Design of Mobile Wireless Technology for Individuals with Cognitive Impairments

RESNA 28th Annual Conference - Atlanta, Georgia

Vicki Haberman, Michael L. Jones, PhD, James L. Mueller, BID, MA

Shepherd Center, Crawford Research Institute, Atlanta, GA 30309


Using a human centered-design approach, a compensatory aid is being developed to support community re-entry for persons with cognitive impairments resulting from acquired brain injuries (ABI). With mobile wireless technology as a design platform, research in computer science and rehabilitation engineering is integrated with industrial design to explore the central concern: the design of a user interface that is understandable and operable by individuals with significant cognitive impairments. By testing an assessment device in the community, usability of the device interface in real-life situations is enhanced. It is expected that much of what is learned during this project will be applicable to enhancing the usability of a variety of mobile wireless technologies for users without disabilities.


cognitive prosthesis, mobile wireless technology, brain injury


Acquired brain injuries (ABI) result in functional and psychosocial changes where cognitive impairments are the most common and perhaps the most debilitating result. All brain injuries are unique with commonalities in the most prevalent cognitive consequences: memory, organization, attention, concentration, initiation, and task completion [1] . In addition to cognitive changes, emotional or behavioral problems emerge, stemming from an individual’s impaired ability to sense and perceive his or her surrounding environment and react appropriately [2] . Impaired sensation and perception impact an individual’s ability to perform the complex physical and intellectual activities of daily life, forcing reliance on others. Through the use of compensation methods, individuals are able to re-gain some independence, relieve caregiver burden, and move toward self-sufficiency [3] . It is through social support, including the environment and supportive devices, where design has the greatest impact on independence.

In September 2002 focus groups were held with individuals with ABI, their caregivers, and clinicians to help establish an explicit list of user needs. Held at the Side by Side Clubhouse in Decatur, Georgia, a meeting place for people with brain injuries to transition from medical patient to contributing community member, the conversations focused around difficulties individuals with ABI currently face. In addition to the techniques currently used to help compensate for injuries, the pros and cons of current electronic compensatory devices were discussed. Combining information from literature reviews, focus groups, observational research, and structured interviews, the need emerged for a mobile electronic device to assist in the support of individuals returning to the community following an ABI. The concepts that guide design for individuals without disabilities are insufficient to address the needs of individuals with a brain injury [3] . To ensure the addition of mobile technology provides an advantage over traditional compensatory methods, it is necessary to evaluate the human-device interface on an individual basis.

As handheld organizers came to market, they were modified for use as compensatory aids. Of note are devices based on the Pocket PC platform including: the Planning and Execution Assistant and Trainer (PEAT), an electronic calendar and address book designed to increase independence [4] , The Jogger, a mobile prompting and cuing device [5] , and Pocket Coach [6] , a verbal prompting device . While each of these devices has strengths, each has limited interaction modalities and does not permit self-evaluation and selection of a preferred method.


The design for a small screen on a handheld device brings challenges. There are two conflicting design goals [7] ; fast access to all functions and visual simplicity. Some guidelines for interfaces and the use of telecommunications products by individuals with cognitive impairments exist [8, 9] but require expansion to the use of mobile, hand-held products in real-life environments. To evaluate the preferred input and output modalities for an individual with an ABI, the hardware and software of a mobile wireless handheld, the Hewlett Packard iPaq 5455, was customized for use in a series of structured exercises. The exercises were conducted in real-life situations including both visually crowded and physically crowded environments where the effects of noise, glare, weather, and other factors were assessed. The user was expected to keep track of the device throughout the half-day exercise by using his/her own carrying method or choosing a provided option.

The full assessment included an initial briefing with the participant and his/her caregiver, device training sessions including a sample task exercise, three task exercises, a time-out period, a reminder request, and a debriefing. Though accompanied by a researcher acting as “caregiver”, the user was asked to accomplish all tasks while interfacing only with the device. Device navigation is broken down into three main areas, “OK” signifying completion and moving forward in the interface, “Help” signifying the need for additional information, and “Reminder” signifying the need to input information on-the-go.

The reminder section is conceptually separated from the task exercises and is designed to be accessible throughout the series of three exercises. During a pause in the program, the research assistant asks the user to remember a request. At the end of the assessment exercise, this prompt is used to determine whether or not the individual was able to remember the request and use the device to help in the task. By accessing the “Help” menus, the user is guided through a series of hints ending with the ability to request help from the “caregiver”. If the user fails to ask the “caregiver” when necessary, it is an indication that he/she may have difficulties if alone in the community, and further evaluation is necessary.


During summer 2004, twenty participants completed the assessment exercise including the device trainings and half-day exercise. During the training exercises, the researcher and participant selected appropriate input and output interaction modalities as well as determined a preferred method for carrying the device. By conducting the assessment in “real-life” rather than in a lab, unexpected situations arose including: travel route accessibility, background noise, and participant impulsivity. The knowledge gained through these situations increased the understanding of user needs and device specifications.

Initial data analysis examined participants’ progress during device training, completion of each task, success during reminder exercise, and thoughts on device usage. Through this analysis, three areas for improvement emerged: hardware, software, and training. It was found that modifications to all three areas could enhance the distinctions between the functions of “OK”, “Help”, and “Reminder”. Using the feedback and analysis as a guide, minor changes were made to the protocol including: modifying the four-way navigation button to enhance feedback and control, adding a transparent cover to the “Help” button giving it a physical distinction, and creating a training dialogue stressing the differences between the three navigation areas. In December 2004, five participants assessed the modified device. There were marked improvements to both the physical and cognitive aspects of using the device and navigating the prompts.


By combining a full analysis from the second round of testing, the additional hardware, software, and training areas marked for improvement will be combined to help form a set of guidelines for designing mobile wireless devices for individuals with cognitive impairments. Upon completion of the project, results will be distributed to mobile device designers and manufacturers to impact the usability of mobile technologies. As technology continues to evolve, aspects of the original protocol, previously constrained by limits of technology, will be revisited in hopes of implementing them during the next phase of research. It is expected that knowledge from the interface modality investigations coupled with new technology will lead to further developments and refinement to guidelines. By continuing to develop these guidelines to increase the usability of handheld devices for individuals with cognitive impairments, it is expected that products will also become more accessible for individuals without disabilities.


The researchers would like to extend a special thank you to the members of the Side by Side Clubhouse. This is a publication of the Rehabilitation Engineering Research Center on Mobile Wireless Technologies for Persons with Disabilities, which is funded by the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education under grant number H133E010804. The opinions contained in this publication are those of the grantee and do not necessarily reflect those of the U.S. Department of Education.


  1. Types of Brain Injury . (2004). April 1, 2004.
  2. Page, T.J., The Road to Rehabilitation Companion Guide: Part 4 Behavior. 1998, Brain Injury Association.
  3. Bergman, M.M., The necessity of a clinical perspective in the design of computer prostheses. The Journal of Head Trauma Rehabilitiation, 1991. 6 (2): p. 100-104.
  4. Levinson, R., The Planning and Execution Assistant and Trainer (PEAT), in The Journal of Head Trauma Rehabilitiation. 1997, Attention Control Systems, Inc.
  5. The Jogger System .
  6. AbleLink Technologies . (2004).
  7. Bergman, E., ed., Information Appliances and Beyond : Interaction Design for Consumer Products. Morgan Kaufmann series in interactive technologies. 2000, San Francisco: Morgan Kaufmann Publishers.
  8. Francik, E., et. al., Telecommunications Problems and Design Strategies for People with Cognitive Disabilities: Annotated Bibliography and Research Recommendations. 1999, World Institute on Disability.
  9. Vanderheiden, G. and K.R. Vanderheiden, Accessible Design of Consumer Product - Guidelines for the Design of Consumer Products to Increase their Accessibility to People with Disabilities or Who are Aging. 1992, University of Wisconsin-Madison.

Author Contact Information:

Vicki Haberman
Shepherd Cente
Crawford Research Institute
2020 Peachtree Rd., NW
Atlanta, GA 30309
Ph: (404) 350-7397