a strategy to im-prove functioning of persons with disability is com-monly accepted as of high value. It is an area where dif-ferent professional specialties converge (e.g. engineer-ing and health), but the theme has a narrow presencein academic syllabus among graduation programs. De-spite the impact of this strategy on the level of partici-pation for people with disabilities, the fact is that healthprofessionals still demonstrate a lack of positive atti-tude towards assistive technology and a lack of trainingfor its counseling or prescription. The aim of this studywas to evaluate the impact of the Special Needs Course(driven for assistive technology) in undergraduate stu-dents from the School of Health Sciences - Universityof Aveiro, Portugal. This course if framed by the Inter-national Classification of Functioning, Disability andHealth (ICF) conceptual model.Method: Sequential mixed methods were used basedon the first three levels of Kirkpatrick Model of Train-ing Evaluation. From the nursing graduation program,32 students (26 female) and aged between 18 and 24years participated in the first two levels of the study.For the third level four health professionals were re-cruited (three female), aged between 28 and 32 yearsand with more than five years of experience, who hadattended the course during graduation. Concerning thefirst level of the Kirkpatrick Model (‘Reaction’), theresults from the questionnaire (comprising eight items;1–9 likert scale, 9 = higher quality) used in QualityManagement System of University of Aveiro were an-alyzed. The second level (‘Learning’) achieved by stu-dents was assessed using the pre- (day 1) and post-training (last session) test, containing five questions onthe content addressed and five questions on contentsnot addressed but related to the theme. Finally, the thirdlevel (‘Behavior’) was assessed through a focus group.Data analysis included descriptive and inference statis-tics for the first two levels and content analysis for thethird level.Key results: The global median for ‘Reaction’ wasMed = 7 (IQ1–IQ3 = [6.5–7.5]), with the highest val-ues found in question about ‘availability of study mate-

rials’ and lower values found in ‘articulation betweenthe activities developed and the previous competences.The repeated Anova measures show a significant ef-fect for the difference between pre- and post-trainingin addressed questions when compared with the dif-ference for not addressed questions (F(1,31) = 6.4,p < 0.05). Focus group revealed: (i) the content of thecourse is considered important for those that work withpersons with disabilities or elderly persons in commu-nity but less for those who work on hospital settings;(ii) ICF approach improves clinical reasoning for ‘en-abling’ but professional contexts still show reluctancein adopting it as a framework for practice; (iii) a mul-tidisciplinary approach should be implemented duringpractical classes.Conclusion: The Special Needs Course is an appliedmodel for integrating assistive technology in healthprofessionals’ education. Although the students reveala lack of previous experiences in approaching thesethemes, the results suggest a good adherence and learn-ing of the content addressed. The real impact of thiscourse on professional competencies and consequentlyon health interventions should continue to be deep-ened.Keywords: Special needs course, Graduation pro-gram, Assistive technology, ICF.∗Corresponding author. E-mail: [email protected]

The Impact of Using Learning Apps on ExecutiveFunctions: Task Initiation and Persistence of Stu-dents with Attention and Learning DisorderBetty ShrieberProgram Director of M.Ed program in EducationalTechnology at Kibbutzim College of Education, Tech-nology and the Arts, Tel-Aviv, Israel

Background: The presentation will describe sevenstudies that have been examining the impact of usinglearning apps: iPad apps and learning software, to en-hance executive functions: task initiation and persis-tence among students with ADHD (Attention DeficitHyperactive Disorder), SLD (Specific Learning Disor-ders), and challenging behavior students, characterizedwith difficulties in emotional regulation.Initiation and completion of academic tasks pose themost common difficulties for pupils with learning dif-ficulties. Task initiation is defined as the ability to in-dependently begin a task when someone wants or isinstructed to do so (Anderson, 2002; Gioia, Isquith,& Guy, 2015). Task persistence or sustained attention


refers to continuous performance of a task without dis-traction in order to complete the task (Barkely, 1997).Difficulties in sustaining working memory have a neg-ative impact on one’s ability to remain attentive and fo-cused for appropriate lengths of time (Isquith, Gioia,Guy, Kenworthy & Staff, 2008).Method: Seven single-subject research design wereused for this study. An ABAB design, with a with-drawal between Phase B1 and Phase A2, was imple-mented (Cooper, Heron, & Hewar, 2007; Kennedy,2005).Subjects span a range of backgrounds, including age,school, and different learning disorders: ADHD, chal-lenging behavior students and students with SLD. Eachindividual is separately exposed to a series of lessonsunder controlled conditions (baseline) and a seriesof lessons under experimental conditions (interven-tion). The data provide a framework for describing thechanges in the use of single-subject designs for eachstudent.Phase A was used to establish a baseline and to mon-itor the use of traditional materials, while during theintervention phase (B), teachers used a portable com-puter or iPad with learning apps, including camera anddynamic interactive games.Key results: The graphed data indicated a clear differ-ence between Phases A and B across all participantsand across all variables. The means showed similaritieswithin phases and a clear difference between Phases Aand B.The visual examination results suggest a decrease av-erage of time response to the assignments (Task ini-tiation) along with reducing the average number ofbreaks during the intervention phase (task persistence),when use a laptop or iPad with learning apps. Also, thechanges in levels for all studies occurred immediatelyafter the change in phases. Phase B2 level show sta-bility in the graph variation and/or data reduce, for allparticipants.Conclusion: Children with ADHD, SLD, and chal-lenging behavior, have hard time to initiate tasksand keep attention persistence during learning assign-ments. The study indicates that using learning apps al-lows these students to engage their assignments andextends the duration of attention throughout the task.Using learning apps along with assistive technology,helps raise children interest in learning, provides in-stant feedback, and increases the students’ accessibil-ity (as with reading software) to challenging material.When students succeed to accomplish tasks as a resultof their hard work, they feel empowered as they rec-

ognize that their persistence will lead to improved aca-demic performance (Meltzer, Dunstan-Brewer & Kr-ishnan, 2018).Keywords: Specific Learning Disorders, Executivefunctions, (Learning apps), (Task initiation).∗Corresponding author. E-mail: [email protected]

“ADAPEI transport”: A Learning and NavigationApp for Young Adults with Intellectual Disabilitiesto Improve their Autonomy to Take Public Trans-portJesus Zegarra Floresa,∗, Gaëlle Malnatib, Jean-Jacq-ues Stevensb, Nadia Laaysselb, Gilbert Genevièveb,Jean-Baptiste de Vaucressonb, Remi Coutantb andJean Pierre RadouxaaMedic@, Département de recherche d’Altran, Parcd’Innovation, Boulevard Sébastien Brandt, Bât Gauss,CS 20143, 67404 Illkirch, FrancebADAPEI du Territoire de Belfort, 11 route de Phaf-fans, Roppe 90380, France

Background: This project is done in collaboration be-tween Altran and ADAPEI from Belfort (associationfor helping young adults with intellectual disabilities).Problems can happen to disabled young adults whenthey want to go from a departure point to the final pointtaking the public transport because of the complexityof the transport network. The aim of our work is to de-velop a learning and navigation app to improve theirautonomy for taking public transport with a menu tosave paths and another to navigate. In the state of theart, an adapted navigation app called Way2B has beenfound.Method: Our app has been developed in an Androidsystem. To create a path, all the peripheries of thePhone have been used: for example, the camera to takea photo from every landmark, the microphone to recordthe actions to do, the keyboard for typing the actions todo. Pictograms associated to the actions, the line, nameand time schedules of the bus can also be added. GPScoordinates are also saved in every landmark. Whilesaving the path, GPS coordinates are also recorded ev-ery second. This information is used to visualize se-quentially, in a map the path done with the waypoints.Three main functions based on data fusion have beenprogrammed to help the children:

– To prevent the child to press on the stop button inthe bus


– To indicate the direction to take when they get offfrom the bus.

– To anticipate the change of directions in pedestriannavigation.

Tests were done with specialists who used the app forthe first time to record 2 adapted paths. Additionally, 2children with medium level of disability and mediumexperience taking public transport (always accompa-nied by a specialist) tested the functions of the app in 2hybrid paths (bus and pedestrian mode) accompaniedby a researcher and a specialist.Key results: After using the app for recording a pathwith 4 steps and another with 8 steps, specialists thinkthat the app is intuitive and easy to use and they cancreate adapted paths in a fast way.The alarms for preventing to press the stop in thebus were understood by the children and automaticallythey pressed on the button. The information on themap like the current position and the arrows for turningright or left seem to be understood by the children afterexplaining them the meaning. While they were doingthe pedestrian path we have asked them what actionsto do when arrows appear and they answered correctly.Conclusion: We have shown the efficiency of ADAPEItransport having encouraging results. It has been testedthe efficiency in the creation of the path having goodresults and acceptance with new end users. Childrenhave understood different information like alarms andimages that appears on the screen during navigationconfirming their accuracies. Future work will includeadding information from bus time schedules in realtime and more tests with children to validate the func-tions.Keywords: GPS, bus, transport, navigation, intellec-tual disability.∗Corresponding author. E-mail: [email protected]

Assessment of SlideWiki OpenCourseWare Plat-form by Individuals with Mild or Moderate Intel-lectual DisabilitySophia Karagounia, Elli Kafritsab,∗, Maria Moukac

and Dimitris Tourlidasda,b,c,dResearch & Development Department, Marg-arita Vocational Training Center, Mesologiou 4–6 &Redestou 7–9, Nea Penteli, 152 36, Athens, Greece

Background: The introduction of new software doesnot often take into account the opinion of people withintellectual disability (ID) and issues, such as acces-

sibility, usability and inclusive design are often ne-glected or left out. The purpose of this research wasto train people with ID in order to use the SlideWikiOpenCourseWare (OCW) platform and examine theextent to which it is accessible to this population. Re-cent research indicates that SlideWiki, which amongothers allows the creation of highly-structured remix-able and easily shared OCW, is a promising additionin the field of web-based learning. However, specificadaptations are needed, such as easy-to-read descrip-tion of the platform functions so as to be fully accessi-ble to learners with ID.Method: The sample of this study (n = 10) consistedof 4 women and 6 men with mild and moderate ID,aged from 20 to 50 years old, attending a vocational ed-ucation and training center in Greece. The training andassessment period lasted from 6 to 8 weeks depend-ing on the group of beneficiaries. The hourly trainingsessions took place from once to twice a week and oc-curred almost concurrently with the platform assess-ment. The training tools used were presentations up-loaded in the platform in an easy-to-read format and aneasy-to-read manual in printed form. Presentations cre-ated by the participants in topics that interested themwere also used. The participants assessed the accessi-bility of the initial page and the easiness of the searchfunction, the profile creation and signing in. They alsoevaluated their understanding of the text in the screen,the platform settings, the use of colors, text functions,pointer and other functional characteristics and theywere able to manage their presentations. The trainersobserved some initial difficulties in the handling of theplatform by the participants, although eventually theybecame accustomed with some features of the new edi-tion. In order to develop a more comprehensive under-standing of the data, triangulation was used. The par-ticipants completed 3 forms at the end of the trainingperiod in order to record their exact opinions and facil-itate the data quantification.Key results: The different forms provided divergentresults, regarding the accessibility and easiness of theplatform. Moreover, the opinion of the trainers on howthe beneficiaries perceived the use of the software wasnot always identical with the opinions recorded in theforms. The most important finding though, was that thebeneficiaries prided themselves on working as a teamand having their opinion taken into consideration.Conclusion: The suggestions that were put forwardby the beneficiaries are worth mentioning, as thesecould make the platform more usable and convenient tothe people with ID. Some key suggestions include the


translation of the platform, the change in the appear-ance of certain functions (e.g. arrows, pointer) and theuse of speech-to-text option which might be more con-venient than text-to-speech specifically for this popu-lation.Keywords: SlideWiki, Intellectual Disability, Open-CourseWare.∗Corresponding author. E-mail: [email protected]

Can Accessible Technology Help Person CenteredPlanning? Exploring the Role of an ICT Solution toEvidence Value in Service Delivery for People withIntellectual Disabilities (ID)Sarah Gavra Bolanda,∗, John Owuorb, Alan Byrnec

and Peter GallagherdaLiffey Services, Saint John of God Community Ser-vices clg, Cookstown Way, Tallaght, Dublin 24, IrelanddSaint John of God Hospitaller Services, Stillorgan,Co. Dublin, Ireland

Background: Under ‘New Direction Guidelines’ fromthe Health Services Executive (HSE) Ireland, thereare pointers to how the implementation of a digitalenvironment can support and ensure a more efficientand effective service. However, health and social ser-vice providers face persistent challenges such as bud-get limitations and inadequate staffing levels. Otherchallenges include compliance to national, and interna-tional regulations such as HIQA (Ireland) UNCRPD,Accessibility ACT and GDPR. All these affect the abil-ity of services to invest in and manage digital environ-ments required to support efficient and effective ser-vices. Saint John of God, Liffey Services have en-gaged in a pilot project with Asperico the developers ofiplanit, a cloud based person-centered client manage-ment system. It supports person centered provision bykeeping track of client’s goals, focusing on outcomesand giving the user easy access to their information.The project builds on a previous one which exploredhow Assistive Technology (AT) can be used to supportindependent living and the adoption and developmentof accessible digital personal plans.Method: The pilot project is complemented by aStrauss and Corbin’s grounded theory study that usesan interpretive approach, underpinned by symbolic in-teractionism as the theoretical framework, to gain in-sights into the participants’ narratives on how iplanitmediates person-centered planning. This qualitativestudy is split into three phases; i) desktop study phase

with literature review, ii) pre-pilot interviews and, iii)a post-pilot focus group discussions. The pre-pilot in-terviews were carried out between May 2018 to April2019. A total of 34 participants were interviewed forphase two including 12 persons with ID, 6 familymembers, 10 support staff, 6 management and commu-nity members.Key results: Data analysis found that accessible dig-ital personal plans facilitated plan owners to feel em-powered, and a sense of ownership over their informa-tion and plans. iplanit has provided better accessibil-ity to relevant information for all stakeholders. It givesthe plan owner autonomy over the development of theirplans, a direct say in what they would like to achieveevidenced through the use of accessible multimedia.For service providers, the system provides an accessi-ble platform to evidence personal plans, related activi-ties and outcomes. Findings also indicate reduced needfor administrative resources compared to paper-basedplanning. It supports the move to community serviceprovision. There was also evidence of improved in-formation sharing and access between relevant stake-holders. Used effectively, iplanit can improve account-ability for staff and management and provide value formoney evidence in investing in digital solutions.Conclusion: Accessible digital solutions can sup-port person-centered planning and improve serviceefficiency and effectiveness if the solutions are co-designed with relevant stakeholders. However, co-designing digital solutions can be challenging. Tech-nology developers can be reluctant to provide the nec-essary built-in assistive technology needed to ensurethat all stakeholders can engage in the solution. Issuesof copyright and public good versus profitability canalso be difficult to manage in co-design processes. Fur-ther research is required to explore how best to involvepeople with ID and different interest stakeholders inco-design of digital solutions.Keywords: Person Centered Plans, Accessible Tech-nology.∗Corresponding author. E-mail: [email protected]

Evaluating a Social Inclusion Intervention withSupport of a Mobile Application among YoungAdults with Intellectual DisabilitiesJ.S. Louw∗ and G. LeaderbaTrinity College Dublin (TCD), School of Nursing andMidwifery, Dublin, D02 T283, Republic of IrelandbNational University of Ireland, Galway (NUIG),School of Psychology, H91 TK33 Galway, Republic ofIreland


Background: Social inclusion has been regarded as akey outcome in the general health of all individuals andit has been reported to have a number of benefits, par-ticularly for young people with intellectual disabilities(ID). Research on social inclusion and the use of digitaltechnology among young adults with ID are reported toplay a vital part in how they can connect socially. Toooften, young people with ID are excluded from tak-ing part in social activities because they struggle to un-derstand social cues and respond appropriately. There-fore, this pilot study investigated a social inclusion in-tervention with the support of a mobile application toimprove social interaction skills for young people withID.Method: A pre-post study design was adopted to eval-uate the implementation of a social inclusion interven-tion with the support of a mobile application. In ad-dition, three social validity questions were included atthe end of each social activity that was uploaded onthe mobile app. Ten participants with ID, 18 years andolder, participated in a weekly intervention session us-ing the mobile app over a period of 12 weeks. Partici-pants were recruited from four institutions that provideday services to people with ID. Seven staff membersparticipated with the service users to implement the in-tervention. The staff completed six intensive trainingsessions on how to use the mobile app. Parents, the tenyoung people with ID and staff provided input on theprototype of the mobile app prior to the interventionbeing implemented.Key results: Altogether 95% of participants were di-agnosed with a moderate intellectual disability andonly 50% of participants managed to complete all the 6social inclusion activities selected prior to the interven-tion being implemented. Examples of social inclusionactivities included listening to music, swimming, shop-ping and taking a walk. The social interaction skillsaligned with the selected social activity included a fo-cus on listening skills, eye contact and communicationskills. Staff uploaded 3 to 6 prompts as a step-by-stepguide for each activity. The majority of participants re-ported the prompts as helpful in completing their socialactivities. Personalized pictorial images were uploadedon the mobile app for each activity and this encour-aged and enabled participant interest. The majority ofparticipants (96%) reported acceptance of the use andsupport of the mobile app when participating in socialactivities.Conclusion: The mobile app was regarded as valuedwhen used to help participants with improving their

communication skills. More importantly, the signifi-cance of an intervention that used the support of a mo-bile app was seen as a unique facilitator to help com-municate between staff and parents on how best to sup-port young adults with ID at home and similarly at theday service. The findings of this pilot indicate that in-creased opportunities where participants can practiceand participate in social interaction skills with the useof assistive technology are most needed. This will re-sult in improving self-confidence and a sense of inde-pendence for young adults with ID when they engagein real-world social environments.Keywords: Social Inclusion, Youth, Technology, Com-munication.∗Corresponding author. E-mail: [email protected]

Using High Fidelity Work Simulator for VocationalOrientation, Skill Assessment and Development ofYoung Adults with DisabilitiesMárk Ágoston Pulaya,∗ and Erika JókaibaBudapest University of Technology and Economics,Department of Ergonomics and Psychology, Budapest,HungarybÓbuda University, Budapest, Hungary

Background: Work is crucially important for peoplewith disabilities as it fosters their quality of life. Manystudies focus on the assessment of vocational aptitudeof people with different kinds of disabilities but mostof them are qualitative research; paper based tests andsimple observations. However, beside those technicsour main focus is already on the accurately measur-able functions that remained intact and therefore canbe the basis of appropriate work skills. Hence, we useda sophisticated and complex high fidelity work simu-lator (WS) that has the necessary broad spectrum ofevaluation test batteries. This research is a part of acomplex vocational orientation program in Hungaryfor teenagers and young adults with disabilities. Themain objective of our research was to create a method-ology using a reference database to support aptitude as-sessment and work diagnostics of teenagers and youngadults with disabilities to helping vocational schooland career choices, labor market orientation or the as-sessment of specific job skills.Referring to the well-known Human Activity Assis-tive Technology (HAAT) Modell – of which the occu-pational performance is an important element – it de-scribes how a person performs an occupation. Assis-tive technology (AT) in a broader sense – includes any


assistive, adaptive, and rehabilitative devices for peo-ple with disabilities in order to promote greater inde-pendence by enabling them to perform tasks.Method: The WS consists three measuring panels, asindependent workstations. P1. for measuring static anddynamic forces in standing position, P2. for measur-ing holding/grasping forces, touching/tactile functions,and fine motor abilities in sitting position, P3. for mea-suring work endurance/loadability, monotony suscep-tibility in complex workflows. This full scale examina-tion consists 36 different task situations each with 2–19 corresponding performance parameters, altogethertotalling up to 203.We compared the values of all these 203 measured pa-rameters between the group of 179 “healthy” personsand the sample of the 100 “disabled” young (13–30years) persons to determine which parameters are sig-nificantly different between these categories. We usedmostly the One-Sample T-Test to compare each “dis-abled” sample mean with the corresponding “healthy”sample means as fixed numbers. A rather strict signifi-cance level of 0.01 was set instead of the usual 0.05.Key results: We have found many statistically sig-nificant differences between groups. There are many

remarkable overlaps of the “healthy” and “disabled”distributions: there were many “disabled” persons whoperformed better in certain parameters than the aver-age of the “healthy” persons. Also there were many“healthy” persons whose performance was worse incertain parameters than the average of the “disabled”persons.Based on the results of a work diagnostic measure-ments, we can give a feedback to students, career advi-sors or HR managers about the prospective employee’sfunctional workability: which skills are outstanding,average, or need to be improved for the desired profes-sion, career or job.Conclusion: This broad variety of task situations andthe vast repertory of corresponding measurable perfor-mance parameters of the WS makes it especially ap-propriate for skill assessment, skill development andalso for vocational aptitude tests of different kinds ofdisabled persons.Keywords: Work Simulator, Vocational Orientation,Skill Assessment,∗Corresponding author. E-mail: [email protected]


Part 8: Service Delivery and OutcomeResearch

Barriers to Assistive Technology in EuropeMaurice Grinberga,b,∗ and Evgeniya Hristovaa,baDepartment for Cognitive Science and Psychology,New Bulgarian University, Montevideo str. 21, 1618Sofia, BulgariabASSIST – Assistive Technologies, Razvigor str. 3A,1421 Sofia, Bulgaria

Background: The results of the project “Barriers tothe wider deployment of person centred technology inservices for persons with disabilities,” commissionedby the European Association of the Service Providersfor People with Disabilities (EASPD) will be pre-sented. The goal of the project was to identify what arethe main barriers and consequently the potential facil-itating factors that would enable the uptake of PersonCentred Technology (PCT) in the social sector.Method: The research work had two related parts –a theoretical analysis of the barriers to PCT based onexisting studies; and the design and deployment of aquestionnaire aimed at gathering data from profession-als in service providers for People with Disabilities(PwD) as to their perception of the identified barriers.The theoretical part is based on some of the most im-portant recent reviews and authoritative sources of in-formation on the topic. Fifteen groups of barriers wereidentified. The questionnaire was developed follow-ing the theoretical analysis and it covers all identifiedgroups of barriers. The questionnaire was administeredin 5 languages and was filled in by 137 professionalsworking in social service providers for people with dis-abilities from 18 European countries. 100 participantswere included in the subsequent analysis.Key results: The results of the questionnaire show thatprofessionals in Europe are unanimous about the use-fulness of PCT for PwD (mean rating of 6.4 out of7). However, the data about the percentage of serviceproviders’ staff members using PCT is alarmingly low– 36% overall (about 25% for Central, Eastern, and

Southern Europe; 78% for Northern Europe). A simi-lar large discrepancy between the North and the rest ofEurope is also seen in the ratings about the good useof PCT in social service providers – 5.8 (out of 7) forthe North and 4.5 for Central, 3.4 for Eastern, and 3.6for Southern Europe. However, the average rating forEurope (4.2) is not satisfactory.Another big issue is that only 22% of the serviceproviders’ staff is rated as being expert in PCT (50%for Northern Europe and about 12% for the rest of Eu-rope). Additionally, according to the data, profession-als working in SPPD have had on average less than 1course in PCT during their formal education.The analysis of the results shows that the most impor-tant barriers to the usage of PCT identified by the studybelong to the following groups: Financial (except forNorthern Europe with rating 4.5), Training, and Qual-ified Professionals barriers. Next in severity come theResource, PwD and their Families’ Knowledge andSkill, Environmental, and Legislative and Regulatorygroups of barriers.Conclusion: The results of the study show that despitesome differences in perceived severity, the barriers toPCT in SPPD are common to Central, Eastern, North-ern, and Southern Europe. The groups of barriers re-lated to training and qualification with respect to PCTseem the most prominent for all Europe.Facilitating measures need to be systemic, startingfrom the establishment of university curricula whichwill account for the exponential growth of PCT.Keywords: barriers to assistive technology, profes-sionals working with people with disabilities, trainingand qualification in assistive technology.∗Corresponding author. E-mail: [email protected]

Demanding Assistive Technology for Study andWork in Finland 2007–2018Anna-Liisa Salminena,∗ and Jenna Mäkinenb

ISSN 1055-4181/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved

S166 Part 8: Service Delivery and Outcome Research

aResearch Department, The Social Insurance Institu-tion of Finland, Nordenskiöldinkatu 12, 00250, Hels-inki, Finland

Background: Finnish legislation guarantees disabledpeople the right to assistive technology (AT) that im-proves their ability to manage their daily activities in-dependently. Responsibility for providing and financ-ing such equipment falls upon the municipalities. How-ever, if an illness or impairment makes working orstudying impossible without personal AT, the SocialInsurance Institution of Finland (Kela) can acquire theneeded devices. Kela provides only particularly de-manding and expensive devices. This includes equip-ment such as video magnifiers, Braille and large-format displays and computers. Kela provides AT forpeople aged 16 or over. The aim of this study is to de-scribe changes in the use of AT benefits paid by Kelain 2007–2018 in terms of different diagnostic and agegroups and the cost of AT. In addition, the study de-scribes reasons for rejecting AT applications.Method: The study is based on Kela registers from2007 to 2018 and a focus group interview for the fivespecialists responsible for the AT benefits at Kela.Key results: The yearly number of disabled peoplewho received AT acquired by Kela ranged between 550and 600 persons in 2007–2018. Slightly over half ofthem were women. Most recipients belonged to theage group 16–19. However, the proportion of this agegroup in relation to the other age groups decreasedyearly. Until 2012, most recipients were students, af-ter which the majority were employed. The most com-mon reasons for receiving the devices were related tovision loss and hearing loss. The number of devices ac-quired based on vision loss varied during the study pe-riod, whereas the number of devices acquired based onhearing loss increased. Other common conditions wereneural diseases, such as cerebral palsy, but the num-ber of acquired devices decreased over time. The totalcost of the Kela-funded devices varied between 1.2 and1.6 million euros, and individual AT solutionscost2,000–2,500 euros on average. Kela rejected approxi-mately one third [216–279] of the AT applications an-nually. The most common reasons for rejection were:the applicant did not have a sufficient disability, the de-vice was not necessary for work or study, or the de-vice was not demanding and expensive and needed tobe financed by the applicant’s municipality.Conclusion: The yearly need for demanding and ex-pensive AT acquired by Kela remains roughly thesame. The number of recipients who are young or who

study decreases over time. This may be explained bythe fact that computer technology is now everydaytechnology and it is provided by schools or municipal-ities or bought by the persons themselves.Keywords: Assistive technology, Provision, Study andWork.∗Corresponding author. E-mail: [email protected]

Augmentative and Alternative Communication Sys-tems for Multilingual Contexts: A South AfricanPerspectiveKerstin M. Tönsinga,∗, Shakila Dadaa, Karin vanNiekerka, Georg I. Schlünzb, Ilana Wilkenb, JocelynMngomezulua, Danél Hattingha, Ngwanamashiane R.B. Mothapoa, Refilwe E. Morwanea and Nomadlozi B.BokabacaCentre for Augmentative and Alternative Communi-cation, University of Pretoria, Communication Pathol-ogy Building, Lynnwood Rd, Hatfield, Pretoria, 0002,South AfricabHuman Language Technology Research Group, Mer-aka Institute, Council for Scientific and Industrial Re-search, Scientia 627-Jr, Meiring Naude Rd, Pretoria,0081, South AfricacDepartment of African Languages, University of Pre-toria, Humanities Building, Lynnwood Rd, Hatfield,Pretoria, 0002, South Africa

Background: In the field of augmentative and alterna-tive communication (AAC) there is a dearth of knowl-edge to guide the design and implementation of AACsystems that give access to multiple spoken languages.With 11 official languages, South Africa is a context oflinguistic and cultural diversity. However, due to a vari-ety of socio-political and historical factors, AAC inter-vention and AAC technology are provided almost ex-clusively in English. Studies were therefore undertakenwith the overall aim of developing augmentative andalternative communication (AAC) systems that wouldgive access to expression in various South African lan-guages. The aims of these studies were:

– To describe the perceptions and needs of stakehold-ers (rehabilitation professionals and persons usingAAC) regarding non-English and multilingual AACsystems;

– To identify core vocabularies in three South Africanlanguages to guide vocabulary selection for non-English and multilingual AAC systems.


Method: The first study used a qualitative design. On-line and face-to face focus groups were held with 15purposively selected South African rehabilitation pro-fessionals working in the field of AAC to understandtheir perceptions of multilingual issues in AAC serviceprovision including AAC systems and technology. Fo-cus group data were analyzed using inductive thematicanalysis.In the second study, a predominantly quantitative sur-vey design was used to obtain the perspectives of27 multilingual South African adults using AAC onmultilingual AAC issues. Participants were recruitedthrough an empowerment program for adults usingAAC and also through an email list. Data were ana-lyzed using predominantly descriptive statistics.The three core vocabulary studies made use of quan-titative descriptive observational designs. Speech sam-ples were collected from six isiZulu-speaking, sixSepedi-speaking and 12 Afrikaans-speaking preschool-ers via body-worn audio recorders during routinepreschool activities. Participants were selected usingconvenience sampling. The speech samples were tran-scribed and the linguistic units (words or morphemes,as dictated by the linguistic structure of the language)that were used with a frequency of at least 0.5‰and byat least half of the participants were identified as thecore vocabulary.Key results: Both stakeholder studies indicated a needfor AAC systems that allowed access to South Africanlanguages and also access to more than one language.Desired technology features included text-to-speechcapabilities, text prediction and pre-stored vocabularyin appropriate South African languages, and the abilityto code-switch seamlessly. Core vocabulary lists wereidentified comprising of linguistic units (words and/ormorphemes) used most frequently and commonly bypreschoolers, ranging from 239 words in Afrikaans,226 words in Sepedi, to 213 morphemes or formativesin isiZulu. The influence of linguistic structure on AACsystem design was also highlighted.Conclusion: The results highlight the need for and de-sired features of AAC systems that give access to non-English South African languages and also multilingualsystems. Core vocabulary lists in the three languagescan be used to assist with selecting vocabulary that al-lows for sentence construction and a level of linguis-tic generativity. These studies also highlight language-specific and language independent design considera-tions for AAC systems giving access to multiple lan-guages.

Keywords: Augmentative and alternative communi-cation, Core vocabulary, Multilingual, South Africa,Stakeholder, System design.∗Corresponding author. E-mail: [email protected]

Access to Appropriate Assistive Technology in Less-resourced Settings: Argentina’s CaseAuthor Silvana ContepomiArgentine Assistive Technology Association

Background: Assistive Technology (AT) promotes in-clusion in people with disabilities across their lifes-pan. Although AT products are essential, successfulaccess depends on integrated efforts related to endusers (‘people’), provision, personnel, and policy, con-sidered the 5 ‘P’s by the (WHO- GATE). Argentina,is an emerging-frontier country, Currently, 32% of itspopulation live in poverty and disability is prevalentin 10.2% of the population. Most remote and vul-nerable places lack appropriate processes to guaran-tee the rights of people with disabilities. The existingway of wheelchair distribution is massive and discon-nected from the essential Service. Challenges are lackof: person-center approach – policy implementation –services related to appropriate AT provision- mainte-nance of products. The aim of the pilot project researchis to figure out if we can improve the results in inclu-sion with wheelchair provision service as a process inaccordance to the WHO’s paradigm.Method: A Pilot project of AT provision was setupin Chaco Salteño, a vulnerable region of Argentina. Ateam of 3 experts composed by 1 physical therapist and2 social workers defined the 7 phases for an adaptedprogram on AT provision to ensure insertion of theWHO paradigm on the 5 “p” and the WHO’s 8 stepsof wheelchair provision. 7 Phases we planned in orderto achieve our goals: 1: Advocating Policy/Provision,involve local government. 2: Personnel, community-based rehabilitation training. 3: People, referral peoplein need of AT. 4: Personnel, training 2 local leaders inproduct preparation. 5: Provision, assessment and se-lection by expert. 6: Product, funding, donations wereaccepted. 7: Provision/Personnel, follow up every 3/6months. Interview to obtain results.Key results:– Coordinated efforts with the government to advance

5 “P” understanding the population’s needs– 32 users were provided with appropriate wheelchair

and training


– 140 health agents trained in CBR increasing aware-ness shown in number of cases

– 2 local leaders instructed in product maintenance.Diminish abandon products

– Increased community participation / inclusion(fig.1)

Conclusion: This Program is just a pathway ensuringappropriate AT products and service provision for thevulnerable community. The benefits of AT should beknown by the stakeholders involved with disabled peo-ple throughout their lifespan. Future perspectives:

– Monitoring and evaluation programs in order tobuild the evidence of the cost and benefits of AT.

– Building capacity goes hand in hand with the inte-gration of these services into existing healthcare andsocial programs for ensuring equitable access to ap-propriate AT

– Program can be replicate in less resource settings inLatin America.

Keywords: Less-resourced settings, Service steps,wheelchair provision∗Corresponding author. E-mail: [email protected]

Availability and Awareness of Assistive Products inBangladesh from the Perspective of RehabilitationProfessionalsMehedi Hasan Khana,∗, Hidehisa Okua and MitsuhikoSanoaaGraduate School of Rehabilitation, Kobe Gakuin Uni-versity, 518 Arise, Ikawadani-cho, Nishi-ku, Kobe,651-2180, Japan

Background: Bangladesh is considered as lower-middle income country with approximately 164 mil-lion population. Although 9.1% of total population areexperiencing disability, the production and distributionof assistive products (AP) have not been sufficient sofar. Offering APs in the market and making appro-priate choice to effective use of APs are two burn-ing problems of Bangladesh. Affordable domestic pro-duction and imports from overseas may minimize de-mand problem but adequate knowledge of rehabilita-tion professionals (RP) about APs is indispensable formaximizing services. To improve this situation, this re-search was carried out first to reveal the kind of avail-able APs in Bangladesh along with measuring the levelof awareness of RPs about APs.Method: As there is no any business enterprise to pro-duce APs in Bangladesh, Center for the Rehabilitation

of the Paralysed (CRP), the only rehabilitation cen-ter and Center for the Development of the Disabled(CDD), the prominent disability related organizationplay vital role in production and distribution of APs.On the other hand, WHO has developed a 50 Prior-ity Assistive Products List (APL) to improve accessto high quality, affordable APs for all in 2016. In thisresearch, that APL was selected as a list of standardAPs. The kind of available APs in Bangladesh, hasbeen surveyed by analyzing statistical data publishedby CRP and CDD. To measure the level of awarenessof RPs about APs, all the RPs of CRP were surveyedby questionnaire. The total participants were 115 RPswhich included PT-52, OT-32, SLT-16, and P&O-15.In the questionnaire participants were asked about theirawareness of 50 APs from APL along with their pro-fessional information. This research has been carriedout from September 2018 to April 2019 with the per-mission of CRP Research Ethics Review Committee.Key results: The survey result revealed that, 23 outof 50 kinds of APs from the APL were available inBangladesh and all those available APs were from Mo-bility, Communication and Environment categories ofAPL. In terms of awareness of RPs about APs, only1 participant from P&O knew all 50 APs from APLproperly. However, there were 7 more participants (OT-3, SLT-3 and P&O-1) who knew 40+ APs from APL.The study also indicated that only 9 participants knewall the 23 APs available in Bangladesh. Statistical anal-ysis indicated that the awareness about APs in OT wassignificantly higher than that in PT. The survey furtherdenoted that 90.5% of RPs didn’t have any knowledgeabout database of APs although 48.0% RPs obtainedinformation of latest APs from internet. The study alsofound that 81.0% RPs never had an opportunity toparticipate any AP related seminar/conference outsideBangladesh and 13.1% RPs didn’t have any scope toget information about latest APs.Conclusion: The preliminary result of our research in-dicated that, the numbers of available APs in Bangla-desh were fewer than the APL and the awareness levelof RPs about APs was inadequate. Establishment ofworthy environment to learn more APs effectively ishighly needed along with solving the priority issues.Keywords: Rehabilitation professional, Bangladesh,Assistive Products List.∗Corresponding author. E-mail: [email protected]


Assistive Technology Access: A global concern inthe Canadian context – stakeholder perspectives onunmet needs, gaps in services, and ethical, social,and policy issuesNatalia Zdaniuk∗, Rosalie Wang, Evelyne Durocherand Michael WilsonDepartment of Occupational Science & OccupationalTherapy, University of Toronto, 160-500 UniversityAve., Toronto, ON, M5G 1V7, Canada

Background: As technology development advances,access to assistive technology (AT) remains a globalconcern. The World Health Organization has deter-mined an urgent need for AT policies that enable equi-table access nationally and regionally. In Canada, thereare unmet needs and access to AT remains challeng-ing, raising equity concerns. Programs offering AT arefragmented and complex, resulting in barriers for con-sumers and healthcare providers. There is a clear ur-gency for coordinated research and policy implementa-tion for AT access. This study is part of a larger projectto understand and advance Canadian policies for ATaccess. This study covers a previous gap in research byengaging stakeholder perspectives about AT in Canadain relation to policy, provision, and services. The pur-pose of the study is 1) to examine how AT is accessedby Canadians and identify funding/service gaps, and2) to explore the perceived ethical, social, and policyissues affecting AT access and adoption. The findingswill contribute to better aligning policies/services withthe perceived social and ethical values of Canadiansand improve equitable access through policy imple-mentation.Method: In this study we undertook 30 key informantinterviews with Canadian policymakers and stakehold-ers representing federal, provincial, and territorial ju-risdictions, and organizations operating nationally. Us-ing a purposive expert sampling framework, the re-searchers aimed for 2–3 representative policymak-ers/stakeholders from 14 Canadian jurisdictions. Usingthematic analysis, the researchers reviewed and codedinterview transcripts, refining themes based on ongo-ing review and discussion. Themes were sorted basedon value placed by respondents, frequency of appear-ance, and significance to the research purpose.Key results: Three prominent needs emerged fromthe interviews, raising key issues to address in futurepolicy proposals: 1) The need for a more holistic ap-proach, offering a national-scale intervention to cur-rently silo-ed services that limit AT access and do notreflect a client’s full range of needs; 2) The need for

client-centred policies and programs, offering broaderinclusion and prioritizing choice and independence;3) The need for capacity building, including educa-tion/awareness campaigns, and training for practition-ers, clients, and caregivers – including those facing bar-riers to information, such as rural populations and new-comers to Canada. Under these themes, multiple gapsin service/provision/policy were identified, and a list ofgroups with unmet needs was developed. Respondentsalso identified proposals to address these concerns, in-cluding building national standards, providing subsi-dies, and developing centres of excellence for educa-tion.Conclusion: The findings show what stakeholders andpolicymakers perceive as the greatest concerns for ac-cess to AT in Canada, highlighting the barriers andgaps in accessibility, as well as offering strategies forpolicy implementation and service improvement. Thestudy offers practical implications to guide ongoing re-search engagement with policymakers and stakehold-ers. While based in a Canadian context, the study ad-dresses a global concern and offers a meaningful con-tribution to the AT field by engaging in a process to im-prove access to AT. This work contributes to broadersocial change by addressing the call for accessible ATsto operate as mediators of sustainable and equitable de-velopment internationally.Keywords: Policy, Access, Equity, Client-centred,Capacity-building

Continuous Outcome Scaling: A DiscriminativeMethod for Person-Centered Assistive TechnologyOutcomes StudiesNatasha Layton∗, Karen Rispinb and Vicki SheafercaDepartment of Health Professions, Swinburne Uni-versity of Technology, John St, Hawthorn, Vic 3122,AustraliabDepartment of Biology, LeTourneau University, 2100S. Mobberly Avenue, Longview, TX, USAcSchool of Psychology & Counseling, LeTourneauUniversity, 2100 S. Mobberly Avenue, Longview, TX,USA

Background: Accurate measurement is a critical ele-ment of assistive technology (AT) provision. Outcomemeasures which are useful in both clinical settings andfield studies must have evidence which confirms theirreliability and validity. This paper considers the appro-priateness of using a graded visual analogue scale withgrades as anchors for the scale. Specifically, the abil-


ity of graded visual analogue scales to discern mean-ingful differences for a population of young manualwheelchair users and their practitioners within low-and middle-income countries.Method: This paper reviews the literature on contin-uous scaling applicable to assistive technology out-comes. We then describe the development of gradedvisual analogue scales using grades as anchors withina mixed methods protocol. Studies drawing on elevendatasets related to wheelchair and prosthetic/orthoticfunctioning are reviewed to identify important param-eters for validation and to critically evaluate tool per-formance.Key results: Graded visual analogue scales withgrades are anchors demonstrate strong ability to dis-cern meaningful difference. This method provides datawith enough detail to make it useful usable for clinicaland design responses.Conclusion: Meaningful outcomes measurement withuseable tools is critical to evaluate and build assistivetechnology access globally, and a high priority consid-ering the UN Sustainable Development Goals. This pa-per proposes a protocol for use of graded visual ana-logue scales and demonstrates evidence of its reliabil-ity and validity across a range of studies. The gradedvisual analogue scale approach to outcome measure-ment offers relevant, rapid and sensitive measures,widely applicable. The paper concludes with consider-ations for the potential use of continuous scaling fromthe twin perspectives of consumer usability and utilityin low- and middle-income countries.Keywords: outcomes, disabilities, person-centered,continuous∗Corresponding author. [email protected]

Towards a Successful Match Between User and As-sistive Technology: A Correlational Study on User’sSatisfaction, Perceived Effectiveness, and Psychoso-cial Impact of an Assistive SolutionStefano Federicia,∗, Eugenio Valenzanoa, Maria LauraMelea,b and Fabrizio CorradicaDepartment of Philosophy, Social & Human Sciencesand Education, University of Perugia, Perugia, ItalybMyèsis, Research and Development Company, Rome,ItalycLeonarda Vaccari Institute for Rehabilitation Integra-tion and Inclusion of Persons with Disabilities, Rome,Italy

Background: This work is an exploratory study to in-vestigate the relation among three main psychosocialfactors measured after an Assistive Technology (AT)system provision: (i) the user’s satisfaction, (ii) the per-ceived effectiveness, and (iii) the psychosocial impactof the assistive solution. The main objective is to un-derstand whether the correlated psychosocial measurescan predict a successful outcome of the AT assignationprocess. The study embraces the ICF’s biopsychoso-cial perspective of disability and the Matching Personsand Technology model by adopting the Assistive Tech-nology Assessment (ATA) process, an ideal model forthe effective outcome of AT assessing and provision(Federici & Scherer, 2018).Method: The study was conducted in an AT servicedelivery center by following the guidelines provided bythe ATA model. Fifty-five subjects (72.7% males, min4 – max 14 years old) participated in the study, whichconsisted of five main phases. Two preliminary phasesfocused on the analysis of participants needs with theaim to identify the best AT solution through a psycho-logical counseling process and the administration ofthe Matching Assistive Technology & Child (MATCH;Federici et al., 2009). Then, the third phase of post-assignation focused on the outcome of the assistivesolution assignation process measuring the user’s sat-isfaction and the perceived effectiveness, as well asthe functional independence, well-being, and quality oflife. The factors were assessed through (i) the QuebecUser Evaluation of Satisfaction with assistive Technol-ogy (QUEST; Demers et al., 2002), (ii) the Individu-ally Prioritized Problem Assessment (IPPA; Wessels etal., 2002), and (iii) the Psychosocial Impact of Assis-tive Devices Scale (PIADS; Jutai and Day, 2002). Afinal post-assessment phase consisted in providing theusers with tailored training for the use of the assignedAT and in conducting interviews to caregivers (teach-ers and educators) and peers to investigate the impactof the AT solution in the users’ milieu.Key results: Findings after the AT system provisionshowed high levels of user’s satisfaction (Total QUESTM = 4.80; QUEST device M = 4.71; QUEST ser-vices M = 4.99), an increase in quality of life lev-els and a decrease of about 40% of the perceived dif-ficulty of use. A highly significant positive correlationamong the three questionnaires QUEST, IPPA, and PI-ADS was found (0.473 6 r 6 0.762; p 6 0.01). A sig-nificant linear relationship between the questionnairescores and the abandonment rate shows that question-naire scores can predict each other (0.224 6 R2 60.581; p 6 0.01). Finally, the AT assessment outcomeshowed a 5.17% rate of abandonment.


Conclusion: A positive relation among psychosocialfactors of users’ satisfaction, perceived effectiveness,and the psychosocial impact of the assistive solutionhighlighted a statistical dependence among the threedifferent metrics recommended by the ATA modelfor the post-assignation assessment process (QUEST,IPPA, and PIADS), also explaining the strength of eachpsychosocial factor on the AT assessment outcome interms of abandonment of the assistive device. Futureworks will extend the age range and focus on designinga mathematical model for predicting the percent prob-ability of AT getting abandoned by the user, immedi-ately after the post-assignation assessment process.Keywords: Assistive Technology Assessment model,Matching Assistive Technology & Child – MATCH,QUEST, IPPA.∗Corresponding author. E-mail: [email protected]

What is the pay-off? Usability and cost benefit ofassistive technology at workplaceSajay Arthanat and Alyson MessinaOccupational Therapy, University of New Hampshire,USA

Background: Assistive Technology (AT) devices en-able individuals with disabilities (IWDs) to fulfill workroles and engage in meaningful employment. However,the employment rate of IWDs in the United States issignificantly lower (18.7%) compared to that of able-bodied individuals (65%). A major factor here per-tains to barriers with implementation of AT devices. Tohighlight the role of AT, we conducted a comprehen-sive survey of employees with disabilities on their useand utilization of workplace AT. Specifically, the studysought to: a) identify AT devices that are being used atwork; b) examine how well the devices effectively andefficiently fulfilled work roles; c) examine perceivedskills and accommodations for use of AT; and aboveall; d) analyze the cost-benefit of integrating AT de-vices at workplace.Method used: The survey was developed using a pilot-tested work-driven framework, the Usability Scalefor Assistive Technology-Workplace (USAT-W). Theframework first delineates the work roles of the em-ployee, focuses on tasks within each role, and thenconsiders the AT support needed to fulfill each role.The effectiveness and efficiency with which the em-ployee interacts with the AT devices, as well as theskills involved and accommodations received for each

device within the roles, are then evaluated. This frame-work was adapted into the survey, pilot tested with asmall cohort of employees with disabilities, and thenuploaded on Qualtrics survey database. We includedan additional section seeking information on the em-ployee’s income and total cost with acquisition, train-ing, and service for each AT device. Convenience sam-pling was used to recruit participants across the UnitedStates from multiple sources- Qualtrics health panels,disability support networks, and Centers for Indepen-dent Living.Key Results: 206 employees with disabilities whoused AT (with an average 8.1 years of work expe-rience) completed the survey. The three main cate-gories of AT were worksite modifications (25.7%), de-vices for mobility (23.8%) and computer access de-vices (21.8%). Nearly 90% of respondents rated them-selves to be “productive” to “very productive” in allwork roles involving AT. About 84% to 93% statedtheir AT devices to be “effective” or “very effective”,and “efficient” or “very efficient” for fulfilling theirwork roles. Significant correlations (r ranging from 0.3to 0.6; p < 0.01) were detected between AT skills,accommodations, and work productivity. In contrastto the average annual income of $47,135 (Std.dev =$33,558), the average total cost of AT devices was$7074 (Std.dev = $15,868), almost a 7:1 ratio. Despitethe high variance, the one-time total cost of AT deviceswas a much smaller fraction of the respondents’ annualincome across all impairments and job categories.Conclusion: These findings indicate the breadth androle of AT devices at work. The economic benefits ofproviding AT with respect to income and earning po-tential far surpass any associated implementation costs.While past research has delineated barriers to AT pro-vision, underscoring the value and economic pay-offof workplace AT is critical to highlight the role of ATto service providers, employers, and policy makers.∗Corresponding author. E-mail: [email protected]

Technology’s Impact on Tasks of Employees withDisabilities in Germany (2006–2017)Sabrina Inez WellerBIBB Federal Institute for Vocational Education andTraining, Robert Schuman Platz 3, 53715 Bonn, Ger-many

Background: The ongoing computerization of oureconomy leads to a transformation of the world of


work. New technologies and new working require-ments result in changes in employees’ task composi-tion. According to the Routinization hypothesis, theincreasing use of computer technologies in the work-place is leading to a complementary of non-routine(analytic and interactive) tasks and substitution of rou-tine (manual and cognitive) tasks). This paper analy-ses the influence of the computerization (the use ofcomputer as main work tool) on the tasks of employ-ees with disabilities. It is examined whether the tech-nological change is leading to the same shift towardsmore non-routine tasks and to the same substitutionand complementary effects of technology in workplaceamong employees with disabilities as it is among thosewithout impairments between 2006 and 2017.Method: We use representative data form the GermanBIBB/BAuA Employment Surveys 2006 and 2017,where 20,000 gainfully employed people were askedabout their Qualification and Working Conditions. Werun separate regression models for employees with andwithout a certified disability in the years 2006 and2017, where we analyse the influence of computer us-age (independent variables) on different task categories(routine, manual, interactive and analytical tasks; de-pendent variables).Key results: Our results show no significant differ-ences in the technology usage of employees with andwithout disabilities on workplace. Moreover, the im-pact of technologies on the tasks carried out do notdiffer significantly between disabled and non-disabledemployees.Conclusion: The analyses confirm the Routinizationhypotheses for disabled employees: the usage of tech-nology on workplace is leading to the same shift to-wards more non-routine tasks and to the same substi-tution and complementary effects on tasks for disabledand non-disabled employees. One explanation for thefact that computerization affects in the same way peo-ple with and without disabilities could be that the dataused focusses on persons who are integrated in the gen-eral labour market. In future research we will analysethe effect of various types of technology (e.g. toolsfor communication and information management, in-put and output devices for computers) on the tasks ofemployees with different impairments to find more dif-ferentiated results.Keywords: Disability, Labour market participation,Routinization.∗Corresponding author. E-mail: [email protected]

Assistive Technology Outcome Measures: A Reviewof Recent LiteratureClaudia Salatinoa,∗, Renzo Andricha and LorenzoDesideribaIRCCS Fondazione Don Carlo Gnocchi, Milan, ItalybAIAS Bologna Onlus, Piazza della Pace 4/A, 40134Bologna, Italy

Background: Effects, costs and economic impact ofassistive technology are indicated among the top pri-orities in the Global Priority Research Agenda on As-sistive Technology, published by the World Health Or-ganization in 2017. Internationally validated AT out-come measures can be useful to measure whether ATinterventions lead to successful outcomes at individuallevel, and more in general to collect evidence about ATappropriateness and cost-effectiveness. The authors –who work in AT assessment teams of rehabilitation andAT centers – were interested in finding out outcomemeasures applicable to any AT categories, which couldbe used in the follow-up stage of AT interventions indaily practice.Method: A literature overview was undertaken in or-der to identify validated outcome measurement tools,in use among the AT communities, that could be ap-plied to any individual AT intervention. Three AT ex-perts identified a list of 13 journals and 3 conferenceproceedings whose field of interest included AT, andanalyzed articles published in their 1312 releases be-tween 2003 and 2016. First, 459 articles were retrievedthat contain the terms “OUTCOME” or “MEASURE”or “EFFECTS” or “TOOL”. Second, each expert readthe abstracts and assigned a relevance score. Paperswere considered “relevant” if the abstract declared thatthe described instruments were intended to measurethe outcome of individual AT interventions; otherwisethey were scored as “not relevant”. Third, the 53 arti-cles scored as “relevant” by all the three experts wereanalyzed in depth and the data describing the studyand the instruments were extracted and coded. Forexample, each instrument was classified according towhether it was: 1) intended for general use in rehabil-itation programs, 2) designed to be applied to specificcategories of assistive products, and 3) applicable toany AT products.Key results: 86 instruments were reported in the 53selected articles. However, only 5 instruments werefound to be outcome measures actually applicable toa broad range of assistive products: PIADS, QUEST2.0, FIATS, IPPA and SCAI. These instruments weredescribed in 29 articles, which indicates they are


quite widely known and used in several Countries.These instruments investigate different outcome do-mains – respectively – psychosocial impact, satisfac-tion, caregivers’ burden, perceived effectiveness andsocial costs.Conclusion: Outcome measures are extremely impor-tant to demonstrate the AT fundamental role and addedvalue, to quantify their impact and to inform fund-ing decisions. However, a very simple set of easy-to-administer measures should be chosen to make themeasurement sustainable in clinical practice. The fiveinstruments identified by this study seem to meet thisneed; they also investigate different outcome domainswhose combination provides a comprehensive insightinto the AT impact on the user’s life. The authors arecurrently engaged in further research to seek the bestcompromise between making outcome measurementsustainable in clinical practice and collecting the wholespectrum of data that can fully enlighten the AT im-pact.Keywords: assistive technology intervention; outcomemeasurement; follow-up∗Corresponding author. E-mail: [email protected]

Outcome of Provision of “Uncomplicated” AssistiveDevices to Older People in the Faroe Islands – anIPPA pretest-posttest StudyTurið Jacobsen, Maria Skaalum Petersen and Gro GadeHaanesThe University of the Faroe Islands, Faculty of HealthSciences

Background: Researching the outcomes of assistivedevices (ADs) is important for clinical and policydecision-making. The Faroe Islands have an ageingpopulation, and there is a lack of knowledge aboutoutcome of ADs for older people. Older people re-cieve most of the ADs from the publicly funded AD-centre. This study aimed to evaluate to what extentolder people experience diminished difficulty in per-forming daily activities due to provision of uncompli-cated ADs, e.g bath chairs and rollators. Additionally,the aim was to examine possible association betweeneffect and “sociodemographic factors” and “difficultyat baseline”. This is the first study of AD provision inthe Faroe Islands.Method: The design was a pretest-posttest AD inter-vention study. It was conducted in five out of sevenmunicipal districts and ran for eight months. Seven

municipal OTs collected data in their districts. Inclu-sion criteria: citizens 67 years and older living at homewho wished ADs to perform daily activities. Exclusioncriteria: citizens without sufficient cognitive or hear-ing functioning necessary to participate in an interviewand citizens with massive need for care. Data collec-tion: The effect was evaluated by means of the Indi-vidually Prioritised Problem Assessment (IPPA). IPPAassesses to which extent activity problems identifiedby AD users are diminished after recieving ADs. Atbaseline, the participant identified and rated their activ-ity problems regarding importance and difficulty andre-evaluated them at follow-up 3.5 months after re-ceiving the ADs. The scores range is 1–25 points. Ahigh score demonstrates a large difficulty. The effect isthe difference between mean baseline score and meanfollow-up score. Max possible difference is 24 points,which demonstrates a large effect. Intervention: mu-nicipal OTs assisted with the application for the ADsfrom the state AD-centre, that might address the ac-tivity problems. When the ADs were recieved, the OTpaid one visit to test and adjust the ADs, and to instructin using. The overall effect was assessed with a pairedt-test. The effect size was calculated and interpretedaccording to Cohen’s d: an effect size of 0.20 is small,0.50 is moderate and 0.80 or more is large. One-wayANOVA was used to explore association between theeffect and the determinants.Key results: In total 52 persons, 37 women and 15men aged 69-93, mean age 83 years participated in thestudy.Mean baseline total score was 17.73 (SD = 4.09),mean follow-up score was 9.14 (SD = 3.41). Mean re-duction in difficulty was 8.59 points (95% CI: 7.37–9.81) (p 6 0.001). At the individual level the effect was−5–20 points. Effect size was 1.96. Only “high diffi-culty at baseline” was associated with large effect (p <0.001).Conclusion: The effect size by 1.96 was large andshows positive effect of the AD provision. Only diffi-culty at baseline was associated with large effect. Thevariation of effect highlights the importance of eval-uating AD interventions on an individual level. Fur-ther studies are needed to investigate which factorsin the service delivery proces influence the outcome.This could provide the authorities with evidence in theplanned re-evaluation of the AD service.Keywords: assistive devices, outcome, older people,daily activities.∗Corresponding author. E-mail: [email protected]


Developing an administration manual for the elec-tronic Mobile shower commode ASsessment Tool(eMAST): A case studyEmma Friesena,b,∗aRaz Design Inc, 22 Howden Road, Toronto, CanadabIndependent Researcher, Amsterdam, The Nether-lands

Background: In Assistive Technology (AT), there isan ongoing need to develop, implement, and reporton outcomes of AT provision and service delivery. Inthe past decade, efforts have largely focused on devel-oping and validating new outcomes measurement in-struments for use in real-world service delivery set-tings. In order to utilize these in practice, expertsin instrument development recommend that documen-tation, in the form of administration guides or usermanuals, should also be produced. While many re-sources exist to support instrument development, com-paratively few appear available for developing admin-istration or user manuals. Such documents serve as asingle, comprehensive repository of information on aninstrument to facilitate their uptake and use in prac-tice. The purpose of this paper is to describe the de-velopment of an administration manual to accompanya recently-developed outcomes measure, the electronicMobile shower commode ASsessment Tool version 1.1(eMAST 1.1). The eMAST, first published in 2016, as-sesses mobile shower commode usability from the per-spective of adults with spinal cord injury. This paperserves as a practical case study on developing an ad-ministration and user manual for researchers undertak-ing such work.Method: The author reviewed the following resourcesto identify necessary elements for an administrationmanual: published literature on scale development;published guidelines from online repositories and dis-tribution platforms on administration manuals for in-struments hosted on their sites; data extraction domainsused in published reviews of AT outcomes measures;and published administration or user manuals for ex-isting, validated outcomes measures for wheeled mo-bility and usability.Key results: The following elements were identifiedas necessary for inclusion in the eMAST administra-tion manual: administrative details of the instrumentincluding its full name, authors and their contact de-tails, copyright status, authorized distributors, require-ments for training or accreditation of administratorsprior to use, costs or fees for licensing and use, re-porting and disclosure requirements, and recommen-

dations for citations in publications; background infor-mation on the development and validation history ofthe instrument, including a summary of key develop-ment phases, populations used for validation, and po-tential limitations or threats to validity; psychometricproperties as reported in published studies; administra-tive properties as reported in published studies; instruc-tions for use and guidance on administering the instru-ment, including recommended delivery format/s andavailability of templates or formatted instruments (i.e.electronic, online, paper), recommended timing for ad-ministration (e.g. immediately after using the AT or af-ter a week of use), scoring of the instrument, and in-terpretation of sub- and total- scores. These elementswere then used by the author to create a draft versionof the eMAST Administration Manual. The draft willbe subject to external review by potential administra-tors of the eMAST in both research and service deliv-ery settings.Conclusion: This case study describes developmentof an administration manual to accompany a validatedoutcomes measurement instrument. The comprehen-sive manual contains information on the instrument’sbackground, psychometric and administrative proper-ties, and administration procedures for the eMAST.The manual will next be subject to external review byexperts.Keywords: Outcome measures; Questionnaires; Useradministration manual; mobile shower commodechairs; Practitioner research.∗Corresponding author. E-mail: [email protected]

Cross-Walking the Matching Assistive Technologyto Child Assessment to the ICF ModelSusan A. Zapfa,∗ and Marcia J. SchererbaPost-Professional Occupational Therapy Program,Rocky Mountain University of Health Professions,Provo, UT, USAbThe Institute for Matching Person and Technology,Webster, NY, USA

Background: The Matching Assistive Technologyto Child-Augmentative Communication EvaluationsSimplified (MATCH-ACES) assessment incorporatesthe International Classification of Functioning, Dis-ability and Health (ICF) model within the assessmentframework in order to provide a common languageand structure for assistive technology assessments. Thepurpose of this descriptive analysis is to cross-walk


constructs of the MATCH-ACES assessment to theICF in the areas of educational participation, aca-demics, and functional living skills with a special em-phasis on intellectual disabilities. The authors hypoth-esize that the MATCH-ACES constructs/questions willcorrelate with the ICF body & structures codes, activi-ties and participation codes, environmental codes, andpredisposition factors that influence assistive technol-ogy use.Method: The lead author created a preliminary cross-walk and electronic database and cross-referenced theMATCH-ACES assessment questions (constructs) tothe ICF domains using a typology mapping table andestablished criterion rules. The crosswalk was exam-ined by two additional reviewers to determine the levelof agreement of the MATCH-ACES constructs mappedto the ICF domains. Feedback was incorporated intothe second revision of the crosswalk and the primaryauthor developed a concept map visualizing the cross-walk of both assessments with a focus on intellectualdisability.Key results: Preliminary results indicated a high per-centage of agreement between both reviewers in crosswalking the MATCH-ACES assessment to the ICFmodel. Specific outcomes of this analysis include thedevelopment of common AT language across univer-sal assessments in healthcare and education and thefocus on participation for children and youth withimpairments that impede function. This is the initialstage in mapping both assessments to develop a stan-dard AT assessment with universal language for health-care providers. Further research is needed to conducta larger analysis of the constructs mapped to establishfurther reliability of this process.Conclusion: A preliminary analysis found theMATCH-ACES assessment process cross-walks withthe ICF model in both the cognitive components of theneeds analysis form and the predisposition scales. Asecond contribution relates to the need to develop astandard assessment process that uses evidence-basedresearch and universal terminology.Keywords: Matching Assistive Technology to Child(MATCH), International Classification of Functioning,Disability and Health (ICF), Crosswalk∗Corresponding author. E-mail: [email protected]

Translation and Preliminary Validation of the Ital-ian Version of the Family Impact of Assistive Tech-nology Scale for Augmentative and AlternativeCommunication (FIATS-AAC.it)

Riccardo Magnia,∗, Elvira Vegliob, Jessica Carlonia,Steve Ryand and Lorenzo Desideric,∗aCOAT Centro Orientamento Ausili Tecnologici Ass.Onlus – Piazza Garibaldi 5 06039 Trevi, ItalybAUSL Umbria 1, Via della Pallotta 42, Perugia, ItalycAIAS Bologna Onlus, Piazza della Pace 4/A, 40134Bologna, ItalydHolland Bloorview Kids Rehabilitation Hospital,University of Toronto, Toronto, Canada

Background: Developing effective communicationskills is crucial for social and cognitive development,everyday functioning and inclusion in society. Inter-ventions to improve communication skills of childrenwith communication-related disabilities make use ofalternative and augmentative communication (AAC).Recent studies have shown the effectiveness of theseinterventions on a number of clinical conditions; lessclear, however, is whether the benefits from AAC in-terventions extend also to children’s families. Under-standing the impact of AAC on the lives of childrenand their families is important because family mem-bers often play a fundamental role in the successful in-tegration of an AAC system into child’s life. The Fam-ily Impact of Assistive Technology Scale for Augmen-tative and Alternative Communication (FIATS-AAC)is an emerging, reliable parent-reported outcome mea-sure designed to detect the functional impact of AACinterventions on family systems. The present contribu-tion reports on development and evaluation of the mea-surement properties of an Italian version of the FIATS-AAC (hereafter, FIATS-AAC.it).Method: The authors translated and adapted theFIATS-AAC to the Italian context by following astandard linguistic validation protocol that employeda translation-back-translation technique. The initialFIATS-AAC.it was administered by either phone orface-to-face encounters to 30 parents or caregivers ofchildren with chronic disabilities who were aged 3 to18 years. Parents completed the FIATS-AAC.it twicewith a one-week interval. During the second adminis-tration, parents also completed the Impact on FamilyScale (IFS) to assess construct validity. The IFS is apublished measure of the psychosocial consequencesof having a child with a disability on the family.Key results: Test–retest reliability for the FIATS-AAC.it total scale was acceptable (intraclass correla-tion coefficient (ICC) = 0.98 (absolute agreement).Internal consistency for the total scale was also ac-ceptable (Cronbach’s alpha = 0.87). Individual alphavalues for FIATS-AAC.it subscales ranged from 0.19to 0.87, with 9 of 13 dimensions exceeding the reco-


mmended threshold for homogeneity (alpha > 0.7). Ashypothesized, correlational analyses revealed a nega-tive correlation between FIATS-AAC.it and IFS (r =−0.73; p < 0.01), suggesting that the measure taps intoa construct related to the psychological consequencesof having a child with a disability. However, parentsand AAC professionals reported the 89-item FIATS-AAC.it to be lengthy (about 20 minutes to complete).Conclusion: The FIATS-AAC.it is a promising Italiantool to assess the child and family functioning in ar-eas that may be impacted by the introduction of AACinterventions. The present study provides support for

the reliability and validity of the total scale. The mea-surement properties of the FIATS-AAC.it generallyalign with those reported for the original English ver-sion. Further research is needed to confirm these find-ings and other properties (responsiveness). In addition,a shorter version would be a welcomed alternative forboth AAC professionals and parents.Keywords: AAC, children with complex communi-cation needs, outcome measurement, effectiveness,family-centered services.∗Corresponding author. E-mail: [email protected],[email protected]


Part 9: Policy

International Classification of Functioning, Disabil-ity and Health and the Convention on the Rightsof Persons with Disabilities as a Framework for ATClassification and CategorizationJames Rwampigi Aniyamuzaalaa,∗ and NatashaLaytonbaPhD Candidate at University College Dublin c/o Hey-sestrasse 16/1, 4060 Leonding, AustriabDepartment of Health Professions, Swinburne Uni-versity of Technology, John Street, Hawthorn ,Vic3122, Australia

Background: Assistive technology is a powerful en-abler of the person’s participation in the different en-vironments. Assistive technology is however under-stood to be many things by many stakeholders and thislimits its potential. Dominant medical and rehabilita-tive discourses have shaped assistive technology lan-guage, terminology, scope, research priorities and out-come measures. The rights-based model considers as-sistive technology as a human right, a need and an en-abler of full participation in all aspects of life of theperson. This paper considers this history, reconciles theAT approaches, and proposes a new model drawing ontwo powerful contemporary frameworks.Method: The constructivists argues that knowledgecan be generated through critical discourse analysis(CDA) and we reflect on early claims of knowledgemanifested in academic and non-academic literaturerelated to ways of codifying assistive technology. Theresearch paper is also informed by the standpoints ofthe authors and AT user experience of the first au-thor. A content analysis of three pivotal articles is con-ducted utilizing UN CRPD as an AT categorizationframework model and WHO ICF model as a classifi-cation framework model. The authors critically anal-yse the difference between AT classification (classeswith fixed boundaries) and AT categorization (cate-gories with flexible boundaries) systems and their im-plications for framing assistive technology.Key results: Existing studies on AT Classification sys-tems do not take the UN CRPD into consideration

or differentiate between AT solution classification andcategorisation. The AT Functioning, classification andcategorisation (ATFCC) model organizes AT solutions(AT products, services and users) into both classes andcategories under a one framework model. AT Clas-sification system is based on the WHO-ICF model(body functions, and compensation of the body struc-ture functions), medical and social model approachestowards persons with disabilities. AT categorizationis based on the human rights-based approach and theFunctional Diversity model towards persons with dis-abilities. AT solution classes are outcome of the inter-action of AT solution with the person’s body parts withfunction limitations and body function limitations. ATsolution categories are outcome of the interaction be-tween AT solution and a person’s environmental or par-ticipation context. This model enables holistic AT as-sessment because it captures both the body function orbody structure function difficulties and the full partic-ipation context of a person with functional difficultiesin need of AT. Such a model may facilitate equitableallocation of resources for diverse AT users and pur-poses.Conclusion: This model enables holistic AT assess-ment because it captures both the body function orbody structure function difficulties and the full partic-ipation context of a person with functional difficultiesin need of AT at the same time. Such a model may fa-cilitate equitable allocation of resources for diverse ATusers and purposes. ATFCC framework model influ-ences formation of AT information and data manage-ment system by organizing AT solutions in classes andsub-classes and categories and sub-categories based onthe WHO-ICF and UNCRPD respectively. It can facil-itate the development of AT policies and AT fundingmodels to cover a wide range of AT needs to enableparticipation in all aspects of life.Keywords: Functioning, Rights, Assistive Technol-ogy, Classification, Categorisation.∗Corresponding author. E-mail: [email protected]


S178 Part 9: Policy

Political factors and assistive technology: A Multi-ple Streams Framework analysis of assistive tech-nology landscapeNatasha Altina,b,∗aDalla Lana School of Public Health, University ofToronto, Health Sciences Building, 155 College St., 6th

floor, Toronto, ON, M5T 3M7, CanadabInternational Centre for Disability and Rehabilita-tion, University of Toronto, Rehabilitation SciencesCentre, 500 University Ave, room 845, Toronto, ON,M5G 1V7, Canada

Background: To maximize the promise and sustain-ability of the assisitive technology (AT), AT interven-tions need to be recognized in legislations and policies.However, this is not the case within the Canadian ATlandscape, which creates a significant variation in theavailability and accessibility of the AT interventions.These discrepancies lead to system-level barriers thatprevent AT professionals from effectively supportingAT users. The aim of this paper is to:1) understand political complexities impacting the

Canadian AT landscape and the potential for ATpolicy advancement;

2) identify how AT professionals can support the ATpolicy advancement by considering political com-plexities.

Method: This paper draws on the Kingdon’s Multi-ple Streams Framework (MSF) to identify actions andconditions necessary to place AT policy advancementon the government agenda to stimulate policy relevantchanges to optimize the AT provision. The MSF is apolitical theory that examines how issues get onto thepolicy agenda and how proposals are translated intopolicy changes. Kingdon generates MSF’s key theoret-ical constructs by outlining meaningful categories ofpolicy formulation into three streams: problem recog-nition, generation of policy proposals and politics.Key results: The current categorization of the AT pro-vision under the healthcare umbrella prevents govern-ment actions towards optimization of the AT system.Currenly, the AT concerns are not perceived as press-ing problem when compared to more easily understoodmedical priorities (e.g. shortage of hospital beds). Tostimulate actions from the government, AT profession-als must highligh a mismatch between the current ATsituation and the government’s conception of the op-timal state. For example, repositioning AT concernsfrom the healthcare to a social justice issue that impactsone’s ability to enjoy fundamental rights re-defines thecurrent AT concerns as a problem appropriate for a

prompt governmental action. For the policy to be en-acted, AT professionals must generate policy proposalsthat are technically and politically feasable, groundedwithin the language and value system practiced bythe policy makers. The AT professionals must recog-nize a long gestational process for the proposal to beconsidered a ‘go-to’ solution, thus, AT professionalsmust concentrate their efforts on preparing both pol-icy and public communities to the proposed solutions.Currently, the Canadian national mood is not recep-tive of the AT policy advancement, thus AT profes-sionals need to lay the groundwork for shaping thereceptiveness of national mood to the AT policy re-form by engaging with people in and around govern-ment. Once the policy window opens, it will allow ATprofessionals to ‘push’ proposed solutions by couplingthem to the emergence of pressing problem and politi-cal events.Conclusion: Within the current Canadian AT land-scape, policy windows are tightly closed, as the inad-equate AT system has not been defined as a problemand the national mood is not receptive to the AT re-form. However, as policy windows are short-lived op-portunities for change that require immediate and well-thoughtout actions, present environment is favourablefor the AT professionals to initiate the AT policy ad-vancement process with the clear understanding of thepolitical factors influencing the AT landscape.Keywords: AT, political realities, AT policy advance-ment.∗Corresponding author. E-mail: [email protected]

Re-thinking the Advancement of Assistive Technol-ogy Systems from the Human Rights PerspectiveNatasha Altina,b,∗aDalla Lana School of Public Health, University ofToronto, Health Sciences Building, 155 College St., 6th

floor, Toronto, ON, M5T 3M7, CanadabInternational Centre for Disability and Rehabilita-tion, University of Toronto, Rehabilitation SciencesCentre, 500 University Ave, room 845, Toronto, ON,M5G 1V7, Canada

Background: Despite a social advancement in thenotion of disability and the identification of the as-sisitve technology (AT) as a human right by the UnitedNations Convention on the Rights of Persons withDisabilities (UNCRPD), the constructs of the medi-cal model of disability still underlie many of today’s

Part 9: Policy S179

AT policies and practices. With the momentum cre-ated by the Global Cooperation on Assistive Technol-ogy’s (GATE) call for user-central redevelopment ofAT systems, an important question arises of how to ad-dress the structural discriminations rooted deep withinthe existing AT systems and re-frame these systemsto reflect users’ decision making over the resourcesthat impact their lives. A possible answer lies in crit-ically examining and re-framing the existing AT sys-tems through a human rights perspective.Method: This paper draws on the United Nation’sHuman Rights Based Approach (HRBA) to explore aparadigmatic framework shift necessary to advance ATsystems to best serve its intended beneficiaries. TheHRBA is a conceptual framework that seeks to under-stand and address the root causes of systemic problemsby analyzing implicit inequalities and discriminationswithin the existing systems.Key results: The application of the HRBA to AT, shiftsthe way AT and AT systems are conceptualized. AHRBA framework positions AT as a tool that respondsto human diversity and fosters an inclusive society. Itfurther conceptualizes AT system as a system that aimsto maximize social inclusion and the exercise of equalrights through user-driven AT provision. Furthermore,the application of the HRBA to AT, redefines unequalpower-relations and establishes new roles and relation-ships between:

1. people with disabilities (PwD) as rights holders andactive members of society – who can make theirown decisions and claim their rights to AT and

2. government bodies as duty-bearers - who are ob-ligated to respond to PwD claims and fulfill theirrights to AT.

Transformation of the power-relations illuminates dis-crimination and injustices within the current AT sys-tems which stems from the outdated conceptualizationof disability rooted deep within existing AT policiesand practices.Through the identification of systemic discriminationwithin the current AT system and through recognizingPwD as key actors in the decision making process thatimpacts their lives, the HRBA:

1. empowers PwD to challenge inequities within thecurrent AT systems;

2. emphasizes the responsibility of the governmentbodies to respect, protect and fulfill the right ofPwD to appropriate AT.

Conclusion: The HRBA brings forward a novel per-spective to the AT field as it focuses on recogniz-

ing structural causes behind the inadequate AT sys-tems and addresses these by transforming the unequalpower-relations between PwD and government bodies,thus stimulating a fundamental change within AT sys-tems. However, in order to translate HRBA efforts tomeaningful actions, it requires a deep political knowl-edge of AT context, mapping of actors and alliances,and understanding dynamics of policies that preventeffective enjoyment of AT rights. The effectiveness ofHRBA application to AT and its proposed potential re-quires collaboration with and ‘buy-in’ from those whocurrently have power.Keywords: Human rights approach to AT.∗Corresponding author. [email protected]

“Equipping, Empowering, enabling”: Center-staging Assistive Technologies in Disability and Re-habilitation Policy Discourse in IndiaShweta Sharmaa, Rajib Dasguptab and RavinderSinghcaDepartment of Non-communicable Diseases, IndianCouncil of Medical Research (HQ),V RamalingaswamiBhavan, Ansari Nagar, New Delhi 110029, IndiabCentre of Social Medicine and Community Health,Jawaharlal Nehru University, New Delhi 110067, In-diacDepartment of Non-communicable Diseases, IndianCouncil of Medical Research (HQ),V RamalingaswamiBhavan, Ansari Nagar, New Delhi 110029, India

Background: Global demographic and epidemiologi-cal transition reflects an upsurge in NCDs, ageing andinjuries with manifold rise in disabilities and func-tional impairment. World Health Assembly Resolution(2018) called for greater emphasis on Assistive Tech-nology (AT) including strengthened data, policy, stan-dards and investments. South-East Asia (SEAR) hasthe second highest prevalence rate of moderate disabil-ity (16%) and third highest prevalence rate of severedisability (12.9%), as per the World Disability Report(2011). The 2011 Indian census recorded 2.21% of thetotal population (26.8 million persons) as Persons withDisabilities (PwDs). WHO estimates indicate 90% ofthe PwDs have no access to ATs; the inability to affordand maintain ATs result in exclusion, poverty and in-creasing burden on affected families/communities, es-pecially in low and middle income countries.This review is a critical analysis of the evolution ofcontemporary global mandates and priority areas in AT

S180 Part 9: Policy

research; and, how the Indian Council of Medical Re-search (ICMR) plans to align Indian research and pro-grammatic priorities along the global dialogue.Method: Policy review and analysis was undertakenby a three member inter-disciplinary team of pub-lic health experts, selected by the ICMR’s Disabilityand Rehabilitation Unit. Key international and nationaldocuments of the last ten years including policy doc-uments, reports, WHO technical papers, academic ar-ticles and advocacy pieces were reviewed and triangu-lated.Key results: The results have been divided in two subsectionsA) Emerging priorities articulated across global and

national agenda which need to be addressed bypolicy decisions and revised research strategies –A review of global and national type and qualityof data on estimates of unmet need found it to be-ing complete and fragmented. To bridge the gap inpolicy and practice a comprehensive national pol-icy for people with disabilities and functional im-pairments was identified to strategically channel-ize available resources. Program priorities for ATsought to address both service provisioning as wellas research; and to establish linkages across pri-mary, secondary and tertiary levels of care.

B) India specific initiatives undertaken by ICMR Dis-abilities or functional impairments need to be treat-ed/managed as distinct epidemiological entities,for which ATs constitute the core intervention (forrehabilitation). The AT industry as well as thepolicies regarding its design, manufacturing, mar-keting and provisioning is evolving in India. TheWHO recommends a distinct program for ATs thatneeds to take account of demand, manufacturing,standards, availability, affordability, reach, main-tenance and sustainable use. The ICMR plans toalign its research priorities as per the internationalconventions and WHO recommendations; nationalpriority areas for research were also identified.

Conclusion: Research for ATs needs to take into ac-count demand, manufacturing, standards, affordability,reach, maintenance, and sustainability. Public healthcare systems and sub-systems requires comprehensivepackage for disabilities and functional impairmentsattributed to ageing, NCDs, mental health disordersand injuries along with prioritizing cost-effective ap-proaches in LMICs. Strategy should not be just aboutavailability of devices or technologies but compre-hending the complex lived experience of the PWDsacross age, socio-economic groups and shaping a flexi-

ble and sustainable system that is equitous to this vastlydisadvantaged group.Keywords: Assistive Technology, India, Policy,LMICs.∗Corresponding author. E-mail: [email protected]

Access to Assistive Technology in Hungary – Whatis (Not) Done About it?Nora Menich∗

Deparment of Social Policy, Faculty of Social Sciences,Eötvös Loránd University, H-1117 Budapest, PázmányPéter sétány 1/A, Hungary

Background: There are almost 500.000 people whoconsider themselves disabled in Hungary. There is noavailable statistical data regarding the number of peo-ple in need for an assistive device, although 1.5 mil-lion people, 15% of the whole population face diffi-culties in everyday-life activities based on the latest(2016) available representative, self-reported data. Thenumber of people in need for an assistive device is in-creasing as the population ages and most of them are inneed of financial support to access: families which in-clude at least one person with disabilities earn 15 per-cent less in average than a family without a disabledmember and the risk of social exclusion and poverty is22 percent higher among people with disabilities thanin the non-disabled population. What kind of assistivedevices and related services does the Hungarian stateprovide, for whom, under what eligibility conditionsand why? The presentation will conclude the partial re-sults of a doctoral research (2017–2020) which will ex-amine the role of the state in assistive technology pro-vision in Hungary compared to 4 other European coun-tries (IT, DE, DK, UK).Method: The PhD research focuses on the role ofthe state in Hungary, the examined variables are leg-islation, financing, provision and control concerningAT accessibility. The methods used for the presentedHungarian study are qualitative: besides the literaturereview, comprehensive legislation analysis, sociolog-ical professional interviews and user interviews weremade. The thesis will include sociological illustrativecase studies about Italy, Germany, Denmark and theUnited Kingdom which can demonstrate good prac-tices or, in any event, different patterns of accessibil-ity. With the exception of Hungary, the case studies arebuilt upon ongoing short study trips to the foundingmember institutions of the European Assistive Tech-nology Information Network.

Part 9: Policy S181

Key results: It was found that there are large inequali-ties between Hungarian people who can afford a prod-uct themselves and the ones who need financial sup-port to do so. One of the most important human rightsis flouted depending on the financial status of the user:freedom of choice. There is a national list of medi-cal aids, those can be granted through social insurance,but the list has not been updated for ages meaning theISO 9999:2003 is used. The provision system is ob-solete and there appears to be a considerable obstacleto modernize it: the financial-economic aspects appearto have precedence in policy-making over professionaland user-orientated considerations. The greatest losersof the obsolete system are people with communicationdisorders and severe disabilities as well as people withmental health conditions and children.Conclusion: The presented section of the PhD re-search is the first analysis of the Hungarian AT provi-sion on the field of social policy that creates the pos-sibility of international comparisons. The study pointsout significant inequalities in accessibility which cancontribute to forming the main indicators of the na-tional policy-making.Keywords: assistive technology, accessibility, socialpolicy, service delivery, Hungary.∗Corresponding author. E-mail: [email protected]

Young women, Disability and Technology: A Sur-vey Study from the RISEWISE ProjectAyþe Ulu Yalçınkayaa,∗, Mustafa Alperen Kursuncub,Federica Imperialec, Valentina Fiordelmondod, ZeynepSümera and Evert-Jan HoogerwerfdaDepartment of Educational Sciences, Middle EastTechnical University, 06800 Ankara, TurkeybDepartment of Educational Sciences, Ordu Univer-sity, 52200 Ordu, TurkeycSimAv, University of Genoa, Via Antonio Pastore 3,16132 Genoa, ItalydAIAS Bologna onlus, Piazza della Pace 4/a, 40134Bologna, Italy

Background: The “RISEWISE”-project (Horizon2020, GA690874) investigates barriers that womenwith disabilities meet in their life. Technology can ei-ther be an enabler or a barrier for them. Within theproject a survey was carried out to investigate the re-lationship between technology and disability and tocompare the perceptions of young women with (WD)and without disabilities (WW).

Method used: The survey, targeting women belongingto the digital generation (age between 15 and 29 yearsold), was developed in English and translated in threelanguages (Italian, Spanish, Turkish) to obtain a crosscultural data set. The survey consists of 234 items indifferent sections: autonomy, frequency of technologyuse, satisfaction with technology, software, apps andsocial media preferences, confidence in using smart-phones, interaction with technology, benefits and im-pact of using technology, barriers for technology use,support needs and perceptions regarding gender differ-ences in technology use. The survey was administeredto the participants online. Non-random, snowball sam-pling was used in data collection between September2018 and March 2019.Key results: Preliminary results arise from 228 womenthat have completed the survey, of which 27 byWD’s: (motor (6), visual (14), hearing (2), emotional-relational (1) and multiple (4)). Bivariate correlationsamong variables showed that for the entire group thereis a significant positive relationship between frequencyof technology use and level of satisfaction (r = 0.83,p < 0.01), expected benefits (r = 0.31, p < 0.01)and empowerment (r = 0.28, p < 0.01). As the per-ceived benefits of using technology increase, there is asignificant increase in empowerment (r = 0.80, p <0.01), in needs and wishes regarding technology (r =0.41, p < 0.01) and in support needs (r = 0.44,p < 0.01). No significant differences were found be-tween WD and WW, except in the main areas of feltempowerment: both indicated “education” and “infor-mation gathering”, while WD highlighted also “em-ployment” and WW “communication”. Further, WDindicated “to find more appropriate solutions for myneeds”, “to have better skill in using technology” and“to have more information about the options” to bestrongly related to their needs regarding technology.The barriers that prevent technology use are differentfor the two groups. WD mentioned the lack of sup-port from public institutions, accessibility issues andlack of information and support while WW mentionedlack of time, money and interest. WD expected sup-port mostly from paid experts, AT centers and produc-ers/companies. Both groups agree that gender differ-ences between men and women impact on the purposeof using technology, the choice and the intensity of use.For both groups, society “as a whole” is to blame forthe underrepresentation of women in technology re-lated disciplines and careers.Conclusions: In terms of confidence, frequency oftechnology use and positive attitudes towards technol-

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ogy use there does not seem to be a big difference be-tween WW and WD. Both groups do not hesitate to en-gage with technology and benefit from it. Nevertheless,there are differences in information and support needs.This might indicate that if this support is not provided

many women with disabilities may remain excludedfrom fully benefiting from technology.Keywords: Women with disabilities, Digital divide,Risewise project, Empowerment, Gender.∗Corresponding author. E-mail: [email protected]


Part 10: Digital Health

Telehealth Product and Service Design for an Age-ing PopulationMalcolm Fisk∗

Centre for Computing and Social Responsibility, DeMontfort University, Gateway House, The Gateway,Leicester, UK

Background: This paper draws on research under-taken within the European Commission funded PRO-GRESSIVE project (www.progressivestandards.org)on ‘Standards around ICT and Active and HealthyAgeing’. The project ran from 2016 to 2019. It raisedawareness of design imperatives relating to productsand services that are useful when accessed by or pro-vided for older people. The focus in this paper is ontelehealth i.e. ‘the means by which technologies andrelated services concerned with health and well-beingare accessed by people or provided for them at a dis-tance’. Within telehealth’s remit are services and tech-nologies from social alarms and telecare to the Internetof Things (IoT), smart homes and wearables.The paper signals some shortcomings in telehealthproduct and service designs that can be a consequenceof patronising or ageist beliefs about older people; orarise through overly commercial orientations. Somecommercial orientations may be associated with a viewof older people as a ‘market’ to be exploited rather thanas contributors to economic and social life (as workers,carers, entrepreneurs, innovators and leaders).Method: The paper explores ethical issues that shouldappropriately be taken into account for telehealth prod-uct and service design if the position, needs andchoices of older people are to be properly under-stood. It undertakes a comparative analysis of the ‘eth-ical tenets’ determined (following consultations witha ‘task force’ comprising seven older people con-vened by Age Platform Europe) in the PROGRES-SIVE project, alongside other ‘frameworks’ and themethodologies that underpinned them such the PUX(Personal User Experience) guidelines (deriving fromthe work of the European Innovation Partnership on

Active and Healthy Ageing); the Age of No RetirementIntergenerational Design Principles; the ISO 26000guidelines on ‘Social Responsibility’; and the work ofthe European Commission programme for ‘Responsi-ble Research and Innovation’.Key results: The key outcome of the comparative anal-ysis is a succinct ethical framework for telehealth thathas wider relevance for health and related social careservices. The framework is considered in relation to a‘telehealth change imperative’ that seeks to harness, inpositive ways, the disruptive impact of new technolo-gies; and to facilitate people’s access to and adoptionof such technologies (and use of services) in new ways.Conclusion: The paper argues that an appropriate eth-ical approach can underpin the role of telehealth inshaping future health services. It affirms that there isno ‘doomsday’ scenario of unsustainable services ora ‘burden of care’ because of the growing number ofneedy older people. Instead there is an opportunity fortelehealth, subject to design considerations, relating towhich

– through day to day technologies (smart phones, TV,wearables, etc.), older people are empowered bytheir access to information, employment and learn-ing opportunities, social networks and more – in-cluding telehealth products and services;

– interoperable, accessible, usable, safe and otherwisewell-designed telehealth products and services areavailable in ways that minimise intrusion and affordcontrol by the older people who might wish to usethem; and

– social norms are adopted that incentivise older (in-deed, all) people to build their health literacy andengage in the management their health and relatedlifestyles.

Keywords: Telehealth, Standards, Ageing, Ethics, De-sign.∗Corresponding author. [email protected]


S184 Part 10: Digital Health

A Digital System Supporting Effective RemoteMulti-agency Home VisitsFabio Ciravegnaa, Natalie Jonesb, Vitaveska Lanfran-chia, Jennifer Readc, Emma Simpsonb, Claire Revitte,Colette Fegand, Sarah Storeyg, Amber Wildf and PeterCuddc

aDepartment of Computer Science, University ofSheffield, Sheffield, UKbSheffield Teaching Hospital NHS Foundation Trust,Sheffield, UKcSchool of Health and Related Research, University ofSheffield, Sheffield, UKdDepartment Allied Health Professions, Sheffield Hal-lam University, Sheffield, UKeStroke Pathway Assessment and Rehabilitation Cen-tre, Sheffield, UKfSheffield Health and Social Care NHS FoundationTrust, Sheffield, UKgSheffield City Council, Sheffield, UK

Background: Unnecessary delayed discharge is a ris-ing systemic problem. The total of delayed days in theUK has increased by 52% between 2014 and 2017,the majority being related to patients with chronic orlife-changing conditions awaiting for a care package tobe organised at home. Sheffield Teaching Hospital fo-cuses on the “discharge to assess” paradigm, where pa-tients are transferred to a community setting and thenassessed. This requires mechanisms to coordinate thecare between city council, hospital, social care etc. thatincorporate services that select, install and support as-sistive technology.Method: We created a telepresence prototype to se-curely perform remote home assessments, sharingof notes, recording/taking photos across services. AtAAATE 2018 we presented the initial prototype. In thispaper, we describe the final prototype developed fol-lowing a series of stakeholders focus groups and PPIs.The process requires the patient, a registered volunteeror a relative based in the patient’s home to connect viaa smartphone to the Hospital. Video connection is pro-vided via the browser, no app installation or subscrip-tion needed. The patients will receive a link to a web-page via text message or email. Clicking on the linkwill open a direct video communication with the ser-vice provider. During the visit, the operator is in fullcontrol of the remote phone and camera, being able toturn on/off the flash (torch mode), flip the camera, takescreenshots and videos, zooming in and out to appreci-ate details, etc. All data (notes, pictures, etc.) are storedsecurely on a central server.

The system also supports physical home visits by en-abling taking pictures and writing notes that are thensent to the central server, therefore becoming a onestop shop for all discharge information for both physi-cal and remote visits. As the visit may involve differentservices beyond the hospital (e.g. care homes, socialservices, city councils, etc.), the technology supportssimultaneous participation of multiple users from mul-tiple locations. That can include remote family mem-bers. This enables:1) sharing of essential care planning and information

among services;2) user engagement and personalisation of care, th-

rough the ability of involving patients and remotefamily/carers in decision making;

3) an easy channel for post-discharge follow-up.Key results: We contribute to the “discharge to assess”paradigm by enabling effective remote visits, informa-tion sharing and continuity of care. We enable patientsand carers to fully participate in a delicate phase of thedischarge process.Conclusion: We present a system for remote visitssupporting effective remote multi-agency home visits,streamlining the service, making patient and familyinvolvement a corner stone of the discharge processhence improving quality of care and outcome of theprocess.Keywords: discharge to assess, remote monitoring, re-mote visits.∗Corresponding author. E-mail: [email protected]

ProACT: Person-centred Digital Integrated Carefor Adults Aged 65 Years and Over, Living withMultimorbidityJohn Dinsmorea, Emma Murphya, Mary Galvina,∗,James Sheerinb, Lorraine Tompkinsb, Evert-JanHoogerwerfb,∗, An Jacobsc, Cora Van Leeuwenc, Myr-iam Sillevis Smittc, Valentina Fiordelmondob, LorenzoDesiderib, Patricia Sheridand, Karen Coand, SuzanneSmithd and Julie DoyledaTrinity Centre for Practice and Healthcare Innova-tion, Trinity College Dublin, School of Nursing andMidwifery, D’Olier Street, Dublin 2, IrelandbAIAS Bologna onlus, Piazza della Pace 4/a, 40132Bologna, Italycimec-SMIT, Pleinlaan 9 second Floor, 1050 Brussels,BelgiumdNetwellCASALA, Dundalk Institute of Technology,Co. Louth, Ireland


Background: At present in Europe there are 50 mil-lion people living at any one time with multimorbid-ity. However, our healthcare systems have not beendesigned to effectively support these people in theirdaily care needs. ProACT (Integrated Technology Sys-tems for ProACTive Patient Centred Care) is a digi-tal health research programme funded under the Euro-pean Union Horizon 2020 framework that seeks to ad-dress this problem by developing and evaluating a dig-ital integrated care system to support older adults (65years and over) living with multimorbidity. This pre-sentation will outline the main findings of the ProACTproject where the daily experiences of participants liv-ing with multimorbidity were captured and respondedto through the design of digital health solutions.Method: Vital to ProACT, was eliciting the voicesof people living with multimorbidity as well as thevarious people caring for them (formal/informal care-givers, health care practitioners). A co-design method-ology was adopted, making these stakeholders activeparticipants in the design of ProACT. Across Irelandand Belgium the following was conducted over a 42month project period; a qualitative user requirementsstudy (n = 124 stakeholders); co-design workshopsand usability testing (n = 60 stakeholders); a 12 monthlongitudinal, action research proof of concept trials (in-volving n = 120 patients and their care networks).The primary trial sites were also supported by a trans-fer site in Italy consisting of 15 people with multimor-bidity (PwM) and their care network, and a Europeantransferability study was conducted to assess cultural,social, infrastructural, and political determinants foradoption and scalability of the system Traditional qual-itative research techniques were combined with user-centred design methodologies to support the design,development and implementation of the ProACT digi-tal system.Key results: The main findings from the project willbe presented, including the main themes that emergedfrom: the initial user requirements gathering (impact ofmultimorbidity; self-management; medication; knowl-edge, information and education; sources of support;communication; training; and technology); the co-design workshops and usability testing, which en-sured that the ProACT technologies were designedto respond to previous themes; and finally results ofthe PoC trials, including themes pertaining to self-management, the ProACT ecosystem, integrated care,and empowermentConclusion: Conclusions will demonstrate how dig-ital health solutions can improve home-based inte-

grated care, supporting older people with multimorbid-ity to live independently in their community. Further-more, this project illustrates how using existing Hu-man Computer Interaction (HCI) and behavioural sci-ence methodologies can improve the design, develop-ment and implementation of digital assistive technolo-gies focused on older adult self-management of healthand well-being within multi-stakeholder and diverseecosystems of care and support.Keywords: Digital Health, Behaviour Change, Multi-morbidity, Digital Integrated Care, Ageing.∗Corresponding author. E-mail: [email protected]

Advancing Home-based Integrated care for Olderadults with Multiple Chronic Conditions: Prelimi-nary Results from the Italian ProACT trialArianna Gherardinia,∗, Lorenzo Desideria, Lisa Ces-arioa, Massimiliano Malavasia, Valentina Fiordel-mondoa, Carlo Montanaria and Evert-Jan HoogerwerfaaAIAS Bologna onlus, Piazza della Pace, Piazza dellaPace 4/A, 40134 Bologna, Italy

Background: A key challenge for healthcare systemsin Europe is to improve best practices around the pro-vision of continued, well-coordinated, person-centredcare for older adults with multimorbidity (OAM). Atpresent, however, most health systems still focus onsupporting a single disease framework of care, thus re-sulting in suboptimal outcomes for the health servicesusers. ProACT is an EU-funded project aimed at de-veloping and evaluating an ecosystem to integrate awide variety of new and existing digital technologiesto improve and advance home-based integrated carefor older adults with multimorbidity, including asso-ciated co-morbidities. In detail, the ProACT kit inte-grates a wide variety of new and existing technologiesto improve and advance home-based integrated care forolder adults with multimorbidity with a view to (1) im-prove self-management of chronic conditions, (2) pro-mote behavior change, and (3) increase integration be-tween and within health & social services. This studyreports on the evaluation of the ProACT kit in the Ital-ian context with a view to collect preliminary informa-tion on its usability and acceptability.Method: The study followed a mixed quantitative-qualitative research design. In this contribution we re-port on the qualitative data collected. A total of 10users (age range 65–83 years) were asked to use theProACT kit in their homes on a daily basis. The basicProACT kit included the following devices: a smart-


watch, a digital weight scale, and a digital blood pres-sure monitor. A tablet was given to the users to al-low the visualization of the readings from the devices.Health professionals were also given the possibility toread each users’ reading from a dedicated web inter-face. After 1 month of use, users participated in two fo-cus groups to assess their views and experiences aboutthe ProACT kit. A thematic analysis was conducted onthe transcripts.Key results: Three main themes were identified toexplain how ProACT can facilitate self-managementand behavior change as well as identifying the bar-riers to its adoption: Context, Process, and Outcome.The Context domain encompasses individual, family,and environmental factors. The process domain refersto procedural aspects of self-management, includingspecific behavior change strategies (goal setting, self-evaluation, and self-monitoring). The outcome do-main includes short-term outcomes, such as success-ful symptom management and changes in health be-haviors, which over time might result in distal out-comes, including reduced health system utilization andcosts. To understand the potentials of ProACT to fos-ter integrated care for people four dimensions of inte-gration were further identified: Organizational, Func-tional, Service and Clinical.Conclusion: The context in which this study was car-ried – as well as potential users of digital health tech-nologies - seems to be ready to accept digital trans-formation of health and social services, providing thattechnologies are considered as a support to human ac-tivities and not merely substitutes. Technology shouldbe designed taking into account diverse users’ abilitiesand needs that can change over time. Context-relatedfactors driving the organizational change needed toease the adoption of digital health devices by all stake-holders need to be identified.Keywords: Integrated care, ageing, digital health, be-havior change∗Corresponding author. E-mail: [email protected]

Why do Dutch Older Adults Use Online Commu-nity Care Platforms, or Not?Sarah Willarda,b,∗, Marieke Spreeuwenberga,b, Erikvan Rossuma,b, Nadine Spiertsa and Luc de Wittea,caCentre of Innovative Care and Technology (EIZT),Zuyd University of Applied Sciences, Henri Dunant-straat 2, 6419PB, Heerlen, The NetherlandsbSchool CAPHRI, Care and Public Health Research

Institute (CAPHRI), Faculty of Health, Medicine andLife Sciences, Maastricht University, Maastricht, TheNetherlandscCentre for Assistive Technology and Connected Heal-thcare (CATCH), University of Sheffield, Sheffield, UK

Background: The ageing of the Dutch populationhas led to healthcare reforms in which local govern-ments encourage older adults to age-in-place and toself-manage their (health)care, if possible in collabo-ration with their social network and community. Priorresearch indicates that online communities can havea positive impact for older adults on civic participa-tion, maintaining and developing social relationshipsand the exchange of various forms of social support.An example is an online community care platform(OCC-platform). Via OCC-platforms older adults canaccess applications that aim to support civic and so-cial participation. The current study explores a DutchOCC-platform implemented through an intensive user-centered process that took more than a year. Despitethe efforts to implement this platform that fulfilled userrequirements and conformed to important prerequisitesdistinguished by previous research, it was barely usedby older adults. The purpose of this study was to gaininsight in the experiences of older adults with the plat-form and their motives to adopt or reject it.Method: In this qualitative study, three panels of olderadults (N = 16) were interviewed in focus groups:1) digitally skilled platform users, recruited online viathe OCC-platform, 2) digitally poor platform users, re-cruited via a course about digital skills, and 3) non-users, who were members of a local activity-basedgroup which was intensively involved in the implemen-tation process but nonetheless chose not to use the plat-form. The Consolidated Framework for Implementa-tion Research (CFIR) was used for the developmentof the interview guide and during the directed contentanalysis of the collected data.Key results: The user-panels indicated that they barelyused the platform and that it did not have any positiveimpact on their civic or social participation. Further-more, all panels (users and non-users), predominantlygave motives for rejecting the OCC-platform, whichwas seen as: 1) externally developed, not accessibleor user friendly and its information content as eitheroutdated or as not matching expectations; 2) merelyproviding information one-sidedly and not as a two-way communication platform for facilitating civic andsocial participation; 3) intended for other people thanthemselves, i.e. “we are not old or frail”. Finally, the


non-users explained their lack of engagement in theimplementation process due to interference and influ-ence of other stakeholders; the (implementation of the)OCC-platform was not viewed as a self-made choicebut rather as imposed on them by professionals andmunicipality-agents.Conclusion: The OCC-platform was largely rejectedwhilst it conformed to the user(-interface) require-ments. Users were intensively involved in its devel-opment. We expected the platform to be usable, ac-cessible and functional. The results invalidate theseexpectations. This raises fundamental questions abouthow to co-create such platforms and how to make surethey are used. Working with end users in the develop-ment process doesn’t guarantee that the product actu-ally meets a felt need. Future recommendations are: 1)to perform a comprehensive holistic study on the innersetting of a given community and 2) to employ ’out-of-the-box’ methods to accomplish the latter, such as‘Co-creation’ and ‘Design Thinking’.Keywords: ageing-in-place, online community plat-form, social network, civic participation, social support∗Corresponding author. E-mail: [email protected]

Opportunities for Multimedia Tools to ConnectCare ServicesNatalie Jonesa,∗, Peter Cuddb, Claire Revitta, EmmaSimpsona, Jennifer Reada and Colette FegancaOccupational Therapy Department, G Floor, SheffieldTeaching Hospitals NHS Foundation Trust, 10 GlossopRoad, Sheffield S10 2JF, UKbFaculty of Medicine, Dentistry and Health, School ofHealth and Related Research, University of Sheffield,Sheffield, UKcSheffield Hallam University, Sheffield, UK

Background: Making use of digital technologies tosupport delivering AT through a remote service is oc-curring somewhat haphazardly. The rehabilitation fieldis already advancing remote services and its applica-tion in AT services needs to catch up.ATs can be useful tools for meeting support needswhen people are discharged from acute care. In manynations multiple care providers, other agencies, familyand friends form the network of stakeholders in deter-mining needs and solutions. The who, the way and thewhat of the services involved vary across diseases anddisability. The nett result is that real world services arecomplex and often service users cannot directly partici-pate in decision making, and AT needs to be considered

alongside other interventions. Previously work has ex-plored digital multimedia tools facilitating communi-cation and sharing in the network but from the perspec-tive of acute service discharge to people’s own homes.Now what the technology could empower within cur-rent services, involving the perspectives of the commu-nity services and agents, is being investigated.Method used: A collaborative and co-production qual-itative approach is being employed. All the main stake-holder service providers within one city (3) are partof the team and guiding the engagement of their staff(N = 45–75) in focus group based workshops(3); inwhich, after introduction to the technology they canspeculate and suggest how it might be useful in theirroutine practice. A synthesis from the workshop datawill be reviewed by the project team and by serviceusers. Indeed throughout service users have been andare being consulted to express their perspectives onthe usefulness and acceptability of services/uses beingsuggested. All the stakeholder groups contacted so farhave staff enthusiastic to take part – both in the collab-oration and in the workshops. Three workshops havebeen held, 52 attended, this included members of ac-tively supporting non-governmental organisations.Key results: Whether service users (needing AT) havetheir needs assessed before discharge or at dischargefrom acute care having the direct involvement of theservice users is highly desirable.Preliminary analysis of the workshop data indicatesthat there are many potential novel uses and some sug-gestions for modifications to the technology have beenidentified; as expected there are some concerns aboutsecurity and data governance. This approach is effec-tive in triggering inventive and critical thinking forthe use of AT in clinical practice. Early on the con-sultations outside the workshops have been important.For instance, the perspective of the social care serviceprovider is very different and will significantly impactour final findings.Conclusion: Embedding the research and develop-ment through involving stakeholders is empoweringto answering real world challenges. However it alsomeans that the challenges are more significant. None-theless, the positive attitudes and responses to involve-ment in the project are encouraging that multimediatools will be acceptable to staff and there is an opportu-nity to improve intra- and inter- service operations anddelivery of AT solutions.Keywords: Multi-media tools, remote services, co-production, digital, communication.∗Corresponding author. E-mail: [email protected]


A Systems Approach to the implementation of anational model of Assistive Technology Service De-livery: Challenges and Opportunities Designing forthe future: A Systemically Viable Assistive Technol-ogy Service for Disabled and Older People in Ire-landJoan O’Donnell, Siobhán Long and Pierce RichardsonEnable Ireland, Ireland

Background: Irish Assistive Technology services havebeen under-resourced and inequitable by comparisonwith Australia, Finland and Denmark. This researchsought to understand service delivery across education,health, employment and independent living, identifygaps, and establish the cost benefit of AT provision.The research sought to develop a systemically viablemodel for a coherent service, in a world characterizedby Volatility, Unpredictability, Complexity and Ambi-guity (VUCA), where public budgets are in flux, andtechnological advances are rapid, that understood thecomplexity of disability as a “wicked problem”.Method used: Soft Systems Methodology guided asystemic inquiry into current service levels: this in-cluded 15 stakeholder interviews and two group con-sultations using World Café methodology with 57 par-ticipants across state service providers, AT users, ther-apists, makers, academics and industry. Participantsself-selected as members of a community of practicefor AT. In accommodating the worldviews of differ-ent stakeholders, it became clear that a multifacetedapproach was required that was flexible enough to re-spond to the complexity of disability and the diversityof people’s circumstances and AT needs. It would needto encompass the whole journey from assessment toprovision, training and follow up support. 3 case stud-ies of individuals in different life situations were de-veloped to establish a rationale for the cost benefit ofan adequate AT service. They indicated the potential

for significant savings if people are supported via ATto engage in education, work and live independently.Key results: A qualitative analysis of current servicesindicated discrepancies in service provision and bud-gets nationally: there was a lack of clarity on howbudgets were spent and the employment support bud-get was under-utilised. There was little evidence ofcooperation across departments resulting, for exam-ple, in difficulties for people transitioning to take theirAT from school to work. The research also indicatedvery different understandings of the relevance of AT:the Department of Education is forward looking in in-troducing AT at preschool level, yet in work supportmechanisms are outmoded. Collaboration between dif-ferent agencies is limited, with little political under-standing of the potential of Assistive Technology.Conclusion: The research confirmed that Ireland’s ATservices were sufficiently underdeveloped and siloedto require the design of a coherent national model. Weproposed the development of an eco-system to create acomprehensive service to include a policy commitmentfrom central government and a Central Co-ordinatingAgency to take ownership of procurement, funding,co-ordination of service provision, training and infor-mation provision and create space for innovation in thisdomain. Included, is the concept of the AT Passport - asingle resource to support Assistive Technology usersto access the supports they need. The current politicaland policy environment points to an urgent need forthe design of a central resource at a strategic govern-ment level. This is systemically desirable and is on thecusp of becoming an idea “in good currency”. We alsopostulate that it has the potential to lead the way in re-defining approaches to addressing other complexitiesof living with a disability in a climate-change world.∗Corresponding author. E-mail: [email protected]


Part 11: User Participation

Co-creation of Assistive SolutionsJorge Gómez Sanz, Rubén Fuentes and Juan Pavón∗

Facultad de Informática, Universidad Complutense deMadrid, 28040 Madrid, Spain

Background: The working hypothesis is that collab-oration of experts to define Ambient Assisted Living(AAL) solutions for people with disabilities is oftendifficult because the lack of a common language thatwould allow each one to state what is the problem andthe solutions from their point of view. The interlinguathat is proposed here is the use of videos, which arebased on the use of simulations of daily living situa-tions and technological solutions that can help to im-prove such situations. The communication among par-ticipants uses these simulations to support their under-standing and discussion of the setting, and participantsprovide their observations in terms of modificationsand annotations on these simulations. This workflowof interactions would facilitate arriving to a consensuson the problem’s definition and the assessment of thesolutions.Method: The approach is multi-disciplinary as it in-volves the participation of different specialists (engi-neers for implementing the solutions, sociologists, psy-chologists, social workers) as well as the care givers(in many cases also relatives) and the end users. Thereis a combination of different methodologies from so-cial sciences and software engineering. The flexibilityof the process is supported by model-driven engineer-ing techniques. This allows generating the simulationsfrom graphical models that specify their different as-pects (e.g. the activities or the space).Key results: (1) A web-based collaborative platformthat facilitates the discussion and agreement among ex-perts with different profiles. (2) Case studies that willillustrate the use of the platform for modelling disabil-ities that are related with neurodegenerative processes.(3) Modelling languages that are adapted to expertsof different specialties, in order to formalize existingknowledge in AAL that is normally partially recorded.

(4) A catalogue of typical behaviours of persons andsimulation elements that can be reused. (5) Guidelines,collaboration recommendations, and examples for us-ing the platform and visual methods for the creationand validation of new scenarios.Conclusion: The software tools have been distributedas open source and a website shows several casestudies: http://grasia.fdi.ucm.es/hackwithpeople/. Thisplatform supports a collaborative development of AALsolutions, with collaboration of all the interested stake-holders (e.g. final users, relatives, caregivers and ex-perts). The use of videos as a mechanism to understandand discuss on the problem and present solutions hasshown to be more effective than other traditional engi-neering tools (e.g., diagrams, technical specifications).Keywords: Ambient Assisted Living, Simulation, Vir-tual Living Lab, Co-creation.∗Corresponding author. E-mail: [email protected]

Hackcessible: Towards a new model for stimulatinguser-led innovation in Assistive TechnologyAejaz Zahida,∗, Peter Mylonb and Simon WheatcroftcaInnovation Hub, SYB Integrated Care System, 722Prince of Wales Road, Sheffield, UKbiForge Makerspace, Faculty of Engineering, The Uni-versity of Sheffield, Sheffield, UKcDepartment of Computer Science, The University ofSheffield, Sheffield, UK

Background: In recent years Co-Design or Participa-tory design methods have been mentioned by numer-ous researchers and developers as a preferred frame-work for product or service design and increasinglyby those involved in assistive technology development.With increasing democratization of design and fabrica-tion tools, we are also seeing many instances of assis-tive technology users themselves innovating solutionsfor their own needs globally and in many cases shar-ing these solutions online in an open source manner.Furthermore, hackathons and make-a-thons addressing


S190 Part 11: User Participation

disability needs are gaining popularity the world overas a means to stimulate new innovation in assistivetechnology by leveraging the skills of the maker com-munity, students and technology developers in a veryshort and intense timeframe. The authors have partic-ipated in and studied numerous models of such con-centrated events focused on disability innovation andfound significant gaps in need finding, user involve-ment and post-event sustainability of projects. The au-thors propose a new model for a disability focusedhack/make-a-thon that brings together elements of par-ticipatory design and user innovation, along with aframework for sustainable technology & enterprise de-velopment beyond what is typically a weekend longevent.Method used: We present a case study for a hackathon/make-a-thon, along with a carefully curated pro-gramme of pre- and post-hackathon workshops thathave been designed to both facilitate user led innova-tion and create opportunities for sustained technologydevelopment. In addition, at every stage of the process,we have surveyed participants to assess the effective-ness of this model.Key results: Under this model over 75% of participat-ing teams have developed prototype solutions that havebeen taken forward for either commercialization or asopen source assistive technology projects.Conclusions: By facilitating a collaborative user-ledinnovation approach between a diverse team of tech-nology developers and technology users, and througha sustained process of co-learning, co-design and co-creation, we have developed a new model for stimulat-ing and accelerating assistive technology innovation inhackathons that results in a greater probability of suc-cessful outcomes.Keywords: Hackathon, Assistive, Co-Design, Co-Creation, Participatory∗Corresponding author. E-mail: [email protected]

Study on How Health Care Service Providers To-gether with Industry Partners Can Co-design Ac-cessible Assistive Technology for Individuals withIntellectual Disabilities (ID)John Owuora, Sarah Gavra Bolandb,∗, Aine Walshc

and Peter GallagherdaASSISTID Fellow, ALL Institute, Maynooth Univer-sity, County Kildare, IrelandbLiffey Services, John of God Community Services clg.Cookstown Way, Tallaght, Dublin 24, IrelanddSaint John of God Hospitaller Services, Stillorgan,Co. Dublin, Ireland.

Background: The global drive to promote inclusion ofpeople with intellectual disability (ID) into communityliving has had significant progress in the educational,social and occupational fields. The availability of qual-ity digital education has been suggested in the litera-ture to enhance the access of adults with ID to soci-etal goods and their rights, enabling them to becomeactive citizens. However only 1 in 10 people with dis-ability who need assistive technology (AT) has accessglobally. For people with intellectual disability (ID),the proportion of those who need AT that have accessremains unknown. This study aimed to offer evidenceon how AT can be co-designed between health careservice providers and technology industry partners tosupport social inclusion for people with ID. The studylooks at an Erasmus+ funded Project DESKTOP withsix EU country service providers working with Fun-dación Vodafone España, to co-design and build an ac-cessible app Mefacilyta, to assist independence withdiverse and transitioning service providers.Method: The study used a cross-sectional comparativequalitative investigation focusing on the central issueof the role of AT in facilitating social inclusion andboosting equality for people with ID. Data were col-lected using face to face interviews between January toJuly 2017. Observations were used to complement anyverbal data gathered through interviews. The study in-volved participants with diverse communication abili-ties, making it impossible to solely rely on interviewshence the use of mixed methods. Literature review wasused to synthesize existing knowledge on how AT en-hances social inclusion (access to services and inter-personal relationships)Key results: The Mefacilyta App enabled the users toimprove their ability to carry out various tasks withreduced support requirements. AT was seen to signif-icantly empower its users to improve their indepen-dence and wellbeing. It was important to see how openthe technology builder, Fundación Vodafone España,were to engage with the end users of the tool to ensureit was suitable for all. Participants in the present studywere not only able to use the App to learn life skillsbut were also involved in how to improve the app toenhance usability enabling them to perform tasks thatwould have previously relied on support from others.One example how the users influenced the tool can beseen in the adoption of a more accessible calendar fea-ture that now has text to speech integration. These ad-ditional features supported the autonomy of the users,it was a great boost for their self-esteem, sense of well-being and community inclusion.


Conclusion: Assistive technology can support inclu-sion for people with ID, particularly if there is collabo-rative co-development between all relevant stakehold-ers to ensure needs-based solutions. But access and us-age barriers need to be overcome. Technology devel-opers need to work directly with people with disabili-ties to co-design accessible solutions. Further researchis needed to explore how best to ensure stakeholderengagement particularly how-to co-design with peoplewith severe levels of ID.Keywords: Co-Design, Assistive Technology, digitaldivide, user centered design.∗Corresponding author. E-mail: [email protected]

Assistive Technology Users at the Coal Face of Con-fronting Intrinsic Design Issues in their AssistiveTechnologyBernard Timminsa,∗, Siobhan Longb and LorraineD’ArcycaLecturer at School of Mechanical & Design Engineer-ing, City Campus TU Dublin, Dublin, IrelandbNational Manager, Assistive Technology and Seat-Tech services Enable IrelandcLecturer at School of Civil and Structural Engineer-ing, City Campus TU Dublin, Dublin, Ireland

Background: At the Technological University ofDublin a Product Design programme students, andmembers of the Disabled Community (Assistive Tech-nology users) have teamed together to create a uniquemultidisciplinary learning environment for AssistiveTechnology and Universal Design. Finally, this paperwill show the outcomes of various student feedbackshighlighting the observed benefits of this approach.Method: Having discussed design with AT Users stu-dents realise very quickly that AT devices are not the‘panacea for all ills’. Indeed the challenges of using‘off-the-shelf’ generic AT devices becomes immedi-ately clear, as people with varying degrees of disabil-ity experience difficulty adapting to and using thesegeneric devices. Remarkably there is a reported aban-donment rate of 78% for certain AT technologies. Stu-dents are encouraged to keep this notion of abandon-ment very much in mind when they are developingtheir design concept, and they are encouraged to (andsupported by Enable Ireland) engage with both clientsand staff, to seek their feedback, on their emerging de-signs. The students have complete freedom with theAT design, but are expected to draw upon theoreticalconcepts delivered in class in order to support their

ideas. It is expected that the design will be responsiveto client’s needs.Key results: An important aspect of this multidisci-plinary approach is that everyone involved recognisesthat people with disabilities have the same aspirationsto independence as their peers, this partnership soughtto address the inequalities that exist in some productdesign which limit their use, and to identify novel de-sign concepts which would enhance autonomy and in-dependence for participants and for the wider commu-nity. interact extremely well with clients, and developgood working relationships. Clients report favourablyon students, and enjoy the special attention that theproject confers upon them. As a result, successivegroups of students are encouraged by their commu-nity engagement and have been inspired towards com-munity engagement/design after graduation. During asurvey the students answered the following question:“How much has this experience changed your percep-tions of design?” The mode response was 100% andthe average response was 83%. In this journey fromtheory to practice, through engagement with clients,students learn about responsive design.Conclusion: This approach has outcome and impact,both on the student and the community that is pervasiveand far-reaching. While on the one hand the outcomesof this element of the module appear modest (prod-uct design), the enactment of this results in a powerfuland emotive journey for the student, one that not onlypromotes learning in the real world, and engages andempowers community partners, but has fostered thedevelopment of influential partnership across industryand practice. Through the fostering of community rela-tions, and building relationships between industry andthe third level organisation that this module has cre-ated, pathways have been developed that pave the wayfor the Engineering community to positively engagewith AT design and national disability services that canhave far-reaching consequences and raise awareness ofthe need for Universal Design.Keywords: Universal Design, Community, Engage-ment, Assistive Technology, Enable Ireland.∗Corresponding author. E-mail: [email protected]

Enabling User-centered Design and Evaluation toIncrease Acceptance of Wearable Robotic AssistiveTechnologiesJan T. Meyera,∗, Olivier Lambercya and RogerGasserta

S192 Part 11: User Participation

aDepartment of Health Sciences and Technology, ETHZurich, Switzerland

Background: With wearable, lightweight and moreaffordable robotics on the rise, new opportunities fordaily life assistance for people with neuromuscular dis-orders become available. However, the successful ap-plication of a device stands and falls with the respec-tive user experience and technology acceptance. Un-fortunately, the majority of promising research proto-types underestimate these obstacles or fail to considerthe human factors confounding assistive technologyusage. User-centered design (UCD) of assistive tech-nologies has shown to remarkably increase user experi-ence. An intensified target population interaction withearly prototypes can potentially provide valuable in-sights to overcome the gap between in-lab testing andclinical or home application. However, understandingand analyzing user experience is not yet sufficientlyestablished, lacking clear guidelines and standardizedmeasures. This generates difficulties to define require-ments and assess device performance, especially in theemerging area of wearable robotics. There is a need tosimplify and enable the user-centered evaluation anddesign of assistive technologies to successfully tacklethe prominent acceptance limitations.Method: We propose a UCD framework for wearablerobotic assistive technologies, addressing three spe-cific aspects currently limiting the success of UCD de-sign processes: (i) planning and preparation, (ii) con-text and needs assessment and (iii) user testing andevaluation. To understand the current limitations ofUCD, surveys are being conducted with developmentexperts, health care professionals, caregivers as well asend-users and their next of kin. With this collection andrepository of knowledge, an improved understandingand assessment of user needs in the context of deviceusage can be proposed. Through contextualization,we define required stakeholder involvement milestonesduring development and achieve a more targeted selec-tion of user experience measures. A UCD toolbox se-lecting and proposing standardized outcome measuresfrom an online database is currently being established,with the aim to define comparable evaluation protocolswith appropriate measures fitting the context of use. Apreliminary version of the UCD framework was testedto evaluate and redesign the physical human-robot in-terface of the VariLeg powered lower limb exoskele-ton, involving two experienced paraplegic users.Key results: The UCD framework under developmentaims to provide standardized, context-specific outcome

measures to (a) assess end-user experiences (b) iden-tify key limitations and (c) provide more generaliz-able usability results when testing wearable robotic as-sistive technologies. The enhanced feedback from theevaluation phase can be used to further refine the con-text and needs assessment and initiate the next designcycle. In our research with the VariLeg gait exoskele-ton, this has shown to facilitate target population in-volvement and motivated the iterative design of indi-vidual interface components, leading to an increase of45% in the perceived usability, measured by the Sys-tem Usability Scale (SUS).Conclusion: Acceptance limitations of novel assistivetechnologies are aimed to be tackled with a simplifiedUCD approach. Maximizing user experience relativeto the context of use can help to close the gap betweenin-lab testing of research prototypes and real-life appli-cation in daily usage. This can not only increase devel-opment efficiency but, more importantly, increase thequality of life of those in need of technological support.Keywords: User-centered Design, Assistive Technol-ogy, Wearable Robotics, Usability Evaluation∗Corresponding author. E-mail: [email protected]

Benefits Beyond ExperienceVivienne Conway∗ and Amanda MaceWeb Key IT Pty Ltd, 10 Tonrita Place, Wanneroo, WA6065, Australia

Background: Many organisations provide digital ac-cessibility services. Management generally view ac-cessibility as benefiting a handful of their user group.They question the ‘Return on Investment’ on moneyspent on accessibility compliance. When an organisa-tion truly embraces accessibility, not only do we meetlocal legislative and International human rights obliga-tions, but we reduce costs, and build our internal ca-pacity for design and innovation. Clients become ourpartners in building for universal design and build part-nerships with their customers, continually creating de-lightful user experiences. In our observation of variousorganisations and their approach, we have located a setof characteristics of the organisation taking the roadless travelled to embrace accessibility organisation-wide.Method used: Our work is observational, based uponexperience with a broad range of clients from federalgovernment to not-for-profit. Using our Digital Acces-sibility Maturity Model (DAMM), and working withorganisations we assess their placement on the DAMM


from 0 – no knowledge/application to 5 – embed dig-ital accessibility into all projects, products, processesand business management. The characteristics and ex-perience of the mature organisation demonstrate thereare benefits in becoming accessible beyond that of thepractical interaction of the user with disabilities.Key results: The organisation placing highly on theDAMM looks beyond a technical compliance/checklistmentality. Compliance is only as good as your abil-ity to ensure that the philosophy is embraced and allnew content is tested to ensure compliance. There willalways be issues out of your control – such as user-generated content and difficulty locating accessiblethird-party products. The mature organisation incorpo-rates best practices into its culture and practice, mak-ing it part of their standard operating procedure. Theyprioritize people with disabilities when making designdecisions. Accessibility is integrated into training andeducation programs. They test to ensure that users ofassistive technology are able to have a seamless ex-perience, as equivalent as possible to that of the per-son without disability. When accessibility is viewed bythe mature organisation, they see benefits beyond that

of the user’s individual experience. When a user has agreat (accessible) experience, it is not just the fact thatthey are able to accomplish a task. One example is theuser tester who had such a good experience with a lo-cal government website she stated “it made me wantto move there”. There are benefits beyond user experi-ence, such as public relations, customer referral, lead-ership and reputation. The organisation approachingthe more mature end of the continuum by incorporat-ing diversity into their hiring practices, ensures all dig-ital material is accessible, and looks for ways to showleadership.Conclusion: The more mature organisation, sees thebenefit of incorporating the needs of all of their usersinto their design as well as into other aspects of theirorganisation. They realize that meeting the needs ofpeople with disabilities allows them to create a betterexperience for all of users. They approach accessibil-ity as an opportunity to create a new and more satisfy-ing type of interaction with their user – one that goesbeyond compliance with a standard.∗Corresponding author. E-mail: [email protected]


Part 12: Internet of Things

Universal Controller: An Open Source SoftwareDevelopment Promoting Connectivity with Assis-tive Technology Devices and the Internet of ThingsI. Radcliffea,∗, F. Boyceb, H. Dengc, B. Hodossya, M.Lavrova, M. McCoola, T. Seowb, R. Tana, Y.S. Tana,J. Tsod, S.K. Yia and B. MaireaDepartment of Bioengineering, Imperial College Lon-don, South Kensington, London SW7 2AZ, UKbDepartment of Mechanical Engineering, ImperialCollege London, South Kensington, London SW7 2AZ,UKcDepartment of Electrical & Electronic Engineering,Imperial College London, South Kensington, LondonSW7 2AZ, UKdDepartment of Computing, Imperial College London,South Kensington, London SW7 2AZ, UK,eWooden Spoon, Sentinel House, Ancels Business Park,Harvest Crescent, Fleet, Hampshire, GU51 2UZ, UK

Background: The Assistive Technology (AT) marketwill surpass $26 billion by 2024 (Forbes, March 2017),with over 1 billion people globally requiring assistiveproducts. This sizeable market is wide ranging anddisparate due to the diversity of the end user needs.Successful development and application of AT prod-ucts for people with disabilities is made difficult by thecomplexities of the market.The Internet of Things (IoT) equipment market is es-timated to be $520 billion by 2021 (Forbes, August2018). The explosive growth of the IoT is due to itspotential to connect things-to-things, people-to-thingsand people-to-people. However, few IoT developmentstake into consideration people with disabilities. Thereare IoT connectivity solutions available for some prod-ucts but there is a lack of connection with AT InputDevices. Hence, the benefits of IoT are still yet to beleveraged to its maximum potential in promoting inde-pendent living.There is a need for an open source software packagecapable of linking AT Input Devices to any connectabledevice using programmable settings to allow flexibil-

ity for users. Such a system would enable the devel-opment of new AT devices and provide accessibility toIoT devices for people with disabilities.Method: At the request of children’s charity WoodenSpoon, a multidisciplinary team of undergraduate stu-dents at Imperial College London developed an opensource software platform to allow the control of outputdevices via a variety of AT Input Devices in a plug-and-play fashion. The software is built as a web or desktopapplication so can be used on any computer or smart-phone. Users can use their own specific input devicessuch as buddy buttons, puff and suck switches or eyetrackers to control a variety output devices all via oneapplication.Key results: Three demonstration projects were devel-oped using the system to show its potential:

1. Control of a Phillips smart lamp,2. Interaction with Alexa using a Tobii eye tracker to

type commands,3. Control of a robotic arm using an AT joystick

through the interface.

A demonstration was run for the staff at the Ace Cen-tre, a charity specializing in AT, this provided positiveand insightful feedback which highlighted the impor-tance of accessibility of the system settings and en-abling customization by the user to meet their needs.These concepts where then were integrated into the fol-lowing iteration of the system. The feedback indicatedthat the system would have value to users, developersand suppliers.Conclusion: A platform technology has been devel-oped which enables the connection of conventional ATInput Devices, such as joysticks and buddy buttons,with IoT connected Output Devices, such as smartlamps and robotic arms. The aim is for this softwareto be released under an open source licence to allowusers free access to it and to promote further develop-ment and connectivity within the AT field. A success-ful proof of concept demonstration was delivered in thefirst phase of this project with three examples of its ap-


S196 Part 12: Internet of Things

plication. The development is to continue in partner-ship with the Apperta Foundation.Keywords: Control, Open Source, IoT, Connectivity.∗Corresponding author. E-mail: [email protected]

Implementing an IoT Based Task Analysis Systemto Promote Autonomy in Daily Hygiene of Adultswith Autism in a Residential HouseFederica Sommaa,∗, Angelo Regaa, Onofrio Gigliottaa

and Giuseppina NappibaDepartment of Humanistic Studies, University ofNaples Federico II, Naples, ItalybAIAS Onlus, Nola, Naples, Italy

Background: The Internet of Things, IoT, has beenincreasingly gaining attention in educational contextsbecause it allows to connect physical objects througha network to enrich users’ experience. Recently, par-ticular attention has been placed to wearable objects,accessorizes provided with intelligent devices, such asbeacons: usually bluetooth devices able to transmit andreceive signals within short distances. IoT can improvethe lives of people with disabilities. A good quality oflife must include the possibility of being independentin all contexts and activities such as personal hygiene,dressing and undressing activities, moving in space.Unfortunately, autonomy is often lacking in peoplewith autism.To support the learning process of daily living activi-ties of people with autism, it is important to facilitate atask, for example through a task analysis that analyzesand describes the sequence that composes an action, inthe logical order for its correct execution. Our purposeis to verify whether wearable intelligent objects, com-plemented with a task analysis system, can be used, ina residential context, to facilitate everyday hygiene inindividuals with severe autism.Method: Participants will be 2 adults with severeautism. A single-subject study was chosen because it ismore suitable for the development of technologies forsevere disability. The experimentation will take placein the Residential Section of the A.I.A.S. Center (Nola,Naples), which offers a suitable housing solution. Theessential tools for the study will be the beacons, pro-duced by the Estimote company and already used in thecenter, and 1 10-inch tablet containing a software fortask analysis. The task analysis will consist of a sub-division into small steps of daily hygiene tasks, suchas brushing teeth. Whenever the participants will en-

ter the bathroom, the tablet will retain the sensor signaland activate by playing on the tablet videos of all stepsof the task. The participant will be able to observe thesequence and asked to reproduce it.Key results: We expect that the beacon system, com-plemented with the task analyses software, will facil-itate the daily hygiene skills of participants with se-vere autism, thus favoring their personal autonomy,and gradually helping them to generalize these skills inother contexts.Conclusion: Internet of Things will impact on our ev-eryday life. Those who already have some devices,connected to the Internet, already appreciate the pos-sibility to remotely control their own home devices.However, we think that more advantage can be gainedby people with special needs.The purpose of the residential structure is to implementa global therapeutic, rehabilitative and educational lifeproject. The use of the IoT system allows the personto take advantage of the help of the surrounding en-vironment for accomplishing his specific task withoutrelying on the human operator. The final goal of ourwork, however, is to promote independence also fromour system, in fact, once individuals will succeed intheir tasks the artificial support will be gradually re-moved to let them back to their usual contexts with newskills.Keywords: IoT, Task Analysis, ASD, Beacon, Reha-bilitation.∗Corresponding author. E-mail: [email protected]

The use of Internet of Things (IoT) and AssistiveTechnology (AT) in developing ‘Smart Homes’ forhealth and social care in the UKGeorge Nightingalea,∗, Tahira Resalata,∗, SimonNga,∗, Dan Habbershawa,∗, Germayne William-Sylvestera,∗ and Aejaz Zahid b

aCohort 2017, Sheffield Engineering LeadershipAcademy, The University of Sheffield, Sheffield, UKbCentre for Assistive Technology and ConnectedHealthcare, The University of Sheffield, Sheffield, UK

Background: Consumer smart technology is a rapidlygrowing industry and becoming increasingly present inour day to day lives. The convenience this presents ishugely beneficial, but it can be utilised in a far morevaluable way; to increase the independence of indi-viduals with physical or cognitive disabilities in theirhomes, as well as monitor their lifestyle to assist in

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their care. However, using this technology in an assis-tive way to build an ecosystem of smart devices andsensors using Internet of Things (IoT) technology isan unfamiliar concept, unknown to both health and so-cial care providers and the general public. The digi-tal infrastructure required to realise this idea is alsonot currently available to the majority of regional careproviders in the UK. This paper presents a case studywhere assistive technology and IoT are being used toaddress the challenges of providing health and socialcare in Barnsley Metropolitan Borough Council.Method: The aim was to simulate a smart-home testbed that can demonstrate to care providers across thecountry, the capability of consumer IoT technologiesand the benefit they provide to increasing the qual-ity of care. Initially, interviews were conducted withmembers of Barnsley Council and health and socialcare professionals, as well as research to explore themultifaceted capabilities of consumer technologies toaid with lifestyle monitoring and residential assistance.Key target areas were identified based on the propor-tion of resources being spent on health and social care.Within this study, a scale physical model of a smarthome was created, containing sensors to mimic cur-rent consumer technology. This model house served asa testbed that facilitated easy and quick simulation ina number of configurations. These sensors were eval-uated on their ability to fulfil the monitoring needsof patients with frailty, dementia, learning disabilities,and mental health issues. A feasibility case was alsobuilt to help catalyse the process of implementing thesenew technologies amongst the services of healthcareproviders across the country. Finally, an IoT digitalframework was designed which would be accessible toprospective patients and social care bodies, working ona feedback loop system to provide information aboutthe optimum technology available to suit each need.Conclusion: The future of residential healthcare maylie within the optimisation of AT using IoT. In thisstudy, we are developing this through linking a digitalIoT framework with data collected from a simulatedsmart home environment. Although this study is onlythe first step towards a more efficient system, we be-lieve that IoT may be integral to providing patients theindependence they may not currently be receiving.Keywords: IoT, residential-healthcare, smart-technol-ogy, lifestyle-monitoring, alzheimer’s∗Corresponding author. E-mail: [email protected]

Waking-up in the Morning: A Gamified Simulationin the Context of Learning Activities of Daily Liv-ingPolyxeni Kaimaraa,∗, George Miliotisb, IoannisDeliyannisc, Emmanuel Fokidesd, Andreas C. Oikon-omoue, Agnes Papadopoulouf and Andreas Florosga,b,c,f,gDepartment of Audiovisual Arts, Ionian Uni-versity, Tsirigoti Sq. 7, 49100 Corfu, GreecedDepartment of Primary School Education, Univer-sity of the Aegean, 1 Dimokratias str., 85132, Rhodes,GreeceeDepartment of Education, School of Pedagogical andTechnological Education (ASPETE), Papanastasiou13, 54639 Thessaloniki, Greece

Background: The degree of child independence in Ac-tivities of Daily Living (ADLs) is crucial for parents,caregivers, educators, and therapists. Achieving basicskills is vital not only for children with developmentaldisabilities but also for typically developing preschool-ers and primary school students. People with develop-mental disorders often have difficulties while perform-ing ADLs, (e.g. dressing, cooking, cleaning and per-sonal hygiene), whose acquisition leads to increasedindependence; therefore teaching focuses on convey-ing functional skills.The relevant literature suggests that children with de-velopmental disabilities face the following difficulties:

– comprehension of symbolic play and pretense– low imagination level– resistance to changes to their environment or daily

routines– limited ability to identify with others– trouble applying what they have learned to real life

Three instructional approaches are commonly appliedto promote daily living skills: (1) in-vivo instruction,(2) video-based instruction (VBI) and (3) computer-based intervention (CBI). The problem with all threeapproaches individually is that application of taughtskills to real life is very difficult for children with alimited ability to identify with others.In order to overcome this difficulty, we are designingand developing an interactive simulation game called“Waking-up in the Morning” with image fidelity to en-sure natural representation and better transfer of skillsto real-world conditions. Our research questions arelisted below:

– can the game function as educational material in thecontext of ADLs, both for students with special edu-cational needs and their typically developing peers?

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– can gaming become the bridge between children re-gardless of their cognitive profile, promoting collab-orative learning through peer-mentoring?

At this stage, alongside the game development per se,several of its aspects are examined (e.g., gamificationtechniques and interface design), taking into accountusers’ evaluations and feedback (students with de-velopmental disabilities and typically developing stu-dents) and game design experts.Method: Our main goal is to investigate transme-dia learning in inclusive conditions through gami-fied content that combines the three instructional ap-proaches (in-vivo instruction, VBI and CBI), tradi-tional gaming modes and cutting-edge technologies:cards, virtual/augmented reality and 360◦ interactivevideos. VR-enabled headsets, laptops, tablets, smart-phones and interactive whiteboards will be used, de-pending on the player-learner’s characteristics. Our lit-erature review establishes the benefits that emergingtechnologies bring to individuals with special educa-tional needs, as well as obstacles they face in the use of

VR devices, which are necessary to support novel gam-ing methodologies. The target group combines typi-cally developing children aged seven years old andindividuals with developmental disabilities of similarmental age. The simulation game will be tested in in-clusive environments in general schools.Conclusion: The purpose of this paper is to presentour alternative approach, game design and productionfor teaching ADLs using cutting-edge technology. Inthe near future, we will examine if the proposed sim-ulation game can be used to support different learningstyles and differentiated instruction. The ultimate goalof the research is to suggest good practices in the fieldof gamified and highly interactive digital learning ma-terials for the implementation of inclusive education.Keywords: Activities of Daily Living, Interactive360◦ Game, Simulation, Transmedia Learning, Vir-tual/Augmented Reality.∗Corresponding author. E-mail: [email protected]


Part 13: (e)Accessibility

Accessibility Equals InnovationVivienne Conway∗ and Amanda MaceWeb Key IT Pty Ltd, 10 Tonrita Place, Wanneroo, WA6065, Australia

Background: For people with disabilities, assistivetechnology (AT) is a necessity. AT is often pro-hibitively expensive for people with disabilities, es-pecially new technology. If we can influence creatorsof AT of the opportunities for innovation through aUniversal Design approach, the lives of people withdisabilities will be improved, and appeal to a largersegment of users. While AT has largely come aboutthrough innovation to solve a particular need, that in-novation has provided benefit for an unintended groupof users. AT is largely seen as confined to people withdisabilities, however, incorporating Universal Designprinciples broadens the commercial potential, makingit more affordable. Developers should understand thatmeeting a particular user group’s needs, provides anopportunity to benefit a larger user group. The role ofUniversal Design in AT, encourages design for a wideraudience, encouraging innovation and enabling moreeconomic solutions for accessibility issues.Method used: We observe AT employed by our usertesters, and see that what is essential for them, is nowbeing used for different purposes. Technology such aseye-tracking and voice-activation software, was devel-oped for people without the use of their hands to workwith digital material. Eye-tracking is now being usedto predict user behavior to determine the best place-ment of material. Voice activation, is being used byprofessionals, decreasing the time and cost of dicta-tion/transcription. The principal of Universal Designshows that developing technology that will be usableby a broad group of users broadens the commercial po-tential for the technology, which may lower the costand ensure better support than technology intended formore specific audiences.Key results: Developing AT for people with dis-abilities has led to opportunities for innovation. Not

only does the wheelchair ramp benefit someone in awheelchair, it also benefits the mother pushing a pram.Global initiatives, such as the WHO’s GATE programare looking to provide access to assistive technologyfor everyone, enabling the person to lead the type oflife they wish. Embracing innovation which benefitsthe wider society, benefits more than people with dis-abilities. Incorporating the concept of Universal De-sign to create more accessible digital environmentsneed not diminish the emphasis on the needs of peoplewith disabilities. Enforcing accessibility meets with re-luctance, though it is intended to make life better forpeople. If we were to change the motive for develop-ing products to meet a wider possible audience, therewould be greater commercial interest, and hence moreinnovation to assist users with disabilities.Conclusion: AT is not a ‘nice to have, for a minor-ity of people’, it is a necessity for many. IncorporatingUniversal Design principles into AT development pro-vides an opportunity to develop products that delight awider audience, while also meeting the needs of peo-ple with disabilities. The practical implication is that ifwe change our mindset about the audience for technol-ogy advancement for people disabilities, we have anadded commercial incentive to sell products that im-prove lives for a wide range of people.∗Corresponding author. E-mail: [email protected]

Complex PDF Remediation for Accessibility: Re-view of Current MethodologiesValentín Salinas LópezInstitut Integriert Studieren, Johannes Kepler Univer-sität Linz, Altenberger Straße 69, 4040 Linz, Austria

Background: There is a growing demand to remedi-ate complex non-accessible PDF. For instance, school-books which are required to be accessible and show awide variability in their morphology. A problem liesin the existence of an extensive bibliography of digi-


S200 Part 13: (e)Accessibility

tal teaching material that are delivered using PDF notaccessible. Currently the tasks involved in making aPDF accessible are expensive due that many of themhave to be performed manually. Among these, struc-turing PDF content is especially time-consuming. Tag-ging i.e. associating a label to each significant elementof the document, is a prime example thereof, as it is ofuttermost importance in order to enable assistive tech-nologies, such as screen readers or accessible forms formotor disabled people that do not use analog pointingdevices. The question that arises is whether it is possi-ble to make this process cheaper. To do so this tries toidentify the current needs in the remediation procedureto enable a following research about improvements.Method: In a first stage, a comparison is made be-tween the current PDF reading and authoring tools.The selection criteria for the software to be comparedis, its popularity and it must be intended for an individ-ual user using a PC. This filter keeps out little-knownsoftware that professional of the document accessibil-ity remediation seldom use, and also online remedia-tion services that often not to allow public access totheir internal procedures.In second stage, it is chosen one tool. With this, it isanalyzed the procedure to make PDFs accessible. Theeffort is measured using the amount of steps, the num-ber of user interactions to achieve each step and theobstacles and inconsistencies found in the workflow.The documents used in the second stage are non-accessible PDF schoolbooks. Since these meet the re-quirements of complexity and need for remediation.Key results: Acrobat Reader DC is chosen after ana-lyzing the comparative. The main reasons are that Ac-robat is de facto desktop application for working withPDFs, other software describe a procedure for remedi-ation quite similar or need the use of Acrobat in somesteps. It worth mention that many analyzed tools arenot able to accomplish completely the procedure ofmaking accessible PDFs.Results show that Acrobat is not optimized for ac-cessibility remediation. The user has to perform com-plex manual actions very often. Automations offeredby the software are useful and save time and effort,but fail when the complexity of the document increasesslightly. Many times, correct the results of the automa-tions involve doing greater effort actions than the nec-essary ones to accomplish procedure in a completelymanual manner.Conclusion: The process of fix the accessibility ofPDFs can be improved using a tool designed specif-ically for this purpose. Acrobat DC may be a good

choice for the remediation of documents with simplestructure, but not in other case mainly because poor re-sults of the automated task. Therefore, there is roomfor future improvements in the automation of tasks forthe treatment of complex documents.Keywords: PDF, Accessibility remediation, SOTA,tool comparison, teaching material.∗Corresponding author. E-mail: [email protected]

Holistic Evaluation Method and Tools for LocalGovernment Websites Case Study: EEC, ThailandPrajaks Jitngernmadan∗

Faculty of Informatics, Burapha University, 169 Long-hard Bangsaen Rd., Saensook, Muang, Chon Buri,20131, Thailand

Background: Eastern Economic Corridor (EEC) lo-cates in the Eastern part of Thailand, which should fa-cilitate the Thai economy in the long run. Thai govern-ment sets this area to be the heart of national innova-tion and technology development. While the economicaspect is the main target, the social aspect is also im-portant due to the great number of estimated migrantworkers (more than 33,000). Currently, local govern-ments set up their own websites providing informationand e-government services; including relocation, reg-istration, ID card extending, etc.Since the variety of the potential users is tremendous,these websites have to universally usable and acces-sible. There are works tried to evaluate Thai govern-ment websites. However, they only covered evaluationpartially, without consideration of social and economicaspects. The aim is to identify factors that affect theaccessibility, usability, and user experience and com-bining each factor and its testing method into an area-based holistic evaluation method, which covers 4 areasincluding Availability, Mobile Device Readiness, Ac-cessibility, and Usability.Method: The most important 10 local governments’websites are selected for evaluation in our laboratory.The availability is defined through a web contentdownload speed over slow Internet connection, reacha-bility upon multiple requests, web content display abil-ity, and security issue. For testing, a semi-automatictesting toolset was chosen: the Google Chrome De-velopment Tools. These tools are used for differentInternet connection speed simulation, secure protocolHTTPS, and meaningful page load checking. The mo-bile device readiness is defined through meaningful re-

Part 13: (e)Accessibility S201

sponsive web design for small displays. The GoogleChrome Development toolset is used to simulate awebsite in different screen sizes. The accessibility of awebsite is tested using the W3C Markup Validator andWAVE from WebAIM. The first one is used to checkHTML implementation. The latter is used for acces-sibility testing against WCAG 2.0 level AA. Further-more, a color contrast between foreground and back-ground colors is examined. The standardized heuris-tic evaluation for user interface design, suggested byJakob Nielsen, is used for usability testing and it con-tains 10 usability criteria, which is evaluated by ex-perts.Key results: In terms of availability, only 3 out of 10websites passed the speed test, and none of them usessecure protocol. For mobile device readiness, 3 web-sites can be considered as ready due to their meaning-ful responsive design. For accessibility, only 4 web-sites have errors less than 50. Most of them have a highnumber of programming syntax errors. And for usabil-ity, none of the websites can reach the highest score.Furthermore, 60% of the websites use Flash contentonly for decorative purpose.Conclusion: For evaluating local governments’ web-sites by means of supporting economic and social as-pect, different factors and evaluation strategies have tobe identified and tested. We suggest 4 evaluating as-pects (Availability, Mobile Device Readiness, Acces-sibility, and Usability) for local governments in EECarea. The combination of evaluation factors and meth-ods can be used as a standard strategy for evaluation.The next step is to provide a handy toolset and man-ual for standardized Thai local governments’ websiteevaluation.Keywords: Website, Accessibility, Holistic, Govern-ment, Evaluation.∗Corresponding author. E-mail: [email protected]

Usability Assessment of an Accessible Voting Sys-tem – A Mixed Method StudyJoaquim Alvarelhãoa, Nelson P. Rochab,∗aSchool of Health Sciences, IEETA, University ofAveiro, Campo Universitário de Santiago, 3810-193Aveiro, PortugalbDepartment of Medical Sciences, IEETA, Universityof Aveiro, Campo Universitário de Santiago, 3810-193Aveiro, Portugal

Background: Persons with disability have fewer op-portunities to participate in politics, including voting in

elections. There is a lack of information about the par-ticipation levels of persons with limitations in fulfillingthe ballot in paper. Although in some countries it maybe possible to use alternative forms, such as voting ac-companied by another person, there is still no systemto guarantee the person’s independence in completingthe ballot paper in a secret manner. This experimentalstudy aimed to evaluate the usability from the point ofview of the user of an Accessible Voting System (AVS)in a real election.Method: A parallel mixed method study was con-ducted in the Executive Board election of Oporto’sCerebral Palsy Association, Portugal. From the seventytotal voters, thirty-one adults (twelve with CerebralPalsy, GMFCS: I–II = 5; III–V = 7) that choose to voteusing the AVS were included (19 males, aged between24–73 years old). The AVS comprises: (i) a computerapplication with voting options; (ii) visual and auditoryinstructions for the user; (iii) different input methodslike touchscreen or scanning; (iv) different simultane-ous output methods such visual or auditory; and (v) aprinter for produce an individual secret ballot paper. Aquantitative usability assessment was made using PostStudy System Usability Questionnaire (PSSUQ) thatcomprises 19 items (1–7 Likert scale, 1 = better us-ability). In addition to a global score, PSSUQ providesresults in three domains: (i) System Usefulness; (ii) In-formation Quality; and (iii) Interface Quality. Qualita-tive data of persons with Cerebral Palsy was obtainedthrough a structured interview covering: (i) previousexperiences of voting; (ii) what was the sensation ofusing the system; and (iii) recommendations for im-provement.Key results: Global usability score for PSSUQ wasmean = 1.3 (dp = 0.35). For subscales System Useful-ness, Information Quality and Interface Quality scoreswere mean = 1.1 (dp = 0.30), mean = 1.2 (dp =0.55), mean = 1.5 (dp = 0.80), respectively. No dif-ference was found in scores between Cerebral Palsyvoters and other users. In the same sense, no associ-ation was found between PSSUQ results and age orgender. From users with Cerebral Palsy, two never hadvoted before, eight used to vote accompanied by an-other person and two by themselves. The sensation ofusing the system was described as: [A] “System is ac-cessible and practical in use.”; [B] “More autonomy.”;[C] “Easier than manual voting.”; [D] “[. . . ] becauseI went alone, it was good do not have to take anyonewith me, it should be implemented at the national level[. . . ].”; [E] “I felt it was easy to understand.”; [F] “Afreedom, so the vote is ‘more’ secret, nobody knows.

S202 Part 13: (e)Accessibility

Must be this way to vote for the Government.”; [G] “Ifelt I was doing a normal act of citizenship. I think itshould be implemented all over the country.”; [H] “Itwas my first secret ballot [. . . ].”; [I] “I feel very welland comfortable, it’s very easy.”.Conclusion: The results shown a high level of usabil-ity of the AVS and can contribute for this kind of toolsto be made available in national and European elec-tions. Other more in-depth studies should be carried

out, including in other populations, in order to confirmthe results.Keywords: Accessible voting system, Usability as-sessment, Mixed method assessment.∗Corresponding author. E-mail: [email protected]


Part 14: Platform Speeches

Bridging the Gap Between Research and Practice:Investigation of Needs and Characteristics of End-users, for a Future Inclusion of BCIs in AT-centersRiccio Angelaa,∗, Schettini Francescab, Giraldi Enri-coa, Cincotti Feboa,c and Mattia DonatellaaaNeuroelectrical Imaging and BCI Lab, IRCCS Fon-dazione Santa Lucia, Rome, ItalybServizio Ausilioteca per Riabilitazione Assistita conTecnologia (SARA-t), Fondazione Santa Lucia (IR-CCS), Rome, ItalycDepartment of Computer, Control, and ManagementEngineering Antonio Ruberti, “Sapienza” Universityof Rome, Rome, Italy

Background: Brain computer interfaces (BCIs) mea-sure signals related to specific brain activity and trans-late them into outputs to control external devices. It isdemonstrated that BCI can provide people with com-munication disorders with an Assistive Technology(AT) restoring their interaction with the environment.Despite BCI technology could improve inclusivenessof AT solutions, BCIs are not currently available in theAT-centers portfolio. A step forward the inclusion ofBCIs in AT-centers, is their integration with existing(available in the market) assistive or mainstream tech-nologies, resulting in a hybrid BCI-based communi-cation device. The aim of the study is to investigatethe characteristics of patients attending an AT-center,who could take advantage from BCI introduction inAT-centers as an additional/alternative AT channel. Webelieve that a step to bridge the translational gap be-tween BCI development and end-users, consists in theclear definition of users’ characteristics and their abil-ity to control a BCI.Method: Ten patients (43.3 ± 9.9 y.o., 2 men) with dif-ferent diagnosis participated in the study. All patientshad undergone a multidisciplinary evaluation and anAT training in an AT-center, because they were limitedin (at least) one aspect related to interpersonal commu-nication and/or interaction with digital technologies.Protocol consists of two part . i) Need assessment: pa-

tients were administered with the Individual PrioritizedProblems Assessment (IPPA) to investigate their needsand they were involved in an AT training aimed at iden-tifying the AT solution matching them. Patients agreedto participate in the BCI session, which will be per-formed in the next weeks; ii) BCI session: scalp poten-tial will be acquired by means of 16 active electrodes.A P3-speller interface (a matrix of alphabetic itemsrandomly flashing) will be displayed. Patients will beasked to spell words by focusing attention on the de-sired items. The Tobii Technology 4C eye-tracker willbe used to collect eye-gaze data.Key results: Fifty-eight problems in total were iden-tified, with an average of 6 (5.8) problems for partic-ipant (SD = ± 1.9; min = 1, max = 7). Problemsmost commonly reported concerned “reading/writing”(N = 8 patients), “communication” (N = 7 patients)and “phone access” (N = 6 patients). AT solutions in-cluded touch screen (N = 4), head tracker (N = 2)and eye tracker (N = 3) as input channels to controlcustomized user interfaces. Relationship between pa-tients’ clinical and neurophysiologic (ERPs) character-istics and BCI control performance will be reported.Influence of eye-movements will also be reported.Conclusion: In this study, we reported preliminarydata about needs and matching AT solutions of poten-tial end-users of a hybrid-BCI device for communi-cation. The overall aim is to generate profiles of pa-tients that would potentially use the BCI as an addi-tional/alternative channel for AT. With this aim, in thenext step, patients’ performance in controlling a P3-based BCI will be investigated and the relationshipwith user’s characteristics (clinical and neurophysio-logical) will be established. We consider this as an im-portant step for the integration of BCI with daily ATdevices (personalized hybrid BCI) and for BCI inclu-sion in the AT-centers portfolio.Keywords: Brain-computer interface, communication,users’ need, hybrid, eye-tracker.Acknowledgement: This work was partially sup-ported by the Promobilia Foundation (Grant Ref.17137).


S204 Part 14: Platform Speeches

∗Corresponding author. [email protected]

Environment and People Perceptions: The Experi-ence of NEVArt, Neuroestethics of the Art VisionM. Coccagnaa,∗, P. Avanzinib, M. Fabbri Destrob, G.Vecchiatob, A. Banzic, R. Folgieric, V.A. Sironic andS. MazzacaneaaCIAS (Research Centre for pollution control in highsterile rooms), Department of Architecture, Universityof Ferrara, [email protected], via della Ghiara 36, 44121Ferrara, ItalybInstitute of Neuroscience, National Research Councilof Italy, Parma, ItalycCESPEB (Research Institute on the History of Biom-edical Thought), Milan, Italy

Background: For several years, neuroscience has beeninvolved in understanding the neurobiological bases ofhow people perceive their space and every commonactivity and to change organizational and architecturaltools, to brake the existing barrier for a universal de-signed environment. Dues to the difficulties in usingmedical devices outside laboratories, scientists simu-lated their scenarios. The obtained results followed theclassical view of cognitive science, which considersthe brain as a machine that processes stimuli in a hi-erarchical way, at different stages of complexity. Thechance of conducting real field studies is now easierthrough the increasing availability of low size sensorsand wireless networks for EEG and EMG analysis. Thesame for other physical and physiological parameters,such as the tracking of eye movements and the electri-cal conductivity of the skin, closely related to the indi-vidual’s most instinctive and unconscious reactions.Method: The NEVArt project wants to investigate atypical emotional feature, as the evaluation of the artis-tic production and the wide aesthetic involvement gen-erated by the vision of an art work, using a scien-tific approach and a statistically relevant amount ofdata. The research aims also to compare and evalu-ate both the medical and signal affordability of datagenerates by new Wi-Fi tools, often developed outsidethe health field (i.e. video games, meditation skills,mental-physical sport performance, etc). The first re-search step is to analyse how the brain perceive emo-tions in real scenarios, to further exploit this informa-tion improving the architectural environment, the wayof exhibiting art and the approach to people that, duesto their specific background or physical-mental capac-ities, perceive some elements as a barrier or an im-

provement (to understand or to be understood). TheNEVArt research group (including neurologists, engi-neers, architects, psychologists, ICT and art experts)will detect the aforementioned parameters by moni-toring volunteer (at least 600 people) to analyse theirexplicit and implicit reactions using different kind ofsensors, during their visit to the exhibition “Paint-ing affections: sacred painting in Ferrara between the‘500 and the ‘600”’, set up at the Estense Castle inFerrara from 26 January to 26 December 2019. Thestudy database include: records collected by the inves-tigator upstream (crowding, thermos-hygrometric con-text, lighting, noise, etc.), non-sensitive and anony-mous data filled in by the voluntary visitors in thefirst section of a questionnaire (age, schooling, habitof attending exhibitions, interest in the subject, levelof fatigue/initial fatigue, etc.); subjective evaluation bythe volunteer of the works viewed (in the second sec-tion of the survey); the tracks of each analysis toolworn (including the video made in real time with theeye tracker). All data will be uploaded at the end ofeach working day by the investigator, within a pro-tected database (created by CIAS and already used forother similar clinical surveys). All the recorded mate-rials will be periodically analysed and statistically re-elaborated using T-test and ANOVA, by the researchgroup, relating objective data (collected with sensors)and objective data (entered by the participant and theexperimenter), so as to assess the incidence of elementsof agreement and/or dissonance.Key results: NEVArt may provide a framework ofpeople’s physiological, neurological and cognitiveemotional reactions, on a broad statistical basis, duringthe vision of art (now painting but following sculpture,architecture, etc.). The main NEVArt aims are:1. obtain a neurobiological validation of the experi-

ence of aesthetic perception, with particular refer-ence to bodily and mental involvement (neurovege-tative, motor, emotional), both implicit (from EEG,galvanic) and explicit (from survey), facing theartistic work and testing the possibility of calibrat-ing some of these sensory levels (disgust, indiffer-ence, pleasantness, etc.);

2. quantify the intensity and type of instrumental sig-nals recorded as a function of the level of aestheticperception, comparing the obtained results throughmultisensory EEG, EMG and eyetracking tools inreal museum conditions (Scenario A) and with highsensitivity EEG 64 channels sensors, EMG and eye-tracking for a limited number of paintings and usinga low environmental stimulation (Scenario B);

Part 14: Platform Speeches S205

3. to identify the descriptive parameters of the citedexperiences, in order to create a significant scaleto represent the physical, emotional, cognitive re-sponses on external strains, referable to the art vi-sion.

Conclusion: Due to the CIAS experience on large clin-ical surveys, the collection of a huge amount of data it’sextremely useful to consolidate the information col-lected through different sensory channels and diversetools. Using this method, it will be possible to cre-ate a stable framework of information within study re-actions, comparing these background data to similarstimuli by people with specific disabilities. Otherwise,the risk of lack of reliability of records, may confusethe perceptions based on experience and knowledge ofpeople (which is expected to have common variationsamong all participants) with those one arising fromcognitive or sensory deficits. The analysis of a feel-ing perceptions as the “aesthetic pleasure”, it is wellsuited to identify a set of primordial elements that canbe tested and stimulated even in subjects with differentabilities. The research knowledge, both in term of tech-nical skills and upgrade in neuroscientific awareness,will be fundamental to proceed with a set of new re-search topics. These expected improvement (partly im-plemented in parallel with the second stage of NEVArt)

include the sense of smell (i.e. product and environ-mental odours), the didactic field (teaching methodolo-gies aware of vision and perception features), medicalpurposes, in particular improving some past researchof the CIAS about the Parkinson’s disease and somenew studies about the communication with people withspecific cognitive disorders, as Autism, in order to re-late their emotional/physiological/cognitive responseto different external stresses (starting from basic stim-uli as colour, forms, lights, smell, etc.). Expected re-sults also on the exhibit field, to provide suggestions onhow to achieve the best way to display art works, en-hancing the elements with the greatest impact on visi-tors. The environmental field, improving new methodsto measure the subjective response of users to settingparameters (light, heat, cold, etc.) in order to combinethe analysis of objective standards and on the field per-ceptions. In the safety topics, studying the impact ofsensory data to verify the users’ perceptions in emer-gency situations and how to take into account peopleawareness in emergency preparedness, especially withreference to wayfinding and to use of signs, lights andcolours.Keywords: neuroestethics, art, beauty, perceptions∗Corresponding author. E-mail: [email protected]

Policy Session supported by ProAct

Transferability of digital solutions for

Integrated Care (ProAct qualitative research) Maite Ferrandoa,*, Evert-Jan Hoogerwerfb and Asel Kadyrbaevac

a Association for the Advancement of Assistive Technology in Europe, Linz, Austria b AIAS Bologna onlus, Bologna, Italy c European Association of Service providers for Persons with Disabilities, Brussels, Belgium

Background: There is a need for stronger collaboration and integration of services between health and social care

systems. Digital technology, which is a key driver of innovation in the care sector, presents an opportunity to address this

challenge. Over the last decade, several digital platforms have been developed to support the delivery of integrated care

in community settings. Nevertheless, few of them have been scaled up or moved beyond the geographical and/or service

delivery context in which they have been developed, tested and initially deployed. On the contrary, most of the efforts

done so far to develop technology for a more efficient integrated care have provided only ad hoc solutions, thus, limiting

the impact and outreach of the innovations and leading to continuously reinventing the wheel. In addition, this

transferability gap also prevents companies from exploiting and commercializing these solutions.

In order to shed light on the topic, a dedicated research is being conducted by AAATE, EASPD and AIAS in the

framework of the ProACT project (http://proact2020.eu) funded by the European Commission under the Horizon 2020

framework. The referred research, so-called Transferability Study, aims at providing an explanatory model of the (positive

and negative) factors which contribute to the transferability of digital platforms supporting integrated care. The

Transferability model will provide key knowledge and essential insights for policy makers, service providers, end-user

organizations and/or associations of professionals to become active drivers in the successful transfer of digital innovations

supporting care, in general, and integrated care in particular.

Method: The methodology of the research is structured in three interconnected phases with a duration of two years. The

phases cover: desk research, based on the analysis of the state-of-the-art and existing good practices (phase 1); qualitative

research with relevant experts working on the field, in particular those with experience in implementing or scaling up

digital solutions in integrated care settings (phase 2); and a final phase which applies the Delphi methodology to validate

the conclusions elaborated in the previous phases, by involving a wide community of stakeholders (phase 3).

Key results: An overview of the results of the second phase of the above-mentioned transferability study will be

presented, based on the implementation of semi-structured interviews following a qualitative research design. The study

involved 20 experts from 13 different European countries, including several Eastern European countries, invited to

participate due to their knowledge on the implementation of health and social care digital solutions and/or their experience

in transferring integrated care technologies and practices.

Conclusion: Among the conclusions of the interview analysis, there are relevant insights about the key factors involved,

which vary from organisational and structural barriers to instrumental, attitudinal or cultural facilitators influencing the

transferability of the digital solutions. These responses were coded according to the Consolidated Framework for

Implementation Research (CFIR). The experts also refer to the need of standardization in integrated care as a driver for

transferability. These results are a first attempt to provide a deeper and systematized understanding of the barriers and

facilitators to transfer digital solutions

Keywords: Transferability, Digital solutions, Integrated care, CFIR.

*Corresponding author. e-mail: [email protected]

Tweetable abstract: Key drivers and barriers to transfer digital solutions for integrated care. Qualitative research.

CFIR. ProAct case study

mailto:[email protected]

Technology and Disability 31 (2019) S207–S222 S207IOS Press

Author Index Volume 31, Supplement 1

Aarts, S., see Daniëls, R. S72Abe, T., see Manabe, K. S119Ableitner, T., S. Metzl, S. Soekadar, A. Schilling, C.

Strobbe and G. Zimmermann, User Acceptance ofAugmented Reality Glasses for Hand Exoskele-ton Control S128

Abou-Zahra, S. and S. Lee, Cognitive and LearningDisabilities work at W3C and for the Easy Read-ing Project S8

Achille-Fauveau, S., see Parkin, C. S91Achou, B., see Vincent, C. S116Ades, V., see Vella, F. S157Afdhil, N., see Savage, M. S95Agbakuribe, B.C., An Investigation into Pedagogical

and Opportunity Barriers in STEM Education ofVisually-Impaired Nigerians: Why Disabled Peo-ple Must be Involved S21

Aigner, B., see Klaus, B. S143Akamatsu, H., see Iwabuchi, M. S42Akamatsu, K., see Tsujikawa, S. S154Alessa, T., M.S. Hawley and L. de Witte, Smartphone

Apps to Support the Self-Management of Hy-pertension: Identification of the Most SuitableApps S45

Alghaib, O.A., see Holloway, C. S96Allen, M., R.J. Gowran, M. Goldberg and J. Pearlman,

Wheelchair Stakeholders Meeting 2018 – Devel-oping a Global Wheelchair Sector Report withPriority Actions Toward Sustainable WheelchairProvision: Appropriate Wheelchairs, a GlobalChallenge S24

Altin, N., Political factors and assistive technology: AMultiple Streams Framework analysis of assistivetechnology landscape S178

Altin, N., Re-thinking the Advancement of AssistiveTechnology Systems from the Human Rights Per-spective S178

Alvarelhão, J. and N.P. Rocha, Usability Assessmentof an Accessible Voting System – A MixedMethod Study S201

Alvarelhão, J., A. Queirós, M. Cerqueira, A.G. Silvaand N.P. Rocha, A special Needs Course in Un-dergraduate Health Professions: An EvaluationUsing Mixed Methods S158

Amaike, K., see Kitagawa, K. S133Andreoni, G., see Sironi, R. S73Andrich, R., see Pigini, L. S56Andrich, R., see Salatino, C. S172Angela, R., S. Francesca, G. Enrico, C. Febo and M.

Donatella, Bridging the Gap Between Researchand Practice: Investigation of Needs and Char-acteristics of Endusers, for a Future Inclusion ofBCIs in AT-centers S203

Aniyamuzaala, J.R. and N. Layton, International Clas-sification of Functioning, Disability and Healthand the Convention on the Rights of Persons withDisabilities as a Framework for AT Classificationand Categorization S177

Aoki, T., see Iwabuchi, M. S42Aplin, T., see de Jonge, D. S54Arberas, E.J., see García, T.P. S49Ariake, Y., see Yoda, I. S140Arias-Vergara, T., see Vasquez-Correa, J.C. S85Arlati, S., see Spoladore, D. S129Arlati, S., V. Colombo, M. Malosio, S. Mottura, S. Piz-

zagalli, A. Prini, E. Biffi, C. Genova, G. Reni andM. Sacco, A Simulator to Promote the Return toWork of Wheelchair Users S89

Arthanat, S. and A. Messina, What is the pay-off? Us-ability and cost benefit of assistive technology atworkplace S171

Arvai, A., see Sik-Lanyi, C. S150Atoyebi, O.A., see Routhier, F. S117Auger, C., see Routhier, F. S117Ausen, D., see Grut, L. S110Austin, V., see Fineberg, A.E. S95Austin, V., see Holloway, C. S96Avanzini, P., see Coccagna, M. S204Awazawa, H., see Yoda, I. S140Azevedo, L., Play and Augmentative Mobility: the

INMAC (INclusive Mobility for All Children)Vehicle S60


S208 Author Index Volume 31, Supplement 1

Azuma, M., see Uchida, T. S134

Balakrishnan, M., see Upadhyay, V. S126Baldiris, S., see Garzón, J. S67Banes, D., see Draffan, E.A. S41Banzi, A., see Coccagna, M. S204Barajas, F.R., see Barbareschi, G. S97Barbareschi, G., F.R. Barajas, U. Pandya and C. Hol-

loway, Innovate Now: Creating an Assistive Tech-nology Innovation Ecosystem in Nairobi S97

Barbareschi, G., see Holloway, C. S96Barbareschi, G., W. Teerlink, L.P. de Melo and C.

Holloway, Moulding a New Prosthetic ServiceDelivery System with the Amparo ConfidenceSocket S98

Baxter, M.F., see Zapf, S.A. S50Beaudoin, M., see Routhier, F. S117Bech, L., see Wuttke, L. S65Bedaf, S. and L. de Witte, Care Robotics in Europe and

Asia; A Multicultural Perspective S103Beekman, E., see Ummels, D. S44Behar, S., see Krumins, V. S127Benassi, F., see Costanzo, A. S122Bertel, L.B., E. Brooks and S. Dau, Robot-supported

Inclusion and Learning: A Case Study on theKUBO Robot in Early Childhood Education S22

Besio, S., see Giraldo, M. S114Besio, S., What Is Play in Robotics Today? S58Beurskens, A.J., see Ummels, D. S44Bhatnagar, T., see Upadhyay, V. S126Bianquin, N. and D. Bulgarelli, Mainstream Tradi-

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Bianquin, N. and D. Bulgarelli, Mainstream traditionalor robotic toys: Which of them better supportsplayfulness in children with disabilities? S66

Biasin, E. and E. Kamenjasevic, ‘Sharing is Caring’:What are the Main Legal and Ethical Challengesto be Looked at when Codesigning AssistiveTechnologies? S71

Bieker, K., see Zaynel, N. S9Biffi, E., see Arlati, S. S89Black, R., A. Waller and C. McKillop, Presentation

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Blom, A., see Schrevel, S. S74Blot, J., see Parkin, C. S91Bodor, B., see Sik-Lanyi, C. S148Boiten, S., see Fineberg, A.E. S95

Bokaba, N.B., see Tönsing, K.M. S166Boland, S.G., J. Owuor, A. Byrne and P. Gallagher,

Can Accessible Technology Help Person Cen-tered Planning? Exploring the Role of an ICT So-lution to Evidence Value in Service Delivery forPeople with Intellectual Disabilities (ID) S162

Boland, S.G., see Owuor, J. S190Bonarini, A., see Jansens, R. S61Bonarini, A., Simple Robots for Simple Play: Exploit-

ing the Resources in Real Situations S59Booka, M., see Fujisawa, S. S28Borelli, E., see Costanzo, A. S122Borgestig, M. and H. Hemmingsson, Eye Gaze Tech-

nology’s Effect on Participation and FunctionalIndependence S32

Borgestig, M., see Hemmingsson, H. S29Borilovic, J., M. Lovarini, L. Clemson and K.

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Bosse, I., see Edler, C. S15Bourassa, J., see Vincent, C. S112Bourassa, J., see Vincent, C. S116Boyce, F., see Radcliffe, I. S195Braun, S.M., see Ummels, D. S44Bremault-Phillips, S., see Vincent, C. S116Brennera, P., see Zimmermann, G. S39Brooks, E., see Bertel, L.B. S22Brown, C., see Vincent, C. S116Brusadelli, S., see Masciadri, A. S119Buchholz, M., see Derbring, S. S11Buchholz, M., U. Ferm and K. Holmgren, How do

We Provide Necessary Support to Enable RemoteCommunication for People with CommunicationDifficulties? S138

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Bühler, C., see Dirks, S. S13Bühler, C., see Wuttke, L. S65Bukenbergs, S., see Sevit, R. S75Bulgarelli, D., see Bianquin, N. S60Bulgarelli, D., see Bianquin, N. S66Burzagli, L. and P.L. Emiliani, People Moving in a

Smart City S125Buurman, B.M., see Pol, M. S121Byrne, A., see Boland, S.G. S162

Caiado, A., see Encarnação, P. S62


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Cam, D., see Cudd, P. S18Capetillo, A., see Hayhoe, S. S17Cappalonga, F., see Schettini, F. S33Carbone, F., F.D. Cascone, A. Gloria, M. Martorelli,

D. Natan-Roberts and A. Lanzotti, Developmentof an AAC System for a Student with Speech Im-pairment and Spastic Quadriplegia S140

Carew, M., see Holloway, C. S96Carloni, J., see Magni, R. S175Carrizosa, H.G. and S. Hayhoe, Arches Project –

Validation of Technological Outcomes of Gam-ing Software based on a Participative ResearchMethodology S16

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Casimir, E., see Cudd, P. S18Ceccarini, C., see Prandi, C. S80Cerbas, S., see Sik-Lanyi, C. S150Cerqueira, M., see Alvarelhão, J. S158Cersosimo, A., see Lepore, C. S152Cesario, L., A. Gherardini, M. Malavasi, V. Fiordel-

mondo, C. Lepore, E. Hoogerwerf and L. Desideri,Promoting the Use of Social Robots to EngageStudents with Special Education Needs (SEN):Development of a Teacher-friendly App S106

Cesario, L., see Gherardini, A. S185Cesario, L., see Lepore, C. S152Charalambou, C., see Mavrou, K. S68Chatzidimitriadis, S., see Oprea, P. S88Cheban, K., see Gowran, R.J. S25Chen, W., Harnessing MOOCs and OERs in teaching

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Simpson, C. Revitt, C. Fegan, S. Storey, A. Wildand P. Cudd, A Digital System Supporting Effec-tive Remote Multi-agency Home Visits S184

Clemson, L., see Borilovic, J. S55Clifford, A., see Gowran, R.J. S25Coan, K., see Dinsmore, J. S184Coccagna, M., P. Avanzini, M. Fabbri Destro, G. Vec-

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Cocchi, M., see Spoladore, D. S129Cocconcelli, F., see Mora, N. S42Colombo, V., see Arlati, S. S89Colonna, A., see Lepore, C. S152Comai, S., E. De Bernardi, A. Masciadri and F. Salice,

MEP CROWD: Improving Mobility of Users withData and Images of High Quality S78

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G. Tola, GAP REDUCE. A Research Devel-opment Project Aiming at Developing a Tool forPromoting Quality of Urban Life of People withAutism Spectrum Disorder S7

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Conway, V. and A. Mace, Accessibility Equals Innova-tion S199

Conway, V. and A. Mace, Benefits Beyond Experi-ence S192

Corradi, F., see Federici, S. S170Corzani, M., see Danial-Saad, A. S149Corzani, M., see Danial-Saad, A. S151Costanzo, A., F. Benassi, E. Borelli, D. Masotti and G.

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Coutant, R., see Flores, J.Z. S160Craddock, G., D. Rice, C. Doran and L. NcNutt, Uni-

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Paling and S. Pickup, Starting on the InnovationPath for a Fatigue Management App for Peoplewith Multiple Sclerosis S18

Cudd, P., see Ciravegna, F. S184Cudd, P., see Jones, N. S187Cudd, P., see Potter, S. S38

D’Arcy, L., see Timmins, B. S191Dada, S., see Tönsing, K.M. S166Dahlstrand, M.P., see Holmqvist, E. S30


Danial-Saad, A., L. Chiari, S. Laufer, M. Corzani andM. Elboim-Gabyzon, Hand Function in Skills ofModern Day among Elderly Individuals S149

Danial-Saad, A., M. Corzani, C. Tacconi and L. Chiari,Experience Level and Usability Evaluation whileUsing “TATOO”, a Touchscreen Assessment Tool

S151Daniëls, R. and S. Aarts, Structural Collaboration Be-

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