Pat A. Brown

Informing the design of an automated wayfinding system for individuals with cognitive impairments

Individuals with cognitive impairments are often prevented from independently living, working, and fully participating in their community due to wayfinding concerns. We conducted two user studies of a mobile wayfinding aid designed to support such individuals. The first study examined usability issues related to wayfinding outdoors. The results were positive overall, but showed that the directions we used were at times too low-level, requiring strict adherence to the route and therefore highly precise message timing. The second study examined the use of landmarks to provide directions at a higher-level, as a way to overcome the limitations of the directions we were using. We found that certain types of landmark-based directions were significantly easier to follow, but individual performance varied across most direction types. The findings from both studies show that individuals with cognitive impairments would benefit from a wayfinding system that is capable of supporting customizable and adaptable direction selection.

Customizing directions in an automated wayfinding system for individuals with cognitive impairment

Individuals with cognitive impairments would prefer to live independently, however issues in wayfinding prevent many from fully living, working, and participating in their community. Our research has focused on designing, prototyping, and evaluating a mobile wayfinding system to aid such individuals. Building on the feedback gathered from potential users, we have implemented the systems automated direction selection functionality. Using a decision-theoretic approach, we believe we can create better wayfinding experience that assists users to reach their destination more intuitively than traditional navigation systems. This paper describes the system and results from a study using system-generated directions that inform us of key customization factors that would provide improved wayfinding assistance for individual users.

Conducting systematic evidence reviews: core concepts and lessons learned.

A systematic review (SR) is an essential component of evidence-based practice, because it synthesizes information on a particular topic that is necessary to inform health-related decision making. The purpose of this article is to document the process of producing a high-quality SR within the field of rehabilitation in contrast to other fields (eg, pharmaceutic research). We describe the notable methodologic challenges to producing high-quality SRs for rehabilitation researchers. Broadly, we outline how the quality of SRs is evaluated and suggest mechanisms for researchers to address potential pitfalls. Because meaningful SRs can and should be conducted in this field, we provide practical guidance regarding how to conduct such an SR. We outline a series of 8 important steps in the production of an SR: forming a committee, creating a development plan, conducting a literature review, selecting articles for inclusion, extracting data, preparing tables of evidence, facilitating external review and publication, and forming conclusions and recommendations. For each step of the SR process, we provide detailed description about the methodologic decisions involved and recommended strategies that researchers can implement to produce a high-quality SR. Using these preestablished steps and procedures as a guideline will not only help to increase the efficiency of the SR process, but also to improve the quality. The availability of high-quality SRs with plain language summaries promotes access to the best quality information for all involved in decision making.

Cognitive support technologies for people with TBI: current usage and challenges experienced

Abstract Purpose: We investigated the current use of off-the-shelf cognitive support technologies (CSTs) by individuals with traumatic brain injury (TBI), the challenges they and their caregivers face when using these technologies, the functional areas where support is needed, and their current experience in learning new technologies. Method: We conducted two focus groups with participants with TBI and their caregivers. Focus group interactions were captured using recordings and a court reporter. Transcripts were analyzed qualitatively. Results: We identified three core themes – consumer and caregiver self-reported needs for support, how support is used on a daily basis and consumer and caregiver attitudes towards the use of support by types of support. We also inferred implications for design of CSTs. Conclusions: Individuals with TBI use consumer available technologies to support cognition. The design of most of these devices is not targeted to meet the needs of people with TBI, and they can be challenging to use independently, but individuals and their caregivers still benefit from their use by embedding technology as one type of support within a broader support network that includes personal assistance. Implications for Rehabilitation People with traumatic brain injury (TBI) are attempting to use a wide range of consumer available technologies to support cognition, although not always successfully. One important role for rehabilitation providers could be helping people with TBI use these technologies with more accuracy and success. People with TBI note that an important element in adopting new technology is good training in its use. Cognitive support technologies (CSTs) are one part of broader network of supports. People with TBI and their caregivers desire independence but do not want to lose the human element that can be provided by a caregiver. New technologies should be implemented with an understanding of an individual’s broader support network. Psychosocial aspects of TBI need to be considered when designing and implementing CSTs. In particular, rehabilitation providers need to address the anxiety that many people with TBI experience, including fear about forgetting and their need for early, repeated reminders so they can prepare for upcoming events.

Aging with Disability in the Workplace

Aging with disabilities, such as multiple sclerosis, spinal cord injury, muscular dystrophy, and postpolio syndrome, can lead to barriers to participation, including employment barriers. Many individuals develop strategies for overcoming these barriers that may become less successful as they experience more secondary conditions concomitant with the aging process. Rehabilitation professionals can help to overcome barriers to workplace participation and should work with clients to enhance employment outcomes.

Linking Transition Services to Student Outcomes for Students with Moderate/ Severe Mental Retardation

The study sought to determine the impact of the transition mandate on student outcomes for students with moderate/severe mental retardation. Using a telephone follow-up protocol, I conducted interviews with the parents or guardians of all 1990 and 1995 graduates with moderate/severe mental retardation from three school districts in Washington State who chose to participate in this study. This study documented the postschool status of these two groups at one year and at six years out of school in several areas: employment; enrollment in postsecondary school or training; engagement in employment, education or both; and independent living. Interviews also were conducted with the families, teachers, and administrators of three 1990 graduates and three 1995 graduates of these school districts in order to document the link between the high school program and postschool student outcomes and the impact of the transition mandate on the high school program. The survey data revealed similar outcomes for the graduates at one and six years out of school. Interviews with students, families, teachers, and administrators and a review of student records indicated that the high school programs have become more community-based, employment oriented, and age-appropriate with an increased emphasis on establishing linkages with adult service providers. These interviews also suggest several barriers to local implementation of the transition mandate, including the cost of providing community experiences and models of special education that may not support transition.

Aging with a disability and state vocational rehabilitation services

BACKGROUND Disability prevalence in older adults is increasing. Given the low rates of employment among people with disabilities, especially those aging with multiple sclerosis (MS), spinal cord injury (SCI), late effects of polio (LEP), and muscular dystrophy (MD), services from federal-state vocational rehabilitation (VR) programs could positively impact employment status. OBJECTIVE To describe VR services for individuals aging with MS, SCI, LEP and MD and the impact of aging on employment status. PARTICIPANTS Thirteen Washington State VR counselors and 26 individuals, 45 to 65 years old, with MS, MD, LEP or SCI. METHODS We examined national Rehabilitation Services Administration data (2006, 2007), including case closure, service outcomes and other demographics. We then purposively selected Washington State for our study. Interviews provided consumer and counselor perspectives on the components of successful case closure (employed) and the impact of aging and disability on employment. RESULTS Washington State and national data were similar. Organizational and individual factors influence the effectiveness of VR services. CONCLUSION People who could benefit from VR services are not being served; those who are served, are getting neither comprehensive services nor high quality outcomes. Additional research is needed to understand the variables associated with effective use of VR services.

Implications for Location Systems in Indoor Wayfinding for Individuals with Cognitive Impairments

We studied an indoor wayfinding application for individuals with cognitive impairments using Wizard-of-Oz techniques. This gave us insights into the technological considerations for the location system underlying such an application. We have abstracted these into generally desirable properties for location-aware systems for wayfinding. In addition to general requirements for accuracy and robustness, we discuss what other information about the environment should be provided that supports wayfinding. Our work showed that combining rich environment information with user location is key to making indoor wayfinding applications feasible