Transcript User

Patient-Centered Design
as a research strategy
for cognitive assistive technology
Elliot Cole
Institute for Cognitive Prosthetics
CHI Cognitive Technologies Workshop
April 22-3, 2006
• Video
– Originally intended to be therapist training
video showing the software customization
process
– Patient was having a low-functioning day, and
couldn’t do task
– When she remembers Christmas pictures, her
level of functioning increases
– “but I don’t remember it”…..
A cognitive prosthesis
Video
What is a Cognitive Prosthesis
• Dramatically, palpably increases level of
cognitive functioning
– In weeks to months
– In seconds
• Computer technology has unique
capacities to help support people in their
daily activities
• With the right fit, it can help activate the
individual with cognitive disabilities
What is a cognitive prosthesis
• Designed for rehabilitation purposes
• Uses computer technology, and perhaps other
technologies
• Directly supports cognitively-based daily
activities
• Highly customized to the needs of the individual
person
– To make the individual effective in performing a task
– User friendly to the patient
– Does not provide unneeded features
• Collects data relevant to system and personal
assessment
Contributing areas of CS
• Office automation
– Personal support software
– Workgroups
– Process redesign, with technology as an actor
• CHI - uniquely
• Research design
– Identifying the phenomenon
– Sampling
– measurement
• System evaluation – why systems fail
– Working non-solutions
• End-user computing and user support (therapists,
patients, caregivers)
CHI and designing for disabilities
• Most of the functionality of these
applications are widely used
• It is the user interface that is the key
difference in serving the disabilities areas.
• The UI requirements are far more
demanding
Institute for Cognitive Prosthetics
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~ 100 patients
10,000’s of hours of therapy services
Most have had 6 months+ of intensive services
Mild to profound, and multiple deficits
Interdisciplinary staff
– CS, application development, delivery systems
– Clinicians in many disciplines
– Patients as key contributors
• Research fruits integrated quickly into services
• A focus on delivery systems
A robust system
From the user’s perspective
• Optimally increases an individual’s
level of functioning
• Over the long haul
• For her/his priority activities
• As they reveal themselves over time
Performance Measures
User
Task
Characteristics
Characteristics
•State to state transition time
•Work time per unit
•Length of productive working time
•Number of errors
Technology
Characteristics
•Ease of error recovery
•Training time per feature
•Training information remembered
•Stress
Software customization
Video
Process of prosthetic software use
Video
Mixing technology & paper
The paper component
Reading disabilities
Who are our users?
• People who cannot fully participate in life
activities, developmental or acquired…
• …Because of Cognitive dysfunction
• Cognitive abilities are our stock in trade
Islands of deficits in seas of abilities:
causes of unexpected activity failures
Islands of abilities in seas of deficits:
Unexpected abilities that can be leveraged
Capturing the user’s characteristics:
The user as a moving target
• Initial user model
• Refinements to user model, correcting the initial
user model
• The user’s increasing capabilities as a result of
the initial successes of the assistive technology
• There is anecdotal evidence that the curve
continues upward slowly over the years.
• Adjustments necessary for degenerative
conditions
The design space:
A universe of 1
• Cognitive deficits
• Cognitive abilities
• Activities to be supported
– Priority activities
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Setting(s) where activities are performed
Parameters of the disease process
The individual’s support system
The individual’s learning & achievement curve
– Supportive compensation
– Additional rehabilitation
Why be patient-centered
• It provides an environment for domain
learning
– What is the nature of the phenomena
– Institutional structures and procedures
– Design methodology considerations
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A focus on the patient’s perspective
A focus on patient priorities
A focus on patient design participation
Potential for hypothesis-testing in design
Validity of usability
• Useful and important in long-term use confirmed
by usage data (for a broad range of activities)
• Useful and important in short term use confirmed
by usage data and testimonial
• Useful but not very important in short term use
• Useful and important in hi-fi mock-up is
hypothesized by cognitively impaired user
• Useful and important in focus group
hypothesized by cognitively impaired users
Our users’ design capabilities
• Many of you have extensive experience
designing with your users, and have
written about some of the small-granularity
abilities and deficits.
• Our users are often the most sensitive
measurement instrument for interface
design.
Complexities of technologies as
compensatory and rehabilitative
• Initial compensation increases LOF
• Produces new opportunities for
rehabilitation
• Brain plasticity as a cure
• What is the role of widely adopted
technologies, e.g., calculator, spell check
Some methodological issues
Video
Research issues
• Models of cognition and cognitive
functioning
– Different disciplines
– Different schools within a discipline
– The issue of ecological validity
– Levels of granularity
• Classification of activities
Research Issues
• Creativity of our users in using our tools
• Sampling issues
• 2 decades of resistance to the clinical use
of AAC and cognitive AT (insurance
companies had no problem in paying for
CAT)
The importance of cognitive AT
• Interface design is THE issue
• Provides an opportunity to explore tacit
assumptions in interface design
• A unique sense of accomplishment
• A unique view into brain functioning, with
potentially important research tools
• Working with wonderful people
• SIG CHI has been very receptive
• An opportunity to help launch a research field