Abstract

A gap analysis identifies the gap between where you are now and where you want to be. This document is a gap analysis of the state of accessibility for People with learning disabilities and cognitive disabilities when using the Web and information technologies. We aim to identify and describe the current situation and contrast it to what we want to happen. This document is not a specification (non-normative). It will be used as a base document to suggest techniques and create a roadmap for improving accessibility for people with learning disabilities and cognitive disabilities.

This document is divided into sections. This introduction is the first section. The second section analyses the current situation, in terms of user groups, technologies and existing standards. Subsequent sections will identify gaps and potentials and make suggestions for techniques and for the roadmap.

Status of This Document

This section describes the status of this document at the time of its publication. Other documents may supersede this document. A list of current W3C publications and the latest revision of this technical report can be found in the W3C technical reports index at http://www.w3.org/TR/.

@@

This document was published by the Web Content Accessibility Guidelines Working Group as an Editor's Draft. If you wish to make comments regarding this document, please send them to public-comments-wcag20@w3.org (subscribe, archives). All comments are welcome.

Publication as an Editor's Draft does not imply endorsement by the W3C Membership. This is a draft document and may be updated, replaced or obsoleted by other documents at any time. It is inappropriate to cite this document as other than work in progress.

This document was produced by a group operating under the 5 February 2004 W3C Patent Policy. W3C maintains a public list of any patent disclosures made in connection with the deliverables of the group; that page also includes instructions for disclosing a patent. An individual who has actual knowledge of a patent which the individual believes contains Essential Claim(s) must disclose the information in accordance with section 6 of the W3C Patent Policy.

This document is governed by the 1 August 2014 W3C Process Document.

Table of Contents§

1. Introduction§

This section is non-normative.

A gap analysis identifies the gap between where you are now and where you want to be. This document is a gap analysis of the state of accessibility for People with learning disabilities and cognitive disabilities when using the Web and Information and Communication Technologies (ICT). We aim to identify and describe the current situation and contrast it to what we want to happen.

 This document will be used as a base document to enable discussion, suggest techniques and create a roadmap for improving accessibility for people with learning disabilities and cognitive disabilities.

This document is divided into sections:

1.1 Importance of This Document§

This document is important because enabling people with learning and cognitive disabilities to use the Web and ICT is of critical importance to both the individuals and to society.

More and more the internet and ICT has become the main way people stay informed and current on news and health information, keep in touch with friends and family, and provides independence, convenient shopping, and other. People who cannot use these interfaces will have an increased feeling of being disabled and alienation from society.

Further, with the advent of the Web of Things everyday physical objects are connected to the Internet and have ICT interfaces. Being able to use these interfaces now is an essential component of allowing people to maintain their independence, stay in the work force for longer and stay safe.  

Consider that the population is aging. By 2050 it is projected there will be 115 million people with dementia worldwide. It is essential to the economy and society that people with mild and moderate levels of dementia stay as active as possible and participate in society for as long as possible. However, at the moment even people with only a mild cognitive decline find may standard applications impossible to use. That means more and more people are dependent on care givers for things that they could do themselves, increasing the crippling cost of care and reducing human dignity.

We therefore invite you to review this draft, comment and consider how your technologies and work may be effected by these issues.

1.2 Assumptions§

There is a huge number of cognitive disabilities and variations of them. If we attempt an analysis of all the possibilities, the job will be too big and nothing will be achieved. Therefore we are adopting a phased approach, selecting in phase one a limited scope of eight diverse disabilities, and hope to achieve something useful within that scope. Also note that helping users improve skills, and emotional disabilities, are out of scope for phase one. We anticipate this analysis will continue to a second or third phase where more user groups are analyzed and the existing analyses are updated with new research and with new technologies and scenarios.

 

1.3 Comments§

This is an early and incomplete draft for review and to help us get comments and early feedback. We are particularly interested in:

We welcome comments and suggestions. Please send comments to … All comments will be reviewed and discussed by the task force. Although we cannot commit to formally responding to all comments on this draft, the discussions can be tracked in the task force minutes. 

2. Summary of User Groups and Cognitive Function§

Include: mapping of disabilities and cognitive function.

3. Potential for Inclusion§

3.1 Proposed Directions§

The aim of the Cognitive and Learning Disabilities Accessibility Task Force (COGA) is to improve Web accessibility for people with cognitive and learning disabilities.

This is a discussion document,  that looks at what could be done for accessibility for people with cognitive and learning disabilities. It is intended to help us (COGA) identify what needs to be done to get there.

Note

Much of this may be out of scope for our mandate and role as a W3C task force.

3.1.1 What is Needed§

The pieces of what needs to happen next (described in the text bellow)

3.1.2 Techniques for Everyone§

There is a substantial amount of techniques  that are helpful  for over 90% of people with cognitive disabilities. These techniques need to be gathered in one place.

For example, most people with any cognitive disability may be disturbed when form data is lost when a session times out. Almost all COGA use groups may need help or  need to double check data entered into a form. Timing out so that they need to start again may make a form unusable.

See sample page format to help us gather techniques as we come across them, so that they do not get forgotten or are hard to find later when we are finished the gap analysis.

3.1.3 Techniques for User Groups§

We also need to document t techniques that are good for some COGA user groups and not for others (depends on cognitive function and localization). For example, text under symbols may be useful for many people with dementia but unhelpful for many people with severe language disabilities.

In a localization example using left hand side text alignment is helpful for  English sites but right hand side text alignment is  helpful for sites in Arabic or Hebrew.

See sample page structure and more examples.

3.1.4 Grouping Techniques§

Once we have a comprehensive set of techniques  we may want to grope techniques  into “enhancements”. For example, we may make a group of techniques as “simple text” enhancements, making it easier to reference.

We may also want to identify how different enhancements benefit people with different limitations of cognitive functions.

To achieve this we may need to label groups of cognitive functions, so that we ca simplify linking enhancements to cognitive functions. See an initial page of cognitive function.

Once we have a set of enhancements we can enable standards such as EARL to identify  which documents support which enhancements.. Other supported systems include GPII, ISO, Cload4All and possibly Fluid.

Once we have a comprehensive set of techniques we can also explore what is needed to make a website adaptable to different COGA groups of users.  We may be able to identify semantics that enable adaptation for specific learning and cognitive disabilities and to conflicting needs of different users.

This could include:

  • Adaptive text: This would enable text to become simpler or more literal or adapt to the user needs.
  • Adaptive components: There are many ways to make the same widget. Because different web site implement the same functions differently the user needs to learn how to interact and use with the specific page widgets. Enabling adaptive components would enable the user to use one interface, that they know how to use, across many different sites.
  • Adaptive pages: This would enable changing or adapting the page layout , cutting out extra features or confusing aspects of the page. This would semantics to enable adaptive interfaces and AT. This would enable adaptive interfaces to allow users to use complex interfaces via an independent and familiar interface tailored to their scenarios and strengths. As this interface is designed for the user/user group, all features are familiar and the same buttons and metaphor will be used across all conforment applications.
  • Adaptive media:
  • Adaptive forms and billing: This may result in suggestions to ARIA 2.0  and PF for additional semantics to enable AT to provide techniques  

(See more information)

This may result in suggestions  to PF group for the ARIA 2.0 specification

3.1.5 Special Projects§

There may be other accommodations that are needed that our outside the handshaking approach or adaptable pages

  • Accessible menu systems for people with  cognitive disabilities: This will look at what measures or techniques  could make phone menu systems usable by for people with  cognitive disabilities, such as enabling people to reach an operator.  (Relevant specification: voice Ml)
  • Interoperable AAC symbols AND
  • Lexicon and symbol that support low literacy.
  • Labels for cognitive function: See an early draft.

See more ideas.

3.2 How Inclusion Could Be Improved§

To port from https://www.w3.org/WAI/PF/cognitive-a11y-tf/wiki/Section_3.

3.2.1 Developer Strategies§

3.2.2 Special Cases§

4. Gap Analysis§

Includes table Mapping Cognitive Issues to Accessibility Issues

The TOC proposal included methodology for performing gap analysis, but it had the same content as the methodology in user research below, so wasn't included here.

 

5. Methodology in User Research§

In making user scenarios and user group research we are taking a multilevel approach.

5.1 Asking the Users§

  1. What do they have trouble with?
  2. What tasks do they need help with?
  3. What tasks they avoid
  4. What tasks often lead to mistakes

5.2 Addressing Specific Topics§

In the user group research section of the gap analysis, we aim to identify abstract principles for accessibility for people with cognitive and learning disabilities, and core challenges for each user group as well as practical techniques.

However, when trying to identify abstract principles, it is often helpful to look at concrete user scenarios and challenges that different user group’s face. For that purpose we have identified the practical and diverse user scenarios that should be considered in user group research. These include:

5.2.1 Communication§

Making sure users can communicate with people and be part of society. Tasks to investigate:

  1. Use email and chat effectively
  2. Being aware of a change
  3. Share pictures and information
  4. Play
  5. Request information

5.2.2 Applications§

  1. Apps to enable work such as document authoring
  2. Critical DHTML content and applications such as: enroll and manage healthcare, make an appointment, enroll and manage banking, shop online
  3. sign-up / register and manage account profile on a site, book and manage travel
  4. Enroll in and participate in online education
  5. Apps such as mobile apps
  6. Directions / locations

5.2.3 Information and Communications Technology (ICT) Systems§

  1. Use the Web of Things applications such as temperature control, entertainment systems
  2. Phone menu systems
  3. Other menu systems

5.2.4 Research and Education §

  1. Understand content and learning material
  2. Search, research, and find information
  3. Enroll in and participate in online education

5.2.5 Access to Critical Information §

  1. Read and share news
  2. Find weather alerts
  3. Find and read emergency information
  4. Find out rites and social service information

5.3 Cross-Cutting Concerns§

Using content should be:

  1. Safe
  2. Effective
  3. Minimal frustration

6. Research on User Groups§

This section describes the state of the art in classification of cognitive function.

User group research modules follow. This is Phase 1. The group hopes to add more groups such as effects of Post-Traumatic Stress Disorder (PTSD) on cognitive function.

6.1 Dyslexia§

Dyslexia is a syndrome best known for its affect on the development of literacy and language related skills. There are a number of different definitions and descriptions of dyslexia. The syndrome of dyslexia is now widely recognized as being a specific learning disability of neurological origin that does not imply low intelligence or poor educational potential, and which is independent of race and social background.

6.1.1 Cognitive Functions§

This section is a technical reference. Jump to the next section on #Symptoms for more practical information.

Overview: Mainstream credible research in behavioral neurology agrees that Dyslexia is a consequence of an altered neural substrate, in the various regions of the brain which are responsible for the reading process. fMRI scans (18, 19) have show that different subgroups of dyslexia exhibit under activity in areas such as:

  • V5/MT (BA Area 19) - resulting in visual discriminatory problems (9, 15), possibly disturbing magnocellular function 41
  • auditory cortex (BA areas 41 and 42 ) - resulting in low auditory discrimination skills (32),
  • superior temporal gyrus (BA Area 22) Wernike's area and striate cortex or V1(Area 17)- resulting in a phoneme processing problem (5, 22, 23 ), and pattern recognition.
  • the angular gyrus (Area 39) in the inferior parietal lobule - coursing poor cross modal associations (22, 24, 28, 30).

Other studies #42 using PET have shown less activation than the controls in left inferior frontal gyrus (BA areas 45/44/47/9), left inferior parietal lobule (BA area 40), left inferior temporal gyrus/fusiform gyrus (BA areas 20/37) and left middle temporal gyrus (BA area 21). There are also studies with different approaches such as identifying ectopias clustered round the left temporoparietal language areas. #44

The different schools of research have championed the different neurological bases of dyslexia, and its resulting subgroups of dyslexia.

6.1.1.1 Auditory Discrimination§

(Main research - see Tallal et all (32)) This body of research has shown that many dyslexics have defects in the left auditory cortex. The auditory cortex is responsible for sound naming and identification and temporal processing (such as interval, duration, and motion discrimination).

Note that dyslexia does not affect hearing, but the identification and differentiation of sounds.

6.1.1.2 Visual Recognition Skills§

(Main school of research Livingstone (1993) and Martin and Lovegrove 1988) )(see 9, 15) Dyslexics have reduced synaptic activity in the V5 area (also known as visual area MT, middle temporal), is a region of extra-striate visual cortex that is thought to play a major role in the perception of motion.

V5 is part of the broader "magno-cellular -- large cell -- system" that processes fast-moving objects, and brightness contrasts. One interpretation is that a specific magno-cellular cell type develops abnormally in people with dyslexia (3).

For results of clinical tests see (1)

6.1.1.3 Phoneme Processing§

Main research from Shaymitz (1998) and Rumsy (1996), (see 5, 10,11, 14 –17) The language regions in the superior temporal gyrus (Wernike's area) and striate cortex are found to underachieve in the dyslexic. These areas respond to simple phoneme processing tasks. (Areas that respond to more complex language tasks, an anterior region, the IFG, displayed relative over activation in dyslexics.)

Games involving nonsense words, rhyme, and sound manipulation will be enhanced by special auditory effects: The consonants are recorded louder while the adjacent vowel is lengthened and its sounds softened. All games are carefully leveled by the complexity of the manipulations involved. (For results of clinical tests see Ojemann 1989, Bertoncini et al 1989 ).

6.1.1.4 Cross-modal Association§

Main research from Leon (1996) and Shaymitz (1998) (see 8, 22, 24, 28,30)

The angular gyrus, a brain region considered pivotal in carrying out cross-modal (e.g., vision and language) associations necessary for reading, is involved. The current findings of under activation in the angular gyrus of dyslexic readers coincide with earlier studies of those who lost the ability to read due to brain damage centered in that same area of the brain.

The ability to link visual stimuli to auditory interpretation can be stimulated by Multimedia implementation of the coming together of these separate disciplines. Activities are all carefully leveled to correlate the child's current ability level.

6.1.1.5 Visual Recognition Skills§

(Main school of research Livingstone (1993) and Martin and Lovegrove 1988) )(see 9, 15) Dyslexics have reduced synaptic activity in the V5 area.

V5 is part of the broader "magno-cellular -- large cell -- system" that processes fast-moving objects, and brightness contrasts. One interpretation is that a specific magno-cellular cell type develops abnormally in people with dyslexia (3).

For results of clinical tests see (1)

6.1.1.6 Working Memory§

(Main school of research Beneventi et al.2008)

Reduced activity in the pre-frontal and parietal cortex may result in working memory deficits. #40

6.1.2 Symptoms§

Common symptoms are:

  • Reading is typically slow and laborious. If they are undiagnosed or diagnosed late, they may be illiterate or barely literate.
  • Concentration tends to fluctuate.
  • Poor and unusual spelling and grammar. Handwriting is unusable or very messy.
  • Poor physical coordination
  • Difficulty remembering information, (tends to fluctuate)
  • Difficulty with organizing and planning
  • Difficulty working within time limits
  • Difficulty thinking and working in sequences, which can make planning difficult
  • Visual processing difficulties, which can affect reading and recognizing places
  • Poor auditory processing skills, which can make listening to oral instructions difficult, tiring and confusing

6.1.3 Challenges§

6.1.3.1 Memory§
  • Poor short term memory for facts, events, times, dates, symbols.
  • Poor working memory; i.e. difficulty holding on to several pieces of information at the same time. This is especially challenging while undertaking a task e.g. taking notes as you listen, addressing compound questions.
  • Mistakes with routine information e.g. giving your age, and phone number or the ages of children.
  • Inability to hold on to information without referring to notes.
6.1.3.2 Automatizing Skills§

Dyslexics do not tend to automatize skills very well, and a high degree of mental effort is required in carrying out tasks that non-dyslexic individuals generally do not feel requires effort. This is particularly true when the skill is composed of several sub-skills (e.g. reading, writing, driving).

6.1.3.3 Information Processing.§
  • Difficulties with taking in information efficiently (this could be written or auditory).
  • Slow speed of information processing, such as a 'penny dropping' delay between hearing or reading something and understanding and responding to it.
6.1.3.4 Communication Skills§
  • Lack of verbal fluency and lack of precision in speech. (relevant for voice systems)
  • Word-finding problems
  • Inability to work out what to say quickly enough
  • Misunderstandings or misinterpretations during oral exchanges
  • Sometimes mispronunciations or a speech impediment may be evident.
6.1.3.5 Literacy§
  • Difficulty in acquiring reading and writing skills. Reading is likely to be slow.
  • If they are undiagnosed or diagnosed late, may be illiterate, barely literate and it will be very laborious
  • Where literacy has been mastered, problems continue such as poor spelling, difficulty extracting the meaning from written material, difficulty with unfamiliar words, and difficulty with scanning or skimming text.
  • Particular difficulty with unfamiliar or new language such as jargon.
6.1.3.6 Organization, Sequencing§
  • Difficulty organizing a sequence of events.
  • Incorrect sequencing of strings of numbers and letters. (passwords, phone numbers)
  • Chronic disorganization and misplacing/losing items.
  • Difficulty with time management and passage of time
6.1.3.8 Sensory Sensitivity§
  • Sensitivity to noise and visual stimuli.
  • Impaired ability to screen out background noise / movement.
  • Sensations of mental overload
  • Tendency to "switch off".
6.1.3.9 Lack of Awareness§
  • Failure to notice body language.
  • Failure to realize the consequences of their speech or actions.
6.1.3.10 Visual Stress§
  • Some people with dyslexic difficulties may experience visual stress when reading but especially when dealing with large amounts of text. So breaks are often needed.
6.1.3.11 Coping Strategies§

It must be emphasized that individuals vary greatly in their learning difficulties. Key variables are the severity of the difficulties and the ability of the individual to identify and understand their difficulties and successfully develop and implement coping strategies.

By adulthood, many people with dyslexia are able to compensate through technology, reliance on others and an array of self-help mechanisms - the operation of which require sustained effort and energy. Unfortunately, these strategies are prone to break down under stressful conditions which impinge on areas of weakness.

6.1.3.12 Effects of Stress§

People are particularly susceptible to stress (compared with the ordinary population) with the result that their impairments increase.

6.1.4 Scenarios and User Stories§

6.1.4.1 Scenario: Online Research§

A is a high school student with dyslexia. Although he can read his level is slow and he finds it difficult. A has a school project and needs to do online research. A does not use a screen reader as they are afraid that that will stop him reading and improving his skills. A needs to be able to find the content he needs easily, both finding the right resource and the right information inside that resource with minimal reading, and will then read the sections that he needs. He will do a web search, and a quick review of different pages to find the pages he needs.

Table of ICT Steps and challenges
Step Challenge
Search query
Scanning results
Doing a short review of different options and finding the most appropriate
Finding the right content in the right document
Reading the right content
Collecting the information
Copying for Citing the resources and collecting them with the right information
Saving the work
Putting it together and writing the paper Out of scope of this use case
6.1.4.2 Scenario: Finding Out About a Change Event in an Email§

B is a mother with young children. She has dyslexia. B reads the words, and then stops to understand them. B is also a slow reader. B receives many emails and important emails often are below or behind the scroll bar. Reading the summaries of each email takes time. B has set her email app to tag emails from her child's school as important. However B still needs to differentiate between emails from her children’s school that are crucial and emails that are just informative. B needs to be able to find the important content (such as school finishing at a different time next Monday) in a long school newsletter.

B’s email application changes and she no longer knows how to tag senders as important. At the same time her child starts at a new school. She has difficulty finding the information on how to tag emails from the new school as important. Also the school starts sending many emails about projects they are doing and what is happening in class, so she does not have time to read each email from them as soon as it arrives. She postpones this task and important emails get lost.

Table of ICT Steps and challenges
Step Challenge
Finding out how to tag/label this from a sender as important (first time)
Remembering the process (re-finding it next time)
Tagging/labeling the new teacher
Identifying important emails from the teacher and distinguishing them from general interest emails
Finding important content in long emails
6.1.4.3 Scenario: Using a Electronic Interface§

C is an adult living alone. He has dyslexia. C has impaired vision and auditory memory, and finds remembering sequences extremely challenging. C has a garden with an automatic watering system with a one line ICT (electronic) interface. The interface is not user friendly. C needs to select what sprinkler he is setting using an arrow key, then needs to set the first time it should go on, (using the arrow key in the number mode) press enter, and then set the duration the sprinkler should run. He then needs to repeat the steps for the second time (or leave it blank). He then needs to repeat the process for the next sprinkler in the correct order. C has been shown how to use the system many times, however each time the system needs to be adjusted he makes mistakes and gets confused. Ten years later C still needs to call the gardener to change the settings and is consonantly relearning the interface.

Table of ICT Steps and challenges
Step Challenge
learning the steps involved Learning the sequence
Performing the steps correctly Remembering the sequence. Performing it in the correct order
Undoing mistakes Remembering what point he is at in the sequence. Going back a step and tracking the step he is at now. -
6.1.4.4 Scenario: Using a Phone Menu§

D is looking after his elderly father. D has dyslexia and impaired working memory and impaired auditory discrimination. D can do one mental process at a time. D is weak at remembering numbers. He can remember one number at a time. D typically makes mistakes when dialing numbers. Often he will dial a number 3 or 4 times before he gets it right. D needs to speak to a doctor about his father who is sick. The doctor's office has an answer phone system with multi-layers. It takes D two attempts to dial the office. When faced with the menu system, D needs to listen to several similar options, understand the words, process the words, make a choice and identify the correct number and enter the correct number into the keypad. Because he is trying to remember numbers whilst he is trying to listen to the next option he misunderstands the options. He makes an incorrect choice. When trying to recover from the error he enters an invalid number and gets thrown off the line. D needs to redial this number, but as he is now upset it takes him four attempts to dial it correctly. He is then faced with the same phone system. D makes more mistakes. After half an hour he asks a neighbor to help him. D is very upset which in turn upsets his sick father. D's self confidence at being able to look after his father is shattered.

Table of ICT Steps and challenges
Step Challenge
Identifying the option he needs and remembering the right number associated with that option. Auditory discrimination under pressure, memory of the correct number, whilst listening and processing other options.
Entering the correct number Mapping the symbol to the number under pressure, eye hand coordination
Undoing mistakes Staying calm so that his skills do not further deteriorate. -

6.1.5 How They Use The Web and ICT§

Dyslexics tend to use mainstream technologies to help them. For example, using a Word-processor's spell checker. They may use free screen readers or screen readers that highlight text as they read. They may use assistive technology such as Dragon or a Daisy reader, although this seems to be used more as a teaching aid and not for typical Web access. Special software to help dyslexics includes Text Help.

6.1.6 Characteristics of Content Optimized For This Group§

Content made for people with dyslexia tends to have

  • Icons to visually reinforce structure and what each section is (such as examples, tips etc)
  • Diagrams that illustrate the point of the content
  • Short paragraphs, short sentences
  • Content tends to start with a summary of the point. This can also be true at the document or paragraph level where the first sentence raises the main point of the paragraph
  • Well structured text with headings (reducing reading of irrelevant text)
  • Use of bold on key terms (helps finding of relevant text)
  • A "read it to me" button, that highlights text as it is read and is simple to use
  • Has a clear, well-structured, minimalistic navigation system and is free from confusing steps and complex user interface flow

In general, content for dyslexics helps the user find the text they are looking for via visual aids, and reduces the need to read though irrelevant text to find the information that they are looking for.

6.1.7 Specific Technologies§

Assistive technologies include (incomplete list):

  • Text help
  • Dragon
  • Kurzweil
  • Ghotit
  • Learning Ally
  • Zoomreader
  • speak-it
  • Read2Go

6.1.8 Summary of Existing Research and Guidelines§

There are organizations who have produced guidelines for creating content for people with dyslexia, such as The British Dyslexia Association guidelines, and The Irish Dyslexia Association

6.1.8.1 Summary/Exerts of The British Dyslexia Association Guidelines and Dyslexia Style Guide§

This Guide is in three parts: 1. Dyslexia Friendly Text. 2. Accessible Formats. 3. Website design.

6.1.8.1.1 Dyslexia Friendly Text§

The aim is to ensure that written material takes into account the visual stress experienced by some dyslexic people, and to facilitate ease of reading. Adopting best practice for dyslexic readers has the advantage of making documents easier on the eye for everyone.

6.1.8.1.1.1 Media§
  • Use a plain, evenly spaced sans-serif font such as Arial. See the BDA New Technologies Committee website: http://bdatech.org/what-technology/typefaces-for-dyslexia/
  • Font size should be 12-14 point. Text should be expandable.
  • Use dark colored text on a light (not white) background. (Avoid pure white backgrounds because of glare)
6.1.8.1.1.2 Headings and Emphasis§
  • For Headings, use larger font size in bold, lower case.
  • Boxes and borders can be used for effective emphasis.
  • Avoid underlining and italics: these tend to make the text appear to run together. Use bold instead.
  • AVOID TEXT IN BLOCK CAPITALS: it is much harder to read.
6.1.8.1.1.3 Layout §
  • Use left-justified with ragged right edge.
  • Avoid narrow columns (as used in newspapers).
  • Lines should not be too long: 60 to 70 characters.
  • Avoid cramping material and using long, dense paragraphs: space it out.
  • Line spacing of 1.5 is preferable.
  • Avoid starting a sentence at the end of a line.
  • Use bullet points and numbering rather than continuous prose.
6.1.8.1.1.4 Writing Style§
  • Use short, simple sentences in a direct style.
  • Give instructions clearly. Avoid long sentences of explanation.
  • Use active rather than passive voice.
  • Avoid double negatives.
  • Be concise.
6.1.8.1.2 Increasing Accessibility§
  • Flow charts are ideal for explaining procedures.
  • Pictograms and graphics help to locate information.
  • Lists of 'do's and 'don'ts' are more useful than continuous text to highlight aspects of good practice.
  • Avoid abbreviations if possible or provide a glossary of abbreviations and jargon.
  • For long documents include a contents page at the beginning and an index at end.
6.1.8.1.3 Checking Readability§

Note: You can set spell checker in MS Word to automatically check readability. MS Word will then show your readability score every time you spell check.

  • Check long documents in sections, so that you know which parts are too hard.
  • Flesch Reading Ease score: Rates text on a 100-point scale; the higher the score, the easier it is to understand the document. For most standard documents, aim for a score of approximately 70 to 80.
  • Flesch-Kincaid Grade Level score: Rates text on a U.S. grade-school level. For example, a score of 5.0 means that a fifth grader, i.e. a Year 6, average 10 year old, can understand the document. For most standard documents, aim for a score of approximately 5.0, by using short sentences, not by dumbing-down vocabulary.
6.1.8.2 Accessible Formats§

Use an accessible format so that content can be read by screen reading software.

  • We suggest offering both the source MS Word files and derived PDF files where possible.
  • Publicise availability of accessible formats.
6.1.8.2.1 Preparing a Document for Text-Reading Software§
  • Listening to a document using a text reader will take longer than visual reading.
  • Put full stops after headings to make the voice drop and pause; a pale tint similar to the background color will make the dots less visually distracting.
  • Put semi-colons, commas, or full stops after bullet points to make a pause.
  • Use Styles in Word to organize headings and formatting.
  • Contents Page listings should be hyper-linked.
  • Number menu items.
  • Use internal and external hyperlinks for ease of navigation.
  • Avoid text in capital letters in mid-line, as they may be read as single letters.
  • Include as few signs and symbols as are absolutely necessary, e.g. * asterisks or dashes (both short and long), as these will be spoken.
  • Long dashes should be avoided: use colons to make the voice pause.
  • Use straight quotation marks. Curly or slanting ones may be read out as ‘back quote’ by some screen readers.
  • Avoid Roman Numerals and 'No.' for number.
  • Consider whether abbreviations and acronyms need full stops.
  • Use hyphens in compound words to aid text reading pronunciation.
  • Chunk phone numbers to avoid being read as millions or hundreds of thousands.
6.1.8.2.2 Website Design§

Research shows that readers access text at a 25% slower rate on a computer. This should be taken into account when putting information on the web. When a website is completed, check the site and information for accessibility by carrying out these simple checks.

  • Navigation should be easy. A site map is helpful.
  • Use graphics, images, and pictures to break up text, while bearing in mind that graphics and tables may take a long time to download.
  • Very large graphics make pages harder to read.
  • Offer alternate download pages in a text reader friendly style.
  • Where possible, design web pages which can be downloaded and read off-line.
  • Moving text creates problems for people with visual difficulties. Text reading software is unable to read moving text.
  • Content's links should show which pages have been accessed.
  • Encourage the use of hyperlinks at the end of sentences.
  • Make sure that it is possible for users to set their own choice of font style and size, background and print colours.
6.1.8.2.3 See Also§
6.1.8.3 Other Guidelines§

Tips found across the web include http://www.dyslexia.com/library/webdesign.htm

  • Keep paragraphs short, and use a small amount of text on each page.
  • If a long article is posted, create a topic index at the beginning, so that the dyslexic reader can quickly narrow in on the parts that interest him or her.
  • Use default font settings or provide a way for users to choose their own styles.

Read more: http://www.dyslexia.com/library/webdesign.htm#ixzz2yAl09G77

  • Use small icons to help with navigation between frequently used web pages.
  • Avoid using background images behind text. Make sure that there is a good contrast between the color of the background and the color of the text.
  • Do not set up background music to play, unless the site gives the user a choice whether to turn it on.

Read more: http://www.dyslexia.com/library/webdesign.htm#ixzz2yAjpgQlL

6.1.9 Extent To Which Current Needs Are Met§

WCAG does help in that content can be used by a screen reader and headings should be used. Many of the most useful checkpoints are AAA and hence not implemented or are advisory techniques and hence, likewise, not adopted.

AA level conformance to WCAG does not significantly help reduce cognitive load or reduce dependency on text by formatting and pictorial aids. Other guidelines(non W3C such as British Dyslexia Association Guidelines) fill in some of the gaps in WCAG.

None of the reviewed guidelines help ICT interfaces of voice mail systems. They also do not address getting additional help.

6.1.10 Potentials and Possibilities§

Added to brainstorming section

6.1.11 Prevalence§

Dyslexia is a hidden disability thought to affect around 10% of the population, 4% severely.

Note that recent studies indicate that dyslexia is particularly prevalent among small business owners, with roughly 20 to 35 percent of US and British entrepreneurs being affected. This is important as often people feel the dyslexics are not in their user audience. With the exception of a scrabble game site, that is very unlikely. [39]

6.1.12 Sources and References§

http://www2.open.ac.uk/students/disability/dyslexia-or-other-specific-learning-difficulties.php

http://www.bdadyslexia.org.uk/about-dyslexia/adults-and-business/dyslexia-and-specific-learning-difficulties-in-adu.html

6.1.12.1 References to Research§

1. Bakker ,(1990) Neurophysiological Treatment of Dyslexia, Oxford University Press,.

2. A Galaburda,(1993) Dyslexia and Development: Neurobiological Aspects of Extra-Ordinary Brains, ed., Harvard University Press, London.

3. Getting the Message Across, published by the Questions Publishing Company, Birmingham, England, 1996, on behalf of the British Dyslexia Association.

4. B Blachman and L. Erlbaum.(1997) Foundations of Reading Acquisition and Dyslexia: Implications for Early Intervention, ed. Associates Publishers, New Jersey,.

5. S Shaywitz et all (1998) Functional disruption in the organization of the brain for reading in dyslexia . Proc. Natl. Acad. Sci. USA Vol. 95, pp. 2636–2641

6. C. Njioktien ,(1998) Nuerological Arguments for a joint developmental Dysphasia-Dyslexia syndrome

7. M Snowling (1997) Dyslexia A Cognitive Developmental Perrspective, Blackwell Massachusetts USA

8. G Lyon and j. Rumsey,(1996) Neuroimaging a window to the neurological foundations of learnng and behavior in children, Pual Brooks 58-73

9. Eden, G. F., VanMeter, J. W., Rumsey, J. M., Maisog, J. M., Woods,R. P. & Zeffiro, T. A. (1996) Nature (London) 382, 66–69.

10. Paulesu, E., Frith, U., Snowling, M., Gallagher, A., Morton, J.,Frackowiak, R. S. J. & Frith, C. D. (1996) Brain 119, 143–157.

11. Rumsey, J. M., Nace, K., Donohue, B., Wise, D., Maisog, J. M.& Andreason, P. (1997) Arch. Neurol. 54, 562–573.

12. Van Orden, G. C., Pennington, B. F. & Stone, G. O. (1990)Psychol. Rev. 97, 488–522.

13. Lukatela, G. & Turvey, M. T. (1994) J. Exp. Psychol. Gen. 123,107–128.

14. Demonet, J. F., Price, C. Wise., R. & Frackowiak, R. S. J. (1994)Brain 117, 671–682.

15. Henderson, V. W. (1986) Brain Lang. 29, 119–133.

16. Petersen, S. E., Fox, P. T., Snyder, A. Z. & Raichle, M. E. (1990)Science 249, 1041–1044.

17. Pugh, K., Shaywitz, B., Constable, R. T., Shaywitz, S., Skudlarski, P., Fulbright, R., Bronen, R., Shankweiler, D., Katz, L., Fletcher,J. & Gore, J. (1996) Brain 119, 1221–1238.

18. Friston, K. J., Ashburner, J., Frith, C. D., Poline, J.-B., Heather,J. D. & Frackowiak, R. S. J. (1995) Human Brain Mapping 2, 165–189.

19. Talairach, J. & Tournoux, P. (1988) Coplanar Stereotaxic Atlas of the Human Brain. Three-Dimensional Proportional System: An Approach to Cerebral Imaging (Thieme, New York).

20. Bavelier, D., Corina, D., Jezzard, P., Padmanabhan, S., Clark, V. P., Karni, A., Prinster, A., Braun, A., Lalwani, A., Raus-checker, J. P. et al. (1997) J. Cognitive Neurosci. 9, 664–686.

21. Woodcock, R. W. (1987) Woodcock Reading Mastery Tests, Revised (American Guidance Service, Circle Pines, MI).

22. Black, S. E. & Behrmann, M. (1994) in Localization and Neuro-imaging in Neuropsychology, ed. Kertesz, A. (Academic, New York), pp. 331–376.

23. Geschwind, N. (1965) Brain 88, 237–294.

24. Benson, D. F. (1994) The Neurology of Thinking (Oxford Univ. Press, New York).

25. Galaburda, A. M., Sherman, G. F., Rosen, G. D., Aboitiz, F. & Geschwind, N. (1985) Ann. Neurol. 18, 222–233.

26. Geschwind, N. (1985) in Dyslexia: A Neuroscientific Approach to Clinical Evaluation, eds. Duffy, F. H. & Geschwind, N. (Little, Brown, Boston), pp. 195–211.

27. Shaywitz, B. A., Shaywitz, S. E., Pugh, K. R., Constable, R. T., Skudlarski, P., Fulbright, R. K., Bronen, R. T., Fletcher, J. M., Shankweiler, D. P., Katz, L. et al. (1995) Nature (London) 373, 607–609.

28. Dejerine, J. (1891) C. R. Societe du Biologie 43, 197–201.

29. Damasio, A. R. & Damasio, H. (1983) Neurology 33, 1573–1583.

30. Friedman, R. F., Ween, J. E. & Albert, M. L. (1993) in Clinical Neuropsychology, eds. Heilman, K. M. & Valenstein, E. (Oxford Univ. Press, New York), pp. 37–62.

31. Benson, D. F. (1977) Arch. Neurol. 34, 327–331.

32. Tallal et all (1993) Temporal information processing in the nervous system: special reference to dyslexia and dysphasia. New York : The New York academy of science

33 Tallal et all (1998) New York : The New York academy of science

34. Hulme (1981) Reading and retardation and multisensory teaching: London :ROUTLEDGE AND KEGAN PAUL

35. Bradley (1981),

36, Thomson and Gilchrich: Dyslexia a multidisiplinary approch London Chapan and Hall

37. Bradley and Bryant (1983), Categorising sounds asnd learning to read. Nature, 301, 419.

38. Dyslexia at college Miles Dorothy and Gilrpoy 1986 New York Methuen

^ 39 Brent Bowers (2007-12-06). "Tracing Business Acumen to Dyslexia". New York Times.Cites a study by Julie Logan, professor of entrepreneurship at Cass Business School in London, among other literature.

40 b Berninger, Virginia W.; Raskind, Wendy, Richards, Todd, Abbott, Robert, Stock, Pat (5 November 2008). "A Multidisciplinary Approach to Understanding Developmental Dyslexia Within Working-Memory Architecture: Genotypes, Phenotypes, Brain, and Instruction". Developmental Neuropsychology 33 (6): 707–744. doi:10.1080/87565640802418662. PMID 19005912.

<a name="41">41</a> a b Stein, John (1 January 2001). "The magnocellular theory of developmental dyslexia". Dyslexia 7 (1): 12–36. doi:10.1002/dys.186.

42http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2006.01684.x/abstract;jsessionid=0C68D8EFA292BDC2CD782A68E41AD2D4.f03t03

43 Cao, F., Bitan, T., Chou, T.-L., Burman, D. D. and Booth, J. R. (2006), Deficient orthographic and phonological representations in children with dyslexia revealed by brain activation patterns. Journal of Child Psychology and Psychiatry, 47: 1041–1050. doi: 10.1111/j.1469-7610.2006.01684.x

44 http://www.ncbi.nlm.nih.gov/pubmed/11305228

45 Developmental Psychopathology, Risk, Disorder, and Adaptation Donald J. Cohen John Wiley & Sons, Feb 27, 2006

6.2 Aphasia Due to Brian Injury§

Write a short overview of the group to give readers a sense of context

6.2.1 Cognitive functions§

Identify cognitive functions affected by aphasia

Aphasia is a communication disorder that impairs an individual's abilities to speak, write, read or understand speech, or a combination of these abilities. Aphasia is caused by brain damage due to stroke, injury, brain tumors or infections and can be mild to severe.

6.2.2 Symptoms§

Inability to read, naming problems (finding the right word to refer to something), mis-articulated words, grammatical errors in speech, difficulty with numerical calculations, slow and effortful speech, inability to compose written language or inability to understand speech.

6.2.3 Their Challenges§

6.2.3.1 Language Abilities Affected by Aphasia§

Aphasia can affect any aspect of language -- reading, writing, speaking or listening, or combinations of these abilities. However, difficulty in reading is probably the symptom that most impacts use of the web, because most websites do not make heavy demands on the other language-related skills. Minimal writing, such as form-filling, is common on websites, but extensive writing, such as a product review or blog comment, is usually optional. Speaking is rarely required for interacting with a conventional website. It may be used in websites that support real-time human-human communication, but then a human is present who can make an extra effort to understand someone who doesn't speak fluently. Speaking, however, is often required in telephone voice applications. Using the keypad as an alternative to voice may also be difficult for some people with aphasia. Listening is required for websites where audio or video material is presented. Closed-captioning is not necessarily an option because many people with aphasia are unable to read. Many people with aphasia have some degree of hemiplegia, associated with the brain injury that affected their language. This means that using a mouse or keyboard can be difficult, so typing is not necessarily available as an alternative. In addition to difficulty reading text, some people with aphasia find certain websites confusing, for example, if there's too much material.

6.2.3.2 Variability of Symptoms of Aphasia§

Another aspect of aphasia that impacts web accessibility is that the symptoms of aphasia vary considerably from person to person, and even in the same person from day to day. For example, some people with aphasia find that reading text for 15 or 20 minutes is ok, then the "brain shuts down". However, for some people reading is unaffected. Some people with aphasia can speak fairly well, but some don't talk at all. Specific aspects of reading might be differentially affected, for example, numbers, or people's names.

6.2.4 Scenarios and User Stories§

Add persona and scenario

Add table of ICT Steps and challenges.

6.2.5 How They Use the Web and ICT§

to include: Email, apps, voice systems, IM

Add table.

Task Description
People with aphasia use the web to shop, get information, communicate with others, and be entertained. These tasks involve the language abilities affected by aphasia (listening, speaking, reading and writing), although to different extents. Tasks like shopping, getting information and being entertained typically heavily involve reading, with some writing required for form-filling. Communicating with others via email or social networking requires both reading and writing. People with aphasia who have difficulties with spoken language may find it hard to understand the audio tracks of videos. Speaking is very rarely required for interacting with a traditional website, so speaking difficulties are unlikely to impact web usage by people with aphasia. Telephone voice applications, on the other hand, are likely to be very difficult to use for people whose speech is affected.

6.2.6 How People with Cognitive Sisabilities Use Optimized Content and Special Pages§

Add examples with descriptions of features

6.2.7 Characteristics of Content Optimized For This Group§

Impairments in reading ability affect many aspects of web usage. We can separate reading tasks into reading multiple paragraphs of informative text and reading captions on form items. Paragraphs of informative text can be made easier to read through general techniques that improve readability, such as simpler language, well-structured layout and organization, use of white space, and typography that enhances legibility. Form filling also requires reading, but in a different way. The purpose of reading the caption on a form is to understand what the user has to do to provide the correct information for the form. Form captions need to be simple and clear. The user should be able to hear as well as see the caption on a form as needed, even repeating the audio several times if necessary. Well-designed icons can also supplement text and audio captions. The user should also be able to hear their own input, since some people with aphasia can write but not read.

6.2.8 Specific Technologies§

Text to speech

6.2.9 Summary of Existing Research and Guidelines§

Add literary summary and insert guidelines and or references

6.2.10 Extent To Which Current Needs Are Met§

Review challenges and describe where needs are met. Identify gaps

6.2.11 Potentials and Possibilities§

Add ideas for filling gaps

6.2.12 Prevalence§

Although estimating the prevalence of aphasia is difficult, especially in the developing world, aphasia is estimated to affect about 0.4 percent of the population. "This year 130,000 people in the UK will have a stroke. One-third of those who survive will have aphasia. Surprisingly, there are currently about 250,000 people with aphasia in the UK alone." - from http://www.ukconnect.org/aphasiaquestionsandanswers_302.aspx

6.2.13 References to Research§

Add section

6.3 Non-Vocal§

Communication Difficulties and Disorders may include non-vocal individuals such as those who have Aphonia, Anarthria and other disabilities that preclude any form of speech and language. The description also includes those with Aphasia who may have receptive and expressive difficulties, Dysarthria and dyspraxia where words may become unintelligible and a wide range of other difficulties that make articulation of accurate sounds difficult, language expression and understanding hard to achieve and vocalization impossible. This can include those who have hearing impairments and cognitive disabilities.

The American Association of Speech-Language-Hearing Association (ASHA) definition for communication disorders is as follows: "A communication disorder is an impairment in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal and graphic symbol systems. A communication disorder may be evident in the processes of hearing, language, and/or speech. A communication disorder may range in severity from mild to profound. It may be developmental or acquired. Individuals may demonstrate one or any combination of communication disorders. A communication disorder may result in a primary disability or it may be secondary to other disabilities. - See more at: http://www.asha.org/policy/RP1993-00208/#sthash.AEt5fyvf.dpuf"

6.3.1 Cognitive Functions§

Cognitive function as "an intellectual process by which one becomes aware of, perceives, or comprehends ideas" (Mosby, 2009)may or may not be tied directly to a communication disorder. An individual may have high cognitive functioning and still be unable to communicate.

An example would be Aphasia that impairs an individual's abilities to speak, write, read or understand speech, or a combination of these abilities. Aphasia is caused by brain damage due to stroke, injury, brain tumors or infections and can be mild to severe.

6.3.2 Symptoms§

Anarthria: Loss of the motor ability that enables speech. Complete loss of the ability to vocalize words as a result of an injury to the part of the brain that is responsible for controlling the larynx.

Aphasia: A disturbance of the comprehension and formulation of language caused by dysfunction in specific brain regions. There may be an inability to read, naming problems (finding the right word to refer to something), mis-articulated words, grammatical errors in speech, difficulty with numerical calculations, slow and effortful speech, inability to compose written language or inability to understand speech.

Apraxia: An acquired oral motor speech disorder affecting an individual's ability to translate conscious speech plans into motor plans.

Autism: A disorder of neural development characterized by impaired social interaction and verbal and non-vocal communication.

Aphonia: The inability to produce voice.

Alalia: A delay in the development or use of the mechanisms that produce speech.

Dyslalia: Difficulties in talking due to structural defects in speech organs.

Developmental verbal dyspraxia: Motor speech disorder involving impairments in the motor control of speech production.

Developmental Disabilties: Fragile X, Down syndrome, pervasive developmental disorders, fetal alcohol spectrum disorders, cerebral palsy.

Intellectual Impairment: traumatic brain injury, lead poisoning, Alzheimer's disease.

6.3.3 Their Challenges§

The following rights are summarized from the United States of America's Communication Bill of Rights put forth in 1992 by the US National Joint Committee for the Communication Needs of Persons with Severe Disabilities. (1992). Guidelines for meeting the communication needs of persons with severe disabilities. Asha, 34(Suppl. 7), 2–3. http://www.asha.org/NJC/bill_of_rights.htm

"All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence. All people have the following specific communication rights in their daily interactions.

Each person has the right to

  • request desired objects, actions, events and people
  • refuse undesired objects, actions, or events
  • express personal preferences and feelings
  • be offered choices and alternatives
  • reject offered choices
  • request and receive another person's attention and interaction
  • ask for and receive information about changes in routine and environment
  • receive intervention to improve communication skills
  • receive a response to any communication, whether or not the responder can fulfill the request
  • have access to AAC (augmentative and alternative communication) and other AT (assistive technology) services and devices at all times
  • have AAC and other AT devices that function properly at all times
  • be in environments that promote one's communication as a full partner with other people, including peers
  • be spoken to with respect and courtesy
  • be spoken to directly and not be spoken for or talked about in the third person while present
  • have clear, meaningful and culturally and linguistically appropriate communications"
6.3.3.1 How Symptoms Result in Challenges for Young People who are Non-Vocal§

Young non-vocal communicators are very often encouraged to make vocal speech and all efforts are made to achieve that goal. There is a persistent idea that if AAC systems are introduced early in a child’s life it will delay or prevent the development of verbal speech. This conclusion is erroneous. Research (http://www.pecsusa.com/research.php) has shown that the introduction of AAC early in a child’s life will actually help the child develop verbal speech if that capability exists. The emphasis on making verbal speech still continues after AAC is introduced, but the fact that the child now has a means of communicating means that their right to communicate is already being supported. In situations where Speech and Language Pathologists (SLP) attempt to introduce AAC early the challenge to enlist the family/caregivers as supporters of AAC often fails. In situations where no SLP is available and/or the knowledge that there are relatively inexpensive interventions available and/or the parents/caregivers do not support the system, the child is not supported with an AAC system and expectations fall far short of the child's potential.

Major Challenges:

6.3.3.1.1 No Support§

Because very special conditions must be present to support a non-vocal communicator with AAC (resources, knowledge, support) non-vocal people are often not helped to develop even low-tech communication systems. This leads to vastly reduced opportunities for the non-vocal communicator. In individuals for whom functional level prohibits using AAC tools, there are other strategies such as indirect selection, facial expression, vocalizations, gestures, and sign languages.

6.3.3.1.2 Non-Interoperability§

Since high-tech AAC systems almost always have different operating systems and file structures, each time a new device is added someone has to manually re-program the communication system. This non-interoperability problem exists across almost all devices, even extending to multiple devices developed within by a single manufacturer. This is a major challenge facing most non-vocal people using high-tech AAC systems.

6.3.3.1.3 Costs of Low-Tech AAC§

Communication books, symbol sets and software to customize and print icons, activity boards, picture schedules, and other low-tech communication tools are relatively inexpensive as is training for non-vocal people, SLPs, and parents/caregivers. Inexpensive is a relative term, and many communities do not have resources for even the basic tools, but if a basic methodology is employed, then even makeshift tools will enable some communication beyond making sounds, pointing, and gesturing.

6.3.3.1.4 Costs of High-Tech AAC§

High-tech AAC systems are expensive as are extended warranties. The life of a device is usually limited to the life of the extended warranty offered by the manufacturer. This is due not only to the expense involved in supporting an out-of-warranty device but also to the fact that parts become scarce when devices are discontinued and manufacturing stops. Medicare standards (in the US?) prohibit the purchase of a new device until five years from the purchase date of the previous device so insurance companies and institutions follow that pattern. This makes the de-facto life of high-tech AAC devices five years, and this is echoed by manufacturer warranties which typically extend coverage to five years.

6.3.3.1.5 Costs of Lack of AAC§

There are costs associated with failing to implement AAC. These costs include social and health consequences for neuro-typical as well as other communicators. AAC introduces a range of behavior modification techniques for non-neuro-typical individuals. Example: use of a picture schedule creates the opportunity for frictionless transitions in individuals for whom transitions are difficult and who may act out their fears with self-harming or other behaviors.

6.3.3.2 How Symptoms Result in Challenges for People with Aphasia§
6.3.3.2.1 Language Abilities Affected by Aphasia§

Aphasia can affect any aspect of language -- reading, writing, speaking or listening, or combinations of these abilities. However, difficulty in reading is probably the symptom that most impacts use of the web, because most websites do not make heavy demands on the other language-related skills. Minimal writing, such as form-filling, is common on websites, but extensive writing, such as a product review or blog comment, is usually optional. Speaking is rarely required for interacting with a conventional website. It may be used in websites that support real-time human-human communication, but then a human is present who can make an extra effort to understand someone who doesn't speak fluently. Speaking, however, is often required in telephone voice applications. Using the keypad as an alternative to voice may also be difficult for some people with aphasia. Listening is required for websites where audio or video material is presented. Closed-captioning is not necessarily an option because many people with aphasia are unable to read. Many people with aphasia have some degree of hemiplegia, associated with the brain injury that affected their language. This means that using a mouse or keyboard can be difficult, so typing is not necessarily available as an alternative. In addition to difficulty reading text, some people with aphasia find certain websites confusing, for example, if there's too much material.

6.3.3.2.2 Variability of Symptoms of Aphasia§

Another aspect of aphasia that impacts web accessibility is that the symptoms of aphasia vary considerably from person to person, and even in the same person from day to day. For example, some people with aphasia find that reading text for 15 or 20 minutes is ok, then the "brain shuts down". However, for some people reading is unaffected. Some people with aphasia can speak fairly well, but some don't talk at all. Specific aspects of reading might be differentially affected, for example, numbers, or people's names.

6.3.4 Some Personae with Use Cases that Address Key Challenges§

6.3.4.1 Young Non-Vocal Woman§

S is a 21 year old woman with a chromosomal deletion known as Cri-du-chat Syndrome, or Five P Minus (5p-). She is a mosaic; she has the transcription error in approximately 50 percent of her cells, so some of the classic Cri-du-chat symptoms are not present such as congenital heart problems and microcephaly. S has orthopedic impairments, is ataxic (loss of full control of bodily movements) and hypotonic (abnormally low body tone) and she is developmentally disabled. She is also nearly completely non-vocal, but she has a communication system. S uses the Picture Exchange Communication System (PECS) (http://www.pecsusa.com/pecs.php) as her base methodology and this is invoked in whatever communication book, picture schedule, choice boards, and other low-tech systems she uses. PECS methodology is also used in her high-tech voice output devices. Using PECS as the base methodology supports her with a consistent approach that has allowed her to develop into a very confident communicator. Since she cannot read or write she relies on icons and pictures to navigate and make her communication choices. She has been using a communication book since she was five years old (and still does) and she started using high-tech AAC systems when she was ten years old. All of her high-tech AAC devices have been purchased from a single vendor, and none of them have been interoperable, requiring her communication environment to be created manually at each change of device. None of her other non-vocal classmates/peers have communication systems.

6.3.4.2 Professional Man with Aphasia§

Mr C was a highly skilled accountant before he suffered a stroke, he read widely and enjoyed using technology for both his work and leisure activities. After a severe left sided brain haemorrhage he not only could not speak clearly and had difficulty understanding conversation, but he also found that he could not read or write in a recognizable way. He found it hard to concentrate and when trying to use the Internet he did not have the skills to search for things of interest let alone read the content of the web pages. He was extremely frustrated, found himself breaking down. It was extremely distressing for his family. Slowly words returned and reading skills improved but he found the clutter on the screen exasperating and often failed to select the correct link or menu item. As he progressed in his rehabilitation, he was able to read slowly and made limited use of text to speech and increased font sizing. However, he tired easily, complained of eye strain and would often give up if he could not find something he was searching for. He could not cope with CAPTCHA technology, found form filling difficult and would often buy the wrong items on Amazon by accident. However, with support and using simple technologies to de-clutter web sites, so that the text was clear without advertisements and excessive imagery Mr. C continued to take up the challenge of reading from the screen and his skills slowly improved. Eventually he was able to make use of social networks with friends who understood his difficulties and enjoyed asynchronous communication where he did not have to answer immediately and could take his time reading and composing messages.

6.3.5 How They Use the Web and ICT§

There are many people who have spoken language communication difficulties who can cope with the use of the web and ICT at a very high level. It can provide their only method for dialogue using e-mail, instant messaging, social media etc. Individuals with cognitive disabilities as well as communication difficulties may on the other hand struggle with elements of Internet usage. They may find the intricacies of navigation, complex content and confusing messaging systems hard to access.

There remains a lack of suitable systems that are simple enough for symbol users to engage with a wide range of social networks, email and voice systems. Users generally need to use bespoke software that allows for symbol to text and text to symbol conversions. Use of the web is hampered by a lack of symbol based informational sites - simple word to symbol translation does not always solve comprehension problems.

People with aphasia use the web to shop, get information, communicate with others, and be entertained. These tasks involve the language abilities affected by aphasia (listening, speaking, reading and writing), although to different extents. Tasks like shopping, getting information and being entertained typically heavily involve reading, with some writing required for form-filling. Communicating with others via email or social networking requires both reading and writing. People with aphasia who have difficulties with spoken language may find it hard to understand the audio tracks of videos. Speaking is very rarely required for interacting with a traditional website, so speaking difficulties are unlikely to impact web usage by people with aphasia. Telephone voice applications, on the other hand, are likely to be very difficult to use for people whose speech is affected.

6.3.6 How People with Cognitive Disabilities Use Optimized Content and Special Pages§

Add examples with descriptions of features

6.3.7 Characteristics of Content Optimized for This Group§

Impairments in reading ability affect many aspects of web usage. We can separate reading tasks into reading multiple paragraphs of informative text and reading captions on form items. Paragraphs of informative text can be made easier to read through general techniques that improve readability, such as simpler language, well-structured layout and organization, use of white space, and typography that enhances legibility. Form filling also requires reading, but in a different way. The purpose of reading the caption on a form is to understand what the user has to do to provide the correct information for the form. Form captions need to be simple and clear. The user should be able to hear as well as see the caption on a form as needed, even repeating the audio several times if necessary. Well-designed icons can also supplement text and audio captions. The user should also be able to hear their own input, since some people with aphasia can write but not read.

  • Important points are short with no ambiguity and may need to be highlighted with images and boxed.
  • Each point is made in a clear order so it tells a story.
  • Sentences are in first person where possible and use easy to understand words.
  • Numbers are kept in numerical format unless large and unwieldy when they also need to be in written form.
  • Increased amounts of white space and 14 point or larger sans serif fonts are used.
  • Bold type for headings and keywords
  • Colour can be used to link items
  • Pictures are of good quality and clearly represent what is being discussed.
  • Keep to one style for all items with clear logical navigation

Below is the direct quote from Tanya A. Rose, Linda E. Worrall, Louise M. Hickson, Tammy C. Hoffmann, (2012) Guiding principles for printed education materials: Design preferences of people with aphasia. International Journal of Speech-Language Pathology 14:1, pages 11-23.

  • Numbers: Present smaller numbers as figures.
  • Present larger numbers (e.g., 40,000) in both figures and words.
  • Present fractions in words.
  • People with aphasia may have a clear preference regarding which representation (i.e., figures or words) they consider easier to read, and should be provided with the option to choose, where possible.
  • Font size and typeface: Use a minimum 14-point font.
  • Use a san serif font (e.g., Verdana or Arial).
  • Use a font that is clear and bold.
  • Line spacing and blank space: Use 1.5 or double line spacing for paragraphs.
  • Ensure blank space is included around sections of text.
  • Document length: People with aphasia may want several pages of information if it is presented in a simplified format.
  • Preferences for document length may not be related to the recipient ’ s reading ability or aphasia severity, and the recipient ’ s preference for amount of information should be ascertained.
  • Graphics: Include graphics, preferably photographs.
  • Check preferences for the inclusion of graphics and preferences for graphic type, particularly when developing written information for people with more severe reading difficulties.
  • Ensure all graphics relate to the text and are labelled.

More References Kitching, J. (1990). Patient information leafl ets: The state of the art. Journal of the Royal Society of Medicine , 83 , 298 – 300. Tarleton, B.,(‎2008) Finding the Right Help - University of Bristol http://www.bristol.ac.uk/wtwpn/resources/finding-the-right-help-report.pdf (accessed 27th June 2014)

6.3.8 Specific Technologies§

Specific technologies that can help those who have communication difficulties vary enormously. They range from simple text to speech that can aid reading ability, the highlighting of text as items are read aloud, enlarged font sizing and different font styles to complex communication aids.

Those who have Aphasia may find it helpful to use the reading aids mentioned above and those who cannot communicate with text may need to use symbols or pictograms or other forms of augmentative and alternative communication (AAC). There are a wide range of systems including unaided AAC systems that do not require an technologies but may include facial expression, vocalizations, gestures, and sign languages. Then there are the low-tech communication aids which may be defined as those that do not need batteries, electricity or electronics such as communication books and boards. High-tech communication systems can include speech generating devices and software for computers, tablets, and smart phones.

Specific groups of AAC users: cerebral palsy, intellectual impairment, autism, developmental verbal dyspraxia, traumatic brain injury (TBI), aphasia, locked-in syndrome, amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis, dementia.

Types of symbol AAC methodologies:

  • Picture Exchange Communication System (PECS),
  • MinSpeak etc
  • LAMP

Symbol sets:

  • Bliss symbols
  • Symbol Stix
  • PCS
  • Widgit
  • ARASAAC
  • Sclera

6.3.9 Summary of Existing Research and Guidelines§

Add literary summary and insert guidelines and or references

6.3.10 Extent To Which Current Needs Are Met§

To do: Review challenges and describe where needs are met. Identify gaps

It entirely depends on the degree to which an individual is able to use language both written and spoken, expressive and receptive but it is clear that those who have considerable communication disorders with minimal literacy skills will have difficulty accessing web pages and coping with navigation within and between sites. To this extent there are considerable gaps that need to be bridged including:

  • lack of clear navigational elements - guidance should not just be about screen reader and keyboard access but also about usability
  • clutter around main content - guidance needs to ensure increased use of white space where it can be used to highlight key points
  • poor headings, paragraph structures - guidance needs to highlight how use of markers for these elements such as icons, bold text and consistent spacing can help understanding
  • poor summarising of content - guidance to authors to ensure they provide overview of content in clear fashion
  • use of colour to aid comprehension - guidance to ensure sites maintain a consistent style if this method for key points is used.
  • addition of media elements - guidance to access players and use of captions with summaries can help all users.

6.3.11 Potentials and Possibilities§

Add ideas for filling gaps

"People with aphasia comprehended significantly more aphasia-friendly paragraphs than control paragraphs. They also comprehended significantly more paragraphs with each of the following single adaptations: simplified vocabulary and syntax, large print, and increased white space. Although people with aphasia tended to comprehend more paragraphs with pictures added than control paragraphs, this difference was not significant. No significant correlation between aphasia severity and the effect of aphasia-friendly formatting was found. " http://www.tandfonline.com/doi/abs/10.1080/02687030444000958#.U6dOVPldXxU

Research has shown that Speech Therapists are not necessarily the best judge of whether a website is good or bad in terms of clarity, layout etc for someone who has Aphasia. (Carlye Ghidella, Stephen Murray, Melanie Smart, Kryss McKenna & Linda Worrall, (2005) Aphasia websites: An examination of their quality and communicative accessibility. Aphasiology 19:12, pages 1134-1146.)

6.3.12 Prevalence§

Between 6 and 8 million people in the U.S. have some form of language impairment. Research suggests that the first 6 months of life are the most crucial to a child's development of language skills. For a person to become fully competent in any language, exposure must begin as early as possible, preferably before school age. Anyone can acquire aphasia (a loss of the ability to use or understand language), but most people who have aphasia are in their middle to late years. Men and women are equally affected. It is estimated that approximately 80,000 individuals acquire aphasia each year. About 1 million persons in the U.S. currently have aphasia. Although estimating the prevalence of aphasia is difficult, especially in the developing world, aphasia is estimated to affect about 0.4 percent of the population. "This year 130,000 people in the UK will have a stroke. One-third of those who survive will have aphasia. Surprisingly, there are currently about 250,000 people with aphasia in the UK alone." - from http://www.ukconnect.org/aphasiaquestionsandanswers_302.aspx

Voice Source: Compiled by NIDCD based on scientific publications.

Approximately 7.5 million people in the United States have trouble using their voices. Spasmodic dysphonia, a voice disorder caused by involuntary movements of one or more muscles of the larynx (voice box), can affect anyone. The first signs of this disorder are found most often in individuals between 30 and 50 years of age. More women than men appear to be affected. Laryngeal papillomatosis is a rare disease consisting of tumors that grow inside the larynx, vocal folds, or the air passages leading from the nose into the lungs. It is caused by the human papilloma virus (HPV). Between 60 and 80 percent of laryngeal papillomatosis cases occur in children, usually before the age of three. Speech Source: Compiled by NIDCD based on scientific publications.

The prevalence of speech sound disorders in young children is 8 to 9 percent. By the first grade, roughly 5 percent of children have noticeable speech disorders; the majority of these speech disorders have no known cause. By the time they are six months old, infants usually babble or produce repetitive syllables such as "ba, ba, ba" or "da, da, da." Babbling soon turns into a kind of nonsense speech jargon that often has the tone and cadence of human speech, but does not contain real words. By the end of their first year, most children have mastered the ability to say a few simple words. By 18 months of age, most children can say 8 to 10 words. By age 2, most put words together in crude sentences such as "more milk." At ages 3, 4, and 5, a child's vocabulary rapidly increases, and he or she begins to master the rules of language. It is estimated that more than 3 million Americans stutter. Stuttering can affect individuals of all ages, but occurs most frequently in young children between the ages of 2 and 6. Boys are 3 times more likely than girls to stutter. Most children, however, outgrow their stuttering, and it is estimated that fewer than 1 percent of adults stutter. Language Source: Compiled by NIDCD based on scientific publications.

6.3.13 References to Research§

Brennan, A., Worrall, L., & McKenna, K. (2005). The relationship between specific features of aphasia-friendly written material and comprehension of written material for people with aphasia: An exploratory study. Aphasiology, 19(8), 693-711. doi:10.1080/02687030444000958

Herbert R., Haw, C., Brown, C., Gregory E. and Brumfitt, S. (2012). Accessible Information Guidelines. London: Stroke Association. Retrieved from http://www.stroke.org.uk

Caitlin Brandenburg, Linda Worrall, Amy D. Rodriguez & David Copland, (2013) Mobile computing technology and aphasia: An integrated review of accessibility and potential uses. Aphasiology 27:4, pages 444-461.

Tanya A. Rose, Linda E. Worrall, Louise M. Hickson & Tammy C. Hoffmann, (2011) Exploring the use of graphics in written health information for people with aphasia. Aphasiology 25:12, pages 1579-1599.

Aimee Dietz, Karen Hux, Miechelle L. McKelvey, David R. Beukelman & Kristy Weissling, (2009) Reading comprehension by people with chronic aphasia: A comparison of three levels of visuographic contextual support. Aphasiology 23:7-8, pages 1053-1064.

Tanya A. Rose, Linda E. Worrall, Louise M. Hickson, Tammy C. Hoffmann, (2012) Guiding principles for printed education materials: Design preferences of people with aphasia. International Journal of Speech-Language Pathology 14:1, pages 11-23.

Rose, T. A., Worrall, L. E., Hickson, L. M., & Hoffmann, T. C. (2012). Guiding principles for printed education materials: Design preferences of people with aphasia. International Journal of Speech-Language Pathology, 14(1), 11-23. doi:10.3109/17549507.2011.631583

6.4 Aging and Dementia§

The Aging and Dementia Gap Analysis focuses on issues and techniques for improving inclusion and quality of life for people with dementia using ICT. Our strategy includes a key ambition to develop ICT techniques that will work better for people affected by dementia - and to define, develop and improve dementia and aging friendly ICT.

Many people are able to age in good health and remain active participants in society throughout their lives. But others experience physical and cognitive limitations, and may lose the ability to live independently. Although dementia mainly affects older people it is not a normal part of aging.

The most elder-rich period of human history is upon us. How we regard and make use of this windfall of elders will define the world in which we live.

A good phrase to remember regarding people with dementia; “If you’ve met one person with dementia, you’ve met one person with dementia” – largely attributed to the late Tom Kitwood although no direct source has been found..

6.4.1 Description of Aging and Cognitive Decline§

Need AGING definition here...... From Miriam Webster's Dictionary, the definition of aging is: Gradual change in an organism that leads to increased risk of weakness, disease, and death. It takes place in a cell, an organ, or the total organism over the entire adult life span of any living thing. There is a decline in biological functions and in ability to adapt to metabolic stress. Changes in organs include the replacement of functional cardiovascular cells with fibrous tissue. Overall effects of aging include reduced immunity, loss of muscle strength, decline in memory and other aspects of cognition, and loss of hair colour and elasticity in the skin. In women, the process accelerates after menopause.

Aging definition: an age-dependent or age-progressive decline in intrinsic physiological function, leading to an increase in age-specific mortality rate (i.e., a decrease in survival rate) and a decrease in age-specific reproductive rate (7) To sum it up, aging is a complex process composed of several features: 1) an exponential increase in mortality with age; 2) physiological changes that typically lead to a functional decline with age; 3) increased susceptibility to certain diseases with age. So, I define aging as a progressive deterioration of physiological function, an intrinsic age-related process of loss of viability and increase in vulnerability. (8)

6.4.2 Description of Dementia and Cognitive Decline§

Dementia is defined as a severe loss of cognitive abilities that disrupts daily life. Symptoms include memory loss, mood changes, visual perception, focus challenges, and problems with communicating, decision making, and reasoning. Dementia is not a normal part of growing old. It is caused by diseases of the brain, the most common being Alzheimer's. Dementia is progressive, which means the symptoms will gradually get worse.

6.4.2.1 Description of Alzheimer's§

Alzheimer’s disease (62% of those with dementia): A physical disease caused by changes in the structure of the brain and a shortage of important chemicals that help with the transmission of messages. In short, Alzheimer's is a brain disease that causes a slow decline in memory, thinking and reasoning skills.

Statistics are from 2013 UK Study. Need to map with WHO and others.

6.4.2.2 Description of Less Common (Non-Alzheimer's)§

Set of non-Alzheimer's Dementia diseases:

  • Vascular Dementia (17%): Caused by problems in the supply of blood to the brain, commonly cause by a stroke or a series of small strokes.
  • Mixed Dementia (10%): A type of dementia where a person has a diagnosis of both Alzheimer’s disease and vascular dementia.
  • Dementia with Lewy bodies (4%): One of the less common forms of dementia, it is caused by irregularities in brain cells. Leading to symptoms similar to Alzheimer’s disease and Parkinson’s disease.
  • Rarer causes of Dementia (3%): There are many rarer causes diseases and syndromes that can lead to dementia or dementia-like symptoms, including Corticobasal degeneration and Creutzfeldt-Jakob disease.
  • Fronto-temporal Dementia (2%): Rare when all ages are taken into account but relatively common in people under 65, it is a physical disease that affects the brain.

Statistics are from 2013 UK Study. Need to map with WHO and others.

6.4.3 Cognitive Function§

This section is a technical reference. Jump to the next section on Symptoms for more practical information.

6.4.3.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. Understanding the role of age and fluid intelligence in information search, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on Computers and accessibility, 119-126, S. Trewin, J.T. Richards, V.L. Hanson, D. Sloan, B.E. John, C. Swart, J.C. Thomas, 2012. (Contributed by Katherine Deibel)
  2.  ??
  3.  ??
6.4.3.2 Cognitive Function Decline Due to Dementia§

Overview: The parts of the brain and cognitive functions affected depend upon the type of dementia.

6.4.3.2.1 Alzheimer's§

Alzheimer’s: Specific Causes are being researched, but scientists note a buildup of two abnormal proteins (amyloid and tau) which damage nerve cells in the brain. The proteins form different types of clumps, plaques or tangles, which interfere with how brain cells work and communicate with each other. Plaques are usually first seen in the area of the brain that makes new memories (the hippocampus of the medial temporal lobe), but then moves to other parts of the brain as the disease progresses.

6.4.3.2.2 Auditory Discrimination§

Whenever the temporal part of the brain becomes diseased, people with dementia have difficulty making sense of sounds. They may lose the ability to follow conversations or become abnormally sensitive to sound. People can also become uncertain about the location of sounds, and social situations and music may be more difficult to enjoy.

6.4.3.2.3 Visual Recognition Skills§

In Posterior Cortical Atrophy, a rare form of Alzheimer’s, the parietal and occipital lobes of the brain are affected by the same abnormal proteins found in Alzheimer’s causing difficulty in seeing where and what things are.

6.4.3.2.4 Phoneme Processing§

In frontotemporal dementia, the temporal lobe is affected causing difficulty with speech and language.

6.4.3.2.5 Cross-modal Association§

People with Alzheimer’s disease have a buildup of abnormal proteins in the Hippocampus which causes it to malfunction, affecting the ability to recognize places and they may become disoriented.

6.4.3.2.6 Working Memory§

In Alzheimer’s disease, the buildup of abnormal proteins in the Hippocampus affects the ability to store new memories.

When the temporal lobe is affected by fronto-temporal dementia, it causes difficulty in recollection of factual information.

6.4.3.2.7 Behavioral§

Fronto-temporal dementia is thought to be caused by proteins building up in the frontal lobe of the brain and patients often experience changes in personality and behave inappropriately.

6.4.3.2.8 Physical§

In corticobasal degeneration, the cortex and basal ganglia become damaged, which is currently thought to occur due to the overproduction of the tau protein. This causes problems movement to be stiff or jerky and affects one or more limbs.

6.4.3.2.9 Consciousness§

Dementia with Lewy bodies affects the cerebrum where small round lumps of proteins build up and can cause fluctuations of consciousness as well as hallucinations, delusions (firmly held beliefs in things that are not real) and false ideas (such as paranoia).

6.4.4 Symptoms§

Overview: The parts of the brain affected and the specific symptoms depend upon the type of dementia.

6.4.4.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??
6.4.4.2 Common Symptoms of Cognitive Decline Due to Both Aging and Dementia§
  1. Difficulty remembering information, (tends to fluctuate as the day progresses, and decline over long periods of time)
  2. Difficulty with organizing thoughts
  3. Difficulty working within time limits
  4. Visual processing difficulties, which can affect the ability to recognize places.
6.4.4.3 Symptoms of Cognitive Decline Due to Aging§
  1. Memory: Sometimes forgets names or appointments, but then remembers them later.
  2. Problem Solving: May make occasional errors when balancing a checkbook.
  3. Completing Tasks: May need occasional help to use the settings on a microwave or to record a television show.
  4. Confusion w/ Time or Place: May get confused about the day of the week but then figures it out later.
  5. Visual/Spatial/Temporal Understanding: May have vision changes related to cataracts, low vision and/or color/contrast perception. May have some hearing or speech loss. May have diminished motor ability and acuity. May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: Sometimes has trouble finding the right word.
  7. Misplacing Items: May misplace things from time to time and then need to retrace their steps to find them.
  8. Judgment: Makes a bad decision once in a while.
  9. Withdrawal: May on occasion feel weary of work, family and social obligations.
  10. Mood/Personality: May develop very specific ways of doing things and therefore may become irritable when a routine is disrupted.
6.4.4.4 Symptoms of Cognitive Decline Due to Dementia§
6.4.4.4.1 Symptoms of Alzheimer's§
  1. Memory: Often or completely forgetting names or appointments.
    1. Forgetting recently learned information
    2. Forgetting important dates or events
    3. Asking for the same information over and over
    4. Forgetting to check expiration dates on food
    5. May have problems recognizing familiar faces of family or friends
    6. Increasing need to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own
  2. Problem Solving: Changes in ability to develop and follow a plan or work with numbers.
    1. May have trouble following a familiar recipe or keeping track of monthly bills.
    2. May have difficulty concentrating and take much longer to do things than they did before.
  3. Completing Tasks: Often find it hard to complete daily tasks.
    1. May have trouble driving to a familiar location
    2. May have trouble managing a budget
    3. May have trouble remembering the rules of a favorite game
    4. May have difficulty in completing tasks that involve multiple steps (ex. laundry)
  4. Confusion w/Time or Place: Can lose track of dates, seasons, their location and the passage of time.
    1. May have trouble understanding something if it is not happening immediately.
    2. May forget where they are or how they got there.
  5. Visual/Spatial/Temporal Understanding: May have difficulty reading, speaking, hearing, judging distance and determining color or contrast. Often has diminished motor ability and acuity.
    1. Which may cause problems with driving
    2. May have difficulty understanding/distinguishing mechanical and electronic sounds and alerts. (including some of the very tools that are meant as memory aids) May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: Often has trouble following or joining a conversation.
    1. May stop in the middle of a conversation and have no idea how to continue or they may repeat themselves.
    2. May struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock").
    3. May lose ability to speak.
  7. Misplacing Items: Often puts things in unusual places.
    1. Often lose things and be unable to go back over their steps to find them again.
    2. Sometimes may accuse others of stealing their misplaced items (may occur with increasing frequency).
  8. Decreased Judgment: Experience changes in judgment or decision-making.
    1. Often uses poor judgment when dealing with money, giving large amounts to telemarketers.
    2. Often pays less attention to grooming or keeping themselves clean.
  9. Withdrawal: May start to remove themselves from hobbies, social activities, work projects or sports.
    1. May have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby.
    2. May avoid being social because of the changes they have experienced.
  10. Mood/Personality: Can become confused, suspicious, depressed, fearful or anxious.
    1. May be easily upset at home, at work, with friends or in places where they are out of their comfort zone
  11. Confabulation: “the production of statements or actions that are unintentionally incongruous to the subject’s history, background, present and future situation” Dalla Barba (1993)
6.4.4.4.2 Symptoms of Less Common Dementia (Non-Alzheimer's)§
  1. Memory: Sometimes forgetting names or appointments, and sometimes remembering them later.
  2. Problem Solving: Makes occasional errors when balancing a checkbook.
  3. Completing Tasks: Often needs help to use the settings on a microwave or to record a television show.
  4. Confusion w/ Time or Place: May get confused about dates, seasons, their location, passage of time - but usually it comes back to them.
  5. Visual/Spatial/Temporal Understanding: May have difficulty reading, speaking, hearing, judging distance and determining color or contrast. May have diminished motor ability and acuity. May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: On occasion may have trouble following or joining a conversation and sometimes have problems finding the right word.
  7. Misplacing Items: May put things in unusual places, but can usually find them by retracing their steps.
  8. Decreased Judgment: On occasion may experience changes in judgment or decision-making.
  9. Withdrawal: May on occasion withdraw from work or social activities
  10. Mood/Personality: May on occasion become confused, suspicious, depressed, fearful or anxious.
6.4.4.5 Typical behaviours exhibited by people with Dementia§
  1. Repetitive Behaviour - Asking the same question over and over again - As well as memory loss, this can be due to the person's feelings of insecurity or anxiety about their ability to cope. Repetitive phrases or movements - This can be due to noisy or stressful surroundings, or boredom. It can also be a sign of discomfort, e.g. too hot or cold.
    1. Repetitive actions - Actions such as repeatedly packing and unpacking a bag, or rearranging the chairs in a room, may relate to a former activity.
    2. Repeatedly asking to go home - This can be a sign of anxiety, insecurity, fear or depression. The concept of 'home' might evoke memories of a time or place where the person felt comfortable or safe – they may not recognise their present environment as their home even if it is the place where they live.
    3. Multiple phone calls - Some people with dementia phone their loved ones over and over again - particularly in the middle of the night, they may forget that they have already called, or may be insecure or anxious.
  2. Restlessness
    1. Pacing up and down - Pacing may indicate that the person wants to use the toilet but is unable to tell you or they may be feeling frustrated and want some fresh air.
    2. Fidgeting - Someone with dementia may fidget constantly.
  3. Shouting and Screaming
    1. The person may continually call out for someone, shout the same word, or scream or wail over and over again.
    2. They could be experiencing difficulties with visual perception or hallucinations.
    3. A person with dementia may feel lonely or distressed, if their short term memory is damaged they may not remember that you are in the next room and believe they are alone. They may feel anxious about their failing memory, bored, or stressed by too much noise and bustle.
  4. Lack of inhibition
    1. Some people with dementia may undress in public, having forgotten when and where it is appropriate to remove their clothes.
    2. Apparently inappropriate sexual behaviour may be a result of the physical damage to the part of the brain that allows us to recognise acceptable social behaviours.
    3. Some actions, such as lifting a skirt or fiddling with flies may simply be a sign that the person wants to use the toilet.
    4. The person may behave rudely - for example, by insulting people or swearing or spitting.
  5. Night-time Waking
    1. Many people with dementia are restless at night and find it difficult to sleep. Older people often need less sleep than younger people in any case. Dementia can affect people's body clocks so that they may get up in the night, get dressed or even go outside.
  6. Trailing and Checking
    1. Living with dementia makes many people feel extremely insecure and anxious. This can result in the person constantly following their carers or loved ones around, or calling out to check where they are. A few moments may seem like hours to a person with dementia, and they may only feel safe if other people are nearby.
  7. Hiding and Losing things
    1. People with dementia sometimes hide things and then forget where they are - or forget that they have hidden them at all. The wish to hide things may be due to feelings of insecurity and a desire to hold on to what little the person still has.
  8. Suspicion
    1. Some people with dementia can become suspicious. If they have mislaid an object they may accuse someone of stealing it, or they may imagine that a friendly neighbour is plotting against them. These ideas may be due to failing memory or an inability to recognise people,
  9. Sleeplessness and ‘sundowning’
    1. Many people with dementia, especially in the middle stages, experience periods of increased confusion at dusk, with their disorientation continuing throughout the night. These periods of what is known as 'sundowning' usually diminish as the dementia progresses. (1)

6.4.5 ICT Challenges§

6.4.5.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. Design recommendations for tv user interfaces for older adults: findings from the eCAALYX project, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on computers and accessibility, 41-48, F. Nunes, M. Kerwin, P Alexandra-Silva, 2012. (Contributed by Katherine Deibel)
  2. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)
  3.  ??
6.4.5.2 Challenges§
  • Remembering steps to complete a task, e.g. "How do I send an email?"
  • Overwhelmed by too many functions, complex UIs.
  • Copying information correctly.
  • Difficulty figuring out new UI metaphors.
  • Too many steps to complete a task.
  • Advertising prompts added before getting to a web page are confusing.
  • Menu systems are difficult to navigate and find the right path.
  • 15% of people living with dementia – an estimated 112,500 people (in the UK) – have been victims of financial abuse such as cold calling, scam mail or mis-selling
  • 62% of carers reported that the person they care for had been approached by cold callers or doorstep sales people
  • 70% reported that telephone callers routinely targeted the person they care for. Not only have people lost money, but they and their families have also been suffering stress, exhaustion and frustration as a result.
  • 76% of people reported having trouble managing their money, with a range of issues highlighted such as the challenges of bank’s security procedures, and a lack of dementia awareness in banks and other financial services organisations. UK ONLY (4)
  • Mood/Personality: Controlling confusion and irritability when changes are made to their routine, environment or location. Difficulty in feeling safe.

6.4.6 Scenarios and Use Cases that address Key ICT Challenges§

6.4.6.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. Understanding the role of age and fluid intelligence in information search, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on Computers and accessibility, 119-126, S. Trewin, J.T. Richards, V.L. Hanson, D. Sloan, B.E. John, C. Swart, J.C. Thomas, 2012. (Contributed by Katherine Deibel)
  2. Basic senior personas: a representative design tool covering the spectrum of European older adults, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on computers and accessibility, 25-32, B. Wockl, U. Yildizoglu, I. Buber, B. Aparicio-Diaz, E. Kruijff, M. Tscheligi, 2012. (Contributed by Katherine Deibel)
  3. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)
6.4.6.2 Scenarios§
  • Struggling to remember recent events but easily recalling things from the past
  • Finding it hard to follow conversations or programs (on TV, web, video, webcast)
  • Forgetting the names of friends or everyday objects
  • Repeating yourself or losing the thread of what you are saying
  • Problems with thinking and reasoning
  • Feeling anxious, depressed or angry about forgetfulness
  • Other people starting to comment on your forgetfulness
  • Confused even when in a familiar environment (in space and on TV, web, video, webcast)
  • A decline in the ability to talk, read or write
6.4.6.2.1 Scenario A: Sending an Email§

Scenario A is an elderly person who has limited familiarity with computer devices (desktop, tablets, mobile). A would like to send an email to a family member. A needs to be able to find the mail program easily, interact with the user interface to compose and send an email, know that it has been sent, and, then know if the email has been replied to. A starts by turning on the computer.

Steps and Challenges for booking a train ticket online.

Step

Challenges

Turn on computer

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons; firstly the user may find it hard to identify the power button as they may have forgotten what it looks like. Secondly some power buttons can be quite small which may be difficult for elderly people to press, especially those who have arthritis or a tremor in their hands.

Launch email application

This requires the user to be able to identify the correct icon for their email application. Although there is a certain amount of intuitiveness surrounding the design of icons, sometimes for the elderly this can still be a problem. In this case typing in the name of the email application (if that can be remembered) into the search bar on the start-up menu may help.

Select button to compose new email

The majority of buttons with an email application are labelled and therefore the user must simply read the icon labels until they find the correct one for ‘new email’

Type in address of recipient

If the user is able to remember the email address of the recipient they can then type the address in the box labelled To. If the user must access their address book to find the email address they must select the address book (or contacts list) icon and then type in the name of the person they wish to email and their address should then come up. All of the above requires recognition and retrieval of information from the long term memory which could be a problem for those with memory problems.

Type in email subject

Type a title for your email into the subject box. This field is not mandatory and therefore if the user is unable to enter any text in this field it will not affect the actual sending of the email. However most applications will show a warning message such as ‘do you wish to send this email without a subject’ however it will still enable you to press send successfully.

Type content of email

This should be fairly simple provided the user can remember what they wished to say in their email.

Send email

The majority of email applications will have a clearly labelled button for sending the email.

Return to inbox

This step happens automatically after an email has been sent in the majority of email applications.

Minimize email application to background

By selecting the third button from the left in the top right hand corner of the email application the user is able to minimize their emails, however if the user cannot remember what the minimize button looks like or where it is located, this could be a problem for them.

Open email application from time to time to check if reply has been received

The challenges associated with this step will be the same as the challenges associated with step 2.

6.4.6.2.2 Scenario B: Buying a Train Ticket Online§

Scenario B is a gentleman in his early 50s who has recently been diagnosed with frontotemporal dementia (early onset). He is trying to buy a train ticket online for a return journey the following day. At any point during this process the user may forget what they are doing which could result in either no ticket being purchased, or alternatively they may buy the wrong ticket, for example they may wish to travel tomorrow but purchase a ticket for the following week.

Steps and Challenges for booking a train ticket online.

Step

Challenges

Turn on computer

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons; firstly the user may find it hard to identify the power button as they may have forgotten what it looks like, to extend this further the user may have entirely forgotten what the computer is for or where to find it. In this instance the task becomes impossible until their memory returns. Secondly some power buttons can be quite small which may be difficult for those with reduced dexterity, particularly for those who are older and may have arthritis or a tremor.

Open internet browser

Navigate home screen with mouse and identify web browser icon and select to open. Typical memory problems

Type in URL for train ticket booking website

Typing in the first few letters of the web address in the search bar should

Select icon for booking train tickets

If the icon is not labelled this could be difficult if the user forgot what the icon to buy tickets looked like, however most icons for booking train tickets are clearly labelled, therefore the only issue for the user should be recognizing the correct label and remembering what they are doing.

Tick box for ‘return’

The user needs to remember that they need to purchase a return ticket in order to get home.

Type in from and to destinations

Given that the user is starting from their home address it can be hoped that their nearest train station is securely stored in their long term memory and can be remembered. With regards to the destination they are going to the user is likely to have written this down when arranging the outing which should help them remember the destination.

Select date and time for outbound & return journeys

Choosing appropriate times for travel may be difficult for people with dementia however most train ticket booking websites do not allow you to book a return journey prior to your outbound journey so at least this potential problem is guarded against.

Select number of adult & child passengers

In this instance only 1 person is travelling however when more than 1 person is travelling there is a higher possibility of the wrong number of tickets being purchased.

Tick box for railcards Select railcard type and number that apply for this journey

The user is likely to have a senior or disabled person rail card and therefore must remember to apply their railcard discount to the journey in order to get a discount.

Select continue

-

Tick box for outward & return journeys (details to look at: time, price, class & single/return)

This step involves selecting which type of ticket you wish to purchase, although all the options are laid out in a table sometimes it can be difficult to work out exactly which ticket you wish to buy and how much it costs.

Select ‘buy now’

-

Tick box to reserve seat and if so select seating preferences - optional

This is optional and therefore if the user does not understand it is perfectly fine for them to ignore this step.

Tick box to either; collect tickets from self-service ticket machine and select station or, have tickets sent by post

Self-service ticket machines tend to be fairly complicated therefore as long as there is enough time (7 days prior to start of journey) it is advisable to have the tickets sent by post.

Select ‘continue’

-

Tick box new user

If the user has not used this particular ticket booking site before they must enter all of their personal details, otherwise they just need to remember their email address and password.

Type in personal details (Name, Address, Email, etc.)

Personal details need to be remembered.

Tick box payment card type (Visa, MasterCard, etc.)

On the payment card there is a symbol to indicate which type of card it is, this information must be entered by way of ticking the correct box.

Enter card details (number, expiry date, name, security code)

These are written on the payment card so there is no issue with memory impairment here, however as with each step throughout this process- if the user forgets what they are trying to achieve at any point they are unlikely to be successful in this task.

Type in post code and tick box find billing address

Tick box to agree to terms and conditions and select ‘buy now’

Enter payment card secure bank password

Order complete

6.4.6.2.3 Scenario C: Online Supermarket Shop§

Scenario C is a woman with dementia in her early 70s. She finds it easier to do her supermarket shopping online as she often gets confused in the shop and forgets what she wants to buy.

Steps and Challenges for changing the payment details for an online supermarket shop.

Step

Challenges

Turn on computer

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons; firstly the user may find it hard to identify the power button as they may have forgotten what it looks like. Secondly some power buttons can be quite small which may be difficult for elderly people to press, especially those who have arthritis or a tremor in their hands.

Open internet browser

Navigate home screen with mouse and identify web browser icon and select to open. Typical memory problems

Type in URL for supermarket shopping website

Typing in the first few letters of the web address in the search bar should populate with previous history; however if its the first time a person may not understand how the automatic population of text works.

Select ‘food and drink’ and then ‘buy groceries’

Finding products and selecting a quantity may pose difficulty depending on the user interface.

Log in with username and password

It may be difficult to remember the username and password associated for this online store.

Delete old payment card

Select ‘add payment card’

Type in the card details

These are written on the payment card so there is no issue with memory impairment here, however as with each step throughout this process- if the user forgets what they are trying to achieve at any point they are unlikely to be successful in this task.

Tick box ‘make this my preferred payment card’

Select ‘save’ and then either continue shopping or log out

6.4.6.3 User Stories§
6.4.6.3.1 Scenario A: Send an Email§

Assumption: User has the screen in front of them and it is already turned on.

Scenario A is an elderly person who has limited familiarity with computer devices (desktop, tablets, mobile). A would like to send an email to a family member. A needs to be able to find the mail program easily, interact with the user interface to compose and send an email, know that it has been sent, and, then know if the email has been replied to. A turns on the computer.

Table of ICT Steps and Challenges for Sending an Email
Step Challenge Solutions Comments
1. Find the mail program Search to find. What's the name/icon for the mail program?
2. Activate/open the program Remember how to start up
3. Navigate the UI Familiarize/remind themselves how to use it, understand icons/text labels,

understand how to increase the font size

4. Locate email editor Remember/find correct name for composing (compose, new)
5. Familiarize with the fields Remember what each is used for/find the ones that are really needed vs. optional
6. Insert Email addresses How do I do that, what is an email address and what is its format,

trouble remembering the name or email address for the person to send note to, confusion with prepopulating and word prediction, interaction with the Contacts feature, understand or ignore CC and BCC fields (solution: keep out), how to fix a wrongly entered email address

7. Subject Line Know that one is needed maybe pre-populate
8. Write the Email Not know/understanding email conventions, confusion with spellchecking,

not understanding editor features (bold, italic, color), adding an image/file challenges, how to edit what has been written or how to start over, confusion if time-out occurs

spellcheck - maybe turn off by default
9. Send the email Knowing when you are done (after it goes, where does it go, do you wait for the recipient to respond immediately - is it like a phone call?)
10. Closing the Program Remember how to do that, remembering that you need to do that
11. Getting a Reply How do you know that you have one? May be out of scope for this use case
6.4.6.3.2 Scenario B: Turn up the Heat (using thermostat app)§

Assumptions: User knows they can do this from a remote device, they have the screen in front of them, it is already turned on.

Scenario B is an elderly person with early dementia. Their daughter has shown them how to use a web-enabled mobile application to change the temperature of the house. Winter has arrived and they would like to turn the heat up to keep the house warm enough. B needs help recalling how to access the temperature program, the work flow to change the temperature, and understand the elements of the user interface.

Table of ICT Steps and Challenges for Turning up the Heat
Step Challenge Solutions Comments
1. Find the thermostat program (i.e. Nest) Search to find that control, remember what the control is called, remember where it is
2. Activate/open the program Remember how to start up
3. Navigate the UI Familiarize/remind themselves with it, understand icons/text names, Understand how to increase font size
4. Locate Temperature Control Feature Remember/find correct name for changing (many UI versions, might be slider, button, how do I use that - maybe unfamiliar non-intuitive for them), understand icons/text labels
5. Manipulate the control up or down How to control the level of the Heat (is there a 2nd control?), is that in degrees F or C?, how to use/understand a slider feature
6. Setting the desired temperature How do I do that?,

Understanding that a change has been set, does it save it automatically or do I have to do something to save it?, confusion if time-out occurs

7. Closing the Program Remember how to do that, remembering that you need to do that
6.4.6.4 Personas§
  • “I have great difficulty remembering things, working things out and interpreting things. I use a Dictaphone which helps considerably. I can’t use a normal watch so I’ve gone digital, but that has its limitations. I can’t read very well so I use audio books. I can’t count money, but I haven’t found a way around that yet so any suggestions will be gratefully received! So, I’ve developed strategies to help. These can be very simple but effective if they work. Often it is the simplest things that get the better of us – things we have done all our lives without a problem. But now, because we can’t do them, it is very frustrating.” – Extract from a speech by Ann Johnson at the Uk Dementia Congress November 2010.

6.4.7 How they use the web and ICT to include: Email, apps, voice systems, IM§

6.4.7.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??
6.4.7.2 {Section}§

To do: Add table.

6.4.8 How people with Aging and Dementia can use optimized content and special pages§

To do: Add examples with descriptions of features that could optimize content for users

6.4.8.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??

6.4.9 Characteristics of Content Optimized for Aging and Dementia§

Content for people with dementia and the elderly with cognitive decline then to have:

  1. Large clear buttons with simple graphics and text
  2. Limited features
  3. High contrast
  4. Clear, step by step, instructions
  5. Rapid and direct feedback
  6. Simple, clear writing style.

(Conclusions form The 14th international conference ICCHP 2014 - See below)

6.4.9.1 Summary of Existing Research and Guidelines - Research Sources§

Key features from Phiriyapkanon:

  1. Reduction of complexity: Factions that are rarely used or not necessary should be removed
  2. Clear structure of task: The starting point of tasks and every step should be easily recognized and understood
  3. Consistency of information: Avoid contradictions and inconsistencies of information arraignment
  4. Rapid and direct feedback: Applications should continuously provide easily recognizable feedback of success or failure with every action

They also quote minimize errors, provide onscreen help and high recover-ability Phiriyapkanon t. Is big button interface enough for elderly users, P34, Malardardalen University Press Sweden 2011

K Dobsz et. al. recommends:

  1. Strong contrast of images with content
  2. Simple and large graphics
  3. Sound conformation of accepted and rejected operations
  4. Automatic voicing reading tasks (instructions)

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer (pages 401). Paper: Tablets in the rehabilitation of memory impairment, K Dobsz et al.

Key features from other guidelines:

  1. To help with difficulties in completing complex tasks, one should weight until the elder completes one task before proceeding to the next step
  2. Place tasks in step by step order -

but balance this because too many steps can give a feeling of getting lost.

  1. One has to be consistent in naming steps such as naming all steps begin with a verb (such as "press the button")
  2. Orientation impairments causes elderly to unlearn how to find their way in new surroundings. Therefor:
    1. Menus and useability interfaces need to be simplified to minimize the amount of information that needs to be memorized
    2. An application should work independent of other applications
    3. The screen should not have distracting elements (wallpaper, buttons etc)
  3. Information should be broken down into discreet chunks that the elderly can absorb
  4. Content and information give needs to be consistent
  5. Avoid stress which will further imper cognitive function

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer (pages 401). Paper: Never Too old to use a tablets, L. Muskens et al. pages 392 - 393

Key features for using tablets for the elderly from Dahn et.al:

  1. The user interface should use widgets or large buttons rather then standard apps. Moving between screens should be possible using tabs or buttons and not just gestures.
  2. Dedicated user interfaces often fall short of user requirements. Instead populate the tablet with standard apps with simple interfaces.
  3. Offer a PC like mode with "file explorer" and familiar PC interface features
  4. Supply have a printed manual
  5. Privacy policies should be transparent to build trust
  6. Supply a scaffolding approach to help and support but should allow flexible entry points.

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer ( part 2 page 329). Paper: Supporting seniorr citizens in using tablet computors tablets,Dahn et.al

Lisa Seeman (talk)

  1. Older Equipment and SoftwareSome people who are aging or have dementia will be using older browsers and devices that might not be as capable or fault tolerant as current technologies - or may be missing some of the customized and interactive content provided by newer technologies.

6.4.10 Specific Technologies (reference section below and how they use it differently)§

To do: Add section

6.4.10.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)
  2.  ??
  3.  ??

6.4.11 Summary of Existing Research and Guidelines§

To do: Add literary summary and insert guidelines and or references

6.4.11.1 Use of Language and Communication for Dementias§

[#LANG]

  • Avoid use of voice recognition or spoken commands from the end-user.
  • In either spoken or written information, use simple words, avoiding abstract, unfamiliar vocabulary.
  • In either spoken or written information, use simple sentences with just one idea per sentence. Avoid long sentences with embedded ideas.
  • Avoid pronouns or other forms of language which rely on the end-user having to recall information which they have just read or heard.
  • Support writing with clear visual images to account for potential vision deficits impacting on reading ability.

6.4.12 Extent to which current needs are met§

Review challenges and describe where needs are met. Identify gaps

6.4.13 Potentials and Possibilities (including current WCAG 2 Techniques)§

Overview: This section maps higher-level challenges to existing WCAG 2 Techniques so that we can see where there are clear gaps that will need to provide techniques for.

6.4.13.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??
6.4.13.2 {Section}§

Add ideas for filling gaps

  1. Memory:
    1. enhanced use of color
      1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element Perceivable
    2. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
    3. prompts and cues
    4. index or table of contents
    5. support text with redundant visual and auditory elements
      1. 1.1.1 - Non-text Content (A) says "a text alternative that serves the equivalent purpose" is required Perceivable
      2. 1.3.1 - Info and Relationships (A) says "information, structure, and relationships" to be made available, for example to text-to-speech software Perceivable
      3. Software that visually highlights spoken text
    6. help index
    7. Context Sensitive (support and) Help
      1. 3.1.3 Unusual Words (Level AAA) Understandable
      2. 3.1.4 Abbreviations (Level AAA) Understandable
    8. grouping and symmetry (to leverage visual perception and attention)
    9. Intuitive Design - Ease of Interaction (to leverage spatial memory)
      1. 2.1.1 - Keyboard (A) says "the content is operable through a keyboard interface" Operable
      2. 2.1.2 - No Keyboard trap (A) makes sure that keyboard focus "can be moved away from that component using only a keyboard" Operable
      3. 2.1.3 - Keyboard (No Exception) (AAA) says "all functionality of the content is operable through a keyboard interface" Operable
      4. 2.4.1 - Bypass Blocks (A) says "a mechanism is available to bypass blocks of content that are repeated" Operable
      5. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      6. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      7. 3.3.2 - Labels or Instructions (A) says that labels should be provided "when content requires user input" Understandable
    10. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    11. consistent identification
    12. simplified user controls
    13. error prevention and recovery
    14. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  2. Problem Solving:
    1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
    2. prompts and cues
    3. logical workflow with redundant text, visual and auditory cues
    4. grouping and symmetry (to leverage visual perception and attention)
    5. Intuitive Design - Ease of Interaction (to leverage spatial memory)
    6. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    7. consistent identification
    8. easy user customization
    9. simplified user controls
  3. Completing Tasks:
    1. prompts and cues
    2. grouping and symmetry (to leverage visual perception and attention)
    3. Intuitive Design - Ease of Interaction (to leverage spatial memory)
    4. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    5. simplified user controls
    6. error prevention and recovery
    7. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  4. Confusion w/ Time or Place:
    1. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
    2. identify current state
    3. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    4. consistent identification
    5. simplified user controls
    6. error prevention and recovery
    7. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  5. Visual/Spatial/Temporal Understanding: May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
    1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
    2. large selection targets
    3. zoom controls, large fonts
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
    4. close proximity
    5. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
    6. prompts and cues
    7. support text with redundant visual and auditory elements
    8. help index
    9. context sensitive help
    10. plain language
    11. grouping and symmetry (to leverage visual perception and attention)
    12. Intuitive Design - Ease of Interaction (to leverage spatial memory)
    13. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    14. consistent identification
    15. enhanced use of color and contrast
      1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element Perceivable
      2. 1.4.3 - Contrast (Minimum) (AA) requires a contrast ratio of at least 4.5:1 for the visual presentation of text and images Perceivable
      3. 1.4.6 - Contrast (Enhanced) (AAA) requires a higher contrast ratio of at least 7:1 for the visual presentation of text and images Perceivable
    16. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    17. simplified user controls
    18. error prevention and recovery
    19. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  6. Conversation:
    1. text
    2. support text with redundant visual and auditory elements
    3. simplified user controls
  7. Misplacing Items:
    1. site map
    2. index or table of contents
    3. help index
    4. context sensitive help
    5. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    6. consistent identification
  8. Judgment:
    1. prompts and cues
    2. support text with redundant visual and auditory elements
    3. grouping and symmetry (to leverage visual perception and attention)
  9. Withdrawal:
    1. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    2. simplified user controls
    3. error prevention and recovery
    4. emotional expression (EmotionML)
  10. Mood/Personality:
    1. encouragement
    2. immediate positive feedback
    3. safety controls
    4. grouping and symmetry (to leverage visual perception and attention)
    5. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    6. consistent identification
    7. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    8. simplified user controls
    9. error prevention and recovery
    10. emotional expression (EmotionML)

6.4.14 Prevalence§

6.4.14.1 Research Sources§

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??
6.4.14.2 Prevalence of Dementia§
  • UK (2013 Study)
    • Alzheimer’s Society estimates that there are 428,000 people in the UK who are living with dementia that haven’t been formally diagnosed.
    • Two thirds of people with dementia are women
    • One in three people over 65 will develop dementia
    • 40-64 years: 1 in 1,400
    • 65-69 years: 1 in 100
    • 70-79 years: 1 in 25
    • 80+ years: 1 in 6
    • Future Projections: The number of people in the UK with dementia will double in the next 40 years.
      • 800,000 people with dementia in 2012
      • 1,000,000 people with dementia in 2021
      • 1,700,000 people with dementia in 2051

Worldwide

  • There are an estimated 35.6 million people with dementia worldwide. by 2050 this figure will rise to over 115 million (2)
  • There are 7.7 million new cases every year (9)
  • Alzheimer's disease is the most common form of dementia and may contribute to 60-70% of cases (9)
  • In 2010 dementia had an estimated global cost of US$604 Billion, 1% of of global GDP (3)

By Gender

  • A study cited by the European Collaboration on Dementia (EuroCoDe) states that in Europe approximately five million women have dementia compared with 2 and half million men (5) – cognitive decline is often accelerated in women following menopause.(6)
6.4.14.3 Prevalence of Aging§
  • World Health Organization: 2012 Study
    • The world population is rapidly aging
      • Between 2000 and 2050, the proportion of the world's population over 60 years old will double from about 11% to 22%. The number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.
    • The number of people aged 80 and older will quadruple in the period 2000 to 2050
      • By 2050 the world will have almost 400 million people aged 80 years or older.
    • By 2050, 80% of older people will live in low- and middle-income countries
    • The main health burdens for older people are from non-communicable diseases while the greatest causes of disability are visual impairment, dementia, hearing loss and osteoarthritis.
    • Older people in low- and middle-income countries carry a greater disease burden than those in the rich world
    • The need for long-term care is rising
      • The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050.
    • Effective, community-level primary health care for older people is crucial
    • Supportive, “age-friendly” environments allow older people to live fuller lives and maximize the contribution they make
      • Creating “age-friendly” physical and social environments can have a big impact on improving the active participation and independence of older people
    • Healthy aging starts with healthy behaviors in earlier stages of life
    • We need to reinvent our assumptions of old age
      • Society needs to break stereotypes and develop new models of aging for the 21st century. Everyone benefits from communities, workplaces and societies that encourage active and visible participation of older people.

6.4.15 References to Research§

6.4.15.1 References on Aging§
6.4.15.2 References on Dementia§
6.4.15.2.1 References on Alzheimer's§
6.4.15.2.2 References on Less Common Dementia (Non-Alzheimer's)§

Less Common Dementia (Non-Alzheimer's

(1) (http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=159) (2) Alzheimer’s Society International (3) Alzheimer’s disease International (2010). ‘World Alzheimer Report 2010.’ London: Alzheimer’s disease International. (4) Alzheimer’s Society - ‘Short changed: Protecting people with dementia from financial abuse’ Alzheimer’s Society undertook the largest ever survey carried out on this subject, and analysed responses from 104 carers and 47 people with dementia as well as focus groups and interviews with professionals . (5) EuroCoDe, 2006-2008 (6) http://www.ncbi.nlm.nih.gov/pubmed/19811879 (7) Fabian, D. & Flatt, T. (2011) The Evolution of Aging. (8) www.senescence.info - Joao Pedro de Maglahaes (9) http://www.who.int/mediacentre/factsheets/fs362/en/

6.4.15.3 References from literature reviews on Dementia and ICT from Peter Cudd§
INDIVUI
How Individual Should Digital AT User Interfaces Be for People with Dementia. Peter Cudd, Philippa Greasley, Zoe Gallant, Emily Bolton and Gail Mountain. AAATE proceedings 3012

Abstract. A literature review of papers that have explored digital technology user interface design for people with dementia is reported. Only papers that have employed target user input directly or from other works have been included. Twenty four were analysed. Improvements in reporting of studies are recommended. A case is made for considering the population of people with dementia as so heterogeneous that one design does not suit all, this is illustrated through some case study reports from people with dementia. Furthermore it is proposed that by grouping people into functionally similar sub-groups interfaces may be designed for these groups that will collectively establish a sequence of ‘stepping stone ‘ interfaces that better address appropriate functioning and maintain self-efficacy. Fundamentally people living with dementia are unique individuals with unique specific needs. A priori, in life experiences, interests, willingness to learn, environmental factors and co-morbidities they are as varied as any of their age peers. One thing they do not share with those peers is the degenerative consequences of the specific dementia they have. The progression of their disease also follows a unique timeline – even if the general symptoms (and thus perhaps functional ability) change in a fairly predictable order. In the face of these statements it might be inferred that it is most likely that people with dementia require individual but adaptive (to progression of the disease) bespoke solutions for sustained independent living.

Given the breadth of individuality in people, the effects of dementias and indeed their progression it is impossible to view them as a single homogeneous population in terms of specifying a single user interface. In consequence rather than simply designing for all people living with dementia it is suggested that design for populations at stages of functional ability be investigated. Methods that set out to identify shared and bespoke requirements are needed to systematically establish any generalizability. Currently studies on design of digital AT and indeed other ICT for people living with dementia need to report much more detail on: describing their participants; details of user interface features that worked well; how much and what form carers help took. More attention also needs to compare strategies and features that work to identify those that are best or at least best for specific functional ability or tasks.

6.4.15.3.1 Key refs (as indicated by title)§
[INDIVUI_10]
Making software accessible to people with severe memory deficits. N. Alm, R. Dye, A. Astell, M. Ellis, G. Gowans, J. Campbell. Proceedings of Accessible Design in the digital world, Dundee, 23-25 August 2005.
[INDIVUI_12]
Developing smartphone applications for people with Alzheimer's disease. N. Armstrong, C.D. Nugent, G. Moore, D.D Finlay. Proceedings of the IEEE/EMBS Region 8 International Conference on Information Technology Applications in Biomedicine, ITAB. 2010.
[INDIVUI_13]
Working with people with dementia to develop technology: The CIRCA and Living in the Moment projects. A.J. Astell, N. Alm, G. Gowans, M.P. Ellis, P. Vaughan, R. Dye, J. Campbell. Journal of Dementia Care, 17, 1. 2009, 36-39.
[INDIVUI_25]
Functional requirements for assistive technology for people with cognitive impairments and dementia F.J.M. Meiland, M.E. De Boer, J. Van Hoof, J. Van Der Leeuw, L. De Witte, M. Blom, R.M. Dröes. Communications in Computer and Information Science 277 CCIS. 2012, 146-151.
[INDIVUI_26]
Video reminders as cognitive prosthetics for people with dementia. S.A. O'Neill, S. Mason, G. Parente, M.P. Donnelly, C.D. Nugent, S. McClean, D. Craig. Ageing International36(2). 2011, 267-282.
[INDIVUI_27]
Designing technology to improve quality of life for people with dementia: User-led approaches. R. Orpwood, J. Chadd, D. Howcroft, A. Sixsmith, J. Torrington, G. Gibson, G. Chalfont. Universal Access in the Information Society9(3). 2010, 249-259.
[INDIVUI_14]
“Living in the Moment”: Developing an interactive multimedia activity system for elderly people with dementia. A.J. Astell, M.P. Ellis, N. Alm, R. Dye, G. Gowans, P. Vaughn, Proceedings of the International Workshop on Cognitive Prostheses and Assisted Communication. 2006, 16-20.
[INDIVUI_17]
A user driven approach to develop a cognitive prosthetic to address the unmet needs of people with mild dementia. R.J. Davies, C.D. Nugent, M.P. Donnelly, M. Hettinga, F.J. Meiland, F. Moelaert, R. Dröes. Pervasive and Mobile Computing, 5(3) 2009, 253-267.
[INDIVUI_19]
Usable User Interfaces for Persons with Memory Impairments. R. Hellman. Advanced Technologies and Societal Change. 2012, 167-176.
[INDIVUI_20]
Requirements guideline of assistive technology for people suffering from dementia. J. Hyry, G. Yamamoto, P. Pulli. ACM International Conference Proceeding Series. ISABEL '11 Proceedings of the 4th International Symposium on Applied Sciences in Biomedical and Communication Technologies, Article No. 39. 2011.
[INDIVUI_21]
The challenge of coming to terms with the use of a new digital assistive device: A case study of two persons with mild dementia. E. Karlsson, K. Axelsson, K. Zingmark, S. Sävenstedt. Open Nursing Journal5. 2011, 102-110.
[INDIVUI_23]
Usability of tablet computers by people with earlystage dementia. F.S. Lim, T. Wallace, M.A. Luszcz, K.J. Reynolds. Gerontology, 59. 2013, 174-182.
[INDIVUI_24]
User needs and user requirements of people with dementia: Multimedia application for entertainment. O. Maki, P. Topo. In: P. Topo and B. Ostlund (eds). Dementia, Design and Technology. Assistive Technology Research Series Vol. 24. IOS Press : Amsterdam. 2009.
[INDIVUI_30]
Accessible websites for people with dementia: A preliminary investigation into information architecture. N. Savitch, P. Zaphiris. Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) 4061 LNCS. 2006, 144-151.
[INDIVUI_32]
Designing ICT for the over 80s. E.L. Waterworth, J.A. Waterworth. In: P. Topo and B. Ostlund (eds). Dementia, Design and Technology. Assistive Technology Researc Series Vol. 24. IOS Press : Amsterdam. 2009
[INDIVUI_33]
Maavis : “Touchscreen computer helps care home residents keep in touch with family”, British Journal of Healthcare Computing, 2010, available at http://www.bjhc.co.uk/archive/news/2010/n1010032.htm; Accessed on 26/03/13.
6.4.15.3.2 Others§
[INDIVUI_2]
Technology studies to meet the needs of people with dementia and their caregivers: A literature review. P. Topo. Journal of Applied Gerontology28(1). 2009, 5-37
[INDIVUI_4]
The potential of information and communication technologies to support ageing and independent living. J. Soar. Annals of Telecommunications- Annales Des Telecommunications, 65 (9-10). 2010, 479-483
[INDIVUI_9]
An interactive entertainment system usable by elderly people with dementia. N. Alm, A. Astell, G. Gowans, R. Dye, M. Ellis, P. Vaughan, A.F. Newell. Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) 4555 LNCS (PART 2). 2007, 617-623.
[INDIVUI_11]
A communication support system for older people with dementia. N. Alm, R. Dye, G. Gowans, J. Campbell, ,A. Astell, M. Ellis. IEEE Computer40No 5. 2007, 35-41
[INDIVUI_16]
First steps in designing a videophone for people with dementia: Identification of users' potentials and the requirements of communication technology. I. Boman, L. Rosenberg, S. Lundberg, L. Nygård. Disability and Rehabilitation: Assistive Technology, 7(5) 2012, 356-363.
[INDIVUI_18]
A mobile multimedia technology to aid those with alzheimer's disease. M. Donnelly, C. Nugent, S. McClean, B. Scotney, S. Mason, P. Passmore, D. Craig. IEEE Multimedia, 17(2). 2010, 42-51.
[INDIVUI_22]
Memory aid to structure and support daily activities for people with dementia. Y. Kerkhof, F. Rabiee, C.G. Willems. Assistive Technology Research Series29. 2011, 3-9.
LANG
Language and Communication in the Dementias: Implications for User Interface Design. Philippa Greasley and Peter Cudd. AAATE proceedings. 2013

Abstract. The design of user interfaces for people with dementia does not appear from the literature to take into account the concomitant language and communication deficits when choosing the language used in the interfaces. A systematic approach was used to search databases for studies relating to language and communication in the four most common forms of dementia (Alzheimer’s disease, vascular dementia, fronto-temporal dementia and dementia with Lewy bodies). Studies identified were used as a basis for the commentary in this paper. Communication deficits are common in dementia. From the earliest stages of the disease, the person with dementia’s capacity for communication declines as difficulties emerge with all aspects of language and functional communication. These deficits have implications for the successful interaction with assistive digital technology designed to improve the quality of life of people with dementia. More consideration should be given at the design stages to the potential impact of communication difficulties on interaction with technology

it is important to note that the authors have not been able to find to date any conclusions about what impact these impairments may have on user interface design.

The results of this review have highlighted areas of strength (reading) and areas of difficulty (spoken language output and understanding some aspects of spoken and written language) in the communication abilities of people living with dementia. Those who design interfaces for this client group should consider the impact that their language and communication choices might have on end-users with dementia. In particular, the following general guidelines should be taken into account, in order to maximise the accessibility of the language of interfaces for people with dementia:

6.4.15.3.3 Key refs (by title)§
[LANG_3]
Review of ICT-based services for identified unmet needs in people with dementia. S. Lauriks, A. Reinersmann, H.G. Van der Roest, F.J.M. Meiland, R.J. Davies, F., Moelaert, R. M. Dröes. Ageing Research Reviews, 6(3), 200) 223-246.
[LANG_6]
Functional requirements for assistive technology for people with cognitive impairments and dementia. F.J.M. Meiland, M.E. De Boer, J. Van Hoof, J. Van Der Leeuw, L. De Witte, M. Blom, R.M Dröes. Communications in Computer and Information Science 277 CCIS, 2012, 146-151.
[LANG_8]
Designing an interface usable by people with dementia. N. Alm, R. Dye, G. Gowans, J. Campbell, A. Astell, and M. Ellis. In Proceedings of the 2003 conference on Universal usability (CUU '03).ACM, New York, NY, USA, 2002 156-157.
[LANG_11]
ICT Interface Design for Ageing People and People with Dementia. J. Wallace, M. D. Mulvenna, S. Martin, S. Stephens, W. Burns. In: M. D. Mulvenna & C. D. Nugent (eds). Supporting People with Dementia Using Pervasive Health Technologies, London: Springer-Verlag. 2010

6.5 Down Syndrome§

Down syndrome also known as Trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is typically associated with physical growth delays, characteristic facial features and mild to moderate intellectual disability.

Education and proper care has been shown to improve quality of life. Some children with Down syndrome are educated in typical school classes while others require more specialized education. Some individuals with Down syndrome graduate from high school and a few attend post-secondary education.

Down syndrome is best known for its affect on the development of literacy and language related skills. Down syndrome is widely recognized as being a specific learning disability of neurological origin that does not imply low intelligence or poor educational potential, and which is independent of race and social background.

6.5.1 Cognitive functions§

This section is a technical reference. Jump to the next section on Symptoms for more practical information.

6.5.1.1 Overview§

Improvements in medical interventions for people with Down's syndrome have led to a substantial increase in their longevity. Diagnosis and treatment of neurological complications are important in maintaining optimal cognitive functioning.

The cognitive phenotype in Down's syndrome is characterized by impairments in morphosyntax, verbal short-term memory, and explicit long-term memory. However, visuospatial short-term memory, associative learning, and implicit long-term memory functions are preserved. Seizures are associated with cognitive decline and seem to cause additional decline in cognitive functioning, particularly in people with Down's syndrome and comorbid disorders such as autism. Vision and hearing disorders as well as hypothyroidism can negatively impact cognitive functioning in people with Down's syndrome.

Dementia that resembles Alzheimer's disease is common in adults with Down's syndrome. Early-onset dementia in adults with Down's syndrome does not seem to be associated with atherosclerotic complications.

Source: The Lancet

6.5.1.2 Auditory Discrimination§

People with Down syndrome often struggle with short-term auditory memory. Most people use memory to process, hold, understand and assimilate spoken language. Auditory memory relates directly to the speed with which we can articulate words, and influences the speed at which people learn new words and learn to read.

Theories about memory suggest that words we hear are received and stored in our working memory in order to make sense of them. They are then transferred to a more long-term store. However, words are only retained in the working memory for two seconds unless consciously kept there by silently repeating them to oneself, called rehearsing. The amount of information we can retain within the two-second span is called the auditory digit span.

Is there a relationship between Down’s syndrome and working memory?

Yes, many people with Down’s syndrome have difficulties in this area. Generally, long-term memory is not impaired; neither is the visual memory, which is often far stronger.

Source: Sandy Alton

6.5.1.3 Visual Recognition Skills§

The cognitive profile observed in Down syndrome is typically uneven with stronger visual than verbal skills, receptive vocabulary stronger than expressive language and grammatical skills, and often strengths in reading abilities. There is considerable variation across the population of people with Down syndrome.

Many studies have included typically developing children matched for chronological age, for non-verbal mental age or on a measure of language or reading ability. Individuals with Down syndrome have also been compared to individuals with learning difficulties of an unknown origin and to individuals who have learning difficulties of a different aetiology (e.g., specific language impairment).

The particular measures of language, reading or non-verbal ability used for matching can affect the conclusion drawn. There are also behavioral aspects of the Down syndrome phenotype other than non-verbal ability and language ability (such as motivational style) that may affect their performance on tasks, including attainment tests, and need to be taken into account.

In terms of education, there is strong evidence to suggest that the relatively recent policy of educating children with Down syndrome in mainstream schools has had a positive effect on language skills and academic attainments. This means that the findings of studies conducted a number of years ago need to be interpreted with caution.

Source: Margaret Snowling, Hannah Nash and Lisa Henderson

6.5.2 Symptoms§

Intellectual and cognitive impairment and problems with thinking and learning and usually ranges from mild to moderate. Common symptoms are:

  • Short attention span
  • Poor judgment
  • Impulsive behavior
  • Slow learning
  • Delayed language and speech development
  • Reading is typically slow and laborious. If they are undiagnosed or diagnosed late, they may be illiterate or barely literate.
  • Concentration tends to fluctuate.
  • Poor and unusual spelling and grammar.
  • Handwriting is unusable or very messy.
  • Poor physical coordination
  • Difficulty remembering information (tends to fluctuate)
  • Difficulty with organizing and planning
  • Difficulty working within time limits
  • Difficulty thinking and working in sequences, which can make planning difficult
  • Visual processing difficulties, which can affect reading and recognizing places
  • Poor auditory processing skills
  • Listening to oral instructions difficult, tiring and confusing

Down syndrome symptoms vary with each person and appear at different times in their lives.

Source: NIH

6.5.3 Their Challenges§

6.5.3.1 Memory§
  • Poor short term memory for facts, events, times, dates, symbols.
  • Poor working memory; i.e. difficulty holding on to several pieces of information at the same time. This is especially challenging while undertaking a task e.g. taking notes as you listen, addressing compound questions.
  • Mistakes with routine information e.g. giving your age, and phone number or the ages of children.
  • Inability to hold on to information without referring to notes.
6.5.3.2 Automatising skills§

Down syndrome do not tend to automatise skills very well, and a high degree of mental effort is required to carrying out tasks that other individuals generally do not feel requires effort. This is particularly true when the skill is composed of several subskills (e.g. reading and writing).

6.5.3.3 Information Processing§
  • Difficulties with taking in information efficiently (this could be written or auditory).
  • Slow speed of information processing, such as a 'penny dropping' delay between hearing or reading something and understanding and responding to it.
6.5.3.4 Communication Skills§
  • Lack of verbal fluency and lack of precision in speech. (relevant for voice systems)
  • Word-finding problems.
  • Inability to work out what to say quickly enough.
  • Misunderstandings or misinterpretations during oral exchanges.
  • Sometimes mispronunciations or a speech impediment may be evident.
6.5.3.5 Literacy§
  • Difficulty in acquiring reading and writing skills. Reading is likely to be slow.
  • If they are undiagnosed or diagnosed late, may be illiterate, barely literate and it will be very laborious
  • Where literacy has been mastered, problems continue such as pore spelling, difficulty extracting the meaning from written material, difficulty with unfamiliar words, and difficulty with scanning or skimming text.
  • Particular difficulty with unfamiliar or new language such as jargon.
6.5.3.6 Organization, Sequencing§
  • Difficulty organizing a sequence of events.
  • Incorrect sequencing of strings of number and letter. (passwords, phone numbers)
  • Chronic disorganisation and misplacing/losing items.
  • Difficulty with time management and passage of time
6.5.3.8 Sensory Sensitivity§
  • Sensitivity to noise and visual stimuli.
  • Impaired ability to screen out background noise / movement.
  • Sensations of mental overload
  • Tendency to "switch off".
6.5.3.9 Lack of Wwareness§
  • Failure to notice body language.
  • Failure to realize the consequences of their speech or actions.
6.5.3.10 Visual Stress§
  • Some people with Down syndrome difficulties may experience visual stress when reading. Especially when dealing with large amounts of text. So brakes are often needed
6.5.3.11 Coping Strategies§

It must be emphasized that individuals vary greatly in their Specific Learning Difficulties profile. Key variables are the severity of the difficulties and the ability of the individual to identify and understand their difficulties and successfully develop and implement coping strategies.

By adulthood, many people with Specific Learning Difficulties are able to compensate through technology, reliance on others and an array of self-help mechanisms - the operation of which require sustained effort and energy. Unfortunately, these strategies are prone to break down under stressful conditions which impinge on areas of weakness.

6.5.3.12 Effects of Stress§

People are particularly susceptible to stress (compared with the ordinary population) with the result that increase their impairments.

6.5.4 Some Personae with Use Cases That Address Key Challenges§

Scenario A is a high school student with Down syndrome.

Although she can read at a 3rd grade level it is slow and she finds it difficult. Books geared towards a younger audience with a lot of pictures help. Plus she can comprehend and remember stories read by others. Test taking is very stressful and it helps when the teacher can help her take the test orally. She is strong on the computer especially when interested in the topics. She can surf the internet and do research but needs to be reminded to stay on task and not get distracted by other sites and advertisements. She does not use assistive technology but has in the past to improve her reading skills. The teacher aide has to remind her to stay on task during exercise. She can do simple research projects but only if supported with reminders and visual ques.

Table of ICT Steps and challenges
Step Challenge
Search query
Scanning results
Doing a short review of different option and finding the most appropriate
Finding the right content in the right document
Read the right content
Collecting the information
Coping for Citing the resources and collecting them with the right information
Remembering the process (re-finding it next time)
Saving the work
Putting it together and writing the paper Her writing is poor and so this would be Out of scope of this user case

6.5.5 How They Use the Web and ICT to Include: Email, apps, voice systems, IM§

Add table.

6.5.6 How People with Cognitive Disabilities Use Optimized Content and Special Pages§

Add examples with descriptions of features

6.5.7 Characteristics of Content Optimized for This Group§

Add descriptions of key features and how it helps users overcome challenges

6.5.8 Specific technologies (reference section bellow and how they use it differently)§

Add section

6.5.9 Summary of Existing Research and Guidelines§

Aim to ensure that written material takes into account the visual stress experienced by some Down syndrome people, and to facilitate ease of reading. Adopting best practice for Down syndrome readers has the advantage of making documents easier on the eye for everyone. Font. (Remember people with Down syndrome can be easily distracted and confused)

  • Use a plain, evenly spaced sans serif font such as Arial and Comic Sans. Alternatives include Verdana, Tahoma, Century Gothic, Trebuchet.
  • Font size should be 12-14 point. Some dyslexic readers may request a larger font.
  • Use dark colored text on a light (not white) background.
6.5.9.1 Headings and Emphasis§
  • Avoid underlining and italics: these tend to make the text appear to run together. Use bold instead.
  • AVOID TEXT IN BLOCK CAPITALS: this is much harder to read.
  • For Headings, use larger font size in bold, lower case.
  • Boxes and borders can be used for effective emphasis.
6.5.9.2 Layout§
  • Use left-justified with ragged right edge.
  • Avoid narrow columns (as used in newspapers).
  • Lines should not be too long: 60 to70 characters.
  • Avoid cramping material and using long, dense paragraphs: space it out.
  • Line spacing of 1.5 is preferable.
  • Avoid starting a sentence at the end of a line.
  • Use bullet points and numbering rather than continuous prose.
6.5.9.3 Writing Style§
  • Use short, simple sentences in a direct style.
  • Give instructions clearly. Avoid long sentences of explanation.
  • Use active rather than passive voice.
  • Avoid double negatives.
  • Be concise.
6.5.9.4 Increasing Accessibility§
  • Flow charts are ideal for explaining procedures.
  • Pictograms and graphics help to locate information.
  • Lists of 'do's and 'don'ts' are more useful than continuous text to highlight aspects of good practice.
  • Avoid abbreviations if possible or provide a glossary of abbreviations and jargon.
  • For long documents include a contents page at the beginning and an index at end.

Note: Checking Readability. To set your spell checker in Word 2003 to automatically check readability, go to Tools, Options, Spelling, and Grammar, then tick the Readability request. Word will then show your readability score every time you spell check. In Word 2007 Click the Microsoft Office Button, and then click Word Options. Click Proofing. Make sure Check grammar with spelling is selected. Under When correcting grammar in Word, select the Show readability statistics check box. Check long documents in sections, so that you know which parts are too hard.

References:

6.5.10 Extent To Which Current Needs Are Met§

Review challenges and describe where needs are met. Identify gaps

6.5.11 Potentials and Possibilities§

Add ideas for filling gaps

6.5.12 Prevalence§

The estimated incidence of Down syndrome is between 1 in 1,000 to 1 in 1,100 live births worldwide. Each year approximately 3,000 to 5,000 children are born with this chromosome disorder and it is believed there are about 250,000 families in the United States of America who are affected by Down syndrome.

Sixty to 80 percent of children with Down syndrome have hearing deficits. Forty to 45 percent of children with Down syndrome have congenital heart disease. Intestinal abnormalities also occur at a higher frequency in children with Down syndrome.

Children with Down syndrome often have more eye problems than other children who do not have this chromosome disorder. Another concern relates to nutritional aspects. Some children with Down syndrome, in particular those with severe heart disease often fail to thrive in infancy. On the other hand, obesity is often noted during adolescence and early adulthood. These conditions can be prevented by providing appropriate nutritional counseling and anticipatory dietary guidance.

Thyroid dysfunctions are more common in children with Down syndrome than in other children. Skeletal problems have also been noted at a higher frequency in children with Down syndrome. Other important medical aspects in Down syndrome, including immunologic concerns, leukemia, Alzheimer disease, seizure disorders, sleep apnoea and skin disorders, may require the attention of specialists in their respective fields.

Source: World Health Organization - http://www.who.int/genomics/public/geneticdiseases/en/index1.html

References to Research§

Add section

6.6 Attention Deficit Disorder / Attention Deficit and Hyperactivity Disorder (ADD / ADHD)§

Attention deficit hyperactivity disorder is generally characterized by some combination of hyperactivity, impulsivity, and/or inattention. Three major types of ADHD are currently described. These symptoms are present in the affected child to such a degree that they significantly interfere in at least two areas of the child's life, such as in the home and classroom. (1)

6.6.1 Cognitive Functions§

Difficulty in remaining seated Difficulty awaiting turn or standing in line. Runs about or climbs excessively when it is inappropriate. Talks excessively: blurts out answers before questions have been completed. Tendency to interrupt: interrupts or intrudes on others, such as butting into conversations or games. Difficulty engaging in quiet activities.

6.6.2 Symptoms§

symptoms of inattention, impulsiveness, irritability, intolerance, and frustration. often forgetful of daily duties, instructions, orders, and recommendations. Difficulties in recalling general information, even with intense effort.

6.6.3 Their Challenges§

  • They demand attention by talking out of turn or moving around the room.
  • They have trouble following instructions, especially when they’re presented in a list.
  • They often forget to write down homework assignments, do them, or bring completed work to school.
  • They often lack fine motor control, which makes note-taking difficult and handwriting a trial to read.
  • They often have trouble with operations that require ordered steps, such as long division or solving equations.
  • They usually have problems with long-term projects where there is no direct supervision.
  • They don’t pull their weight during group work and may even keep a group from accomplishing its task.

6.6.4 Some Personae with Use Cases that Address Key Challenges§

Add persona and scenario

Add table of ICT Steps and challenges.

6.6.5 How They Use the Web and ICT§

apps such as Timers and To-Do Lists to remind them of activities Email to send items to themselves as reminders for follow-up VM - Same as email, send a voice mail as a reminder.

6.6.6 How People with Ccognitive Disabilities Use Optimized Content and Special Pages§

Add examples with descriptions of features

6.6.7 Characteristics of Content Optimized for This Group§

Add descriptions of key features and how it helps users overcome challenges

6.6.8 Specific Technologies§

Many resources/experts suggest using a smartphone with a calendar and to-do list. These can also be used as timers and alarms for limiting time on tasks (work, homework, TV, internet, reading) and can also be used as an alarm system to time leaving for school or work - not just for getting out of bed.

The editors of HealthLine curated a list of the 16 best ADHD apps at http://www.healthline.com/health-slideshow/top-adhd-android-iphone-apps#1

6.6.9 Summary of Existing Research and Guidelines§

Add literary summary and insert guidelines and or references

6.6.10 Extent to Which Current Needs Are Met§

Review challenges and describe where needs are met. Identify gaps

6.6.11 Potentials and Possibilities§

Add ideas for filling gaps

6.6.12 Prevalence§

Add section

Percent of Youth Aged 4-17 with Current Attention-Deficit/Hyperactivity Disorder by State: National Survey of Children's Health - US 8.8 (3)

6.6.13 References to research.§

LD/ADHD stuff: http://www.catea.gatech.edu/scitrain/science/modules/adhd/introduction.php http://www.catea.gatech.edu/scitrain/science/modules/ld/module8_1.php

References:

  1. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0CEYQFjAD&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK64203%2F&ei=mB9IU7iwE-ez8AH6mYDABw&usg=AFQjCNFy7w32udum9OGTHqToONoYaaq9NQ&sig2=YatAY4Cy9qynVmgMoLuDSA&bvm=bv.64542518,d.b2U
  2. http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011-2654.full.pdf
  3. http://www.cdc.gov/ncbddd/adhd/prevalence.html
  4. http://www.additudemag.com/ - Attention Deficit Disorder on-line magazine

6.7 Autism§

"Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less.

A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder." (See 2.)

6.7.1 Cognitive Functions§

  1. "Memory
  2. Problem-solving
  3. Attention
  4. Reading, linguistic, and verbal comprehension
  5. Math comprehension
  6. Visual comprehension" (See 5.)

6.7.2 Symptoms§

"People with ASD often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of learning, paying attention, or reacting to things. Signs of ASD begin during early childhood and typically last throughout a person’s life.

Children or adults with ASD might:

  • not point at objects to show interest (for example, not point at an airplane flying over)
  • not look at objects when another person points at them
  • have trouble relating to others or not have an interest in other people at all
  • avoid eye contact and want to be alone
  • have trouble understanding other people’s feelings or talking about their own feelings
  • prefer not to be held or cuddled, or might cuddle only when they want to
  • appear to be unaware when people talk to them, but respond to other sounds
  • be very interested in people, but not know how to talk, play, or relate to them
  • repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
  • have trouble expressing their needs using typical words or motions
  • not play 'pretend' games (for example, not pretend to 'feed' a doll)
  • repeat actions over and over again
  • have trouble adapting when a routine changes
  • have unusual reactions to the way things smell, taste, look, feel, or sound
  • lose skills they once had (for example, stop saying words they were using)" (See 2.)

Different list of symptoms:

  • poor social skills
  • difficulty with change and transition
  • impairments in executive function
    • "manage time and attention
    • switch focus
    • plan and organize
    • remember details
    • curb inappropriate speech or behavior
    • integrate past experience with present action" (See 6.)
  • sensory integration
    • sensitivity to physical contact
    • sensitivity to loud noises
  • stereotypy

6.7.3 Their Challenges§

6.7.3.1 How Symptoms Result in Challenges for This Group§
  • may not pay attention to primary content because distracted by secondary content
  • may be confused by:
    • instructions that are not well-defined
    • transitions among content-delivery types (e.g., text to video)
    • presentations of content using different formats or designs
  • may not participate in web-based interactions with other people
  • may not recall instructions when subsequently presented with an action to perform
  • may react negatively to auto-playing video or audio
6.7.3.2 Observations from Interview with Anonymous User X§
  • Positive: web facilitates social communication between those who struggle with face to face communication.
  • Negative: communication via the web allows people with ASD to become even more isolated.
  • Often the web is avoided except for work or communication purposes as it is not very user friendly.
  • Some websites specifically are avoided due to the predominant color (red is particularly bad).
  • In many cases there are some very-useful accessibility features that users of websites and applications have the option to adjust. However, it is often difficult to find out how and where to do this. (See 10.)
6.7.3.3 Suggestions from Interview with Anonymous User X§
  • It is easier to view websites that are more visual and use only plain, simple language that doesn’t contain any jargon.
  • Numerous search results can be difficult to sort through to find the right link. Therefore, easy-to-access links are more helpful without many options.
  • Font: very much a personal preference, however in general:
    • Big, plain fonts at least point 12.
    • Bold fonts not skinny.
    • Sites that allow users to customize the font to their own preferences.
  • Color coordination for different parts of the site relating to each other.
  • Key for different colors for different sections.
  • In some cases poor concept of time means can be looking at one site/page/document for many hours without realizing - timer on screen to alert user to how long they have been on that page. (See 10.)

6.7.4 Some Personae with Use Cases That Address Key Challenges§

6.7.4.1 Scenario A: Use a Web Browser to Open a Web Page§

"Trevor is a bright 18-year-old who plays games and watches music videos on his laptop. He lives at home with his parents and younger sister. He attends a special school where the teachers and staff can help with his social and communication challenges from his Autism Spectrum Disorder, while he works to pass his high school exams.

He has problems with visual information and recognizing things on the page, and his reading skills are not helped by his trouble concentrating on the page or screen long enough to read. His teachers showed him how to make the text bigger on the page, and told him how to use a printable view to hide all the ads with moving images that distract him, because he reads every word on the page very carefully and literally. He can be easily confused by colloquialisms and metaphors. He can also be overwhelmed by sites that offer too many choices.

He likes using the school’s forum to talk to his friends. It’s easier to just read what they want to say than to listen and try to figure out their facial expressions.

He shares a laptop with the family, but has first dibs on it because his parents want him to get his schoolwork done. He uses it for homework, but he really likes games with repetitive actions. He doesn’t like new sites much, in the same way that he doesn’t like any changes in his routine: they are tolerated, but not encouraged." (See 8, 9.)

Step Challenge Solutions Comments
1. Activate / open the web browser. Remember how to start the web browser.
2. Open the website. Recall the web address and know how to invoke it with the web browser. Enter the web address.
3. Navigate the website. Familiarize / recall how to use it; and understand icons/text labels and navigation menus.
4. View a webpage. Comprehend the content without being distracted by advertisements, extraneous content, etc.. Increase font size and/or activate the print view of the web browser. The solutions may be mutually exclusive.
6.7.4.2 Scenario B: Send an Email Message§

Middle-aged female with PDD-NOS (Pervasive Development Disorder-Not Otherwise Specified). She experiences significant social deficits and meets all the diagnostic criteria for autistic disorder, but her stereotypical and repetitive behaviors are noticeably mild. She finds it easier to send an email message than communicate via speech with people as it eliminates any social anxiety she may experience when interacting with people in person.

Step Challenge Solutions Comments
1. Turn on computer.
2. Launch email application. The first issue here arises from the glaring white background that is often used in email applications along with poorly-contrasted small fonts. Although there are options for changing some of the design settings, these are often hard to find and difficult to navigate.
3. Select button to compose new email message. Users with autism have a tendency to take a literal understanding of what people say and write. Therefore, the users may not understand any connotations, and are also prone to perhaps lack emotion in their own writing. There is a potential issue here as what users write may come across as unnecessarily blunt even though this is unintended. Similarly, users may misinterpret what is written to them by not understanding the connotations. When reading emails, users with ASD will often break down lengthy emails into more manageable chunks and edit the style/size/color of font.
4. Type in address of recipient. Facilitate comprehension and minimize distractions. Increase font size and/or activate the print view of the web browser.
5. Send email message.
6.7.4.3 Scenario C: Buy a Train Ticket Online§

Older male with Asperger’s who does not have any cognitive impairment. However, he exhibits repetitive behavior and has significant trouble with social situations, specifically communicating with others. He prefers to buy his train tickets online as it eliminates any social interaction which he is not keen on. He struggles to communicate with others successfully. He has extreme anxiety. He has been either unable to purchase a ticket in person, or ended up with the wrong ticket through his lack of ability to express what he needs specifically to the ticket-office attendant. When buying train tickets, there is noticeable task avoidance amongst many people on the spectrum.

Step Challenge Solutions Comments
1. Turn on computer.
2. Open web browser.
3. Type in web address for train ticket booking website.
4. Select icon for booking train tickets.
5. Tick box for ‘return’.
6. Type in departure and arrival locations.
7. Select date and time for outbound and return journeys.
8. Select number of adult and child passengers.
9. Tick box for railcards.
10. Select railcard type and number that apply for this journey.
11. Select continue.
12. Tick box to select specific outward & return journeys (details to look at: time, price, class and single/return). May have a poor concept of time, meaning it is difficult to calculate if a train will arrive in time, especially where the journey involves changing trains.
13. Select ‘buy now’.
14. Tick box to reserve seat and if so select seating preferences- optional.
15. Tick box to either: collect tickets from self-service ticket machine and select station; or have tickets sent by post.
16. Select ‘continue’.
17. Tick box 'new user'.
18. Type in personal details (Name, Address, Email, etc.).
19. Tick box payment card type (Visa, MasterCard, etc.).
20. Enter card details (number, expiry date, name, security code).
21. Type in home address.
22. Tick box to agree to terms and conditions and select ‘buy now’.
23. Enter payment-card secure-bank password.
24. Click 'Submit' button.
6.7.4.4 Scenario D: Shop an Online Supermarket§

Young adult male with ‘classic’ Autism. He has a severe cognitive delay and is non-verbal, a side effect of which is extreme social inhibition. He is able to communicate via pictures when necessary with his family and carers. A local supermarket is a good example of a place where he can easily become overwhelmed, which severely affects his ability to communicate effectively. However, in the comfort of his own home he is much better able to function, and therefore is less dependent upon others for help. The task of online shopping is made much easier if a very- specific item is required and there is little choice.

Step Challenge Solutions Comments
1. Turn on computer.
2. Open web browser.
3. Type in web address for online supermarket website.
4. Select ‘food and drink’ and then ‘buy groceries’. Entering a search item may produce many results. This can be confusing if they are all similar, as it can be difficult to choose which one is best. Increase font size and/or activate the print view of the web browser.
5. Select groceries to purchase. Most items available for purchase will have an image alongside their descriptive text. This should help when choosing the correct items. However, there is a level of inconsistency across different online supermarket shops regarding the images they use to denote each their products. This can be very confusing.
6. Select ‘buy now’.
7. Log in with username and password.
8. Select delivery date and time.
9. Type in delivery-address details.
10. Select payment method.
11. Type in payment-card details.
12. Select ‘order’.

6.7.5 How People with Cognitive Disabilities Use Optimized Content and Special Pages§

6.7.6 Characteristics of Content Optimized for This Group§

6.7.6.1 Consistency§
  • "Ensure that navigation is consistent throughout a site.
  • Similar interface elements and similar interactions should produce predictably similar results." (See 7.)
6.7.6.2 Transformability§
  • "Support increased text sizes
  • Ensure images are readable and comprehensible when enlarged
  • Ensure color alone is not used to convey content
  • Support the disabling of images and/or styles" (See 7.)
6.7.6.3 Multi-modality§
  • "Provide content in multiple mediums
  • Use contextually-relevant images to enhance content
  • Pair icons or graphics with text to provide contextual cues and help with content comprehension" (See 7.)
6.7.6.4 Focus and Structure§
  • "Use white space and visual design elements to focus user attention
  • Avoid distractions
  • Use stylistic differences to highlight important content, but do so conservatively
  • Organize content into well-defined groups or chunks, using headings, lists, and other visual mechanisms
  • Use white space for separation
  • Avoid background sounds" (See 7.)
6.7.6.5 Readability and Language§
  • "Use language that is as simple as is appropriate for the content
  • Avoid tangential, extraneous, or non-relevant information
  • Use correct grammar and spelling
  • Use a spell-checker. Write clearly and simply.
  • Maintain a reading level that is adequate for the audience
  • Be careful with colloquialisms, non-literal text, and jargon
  • Expand abbreviations and acronyms
  • Provide summaries, introductions, or a table of contents for complex or lengthy content
  • Be succinct
  • Ensure text readability
    • Line height: The amount of space between lines should generally be no less than half the character height.
    • Line length: Very long lines of text (more than around 80 characters per line) are more difficult to read.
    • Letter spacing, word spacing, and justification: Provide appropriate (but not too much) letter and word spacing. Avoid full justified text as it results in variable spacing between words and can result in distracting "rivers of white" - patterns of white spaces that flow downward through body text.
    • Sans-serif fonts: These fonts are generally regarded to be more appealing for body text.
    • Adequate text size (Very small text): Text should generally be at least 10 pixels in size.
    • Content appropriate fonts: Visually appealing and content-appropriate fonts affect satisfaction, readability, and comprehension.
    • Paragraph length: Keep paragraph length short.
    • Adequate color contrast: Ensure text is easily discerned against the background and that links can be easily differentiated from surrounding text.
    • No horizontal scrolling: Avoid horizontal scrolling when the text size is increased 200-300%" (See 7.)
6.7.6.6 Orientation and Error Prevention/Recovery§
  • Give users control over time sensitive content changes: Avoid automatic refreshes or redirects. Allow users to control content updates or changes. Avoid unnecessary time-outs or expirations. Allow users to request more time.
  • Provide adequate instructions and cues for forms: Ensure required elements and formatting requirements are identified. Provide associated and descriptive form labels and fieldsets/legends.
  • Give users clear and accessible form error messages and provide mechanisms for resolving form errors and resubmitting the form
  • Give feedback on a user's actions: Confirm correct choices and alert users to errors or possible errors.
  • Provide instructions for unfamiliar or complex interfaces
  • Use breadcrumbs, indicators, or cues to indicate location or progress: Allow users to quickly determine where they are at in the structure of a web site (e.g., a currently active "tab" or Home > Products > Widget, for example) or within a sequence (Step 2 of 4). Next/Previous options should be provided for sequential tasks.
  • Allow critical functions to be confirmed and/or canceled/reversed
  • Provide adequately-sized clickable targets and ensure functional elements appear clickable: Use labels for form elements, particularly small checkboxes and radio buttons, and ensure all clickable elements appear clickable and do not require exactness.
  • Use underline for links only
  • Provide multiple methods for finding content: A logical navigation, search functionality, index, site map, table of contents, links within body text, supplementary or related links section, etc. all provide multiple ways for users to find content." (See 7.)
Specific Technologies§

Add section

6.7.7 Summary of Existing Research and Guidelines§

Add literary summary.

6.7.7.1 Guidelines§

6.7.8 Extent to Which Current Needs Are Met§

Review challenges and describe where needs are met. Identify gaps

6.7.9 Potentials and Possibilities§

Notes for further research:

  1. Add RDF implementation from Lisa Seeman's Natural Language Usage - Issues and Strategies for Universal Access to Information.
  2. Review accommodation possibilities in "Accommodating Students with Disabilities in Science, Technology, Engineering, and Mathematics (STEM)" (PDF). See info starting on page 93.
  3. Review accommodations listed in Katie Haritos-Shea's online course, "Accessible Science Classrooms," specifically the information on accommodations, starting in Module 7: Autism Spectrum Disorders.

6.7.10 Prevalence§

The United States Centers for Disease Control and Prevention estimate 1 in 68 children has been identified with autism spectrum disorder. The data show autism spectrum disorders are almost five times more common in boys than girls; and more common in white children than African-American or Hispanic children. (See 3.) Studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence of about 1%. (See 1.) A study in South Korea reported a prevalence of 2.6%. (See 4.)

6.7.11 References to Research§

  1. Autism Spectrum Disorder (ASD): Data & Statistics, United States Centers for Disease Control and Prevention, 24 March 2014.
  2. Autism Spectrum Disorder (ASD): Facts About ASD, United States Centers for Disease Control and Prevention, 20 March 2014.
  3. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, Surveillance Summaries; 63(SS02): 1-21, Jon Baio, Editors. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 2014.
  4. Prevalence of autism spectrum disorders in a total population sample, American Journal of Psychiatry; 170(6): 689, Y. Kim, B. Leventhal, Y. Koh, et. al., 2013.
  5. Cognitive Disabilities, WebAIM, Center for Persons with Disabilities, Utah State University, 9 August 2013.
  6. Executive Function Skills and Disorders, WebMD, LLC., 16 April 2012.
  7. Cognitive Web Accessibility Checklist, WebAIM, Center for Persons with Disabilities, Utah State University, 2 September 2009.
  8. Book Excerpt: A Web for Everyone, UX Magazine, 7 April 2014.
  9. A Web for Everyone: Designing Accessible User Experiences, S. Horton, W. Quesenbery, January 2014.
  10. Autism Challenges and Avoidances, Interview of Anonymous User X, N. Milliken, J. Grainger, 17 June 2014.

6.8 Dyscalculia§

Dyscalculia is a specific learning disability relating to mathematics. People with dyscalculia have significant problems with numbers and mathematical concepts - but still have a normal or above normal IQ. Few dyscalculics have problems with maths alone, many also struggle with problems being able to learn to tell time, left/right orientation, rules in games and much more.

Researchers have yet to come to a final conclusion with just how many types of dyscalculia exist. David Geary has broken the disability down into 4 main areas (1): - Semantic retrieval dyscalculia - Procedural dyscalculia - Visuospatial dyscalculia - Number fact dyscalculia

It should be noted that this is the opinion of just one researcher and there are many other well established categories for Dyscalculia, one such example is published in the Journal of Learning Disabilities and has arisen from the research of Kosc Ladislav. He has broken Developmental Dyscalculia down into 6 areas; verbal, practognostic, lexical, graphical, ideognostical and operational developmental dyscalculia. (10)

Diana Laurillard (Professor of Learning with Digital Technologies at the Institute of Education, London) - “Although they [dyscalculic individuals] can count, they do not see the relationships between the numbers - e.g. that 5 is made up of 2 and 3. For them it is just a sequence, like the alphabet - we do not see E as made up of B and C, because it's not, it's just later in the sequence”

The UK DfES (Department for Education & Skills) Described Dyscalculia in its National Numeracy Strategy:

"Dyscalculia is a condition that affects the ability to acquire arithmetical skills. Dyscalculic learners may have difficulty understanding simple number concepts,lack an intuitive grasp of numbers, and have problems learning number facts and procedures. Even if they produce a correct answer or use a correct method, they may do so mechanically and without confidence."

6.8.1 Cognitive Functions§

Genetic, neurobiological, and epidemiologic evidence indicates that dyscalculia, like other learning disabilities, is a brain-based disorder. Some research suggests that it may be the result of an altered neural substrate.

It has also been suggested that poor teaching and environmental deprivation may compound the condition(9).

Because the neural network of both hemispheres comprises the substrate of normal arithmetic skills, dyscalculia can result from dysfunction of either hemisphere, although the left parietotemporal area is of particular significance according to UCL Institute of Cognitive Neuroscience. The debate as to whether the left or right parietotemporal area is linked with dyscalculia is hotly contested, however there is more research pointing towards a fault in the left parietotemporal area.

There is some research to suggest that Dyscalculia may occur as a consequence of prematurity and low birth weight and is frequently encountered along with a variety of other neurological disorders, such as attention-deficit hyperactivity disorder (ADHD), developmental language disorder, epilepsy, and fragile X syndrome. Developmental dyscalculia has proven to be a persisting learning disability, at least for the short term, in about half of affected preteen pupils. (2) Dyscalculia can also occur later in life as a result of a brain lesion or other traumatic brain injury.

6.8.2 Symptoms§

Common symptoms include:

  • Normal/Accelerated language acquisition. Good visual memory for the printed word. Good in areas of science, geometry and creative arts (until a level of higher math skill is required and where figures use logic not formulae).
  • Mistaken recollection of names. Poor name/face retrieval.
  • Difficulty with abstract context of time and direction.
  • Poor mental math ability.
  • Mistakes commonly made when manipulating numbers.
  • Inability to grasp and remember math concepts
  • Inability to comprehend or ‘picture’ mechanical processes.
  • Poor memory of the layout of things.
  • Poor sense of direction.
  • Difficulty grasping concepts of formal music education.
  • Struggles with spatial orientation.
  • Poor athletic coordination.
  • Difficulty when playing games.

6.8.3 Their Challenges§

Memory: Poor long term memory resulting in an inability to remember names (despite recognizing faces). Inability to recall schedules or sequences for example dance steps and musical instrument fingering. Unable to remember rules in sports and other games such as card games, also find it hard to remember whose turn it is.

Numbers: Difficulty with numbers specifically in cases of addition, subtraction, omission, reversal and transposition. Inability to count- especially when asked to begin counting at a number other than 1. Particular difficulty with numbers with zero’s and their relationships to each other such as 10, 100, 1000.

Abstract Concepts: Poor concept mastery resulting in an inability to grasp maths concepts. Lack of ability for visualization such as numbers on a clock face and recognizing geographical locations and where they are in relation to these locations. Limited capability for strategic planning such as in chess. Difficulties with spatial orientation such as distinguishing left from right and north, south, east and west. Inability to grasp the concept of time or direction – frequently lost/late and has trouble telling the time. Difficulty handling money, many dyscalculic adults find themselves overdrawn as a result of this. Difficulty in planning for long term, tendency to focus on the present or near future.

Coordination: Poor athletic coordination resulting in difficulty keeping up with rapidly changing physical directions.

The inability to grasp abstract concepts translates to more practical situations:

Financial Planning: Due to the combination of the inability to grasp the concept of money and poor long term memory, financial planning is particularly challenging for dyscalculics. The actual value of products means very little and dyscalculics can also struggle with purchasing the correct quantities, for example when buying food at the supermarket often far too much or too little is bought. When change is given in shops few dyscalculics are able to correctly calculate how much money they have and how much they should have been given back. As a result of all of this, many dyscalculics are consistently overdrawn and rely heavily on others for help.

Currency: Following on from the inability to grasp the concept of money, foreign currency is particularly difficult to comprehend especially as the exchange rates are often changing and calculations are often involved when trying to convert one currency to another.

Temperature: Temperature is meaningless when told in numbers, especially when both Celsius and Fahrenheit are used.

Travelling: Few dyscalculics learn to drive as it is heavily reliant on numbers (speed limits, petrol gauge, distances, etc.). This means many must rely on buses and trains for transport. Getting the right bus/train at the right time and on the correct platform are all huge problems as each of those instances involves the use of numbers and time.

6.8.4 Some Personas With Use Case that Address Key Challenges§

6.8.4.1 Booking a Train Ticket Online§

Scenario A “Jenny” is dyscalculic. She is a mother with 2 young children. She is trying to book train tickets online for herself and her two children. The train journey involves 1 change where she must walk to a different platform and also must ensure that her first train arrives at the change destination with enough time for her to find the correct platform before the train sets off for the second part of her journey. She needs to be able to book the tickets for the correct time and with the appropriate rail card, in order to be able to qualify for discounts. She also needs to be able to remember her password for her bank’s security system in order that she can purchase the tickets; this password is made up of a combination of letters and numbers to fulfil the bank’s ‘secure password’ criteria.

Booking a train ticket online
Step Challenges
Tick box for ‘return’ no challenges
Type in from and to destinations no challenges
Select date and time for outbound & return journeys This step is of particular difficulty as it requires the entry of a date and time for travel. Dyscalculics have a limited ability to grasp the concept of time, therefore may struggle to work out when their train journey is, and also how far away the date and time of their journey is from the current date and time.
Select number of adult & child passengers This step may prove difficult as dyscalculia can reduce the person’s ability to count- however if the numbers are not too high and the counting begins at 1, usually this is achievable.
Tick box for railcards no challenges
Select railcard type and number that apply for this journey This step again involves counting, however as above, if the numbers aren't too high this shouldn't prove too difficult.
Select continue no challenges
Tick box for outward & return journeys (details to look at: time, price, class & single/return) In this step, the only challenge is the selection of the time of the journey. As mentioned above, dyscalculics struggle with the concept of time, therefore they may be liable to selecting a return journey that occurs before the outward journey. Fortunately, most if not all online train ticket applications will not allow the transaction to proceed if this is the case- the error will be flagged in red.
Select ‘buy now’ no challenges
Tick box to reserve seat and if so select seating preferences- optional no challenges
Tick box to collect tickets from self-service ticket machine and select station or tick box to have tickets sent by post Not directly an issue at the point of purchase however collecting the tickets from a self-service ticket machine can be very difficult for dyscalculics. The ticket collection reference number used in order to validate the purchase is made up of an entirely random mix of numbers and upper & lower case letters. It would be almost impossible to commit this reference number to memory or find a pattern in it, therefore it must copied out which gives rise to sequencing issues resulting in the numbers being inputted in the wrong order and therefore the whole process could take a very long time.
Select ‘continue’ no challenges
Tick box new user no challenges
Type in personal details (Name, Address, Email, etc.) no challenges
Tick box payment card type (Visa, MasterCard, etc.) no challenges
Enter card details (number, expiry date, name, security code) Although this step does involve numbers, it does not require any manipulation of numbers such as addition, subtraction, etc. therefore the act of typing the numbers from the card into the website should be achievable; however some people may struggle with sequencing and end up typing the numbers out of order.
Type in post code and tick box find billing address no challenges
Tick box to agree to terms and conditions and select ‘buy now’ no challenges
Enter payment card secure bank password This step is likely to prove most difficult as it requires the use of the long term memory (LTM), which may be fairly limited in dyscalculics, and also the customer is required to enter their password out of its usual order, for example you may be asked to enter the 3rd, 5th and 7th characters in your password. As dyscalculics struggle with the concept of numbers and sequences this step may only be achievable by having the password written down in front of them, however this then reduces the security of their payment method.
Order complete no challenges
6.8.4.2 Using Online Banking to Pay Someone New§

Scenario B “Emily” is a high school student who struggles to understand many of the topics covered in her maths, science and music lessons. She needs to use her online banking account to transfer some money into a friend’s bank account. She hasn’t transferred money online to this particular friend before so she must set up a new user which requires using a card reader and typing in a code which appears on the card reader only for 30 seconds before it changes to increase security.

Using online banking to pay someone new
Step Challenges
Type in customer number and select ‘log in’ This step is challenging as the person is required to use their LTM in order to type in their customer number and dyscalculics typically have a poor LTM and difficulty with sequencing, therefore again they may need to have the password written down and this is then a breach of security.
Type in 3 random digits from pin number (e.g. 1st, 3rd & 4th)

Type in 3 random characters from password (e.g. 2nd, 5th & 10th)

This requires the user to access their LTM to remember the password and then be able to count up each of the numbers/letters so as to enter the correct characters out of their normal pattern. Counting is hard for dyscalculics especially when it doesn’t begin at 1 which increases the difficulty of these 2 tasks.
Select ‘payments and transfers’ and then ‘go’ no challenges
Select ‘pay someone new’ no challenges
Enter details of payee and select ‘add payee’ This task does require numbers so it may be a challenge; however the numbers need to be copied and not manipulated which reduces the complexity.
Type in amount to transfer Calculating numbers is particularly difficult for dyscalculics as their grasp of maths concepts and rules is typically quite poor. Therefore this task could be very challenging.
Follow on-screen instructions to verify new payee

--> Turn on card reader and select function button --> Insert card into card reader --> Type in pin number to card reader --> Type in numbers on the computer screen into the card reader, select ‘ok’ on the reader --> Type the number that appears on the screen of the card reader into the box online --> Click confirm on the website

This task is likely to be the most challenging of the transaction due to the time constraints that are in place for security reasons. Firstly the user must type their pin number into the card reader which requires the use of the LTM. However this can be achieved as often dyscalculics are able to remember their pin number as a pattern. Then the user must enter the numbers on the computer screen into the card reader, this shouldn’t be too difficult as it only requires copying the numbers. The user must then enter the numbers that appear on the screen of the card reader into a text box on the website. This stage is fairly difficult as the numbers on the card reader change every 30 seconds to increase security therefore the numbers must be typed in fairly quickly. Also many dyscalculics struggle to understand the concept of time and therefore may find it difficult to work out quite how quickly they must enter the numbers before they change.
Payment complete no challenges
6.8.4.3 Changing the Payment Details for an Online Supermarket Shop§

Scenario C “George” is an elderly gentleman who doesn't like to leave his house and does his supermarket shop online once a week and gets it delivered to his door. His bank details are stored on the shopping website so he doesn’t have to keep typing them in, however he has just been sent a new bank card as his old one has expired so he must re-enter all the details necessary to complete his shop.

Changing the payment details for an online supermarket shop
Step Challenges
Select ‘food and drink’ and then ‘buy groceries’ no challenges
Log in with username and password no challenges
Delete old payment card no challenges
Select ‘add payment card’ no challenges
Type in the card details This task should be easily achievable as it does not require any manipulation of the numbers; also the numbers do not need to be remembered as they are printed on the card. However dyscalculics struggle with sequencing and therefore may be liable to typing the numbers out of the correct order.
Tick box ‘make this my preferred payment card’ no challenges
Select ‘save’ and then either continue shopping or log out no challenges
6.8.4.4 Online Shopping§

Whilst dyscalculics may find it relatively simple to set up an online shopping account, it is far harder to complete the actual task of shopping. This stems from the inability to grasp the concept of money and the amount a product costs in relation to the amount of money they might have in their bank account. As a result of this dyscalculics frequently find themselves overdrawn as the task of calculating the numbers to produce a final figure which has some meaning to them as opposed to being a collection of random numbers is a concept they cannot master. This often leads to active avoidance of the task or strong reliability on others- neither of which is a sustainable solution. Quantities are also an abstract concept with dyscalculics often buying far too much or not nearly enough as it is difficult for them to work out exactly how much they need. Anything that involves weights and measures e.g. 1 kg of potatoes is also almost impossible to understand.

6.8.5 How They Use the Web and ICT§

There is very little in the way of specific Assistive technologies for dyscalculia. One person reports using Smart sum - more research required.

http://www.dyscalculator.com/ is a talking calculator which is designed with dyscalculia. The Author has not tested this tool yet.

6.8.6 How People with Dyscalculia Use Optimized Content and Special Pages§

Many people with dyscalculia report that they enjoy using the internet, and there are quite a lot of people with dyscalculia using social media and online video. There is little if any optimised content available for dyscalculia. The scenarios give examples of where dyscalculia impacts people using products and services on the internet.

6.8.7 Characteristics of Content Optimized for This Group§

Assistive Technology Devices for Students Struggling in Mathematics from the Georgia Department of Education

There is further research needed before we are in a position to add descriptions of key features and how it helps users overcome challenges. Very little work has been done on this topic.

6.8.8 Summary of Existing Research and Guidelines§

It is widely acknowledged that dyscalculia was first discovered in 1919 by Salomon Henschen a Swedish neurologist who found that it was possible for a person of high general intelligence to have impaired mathematical abilities. At the time it was known as ‘number blindness’. The term Dyscalculia was later coined by Dr. Josef Gerstman in the 1940s. When compared with Dyslexia and other similar learning disabilities, Dyscalculia receives relatively little recognition and there is still limited awareness of its existence.

Although there are many classifications of Dyscalculia it can be broken down into 3 sections; Developmental Dyscalculia- inherited/acquired during prenatal or early developmental period. Post-lesion Dyscalculia- acquired during an incident of traumatic brain injury affecting specific areas of the brain. Pseudo-Dyscalculia- as a result of inadequate instruction.

Formal definition The Department for Education Skills (DfES) defines dyscalculia as: “A condition that affects the ability to acquire arithmetical skills. Dyscalculic learners may have difficulty understanding simple number concepts, lack an intuitive grasp of numbers and have problems learning number facts and procedures. Even if they produce a correct answer or use a correct method, they may do so mechanically and without confidence.”

6.8.8.1 Etiology§

Adult neuropsychological and neuroimaging research points to the intraparietal sulcus as a key region for the representation and processing of numerical magnitude (4). This raises the possibility of a parietal dysfunction as a root cause of dyscalculia (4). The following two studies support this research.

Virtual Dyscalculia Induced by Parietal-Lobe TMS Impairs Automatic Magnitude Processing

UCL scientists state that dyscalculia is a result of a malformation in the right parietal lobe in the brain – however the underlying dysfunction is relatively unknown (c.07). The study involved using neuronavigated transcranial magnetic stimulation (TMS) to stimulate the brain and cause dyscalculia, only for a few hundred milliseconds, in non-dyscalculic individuals. The subjects then completed maths tasks whilst under stimulation and produced dyscalculic like behaviour. However when the left parietal lobe was stimulated under TMS this behaviour was not observed and therefore it can be reasonably assumed that there is a causal relationship between defects in the right parietal lobe and dyscalculia. (3)

The above research is supported by the following research study: Impaired parietal magnitude processing in developmental dyscalculia - The study was conducted by Gavin R. Price, Ian Holloway, Pekka Räsänen, Manu Vesterinen and Daniel Ansari. The study shows that in children with developmental dyscalculia the right intraparietal sulcus is not modulated in response to numerical processing demands to the same degree as in typically developing children. This suggests a causal relationship between impairment of parietal magnitude systems and developmental dyscalculia. (4)

Research by Shalev, et al. suggests that some families have a genetic predisposition to dyscalculia resulting in prevalence 10x higher than in the general population. (5) Although Dyscalculia cannot be cured, it is hoped that early detection and remedial teaching can go a long way to reducing the effects of dyscalculia on the individual.

6.8.8.2 Comorbidity§

High comorbidity with ADHA (estimates range between 15-26%) and Dyslexia (estimates range between 17-64%)(6). There is strong evidence to suggest Turners Syndrome and Gerstmann’s Syndrome are associated with Dyscalculia(7).

6.8.8.3 Guidelines§

Although there are no specific guidelines produced by a governing body, there are several ways to help an individual with dyscalculia in order to improve their mathematical abilities.

  • Study sheets/summary sheets/outlines of most important facts
  • Supplementry aids (vocabulary, multiplication cards, etc.)
  • Visual demonstrations
  • Instructions/directions given in different channels (written, spoken, demonstration)
  • Visual or multisensory materials
  • Mnemonic aids/devices

Some more useful guidelines regarding Dyscalculia, specifically for school children are available from Leeds City Council (PDF): Guidelines for Specific Learning Difficulties in Maths/Dyscalculia

Dyscalculia is still a relatively unknown disability with many of those affected by it not being diagnosed until later in life. Often, children in schools especially, those affected are thought to be stupid or lazy as many people are unaware of dyscalculia’s existence. This is analogous to the treatment of people with dyslexia.

6.8.9 Potentials and Possibilities§

Add ideas for filling gaps

6.8.10 Prevalence§

Studies conducted by Gross-Tsur, Manor and Shalev in 1996 suggest that 6.5% of the population are dyscalculic. Conflicting research done by Lewis, Hitch and Walker in 1994 suggests that 1.3% of the population are dyscalculic while 2.3% are dyscalculic and dyslexic – putting the world population of dyscalculics at 3.6%. (8)

5-6% in school age children. (9)

This gives us the rough estimate that between 3½ - 6½% of the world population is affected by dyscalculia; however no international study has been done on how common it is.

Studies show that the presentation of dyscalculia in male and females is roughly equal; neither gender appears to have a greater predisposition than the other. (9)

6.8.11 References to Research§

(1) Geary, D.C., (1993). Mathematical disabilities: Cognitive, neuropsychological, and genetic components. Psychological Bulletin, 114(2), 345-362. Available from: http://psycnet.apa.org/psycinfo/1994-02259-001

(2) Butterworth, B. (1999). The Mathematical Brain. (London: Macmillan).

(3) Cohen Kadosh, R., et al. (2007). Virtual Dyscalculia Induced by Parietal-Lobe TMS Impairs Automatic Magnitude Processing. Current Biology, 17(8), 689-93. Available from: http://www.sciencedirect.com/science/article/pii/S0960982207010652

(4) Price, G.R., et al. (2007). Impaired parietal magnitude processing in developmental dyscalculia. Current Biology, 17(24), 1042-43 Available from: http://www.cell.com/current-biology/retrieve/pii/S0960982207020726

(5) Shalev, et al. (2001). Developmental Dyscalculia is a Familial Learning Disability. Journal of learning disabilities, 34(1), 59-65. Available from: http://ldx.sagepub.com/content/34/1/59.short

(6) Wilson, A.J. (2008). Dyscalculia primer and resource guide. Available from: http://www.oecd.org/edu/ceri/dyscalculiaprimerandresourceguide.htm

(7) Bruandet, M., et al. (2004). A cognitive characterization of dyscalculia in Turner syndrome. Neuropsychologia, 42(3) 288-98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14670569

(8) www.dyscalculiaforum.com

(9) Shalev, R.S. (2004). Journal of Child Neurology 19 765—771.

(10) Ladislav, K. (1974). Developmental Dyscalculia. Journal of Learning Disabilities. 7(3) 164-177. Available from: http://ldx.sagepub.com/content/7/3/164.short

(11) Clare Trott http://publications.lboro.ac.uk/publications/all/collated/mact2.html

7. Research on Cognitive Functions§

7.1 Reasoning and Executive Function§

Theoretical construct to help researchers think about how the brain actually works.

Background information - Theoretical Models, etc. (Wikipedia - Executive Function)

Loosely group into the following areas: goal formation, planning, goal-directed action, self-monitoring, attention, response inhibition, and coordination of complex cognition and motor control for effective performance. Difficulties in these areas are implicated in various disorders/disabilites.(Wikipedia - Executive Dysfunction)

7.1.1 Definitions§

from: LDonline - What is Executive Function?

  1. Inhibition - The ability to stop one's own behavior at the appropriate time, including stopping actions and thoughts. The flip side of inhibition is impulsivity; if you have weak ability to stop yourself from acting on your impulses, then you are "impulsive."
  2. Shift - The ability to move freely from one situation to another and to think flexibly in order to respond appropriately to the situation (
  3. Emotional Control - The ability to modulate emotional responses by bringing rational thought to bear on feelings. (tolerate frustration)
  4. Initiation - The ability to begin a task or activity and to independently generate ideas, responses, or problem-solving strategies (also, ability to finish)
  5. Working memory - The capacity to hold information in mind for the purpose of completing(/performing) a task
  6. Planning/Organization - The ability to manage current and future- oriented task demands.
  7. Organization of Materials - The ability to impose order on work, play, and storage spaces.
  8. Self-Monitoring - The ability to monitor one's own performance and to measure it against some standard of what is needed or expected.

7.1.2 Functional implications of executive function disorder§

from http://learningdisabilities.about.com/od/eh/a/executive_funct.htm

Trouble with the following:

  • Estimating and visualizing outcomes;
  • Analyzing sights, sounds, and physical sensory information;
  • Perceiving and estimating time, distance, and force;
  • Anticipating consequences;
  • Mentally evaluating possible outcomes of different problem-solving strategies;
  • Ability to choose actions based on the likelihood of positive outcomes;
  • Choosing the most appropriate action based on social expectations and norms; and
  • Performing tasks necessary to carry out decisions.

Manifested as:

  • difficulty planning and completing projects;
  • problems understanding how long a project will take to complete; (jim-author task - estimated time to complete form, application, etc.)
  • struggling with telling a story in the right sequence with important details and minimal irrelevant details;
  • trouble communicating details in an organized, sequential manner;
  • problems initiating activities or tasks, or generating ideas independently; and
  • difficulty retaining information while doing something with it such as remembering a phone number while dialing.

Strategies to over-come or manage deficits:

  • Give clear step-by-step instructions with visual organizational aids. (jim-author task)
    • Be as explicit as possible with instructions. (jim-author task)
    • Use visual models and hands-on activities when possible. (jim -perhaps videos or audio)
7.1.2.1 Additional Strategies§

from: LDonline - What is Executive Function?

  • Take step-by-step approaches to work; rely on visual organizational aids.
  • Use tools like time organizers, computers or watches with alarms.
  • Prepare visual schedules and review them several times a day.
  • Ask for written directions with oral instructions whenever possible.
  • Plan and structure transition times and shifts in activities.
7.1.2.1.1 Managing Time§
  • Create checklists and “to do” lists, estimating how long tasks will take.
  • Break long assignments into chunks and assign time frames for completing each chunk.
  • Use visual calendars at to keep track of long term assignments, due dates, chores and activities.
  • Use management software such as the Franklin Day Planner, Palm Pilot or Lotus Organizer.
  • Be sure to write the due date on top of each assignment.
7.1.2.1.2 Managing Space and Materials§
  • Organize work space.
  • Minimize clutter.
  • Consider having separate work areas with complete sets of supplies for different activities.
  • Schedule a weekly time to clean and organize the work space.
7.1.2.1.3 Managing Work§
  • Make a checklist for getting through assignments. For example, a student’s checklist could include such items as: get out pencil and paper; put name on paper; put due date on paper; read directions; etc.
  • Meet with a teacher or supervisor on a regular basis to review work; troubleshoot problems.

7.1.3 Other References§

7.2 Localized Brain Functions§

Memory functions, Short term, visual , math

7.3 Reading§

special ED. Meta studies

7.4 Cognition§

7.5 Brain Injury§

7.6 Technology Personae§

Taking research persona and creating “technology persona” (tags system to link between use cases and brain function)

8. Review of Current Standards and Technologies§

9. Business Case and Dynamics§

  1. Positives
    1. Cognitive load–dispatches
    2. Aging society
    3. Veterans with brain injury
  2. Negative
    1. Detracting from other peoples experience
    2. Legitimate variance nurodiversity
    3. Legislation based guidelines are burdensome and restrict author freedoms (hence metadata markup clues)
    4. Cross cultural and language learners

10. Gap Analysis§

  1. Summary of where we are
  2. Potential of where we could be
  3. Identification of gaps

11. Suggestions§

  1. A series of suggestions for roadmaps without the finality of the roadmap
  2. Suggestions for products
    1. With benefits and user stories