Bridges for the Mind: Opportunities for Research on Cognitive
Disabilities
Clayton Lewis
Coleman Institute for Cognitive Disabilities
University of Colorado
Keynote talk at ASSETS 2005, Seventh International ACM
SIGACCESS
Conference on Computers and Accessibility, Baltimore, MD, October 10,
2005.
Thanks to the conference organizers, the National
Institute for Disability and Rehabilitation Research, Bill and Claudia
Coleman, Cathy Bodine, Elbert Johns, and RERC-ACT: Rehabilitation
Engineering Research Center on Advancement of Cognitive Technologies.
Cognitive disabilities are diverse and widespread
- A limitation in performing life tasks due to:
- mental retardation and developmental disabilities (e.g.
Down syndrome)
- brain injury
- Alzheimer disease
- severe and persistent mental illness
- These conditions affect over 20 million
Americans… perhaps 400M worldwide
Cognitive disabilities are poorly understood
IQ is defining for some cognitive disabilities, yet
understanding of “intelligence” is elusive
There is no art to read the brain's information processing
construction in the [intelligence-related] data we have at present.
--Deary,
I. (2000) Looking Down on Human Intelligence: From Psychometrics to the
Brain. Oxford: Oxford University Press.
Causes are complex
Chromosomal abnormality in Down syndrome produces many
changes in brain structure
We do not know which, if any, aspects of the currently-known
neurological phenotype causes the mental retardation found in Down
syndrome.
--Pennington, B. and Bennetto, L. (1998) Toward a neuropsychology of
mental retardation. In J. A. Burack, R. M. Hodapp, and E. Zigler (Eds.)
Handbook of Mental Retardation and Development. Cambridge: Cambridge
University Press.
Multiple disabilities are common
Many people with cognitive disabilities also have visual,
motor, auditory, or other challenges as well
Cognitive disabilities are hard to think about
We don’t have good ways to simulate cognitive
disabilities empathically. Here are two examples of difficult to
understand situations.
- A child can have imited short-term memory, but age-level
reading
- Sue Buckley,
Literacy in Language. In
Jean Rondal and Sue Buckley (Eds) Speech and Language
Intervention in
Down Syndrome. London: Whurr Publishers, 2003.
- The popcorn story: A young man is upset after an evening at
the movies because his friend bought the tickets, but wouldn't buy
popcorn. His mother points out that since he didn't have to buy his
ticket, he had enough money to buy popcorn. He understands the
suggestion, but did not think of it at the time.
- Trainer, M. (1991) Differences
in Common.
Rockville, MD: Woodbine House.
Despite the difficulties, conceptual frameworks are emerging
for cognitive technology
- person-oriented vs. environmentally oriented interventions
- Kirsch, N., Shenton, M., Spirl, E., Simpson, R.,
LoPresti, E., and
Schreckenghost, D. (2004) An assistive-technology intervention for
verbose speech after traumatic brain injury. J. Head Trauma
Rehabilitation, 19 (5) 366-377.
- Language & auditory reception, reasoning, learning
& memory, visual perception, cognitive speed, knowledge
& achievement
- Wehmeyer, M.L., Smith, S.J., Palmer, S.B., Davies, D.K.,
&
Stock, S. (2004). Technology use and people with mental retardation. In
L.M. Glidden (Ed.), International Review of Research in
Mental
Retardation (Vol. 29)(pp. 293-337). San Diego , CA :
Academic Press.
- Kinds of applications: communication, mobility, activities
of daily
living, education, employment, sports and recreation
Examples
- communication aids
- GPS-based location guides
- task prompting (daily or work)
- multimedia training for picking out cereal boxes
- single-switch-controlled video games
Possibilities are growing with technology
- Monitoring for verbose speech
- Now: by clinician, cuing via PDA
- Future: automated monitor?
- Extension to monitoring for profanity?
- Kirsch, Shenton, Spirl, Simpson, LoPresti, and
Schreckenghost, 2004, op. cit.
There is a small but lively industry
But volumes are low and prices therefore high
Needed:
Coopetition within assistive technology industry
With supporting standards,
e.g.
AIMS
Better interaction with mainstream technology
Example: Specifying information presentation preferences in
Single
System Signon
The vision: User can specify information presentation preferences on
the Web in a profile, in a single signon, and not have choose options
or express preferences at each site visited.
Standard is evolving for profile content: IMSGLOBAL
ACCLIP
This is being picked up by US Government e-Authentication project in
its USPerson schema
Progress will be aided by convergence of accessibilty needs and needs
for device independent presentation on the web:
At first, it may seem that the challenges being addressed
… are separate and distinct. On closer inspection it becomes
apparent that there are significant overlaps … .
--Device Independence, Accessibility and Multimodal Interaction. An
informative statement by the Device Independence Working Group in
advance of WWW2005
Example
Improved support for “Occasionally Connected
Computing” may simplify development for many assistive
applications
Standards are Crucial… for mainstream tech and for AT
[L]aws and standards are a driving force in the market for
accessibly designed products, as they set the standards and guidelines
for what must be done by the government and industry to accommodate the
needs of individuals with disabilities.
--Design for Inclusion: Creating a New Marketplace. Industry White
Paper, National Council on Disability, 2004
Cognitive assistive technologies have mainstream applications
Many conditions blur towards cognitive limitations
Stress, low literacy, effects of aging
The same “Plain Language” writing
techniques used to accommodate children who are deaf, people with
cognitive reading disabilities and users of English as a Second
Language (ESL) can reduce the cost to translate content into multiple
languages by as much as 30%.
--Steve
Jacobs, IDEAL Group (2004) http://www.ideal-group.org/wb_conference.htm
Rapidly-advancing language technology should be explored
Machine translation is now quite good
Techniques for text simplification could be developed
Manual editing is expensive
Automated methods could increase user independence
This technology would have many mainstream applications
Opportunity for innovative user interface architecture
To allow choice structures as well as interaction media to be
varied within an application
Allow tradeoff of number of choices per screen and number of screens presented in sequence
From technology to people…
The aspirations of people with cognitive disabilities are for
integration and self-determination in society
We have been prepared enough
ASK the people who are living in institutions
Would you trade places
Close institutions
Get us real jobs
Close sheltered workshops
Give US the money to live OUR lives
Money follows the person means it is OURS not programs
We have the right to make our own decisions
with or without the support from others
WE CAN RUN OUR LIVES
--Self
Advocates Becoming Empowered, Summit Statement
Historically, much of “cognitive disability” has
been socially imposed
What we usually understand to be an individual problem is
actually an interactional, or social, product.
--Mark Rapley, The Social
Construction of Intellectual Disability. Cambridge: Cambridge
University Press, 2004
Into at least the 1960’s it was generally assumed
that people with Down syndrome could not learn to read.
Our society is becoming more demanding cognitively
In the rural community, the mildly and moderately
intellectually handicapped had a task and were able to contribute to
the maintenance of the family.
--Ake Johansson, self advocate, in G. Dybwad and H. Bersani, Jr., New
Voices: Self-Advocacy by People with Disabilities. Cambridge, MA:
Brookline Books, 1996
[There is a] mismatch for at least some portion of our lives
between the complexity of the culture's "curriculum" and our capacity
to grasp it.
-- Robert Kegan, In over our heads: the cognitive demands of modern
life. Cambridge, MA: Harvard University Press, 1994
Can technology help create a more supportive social fabric?
Virtual exercise partners [Illinois-Chicago, Colorado]
Always on, unobtrusive communication?
Not based on text?
Social support systems
–43Things, PledgeBank
Things to Do
- Seek ways to shape and adapt mainstream technology
developments to serve the needs of people with disabilities
- Promote standards in assistive technology
- Reflect the interests of people with disabilities in all
tech
standards
- Work on architectures for adaptation
- Work on language technology
- Identifying significant content in documents
- Work on speech technology
- Monitoring affect and content
- Work on communication with images, not language
- Danielsson, H. and Jönsson, B. (2001)
Pictures as
Language. International Conference on Language and Visualisation,
Stockholm, Sweden, November 8 - 9.
- Develop social support technology for people with
disabilities
- Adapt models like ACT-R and SOAR to treat people with
cognitive disabilities
- Reduce the cognitive demands of career
education
- Include people with cognitive disabilities in user testing
panels
- And one more…Contribute to this forum, at
http://www.rerc-act.org/techforum.htm