Construct validity of the Actiwatch-2 for assessing movement in people with profound intellectual and multiple disabilities

Background: Valid measures to assess either small or assisted performed movements of people with profound intellectual and multiple disabilities (PIMD) are required. We analysed the construct validity of the Actiwatch-2 to assess movement in people with PIMD. Method: Twenty-two persons with PIMD were video recorded while wearing an Actiwatch-2. We used 15s-partial-interval recording to record upper body movement, body position and activity situation. Multilevel analyses were used to evaluate if the Actiwatch-2, based on produced counts, could detect changes in these factors. Results: The presence versus absence of upper body movement and an activity situation in which participants were involved versus not involved resulted in significantly higher counts, with a large variety in predicted counts between participants. No relationship between body position and counts was found. Conclusions: The Actiwatch-2 seems able to assess obvious upper body movement in people with PIMD, and whether there is involvement in an activity situation

Psychobiological factors of resilience and depression in late life.

In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind-body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD

Studies on the impact of assistive communication devices on the quality of life of patients with amyotrophic lateral sclerosis

Tese de doutoramento, Ciências Biomédicas (Neurociências), Universidade de Lisboa, Faculdade de Medicina, 2016Amyotrophic Lateral Sclerosis (ALS) is a progressive neuromuscular disease with rapid and generalized degeneration of motor neurons. Patients with ALS experiment a relentless decline in functions that affect performance of most activities of daily living (ADL), such as speaking, eating, walking or writing. For this reason, dependence on caregivers grows as the disease progresses. Management of the respiratory system is one of the main concerns of medical support, since respiratory failure is the most common cause of death in ALS. Due to increasing muscle weakness, most patients experience dramatic decrease of speech intelligibility and difficulties in using upper limbs (UL) for writing. There is growing evidence that mild cognitive impairment is common in ALS, but most patients are self-conscious of their difficulties in communicating and, in very severe stages, locked-in syndrome can occur. When no other resources than speech and writing are used to assist communication, patients are deprived of expressing needs or feelings, making decisions and keeping social relationships. Further, caregivers feel increased dependence due to difficulties in communication with others and get frustrated about difficulties in understanding partners’ needs. Support for communication is then very important to improve quality of life of both patients and caregivers; however, this has been poorly investigated in ALS. Assistive communication devices (ACD) can support patients by providing a diversity of tools for communication, as they progressively lose speech. ALS, in common with other degenerative conditions, introduces an additional challenge for the field of ACD: as the disease progresses, technologies must adapt to different conditions of the user. In early stages, patients may need speech synthesis in a mobile device, if dysarthria is one of the initial symptoms, or keyboard modifications, as weakness in UL increases. When upper limbs’ dysfunction is high, different input technologies may be adapted to capture voluntary control (for example, eye-tracking devices). Despite the enormous advances in the field of Assistive Technologies, in the last decade, difficulties in clinical support for the use of assistive communication devices (ACD) persist. Among the main reasons for these difficulties are lack of assessment tools to evaluate communication needs and determine proper input devices and to indicate changes over disease progression, and absence of clinical evidence that ACD has relevant impact on the quality of life of affected patients. For this set of reasons, support with communication tools is delayed to stages where patients are severely disabled. Often in these stages, patients face additional clinical complications and increased dependence on their caregivers’ decisions, which increase the difficulty in adaptation to new communication tools. This thesis addresses the role of assistive technologies in the quality of life of early-affected patients with ALS. Also, it includes the study of assessment tools that can improve longitudinal evaluation of communication needs of patients with ALS. We longitudinally evaluated a group of 30 patients with bulbar-onset ALS and 17 caregivers, during 2 to 29 months. Patients were assessed during their regular clinical appointments, in the Hospital de Santa Maria-Centro Hospitalar Lisboa_Norte. Evaluation of patients was based on validated instruments for assessing the Quality of Life (QoL) of patients and caregivers, and on methodologies for recording communication and measuring its performance (including speech, handwriting and typing). We tested the impact of early support with ACD on the QoL of patients with ALS, using a randomized, prospective, longitudinal design. Patients were able to learn and improve their skills to use communication tools based on electronic assistive devices. We found a positive impact of ACD in psychological and wellbeing domains of quality of life in patients, as well as in the support and psychological domains in caregivers. We also studied performance of communication (words per minute) using UL. Performance in handwriting may decline faster than performance in typing, supporting the idea that the use of touchscreen-based ACD supports communication for longer than handwriting. From longitudinal recordings of speech and typing activity we could observe that ACD can support tools to detect early markers of bulbar and UL dysfunction in ALS. Methodologies that were used in this research for recording and assessing function in communication can be replicated in the home environment and form part of the original contributions of this research. Implementation of remote monitoring tools in daily use of ACD, based on these methodologies, is discussed. Considering those patients who receive late support for the use of ACD, lack of time or daily support to learn how to control complex input devices may hinder its use. We developed a novel device to explore the detection and control of various residual movements, based on sensors of accelerometry, electromyography and force, as input signals for communication. The aim of this input device was to develop a tool to explore new communication channels in patients with generalized muscle weakness. This research contributed with novel tools from the Engineering field to the study of assistive communication in patients with ALS. Methodologies that were developed in this work can be further applied to the study of the impact of ACD in other neurodegenerative diseases that affect speech and motor control of UL

Towards Design Theory for Accessible IT Artefacts

Accessibility in the use of information technology (IT) artefacts, such as websites, applications, and user interfaces, means that they are designed in such a way that people with the broadest range of abilities can use them. However, although accessibility is a human right, IT artefacts often remain inaccessible. Aside from the available accessibility guidelines, we need sufficient design theories that explicitly state how accessibility should be addressed and designed to develop accessible IT artefacts for all users. This dissertation summarises four articles that address this problem. These studies are conducted with qualitative approaches that include a narrative literature review, a systematic literature review and a design science method comprising a participatory design and interviews. The first article develops an explaining theory of accessibility to gain an understanding of the construct of accessibility, showing possible variables of human abilities, tasks and contexts and their relationships in IT use. The second article illustrates the factors in management, development, user, and IT artefact features, including the roles and actions that these domains have and how they affect the realisation of accessibility. The other two articles contribute to accessibility guidance to improve and support content creators’ text production and writing process of accessible online text in the web context. The dissertation underscores three key determinants of the knowledge of accessibility: (1) assumptions of users’ abilities; (2) users’ actual needs; and (3) factors in the development chain. The foregoing factors contribute to the knowledge of accessibility and would help researchers, particularly design scientists, form prescriptive knowledge for practitioners to achieve accessible IT artefacts. Thus, researchers could better identify the variables, relationships and affecting factors in human abilities, management, development, content creation, tasks, and contexts that need to be addressed when designing IT artefacts for certain tasks and use contexts.Informaatioteknologia-artefaktien (IT-artefaktien), kuten verkkosivustojen, sovellusten ja käyttöliittymien saavutettavuus tarkoittaa sitä, että ihmiset erilaisine ominaisuuksineen ja kykyineen voivat käyttää niitä. Vaikka saavutettavuus on ihmisoikeus, IT-artefaktit eivät kuitenkaan ole aina saavutettavia. Käytettävissä olevista saavutettavuusohjeista huolimatta tarvitsemme suunnitteluteorioita, jotka ohjaavat IT-artefaktien suunnittelua, jotta niistä tulisi saavutettavia kaikille IT-artefaktin käyttäjille. Tämä väitöskirja on yhteenveto neljästä artikkelista, jotka käsittelevät tätä ongelmaa. Tutkimukset ovat tehty laadullisilla menetelmillä, joihin on sisältynyt narratiivinen kirjallisuuskatsaus, systemaattinen kirjallisuuskatsaus sekä suunnittelutieteellinen menetelmä sisältäen osallistavan suunnittelun ja haastattelut. Ensimmäisessä artikkelissa kehitetään kuvaileva saavutettavuuden teoria, jolla saadaan käsitys saavutettavuuden rakenteesta ja joka näyttää mahdolliset muuttujat ihmisen kyvyissä, tehtävissä ja konteksteissa, sekä niiden väliset suhteet. Toinen artikkeli kuvaa saavutettavuuteen vaikuttavia tekijöitä johtamisen, kehityksen, käyttäjän ja IT-artefaktin ominaisuuksien näkökulmista, mukaan lukien roolit ja toimenpiteet, joita näillä kohteilla on. Kaksi muuta artikkelia kehittävät ohjeistuksen sisällöntuottajien työn tueksi saavutettavan verkkotekstin tuottamiseksi. Väitöskirjassa esitetään kolme ratkaisevaa tekijää saavutettavuuden tietämyksessä: (1) olettamukset käyttäjien kyvyistä (2) käyttäjien todelliset tarpeet ja (3) tekijät kehitysketjussa. Näiden tekijöiden tuntemus auttaa erityisesti suunnittelutieteilijöitä muodostamaan ohjaavaa tietoa ammattilaisille saavutettavien IT-artefaktien saavuttamiseksi. Täten tutkijat voivat paremmin tunnistaa muuttujat, niiden väliset suhteet ja saavutettavuuteen vaikuttavat tekijät, jotka liittyvät käyttäjän kykyihin, johtamiseen, kehittämiseen, sisällöntuottamiseen, tehtäviin ja kontekstiin, kun IT-artefaktia suunnitellaan tiettyä tehtävää ja käyttökontekstia varten.fi=vertaisarvioitu|en=peerReviewed

Workload-aware systems and interfaces for cognitive augmentation

In today's society, our cognition is constantly influenced by information intake, attention switching, and task interruptions. This increases the difficulty of a given task, adding to the existing workload and leading to compromised cognitive performances. The human body expresses the use of cognitive resources through physiological responses when confronted with a plethora of cognitive workload. This temporarily mobilizes additional resources to deal with the workload at the cost of accelerated mental exhaustion. We predict that recent developments in physiological sensing will increasingly create user interfaces that are aware of the user’s cognitive capacities, hence able to intervene when high or low states of cognitive workload are detected. In this thesis, we initially focus on determining opportune moments for cognitive assistance. Subsequently, we investigate suitable feedback modalities in a user-centric design process which are desirable for cognitive assistance. We present design requirements for how cognitive augmentation can be achieved using interfaces that sense cognitive workload. We then investigate different physiological sensing modalities to enable suitable real-time assessments of cognitive workload. We provide empirical evidence that the human brain is sensitive to fluctuations in cognitive resting states, hence making cognitive effort measurable. Firstly, we show that electroencephalography is a reliable modality to assess the mental workload generated during the user interface operation. Secondly, we use eye tracking to evaluate changes in eye movements and pupil dilation to quantify different workload states. The combination of machine learning and physiological sensing resulted in suitable real-time assessments of cognitive workload. The use of physiological sensing enables us to derive when cognitive augmentation is suitable. Based on our inquiries, we present applications that regulate cognitive workload in home and work settings. We deployed an assistive system in a field study to investigate the validity of our derived design requirements. Finding that workload is mitigated, we investigated how cognitive workload can be visualized to the user. We present an implementation of a biofeedback visualization that helps to improve the understanding of brain activity. A final study shows how cognitive workload measurements can be used to predict the efficiency of information intake through reading interfaces. Here, we conclude with use cases and applications which benefit from cognitive augmentation. This thesis investigates how assistive systems can be designed to implicitly sense and utilize cognitive workload for input and output. To do so, we measure cognitive workload in real-time by collecting behavioral and physiological data from users and analyze this data to support users through assistive systems that adapt their interface according to the currently measured workload. Our overall goal is to extend new and existing context-aware applications by the factor cognitive workload. We envision Workload-Aware Systems and Workload-Aware Interfaces as an extension in the context-aware paradigm. To this end, we conducted eight research inquiries during this thesis to investigate how to design and create workload-aware systems. Finally, we present our vision of future workload-aware systems and workload-aware interfaces. Due to the scarce availability of open physiological data sets, reference implementations, and methods, previous context-aware systems were limited in their ability to utilize cognitive workload for user interaction. Together with the collected data sets, we expect this thesis to pave the way for methodical and technical tools that integrate workload-awareness as a factor for context-aware systems.Tagtäglich werden unsere kognitiven Fähigkeiten durch die Verarbeitung von unzähligen Informationen in Anspruch genommen. Dies kann die Schwierigkeit einer Aufgabe durch mehr oder weniger Arbeitslast beeinflussen. Der menschliche Körper drückt die Nutzung kognitiver Ressourcen durch physiologische Reaktionen aus, wenn dieser mit kognitiver Arbeitsbelastung konfrontiert oder überfordert wird. Dadurch werden weitere Ressourcen mobilisiert, um die Arbeitsbelastung vorübergehend zu bewältigen. Wir prognostizieren, dass die derzeitige Entwicklung physiologischer Messverfahren kognitive Leistungsmessungen stets möglich machen wird, um die kognitive Arbeitslast des Nutzers jederzeit zu messen. Diese sind in der Lage, einzugreifen wenn eine zu hohe oder zu niedrige kognitive Belastung erkannt wird. Wir konzentrieren uns zunächst auf die Erkennung passender Momente für kognitive Unterstützung welche sich der gegenwärtigen kognitiven Arbeitslast bewusst sind. Anschließend untersuchen wir in einem nutzerzentrierten Designprozess geeignete Feedbackmechanismen, die zur kognitiven Assistenz beitragen. Wir präsentieren Designanforderungen, welche zeigen wie Schnittstellen eine kognitive Augmentierung durch die Messung kognitiver Arbeitslast erreichen können. Anschließend untersuchen wir verschiedene physiologische Messmodalitäten, welche Bewertungen der kognitiven Arbeitsbelastung in Realzeit ermöglichen. Zunächst validieren wir empirisch, dass das menschliche Gehirn auf kognitive Arbeitslast reagiert. Es zeigt sich, dass die Ableitung der kognitiven Arbeitsbelastung über Elektroenzephalographie eine geeignete Methode ist, um den kognitiven Anspruch neuartiger Assistenzsysteme zu evaluieren. Anschließend verwenden wir Eye-Tracking, um Veränderungen in den Augenbewegungen und dem Durchmesser der Pupille unter verschiedenen Intensitäten kognitiver Arbeitslast zu bewerten. Das Anwenden von maschinellem Lernen führt zu zuverlässigen Echtzeit-Bewertungen kognitiver Arbeitsbelastung. Auf der Grundlage der bisherigen Forschungsarbeiten stellen wir Anwendungen vor, welche die Kognition im häuslichen und beruflichen Umfeld unterstützen. Die physiologischen Messungen stellen fest, wann eine kognitive Augmentierung sich als günstig erweist. In einer Feldstudie setzen wir ein Assistenzsystem ein, um die erhobenen Designanforderungen zur Reduktion kognitiver Arbeitslast zu validieren. Unsere Ergebnisse zeigen, dass die Arbeitsbelastung durch den Einsatz von Assistenzsystemen reduziert wird. Im Anschluss untersuchen wir, wie kognitive Arbeitsbelastung visualisiert werden kann. Wir stellen eine Implementierung einer Biofeedback-Visualisierung vor, die das Nutzerverständnis zum Verlauf und zur Entstehung von kognitiver Arbeitslast unterstützt. Eine abschließende Studie zeigt, wie Messungen kognitiver Arbeitslast zur Vorhersage der aktuellen Leseeffizienz benutzt werden können. Wir schließen hierbei mit einer Reihe von Applikationen ab, welche sich kognitive Arbeitslast als Eingabe zunutze machen. Die vorliegende wissenschaftliche Arbeit befasst sich mit dem Design von Assistenzsystemen, welche die kognitive Arbeitslast der Nutzer implizit erfasst und diese bei der Durchführung alltäglicher Aufgaben unterstützt. Dabei werden physiologische Daten erfasst, um Rückschlüsse in Realzeit auf die derzeitige kognitive Arbeitsbelastung zu erlauben. Anschließend werden diese Daten analysiert, um dem Nutzer strategisch zu assistieren. Das Ziel dieser Arbeit ist die Erweiterung neuartiger und bestehender kontextbewusster Benutzerschnittstellen um den Faktor kognitive Arbeitslast. Daher werden in dieser Arbeit arbeitslastbewusste Systeme und arbeitslastbewusste Benutzerschnittstellen als eine zusätzliche Dimension innerhalb des Paradigmas kontextbewusster Systeme präsentiert. Wir stellen acht Forschungsstudien vor, um die Designanforderungen und die Implementierung von kognitiv arbeitslastbewussten Systemen zu untersuchen. Schließlich stellen wir unsere Vision von zukünftigen kognitiven arbeitslastbewussten Systemen und Benutzerschnittstellen vor. Durch die knappe Verfügbarkeit öffentlich zugänglicher Datensätze, Referenzimplementierungen, und Methoden, waren Kontextbewusste Systeme in der Auswertung kognitiver Arbeitslast bezüglich der Nutzerinteraktion limitiert. Ergänzt durch die in dieser Arbeit gesammelten Datensätze erwarten wir, dass diese Arbeit den Weg für methodische und technische Werkzeuge ebnet, welche kognitive Arbeitslast als Faktor in das Kontextbewusstsein von Computersystemen integriert

Claiming Spaces: Proceedings of the 2007 National Maori and Pacific Psychologies Symposium 23rd-24th November 2007

This is the full conference proceedings of Claiming Spaces: Proceedings of the 2007 National Maori and Pacific Psychologies Symposium 23rd-24th November 2007

Immersive virtual reality and education: a study into the effectiveness of using this technology with preservice teachers.

Immersive virtual reality (IVR) is a rapidly advancing technology utilized across varying education fields for learning and educational applications. IVR provides the capabilities of computer simulations and embodied cognition experiences through a hands-on activity, making it a natural step to improve learning. Creating educational applications in IVR for use with students and preservice teachers could be a laborious and costly endeavor and require teacher belief in its effectiveness, so research is essential to investigate whether these applications are useful in advancing prekindergarten through Grade 12 (P-12) student learning. Research in this field is new, limited, and practically void of its use in P-12 learning environments. This inquiry expanded upon the literature on IVR technology in education and preservice teacher use of technology. Specifically, the purpose of this study was to investigate the impact of IVR technology on preservice teachers through an experience focused on the American Civil Rights Movement, specifically on knowledge attainment, lesson planning effectiveness, and motivation for future use in their instructional practice. Participants were 21 elementary preservice teachers in a diverse metropolitan university. Results indicated participants in the IVR group significantly increased scores on a content test, reported engagement with the experience, and indicated likelihood to use IVR with their future students

Schools As Training Grounds for Harassment

This article deals with the schools’ role in permitting and encouraging peer sex- and gender-based harassment of children and the law’s role in failing to hold schools accountable for their negligent and intentional behavior in sanctioning it. Part I discusses the evidence of rampant sex- and gender-based harassment in schools. Part II analyzes the problem through the lens of masculinities theory and explains how cultural notions of masculinity create incentives for boys (and some girls) to engage in peer sex- and gender-based harassment.Part III analyzes court cases and OCR decisions and explains the serious disconnect between the two; it demonstrates the proof difficulties that victims experience when filing suit under Title IX and the resulting lack of incentives for schools to correct the problems. It also shows that, while the OCR has traditionally held schools to more exacting scrutiny than courts, the new Secretary of Education has proposed new regulations that would align its standards with those of the courts. Ironically, if the proposed regulations are promulgated, the result in the era of #MeToo will be to promote even more sex- and gender-based harassment in our schools.Part IV proposes new legal standards and interpretations of existing standards for the courts that would hold schools more accountable for allowing and condoning peer harassment and argues that the courts’ standards should be more similar to those applied by those historically applied by the OCR. To accomplish prevention, educators must understand the role that toxic masculinity plays in peer sex- and gender-based harassment while at the same time be aware of the potential unequal application of school rules to children of different races and classes. Finally, this article concludes that the law should create incentives for schools to fulfill their responsibility to educate themselves and their students to prevent and remedy peer sex- and gender-based harassment. When schools ignore their responsibilities in this area, they become important training grounds for future harassers, a role that the #MeToo movement should not tolerate

Investigating the perception of emotion portrayed through body movements in Motor Neuron Disease

Objectives: Motor Neuron Disease (MND) disrupts signals between the brain and the muscles causing physical disability and speech difficulties. Recent studies suggest that Theory of Mind (ToM), or the ability to interpret facial expressions and empathise with others’ emotions, can be impaired by MND. Research has, however, not yet investigated whether MND causes deficits in understanding emotion portrayed by body movements. The current study used a novel computerised assessment tool, E-Motion, which was developed with the aim of assessing the ability to interpret emotions through body movements. The primary hypothesis was that individuals with MND would be impaired compared to control participants on the E-Motion test. Methods: Fifteen individuals with MND and fifteen neurotypical participants were recruited via an MND patient register and opportunity sampling. Participants completed cognitive and psychological assessments and ToM assessments: a subtest of the Awareness of Social Inference Test (TASIT), the Edinburgh Cognitive and Behavioural ALS Screen social cognition test (ECAS) and the E-Motion assessment. Results: A Mann-Whitney U Test indicated that the MND group performed significantly poorer on the E-Motion test with a large effect size (p<0.01, Eta squared=0.35, 90% CI [0.14, 0.59]) and on the ECAS social cognition subtest, with a medium effect size (p=0.02, Eta squared=0.19, 90% CI [0.02, 0.41]) compared to controls. An independent t-test indicated that the MND group attained lower scores on the TASIT subtest compared to controls with a medium effect size, although group differences were not significant (p=0.17, d=0.51, CI[-0.21,1.24]). Conclusions: Although the E-Motion results suggest possible MND-associated deficits in understanding body language, interpreting data from this task is significantly limited because the E-Motion task has not yet been formally validated. In particular, the E-Motion task requires formal development and validation studies. These studies would be required to quantify its performance across internal, external and content validity metrics to allow firmer conclusions to made. Findings from the E-Motion task should not be over-interpreted, and should be regarded as provisional and exploratory. Further research on tool development and replicating findings will be needed to advance the evidence-base in this area. The results of the validated ECAS social cognition test suggest that some individuals with MND may develop difficulties in understanding the emotions of others. This finding is in accordance with previous research in this area. Further research in larger sample sizes and subtypes of MND are required to ascertain whether ToM deficits are prevalent in the wider MND population