Evaluating the Usability of Three Accessible Smartphone Designs Among People with

Cerebral Palsy
Ricardo D. Ramirez, BA & Susan R. Magasi, PhD
University of Illinois at Chicago, Department of Occupational Therapy

INTRODUCTION MATERIALS AND METHODS (CONTINUED) RESULTS (CONTINUED)

• Due to rapid advances in digital and smartphone technology, the virtual context is Semi-structured Interviews: Participants’ design preference was in accordance with
increasingly important for both occupational therapy (OT) clients and practitioners; their satisfaction scores (see Chart 7). Participants reported a need for alternative
smartphones are often required in order to perform and participate in daily designs, including specialized touchscreens and enhanced voice activation with more
occupations and routines (AOTA, 2014). intuitive software.
• OT practitioners should embrace these technologies as clients can use them to Easier set up for Open Sesame was requested as Cara and Lily could not engage in
manage their health via new service delivery models such as telehealth and will any task with that smartphone design because their head could not be detected by
continue playing a critical role in everyone’s lives (Cason, 2015; Smith, 2017). the camera even with the auditor’s assistance.
• Technology availability and options should be considered when delivering
telerehabilitation services (Cason & Brannon, 2011). 100 Best Imaginable
• Occupation-related technologies can be used while working with people with Excellent
80
disabilities to enhance participation and quality of life (Smith, 2017). Figure 2. Sesame

SUS Score
Figure 1. Standard Figure 3. Open Good
• People with disabilities own and use mobile phones at a significantly lower rate Android phone with Connect Sesame
60
OK
than the general public; accessibility may be a factor (Morris, Jones, & Sweatman, accessibility features (operated via (operated via 40 Poor
2016). (SAPAC). joystick). head control). Worst Imaginable
20
• While smartphones designed for people with disabilities exist, there are not
evidence-informed guidelines to support recommendations of particular devices to RESULTS 0
people with physical disabilities. Participants had differing experiences with each of the smartphones and no device Mike (ambulatory Cara (wheelchair user) Lily (wheelchair user)
had overall greater usability over another. No participant successfully completed tasks participant)
using Open Sesame. Cara (wheelchair user) completed tasks only with the Android Android with accessibility features Sesame Connect Open Sesame
OBJECTIVE with activated accessibility features. Chart 7. Satisfaction scores for each smartphone by participant. SUS Adjective Scale from
Bangor, Miller, & Kortum (2009).
To evaluate the usability of three accessible smartphone designs for the daily use of
Accessing the Internet Taking a picture Sending a two-sentence text message
people with cerebral palsy to ensure that people with disabilities are matched with
Charts 1, 2, and 3. Measurements of effectiveness for each smartphone for each task completed
DISCUSSION
devices that best meet their needs.
by Mike (ambulatory participant), Cara (wheelchair user), and Lily (wheelchair user), respectively. • People with CP have a wide spectrum of needs and preferences for smartphones
that have not been fully addressed yet.
4 4 4 • Smartphones designed for the general disability community may not be the most
MATERIALS AND METHODS
META Score

usable or practical for people with cerebral palsy as effectiveness, efficiency, and
Design: Usability testing comparing efficiency, effectiveness and user satisfaction on 3 3 3 satisfaction need to be uniquely considered for each client.
each of three smartphones (see Figures 1, 2, and 3): 2 • OT practitioners should be aware of the range of accessibility options for
2 2
• Standard Android phone with accessibility features smartphone designs for people with CP, while also practicing in a client-centered
• Sesame Connect (operated via joystick) 1 1 1 manner to provide the client with a smartphone they can use for daily occupations
• Open Sesame (operated via head control) SAPAC Sesame SAPAC based on their usability.
SAPAC Sesame
Sample: Convenience sample of people with limited hand function secondary to Connect Connect
cerebral palsy (n = 3)
Protocol: Participants completed a series of three structured tasks with each
Chart 1. Mike’s effectiveness. Chart 2. Cara’s effectiveness. Chart 3. Lily’s effectiveness. CONCLUSIONS
smartphone, including: Charts 4, 5, and 6. Measurements of efficiency for each smartphone for each task completed by • There is not a universal smartphone design for people with CP.
1. Sending a two-sentence text message Mike (ambulatory participant), Cara (wheelchair user), and Lily (wheelchair user), respectively. • Smartphone developers must work to address the diverse needs of people with CP
2. Taking a picture by involving them and OT practitioners in the design process.
3. Accessing the Internet 360 120 540 • Accessible smartphone designs provide alternative modes of participation for
300 480 people with disabilities but further work is required in order to make these designs
Time (seconds)

Data Collection: As participants completed each tasks, a trained auditor evaluated the 420
three components of usability as defined by the International Organization for 240 more usable for people with CP.
360
Standardization (ISO): 180 300 • Future research should conduct additional usability testing on these designs with
60
• Effectiveness (Part A of the Management of Everyday Technology 120 240 other disability populations.
180
Assessment (META)) 60 120
• Efficiency (time required to complete each task) 0 60 ACKNOWLEDGEMENTS
• Satisfaction (Systems Usability Scale (SUS) and semi structured interview). 0 0 This project was approved by the Institutional Review Board at the University of Illinois at Chicago (UIC) (Protocol
SAPAC Sesame
Data Analysis: Given the nature of the data and small sample size, all data were SAPAC SAPAC Sesame #2017-0160). Partial funding was provided by the UIC Honors College Research Grant and infrastructure support from
Connect the Chicago Cancer Health Equity Collaborative (ChicagoCHEC) (Grant # U54CA202995, U54CA202997, U54CA203000).
analyzed descriptively using a comparative case study approach. Connect Special thanks to Laura VanPuymbrouck, PhD, OTR/L, Anders Kottorp, PhD, OT reg, Ed Hitchcock, OTR/L, and the Sesame
Chart 4. Mike’s efficiency. Chart 4. Cara’s efficiency. Chart 4. Lily’s efficiency. Enable Ltd. Phone Company.

Contact References
Ricardo D. Ramirez American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl.1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Bangor, A., Kortum, P., Miller, J. (2009). Determining what individual SUS scores mean: Adding an adjective rating scale. Journal of Usability Studies, 4(3), 114-123.
University of Illinois at Chicago Cason, J. (2015). Health policy perspectives—telehealth and occupational therapy: Integral to the Triple Aim of health care reform. American Journal of Occupational Therapy, 69, 6902090010.
http://dx.doi.org/10.5014/ajot.2015.692003
Email: rdramir2@uic.edu Cason, J., & Brannon, J. A. (2011). Telehealth regulatory and legal considerations: Frequently asked questions.
International Journal of Telerehabilitation, 3, 15–18. http://dx.doi.org/10.5195/ijt.2011.6077
International Organization for Standardization. (1998). Ergonomic requirements for office work with visual display terminals (VDTs) — Part 11: Guidance on usability (ISO/DIS Standard No. 9241-11:1998). Retrieved from https://www.iso.org/obp/ui/#iso:std:iso:9241:-11:ed-1:v1:en
Morris, J.T., Jones, M.L, & Sweatman, W.M. (2016). Wireless technology use by people with disabilities: A national survey. Paper presented at Annual International Technology and Persons with Disabilities Conference, Northridge, CA. Washington, DC: California State University.
Smith, R. O. (2017). Technology and occupation: Past, present, and the next 100 years of theory and practice (Eleanor Clarke Slagle Lecture). American Journal of Occupational Therapy, 71, 7106150010. https://doi.org/10.5014/ajot.2017.716003