Iterative Design and Usability Testing of the Imhere System for Managing Chronic Conditions and Disability.

A novel mobile health platform, Interactive Mobile Health and Rehabilitation (iMHere), is being developed to support wellness and self-management among people with chronic disabilities. The iMHere system currently includes a smartphone app with six modules for use by persons with disabilities and a web portal for use by medical and rehabilitation professionals or other support personnel. Our initial clinical research applying use of this system provides insight into the feasibility of employing iMHere in the development of self-management skills in young adults (ages 18-40 years) with spina bifida (SB) (Dicianno, Fairman, et al., 2015). This article describes the iterative design of the iMHere system including usability testing of both the app modules and clinician portal. Our pilot population of persons with SB fostered the creation of a system appropriate for people with a wide variety of functional abilities and needs. As a result, the system is appropriate for use by persons with various disabilities and chronic conditions, not only SB. In addition, the diversity of professionals and support personnel involved in the care of persons with SB also enabled the design and implementation of the iMHere system to meet the needs of an interdisciplinary team of providers who treat various conditions. The iMHere system has the potential to foster communication and collaboration among members of an interdisciplinary healthcare team, including individuals with chronic conditions and disabilities, for a client-centered approach to support self-management skills.

Consumer Satisfaction with Telerehabilitation Service Provision of Alternative Computer Access and Augmentative and Alternative Communication.

Telerehabilitation (TR) services for assistive technology evaluation and training have the potential to reduce travel demands for consumers and assistive technology professionals while allowing evaluation in more familiar, salient environments for the consumer. Sixty-five consumers received TR services for augmentative and alternative communication or alternative computer access, and consumer satisfaction was compared with twenty-eight consumers who received exclusively in-person services. TR recipients rated their TR services at a median of 6 on a 6-point Likert scale TR satisfaction questionnaire, although individual responses did indicate room for improvement in the technology. Overall satisfaction with AT services was rated highly by both in-person (100% satisfaction) and TR (99% satisfaction) service recipients.

Clinical evaluation of semiautonomous smart wheelchair architecture (Drive-Safe System) with visually impaired individuals.

Nonambulatory, visually impaired individuals mostly rely on caregivers for their day-to-day mobility needs. The Drive-Safe System (DSS) is a modular, semiautonomous smart wheelchair system aimed at providing independent mobility to people with visual and mobility impairments. In this project, clinical evaluation of the DSS was performed in a controlled laboratory setting with individuals who have visual impairment but no mobility impairment. Their performance using DSS was compared with their performance using a standard cane for navigation assistance. Participants rated their subjective appraisal of the DSS by using the National Aeronautics and Space Administration-Task Load Index inventory. DSS significantly reduced the number and severity of collisions compared with using a cane alone and without increasing the time required to complete the task. Users rated DSS favorably; they experienced less physical demand when using the DSS, but did not feel any difference in perceived effort, mental demand, and level of frustration when using the DSS alone or along with a cane in comparison with using a cane alone. These findings suggest that the DSS can be a safe, reliable, and easy-to-learn and operate independent mobility solution for visually impaired wheelchair users.

Performance testing of collision-avoidance system for power wheelchairs.

The Drive-Safe System (DSS) is a collision-avoidance system for power wheelchairs designed to support people with mobility impairments who also have visual, upper-limb, or cognitive impairments. The DSS uses a distributed approach to provide an add-on, shared-control, navigation-assistance solution. In this project, the DSS was tested for engineering goals such as sensor coverage, maximum safe speed, maximum detection distance, and power consumption while the wheelchair was stationary or driven by an investigator. Results indicate that the DSS provided uniform, reliable sensor coverage around the wheelchair; detected obstacles as small as 3.2 mm at distances of at least 1.6 m; and attained a maximum safe speed of 4.2 km/h. The DSS can drive reliably as close as 15.2 cm from a wall, traverse doorways as narrow as 81.3 cm without interrupting forward movement, and reduce wheelchair battery life by only 3%. These results have implications for a practical system to support safe, independent mobility for veterans who acquire multiple disabilities during Active Duty or later in life. These tests indicate that a system utilizing relatively low cost ultrasound, infrared, and force sensors can effectively detect obstacles in the vicinity of a wheelchair.

Toward automatic adjustment of pointing device configuration to accommodate physical impairment.

PURPOSE: Software was developed which makes recommendations regarding configuration of a computer pointing device, such as a mouse, to accommodate a person's physical impairment. Specifically, a software agent automatically recommends a setting for the computer's control-display gain based on observations of a user's performance in a target selection task. METHOD: The software agent makes its recommendations based on available adjustment settings in the existing operating system. The agent was evaluated in studies with 12 participants who have motor impairments. RESULTS: The agent-selected gain was not associated with significant improvements in selection time or error-free performance compared with the operating system's default gain. Across participants and trials, gain did not have a significant effect on selection time except at the lowest gain settings tested. However, two participants did have notable and consistent improvement in selection time and error-free performance using the agent-selected gain; gain across trials had a significant effect on number of target entries and number of submovements; and a post-hoc analysis indicated improved target selection time when varying both target size and control-display gain. CONCLUSION: These observations provide possible avenues for future work, although the current study indicates that changes to control-display gain, alone, are unlikely to offer improvements in speed or accuracy for the general population of people with motor impairments.

Distributed cognitive aid with scheduling and interactive task guidance.

A cognitive assistive technology system has been designed for use by people with memory and organizational impairments. This system will provide a distributed architecture for both scheduling assistance and task guidance, as well as intelligent, automatic replanning on the levels of both the schedule and individual tasks. A prototype of this architecture has been developed that focuses on interactive task guidance capabilities. Scheduling software has been developed but not fully integrated with the task guidance features. The system has been preliminarily tested through simulated trials, monitored use of the prototype in a clinical setting, and usability trials of the task-design interface with rehabilitation professionals. Participants were able to respond appropriately to cues provided by the system and complete prescribed tasks.

How many people would benefit from a smart wheelchair?

Independent mobility is important, but some wheelchair users find operating existing manual or powered wheelchairs difficult or impossible. Challenges to safe, independent wheelchair use can result from various overlapping physical, perceptual, or cognitive symptoms of diagnoses such as spinal cord injury, cerebrovascular accident, multiple sclerosis, amyotrophic lateral sclerosis, and cerebral palsy. Persons with different symptom combinations can benefit from different types of assistance from a smart wheelchair and different wheelchair form factors. The sizes of these user populations have been estimated based on published estimates of the number of individuals with each of several diseases who (1) also need a wheeled mobility device and (2) have specific symptoms that could interfere with mobility device use.

Participatory design in the development of the wheelchair convoy system.

BACKGROUND: In long-term care environments, residents who have severe mobility deficits are typically transported by having another person push the individual in a manual wheelchair. This practice is inefficient and encourages staff to hurry to complete the process, thereby setting the stage for unsafe practices. Furthermore, the time involved in assembling multiple individuals with disabilities often deters their participation in group activities. METHODS: The Wheelchair Convoy System (WCS) is being developed to allow a single caregiver to move multiple individuals without removing them from their wheelchairs. The WCS will consist of a processor, and a flexible cord linking each wheelchair to the wheelchair in front of it. A Participatory Design approach - in which several iterations of design, fabrication and evaluation are used to elicit feedback from users - was used. RESULTS: An iterative cycle of development and evaluation was followed through five prototypes of the device. The third and fourth prototypes were evaluated in unmanned field trials at J. Iverson Riddle Development Center. The prototypes were used to form a convoy of three wheelchairs that successfully completed a series of navigation tasks. CONCLUSION: A Participatory Design approach to the project allowed the design of the WCS to quickly evolve towards a viable solution. The design that emerged by the end of the fifth development cycle bore little resemblance to the initial design, but successfully met the project's design criteria. Additional development and testing is planned to further refine the system.

Adaptive software for head-operated computer controls.

Head-operated computer controls provide an alternative means of computer access for people with disabilities who are unable to use a standard mouse. However, a person's disability may limit his or her neck movements as well as upper extremity movements. Software was developed which automatically adjusts the interface sensitivity to the needs of a particular user. This adaptive software was evaluated in two stages. First, 16 novice head-control users with spinal-cord injury or multiple sclerosis used head controls with and without the adaptive software. The adaptive software was associated with increased speed in standardized icon selection exercises (p < 0.05). A small increase in accuracy was also observed. In addition, five current head-control users evaluated the software in a real-world setting. One of these five subjects perceived an improvement in comparison to his current head-control system.

Neck range of motion and use of computer head controls.

Head controls provide an alternative means of computer access. This study determined whether neck movement limitations are associated with reduced performance with such head controls. This study also identified features of the cursor movement path that could aid in assessing computer access limitations. Fifteen subjects without disabilities and ten subjects with disabilities received neck range of motion evaluations and performed computer exercises using head controls. Reduced neck range of motion was correlated with reduced accuracy (R2 = 93.5%) and speed (R2 = 79.5%) in icon selection. A model was developed with the use of cursor positioning time and number of velocity peaks to identify when a person was having difficulty with target acquisition (kappa = 0.81). Models such as this may allow head controls to adapt to a user's needs, accommodating difficulties resulting from neck range of motion limitations.