2004 Summer Institute : Final Report

How can we develop information technology to enhance the participation of people with disabilities?

Performance of occupations are important for all people. Occupations are those activities that are significant or necessary to do in one's life. They give meaning to a person's life. Sometimes, they are very personally meaningful, such as providing a nutritious meal to your young child. Others are more practical such as getting money out of the bank machine in order to pay your phone bill. Over the past several decades, technology has added a new dimension to the occupations that we are all involved in. The emergence of the computer, the automated phone menu system, the ATM, the movie ticket kiosk, the electronic airport check-in terminals are all examples of how technology has added a new level of complexity to what we need and want to be able to do.

Adding to this complexity is an attitude of "more is better" in the development of new technologies. There are phones that you can play games on, take pictures with, etc. Because the technology is there, developers tend to include any and all features in order to offer something new to the consumer. However, this attitude to technology development leaves many of us all behind. I often feel frustrated that I can't keep up with the new technology, for example how 'outdated' my 'new' computer), I feel confused by the dazzling array of options available for each piece of technology and I am baffled and embarrassed if I don't know the latest terminology: for example a quick view of the Future Shop website advertised the Rio Fuse 128MB MP3/ WMA Player with ID3 Tag & USB Thumbdrive made my head spin.

The information technologies that we use are the interface between the person using them and the occupations that a person wants to be able to do. With this view, information technologies can be considered a component of our environment. For example, the retail point of sale system is just a link between the person who wants to buy something and the purchase of that item using their money in an account. Thus we need to consider all components, the person, the environment and the occupations as we look at how to develop technologies to facilitate participation.

We can think of each person as having multiple aspects and abilities. One way (but not the only way) of grouping these aspects is to think of a person as having abilities in three areas; physical, cognitive (or thinking), and affective (or emotional). This particular mix of abilities is unique for each individual, some having a little more of one set or a little less of another. We can also extend this idea to recognize that technology demands something from us; whether that be physical, cognitive or affective, or more likely, a combination of the three. In my few minutes with you, I will expand on each of the areas, with particular emphasis on the emotional response that we have to technology and how that response can factor into use, or alternatively, avoidance of technology.

The majority of the effort by developers of technology for persons with disabilities seems to have focused on the physical aspects and abilities of people. Development has been done with the idea that if we can either extend or replace the physical abilities of the person or alternatively, if we decrease the physical access requirements of the environment, we can increase accessibility. This has led to two approaches to addressing the physical aspect of accessibility - these are assistive technology and universal design. Assistive technology takes the approach of adapting, modifying or creating new technologies for people with disabilities to use that allow them to interact within a given context to perform the activities they need or want to do. Examples of assistive technologies include wheelchairs which would enhance or replace the need to walk, screen reading software that replaces the need to view and/or read the computer monitor or an augmentative communication device that replaces or enhances the ability to speak. Each of these devices augments or replaces a specific human physical ability to enable the performance of a particular task. On the other hand, universal design approaches the issue of physical inaccessibility by focusing on changing the environment. The Centre for Universal Design at North Carolina State University defines universal design as "The design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design" . The group working there have developed principles of universal design that if followed (in theory) will make the design of environments (including fabricated environments) more accessible and useable. I believe that the attention paid to universal design has been very important in the development of more accessible environments, allowing participation by more people. However, the portion of the definition that refers to "to the greatest extent possible" highlights the difficulty with this approach. Although this is our continued vision - a world where every environment is accessible to absolutely every person - it is still many years in the future. Yet the principles outlined for universal design can and should be considered in the development of all technologies, including assistive and information technologies. The two approaches that address design for physical accessibility - assistive technology and universal design - need to come together in all newly developed technologies.

The second component relates to the cognitive demands of the technology on the person. By this, I refer to the need for attention, memory, problem solving, abstraction or other cognitive areas in order to access or use the technology. Here, the assistive technology developed has offered somewhat limited assistance. The development of cognitive prosthetic devices is one area of current growth in the field of assistive technology. Cognitive Prosthetics refers to customizable software that helps a person function more independently in everyday tasks. One example is development of software that links a person's computer based day scheduler with their cell phone so that scheduled appointments or activities could be sent to the person through the cell phone throughout the day to remind them of their commitments. However, in general, the design of assistive technology has neglected to consider the cognitive demands of the technology. For example, power wheelchairs are not designed with someone who has significant difficulty with impulse control in mind. There is currently no way for the wheelchair to sense that the user is heading for a flight of stairs and to stop operating. Another example is in the use of voice recognition. This technology requires the application of some high level problem solving strategies if the computer misinterprets what you have said. On the other hand, some of the universal design principles do address the cognitive nature of our abilities. One of the principles - "simple and intuitive use" refers to the need for the design to be easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level. Another principle relates to "tolerance for error". The guidelines that follow this principle indicate that the design should minimize hazards and the adverse consequences of accidental or unintended actions. Availability of the 'undo' option in Microsoft word is one example of a way in which this principle has been applied. The overarching difficulty though is that they are principles and guidelines, and most technology developers have not embraced and incorporated Universal Design principles into their designs.

The third component, the affective or emotional reaction evoked in the user, may be the missing link in the technology development world. The impact of emotional reaction and attitudes to technology has received little discussion in the past. It almost seems as if there is the sentiment - if you can access it physically - good enough. Certainly a very similar attitude used to be pervasive in the environment where that environment might have been considered "accessible" if a service elevator was available at the back of the building or if the business had two people who could lift the person using the wheelchair up the stairs and into the building with little attention or concern to the affective reaction of the consumer. Today, I hope that this is no longer the thinking of the majority of the population. However, that same shift in attitude does not seem to have occurred in the world of technology.

Emotions are a complex reaction to a particular situation. The question needs to be asked - How does using this technology make me feel? If I am feeling frustrated or embarrassed when I use this technology - I'm probably not going to use it. This is human nature. Consideration of these emotions need to factor into the design of all technologies, including assistive and information technologies if they are going to offer the potential they have promised and promote participation in the occupations that we choose to engage in.

I am going to tell you a personal story of my emotional reaction to information technologies. A few weeks ago, I was finished a meeting and leaving a parkade. In order to get out, I had to pay the "electronic parking attendant" before returning to my car. I did so, at which point the "machine" told me I had exactly 10 minutes to leave the parkade. I found my car, and drove it to the gate. The machine there 'told' me to "insert ticket face up". I looked at my ticket - which way was face up? I took a guess and pushed it in. It spit it back at me. I flipped it over and pushed it in again. Once again it spit it back at me. I forget whether I had actually flipped it not only over, but maybe also around when I put it in, so I tried again. Ejected. My first reaction was of frustration - damn the technology, it wasn't doing what it was supposed to. I heard an exasperated honk from the person in the car behind me and my next reaction was one of embarrassment - how could I be so incredibly incompetent in the use of this technology? I finally got out of the parkade after one last desperate attempt at shoving the ticket into the machine and just lucking out.

For me, the physical demands of this task were manageable. I had the range of motion and coordination demanded by that technology to insert the little ticket into the machine. As for the cognitive demands of the task - really, it was not an overly complicated task. Perhaps if I had been more methodical in my problem solving I would have been more successful. However, it was the lack of clarity in how to do that task that led to my emotional reaction to the technology. These feelings are not easy to overcome. When I drove away eventually have achieved my goal of getting out of the parkade, my negative emotions stayed with me for a long time and definitely have impacted on my reaction to electronic parkade systems now. The memory of those feelings comes back to me, both at that particular parkade and when I encounter similar ones. So I take extra steps to examine the ticket before approaching and hope that no one lines up behind me in their car.

Information technologies need to be developed in a way that they will enable participation for people with disabilities. They should evoke feelings of competence, control and mastery. In many cases however, it is exactly the opposite. There are times when use of technology can give rise to many negative feelings. For example, one might feel embarrassed if the use of technology sets you apart in some unfavorable way. It may look strange or "techie" or one might feel embarrassed if using the technology is inordinately time consuming and others are waiting as was in my case.

At other times, using technology can be frustrating. This is a common reaction when technology doesn't work or works inconsistently or unpredictably. If you anticipate the technology will do something and it seems to work sometimes and not others, you may feel frustrated. For example, a short in a power wheelchair control might result in the chair acting unpredictably.

At other times, use of technologies may be disempowering. As humans, we want to feel capable and competent of mastering our world. The feeling that I, as the user, should be able to master the technology and can't may emerge. That somehow the technology is smarter that I am.

A fourth negative emotion is when use of technology evokes feelings of insecurity. Use of technology shouldn't jeopardize one's feeling of security - whether that is because you don't feel confident in the abilities of the technology, such as the feeling that if this door opener fails, I will be stuck - or whether it threatens ones safety - for example if this technology that uses text to speech reads out my bank account balance, everyone else standing in line will know.

So if we know that use of information technology can evoke a negative emotional reaction, how can developers address this? How can we develop information technologies so that they can do what they are intended to do - increase access, provide information and ensure efficiency in a way that promotes participation in desired occupations? As consumers of technology products, we need to admit to these reactions. Our rational side dictates that as we mature, we learn that emotions are our reaction to a situation and within our control. However, in this case, I would suggest that we not always rationalize and suppress our reactions, but rather that they are voiced. Tell developers, vendors and service providers that you don't want to use the device because it is too frustrating. Identify if using a particular technology makes you feel embarrassed or threatens your feelings of security.

It is through careful consideration of the physical and cognitive demands of the fabricated environment that we can address how to promote positive emotional reaction that lead to participation rather than avoidance. So my suggestions are this. Rather than developing products that might lead to embarrassment, develop products that enable feelings of dignity. Rather than designing for frustration, design for efficiency and accuracy. Empower with the technology rather than making them disempowering. Ensure that technologies provide for feelings of safety and security. Demand that developers of technology not only pay attention to the physical and cognitive requirements for using their product, but that the emotional reaction invoked from the use is one that is positive. Forsyth and Kielhofner remind us that the environment is a pervasive factor influencing disability but is also within our realm to change. What we can change as designers and developers of technology for persons with disabilities is to remove constraints and facilitate function within the environment of information and assistive technologies.

As a postscript to my story, I want to add one thought. Perhaps a picture would have helped me at the parking lot, perhaps it would have been colour coding the ticket or perhaps a proximity scanner that read my ticket. I don't know. What I do know is that achieving my goal of getting out of the parking lot in a timely manner without any negative emotions would have contributed to my personal feelings of mastery.

In conclusion, I would like to challenge each of you to think about ways in which development of information technologies for people with disabilities can avoid those potentially negative emotions. Use your own emotional reactions to guide and advocate for the development of technologies that will promote feelings of mastery and facilitate participation in life for people with disabilities.