Designing Assistive Technologies for Context-Specific Communication for People with Aphasia in Novel and Real-World Settings

Obiorah, Mmachi God'sglory

doi:https://doi.org/10.21985/n2-qh3y-m005

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Designing Assistive Technologies for Context-Specific Communication for People with Aphasia in Novel and Real-World Settings

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This dissertation explores the design and evaluation of augmentative and alternative communication (AAC) technologies for people with aphasia. Humans use speech and language to communicate their thoughts and opinions as well as express their individuality, autonomy and agency (George Armitage Miller 1951; Ahearn 2001). Speech and language are important tools for social participation. This makes the impact of the loss of language and/or speech as a result of injury or stroke very significant. Aphasia is an impairment of language, affecting the comprehension and production of speech and language and the ability to read and write (“Aphasia Definitions” n.d.). People with aphasia are unable to participate in many social activities and this can lead to isolation, depression and emotional distress (Ross and Wertz 2003; Spaccavento et al. 2013). Augmentative and alternative communication (AAC) devices are a form of assistive technology designed to support people with aphasia or other speech/language disorders in communication. However, they are often abandoned by persons with aphasia for a number of reasons. First, they are unable to support communication in novel contexts and secondly, they are difficult to design because of the heterogeneity of presentations of aphasia. Researchers and designers of AACs have found it difficult to replicate the power of language, its ability to support clear expression and infinitely unique productions in different settings. In recent years, researchers have been able to improve AACs through the use of context awareness, machine learning, and artificial intelligence. Such improvements are especially promising for supporting relevant and subject-specific utterances in novel settings; however, their predictions are estimates that often require human involvement for final outputs that persons with language impairments are unable to give. In addition, communicative difficulties as a result of aphasia present uniquely in people with aphasia making many current AAC solutions unsuitable for a wide range of presentations. In this dissertation, I contribute to the design and research of AAC devices based on context awareness and a variety of digital / algorithmic approaches. The dissertation takes the form of three phases conducted over a period of 4 years. Through observations of people with aphasia during their therapy sessions and in other naturalistic settings and interviews aided by different prototypes, this study sought to understand how to design AACs for people with aphasia that support subject-specific productions in novel contexts. This study also revisits context awareness as a means to support communication for people with aphasia in novel contexts. Observation of therapy sessions revealed therapist practices that made them suitable communication partners for people with aphasia, the value of residual communicative competencies of people with aphasia to design and the need for AACs to support subject-specific productions and complex communication tasks. The prototypes used in this study supported interviews with people with aphasia and allowed me to explore different ways to incorporate therapists’ practices in AAC design as well as ways to exploit one’s context to support communication. This resulted in my selection of dining in restaurants as a suitably complex task for AAC design. Finally, learnings from the aforementioned research activities and observations of people with aphasia in restaurants informed the design of OrderEat, an AAC that allows people with aphasia to use specific vocabulary to order meals in new and unfamiliar restaurants. This design was also evaluated with a person with aphasia in a restaurant they were unfamiliar with and was able to support him in initiating conversation, exploring new and unfamiliar textual menus and discovering new words independently and in a timely manner. Overall, my research makes several contributions. First, I contribute a better understanding of how to use context awareness to support communication in novel circumstances. Second, I demonstrate how context awareness and therapists’ practices can result in designs that give more communicative control to people with aphasia. Third, I contribute knowledge on methods for designing research for persons with complex communication needs. Finally, I contribute an application, OrderEat, that supports people with aphasia to order meals in unfamiliar restaurants.

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