A Comparison of Electronic and Paper Versions of the Montreal Cognitive Assessment.

OBJECTIVE: The objective of this study was to investigate older adults' performance on the paper and electronic Montreal Cognitive Assessment (eMoCA). DESIGN: Repeated measures and correlational design. PARTICIPANTS: A convenience sample of 40 adults over 65 years of age living in the community. INTERVENTIONS: Participants completed the eMoCA and paper Montreal Cognitive Assessment (MoCA) in a randomized order during 1 session. Participants reported their touchscreen experience and comfort and indicated their modality preferences. MAIN OUTCOME MEASURES: The primary outcome measures were paper MoCA and eMoCA total and subscale scores. Secondary outcome measures included participants' reported touchscreen experience and comfort, as well as post-administration preferences. RESULTS: A moderate statistically significant correlation was found between eMoCA and paper MoCA performance across all participants. Analysis comparing first administration modality only (eMoCA vs. paper MoCA) found no statistically significant difference in total scores; however, there was a statistically significant difference for the visuospatial/executive subscale, which required physical interaction with paper or the tablet. For this subscale, participants scored lower on the eMoCA versus paper MoCA. There was a statistically significant correlation between experience with touchscreen devices and performance on the eMoCA, but not between modality preference and performance. CONCLUSION: Modality of administration can affect performance on cognitive assessments. Clinicians should consider individuals' level of touchscreen experience before selecting administration modality.

Effectiveness and usability of Scanning Wizard software: a tool for enhancing switch scanning.

Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study evaluated Scanning Wizard's effectiveness and usability. Ten people who use switch scanning and ten practitioners used Scanning Wizard in the initial session. Usability was high, based on survey responses averaging over 4.5 out of 5, and qualitative feedback was very positive. Five switch users were able to complete the multi-week protocol, using settings on their own scanning system that were recommended from the Scanning Wizard session. Using these revised settings, text entry rates improved by an average of 71%, ranging from 29% to 172% improvement. Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate. Implications for Rehabilitation Some individuals with severe physical impairments use switch scanning for spoken and written communication. Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study demonstrated high usability of Scanning Wizard (with 10 switch userpractitioner teams) and increased text entry rate by an average of 71% (for five switch users). Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate.

Participatory design in the development of the wheelchair convoy system.

BACKGROUND: In long-term care environments, residents who have severe mobility deficits are typically transported by having another person push the individual in a manual wheelchair. This practice is inefficient and encourages staff to hurry to complete the process, thereby setting the stage for unsafe practices. Furthermore, the time involved in assembling multiple individuals with disabilities often deters their participation in group activities. METHODS: The Wheelchair Convoy System (WCS) is being developed to allow a single caregiver to move multiple individuals without removing them from their wheelchairs. The WCS will consist of a processor, and a flexible cord linking each wheelchair to the wheelchair in front of it. A Participatory Design approach - in which several iterations of design, fabrication and evaluation are used to elicit feedback from users - was used. RESULTS: An iterative cycle of development and evaluation was followed through five prototypes of the device. The third and fourth prototypes were evaluated in unmanned field trials at J. Iverson Riddle Development Center. The prototypes were used to form a convoy of three wheelchairs that successfully completed a series of navigation tasks. CONCLUSION: A Participatory Design approach to the project allowed the design of the WCS to quickly evolve towards a viable solution. The design that emerged by the end of the fifth development cycle bore little resemblance to the initial design, but successfully met the project's design criteria. Additional development and testing is planned to further refine the system.

Use of Scanning Wizard Can Enhance Text Entry Rate: Preliminary Results.

Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study is evaluating Scanning Wizard's effectiveness, with nine people who use single-switch scanning participating to date. Text entry rates have improved by an average of 71%, ranging from 29 to 172% improvement.

Circling motion and screen edges as an alternative input method for on-screen target manipulation.

PURPOSE: To investigate a new alternative interaction method, called circling interface, for manipulating on-screen objects. To specify a target, the user makes a circling motion around the target. To specify a desired pointing command with the circling interface, each edge of the screen is used. The user selects a command before circling the target. METHOD: To evaluate the circling interface, we conducted an experiment with 16 participants, comparing the performance on pointing tasks with different combinations of selection method (circling interface, physical mouse and dwelling interface) and input device (normal computer mouse, head pointer and joystick mouse emulator). RESULTS: A circling interface is compatible with many types of pointing devices, not requiring physical activation of mouse buttons, and is more efficient than dwell-clicking. Across all common pointing operations, the circling interface had a tendency to produce faster performance with a head-mounted mouse emulator than with a joystick mouse. The performance accuracy of the circling interface outperformed the dwelling interface. CONCLUSIONS: It was demonstrated that the circling interface has the potential as another alternative pointing method for selecting and manipulating objects in a graphical user interface. Implications for Rehabilitation A circling interface will improve clinical practice by providing an alternative pointing method that does not require physically activating mouse buttons and is more efficient than dwell-clicking. The Circling interface can also work with AAC devices.

Empirical evaluation of circling interface with head-mounted mouse emulator users.

PURPOSE: To evaluate the performance of the circling interface, which is an alternative interaction method for selecting and manipulating on-screen objects based on circling the target, rather than pointing and clicking. METHOD: We conducted empirical evaluations with actual head-mounted mouse emulator users from two different groups: individuals with spinal cord injury (SCI) and individuals with cerebral palsy (CP), comparing each group's performance and satisfaction level on pointing tasks with the circling interface to performance on the same tasks when using dwell-clicking software. RESULTS: Across all operations, for both subjects with SCI and with CP, the circling interface showed faster performance than the dwell-clicking interface. For the single-click operation, the circling interface showed slower performance than dwell selection, but for both double-click and drag-and-drop operations, the circling interface produced faster performance. Subjects with CP required much longer time to complete the tasks compared to subjects with SCI. If errors caused by circling on an area with no target and unintentional circling caused by jerky movements and an abnormally tiny circle are automatically corrected by the circling interface, their performance accuracy with the circling interface outperformed existing solutions without a steep learning curve. CONCLUSIONS: Circling interface can be used in conjunction with existing techniques and this kind of combined approach achieve more effective mouse use for some individuals with pointing problems. It is also expected to be useful for both computer access and augmentative communication software. Implications for Rehabilitation A circling interface will improve clinical practice by providing an alternative pointing method that does not require physically activating mouse buttons and is more efficient than dwell-clicking. Being used in conjunction with existing techniques, some individuals who are head mouse users can achieve more effective mouse use. The Circling interface can also work with AAC devices.

Consumer Satisfaction with Telerehabilitation Service Provision of Alternative Computer Access and Augmentative and Alternative Communication.

Telerehabilitation (TR) services for assistive technology evaluation and training have the potential to reduce travel demands for consumers and assistive technology professionals while allowing evaluation in more familiar, salient environments for the consumer. Sixty-five consumers received TR services for augmentative and alternative communication or alternative computer access, and consumer satisfaction was compared with twenty-eight consumers who received exclusively in-person services. TR recipients rated their TR services at a median of 6 on a 6-point Likert scale TR satisfaction questionnaire, although individual responses did indicate room for improvement in the technology. Overall satisfaction with AT services was rated highly by both in-person (100% satisfaction) and TR (99% satisfaction) service recipients.

Voice control of a powered wheelchair.

Several researchers have described voice control mechanisms for a power wheelchair, but voice control has yet to become a commercially viable control alternative. One problem with voice control is that the voice's limited bandwidth renders it impossible to make frequent small adjustments to the wheelchair's velocity. One possible solution is to utilize voice control in combination with the navigation assistance provided by "smart wheelchairs," which use sensors to identify and avoid obstacles in the wheelchair's path. This paper describes an experiment that compares the performance of able-bodied subjects using voice control to operate a power wheelchair both with and without navigation assistance.

The Hephaestus Smart Wheelchair System.

The Hephaestus Smart Wheelchair System is envisioned as a series of components that clinicians and wheelchair manufacturers will be able to attach to standard power wheelchairs to convert them into "smart wheelchairs." A prototype of the system has been developed and mounted on an Everest and Jennings Lancer2000 wheelchair. The prototype bases its navigation assistance behavior on the behavior developed for the NavChair Assistive Wheelchair Navigation System, but the underlying hardware and software are being designed to facilitate commercialization. This paper describes our design goals for the Hephaestus system and discusses the current status of the system prototype as well as plans for future work.

Chiral separation of labetalol stereoisomers in human plasma by capillary electrophoresis.

A newly derivatized cyclodextrin [octakis-(2,3-diacetyl-6-sulfato)-gamma-cyclodextrin] was investigated as a chiral selector in capillary zone electrophoresis in a study of the chiral separation of labetalol stereoisomers. Heptakis(2,3-diacetyl-6-sulfato)-beta-cyclodextrin (HDAS-beta-CD) and octakis(2,3-diacetyl-6-sulfato)-gamma-cyclodextrin (ODAS-gamma-CD) were shown to be effective in separating labetalol stereoisomers. Optimal separating conditions of the four stereoisomers of labetalol were achieved with 10 mM HDAS-beta-CD and 10 mM ODAS-gamma-CD in an acidic pH buffer of low molarity. Data illustrating the effects of capillary length and cyclodextrin concentration on the separation are presented. The longer capillary length and high voltage enabled the baseline separation of all isomers in less than 15 min. The optimized method was applied to the analysis of human control plasma containing labetalol utilizing solid-phase extraction (SPE) in the 96-well format.

Quantitative determination of a selective alpha-1a receptor antagonist in human plasma by high-performance liquid chromatography with tandem mass spectrometric detection.

Solid-phase extraction, utilizing a 96-well plate format, was used to isolate an alpha-1a receptor antagonist and internal standard from human plasma. Following the isolation procedure, the analyte and internal standard were separated and detected using reversed-phase HPLC coupled with atmospheric pressure chemical ionization (APCI) mass spectrometry operated in the positive ion multiple reaction monitoring (MRM) mode. Based upon the peak area ratio (analyte: internal standard) the analyte was quantified over a concentration range of 0.02-2 ng/ml. Assay validation results including parameters such as precision and accuracy are presented. The validated method was subsequently used to support human pharmacokinetic studies.

Validating a model of row-column scanning.

PURPOSE: For individuals with severe motor and communicative disabilities, single switch scanning provides a way to access a computer and communicate. A model was developed that utilizes scanning interface settings, error tendencies, error correction strategies, and the matrix configuration to predict a user's communication rate. METHOD: Five individuals who use single switch scanning transcribed sentences using an on-screen keyboard configured with the settings from their communication devices. Data from these trials were used as input to a model that predicted TER for the baseline configuration and at least three other system configurations. Participants transcribed text with each of these new configurations and the predicted TER was compared to the actual TER. RESULTS: Results showed that predicted TER was accurate to within 90% on average. The scan rate was also entered into a previously published model which assumes error-free performance. For our model, the average error for each participant was 10.49%, compared to 79.7% for the model assuming error-free performance. CONCLUSIONS: Our model of row-column scanning was much more accurate than a model that did not consider the likelihood of an error occurring. There is still room for improvement, however, and the results of the study will lead to additional modifications of the model.

Clinical evaluation of semiautonomous smart wheelchair architecture (Drive-Safe System) with visually impaired individuals.

Nonambulatory, visually impaired individuals mostly rely on caregivers for their day-to-day mobility needs. The Drive-Safe System (DSS) is a modular, semiautonomous smart wheelchair system aimed at providing independent mobility to people with visual and mobility impairments. In this project, clinical evaluation of the DSS was performed in a controlled laboratory setting with individuals who have visual impairment but no mobility impairment. Their performance using DSS was compared with their performance using a standard cane for navigation assistance. Participants rated their subjective appraisal of the DSS by using the National Aeronautics and Space Administration-Task Load Index inventory. DSS significantly reduced the number and severity of collisions compared with using a cane alone and without increasing the time required to complete the task. Users rated DSS favorably; they experienced less physical demand when using the DSS, but did not feel any difference in perceived effort, mental demand, and level of frustration when using the DSS alone or along with a cane in comparison with using a cane alone. These findings suggest that the DSS can be a safe, reliable, and easy-to-learn and operate independent mobility solution for visually impaired wheelchair users.

Performance testing of collision-avoidance system for power wheelchairs.

The Drive-Safe System (DSS) is a collision-avoidance system for power wheelchairs designed to support people with mobility impairments who also have visual, upper-limb, or cognitive impairments. The DSS uses a distributed approach to provide an add-on, shared-control, navigation-assistance solution. In this project, the DSS was tested for engineering goals such as sensor coverage, maximum safe speed, maximum detection distance, and power consumption while the wheelchair was stationary or driven by an investigator. Results indicate that the DSS provided uniform, reliable sensor coverage around the wheelchair; detected obstacles as small as 3.2 mm at distances of at least 1.6 m; and attained a maximum safe speed of 4.2 km/h. The DSS can drive reliably as close as 15.2 cm from a wall, traverse doorways as narrow as 81.3 cm without interrupting forward movement, and reduce wheelchair battery life by only 3%. These results have implications for a practical system to support safe, independent mobility for veterans who acquire multiple disabilities during Active Duty or later in life. These tests indicate that a system utilizing relatively low cost ultrasound, infrared, and force sensors can effectively detect obstacles in the vicinity of a wheelchair.

Analyzing performance with computer access technology using unconstrained text entry protocol.

Recent work in human-computer interaction has demonstrated the use of unconstrained text entry protocols, which provide a more natural environment for research participants. We demonstrate the application of this approach to the analysis of word completion. Eleven participants (five nondisabled and six with disabilities) were recruited and asked to transcribe sentences using an on-screen keyboard both with and without word completion while time-stamped keystroke data were collected. The subsequent analysis demonstrates how the entire input stream (including erroneous keystrokes and the keystrokes used to correct errors) can be included in evaluation of performance with a text entry device or keystroke reduction method. Three new measures of keystroke savings are introduced, and the application of these measures is demonstrated.

Toward automatic adjustment of pointing device configuration to accommodate physical impairment.

PURPOSE: Software was developed which makes recommendations regarding configuration of a computer pointing device, such as a mouse, to accommodate a person's physical impairment. Specifically, a software agent automatically recommends a setting for the computer's control-display gain based on observations of a user's performance in a target selection task. METHOD: The software agent makes its recommendations based on available adjustment settings in the existing operating system. The agent was evaluated in studies with 12 participants who have motor impairments. RESULTS: The agent-selected gain was not associated with significant improvements in selection time or error-free performance compared with the operating system's default gain. Across participants and trials, gain did not have a significant effect on selection time except at the lowest gain settings tested. However, two participants did have notable and consistent improvement in selection time and error-free performance using the agent-selected gain; gain across trials had a significant effect on number of target entries and number of submovements; and a post-hoc analysis indicated improved target selection time when varying both target size and control-display gain. CONCLUSION: These observations provide possible avenues for future work, although the current study indicates that changes to control-display gain, alone, are unlikely to offer improvements in speed or accuracy for the general population of people with motor impairments.

How many people would benefit from a smart wheelchair?

Independent mobility is important, but some wheelchair users find operating existing manual or powered wheelchairs difficult or impossible. Challenges to safe, independent wheelchair use can result from various overlapping physical, perceptual, or cognitive symptoms of diagnoses such as spinal cord injury, cerebrovascular accident, multiple sclerosis, amyotrophic lateral sclerosis, and cerebral palsy. Persons with different symptom combinations can benefit from different types of assistance from a smart wheelchair and different wheelchair form factors. The sizes of these user populations have been estimated based on published estimates of the number of individuals with each of several diseases who (1) also need a wheeled mobility device and (2) have specific symptoms that could interfere with mobility device use.

Distributed cognitive aid with scheduling and interactive task guidance.

A cognitive assistive technology system has been designed for use by people with memory and organizational impairments. This system will provide a distributed architecture for both scheduling assistance and task guidance, as well as intelligent, automatic replanning on the levels of both the schedule and individual tasks. A prototype of this architecture has been developed that focuses on interactive task guidance capabilities. Scheduling software has been developed but not fully integrated with the task guidance features. The system has been preliminarily tested through simulated trials, monitored use of the prototype in a clinical setting, and usability trials of the task-design interface with rehabilitation professionals. Participants were able to respond appropriately to cues provided by the system and complete prescribed tasks.