Author: Elizabeth Hoskin
The Problem
Through my interview with Dr. Graham, it became clear that there is a need for technology that can provide people with disabilities access to social interaction and connectedness. When I looked into this issue further, I found that social exclusion is a risk factor for mental health problems however, being socially included can have protective effects (Davies et al., 2008). Additionally, social relationships, both quantity and quality are also known to impact health behaviour and physical health (Umberson et al., 2010). Furthermore, the development of social skills has been linked to employability and independence after graduation (Benz et al., 1997).
Dr. Graham works on active video games or exergames (video games that you control by moving your body) that provide not only physical therapy, but also social connectedness. He told me about an exergame project called ‘Liberi’ that he worked on with Darcy Fehlings of Holland Bloorview Kids Rehabilitation Hospital. Liberi is designed for children and youth with cerebral palsy.
As people with cerebral palsy age, their body mass increases at a greater rate than their muscle strength. This leads to a decrease in their mobility and can lead to social isolation (Hernandez et al., 2014). Therefore, it is important that people with cerebral palsy stay active, which is where Liberi comes in. To play Liberi, you pedal on a stationary bicycle to move your avatar. You also control other elements of the game using a handheld controller. A picture of a child playing Liberi is shown to the right. The faster you pedal, the more power your avatar has. To aid in social interaction, the video game lets you play with other children over the internet and interact with each-other’s avatars and chat in real time. The game allows children to set up play dates with their peers and interact without having to leave home. This is important because having reduced mobility can make outings challenging and cause isolation. For more information on Liberi, check out this link to the Liberi page on Dr. Graham’s lab website: Liberi Home Page.
After the interview, I realized that my ability to seek and achieve social connectedness was something I have been taking for granted. This got me wondering what other technology is out there to help people access social interaction. Therefore, through my individual sub-case assignment, I examined the following question:
What are examples of technology that exists to meet the need for technology that provides access to social interaction and connectives?
I then dug a little deeper to compare and contrast existing technology, and critiqued the technology. As an engineer in training with aspirations of doing design work, I found this to be a very useful and interesting exercise. Here is a summary of the goals I set out for myself:
- Search for examples of technology that exists to provide access to social interaction and connectedness. More specifically, I tried to find diverse examples of technology that met the needs of diverse users.
- Compare and contrast this technology
- Critique this technology to:
- Identify gaps in available technology
- Identify weaknesses or negative impact the technology may have
Exploration Process
To explore this question and meet my goals outlined above, I set out with the steps listed below. To start thinking about points 1 and 2, I searched academic databases for systematic reviews covering social interaction and support organizations for people with disabilities. Then, I looked at examples of technology that were in the systematic reviews, technology that had made the news, and technology listed on websites of organizations that provide support to people with disabilities.
- Explore why social interaction is important to give context to the problem (see what I talked about in the introduction)
- Determine categories of barriers to social interaction
- Look for examples of technology to assist with social interaction for each barrier
- Compare and contrast this technology
- Critique this technology
Observations
Categories of Barriers
To begin searching for what technology exists, I wanted to first explore the types or categories of disabilities that may have challenges with social interaction. I wanted to begin my exploration here because I thought it might give this sub-case a people first perspective.
I found that there were 4 major categories: Cognitive, Sensory, Physical and Mental Health.
Additionally, I have listed some examples of conditions or disorders that fit within this category to give context to some of the issues these users might face. Although these categories are not exhaustive to all disabilities and that there is some overlap between categories, I think that they served as a solid starting point for my next phases of exploration.
- Cognitive
- Autism Spectrum Disorder, Attention Deficit Hyperactive Disorder (ADHD), Down Syndrome, Dementia, Traumatic Brain Injury (TBI)
- Sensory
- Autism Spectrum Disorder, Hard of Hearing or Deaf, Low Vision or Blind, Sensory Integration Dysfunction (SID)
- Physical
- Chronic Pain, Epilepsy, Mobility Impairments, Sleep Disorders
- Mental Health
- Bipolar Disorder, Depression, Anxiety and Panic Disorders, Post Traumatic Stress Disorder (PTSD)
Examples of Technology
A full list of examples of technology that I found can be seen here: Examples of Technology – Full List. Due to time constraints, I tried to find at least two or three examples for each barrier, but know that there is much more out there that I wasn’t able to thoroughly look into. Below, I have summarized the examples technology by barrier, although some technology does overlap between barriers.
Cognitive
Most technology aimed to help people with cognitive impairments interact socially focused on developing or building social skills. These technologies ranged in the users ability from non or mostly non-verbal (the communication board), or verbal (the glasses system). The examples that I found mostly focused on people with autism, and included:
- Smart glass systems that helped facilitate skill development
- A robot for practicing social interacting
- An app for creating custom communication boards.
Sensory
Most technology on the market for people with sensory impairments focus on auditory or visual impairments. These included:
- For people who are hard of hearing or deaf:
- Hearing aids
- Cochlear implants
- Apps that capture spoken language and turn it into text, or turn sign language into text or spoken language.
- For people who are visually impaired:
- Screen-reading technology
- Apps that connect visually impaired users with sighted users for help with simple tasks
- Apps that help users navigate cities independently
Physical
For people with physical disabilities, general physical accessibility of an environment is important to avoid isolation, but I chose to focus on exploring technology that directly helps people with physical disabilities access communication mediums such as smart phones or computers. These included:
- Switches
- Brain computer interfacing
- Speech to text software
Mental Health
All of the technology I found that was geared towards people with mental health disabilities were apps. The apps were:
- Skill building, working on coping strategies
- Symptom tracking to aid in managing a condition
- The app that I found most relevant connected users with other users who want to partake in structured or unstructured conversation.
Categories of Technology
Next, I looked for themes or categories within the technology examples. I found that the technology could be sorted by its availability or development phase, intended user, and intended purpose. Below is a list of all of the themes I observed, but for a full list of where each example of technology was sorted refer to this page: Examples of Technology – Full List.
- Availability or Development Phase: Technology that is still in the start-up phase Vs. technology that is already commercially or clinically available
- Intended User: Technology designed for people with disabilities specifically in mind Vs. technology not specifically designed for people with disabilities
- Intended Use: Technology that is designed for providing direct access to social interaction Vs. technology that isn’t specifically designed to provide direct access social interaction, but could provide benefits in this area by providing equal access to content
Analysis
Based on the observations above, I noticed the following trends:
Themes and Categories of Technology Example
- 75% of examples were already commercially or clinically available.
- 75% of examples were designed to be used by people with disabilities specifically.
- 50% of examples were specifically designed to provide or build skills for social interaction.
Other Observations About The Examples of Technology:
- About half of the technology examples either provided access to or used a smartphone or tablet to provide their intended purpose.
- More technology options exist for people with visual or hearing related disabilities than any other category.
- I wasn’t able to draw any conclusions or observations from a user perspective, therefore I don’t know from a user perspective if these examples of technology are favourable or easily usable.
Discussion
Gaps In The Existing Technology
I found it quite interesting how about 50% of the examples of technology weren’t actually solely designed to meet a social connectedness need. It makes sense that providing access to other things like the ability to navigate your city, or complete tasks independently is important for avoiding isolation and improving access socialization, but I had never thought of it this way before. However, this could also be an indicator that there is still a need for more technology that provides access to social connectedness. In addition, with 25% of the technology in a prototype or research phase, it is clear that more technology is being developed, but that there may still be a significant need for this technology that may or may not be met by what is being developed. Furthermore, more technology exists for people with visual or hearing impairments than any of the other categories of disabilities. This points towards there being larger gaps in the technology needs of people with physical, cognitive and mental health disabilities.
Smartphone, Tablet and Computer Use
About half of the technology examples either provided access to or used a smartphone or tablet to provide their intended purpose. This is an important observation as it related very strongly to the theme: Technology Driven. Smartphones are a relatively new technology, and their invention has allowed many of these technologies to be created. Furthermore, as technology develops, creating apps and other technology that use smartphones or tablets is becoming more accessible to not only designers, but also hobbyists.
A potential downside to providing access to smartphones, tablets and in some cases computers, is that a constant connection to social media may be enabled. This could be positive for the user for many reasons including access to the social connection that social media provides, but it could also be negative as inappropriate use of social media has been linked to negative mental health outcomes (Collier, 2013). Additionally, access to smartphones, tablets and computers opens up users to the risk of being cyber bullied. However, since social media and smart device use is not monitored for health reasons in able bodied populations it should not be monitored or controlled in populations who require adaptive technology to access it either.
The benefit of apps on smartphones or tablets is that they are usually low cost, once a user already owns the device. A downside to apps is that they are limited by the device they are used on. For example, touch screens are challenging for visually impaired users due to the lack of tactile input.
Limitations
This sub-case and the conclusions drawn from it are limited by the following factors:
- This analysis was only done considering my point of view, which is inherently biased and is not from the perspective of a user.
- I used news sources as one of the places that I looked for examples of technology. News sources are more likely to provide flashy and exciting tech, not necessarily the tech that is most effective or used most often.
- I considered approximately 17 different examples of technology. This only begins to scrape the surface of examples of technology that are out there.
- I did not consider financial accessibility when analyzing the technology.
Conclusions
Findings
Below is a list of my key findings. For more elaboration on these findings, please see the analysis and discussion sections above:
- There may be larger gaps in the technology that provides access to social connectedness for people with physical, cognitive and mental health disabilities.
- Overall, there is likely still a need for technology that provides access to social connectedness.
- Smartphones and tablets are a relatively new technology, and their invention has allowed many of these technologies to be created. Furthermore, as technology develops, creating apps and other technology that use smartphones or tablets is becoming more accessible to not only designers, but also hobbyists.
- A potential downside to providing access to smartphones, tablets and in some cases computers, is that a constant connection to social media may be enabled. This could be negative as inappropriate use of social media has been linked to negative mental health outcomes (Collier, 2013).
- Additionally, access to smartphones, tablets and computers opens up users to the risk of being cyber bullied.
- The benefit of apps on smartphones or tablets is that they are usually low cost, once a user already owns the device. A downside to apps is that they are limited by the device they are used on.
Future Work
This analysis was only done considering my point of view, which is inherently biased. I am no expert in any of these areas of disability, and was drawn to technology that I had some background in. Additionally, I did not find any systematic reviews specifically examining technologies like the ones that I explored and when I searched for examples of technology, I could not make judgements about the ease of use, or desirability of the technology from an end user perspective. Therefore, to improve the sub-case, I think that a systematic review would be an effective method for analyzing technologies that are currently being researched. Additionally, asking end users about their technology needs and preferences directly could be very insightful. End users would know much more about what technology would actually be useful to them and what technology is already available to them than an outsider looking in. Finally, I did not consider financial accessibility when exploring device options available. This is a major factor in technology uptake, and should be considered in future work.
To summarize, my suggestions for future work are:
- Complete a more thorough search of technologies and continue building a database of existing technologies.
- Complete a systematic review to explore technologies that are being researched.
- Ask end users about their technology preferences and needs.
- Consider financial accessibility.
References
Benz, M. R., Yovanoff, P., and Doren, B. (1997). School-to-work components that predict postschool success for students with and without disabilities. Exceptional Children, 63(2), 151+.
Collier, R. (2013). Social media and mental health. CMAJ: Canadian Medical Association Journal, 185(12), E577. https://doi.org/10.1503/cmaj.109-4567
Davies, B., Davis, E., Cook, K., and Waters, E. (2008). Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas. Child: Care, Health and Development, 34(2), 214–222. https://doi.org/10.1111/j.1365-2214.2007.00786.x
Hernandez, H. A., Ketcheson, M., Schneider, A., Ye, Z., Fehlings, D., Switzer, L., … Graham, T. C. N. (2014). Design and Evaluation of a Networked Game to Supportsocial Connection of Youth with Cerebral Palsy. In Proceedings of the 16th International ACM SIGACCESS Conference on Computers and Accessibility (pp. 161–168). New York, NY, USA: ACM. https://doi.org/10.1145/2661334.2661370
Hernandez, H. A., Ye, Z., Graham, T. C. N., Fehlings, D., and Switzer, L. (2013). Designing Action-based Exergames for Children with Cerebral Palsy. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (pp. 1261–1270). New York, NY, USA: ACM. https://doi.org/10.1145/2470654.2466164
Umberson, D., and Montez, J. K. (2010). Social Relationships and Health: A Flashpoint for Health Policy. Journal of Health and Social Behavior, 51(Suppl), S54–S66. https://doi.org/10.1177/0022146510383501
ACCESSIBILITY AND INCLUSIVE DESIGN CASE STUDIES 