Yulia Nemchinova shared her findings from literature research and collaboration with experts in cognitive accessibility at the UXPA 2013. From a disable to a differently able: a positive outlook on cognitive accommodations.
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Designing for People with Cognitive Disabilities at UXPA 2013
1. Designing for People
with Cognitive Disabilities in
Language and Literacy
Yulia Nemchinova, DCD
Northrop Grumman and
University of Maryland University College
UXPA 2013, Washington DC
2. Who Has Cognitive Disabilities
Seven percent of the population in the
US have some type of
cognitive, mental or emotional
impairment. (Census 2010)
3
3. Clinical Diagnoses
Attention disorders
Traumatic Brain Injury (TBI)
Developmental disabilities
Cognitive issues related to aging
Learning and language disabilities,
including dyslexia
4
4. Functional Impact
Memory
Attention
Problem solving
Language and reading
Mathematical thinking
Visual and spatial perception
5
5. Why Are We So Behind?
Cognitive impairments are often:
Invisible
Difficult to diagnose
Not universally defined
Not willingly disclosed and
Can be combined with other disabilities
6
8. When Users Encounter
Obstacles…
Lack of confirmation that their
action was correct
Cannot find and review features
Cannot recover from errors
Cannot find landmarks
Do not have enough time to
complete tasks
Cannot save their work at any
time…
9
9. When Users Encounter
Obstacles…
It is a work around for most
users
It is a real showstopper for many
users with cognitive impairments
10
17. Universal Design: Navigation
Consistent navigation and design
Flat architecture
Functioning Back button
Limited the number of links per page
Standard behavior for links
18
18. Universal Design: Content for
Mobile
Direct access to content
Limited content to process
Availability on any screen size
19
20. Language & Literacy
Clear and simple text
6-8 reading level
Short pages, paragraphs and
sentences
Single column of content
Shorter words are not always
better comprehended
21
23. Universal Design: Navigation
Consistent navigation and design on
every page
Flat navigational architecture
Functioning Back button
Limited the number of links per page
Standard behavior for links
24
24. Mobile or Slimmed Down Access
Direct access to content
Limited content to process
Availability on multiple electronic
devices
25
25. Finnish Usability Study
An investigation how students with
cognitive disabilities use computers
Participants: students with mild
intellectual disabilities, limited reading
and writing skills
Application: a familiar (used for about 1.5
year) email application
Method: an informal walkthrough with
elements of contextual inquiry
Recommendation: inclusion of users with
cognitive problems as participants as
well as reviewers
26
26. Usability Testing
Usability studies with cognitively
impaired people are extremely rare
User testing is needed
There is no substitution for actual
users with disabilities
27
27. Take Aways
Think universal design
Explore possibilities for user testing
Apply language and literacy guidelines
28
28. The Future: GPII
Global Public Inclusive Infrastructure
(GPII): http://gpii.net/node/108
29
30. References:
31
Bergel, M., Chadwick-Dias, A., & Tullis, T. (2005). Leveraging Universal Design
in a Financial Services Company. Accessibility and Computing, 82.
Bodine, C., & Lewis, C. (2004). Rehabilitation Engineering Research Center
(RERC) for the Advancement of Cognitive Technologies. Accessibility and
Computing, 80.
Cole, E. (2011). Lessons Learned and Challenges Discovered in Developing
Cognitive Technology for Individuals with Brain Injury. Proceeding of CHI 2011.
Czaja, S. J., Gregor, P., & Hanson, V. L. (2009). Introduction to the special
issue on aging and information technology. ACM Trans. Access. Comput, 4.
Fernando, S., Elliman, T., Money, A., & Lines, L. (2009). Age Related Cognitive
Impairments and Diffusion of Assistive Web-Base Technologies. Universal
Access in HCI, Part I, HCII 2009 (pp. 353-360). Springer-Verlag Berlin
Heidelberg.
31. References (contd.):
32
Francik, E., Levine, S., Tremain, S., Roberts, E., & Bayha, B. (1999).
Telecommunications Problems and Design Strategies for People with Cognitive
Disabilities. Annotated Bibliography and Research Recommendations, World
Institute on Disability.
Gordon, W. A., & Nash, J. (2005). The Interface Between Cognitive
Impairments and Access to Information Technology.
Gregor, P., & Dickinson, A. (2006). Cognitive difficulties and access to
information systems – an interaction design perspective.
Hagood, K., Moore, T., Pierre, T., Messamer, P., Ramsberger, G., & Lewis, C.
(2010). Naming Practice for People with Aphasia in a Mobile Web Application:
Early User Experience. ASSETS: ACM Conference on Assistive
Technologies, 273-274.
Hanson, V. L. (2009). Cognition, Age, and Web Browsing. Universal Access in
HCI, Part I, HCII 2009, (pp. 245-250). Springer-Verlag Berlin Heidelberg.
32. References (contd.):
33
Jansche, M., Feng, L., & Huenerfauth, M. (2010). Reading Difficulty in Adults
with Intellectual Disabilities: Analysis with a Hierarchical Latent Trait Model.
ASSETS’10,. Orlando, Florida, USA.
Judson, A., & Nicolle, C. (2004). Internet accessibility for people who use
augmentative and alternative communication. Conference Proceedings --
International Society for Augmentative & Alternative Communication, 181-186.
Keates, S., Kozloski, J., & Varker, P. (2009). Cognitive Impairments, HCI and
Daily Living. Universal Access in HCI, Part I, HCII 2009 (pp. 366-374).
Springer-Verlag Berlin Heidelberg.
Lepistö, A., & Ovaska, S. (2004). Usability evaluation involving participants with
cognitive disabilities. NordiCHI '04. Tampere, Finland.
Lewis, C. Cognitive and Learning Impairments.
Lewis, C. (2008). Cognitive Disabilities. In The Universal Access Handbook.
33. References (contd.):
34
Lewis, C. (2006, May-June). HCI and Cognitive Disabilities. Interactions , pp.
14-15.
Lewis, C. HCI for People with Cognitive Disabilities.
Lewis, C. (2006). Simplicity in cognitive assistive technology: a framework and
agenda for research. Univ Access Inf Soc (pp. 351-361). Springer-Verlag.
Moffatt, K., & Davies, R. (2004). The Aphasia Project: Designing technology for
and with individuals who have aphasia. Accessibility and Computing, 80, pp.
11-17.
Poncelas, A., & Murphy, G. (2007). Accessible Information for People with
Intellectual Disabilities: Do Symbols Really Help? Journal of Applied Research
in Intellectual Disabilities. 20, pp. 466-474. BILD Publications.
Poulson, D., & Nicolle, C. (2004). Making the Internet accessible for people
with cognitive and communication Impairments. Universal Access in the
Information Society, 3(1), 48-56.
34. References (contd.):
35
Redish, J. (., & Chisnell, D. (2004). Designing Web Sites for Older Adults: A
Review of Recent Literature. AARP.
Rowland, C. (2010). Accessibility: The Need for Champions and Awareness in
Higher Education. Educause Review, 45(6), 12.
Rowland, C. (2010). Transforming the Institution. Educause Review, 45(6), 14.
Savidis, A., & Stephanidis, C. (2004). Developing Inclusive e-Learning and e-
Entertainment to Effectively Accommodate Learning Difficulties., (pp. 42-54).
Solheim, I. (2009). Adaptive User Interfaces: Benefit or Impediment for Lower-
Literacy Users? Universal Access in HCI, Part II, HCII 2009 (pp. 758-765).
Springer-Verlag Berlin Heidelberg.
Summers, K., & Summers, M. (2005). Reading and Navigational Strategies of
Web Users with Lower Literacy Skills. Proceedings of the American Society for
Information Science and Technology, 42.
35. References (contd.):
36
Vigouroux, N., Rumeau, P., Vella, F., & Vellas, B. (2009). Studying Point-Select-
Drag Interaction Techniques for Older People with Cognitive Impairment.
Universal Access in HCI, Part I, HCII 2009 (pp. 422-428). Springer-Verlag
Berlin Heidelberg.
Walser, K., Quesenbery, W., & Swierenga, S. (2008). Designing for Cognitive
Disabilities. UPA 2008 – The Many Faces of User Experience.
Baltimore, Maryland, USA.
WebAIM. (n.d.). Cognitive and Learning Disabilities Literature Review.
Retrieved from WebAIM Web Accessibility in Mind:
http://webaim.org/projects/steppingstones/litreviewsummary
WebAIM. (n.d.). Steppingstones Project on Web Accessibility and Cognitive
Disabilities in Education. Retrieved from WebAIM Web Accessibility in Mind:
http://webaim.org/projects/steppingstones/steppingstones
Hinweis der Redaktion
I am Yulia Nemchinova. I have been always fascinated by human cognition. Lucky for me, last year I was asked to do a lit research how we can better accommodate people with cognitive disabilities as the agency. I hope we can have a dialog and share what is being done.
There are more people that live with a disability or deal with a disability of someone close to them than we can possibly imagine. This is a lot of people that need help!
Cognitive disabilities include conditions such as learning and language disabilities, attention disorders, traumatic brain injury, mental retardation, autism, cerebral palsy, cognitive issues related to aging and more. Many of these impairments are invisible especially in a mild form. This classifies CD by their clinical diagnoses while from the UX perspective, we are mostly interested in how it impacts the experience and interaction.
The impact of cognitive disabilities on human cognition is just as diverse its spectrum and affects memory, attention, language and reading, emotional control, speed of reasoning, executive functions to name a few. Francik (1999) provided a wonderful classification that is widely cited and is indeed helpful.
Cognitive disabilities can be combined with physical ones.
The causes for this situation include several high profile cases of patients’ abuse in mental institutions. It is now known, that from the mid-1950s to late-1970s during medical studies, patients with cognitive disabilities at Willowbrook State School in New York City and other mental institutions were mistreated. While including people with cognitive limitations in user research studies happens very rarely if at all, there are a number of advocacy groups that have access to individuals with cognitive impairments and are willing to assist organizations with improving the quality of life for the cognitively disabled.
This apparently common sense rules are being broken more often than not.
Blindness remains the priority for accessibility researchersLack of research on the usability engineering methods suitable for users with cognitive disabilitiesLimited representation of cognitive impairments within the accessibility communityVery little testing has been conducted
JAWS by Freedom ScientificWindow EyesZoomtextvyaisquaredBrowseAloud by TextHelpRead&Write by TextHelpVoiceOver for iPhone
Universal Design or Barrier Free Design: bus lowered to the ground
Universal Design: Curb side access
Ramps
As a barrier free design
What reading level will accommodate most? The low-literacy study by Kathryn and Michael Summers is mentioning because it was based on the usability testing with low-lit users. Kathryn was my faculty and advisor back at University of Baltimore a few year back, and I know that she has done some work with her brother, Michael, who was with Nielsen/Norman Group at the time, on a low literacy project funded by Pfizer. I have learned that existing reading level formulas are tuned to how we naturally speak, which does not apply to technically sophisticated communications. I gather that to know for real, it needs to be tested.
A researcher from the University of Twente contacted Boer independently in 2009 to run a study on the font's effectiveness. The small study of 21 dyslexics showed that they made fewer errors when reading text set in Dyslexie compared to "normal" typefaces. Boer set all the text on his website in Dyslexie, and prefers to type in it as well as read. "I hope that I can help people with dyslexia so that the everyday struggle in this information society is a little less," Boer tells Co.Design. "Dyslexie is not a cure, but I see the font as something like a wheelchair." If Dyslexie takes off, perhaps we'll see the rise of whole type studios and foundries dedicated to expanding the graphic options optimized for dyslexic people. After all, why should Dyslexie be the only one?
Clayton Lewis, PhD Professor of Computer Science, Scientist in Residence, Coleman Institute for Cognitive Disabilities, University of Colorado
The Finnish study is particularly interesting because it was conducted with the youth at a special needs boarding school, which is rare. The study reports that certain usability methods were not ideal for these users. For instance, the think aloud protocol was found unsuitable. As a result, a modified informal walkthrough along with other observational methods were used instead of standard usability testing. The expert evaluation was done at the beginning of the study (as it is typically advised); interestingly enough “the experts were not able to detect problems understanding the ‘big picture’ (general structure) of the [email] application and how moving between the parts of the application could be problematic in this user group.” In discussion, not only the authors stressed the importance of conducting usability studies with people that are cognitively impaired (as opposed to working with proxies such as caregivers, parents, teachers, etc.), but also propose “including a person with cognitive disabilities into the group of evaluators,” which stood out to me.
Findings from the literature review and interviews with three experts suggest that the best way to validate how well the design accommodates any breaches in cognitive processing is to test it with users that have cognitive limitations. While there are some tools that can improve the daily experiences of users with cognitive impairments, no automated tool or assistive technology as of now can substitute for user research, design, and testing.
And you can help bringing a better cognitive accessibility, so many others will benefit as well.
The goal of the GPII project, also referred to as the Cloud Computing Accessibility Initiative, is to allow easy access to assistive technologies anytime and anyplace via user generated profiles. Once a user profile is created, it will store information pertaining to that user in the cloud. Each user can have multiple profiles. In a nutshell, a user profile will specify assistive technologies (such as screen readers), plug-ins (like Browse Aloud that SSA already has available), and other enhancements desired by the user as well as preferences (screen resolution, font, color, etc.). As soon as the user authenticates – whether from a public library, home, or work – the user will access his or her unique profile configuration. Then, the match-maker capability will search for available software services that will be helpful to that user.