Review: Computer use by older adults: A multi-disciplinary review

The extreme difficulty with which persons with severe disabilities have been taught to maneuver a power wheelchair has been described in case studies, and anecdotal evidence suggests the existence of a patient population for whom mobility is severely limited if not impossible given currently available power wheelchair control interfaces. Since our review of the literature provided little evidence either in support or refutation of the adequacy of existing power wheelchair control interfaces, we surveyed 200 practicing clinicians, asking them to provide information about their patients and to give their impressions of the potential usefulness of a new power wheelchair navigation technology. Significant survey results were: Clinicians indicated that 9 to 10 percent of patients who receive power wheelchair training find it extremely difficult or impossible to use the wheelchair for activities of daily living. When asked specifically about steering and maneuvering tasks, the percentage of patients reported to find these difficult or impossible jumped to 40. Eighty-five percent of responding clinicians reported seeing some number of patients each year who cannot use a power wheelchair because they lack the requisite motor skills, strength, or visual acuity. Of these clinicians, 32 percent (27 percent of all respondents) reported seeing at least as many patients who cannot use a power wheelchair as who can. Nearly half of patients unable to control a power wheelchair by conventional methods would benefit from an automated navigation system, according to the clinicians who treat them. We believe these results indicate a need, not for more innovation in steering interfaces, but for entirely new technologies for supervised autonomous navigation.

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Adequacy of power wheelchair control interfaces for persons with severe disabilities: a clinical survey.

Objective This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. Data sources We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. Review methods All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Results Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or diabetes. Overall, QI interventions were not shown to reduce disparities. Most studies have focused on racial or ethnic disparities, with some targeted interventions demonstrating greater effect in racial minorities--specifically, supporting individuals in tracking their blood pressure at home to reduce blood pressure and collaborative care to improve depression care. In one study, the effect of a language-concordant breast cancer screening intervention was helpful in promoting mammography in Spanish-speaking women. For some depression care outcomes, the collaborative care model was more effective in less-educated individuals than in those with more education and in women than in men. Conclusions The literature on QI interventions generally and their ability to improve health and health care is large. Whether those interventions are effective at reducing disparities remains unclear. This report should not be construed to assess the general effectiveness of QI in the health care setting; rather, QI has not been shown specifically to reduce known disparities in health care or health outcomes. In a few instances, some increased effect is seen in disadvantaged populations; these studies should be replicated and the interventions studied further as having potential to address disparities.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

Describes the motivation for and the design considerations of a low-cost head-operated joystick. The paper briefly summarizes the requirements of head-operated mouse pointer control for people with disabilities before discussing a set of technological approaches that can be used to satisfy these requirements. The paper focuses on the design of a head-operated joystick that uses infrared light emitting diodes (LED's) and photodetectors to determine head position, which is subsequently converted into signals that emulate a Microsoft mouse. There are two significant findings. The first is that, while nonideal device characteristics might appear to make the joystick difficult to use users naturally compensate for nonlinearities, in a transparent manner, because of visual feedback of mouse pointer position. The second finding, from relatively informal, independent trials, indicates that disabled users prefer a head-operated device that has the characteristics of a joystick (a relative pointing device) to those of a mouse (an absolute pointing device).

Controlling mouse pointer position using an infrared head-operated joystick

Experimental research in human - computer interaction commonly uses participant groups that are unrepresentative of demographic realities, being young, technically knowledgeable and highly educated. One way of reflecting society more accurately in research is to include older adults in research groups, but the elicitation of high-quality data from these participants requires alterations in research methods and organization. In the present paper, methodological and organizational experiences from a range of research studies with older participants are reported. It concludes with a list of guidelines for maximizing the research outcomes of working with older adults.

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Methods for human - computer interaction research with older people

Blink detection for real-time eye tracking

https://users.soe.ucsc.edu/~srikur/files/2006_iwc.pdf

Personalising web page presentation for older people

Using speech and touch to enable blind people to access schematic diagrams

Purpose. To identify the types and mix of technology (hardware and software) provided to post-secondary students with dyslexia under the UK's Disabled Student Allowance (DSA), and to determine the students' satisfaction with, and use of, the equipment provided and to examine their experiences with training.Method. A telephone survey of 455 students with dyslexia who had received technology under the DSA from one equipment supplier was conducted over in the period September to December 2005. The survey obtained a mixture of quantitative data (responses to binary questions and selections from a five-point rating scale) and qualitative data (participants identifying positive and negative experiences with technology). In addition, the equipment supplier's database was used to determine the technology supplied to each of the participants.Result. Technology provision is variable between students. The majority of students receive a recording device, text-to-speech software and concept mapping tools in addition t...

Use of assistive technology by students with dyslexia in post-secondary education.

Blind people can access and use textual information effectively in a variety of ways - through Braille, audiotape or computer-based systems. Access and use of graphic information is much more problematic, with tactile versions both time-consuming and difficult to make and textual descriptions failing to provide independent access to the material. The TeDUB Project is developing a system which will automatically generate descriptions of certain classes of graphics (electronic circuit diagrams, UML diagrams and architectural plans) and allow blind people to explore them independently. This system has great potential in work, education and leisure domains to open up independent access to graphic materials for blind people.

Paul Blenkhorn

Papers

Blink detection for real-time eye tracking

Personalising web page presentation for older people

Using speech and touch to enable blind people to access schematic diagrams

Use of assistive technology by students with dyslexia in post-secondary education.

TeDUB: A System for Presenting and Exploring Technical Drawings for Blind People