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Slides from the event "The use of technology in aphasia therapy: The GReAT Project and other applications" held at City University London on 19th January 2012
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Aphasia and Technology: The GReAT Project
Abi Roper and Jane Marshall
On behalf of the GReAT Project TeamDivision of Language and Communication Science
Department of Human Computer Interaction DesignCity University London
Presentation Outline•The Project
•Designing and Refining a Computer Gesture Therapy - Gest
•Gest Demonstration
•Delivering a Computer Therapy
•Gest Pilot Study
•Preliminary Outcomes
Project Aims
• To develop an affordable, computer-based technology that can be used in therapy at home to help people with severe aphasia to gesture.
• To establish how to design effective/engaging interactions for people with aphasia.
• To evaluate the efficacy of the technology within a pilot therapy study
Project Structure
• Phase 1: Designing a prototype gesture therapy using participatory design methods.
• Phase 2: Testing and piloting the prototype
Project TeamHuman Computer Interaction Design & Language and Communication Science
Stephanie Wilson Sam Muscroft Julia Galliers Jane Marshall
Naomi Cocks Tim Pring Abi Roper
Phase 1
• Designing a prototype gesture therapy using participatory design methods.
Consultants
Justine Everson Gerald Hartup Carol Watson
Philip Pepper Emma Buswell
Consultants
• Role: to test and feedback about relevant technology.
• Person Specifications: – Expressive aphasia language difficulties. – Able to attend university once or twice a month for
participatory design sessions.
• Recruited through in house clinic and through links with the Stroke Association Communication Support
Co-ordinators.
• Employed by City University London as Casual Staff members.
Methods: Participatory Design Sessions
• Participatory design – engaging end users in design process
• Sessions explored offline gesture therapy, computer gesture recognition, interaction within 3D worlds and computer interfaces.
• Consultants took part in 9 sessions each
• Project team involved in each session- 1 HCID Researcher- 1 HCID Developer- 1 Speech and Language Therapist Researcher- 2 or 3 Consultants
Session Structure
1. Introduction to scheduled activities
2. Round table gesture activity
3. Demonstration of Technology
4. Trial use of technology by one consultant - followed by interview at computer
5. Tea break
6. Trial use of technology by remaining consultant(s)
Participatory Design
• Watch a video excerpt of the design process in action on the next slide
What did we learn from the Sessions?
1. Consistency2. Simplicity3. Pace4. Reliability5. Rewards6. Individual Differences7. Potential of ‘gaming’.
The Prototype
OK
← →
Demonstration
•Watch a video Demo of the Gest prototype in action on the next slide
Using the Therapy at home
•How does this work at home?Key differences between lab and home – User practising independently, User intending to practise daily. User practising in non-lab conditions.
Things to consider when setting up
•Lighting conditions
•Safety and permanence (negotiate!)
•User comfort and access
Things to consider when training
• Develop the user’s confidence in the system. (Be confident yourself)
Demonstrate:
1. Allow user to observe entirely2. Allow user to observe and operate
interaction buttons3. Allow user to operate alone but with
support as needed (confidence)
Things to consider when training
•Reinforce how to switch the computer on and off several times.
•Make an appointment to come back in one week to review.
•At review appointment, observe and re-train difficult procedures.
Phase 2
• The Pilot Study
Questions• Will practice with Gest improve participants’ production of
gestures &/or spoken words?• Will improvements be specific to items that feature in the
programme?• Will gains occur when Gest is used without ongoing therapist
support?• Will gains be maintained after Gest is withdrawn?• What are participants’ views about Gest?• What are carers’ views about Gest? (where relevant)• Is Gest easy and enjoyable to use?
Participants
• 10 people with severe aphasia– Consent to take part– Fluent pre-stroke users of English– Naming score <20% – Able to recognise pictures– No known dementia or other cognitive impairment
Consent
Screening
Tests (1)
3 Weeks Practice
Tests (2)
Phase 1 with weekly visits from therapist
3 Weeks Practice
Phase 2 with no weekly visits from therapist
Tests (3)
3 weeks no tool
Tests (4)Total time commitment: about 14 weeks
Practice Phases
• Each last 3 weeks• Each practise 15 gestures with the tool• Phase 1: Weekly visits from therapist• Phase 2: Initial but no weekly visits
Tests
• 60 items– Gesture from picture– Name from picture What is the
name of this?
How would you gesture this?Items:
30 practised with Gest
15 familiarised only
15 controls
Scoring Gestures
• Gesture tests are filmed• 4 Scoring videos created• Each video contains 60 gestures in random
order:– 15 from test 1– 15 from test 2– 15 from test 3– 15 from test 4
• Scores– Recognition Score– Rating Score
• Scorers are ‘blind’ to the time of assessment
Scoring Gestures
Usability Evaluations
• Observe participants using the tool• Interview participants• Interview carers (if relevant)
– When technology is installed– After each practice phase
Usage Logs
• Record– Number of sessions– Length of sessions– Levels of programme accessed– Number of gestures recognised
Results so far
Usage
Mean Usage: 7 Participants
0
10
20
30
40
50
60
Daysavailable
No ofsessions
Time used(hrs)
Time persession(mins)
Individual Usage: 3 participants
0
10
20
30
40
50
60
70
80
Days available No ofsessions
Time used(hrs)
Time persession (mins)
Usage x Recognition
Mean Usage over Phases
Usage: Levels
• Three participants use level 1 more than 2 & 3• Two participants use all 3 levels and rate them
equally highly• Two participants rate levels 2 & 3 more highly than 1
• Possibly contingent on navigation abilities
Usage Observations: Challenges
• Set up– Lighting– Positioning (e.g. wheelchairs)– Security
• Glove– Putting glove on the wrong hand– Using the peg board (although often not
necessary)
Usage Observations: Challenges
• Starting and stopping– Pressing key board buttons before menu has
appeared– Not always pressing ‘off’ at end of session
Usage Observations: Challenges
• Navigation– Variable use of OK, forward, back & menu buttons– Variable navigation between levels– Some unprincipled button pushing
Speed and competence may relate to prior computer usage
Usage Observations: Challenges
• Gesture production– Knowing when to gesture; waiting for 321 ping– Knowing when the gesture has been recognised– Variable use of cues; e.g. some adjust handshape
in response to glove image others do not
Usage Observations: Enjoyment
• All signal high enjoyment levels– Thumbs up sign– Drawn smiley face
• Positive reactions to level 2– Game format– Narrative context – Environments
• Positive reactions to level 3– Humour (spider, dentures)– Stroke survivors as actors– Presence of children
Usage Observations: Enjoyment
Other Observations
• Some target spoken words produced during Gest use
• Spontaneous uses of practised gestures (‘umbrella’ gestured when participant noticed that it was raining outside; ‘child’ gesture when talking about grandchild)
Results so far
‘Carer’ Comments
Independence of Use
• ‘She uses it all on her own, I don’t know how to operate it’
• The first session I stayed with L, after that I’ve helped only if she’s found something particularly frustrating’
• All comment that the participant initiated use of Gest
Enjoyment
• All say that the participant enjoyed Gest
• ‘he likes it when they clapped’
• ‘some of the gestures are particularly fitting and she enjoyed rainbow’
Views about Technology
• ‘I was a technophobe and when they said ‘computer’ I thought it was going to cause problems. I thought I wouldn’t understand and he wouldn’t understand it. But it’s so ‘easy’
Reservations
• Carry over to real life (1 carer):
• ‘while she works on it here (points to computer) it doesn’t necessarily translate’
• She wanted a hankie last night and didn’t make a gesture’
Conclusions
• Gest was created through participative design involving people with aphasia– It offers 6 packages of hierarchical practice on 30 gestures– It is accessible even to people with severe strokes– It can be used successfully in diverse home settings– It allows for flexible, self directed practice and is typically
intensively used– It is enjoyable to use, with no reports of increased ‘carer
burden’
Conclusions
• But we do not know if– Gest improves gesture production– Gest improves spoken naming– Effects generalise to unpractised targets– Effects are maintained
• The results of the pilot study will give us answers to these questions
Acknowledgements
The Research Councils UK Digital Economy Programme
The Stroke Association
Consultants and their families
Participants and their families
Thank YouGReAT@city.ac.uk
www.soi.city.ac.uk/great
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