Enhancing Internet Access for People with Disabilities

Robert J Seiler, Antonette M Seiler and Judy M Ireland
East Vic Professional Therapies

A system was designed to establish a systematic method to introduce the Web to clients who have physical disability, are housebound, elderly, or are cognitively impaired. A touchscreen and "kiosk type" Web-browser were used to assist in overcoming various physical or cognitive hurdles.
It provides an objective tool, the "Awareness and Assessment Protocol" (AAP), which takes the client through graded steps allowing professional documentation of various abilities - fine motor, linguistic, cognitive, and perceptual - while at the same time slowly introducing concepts such clicking on buttons, hypertext and Web navigation.
An "Enhanced Web Station" (EWS) provides an interactive tutorial which extends the awareness component, and then allows the client to access and browse the Web from a familiar base.

Clinical trials show that the AAP predicted whether a client could independently use the Web and highlighted the nature of additional support that was required. The touch screen and simplified Browser allowed all clients to experience the Web without reporting feelings of confusion.

Introduction

Recent studies have shown that older adults, especially those with disability, are likely to be disadvantaged as electronic networking becomes more widespread in Australia (1). People with disability may require additional "enablers" to effectively access the Internet (2) as their particular physical or cognitive problems impinge upon their ability to cope with existing computer hardware and software. Specific difficulties encountered include the coordination required to use a mouse, the cluttered unfamiliar choices on a normal Web browser and Web navigation concepts.

The EIA (Enhancing Internet Access) system (3-5) was designed to combine a touchscreen and a simplified Web browser interface with a method which allows clients to "experience" the Web in a sympathetic, non-threatening way. It provides a tool to predict whether a client's visual, cognitive, physical and language skills are sufficient to use the Web, and highlights the additional support required to allow access which is appropriate to the skills and interests of an individual.

The guiding design principles were that the tool should be based upon the principles of Speech Pathology and Occupational Therapy assessment procedures. It would however, use a computer and resemble the Web since those traditional paper-based assessment methods may have less relevance to the skills needed. Clients should not be overwhelmed or experience failure in their attempts. Hence, the tool developed uses simple, uncluttered design, slowly moves toward more typical Web screens, and incorporates both awareness and assessment activities. It provides a well documented, objective assessment and allows therapists who are perhaps unfamiliar with the Internet to offer the Web as a rehabilitation option for clients. This paper summarises the components of the EIA package and documents clinical trials with six clients.

Materials and Methods

The EIA System

The EIA consists of three components, all operating in a simplified Web browser and touchscreen interface.

The Awareness and Assessment Protocol (AAP) is a clinical, predictive tool designed to assess a client's disability and its likely impact on Web use, and also to offer an introductory Web experience. It consists of the following activities:
- Welcome screen Used to orientate and position client
- Touchscreen warmup Familiarises client with the touchscreen and allows introduction of modifications
- Visual field Assesses visual field competency
- Touch accuracy Assesses accuracy when touching on-screen symbols
- Visual discrimination Assesses a range of visual perceptual skills
- Visual memory Assesses ability to remember icons and symbols
- Touch/click practice Introduces concepts of hot spots and rudimentary navigation
- Reading single words Assesses reading and comprehension of single words
- Reading sentences Assesses ability to read increasingly complex sentences
- Reading paragraphs Assesses ability to read and comprehend paragraphs and hypertext-like menus
- Text links Introduces more of the concepts of hypertext and Web navigation
- Reading hypertext Assesses comprehension of material presented in different hypertext formats
The Enhanced Web Station (EWS) includes an interactive tutorial to introduce the required Web concepts for people who are unfamiliar with computing, and "push button", kiosk style Web browser. The tutorial activities include:
- Getting started Explains the tutorial method
- What is the Internet? A brief overview of the Internet and the World Wide Web
- The home page Illustrates the home page concept and the Browser home button
- The back button Moves forward or back through linked screens with the Browser back button
- Pages & scrolling Illustrates pages larger than the screen using Browser scroll buttons
- Hypertext links Uses 3 local "sites" to illustrate increasingly complex hypertext links
- Frames Illustrates frames and user responses in different parts of the screen
- On-screen forms An on-screen "popup" keyboard allows form completion of different field types
- Connect to the Web Loads a familiar home page with a link to the EIA Website
An EIA Web Site which supports the AAP/EWS materials with specialised links to clinical and illustrative Web sites. It also allows searching, URL requests and selection from a set of "favourites".

Clinical Procedure

The AAP was initially administered to 13 male and female volunteers to obtain an indication of normal responses for accuracy and time. Ages ranged from early 20's to mid 60's.
Six new adult clients were selected to represent a broad range of physical, cognitive and linguistic disabilities. None had previous familiarity with the Internet, but some had limited experience with computers. For each client background details, including disability, educational background and social situation were recorded, and the AAP was administered using typical assessment procedure. Then followed (within 2-4 weeks) a single session covering the EWS tutorial, and two monitored sessions of independent Web browsing. In the monitored sessions the therapist provided assistance and prompting as required, and documented all aspects of the client's use of the Web
The ability of the AAP to predict a client's use of the Web and to indicate the additional support required was reviewed.

Results

The individual client AAP scores for accuracy and time, together with normal ranges, are listed in Table 1. The following are summaries of AAP Outcomes, Predictions and the Monitored Web Sessions for each client.

Client 1.
21 yrs. Completed Yr 12. Acquired quadriplegia, C5-6. Wheelchair dependent. Normal language and memory. Requires typing splint. AAP Outcomes: Touch accuracy normal. Visual skills slightly below mean. Reading skills accurate, but slightly slow for complex reading. AAP Predictions: Requires careful screen adjustment. Small targets will be difficult. Needs encouragement. Has the visual, cognitive and reading skills to be independent. Monitored Sessions: Minimal or no prompting for menu bar, hypertext, navigation and searching. Never "got lost".

Client 2.
53 yrs. Completed Yr 7. Acquired incomplete paraplegia, T10. Uses wheelchair. Normal language and memory. AAP Outcomes: Touch accuracy perfect with quick times. Visual and reading skills within normal range. Slower reading complex material. AAP Predictions: No physical difficulties. Will be independent, i.e. will read menus and make choices from searches. Likes quick successes and may become frustrated. Monitored Sessions: Independently used menu bar, hypertext, navigation and searching. No confusion. Tended to give up on a search if not successful.

Client 3.
37 yrs. Completed Yr 9. Incomplete paraplegia, L1. Mild head injury. Normal language. Mild premorbid reading and spelling problem. AAP Outcomes: Touch accuracy normal. Visual discrimination and reading comprehension accurate, but slow. Difficulties on complex visual memory. Mild reading problem demonstrated. AAP Predictions: Will use touch screen, read menus, and make choices following search. May get confused and will take longer to process and make decisions. Monitored Sessions: Low level of prompting needed for most navigation functions. Decreased response initiation. Low level support needed for decision making.

Client 4.
57 yrs. Completed tertiary and research level. Degenerative neurological condition. Moderate to severe receptive, expressive language and memory disorder. Colour blind and visual problems. AAP Outcomes: Normal touch accuracy but slow. Below normal range for all visual and reading skills. Slowed processing skills. AAP Predictions: Can use touch screen. Language and memory disorder will prevent independent use. Reading better for familiar topics. Would function with simple "favourites" lists. Monitored Sessions: Used most menu bar functions. Independent with hypertext. Moderate to high support needed for searches and choice making. More independent with reading familiar topics.

Client 5.
20 yrs. Attended special school. Mild intellectual impairment and visual disorder. Speech normal. Language functional for daily needs and supervised work environment. AAP Outcomes: All tasks except touch accuracy were slower. Inaccurate visual memory. Could not comprehend paragraphs and complex text. AAP Predictions: Can use touch screen. Needs positioning of monitor for visual disorder. May become confused, due to decreased visual memory and reading comprehension. Monitored Sessions: Accurate with touch screen. Low level prompting needed for hypertext and navigation. Moderate level support needed for reading and choice making. Would be operative with "favourites".

Client 6.
24 yrs. Attended regular school with support. Moderate intellectual disability. Physical in-coordination affecting walking and hand movements. Speech largely unintelligible. AAP Outcomes: Touch accuracy and visual tasks all below normal for accuracy and speed. Able to read single words, but unable to read and comprehend sentences and paragraphs. AAP Predictions: Impaired touch accuracy. Will need high support for reading menus and navigation. Will not be independent. Monitored Sessions: Errors in accuracy. Moderate to high prompts needed for navigation, reading and decision making. Enjoyed music, graphics and interactive nature of Web. Could use simple "favourites" lists.

Table 1. AAP Results (Accuracy and Time) for 6 Clients

Exercise Client Number Normal Range

Task Set 1 2 3 4 5 6 Mean Std dev

Visual Field 1 A 9 9 9 9 9 9 9 0.0

2 A 9 9 9 9 9 8 9 0.0

3 A 9 9 9 7 9 9 9 0.0

Touch Accuracy 1 A
T 9
10 9
9 9
11 9
19 9
12 9
18 9
10 0.0
2.9

2 A
T 9
9 9
9 9
12 9
20 9
14 7
27 9
9.5 0.0
2.4

3 A
T 7
12 9
10 9
12 9
21 9
17 4
18 8.5
11.6 1.3
2.4

Visual Discrimination 1 A
T 7
51 7
29 9
48 7
110 8
79 7
83 8
40.5 0.8
13

2 A
T 9
47 9
65 9
53 6
126 8
67 3(6)
66 8.3
55.2 1.0
22.7

3 A
T 9
37 9
40 9
49 7
117 9
85 5(7)
84 8.7
45.2 0.5
19.1

Visual Memory 1 A
T 5
78 7
70 9
72 6
92 7
83 6(7)
84 7.8
61.8 1.1
24.4

2 A
T 9
115 8
107 7
127 5
150 5
124 6
107 8.4
107.9 0.8
8.7

3 A
T 8
117 9
95 7
111 6
146 6
115 4
104 8.2
104.8 1.2
11.1

Reading Words 1 A
T 9
28 8
19 8
33 8
39 9
41 8
55 9
21.6 0.0
6.9

2 A
T 9
28 9
18 9
34 9
40 9
34 9
60 9
18.4 0.0
5.3

3 A
T 9
27 9
24 9
23 9
44 9
37 9
40 8.9
21.2 0.3
6.8

Reading Sentences 1 A
T 9
97 9
89 9
134 7
122 8
101 4
556 9
65.0 0.0
21.9

Reading Paragraphs 1 A
T 4
83 5
67 5
108 1
81 4
71 1
210 4.8
52.7 0.4
33.1

2 A
T 5
58 5
86 5
126 5
102 3
116 -
- 4.5
56.5 0.5
31.2

3 A
T 5
160 5
120 4
249 2
113 2
140 -
- 4.2
83.3 0.8
25.2

Reading Hypertext 1 A
T 5
101 5
77 5
180 4
68 5
108 -
- 5
62.8 0.0
42.5

2 A
T 5
68 5
58 3
151 3
102 3
84 1
194 4.7
50.5 0.5
19.0

3 A
T 3
159 4
153 5
218 4
93 1
82 -
- 4.7
75.4 0.6
49.6

4 A
T 4
142 5
175 4
231 2
99 1
110 -
- 4.4
82.4 0.8
38.6

Exercise	Client Number	Normal Range
Task	Set	1	2	3	4	5	6	Mean	Std dev
Visual Field	1	A	9	9	9	9	9	9	9	0.0
2	A	9	9	9	9	9	8	9	0.0
3	A	9	9	9	7	9	9	9	0.0
Touch Accuracy	1	A T	9 10	9 9	9 11	9 19	9 12	9 18	9 10	0.0 2.9
2	A T	9 9	9 9	9 12	9 20	9 14	7 27	9 9.5	0.0 2.4
3	A T	7 12	9 10	9 12	9 21	9 17	4 18	8.5 11.6	1.3 2.4
Visual Discrimination	1	A T	7 51	7 29	9 48	7 110	8 79	7 83	8 40.5	0.8 13
2	A T	9 47	9 65	9 53	6 126	8 67	3(6) 66	8.3 55.2	1.0 22.7
3	A T	9 37	9 40	9 49	7 117	9 85	5(7) 84	8.7 45.2	0.5 19.1
Visual Memory	1	A T	5 78	7 70	9 72	6 92	7 83	6(7) 84	7.8 61.8	1.1 24.4
2	A T	9 115	8 107	7 127	5 150	5 124	6 107	8.4 107.9	0.8 8.7
3	A T	8 117	9 95	7 111	6 146	6 115	4 104	8.2 104.8	1.2 11.1
Reading Words	1	A T	9 28	8 19	8 33	8 39	9 41	8 55	9 21.6	0.0 6.9
2	A T	9 28	9 18	9 34	9 40	9 34	9 60	9 18.4	0.0 5.3
3	A T	9 27	9 24	9 23	9 44	9 37	9 40	8.9 21.2	0.3 6.8
Reading Sentences	1	A T	9 97	9 89	9 134	7 122	8 101	4 556	9 65.0	0.0 21.9
Reading Paragraphs	1	A T	4 83	5 67	5 108	1 81	4 71	1 210	4.8 52.7	0.4 33.1
2	A T	5 58	5 86	5 126	5 102	3 116	- -	4.5 56.5	0.5 31.2
3	A T	5 160	5 120	4 249	2 113	2 140	- -	4.2 83.3	0.8 25.2
Reading Hypertext	1	A T	5 101	5 77	5 180	4 68	5 108	- -	5 62.8	0.0 42.5
2	A T	5 68	5 58	3 151	3 102	3 84	1 194	4.7 50.5	0.5 19.0
3	A T	3 159	4 153	5 218	4 93	1 82	- -	4.7 75.4	0.6 49.6
4	A T	4 142	5 175	4 231	2 99	1 110	- -	4.4 82.4	0.8 38.6

Conclusions

The AAP, combined with the client background details, was successful in predicting whether a client would be able to use the Web independently.

The visual field assessment highlighted severe visual disorders, and milder forms were confirmed in the other visual assessments (visual memory and visual discrimination)
The results of the visual memory activity was an indicator of how easily a client would "get lost" on the Internet. Those clients who made errors when time delay and a distracting screen were introduced into the memory task, needed more prompting during the monitored sessions, and at times did not realise they had viewed the material previously.
The assessment of reading comprehension indicated whether a client would be able to read menus, make choices resulting from a search, and interpret and make inferences from information in non-standard format such as a table. Those clients with problems comprehending sentences were able to make some menu choices using words, were more successful making choices from icons, and tended to select Web pages which contained high graphic content or music. Those clients who were within normal range on the reading tasks were totally independent by the end of the two monitored sessions.
The EIA method using a touchscreen and modified browser with clinical and training components was a successful way to introduce the Web.
The touchscreen was widely usable, and could be combined with special placement, finger splints or pointers where necessary.

The browser simplifications enabled clients to quickly experience the Web without needing first to learn "how to use the computer".

For those clients who had severe reading, language or cognitive impairments, simple "favourite" lists allowed them to access familiar sites with confidence .
All clients reported that they enjoyed their experience, and felt the system was easy to use.

References

Williamson K et al."Older People and the Internet" .Link-up Mar 1997 p9-12
Wolstenholme R and Stanzel J. "Communications Technology: Information and Access Issues for People with Disabilities". National Disability Research Agenda. Report No 1 Nov 1997 p15-17
Seiler R et al. Enhanced Internet Access for the Disabled (EIAD). Proceedings of the Third Australian Conference on Technology for People with Disabilities. 1997. p226-228.
Seiler R et al. Enhancing Internet Access for the People with Disabilities. In Press. Elsevier Press. Proceedings of the 7th International World Wide Web Conference 1998.
Enhancing Internet Access for People with Disabilities. Web site. http://www.elr.com.au/eiad

Acknowledgments

This project was funded by the "Online Public Access Initiative" 1997, a federal initiative of the Australian Department of Communications and the Arts.
The authors are grateful for assistance provided by Ann Guy and Kathy Woodward, East Gippsland Arts and Recreation Access Group Inc.