Disability and Rehabilitation: Assistive Technology
ISSN: 1748-3107 (Print) 1748-3115 (Online) Journal homepage: http://www.tandfonline.com/loi/iidt20
Field testing of two electronic mobility aid devices for persons who are deaf-blind Claude Vincent, François Routhier, Valérie Martel, Marie-Ève Mottard, Frédéric Dumont, Lise Côté & Danielle Cloutier To cite this article: Claude Vincent, François Routhier, Valérie Martel, Marie-Ève Mottard, Frédéric Dumont, Lise Côté & Danielle Cloutier (2014) Field testing of two electronic mobility aid devices for persons who are deaf-blind, Disability and Rehabilitation: Assistive Technology, 9:5, 414-420 To link to this article: http://dx.doi.org/10.3109/17483107.2013.825929
Published online: 25 Nov 2013.
Submit your article to this journal
Article views: 123
View related articles
View Crossmark data
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iidt20 Download by: [Deakin University Library]
Date: 05 November 2015, At: 21:39
http://informahealthcare.com/idt ISSN 1748-3107 print/ISSN 1748-3115 online Disabil Rehabil Assist Technol, 2014; 9(5): 414–420 ! 2014 Informa UK Ltd. DOI: 10.3109/17483107.2013.825929
ORIGINAL RESEARCH
Field testing of two electronic mobility aid devices for persons who are deaf-blind Claude Vincent1,2, Franc¸ois Routhier1,2, Vale´rie Martel3, Marie-E`ve Mottard3, Fre´de´ric Dumont2, Lise Coˆte´3, and Danielle Cloutier3
Downloaded by [Deakin University Library] at 21:39 05 November 2015
1
Department of Rehabilitation, Universite´ Laval, Que´bec, Canada, 2Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Que´bec, Canada, and 3Institut de re´adaptation en de´ficience physique de Que´bec (IRDPQ), Que´bec, Canada
Abstract
Keywords
Purpose: To test a methodology for assessing the effects of electronic mobility aid devices (EMAD) on the mobility of persons who are deaf-blind in real-life situations. Method: A singlesubject desing was done with four users followed in a program for persons who are deaf-blind. Participants were trained to use two commercial EMADs: the Miniguide and the Breeze. The Canadian Measure of Occupational Performance (CMOP) was administered before training (T1), after training (T2) and three months later (T3). The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) was administered at T2 and T3. A follow-up interview was conducted with the participants and clinicians at T3 to evaluate the benefits of the EMAD and any problems. Results: CMOP suggests that both performance and satisfaction improved following the use of both EMADs in four occupations (functional mobility, active leisure, community life and socialization). QUEST indicates high satisfaction with eight items except for one participant. Follow-up interviews revealed a wide variety of perceptions regarding EMAD use and seven problems although CMOP and QUEST indicated good satisfaction. Conclusion: A high satisfaction score on QUEST does not necessarily imply that an assistive device is efficient in all circumstances; follow-up interviews provided important complementary information.
Assistive technology, blindness, hearing loss, low vision, obstacle detection, orientation, satisfaction History Received 30 May 2013 Accepted 14 July 2013 Published online 25 November 2013
Implications for Rehabilitation For people who are deaf-blind The Miniguide is reliable for detecting obstacles (vibrations are sent as a warning when approaching an obstacle). It is often used to know if taking the right route. It identifies entrances or openings (indicated by the vibrations stopping when pointing at a wall), which can replace the echo-location for blind persons with hearing impairments. The Miniguide helped to locate overhanging objects which are not detectable with a long cane. The Breeze can record landmarks for orientation and it possible to use those landmarks to go back alone later after taking a certain route for the first time with someone else. It helps to familiarize the person with new places. It can tell you where you are at any time. It helps with orientation and the participant also liked this feature because it helped with learning street names. The Miniguide and the Breeze were not efficient in all circumstances; there were some problems with the ergonomic (both), detecting snow banks (Miniguide), sensitiveness to the surroundings in crowded places (Miniguide) and exactitude for geo-localization (Breeze).
Introduction Roentgen et al. published a literature review in 2008 that identified 146 different products for persons with visual impairments [1]. However, only 21 of them were considered to be both available and ready to be used as is, without further adaptation. The authors of that study were surprised to see how many of these
Address for correspondence: Claude Vincent, CIRRIS-IRDPQ, 525, boul. Hamel, bureau H-1312, Que´bec G1M 2S8, Canada. Tel: 418-649-3735. E-mail: [email protected]
systems were no longer available on the market or had failed to penetrate the market. A list of available and discontinued products and prototypes can be found at abledata.com. Few of these products have been rigorously tested. Roentgen et al. published a second study in 2009 to identify studies that documented the effects and effectiveness of electronic mobility aid devices (EMAD) for persons with visual impairments [2]. Only 13 studies were identified that evaluated six different EMADs. Eight studies used an experimental design and had a sample size varying from one to 19. Those studies generally found that the devices increased the participants’ ability to detect
Downloaded by [Deakin University Library] at 21:39 05 November 2015
DOI: 10.3109/17483107.2013.825929
Field testing of two electronic mobility aid devices for persons who are deaf-blind
obstacles, or increased the efficiency of mobility with the navigation tool. For the five remaining studies (surveys and follow-up studies), the number of participants varied between 5 and 298. These studies revealed that the percentage of persons that continued to use the different EMADs varied greatly (from 44% to 100%) depending on whether they still needed the device after getting familiar with the environment. The methodological quality of these studies was considered low, primarily due to the lack of standardized and validated measuring instruments. Some studies can be found on EMAD testing for blind people and somewhat fewer for deaf people. EMAD includes detection and orientation aids. However, no studies with persons with both types of disabilities (blind and deaf) who used an EMAD were found. This is surprising because having both types of disabilities creates new challenges and obstacles for this population [3,4]. Therefore we decided to focus on the effects of EMADs on persons who are deaf-blind (EMAD-DB) in the province of Quebec (Canada). The prevalence of persons who are deaf-blind in the province of Quebec is estimated to 21 per 100 000 according to a report by Munroe et al. in 2005 and the authors still consider this number conservative due to census difficulties [5]. In a previous report in 2001, Munroe et al. found that the leading cause of deafblindness in Canada was Usher syndrome, accounting for between 26% and 33% of all congenital and acquired deafblindness (5–7 per 100 000) [6]. This prevalence is comparable with what has been observed in the USA and Europe [7–10]. Since, to our knowledge, no study used standardized measures to evaluate the effects of EMADs and because the population who are deaf-blind has not been investigated for the use of these aid devices, the purpose of this study was to test a methodology for assessing the effects of EMAD-DBs on the mobility of persons who are deaf-blind. More precisely, we aimed to recruit people with Usher syndrome because the prevalence of this syndrome is high in the population who are deaf-blind and they are likely to use these technical aids. The specific objectives were to: (1) assess performance and satisfaction with independent mobility in various occupations; (2) assess satisfaction with the technical aid; (3) document the feasibility of training with various technical aids with clients aged 50 and older and (4) document actual use of the technical aid three months after training (features used, intensity, frequency, problems encountered, etc.).
Method Research design A single-subject design was conducted in three steps: T1 ¼ initial assessment and intervention; T2 ¼ assessments at the end of the intervention and T3 ¼ follow-up assessments and interviews three months post-intervention. The study was approved by the research ethics board of the Institut de re´adaptation en de´ficience physique de Que´bec (2010-217). All the participants signed a consent form. Intervention and technology A minimum of four steps were included in the user’s training: (1) teaching of the Breeze (helpful for orientation) or Miniguide (helful for detection) features, (2) training on how to use the Breeze or Miniguide indoors or outdoors, (3) cognitive mapping of the chosen route using a tactile map and (4) assisting the user to achieve the mobility target. Total intervention per person was under 3 months. The EMAD was paid for by the Quebec Medicare system. Because of this constraint, only two technologies were available (Figure 1). The Breeze should be helpful for orientation: it is a talking GPS designed for people who are blind or have low vision (HumanWare, Drummondville, Canada: http://www.humanware.com/fr-canada/home). It verbally announces the names of
415
Figure 1. The Miniguide (left) and the Breeze (right) (from GDP Research at http://www.gdp-research.com.au/ and HumanWare at http:// www.humanware.com/en-canada/products/blindness/talking_gps, respectively).
streets, intersections and landmarks along the route. The Breeze includes a highly sensitive GPS, a built-in speaker, a speech synthetis accompanying the text and 8 h of battery. This model costs approximately CAN $1000. The Miniguide should be helpful for detection. It is intended to be an accessory to more traditional aids such as a white cane (GDP Research). It uses ultrasonic echolocation to detect objects and vibrates to indicate objects. The MiniGuide vibrates to indicate the distance of objects – the vibration is faster when the object is near. A single push button is used to activate or deactivate the Mini-Guide and also to change the settings. In this regard, the Mini-Guide involves different modes and options. The main modes are: 4, 2, 1 and 8 meters. Only large objects can be detected at 4 m or beyond, for example, fences or walls. The Mini-Guide costs approximately 400 $CAN. It should be noted that these EMADs were among the 13 studies identified by Roentgen et al. [2]. Selection of participants Participants were recruited from persons who were receiving or had received rehabilitation services from the deafblindness program at the Institut de re´adaptation en de´ficience physique de Que´bec (Que´bec City, Canada). The orientation and mobility (O&M) specialists selected some individuals who could benefit from more ease or independence because they wanted to try new tasks or use known routes without assistance. Potential participants were met by their O&M specialist to give them the information sheet and more detailed explanations, answer any questions they might have and have them sign the consent form if they agreed to participate. The inclusion criteria varied depending on the technology. For the Breeze, participants had to have minimum hearing abilities. For both technologies participants were required: (1) to have already been trained to use a long cane, (2) not to have cognitive impairments or language impairments likely to seriously impede the safe and efficient use of the aid (e.g. intellectual disability, severe adjustment disorder and attention-deficit disorder), (3) to be legally blind (visual acuity 6/60 or visual field 20 in the better eye after correction) and (4) to be able to get around independently indoors or outdoors. For the Breeze, which uses a speech synthesis system, other auditory criteria were added: (5) to have sufficient abilities for speech recognition (open choice) in various listening conditions, for example in the presence of competing noise and (6) to have the possibility of combining the aid with an optimal hearing device in at least one ear (hearing aid or cochlear implant) as users must hear the information transmitted, without impeding access to traffic sounds necessary for safe mobility.
416
C. Vincent et al.
Disabil Rehabil Assist Technol, 2014; 9(5): 414–420
Downloaded by [Deakin University Library] at 21:39 05 November 2015
Measurement tools The standardized questionnaire of the Canadian Measure of Occupational Performance (CMOP) is used to detect changes in users’ perception about their own performance in an occupation over time [11,12]. The CMOP key areas are: personal care (including mobility), productivity and leisure. Performance and satisfaction with occupations are rated on a scale from 0 to 10. A questionnaire concerning training specifications is completed after each training session (date and duration of training, time spent teaching EMAD features and types of exercises indoors and outdoors). The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) questionnaire calculates satisfaction scores for the technological aspects, services and overall scores [13]. The QUEST has good construct validity (factorial: two dimensions), good to very good test-retest reliability (ICC ¼ 0.82, 0.82 and 0.91) and good internal reliability (alpha: 0.76 to 0.82) [14]. The questionnaire consists of 12 items rated on a scale from 1 to 5 (1: not satisfied at all to 5: very satisfied). Comments were also collected for each item when relevant. A semi-structured interview [15] lasting about 45 min concerning the experience with the EMAD-DB was audiotaped. Users were asked four questions: actual use of the EMAD-DB (features used, intensity and frequency), problems and difficulties with the technology, perceived advantages and disadvantages (safety and functional independence), opinion about maintaining this service in the future. The two O&M specialists who trained the users were asked the same questions but based on their experience during the training sessions and follow-up with users. Data collection Before the intervention (T1), users completed the ‘‘participant profile’’ questionnaire with a first O&M specialist. They chose significant routes within specific occupations that could be achieved after the EMAD training. With a second O&M specialist, they completed the CMOP. After the intervention
(T2), the QUEST and CMOP questionnaires were completed in the week following the last intervention. Three months after the intervention (T3), the second O&M specialist administered the QUEST and CMOP questionnaires again and the semi-structured interviews. Two of the researchers (CV and FD) administered the semi-structured interviews with the two O&M specialists. The questionnaire concerning training specification was completed by the O&M specialists after each training sessions. Data analysis Descriptive analyses (mean, standard deviation and frequency) are presented for each variable at each measurement time. For the analysis of the interview content, a qualitative approach was used. The recordings were transcribed. Using an inductive approach [16], the transcripts were first read in their entirety, then a second reading identified the units of meaning that were categorized according to the four questions and subquestions in the interview. N’Vivo software was used for the categorization and management of interview content.
Results Quantitative results Table 1 presents the participant’s profile of three men and one woman aged from 50 to 70-years-old and having the Usher syndrome with different levels of low vision and deafness. Three of them were trained to use the Miniguide and only one, the Breeze. Training was different in term of duration (2h25 up to 9 h) for each participant according to the number of occupations they targeted at the beginning of the study. For example, participant 4 received less training because he chose only one community life activity to realize with the Miniguide (also see note 4, Table 2). The CMOP questionnaire indicated that occupational performance as well as satisfaction improved for all participants with the use of the Miniguide or the Breeze in at least one targeted
Table 1. Clinical profiles and training sessions. Participant 1
Participant 2
Participant 3
Age (years) Gender Education Diagnosis
69 Male Grade 7 Usher syndrome
70 Male College Usher syndrome
55 Male University Usher syndrome
Visual acuity (VA)
Almost total: 6/360 VA light perception Almost total: 5 4VF 0 Profound (bilaterally)
Almost total: 6/360 VA light perception Almost total: 5 4VF 0 Moderately severe to profound (bilaterally)
Profound: 6/120 VA46/360
Visual field (VF) Deafness degree
Technology use in general Regularly Occasionally Rarely Training sessions (nb) Training session time (min) Total time all sessions (h:min) Time spent learning AT functions (h:min) Time spent using AT (h:min) Functional mobility Community life Active leisure Socialization
3 machine shop, computer ... ... 10 for Miniguide 60 to 110 13:40 9:50 3:50 ... ... 333 ...
Profound: 10 4VF 5 Mild to profound (bilaterally)
Participant 4 50 Female Grade 9 Usher syndrome Attention deficit disorder Severe: 6/120 VA46/360 Severe: 20 4VF 10 Moderate to severe (bilaterally)
...
3 computer for work
...
3 computer for hobbies ... 7 95 to 150 12:50 3:50
... ... 9 60 to 90 11:30 5:35
... 3 5 75 to 100 7:20 2:45
9:00 3 ... 3 3
5:55 33 3333 ... ...
2:25 ... 3 ... ...
8 7 3
T1
9 9 N/A
T2
8 9 N/A7
T3
7 6 3
T1
10 9 N/A
T2
8 9 N/A6
T3
Satisfaction from 1 to 10
1
7
7
T1
8
8
9
T2
7 1
N/A6
7
T1
N/A5
10
T3
Performance from 1 to 10
7.5
9
9
T2
N/A6
N/A5
10
T3
Satisfaction from 1 to 10
Participant 2 (Miniguide)2
10 10 9 9 8 10
4 3 6 4 6
T2
5
T1
Performance from 1 to 10
10 9 9 8 10
10
T3
5 4 8 8 6
5
T1
10 9 10 10 10
10
T2
Satisfaction from 1 to 10
Participant 3 (Breeze)3
10 9 10 10 10
10
T3
3
T1
8
T2
Performance from 1 to 10
8
T3
5
T1
8
T2
Satisfaction from 1 to 10
Participant 4 (Miniguide)4
8
T3
Note 1: Participant 1 was evaluated for taking a walk, to go to the workshop located in the backyard and to cross a bridge in a park. Note 2: Participant 2 was evaluated for moving around his property (in the garage, around the pool, around the swing or making compost), moving in a bowling center, participating in social group activities. Note 3: Participant 3 was evaluated for getting back home during the day, getting back home at night, going to the music store on the bus, going to a grocery store during the day (near the house), going to a grocery store at night near the house, going to a creamery during the day and at night, going to a shopping center (unknown route). Note 4: Participant 4 was evaluated for going to get his/her son at school and get him back home at night. Note 5 and Note 6: N/A: not applicable. Since someone accompanied him at the other time measures, the participant did not need to use the Miniguide. Note 7: N/A: not applicable. One of the goals was to walk for pleasure on a bridge but it was closed at that time.
Socialization
Active leisure
Community life
Functional mobility
Occupations
Performance from 1 to 10
Participant 1 (Miniguide)1
Table 2. Performance and satisfaction on CMOP before (T1) and after training (T2), and follow-up at 3 months (T3).
Downloaded by [Deakin University Library] at 21:39 05 November 2015
DOI: 10.3109/17483107.2013.825929
Field testing of two electronic mobility aid devices for persons who are deaf-blind 417
418
C. Vincent et al.
Disabil Rehabil Assist Technol, 2014; 9(5): 414–420
occupation after training and during follow-up (Table 2). The lowest rating for performance and satisfaction was eight out of 10 (participant 4). For all participants, the largest impact was observed between T1 and T2, due to the training (Table 2). In comparison, the subsequent three months of use did not have much effect on the participants’ scores. Table 3 shows satisfaction with the technological aspects of the Miniguide and the Breeze; satisfaction was high (4 or 5 out of 5) for the eight aspects measured for three participants. Participant 4 scored lower on four aspects for satisfaction with the Miniguide (1 or 3 out of 5). There was a constant across the participants for two of the aspects measured, with satisfaction generally increasing after the three months of real-life testing: adjustment of the different functions and durability of the device. Conversely, satisfaction generally decreased for two aspects but only for the Miniguide users (participants 1, 2 and 4): ease of use and comfort.
Downloaded by [Deakin University Library] at 21:39 05 November 2015
Qualitative results The content analysis from the six interviews (four participants and two O&M specialists) revealed highly variable comments. For example, each participant used the Miniguide features differently. Indoors, some preferred to set detection at 0.5 m, others at 1 or 2 m. Outdoors, all three participants set the detection for the Miniguide at a longer range (usually double the range). The frequency of use also varied: daily, every other day, winter only or everyday indoors only. The usage pattern was personalized (see notes under Table 2). For the Breeze, the main features used were the location of landmarks and the ‘‘where am I’’ button, which were used outdoors and en route. Reported benefits for the Miniguide were: It is reliable for its main task, i.e. detecting obstacles (vibrations are sent as a warning when approaching an obstacle). Participants often used it to know if they were taking the right route. It identifies entrances or openings (indicated by the vibrations stopping when pointing at a wall), which can replace the echo-location for blind persons with hearing impairments. Two participants reported that the Miniguide helped to locate overhanging objects which are not detectable with a long cane. It increased the feeling of safety for two of the three participants because the detection range is greater than with the white cane. Walking was also more regular for one participant because of that feeling. It is quite easy to set and use. However, it can be challenging to learn how to use it at the same time as the cane. Also,
when both are used at the same time, there is no free hand to do something else (e.g. open doors). Reported benefits for the Breeze were: It is possible to record landmarks and to use those landmarks to go back alone later after taking a certain route for the first time with someone else. It helps to familiarize the person with new places. It can tell you where you are at any time. It helps with orientation and the participant also liked this feature because it helped with learning street names. It is relaxing for the user since it reduces the concentration needed to follow a familiar route (e.g. going home).
‘‘Even if I know the way by heart, sometimes I bring it with me. Honestly, I like to play with it . . . I think it is fun and interesting, but it is not a device that we can rely on 100%.’’ Seven problems were identified and only one problem was common to the two EMADs: it is difficult to use them during winter due to the cold and wearing gloves. The two O&M specialists also reported that the ability to detect snow banks is not adequate. Reported problems for the Miniguide were: One participant found that the Miniguide was much too sensitive to the surroundings in crowded places (e.g. school). It vibrated too much, which made it useless. That participant, who has some residual vision, would recommend the Miniguide more for persons who are completely blind because he used it more often at night. To be used correctly, the Miniguide must be parallel with the ground. This requires training and concentration. However, an O&M specialist mentioned that this handling error is usually corrected quickly. One difficulty shared by three participants is that they did not always remember the detection range they used before when they want to use the EMAD again after a period of time. The O&M specialists mentioned that they noticed that when participants had a doubt they reset it. Reported problems for the Breeze were: The Breeze helps with orientation. However, it sometimes mixes up street names when the names are hyphenated compound nouns. The GPS function did not work everywhere or every time, for example when surrounded by buildings or en route. Precision was limited to 10 m, meaning that the target destination could be as much as 10 m farther than indicated by the Breeze, as noted by an O&M specialist. This was also
Table 3. Satisfaction on the Quebec User Evaluation of Satisfaction with assistive Technology1 after training (T2) and follow-up at 3 months (T3).
How satisfied are you with the 1. 2. 3. 4. 5. 6. 7. 8. 9.
dimensions (size, height, length, width) of your AT? weight of your AT? adjustment of the different functions of your AT? safety and security of your AT? durability of your AT? ease of use of your AT? comfort of your AT? effectiveness of your AT? Mean score – Technology
Participant 1 (Miniguide)
Participant 2 (Miniguide)
Participant 3 (Breeze)
Participant 4 (Miniguide)
score/5
score/5
score/5
score/5
T2
T3
T2
T3
T2
T3
T2
T3
5 5 4 5 4 5 5 5 4.75
5 5 4 5 5 4 4 5 4.63
4 5 4 4 4 5 5 5 4.50
4 5 4 5 5 5 4 5 4.63
5 5 4 4 5 4 4 4 4.38
5 5 5 5 N/A 5 5 4 4.86
3 4 3 4 3 2 3 5 3.40
4 3 4 3 4 1 1 4 3.00
Note 1. QUEST score: 1 to 5 (1: not satisfied all; 2: not very satisfied; 3: more or less satisfied; 4: quite satisfied; 5: very satisfied).
DOI: 10.3109/17483107.2013.825929
Field testing of two electronic mobility aid devices for persons who are deaf-blind
reported by the participant who, however, indicated that it was more precise when self-recorded landmarks were used. The Breeze should not be recommended for use in unfamiliar places or for people with no sense of direction. As the participant using the Breeze said:
‘‘For familiar places, yes . . . for unfamiliar places you should go at least a couple of times with someone else before using it alone.’’ This feeling was shared by the O&M specialists, who also said it is not safe to use it alone in unfamiliar places. They argued that it is mainly used to reduce the mental energy needed en route (i.e. no need to count streets, etc.). They thought that was the main reason why satisfaction with the use of this EMAD was high.
Downloaded by [Deakin University Library] at 21:39 05 November 2015
Discussion The purpose of this study was to test a methodology for assessing the effects of EMADs on the mobility of persons who are deafblind and to identify their benefits for participants. On field-life, three participants had used an aid for detection and one participant used an aid for orientation. With the help of O&M specialists, participants developed personal goals and increased their mobility using the EMAD. Users’ experience could be valuable for product designers as they could enhance the positive aspects of their device and develop solutions for the negative aspects. The clinical results of this study demonstrate that a high satisfaction score on QUEST does not necessarily imply that an assistive device is efficient in all circumstances. Participants were satisfied with some benefits provided by the Miniguide and the Breeze (highlighted in the QUEST, CMOP and interview transcripts) but their satisfaction was more nuanced when considering the whole experience (qualitative data). These assistive technologies had their share of problems in many situations. Overall, with the methodology described in this study, our goal was achieved because it was possible to obtain measurable effects and details concerning the EMAD in different real-life situations. The questionnaires we used were able to assess performance and satisfaction with the EMAD and the independent tasks. One O&M specialist reported that it might have been difficult for some participants to complete the CMOP at T1 because they had to choose tasks for which they would be trained to use the EMADDB. We think that the discussion between the O&M specialists and the users was really important for the use of these EMADs in real-life conditions as it helped users explore their possibilities safely. For example, it is important for O&M specialists to see the routes the users want to take so they can identify difficulties and advise the users. This study has strengths and weaknesses, mainly related to the type of data sources that was used (quantitative questionnaires, qualitative interview) and the type of research design employed (exploratory single subject design with only four participants). The strengths of this study are based on the procedures implemented to meet the criteria for scientific rigor in quantitative and qualitative research [17–19]. This approach could be used in a clinical setting. Our standardized research and evaluation methodology demonstrated the feasibility of this study because data were collected on the actual use of these technologies, intervention methods, impacts and satisfaction with use. The methodology appears to be transferable to a larger sample size or other EMADDBs. The credibility and accountability of procedural studies are based on the detailed description of the participants’ profile [20],
419
the clinical experience of the O&M specialists who met the participants [20], the pretesting of the survey [21], and the contribution of other researchers in critiquing the survey methods (questionnaires, standardized interviews, documentation of ongoing interventions) and the data analysis (triangulation method) [17,22–24]. The weaknesses of this study are related to the low transferability of the study results [17] since we collected data from only four participants. For example, qualitative data were not redundant among participants. Thus it is plausible that participants performing other types of occupations in their daily life (taking public transport, working, parenting, volunteering, etc.) would result in more diverse sources of benefits and difficulties. However, the aim of the study was to test a new methodology and the next step would be to collect more data on other occupational profiles until data saturation is achieved. The total training time was reasonable (11.3 2.8 h) and the participants did not have any negative comments about their training experience. Results also show that older age (up to 70-years-old) was not an obstacle to the use of the assistive technology, but familiarity with technology might be. More precisely, participant 4 was the youngest (50-years-old) but rarely used technology in general; she found it more difficult to use the Miniguide at the same time as she used a white cane, although she had established only one mobility goal for training (to go get her son at school and get him back home at night). She could not use the Miniguide inside the school effectively because too many children were moving around.
Conclusion This exploratory single-subject design indicated the potential advantages of the EMADs tested but also underlined their limitations, which suggests the importance of a user-centered design approach [25,26]. Furthermore, interviews with O&M specialists are important to better document their strategies and the obstacles encountered during interventions. Interviews could identify problems and advantages that standardized questionnaires could not. The Miniguide is a reliable tool for persons who are deafblind. It is really helpful for individuals who go out to various known places and want help to detect obstacles on the street and to detect openings. The Breeze is not that reliable in many situations (cloudy sky, buildings, etc.). However, user satisfaction is good since it reduces the concentration needed to go from one place to another on a known route, which makes commuting easier and more relaxing. We can conclude that it is important to work with users to identify what they want to accomplish with the EMAD-DB and to evaluate which EMAD-DB could be really helpful, due consideration for its disadvantages.
Acknowledgements The authors wish to thank Veronique Garcia for data compilation and interview transcription and Melanie Couture for clinical research support. Both are from the Institut de re´adaptation en de´ficience physique de Que´bec (Que´bec, Canada).
Declaration of interest The authors report no declarations of interest.
References 1. Roentgen UR, Gelderblom GJ, Soede M, de Witte LP. Inventory of electronic mobility aids for persons with visual impairments: a literature review. J Vis Impair Blind 2008;102:702–24. 2. Roentgen UR, Gelderblom GJ, Soede M, de Witte LP. The impact of electronic mobility devices for persons who are visually impaired: a
420
3. 4. 5.
6.
7.
Downloaded by [Deakin University Library] at 21:39 05 November 2015
8. 9. 10. 11. 12. 13.
C. Vincent et al. systematic review of effects and effectiveness. J Vis Impair Blind 2009;103:743–53. Blumsack JT. Audiological assessment, rehabilitation, and spatial hearing considerations associated with visual impairment in adults: an overview. Am J Audiol 2003;12:76–83. Kricos PB. Hearing assistive technology considerations for older individuals with dual sensory loss. Trends Amplif 2007;11:273–9. Monroe S, Waters C, Owen M. Une e´tude de´mographique sur les personnes sourdes-aveugles au Canada et les services a` leur disposition. In: Socie´te´ Nationale Canadienne des Sourds-Aveugles [Canadian National Society of the Deafblind]; 2005:178 pp. Munroe S. La cre´ation d’un registre national et volontaire des personnes atteintes de surdice´cite´ au Canada: re´sultats de l’e´tude mene´e de 1999 a` 2001. In: Watters C, Owen M, eds. Association canadienne de la surdice´cite´ et de la rube´ole [Canadian Deafblind and Rubella Association]. Winnipeg, MA, Canada: Canadian Centre on Disability Studies; 2001. Available from: http://www.cdbanational.com/PDFs/Demographic%20Study%20(French).pdf. Boughman JA, Vernon M, Shaver KA. Usher syndrome: definition and estimate of prevalence from two high-risk populations. J Chronic Dis 1983;36:595–603. Grondahl J. Estimation of prognosis and prevalence of retinitis pigmentosa and Usher syndrome in Norway. Clin Genet 1987;31: 255–64. Hope CI, Bundey S, Proops D, Fielder AR. Usher syndrome in the city of Birmingham – prevalence and clinical classification. Br J Ophthalmol 1997;81:46–53. Spandau UH, Rohrschneider K. Prevalence and geographical distribution of Usher syndrome in Germany. Graefes Arch Clin Exp Ophthalmol 2002;240:495–8. Chan CCH, Lee TMC. Validity of the Canadian Occupational Performance Measure. Occ Ther Int 1997;4:231–49. Cup EH, Scholte op Reimer WJ, Thijssen MC, van Kuyk-Minis MA. Reliability and validity of the Canadian Occupational Performance Measure in stroke patients. Clin Rehabil 2003;17:402–9. Demers L, Wessels RD, Weiss-Lambrou R, et al. An international content validation of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Occ Ther Int 1999;6:159–75.
Disabil Rehabil Assist Technol, 2014; 9(5): 414–420
14. Demers L, Weiss-Lambrou R, Ska B. The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0): an overview and recent progress. Technol Disabil 2002;14:101–5. 15. Fontana A, Frey JH. The interview: from structured questions to negotiated text. In: Denzin NK, Lincoln YS, eds. The handbook of qualitative research. 2nd ed. Thousands Oaks (CA): Sage; 2000:645–72. 16. Baker C, Wuest J, Stern PN. Method slurring: the grounded theory/ phenomenology example. J Adv Nurs 1992;17:1355–60. 17. Hills M. Human science research in public health: the contribution and assessment of a qualitative approach. Can J Public Health 2000; 91:I-4–12. 18. Carpenter C, Suto M. Qualitative research for occupational and physical therapists: a practical guide. Oxford: Wiley-Blackwell; 2008. 19. Lincoln YS, Guba E. Naturalistic inquiry. Newbury Park (CA): Sage; 1985. 20. Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther 1991;45:214–22. 21. Mayer R, Saint-Jacques M-C. Le questionnaire. In: Mayer R, Ouellet F, Saint-Jacques M-C, Turcotte D, eds. Me´thodes de recherche en intervention sociale. Montre´al, QC: Gae´tan Morin; 2000:22 pp. 22. Mucchielli A. Dictionnaire des me´thodes qualitatives en sciences humaines et sociales. Paris, France: Armand Colin; 1996. 23. Koelen MA, Vaandrager L, Colomer C. Health promotion research: dilemmas and challenges. J Epidemiol Community Health 2001;55: 257–62. 24. Carpenter DR. Triangulation as a qualitative research strategy. In: Streubert HJ, Carpenter DR, eds.Qualitative research in nursing: advancing the humanistic imperative. 3rd ed. Philadelphia (PA): Lippincott; 2003;349–60. 25. Ma MY, Wu FG, Chang RH. A new design approach of usercentered design on a personal assistive bathing device for hemiplegia. Disabil Rehabil 2007;29:1077–89. 26. Stehle C, Albrecht-Buehler C. Developing more desirable products for stroke survivors. Top Stroke Rehabil 2008;15:109–17.
ISSN: 1748-3107 (Print) 1748-3115 (Online) Journal homepage: http://www.tandfonline.com/loi/iidt20
Field testing of two electronic mobility aid devices for persons who are deaf-blind Claude Vincent, François Routhier, Valérie Martel, Marie-Ève Mottard, Frédéric Dumont, Lise Côté & Danielle Cloutier To cite this article: Claude Vincent, François Routhier, Valérie Martel, Marie-Ève Mottard, Frédéric Dumont, Lise Côté & Danielle Cloutier (2014) Field testing of two electronic mobility aid devices for persons who are deaf-blind, Disability and Rehabilitation: Assistive Technology, 9:5, 414-420 To link to this article: http://dx.doi.org/10.3109/17483107.2013.825929
Published online: 25 Nov 2013.
Submit your article to this journal
Article views: 123
View related articles
View Crossmark data
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iidt20 Download by: [Deakin University Library]
Date: 05 November 2015, At: 21:39
http://informahealthcare.com/idt ISSN 1748-3107 print/ISSN 1748-3115 online Disabil Rehabil Assist Technol, 2014; 9(5): 414–420 ! 2014 Informa UK Ltd. DOI: 10.3109/17483107.2013.825929
ORIGINAL RESEARCH
Field testing of two electronic mobility aid devices for persons who are deaf-blind Claude Vincent1,2, Franc¸ois Routhier1,2, Vale´rie Martel3, Marie-E`ve Mottard3, Fre´de´ric Dumont2, Lise Coˆte´3, and Danielle Cloutier3
Downloaded by [Deakin University Library] at 21:39 05 November 2015
1
Department of Rehabilitation, Universite´ Laval, Que´bec, Canada, 2Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Que´bec, Canada, and 3Institut de re´adaptation en de´ficience physique de Que´bec (IRDPQ), Que´bec, Canada
Abstract
Keywords
Purpose: To test a methodology for assessing the effects of electronic mobility aid devices (EMAD) on the mobility of persons who are deaf-blind in real-life situations. Method: A singlesubject desing was done with four users followed in a program for persons who are deaf-blind. Participants were trained to use two commercial EMADs: the Miniguide and the Breeze. The Canadian Measure of Occupational Performance (CMOP) was administered before training (T1), after training (T2) and three months later (T3). The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) was administered at T2 and T3. A follow-up interview was conducted with the participants and clinicians at T3 to evaluate the benefits of the EMAD and any problems. Results: CMOP suggests that both performance and satisfaction improved following the use of both EMADs in four occupations (functional mobility, active leisure, community life and socialization). QUEST indicates high satisfaction with eight items except for one participant. Follow-up interviews revealed a wide variety of perceptions regarding EMAD use and seven problems although CMOP and QUEST indicated good satisfaction. Conclusion: A high satisfaction score on QUEST does not necessarily imply that an assistive device is efficient in all circumstances; follow-up interviews provided important complementary information.
Assistive technology, blindness, hearing loss, low vision, obstacle detection, orientation, satisfaction History Received 30 May 2013 Accepted 14 July 2013 Published online 25 November 2013
Implications for Rehabilitation For people who are deaf-blind The Miniguide is reliable for detecting obstacles (vibrations are sent as a warning when approaching an obstacle). It is often used to know if taking the right route. It identifies entrances or openings (indicated by the vibrations stopping when pointing at a wall), which can replace the echo-location for blind persons with hearing impairments. The Miniguide helped to locate overhanging objects which are not detectable with a long cane. The Breeze can record landmarks for orientation and it possible to use those landmarks to go back alone later after taking a certain route for the first time with someone else. It helps to familiarize the person with new places. It can tell you where you are at any time. It helps with orientation and the participant also liked this feature because it helped with learning street names. The Miniguide and the Breeze were not efficient in all circumstances; there were some problems with the ergonomic (both), detecting snow banks (Miniguide), sensitiveness to the surroundings in crowded places (Miniguide) and exactitude for geo-localization (Breeze).
Introduction Roentgen et al. published a literature review in 2008 that identified 146 different products for persons with visual impairments [1]. However, only 21 of them were considered to be both available and ready to be used as is, without further adaptation. The authors of that study were surprised to see how many of these
Address for correspondence: Claude Vincent, CIRRIS-IRDPQ, 525, boul. Hamel, bureau H-1312, Que´bec G1M 2S8, Canada. Tel: 418-649-3735. E-mail: [email protected]
systems were no longer available on the market or had failed to penetrate the market. A list of available and discontinued products and prototypes can be found at abledata.com. Few of these products have been rigorously tested. Roentgen et al. published a second study in 2009 to identify studies that documented the effects and effectiveness of electronic mobility aid devices (EMAD) for persons with visual impairments [2]. Only 13 studies were identified that evaluated six different EMADs. Eight studies used an experimental design and had a sample size varying from one to 19. Those studies generally found that the devices increased the participants’ ability to detect
Downloaded by [Deakin University Library] at 21:39 05 November 2015
DOI: 10.3109/17483107.2013.825929
Field testing of two electronic mobility aid devices for persons who are deaf-blind
obstacles, or increased the efficiency of mobility with the navigation tool. For the five remaining studies (surveys and follow-up studies), the number of participants varied between 5 and 298. These studies revealed that the percentage of persons that continued to use the different EMADs varied greatly (from 44% to 100%) depending on whether they still needed the device after getting familiar with the environment. The methodological quality of these studies was considered low, primarily due to the lack of standardized and validated measuring instruments. Some studies can be found on EMAD testing for blind people and somewhat fewer for deaf people. EMAD includes detection and orientation aids. However, no studies with persons with both types of disabilities (blind and deaf) who used an EMAD were found. This is surprising because having both types of disabilities creates new challenges and obstacles for this population [3,4]. Therefore we decided to focus on the effects of EMADs on persons who are deaf-blind (EMAD-DB) in the province of Quebec (Canada). The prevalence of persons who are deaf-blind in the province of Quebec is estimated to 21 per 100 000 according to a report by Munroe et al. in 2005 and the authors still consider this number conservative due to census difficulties [5]. In a previous report in 2001, Munroe et al. found that the leading cause of deafblindness in Canada was Usher syndrome, accounting for between 26% and 33% of all congenital and acquired deafblindness (5–7 per 100 000) [6]. This prevalence is comparable with what has been observed in the USA and Europe [7–10]. Since, to our knowledge, no study used standardized measures to evaluate the effects of EMADs and because the population who are deaf-blind has not been investigated for the use of these aid devices, the purpose of this study was to test a methodology for assessing the effects of EMAD-DBs on the mobility of persons who are deaf-blind. More precisely, we aimed to recruit people with Usher syndrome because the prevalence of this syndrome is high in the population who are deaf-blind and they are likely to use these technical aids. The specific objectives were to: (1) assess performance and satisfaction with independent mobility in various occupations; (2) assess satisfaction with the technical aid; (3) document the feasibility of training with various technical aids with clients aged 50 and older and (4) document actual use of the technical aid three months after training (features used, intensity, frequency, problems encountered, etc.).
Method Research design A single-subject design was conducted in three steps: T1 ¼ initial assessment and intervention; T2 ¼ assessments at the end of the intervention and T3 ¼ follow-up assessments and interviews three months post-intervention. The study was approved by the research ethics board of the Institut de re´adaptation en de´ficience physique de Que´bec (2010-217). All the participants signed a consent form. Intervention and technology A minimum of four steps were included in the user’s training: (1) teaching of the Breeze (helpful for orientation) or Miniguide (helful for detection) features, (2) training on how to use the Breeze or Miniguide indoors or outdoors, (3) cognitive mapping of the chosen route using a tactile map and (4) assisting the user to achieve the mobility target. Total intervention per person was under 3 months. The EMAD was paid for by the Quebec Medicare system. Because of this constraint, only two technologies were available (Figure 1). The Breeze should be helpful for orientation: it is a talking GPS designed for people who are blind or have low vision (HumanWare, Drummondville, Canada: http://www.humanware.com/fr-canada/home). It verbally announces the names of
415
Figure 1. The Miniguide (left) and the Breeze (right) (from GDP Research at http://www.gdp-research.com.au/ and HumanWare at http:// www.humanware.com/en-canada/products/blindness/talking_gps, respectively).
streets, intersections and landmarks along the route. The Breeze includes a highly sensitive GPS, a built-in speaker, a speech synthetis accompanying the text and 8 h of battery. This model costs approximately CAN $1000. The Miniguide should be helpful for detection. It is intended to be an accessory to more traditional aids such as a white cane (GDP Research). It uses ultrasonic echolocation to detect objects and vibrates to indicate objects. The MiniGuide vibrates to indicate the distance of objects – the vibration is faster when the object is near. A single push button is used to activate or deactivate the Mini-Guide and also to change the settings. In this regard, the Mini-Guide involves different modes and options. The main modes are: 4, 2, 1 and 8 meters. Only large objects can be detected at 4 m or beyond, for example, fences or walls. The Mini-Guide costs approximately 400 $CAN. It should be noted that these EMADs were among the 13 studies identified by Roentgen et al. [2]. Selection of participants Participants were recruited from persons who were receiving or had received rehabilitation services from the deafblindness program at the Institut de re´adaptation en de´ficience physique de Que´bec (Que´bec City, Canada). The orientation and mobility (O&M) specialists selected some individuals who could benefit from more ease or independence because they wanted to try new tasks or use known routes without assistance. Potential participants were met by their O&M specialist to give them the information sheet and more detailed explanations, answer any questions they might have and have them sign the consent form if they agreed to participate. The inclusion criteria varied depending on the technology. For the Breeze, participants had to have minimum hearing abilities. For both technologies participants were required: (1) to have already been trained to use a long cane, (2) not to have cognitive impairments or language impairments likely to seriously impede the safe and efficient use of the aid (e.g. intellectual disability, severe adjustment disorder and attention-deficit disorder), (3) to be legally blind (visual acuity 6/60 or visual field 20 in the better eye after correction) and (4) to be able to get around independently indoors or outdoors. For the Breeze, which uses a speech synthesis system, other auditory criteria were added: (5) to have sufficient abilities for speech recognition (open choice) in various listening conditions, for example in the presence of competing noise and (6) to have the possibility of combining the aid with an optimal hearing device in at least one ear (hearing aid or cochlear implant) as users must hear the information transmitted, without impeding access to traffic sounds necessary for safe mobility.
416
C. Vincent et al.
Disabil Rehabil Assist Technol, 2014; 9(5): 414–420
Downloaded by [Deakin University Library] at 21:39 05 November 2015
Measurement tools The standardized questionnaire of the Canadian Measure of Occupational Performance (CMOP) is used to detect changes in users’ perception about their own performance in an occupation over time [11,12]. The CMOP key areas are: personal care (including mobility), productivity and leisure. Performance and satisfaction with occupations are rated on a scale from 0 to 10. A questionnaire concerning training specifications is completed after each training session (date and duration of training, time spent teaching EMAD features and types of exercises indoors and outdoors). The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) questionnaire calculates satisfaction scores for the technological aspects, services and overall scores [13]. The QUEST has good construct validity (factorial: two dimensions), good to very good test-retest reliability (ICC ¼ 0.82, 0.82 and 0.91) and good internal reliability (alpha: 0.76 to 0.82) [14]. The questionnaire consists of 12 items rated on a scale from 1 to 5 (1: not satisfied at all to 5: very satisfied). Comments were also collected for each item when relevant. A semi-structured interview [15] lasting about 45 min concerning the experience with the EMAD-DB was audiotaped. Users were asked four questions: actual use of the EMAD-DB (features used, intensity and frequency), problems and difficulties with the technology, perceived advantages and disadvantages (safety and functional independence), opinion about maintaining this service in the future. The two O&M specialists who trained the users were asked the same questions but based on their experience during the training sessions and follow-up with users. Data collection Before the intervention (T1), users completed the ‘‘participant profile’’ questionnaire with a first O&M specialist. They chose significant routes within specific occupations that could be achieved after the EMAD training. With a second O&M specialist, they completed the CMOP. After the intervention
(T2), the QUEST and CMOP questionnaires were completed in the week following the last intervention. Three months after the intervention (T3), the second O&M specialist administered the QUEST and CMOP questionnaires again and the semi-structured interviews. Two of the researchers (CV and FD) administered the semi-structured interviews with the two O&M specialists. The questionnaire concerning training specification was completed by the O&M specialists after each training sessions. Data analysis Descriptive analyses (mean, standard deviation and frequency) are presented for each variable at each measurement time. For the analysis of the interview content, a qualitative approach was used. The recordings were transcribed. Using an inductive approach [16], the transcripts were first read in their entirety, then a second reading identified the units of meaning that were categorized according to the four questions and subquestions in the interview. N’Vivo software was used for the categorization and management of interview content.
Results Quantitative results Table 1 presents the participant’s profile of three men and one woman aged from 50 to 70-years-old and having the Usher syndrome with different levels of low vision and deafness. Three of them were trained to use the Miniguide and only one, the Breeze. Training was different in term of duration (2h25 up to 9 h) for each participant according to the number of occupations they targeted at the beginning of the study. For example, participant 4 received less training because he chose only one community life activity to realize with the Miniguide (also see note 4, Table 2). The CMOP questionnaire indicated that occupational performance as well as satisfaction improved for all participants with the use of the Miniguide or the Breeze in at least one targeted
Table 1. Clinical profiles and training sessions. Participant 1
Participant 2
Participant 3
Age (years) Gender Education Diagnosis
69 Male Grade 7 Usher syndrome
70 Male College Usher syndrome
55 Male University Usher syndrome
Visual acuity (VA)
Almost total: 6/360 VA light perception Almost total: 5 4VF 0 Profound (bilaterally)
Almost total: 6/360 VA light perception Almost total: 5 4VF 0 Moderately severe to profound (bilaterally)
Profound: 6/120 VA46/360
Visual field (VF) Deafness degree
Technology use in general Regularly Occasionally Rarely Training sessions (nb) Training session time (min) Total time all sessions (h:min) Time spent learning AT functions (h:min) Time spent using AT (h:min) Functional mobility Community life Active leisure Socialization
3 machine shop, computer ... ... 10 for Miniguide 60 to 110 13:40 9:50 3:50 ... ... 333 ...
Profound: 10 4VF 5 Mild to profound (bilaterally)
Participant 4 50 Female Grade 9 Usher syndrome Attention deficit disorder Severe: 6/120 VA46/360 Severe: 20 4VF 10 Moderate to severe (bilaterally)
...
3 computer for work
...
3 computer for hobbies ... 7 95 to 150 12:50 3:50
... ... 9 60 to 90 11:30 5:35
... 3 5 75 to 100 7:20 2:45
9:00 3 ... 3 3
5:55 33 3333 ... ...
2:25 ... 3 ... ...
8 7 3
T1
9 9 N/A
T2
8 9 N/A7
T3
7 6 3
T1
10 9 N/A
T2
8 9 N/A6
T3
Satisfaction from 1 to 10
1
7
7
T1
8
8
9
T2
7 1
N/A6
7
T1
N/A5
10
T3
Performance from 1 to 10
7.5
9
9
T2
N/A6
N/A5
10
T3
Satisfaction from 1 to 10
Participant 2 (Miniguide)2
10 10 9 9 8 10
4 3 6 4 6
T2
5
T1
Performance from 1 to 10
10 9 9 8 10
10
T3
5 4 8 8 6
5
T1
10 9 10 10 10
10
T2
Satisfaction from 1 to 10
Participant 3 (Breeze)3
10 9 10 10 10
10
T3
3
T1
8
T2
Performance from 1 to 10
8
T3
5
T1
8
T2
Satisfaction from 1 to 10
Participant 4 (Miniguide)4
8
T3
Note 1: Participant 1 was evaluated for taking a walk, to go to the workshop located in the backyard and to cross a bridge in a park. Note 2: Participant 2 was evaluated for moving around his property (in the garage, around the pool, around the swing or making compost), moving in a bowling center, participating in social group activities. Note 3: Participant 3 was evaluated for getting back home during the day, getting back home at night, going to the music store on the bus, going to a grocery store during the day (near the house), going to a grocery store at night near the house, going to a creamery during the day and at night, going to a shopping center (unknown route). Note 4: Participant 4 was evaluated for going to get his/her son at school and get him back home at night. Note 5 and Note 6: N/A: not applicable. Since someone accompanied him at the other time measures, the participant did not need to use the Miniguide. Note 7: N/A: not applicable. One of the goals was to walk for pleasure on a bridge but it was closed at that time.
Socialization
Active leisure
Community life
Functional mobility
Occupations
Performance from 1 to 10
Participant 1 (Miniguide)1
Table 2. Performance and satisfaction on CMOP before (T1) and after training (T2), and follow-up at 3 months (T3).
Downloaded by [Deakin University Library] at 21:39 05 November 2015
DOI: 10.3109/17483107.2013.825929
Field testing of two electronic mobility aid devices for persons who are deaf-blind 417
418
C. Vincent et al.
Disabil Rehabil Assist Technol, 2014; 9(5): 414–420
occupation after training and during follow-up (Table 2). The lowest rating for performance and satisfaction was eight out of 10 (participant 4). For all participants, the largest impact was observed between T1 and T2, due to the training (Table 2). In comparison, the subsequent three months of use did not have much effect on the participants’ scores. Table 3 shows satisfaction with the technological aspects of the Miniguide and the Breeze; satisfaction was high (4 or 5 out of 5) for the eight aspects measured for three participants. Participant 4 scored lower on four aspects for satisfaction with the Miniguide (1 or 3 out of 5). There was a constant across the participants for two of the aspects measured, with satisfaction generally increasing after the three months of real-life testing: adjustment of the different functions and durability of the device. Conversely, satisfaction generally decreased for two aspects but only for the Miniguide users (participants 1, 2 and 4): ease of use and comfort.
Downloaded by [Deakin University Library] at 21:39 05 November 2015
Qualitative results The content analysis from the six interviews (four participants and two O&M specialists) revealed highly variable comments. For example, each participant used the Miniguide features differently. Indoors, some preferred to set detection at 0.5 m, others at 1 or 2 m. Outdoors, all three participants set the detection for the Miniguide at a longer range (usually double the range). The frequency of use also varied: daily, every other day, winter only or everyday indoors only. The usage pattern was personalized (see notes under Table 2). For the Breeze, the main features used were the location of landmarks and the ‘‘where am I’’ button, which were used outdoors and en route. Reported benefits for the Miniguide were: It is reliable for its main task, i.e. detecting obstacles (vibrations are sent as a warning when approaching an obstacle). Participants often used it to know if they were taking the right route. It identifies entrances or openings (indicated by the vibrations stopping when pointing at a wall), which can replace the echo-location for blind persons with hearing impairments. Two participants reported that the Miniguide helped to locate overhanging objects which are not detectable with a long cane. It increased the feeling of safety for two of the three participants because the detection range is greater than with the white cane. Walking was also more regular for one participant because of that feeling. It is quite easy to set and use. However, it can be challenging to learn how to use it at the same time as the cane. Also,
when both are used at the same time, there is no free hand to do something else (e.g. open doors). Reported benefits for the Breeze were: It is possible to record landmarks and to use those landmarks to go back alone later after taking a certain route for the first time with someone else. It helps to familiarize the person with new places. It can tell you where you are at any time. It helps with orientation and the participant also liked this feature because it helped with learning street names. It is relaxing for the user since it reduces the concentration needed to follow a familiar route (e.g. going home).
‘‘Even if I know the way by heart, sometimes I bring it with me. Honestly, I like to play with it . . . I think it is fun and interesting, but it is not a device that we can rely on 100%.’’ Seven problems were identified and only one problem was common to the two EMADs: it is difficult to use them during winter due to the cold and wearing gloves. The two O&M specialists also reported that the ability to detect snow banks is not adequate. Reported problems for the Miniguide were: One participant found that the Miniguide was much too sensitive to the surroundings in crowded places (e.g. school). It vibrated too much, which made it useless. That participant, who has some residual vision, would recommend the Miniguide more for persons who are completely blind because he used it more often at night. To be used correctly, the Miniguide must be parallel with the ground. This requires training and concentration. However, an O&M specialist mentioned that this handling error is usually corrected quickly. One difficulty shared by three participants is that they did not always remember the detection range they used before when they want to use the EMAD again after a period of time. The O&M specialists mentioned that they noticed that when participants had a doubt they reset it. Reported problems for the Breeze were: The Breeze helps with orientation. However, it sometimes mixes up street names when the names are hyphenated compound nouns. The GPS function did not work everywhere or every time, for example when surrounded by buildings or en route. Precision was limited to 10 m, meaning that the target destination could be as much as 10 m farther than indicated by the Breeze, as noted by an O&M specialist. This was also
Table 3. Satisfaction on the Quebec User Evaluation of Satisfaction with assistive Technology1 after training (T2) and follow-up at 3 months (T3).
How satisfied are you with the 1. 2. 3. 4. 5. 6. 7. 8. 9.
dimensions (size, height, length, width) of your AT? weight of your AT? adjustment of the different functions of your AT? safety and security of your AT? durability of your AT? ease of use of your AT? comfort of your AT? effectiveness of your AT? Mean score – Technology
Participant 1 (Miniguide)
Participant 2 (Miniguide)
Participant 3 (Breeze)
Participant 4 (Miniguide)
score/5
score/5
score/5
score/5
T2
T3
T2
T3
T2
T3
T2
T3
5 5 4 5 4 5 5 5 4.75
5 5 4 5 5 4 4 5 4.63
4 5 4 4 4 5 5 5 4.50
4 5 4 5 5 5 4 5 4.63
5 5 4 4 5 4 4 4 4.38
5 5 5 5 N/A 5 5 4 4.86
3 4 3 4 3 2 3 5 3.40
4 3 4 3 4 1 1 4 3.00
Note 1. QUEST score: 1 to 5 (1: not satisfied all; 2: not very satisfied; 3: more or less satisfied; 4: quite satisfied; 5: very satisfied).
DOI: 10.3109/17483107.2013.825929
Field testing of two electronic mobility aid devices for persons who are deaf-blind
reported by the participant who, however, indicated that it was more precise when self-recorded landmarks were used. The Breeze should not be recommended for use in unfamiliar places or for people with no sense of direction. As the participant using the Breeze said:
‘‘For familiar places, yes . . . for unfamiliar places you should go at least a couple of times with someone else before using it alone.’’ This feeling was shared by the O&M specialists, who also said it is not safe to use it alone in unfamiliar places. They argued that it is mainly used to reduce the mental energy needed en route (i.e. no need to count streets, etc.). They thought that was the main reason why satisfaction with the use of this EMAD was high.
Downloaded by [Deakin University Library] at 21:39 05 November 2015
Discussion The purpose of this study was to test a methodology for assessing the effects of EMADs on the mobility of persons who are deafblind and to identify their benefits for participants. On field-life, three participants had used an aid for detection and one participant used an aid for orientation. With the help of O&M specialists, participants developed personal goals and increased their mobility using the EMAD. Users’ experience could be valuable for product designers as they could enhance the positive aspects of their device and develop solutions for the negative aspects. The clinical results of this study demonstrate that a high satisfaction score on QUEST does not necessarily imply that an assistive device is efficient in all circumstances. Participants were satisfied with some benefits provided by the Miniguide and the Breeze (highlighted in the QUEST, CMOP and interview transcripts) but their satisfaction was more nuanced when considering the whole experience (qualitative data). These assistive technologies had their share of problems in many situations. Overall, with the methodology described in this study, our goal was achieved because it was possible to obtain measurable effects and details concerning the EMAD in different real-life situations. The questionnaires we used were able to assess performance and satisfaction with the EMAD and the independent tasks. One O&M specialist reported that it might have been difficult for some participants to complete the CMOP at T1 because they had to choose tasks for which they would be trained to use the EMADDB. We think that the discussion between the O&M specialists and the users was really important for the use of these EMADs in real-life conditions as it helped users explore their possibilities safely. For example, it is important for O&M specialists to see the routes the users want to take so they can identify difficulties and advise the users. This study has strengths and weaknesses, mainly related to the type of data sources that was used (quantitative questionnaires, qualitative interview) and the type of research design employed (exploratory single subject design with only four participants). The strengths of this study are based on the procedures implemented to meet the criteria for scientific rigor in quantitative and qualitative research [17–19]. This approach could be used in a clinical setting. Our standardized research and evaluation methodology demonstrated the feasibility of this study because data were collected on the actual use of these technologies, intervention methods, impacts and satisfaction with use. The methodology appears to be transferable to a larger sample size or other EMADDBs. The credibility and accountability of procedural studies are based on the detailed description of the participants’ profile [20],
419
the clinical experience of the O&M specialists who met the participants [20], the pretesting of the survey [21], and the contribution of other researchers in critiquing the survey methods (questionnaires, standardized interviews, documentation of ongoing interventions) and the data analysis (triangulation method) [17,22–24]. The weaknesses of this study are related to the low transferability of the study results [17] since we collected data from only four participants. For example, qualitative data were not redundant among participants. Thus it is plausible that participants performing other types of occupations in their daily life (taking public transport, working, parenting, volunteering, etc.) would result in more diverse sources of benefits and difficulties. However, the aim of the study was to test a new methodology and the next step would be to collect more data on other occupational profiles until data saturation is achieved. The total training time was reasonable (11.3 2.8 h) and the participants did not have any negative comments about their training experience. Results also show that older age (up to 70-years-old) was not an obstacle to the use of the assistive technology, but familiarity with technology might be. More precisely, participant 4 was the youngest (50-years-old) but rarely used technology in general; she found it more difficult to use the Miniguide at the same time as she used a white cane, although she had established only one mobility goal for training (to go get her son at school and get him back home at night). She could not use the Miniguide inside the school effectively because too many children were moving around.
Conclusion This exploratory single-subject design indicated the potential advantages of the EMADs tested but also underlined their limitations, which suggests the importance of a user-centered design approach [25,26]. Furthermore, interviews with O&M specialists are important to better document their strategies and the obstacles encountered during interventions. Interviews could identify problems and advantages that standardized questionnaires could not. The Miniguide is a reliable tool for persons who are deafblind. It is really helpful for individuals who go out to various known places and want help to detect obstacles on the street and to detect openings. The Breeze is not that reliable in many situations (cloudy sky, buildings, etc.). However, user satisfaction is good since it reduces the concentration needed to go from one place to another on a known route, which makes commuting easier and more relaxing. We can conclude that it is important to work with users to identify what they want to accomplish with the EMAD-DB and to evaluate which EMAD-DB could be really helpful, due consideration for its disadvantages.
Acknowledgements The authors wish to thank Veronique Garcia for data compilation and interview transcription and Melanie Couture for clinical research support. Both are from the Institut de re´adaptation en de´ficience physique de Que´bec (Que´bec, Canada).
Declaration of interest The authors report no declarations of interest.
References 1. Roentgen UR, Gelderblom GJ, Soede M, de Witte LP. Inventory of electronic mobility aids for persons with visual impairments: a literature review. J Vis Impair Blind 2008;102:702–24. 2. Roentgen UR, Gelderblom GJ, Soede M, de Witte LP. The impact of electronic mobility devices for persons who are visually impaired: a
420
3. 4. 5.
6.
7.
Downloaded by [Deakin University Library] at 21:39 05 November 2015
8. 9. 10. 11. 12. 13.
C. Vincent et al. systematic review of effects and effectiveness. J Vis Impair Blind 2009;103:743–53. Blumsack JT. Audiological assessment, rehabilitation, and spatial hearing considerations associated with visual impairment in adults: an overview. Am J Audiol 2003;12:76–83. Kricos PB. Hearing assistive technology considerations for older individuals with dual sensory loss. Trends Amplif 2007;11:273–9. Monroe S, Waters C, Owen M. Une e´tude de´mographique sur les personnes sourdes-aveugles au Canada et les services a` leur disposition. In: Socie´te´ Nationale Canadienne des Sourds-Aveugles [Canadian National Society of the Deafblind]; 2005:178 pp. Munroe S. La cre´ation d’un registre national et volontaire des personnes atteintes de surdice´cite´ au Canada: re´sultats de l’e´tude mene´e de 1999 a` 2001. In: Watters C, Owen M, eds. Association canadienne de la surdice´cite´ et de la rube´ole [Canadian Deafblind and Rubella Association]. Winnipeg, MA, Canada: Canadian Centre on Disability Studies; 2001. Available from: http://www.cdbanational.com/PDFs/Demographic%20Study%20(French).pdf. Boughman JA, Vernon M, Shaver KA. Usher syndrome: definition and estimate of prevalence from two high-risk populations. J Chronic Dis 1983;36:595–603. Grondahl J. Estimation of prognosis and prevalence of retinitis pigmentosa and Usher syndrome in Norway. Clin Genet 1987;31: 255–64. Hope CI, Bundey S, Proops D, Fielder AR. Usher syndrome in the city of Birmingham – prevalence and clinical classification. Br J Ophthalmol 1997;81:46–53. Spandau UH, Rohrschneider K. Prevalence and geographical distribution of Usher syndrome in Germany. Graefes Arch Clin Exp Ophthalmol 2002;240:495–8. Chan CCH, Lee TMC. Validity of the Canadian Occupational Performance Measure. Occ Ther Int 1997;4:231–49. Cup EH, Scholte op Reimer WJ, Thijssen MC, van Kuyk-Minis MA. Reliability and validity of the Canadian Occupational Performance Measure in stroke patients. Clin Rehabil 2003;17:402–9. Demers L, Wessels RD, Weiss-Lambrou R, et al. An international content validation of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Occ Ther Int 1999;6:159–75.
Disabil Rehabil Assist Technol, 2014; 9(5): 414–420
14. Demers L, Weiss-Lambrou R, Ska B. The Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0): an overview and recent progress. Technol Disabil 2002;14:101–5. 15. Fontana A, Frey JH. The interview: from structured questions to negotiated text. In: Denzin NK, Lincoln YS, eds. The handbook of qualitative research. 2nd ed. Thousands Oaks (CA): Sage; 2000:645–72. 16. Baker C, Wuest J, Stern PN. Method slurring: the grounded theory/ phenomenology example. J Adv Nurs 1992;17:1355–60. 17. Hills M. Human science research in public health: the contribution and assessment of a qualitative approach. Can J Public Health 2000; 91:I-4–12. 18. Carpenter C, Suto M. Qualitative research for occupational and physical therapists: a practical guide. Oxford: Wiley-Blackwell; 2008. 19. Lincoln YS, Guba E. Naturalistic inquiry. Newbury Park (CA): Sage; 1985. 20. Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther 1991;45:214–22. 21. Mayer R, Saint-Jacques M-C. Le questionnaire. In: Mayer R, Ouellet F, Saint-Jacques M-C, Turcotte D, eds. Me´thodes de recherche en intervention sociale. Montre´al, QC: Gae´tan Morin; 2000:22 pp. 22. Mucchielli A. Dictionnaire des me´thodes qualitatives en sciences humaines et sociales. Paris, France: Armand Colin; 1996. 23. Koelen MA, Vaandrager L, Colomer C. Health promotion research: dilemmas and challenges. J Epidemiol Community Health 2001;55: 257–62. 24. Carpenter DR. Triangulation as a qualitative research strategy. In: Streubert HJ, Carpenter DR, eds.Qualitative research in nursing: advancing the humanistic imperative. 3rd ed. Philadelphia (PA): Lippincott; 2003;349–60. 25. Ma MY, Wu FG, Chang RH. A new design approach of usercentered design on a personal assistive bathing device for hemiplegia. Disabil Rehabil 2007;29:1077–89. 26. Stehle C, Albrecht-Buehler C. Developing more desirable products for stroke survivors. Top Stroke Rehabil 2008;15:109–17.
