A usability assessment of a specific alternative computer input device for users with spinal cord injuries

The salient point of this research was to investigate the key factors of assistive devices for people with severe physical disabilities, i.e. spinal cord injury, when selecting and using an input device. The area of study was also concerned with validating a new computer device to enable those individuals with upper-limb impairments to engage the benefits of computer technology, via both user-issue and scientific-based evaluations. A specific methodology, concermng both user-Issue and scientific-evidence, was proposed for the studies related to assistive technology outcome measures. In order to validate the proposed methodology, the research work began with an in-depth survey (Study A), to give an insight into the present selection and utilisation of input devices among those computer users with spinal cord injuries and identify their specific needs when using a computer. Following the findings of this contextual survey, a SCI users' needs hierarchy was proposed for input device selection and use. Specific touchscreen devices, which matched the criteria in the hierarchy, were suggested as a possible solution for users with severe upper-limb disorders. Then, a series of user-centred validation studies, involving a pilot simulation study associated with a dimensional issue of an input device (Study B), followed by usability evaluations at the introductory phase (Study C), after short-term use and training (Study D) and after longer-term use and outcome comparisons (Study E), were carried out. The user perspectives and scientific data obtained from the usability assessments form the SCI subjects were used not only to demonstrate the effectiveness and efficiency of the assistive device, but also to fill the gap between the merely psychological/psychosocial-based measures and the merely scientific-focus evaluation. By merging a specific research technique and a systematic measuring procedure, a conceptual model for evaluating assistive technology outcome measures has been provided for this field of study. Moreover, this research has shown that the integration of user-issue and scientific-evidence can increase the reliability and validity of this type of device outcome measures and, therefore, attain a good match between users and the technology employed

Design of a prototype human computer interface for serial neurological examination in patients with spinal injuries

Patients admitted with spinal injuries following trauma require careful serial examinations to detect any neurological deficit that may develop. Thorough documentation of the findings is of paramount importance. Enforced working practice within the NHS means that these patients are often assessed by different members of staff with varying levels of experience, thus inconsistent documentation can be a cause for concern.The project aim was to design a Human Computer Interface to standardise the performance and documentation of serial neurological examinations in patients with spinal injury, allowing the user to accurately detect any neurological deterioration.A prototype system was developed for ward based PC’s incorporating the essential requirements of the neurological examination. Usability testing was performed on the prototype by recruiting fifteen users who would be expected to routinely perform the neurological examination on spinal injury patients. Usability was defined by a number of well defined goals (impression, efficiency, learnability, memorability, safety and effectiveness) and methods used in the evaluation included direct observation during completion of tasks, a questionnaire and unstructured interview.Both quantitative and qualitative data was collected. This data was subsequently analysed using descriptive and inferential methods. The results of the analysis showed that the users responded favourably to the prototype in respects to the all usability goals except efficiency. This lack of efficiency was expected due to the rigid nature of computer based systems compared to paper based methods of recording data but this disadvantage was more than compensated for by the increased patient safety that the system would provide.It can be concluded from the usability testing that the prototype achieves the aims of the project but further work is required in developing the prototype into a final interface design before beta testing in a clinical environment can be considered

Computer and internet use among people with long-standing spinal cord injury:a cross-sectional survey in the Netherlands

Study design: Cross-sectional surveyObjectives: To describe computer and Internet use (other than for work or study) among people with long-standing spinal cord injury (SCI), examine associations between demographic and lesion characteristics and Internet use, and examine associations between Internet use and mental health, participation, and life satisfaction.Setting: Community, The NetherlandsMethods: Participants were 265 individuals living with SCI for at least 10 years, who were 18-35 at the onset of SCI, aged 28-65 at the time of the study and wheelchair-user. Scales for General and Health-related Internet use were developed.Results: Nearly all (97.7%) participants had Internet access and 98.4% of those used it daily or weekly. Of those with tetraplegia, 47.4% had assistive devices for computer use. General Internet use, such as following news and online banking, was very frequent. Websites with information on general health or accessibility were typically visited a few times a year. Three-quarters never visited websites of other individuals with SCI or foreign websites with information on SCI. General Internet use was associated with male gender, younger age, and higher education. Participants with tetraplegia scored higher on Health-related Internet use compared to participants with paraplegia. Health-related Internet use was associated with worse participation, but not with the other psychosocial variables.Conclusion: Internet has become part of daily life of people with SCI in the Netherlands. However, only one association between Internet use and indicators of psychosocial functioning was found. Possible underuse of adaptive devices and of SCI-specific websites warrant further investigation.</p

Computer and internet use among people with long-standing spinal cord injury:a cross-sectional survey in the Netherlands

Study design: Cross-sectional surveyObjectives: To describe computer and Internet use (other than for work or study) among people with long-standing spinal cord injury (SCI), examine associations between demographic and lesion characteristics and Internet use, and examine associations between Internet use and mental health, participation, and life satisfaction.Setting: Community, The NetherlandsMethods: Participants were 265 individuals living with SCI for at least 10 years, who were 18-35 at the onset of SCI, aged 28-65 at the time of the study and wheelchair-user. Scales for General and Health-related Internet use were developed.Results: Nearly all (97.7%) participants had Internet access and 98.4% of those used it daily or weekly. Of those with tetraplegia, 47.4% had assistive devices for computer use. General Internet use, such as following news and online banking, was very frequent. Websites with information on general health or accessibility were typically visited a few times a year. Three-quarters never visited websites of other individuals with SCI or foreign websites with information on SCI. General Internet use was associated with male gender, younger age, and higher education. Participants with tetraplegia scored higher on Health-related Internet use compared to participants with paraplegia. Health-related Internet use was associated with worse participation, but not with the other psychosocial variables.Conclusion: Internet has become part of daily life of people with SCI in the Netherlands. However, only one association between Internet use and indicators of psychosocial functioning was found. Possible underuse of adaptive devices and of SCI-specific websites warrant further investigation.</p

Qualitative assessment of Tongue Drive System by people with high-level spinal cord injury

The Tongue Drive System (TDS) is a minimally invasive, wireless, and wearable assistive technology (AT) that enables people with severe disabilities to control their environments using tongue motion. TDS translates specific tongue gestures into commands by sensing the magnetic field created by a small magnetic tracer applied to the user’s tongue. We have previously quantitatively evaluated the TDS for accessing computers and powered wheelchairs, demonstrating its usability. In this study, we focused on its qualitative evaluation by people with high-level spinal cord injury who each received a magnetic tongue piercing and used the TDS for 6 wk. We used two questionnaires, an after-scenario and a poststudy, designed to evaluate the tongue-piercing experience and the TDS usability compared with that of the sip-and-puff and the users’ current ATs. After study completion, 73% of the participants were positive about keeping the magnetic tongue-barbell in order to use the TDS. All were satisfied with the TDS performance and most said that they were able to do more things using TDS than their current ATs (4.22/5)

Design, development, and characterization of breathforce : a respiratory training system for patients with spinal cord injuries.

Pulmonary and cardiovascular dysfunction are consistently reported as the leading causes of morbidity and mortality among the 1,275,000 people who are living with chronic spinal cord injury (SCI) in the United States. Respiratory-cardiovascular complications from neurological disorders (primarily COPD and sleep apnea) are currently the number one cause of death and disability in the US. The main goal of this project is to develop an inspiratory-expiratory training device for use in the rehabilitation of patients with respiratory motor and cardiovascular deficits that incorporates existing technologies and promotes successful training methodologies performed at the clinic and at home. An embedded microprocessor was to convert pressure from a physiological range pressure sensor into appropriate units and guide the user through a therapy session, while saving the data for later use by the clinician. Rechargeable batteries were used to allow for portability. A bi-directional breathing apparatus to accompany the microprocessor was developed using FDA approved, off-the-shelf parts. Two therapy modes were programmed into the microprocessor to 1) find max expiratory pressure (MEP) and max inspiratory pressure (MIP) of the user and 2) function as a spirometer to track and display user data during respiratory muscle training (RMT). A transducer tester was used to apply a calibrated pressure to the device to validate the measurement accuracy. Measured values differed from the tester by 1.91%-3.78%. No drift was noticed in the device when left running for an extended period of time and humidity, moisture, and temperature effects did not affect the accuracy of the sensor measurement. A SCI test subject showed an average pressure deviation from target values (10-18.51%) that were less than that of a healthy subject (~40%). The prototype device that was given the name BreathForce. Validation studies are underway for accuracy and effectiveness

Eyes-free tongue gesture and tongue joystick control of a five DOF upper-limb exoskeleton for severely disabled individuals

Spinal cord injury can leave the affected individual severely disabled with a low level of independence and quality of life. Assistive upper-limb exoskeletons are one of the solutions that can enable an individual with tetraplegia (paralysis in both arms and legs) to perform simple activities of daily living by mobilizing the arm. Providing an efficient user interface that can provide full continuous control of such a device—safely and intuitively—with multiple degrees of freedom (DOFs) still remains a challenge. In this study, a control interface for an assistive upper-limb exoskeleton with five DOFs based on an intraoral tongue-computer interface (ITCI) for individuals with tetraplegia was proposed. Furthermore, we evaluated eyes-free use of the ITCI for the first time and compared two tongue-operated control methods, one based on tongue gestures and the other based on dynamic virtual buttons and a joystick-like control. Ten able-bodied participants tongue controlled the exoskeleton for a drinking task with and without visual feedback on a screen in three experimental sessions. As a baseline, the participants performed the drinking task with a standard gamepad. The results showed that it was possible to control the exoskeleton with the tongue even without visual feedback and to perform the drinking task at 65.1% of the speed of the gamepad. In a clinical case study, an individual with tetraplegia further succeeded to fully control the exoskeleton and perform the drinking task only 5.6% slower than the able-bodied group. This study demonstrated the first single-modal control interface that can enable individuals with complete tetraplegia to fully and continuously control a five-DOF upper limb exoskeleton and perform a drinking task after only 2 h of training. The interface was used both with and without visual feedback