We are on the verge of revolutionary change in health care delivery in the U.S., of the likes we have not seen in the last 50-75 years. And I believe physicians, the corresponding medical organizations, and the U.S. government are scared to death of these changes – because THEY will lose CONTROL! In fact, I think the U.S. government is more fearful than even of drug trafficking. And this revolution will come via new mHealth technologies & mobile apps.
Clearly, the U.S. government & industry have resisted changes to health care delivery. But mHealth apps will transition control of health care from the clinical setting/utilization review over to the patient as a consumer, and armed with many new customizable apps and combined with the power and offerings of the Internet. These new technologies and capabilities will enable Americans to be healthier, stronger, wealthier, happier, and more independent – and that just scares the crap out of you-know-who! These new technologies would also help make health care spending more transparent, and likely reveal huge amounts of spending wastes. And that too scares the crap out of you-know-who!
FDA and Congress would have us believe that they have been protecting our privacy through legislation such as HIPAA all along. But, I believe this has ever been about protecting our privacy. It’s been about stalling the capabilities and independence that mHealth would bring, and it’s transitioning control from the current clinical setting and utilization review, to a more transparent system that would give patient’s far more control and say so in their care.
With ObamaCare now coming into the fold in 2014, it will be interesting to see how these new features & coverages play into the new mHealth-concentric care model.
ABOUT ME: Began my career in 1976 as a nuclear imaging technologist, founded my own imaging company, and dev’d skills as a medical intuitive in 1981. Today I put on drum circles for the brain, and provide neurological monitoring & consults for the disorder hydrocephalus via my DiaCeph monitoring method I developed back in 1997.
I had also suffered a brain injury and CNS shunt placement in 1992, and have undergone 12 surgeries to date, with 7 of the devices that were used, and failed, not having been reported to FDA! In 1996, I had successfully petitioned FDA on several problem CNS shunt devices, then in 1997 designed & patented the DiaCeph Test, an early mHealth PDA app for hydrocephalus. Since then, I created many different AI methods for cognition & memory, and cognitive accessibility. I am also a writer & speaker. Based out of Newport Beach, California. Read More »
Proper Cognitive Accessible Designs, Usability, and UX Designs will become the most important functionality of Tech, Web Sites, Product Information, and Store Shelve Displays in the 21st Century. Knowledge will be KING! Does your Product’s Usability meet Mass Consumption?
This blog was originally written as part of a discussion I shared on LinkedIn.com. I shared it here on my blog in Nov. 2013 – and thought to provide an update March 20, 2017. So much is happening in the field of tech, web site, and product “usability” that I cannot begin to cover here. But I will share some recent frustrating tech challenges that raise both “usability” and “cognitive accessibility.” I really think we’ve crossed a threshold today, where going forward, the two will forever be intertwined. So if you didn’t understand cognitive accessibility and special needs designs before, you’re really going to feel lost now.
In a nutshell, about 40% of tech users and consumers have some level of cognitive challenge today, albeit thru a learning disability, neurological disorder, brain injury or concussion, drug & alcohol addiction problems, migraine disorders, or are simply aging. Baby-boomers may be the largest growing segment of the cognitive special needs population today, ranging in age from their early 50s to late 70s. This translates to increased attention and functionality on usability, UX design, and human factors understanding in everything from product design to user instructions, to site/app accessibility, to product packaging and displays on store shelves. It also transcends challenges posed by visual impairment and mobility. In this new millennia, Knowledge is King!
Design & Usability Challenges in Lottery Vending Machines
Let me share something as innocent as a poor design of a lottery machine. The images below came from one of my own adverse experiences recently with a new California Lotto vending machine. I had come to avoid trying to play my own lottery numbers on this machine after several frustrating encounters with it in my area grocery store. Then one evening, I was in a time crunch and thought I’d take another stab at it. But it whacked me upside my head again (figuratively). So I took photos of it and ran a user analysis of its design and display panel. My on-screen notes below are my conclusions. Note that this new machine also has a handicap accessible placard on it. Next, I compared it to its previous model. And below the photos, you will read what I concluded.
Here’s a close up of the vending machine’s operating panel.
And below, is the earlier California Lottery vending machine (circa 2012-13) which I have never had a problem using, yet it does not bear the “handicap placard.”
As to my theory on what went wrong in this newer design lottery vending machine bearing the handicap placard, I think it was designed by an individual in a “wheelchair,” because that is the only way a user would know when their ticket has printed (amidst all of its idiotic & disconnected steps). It is only through a low field of view that a user would know when their ticket printed. Anyone taller than say 4’6″ standing with three feet of the machine would never see the ticket deep in the tray – unless they could recall from a prior experience. You’d just keep trying fixes to make it print! This design renders this machine even a more horrible design for users with cognitive challenges.
What do I know about usability, cognitive accessibility, and human factors engineering?
From 1975 to 1992 I worked with (and was an expert) the most archaic poorly designed nuclear medical instruments. With my own company, Certified Nuclear Imaging, I worked in order 60 hospitals and imaging centers. Then in 1992, I suffered a head injury in an auto accident, and developed post traumatic hydrocephalus, ending up with 12 brain shunt operations today and 500-1000 shunt malfunctions over 25 years. But, if you count my sensory processing disorder (SPD) cognitive challenges from exposure to loud noise and multi-media that is everywhere around us, I’ve faced thousands of challenging cognitive situations over 25 years. One can get pretty innovative when you’re forced to live in a “virtual reality” world because of poor memory. So I came to design many different types of cognitive aides, and today am critical of the large numbers of inadequate web & app panels, user instructions, and the like.
My challenges led me in 1997 to design & patent a diagnostic monitoring app for CNS shunts used in the treatment of hydrocephalus to run on a PDA.
And a DiaCeph Test screenshot from about 2001 taken from a Power Point presentation.
My DiaCeph Test running on a PDA would have been one of the earliest mobile apps, for which I was labeled a “pioneer.” Unfortunately, money for start-ups like DiaCeph Inc. were hard to come by back then. But it led me into designing all kinds of assistive “cognitive” aids, solutions, researching cognition, and eventually usability – the precursor to today’s tech & user usable designs. For several years, I was in regular conduct with staff at Hewlett Packard as they had acquired Compaq and then were the top seller of PDAs, and scientists at the Coleman Institute in Colorado and others around the country. Unfortunately, they were focused on technology solutions for lower functioning individuals, and that just didn’t interest me. However, today we are able to merge this knowledge on human factors and usability.
My goal with my DiaCeph Test was to get patients with hydrocephalus to be able to operate the app by themselves – a huge challenge. So I continually played around with different design concepts. I never went back to school during all of this. But by 1999, I was being introduced as a “neuroscientist.” In 2003, when I couldn’t make a go of my DiaCeph Test, I made it available as paper forms & instructions, then got involved in music & drumming therapy, or “drum circles,” where I poured the next 10 years of my life into.
I’ve had many many amazing experiences and discoveries with drumming, like my popular blog on the Brain Science of Basketball. I’ll save this for another day. But I’ll share that being a drum circle facilitator teaches one a great deal about cognition and human behavior.
In 2011 or so, I created a Cognitive Neuroscience page on my main web site, which features many of my efforts in the neurosciences. However, it does not contain or index the many blogs I’ve written here (as my blogs are more recent). Feel free to scroll thru some of my published web pages and articles.
Let me share one more example of where poor usability crossed over into cognitive accessibility, this time in the Norton Security 2017 Deluxe renewal packet that I purchased from the Norton store on Amazon.com. Their 2017 renewal product came with the instructions for a new installation, which created 2-3 hours of frustration from incorrect install steps, that required a online support and a phone call to fix.
I’ve also had my cognitive and usability challenges with Amazon.com. However, here’s a nice screenshot I’d like to share on the usability of the “contact us” options at Ebay. This type panel and confusing OPTIONS is still the standard in so many large online retailers today.
And one of my favorite web accessibility panels we will someday see for TV programming, is Time Warner Cable‘s internet telephone panel for blocking telemarketers, that I predict someday and have added in graphic functionality the ability to block “unwanted loud TV commercials.” Hurrah!
And additional positive and futuristic usability is in my very popular blog on use of the eWeather HD App to manage migraines and headaches. Though I didn’t design the app, the migraine management application came out of my mHealth experiences with the DiaCeph Test for hydrocephalus. I have painstakingly done as much as I could the enable this weather app to be used as an mHealth app.
It was in 2013 amid so much frustration with tech and multimedia, that I researched and purchased the domain CognitiveAccessibility.org. Regrettably, I am yet to publish its own. It points to a “page” of that title on my main web site. In 2017, I still do all of my own web site publishing, tech, and social media work. And because of all this, I just haven’t found the time to make its own site. I already have 3 web sites, so this would involve publishing and managing a 4th. I haven’t really updated this page since 2013. But I think you’ll get the jist of what I’m trying to do. I believe the time is now to publish its own site, as usability has now crossed the threshold into cognitive accessibility. Tomorrow is now today!
What does the term, “Cognitive Accessibility” actually mean? Well, it means exactly as it sounds. It is defined as “reasonable” intellectual access to public places, things, and technology for persons with “cognitive” or “intellectual” disabilities, and from any number of etiologies (brain injury, learning disabilities, PTSD, developmental, aging).
Access means that the provider must undertake a reasonable amount of consideration & design preparation so persons with cognitive affected disabilities may understand and use the products. The prevailing law in this area comes under both the Americans with Disabilities Act, and Section 508 of the Rehab Act, but more in the latter, which holds specificity in access to web sites and somewhat in product user instructions.
Cognitive Accessible Designs would then be appropriate useful designs of web sites, product labeling, and instructions on products and premises that can reasonably be understood by persons with cognitive disabilities. The reason you haven’t that much about this thru the years is that up until more recently, it was difficult to ascertain what “reasonable & appropriate” designs were as the affected persons had such a broad spectrum of disability and aptitude. So designers didn’t know who & what level they were designing for.
But, over the last 10 years, several things have changed.
First, affected persons are more able to get out and about today thru revisions in social policy, educational, and work programs. Second, we have many in the military who have returned from combat with a spectrum of post TBI & post concussion disorders, and now we have far more awareness of it – as well as new research has become available. Thirdly, we have advances in, and much more availability of, cognitive aids, PDAs, mobile smart phones, etc. today, where many more people are using them, and this high usage is rapidly redefining cognitive accessibility parameters, where cognitive accessible designs are scrambling to keep up. Fourth, we have a significant age related “digital divide,” age 50-55 today, which is raising more and more challenges to our aging population, many of which are still computer illiterate. The tech industry resultingly left these 50M Americans out of consideration in their cognitive accessible designs. And now today, there is ever increasing on these Americans to learn to use tech. And fifth, lest not leave out the rising prevalence of dementias in our aging population. They have considerable cognitive disabilities, and their needs are yet to be met.
All said, there are a lot of Americans today with cognitive disorders. Most are out and about. Instructional designs have not kept up. And now we have a cognitive accessibility crisis!
I hope to get my CognitiveAccessibility.org site online soon. In the meantime, please visit our cognitive accessibility web page on our main web site: http://www.dollecommunications.com/cognitive_accessibility.htm One key emerging challenge lies in the cognitive accessibility of popular internet web sites like Google, Facebook, iTunes, and LinkedIn. Over the last few months, each of these sites have undergone a major update & redesign of their UI, or user interface. Each time a UI is changed, there is a new learning curve for the user. And where users have any medical condition, injury, or aging issue that limits the comprehension of the changes and architecture and subsequent use of the web site, we have a problem. And the problem(s) lie both in accessibility (cognitive), which are protected by disability law, and loss of productivity, which should be of major concern to employers & persons having to use such sites as part of their school or work.
In addition to cognitive accessibility and cognitive accessible designs, most web sites today still pose accessibility challenges due to the “digital divide,” that is, the educational exposure to technology by persons over the age of about 50 today. Such persons and internet users, not having grown up with or been schooled in technology, often find the Internet, tech, and mobile apps a significant challenge. And with so many of these being baby-boomers who have never fully adopted (if at all) the internet & tech boom of the last 15 years, web site and tech providers have a growing challenge. Now, add in the growing challenges of so many items on store shelves today, and the continual rearranging of products on store shelves, and stores and their products and packaging pose additional challenges in Cognitive Accessible Designs.
Take Target, for instance, who own 1700 stores nationwide. On average they rotate, introduce, relocate, or change the products on their store shelves several times per month. And after each change, customers have to re-familiarize themselves with location, product label, and missing/changed items. It presents ever-changing cognitive and visual challenges to shoppers. And if Target and other department stores, and product manufacturers, do not give ample attention to Cognitive Accessible Designs, you end up with a lot of confusion in stores, with lots of returns due to wrong items purchased. These experiences and added time/store visits then lower both accessibility and productivity.
Can you imagine how many man-hours across the U.S. in Target stores alone are at stake due to additional shopping time and lost customer & staff productivity in maintaining these shelves, and handling the many customer returns? The figure must be staggering. Yet, the trend in poor Cognitive Accessible Designs continues.
You’d think companies would want to get this right, to spend a little more time & money when they create these display designs. But these are largely new issues for most of us in the U.S. because of our mobile population, aging baby-boomers, and millions of Americans today with learning disabilities, autism, post brain injury, neurological disorders, and the like. We must address this. This is a matter of national productivity, and disability rights & accommodations!
I have written to several of the leading internet sites, but am yet to engage in any productive discussion yet. My web site suggestions thus far include:
1. When U.S. companies update their UIs and web sites, they should provide new instructions similar to that provided in “boxed” instructions, i.e. User instructions, A 1-page diagram of the site UI and architecture, and precautions & warnings for privacy & user settings.
2. Internet sites should adopt “UI standards” for display & site architecture as to how to set user privacy & notifications. Statistical data on affected internet users with brain and learning disorders requiring “Cognitive Accessible Designs” and protections under the American’s with Disabilities Act and Section 508 of the Rehab Act are considerable.
Some commonly affected disorders include:
1. Post TBI
2. Post brain tumor
3. Post stroke
4. Hydrocephalus, NPH
8. Post concussion disorder
9. Seniors w/ early onset of dementia
As web pages and web sites add more and more content and graphics, it makes the requisite design implications for cognitive accessible designs more and more critical. Recent updates and redesign of UIs including Apple, Norton, and LinkedIn, came without any notice or information that might have lessened the challenge for affected users needing to learn to use the updated UIs.
More than just issues with cognitive accessibility, Cognitive Accessible Designs also raise broad issues in Productivity and in the best use of our time. Clearly, as much as tech, web sites, smart phones, and super stores aid us in productivity, they’re resulting in our spending a huge amount of time trying to make them operational.
Cognitive Accessible Designs will become an increasing public & educational challenge for the U.S. in the years ahead. We’d be wise to commit sufficient resources to get this right.
I’ll continue this update this 2013 blog and hope to get a site up soon at CognitiveAccessibility.org.
ABOUT ME: I suffered a brain injury in 1992 w/ 12 brain shunt operations to date. Background in medical technology, the neurosciences, music & drumming therapy, and considerable insight into technology, AI use of technology, and cognitive accessibility. Work part time as a neuroscientist in music & drumming therapy, medical software/apps monitoring, and the neurosciences.
This blog discusses my disability rights complaint to the U.S. Justice Department Civil Rights Division, and request for a sound sensory accommodation from loud music and screaming broadcast all over my YMCA of Orange County fitness center where I was a member. I had been a member from 2007 to 2011. But it was in the later part of 2010 that a new fitness director was hired, who began putting on zumba classes with loud music and screaming, which was then broadcast all over the gym. Being exposed to this in the adjacent rooms then made me ill.
I undertook numerous remedies to bring a resolution to this. I was eventually asked WHY I couldn’t tolerate it, that loudness levels were within limits set my their national organiozation, and was told to where ear plugs when in the facility – which I tried for a while. But I kept having to take them out when a nearby member spoke to me. Other members (esp seniors) I was told discontinued their membership due to the unhealthful noise. Earlier in 2007, I had abandoned my 25 year membership at 24 Hour Fitness after they began playing loud overhead music. This YMCA gym could have, and should have, made the necessary accommodation I requested. In their ruling, DOJ rejected my complaint in its entirety and instructed me to seek other (esp. civil) remedies. In my opinion, both were legally and morally in the wrong! But there’s very little advocacy for SPD and sound sensory disabilities.
YMCA’s practices effectively barred me and other members with sensory processing disorder from using their fitness facility. The loud music and screaming gave me headaches, nausea, made me dizzy, and irritable – not unlike motion sickness. This is a known medical response for affected individuals to this type of sound sensory stimuli. And it gets better. After I filed my complaint to DOJ, the fitness director created a fake incident alleging I was disturbing other members, where I was told my membership was no longer good. I left and never returned!
Prior to filing my complaint with DOJ, I verbally and requested in writing to management for a change in their music broadcast policies. YMCA declinded to make any accommodation or modification. This was also after I had done volunteer work (music therapy) for this YMCA, and after others (affected seniors) had donated money.
It took DOJ two years to respond with a “no.” My complaint was filed with the “Disability Rights” division, who has jurisdiction over public and private facilities for disability rights accommodations. My complaint asked DOJ to draft new language of protections applicable to public and private venues across the U.S. where loud music or machinery poses unhealthful consequences to persons with neurological and sensory processing disorders.
Mostly what this YMCA needed do as an accommodation – was keep the door of the Zumba classroom closed. But management decided it more important to leave the door open, despite the room already having numerous open windows to the outside that brought in fresh air, and instead chose to broadcast the loud music and screaming through the rest of the facility.
Below is my complaint to DOJ and request for accommodation to the YMCA of Orange County, both of which were denied. These parties theated sound sensitivity and sensory processing disorder as though it were a “comfort” issue, rather than health issue.
A large segment of the U.S. population suffers from sensory processing disorderas a result of either autism, post TBI, PTSD, ADHD, hydrocephalus, post tumor, post stroke, Parkinson’s Disease, multiple sclerosis, migraine disorder, dementia, Alzheimer’s Disease, and more. Affected individuals become very sensitive to loud/erratic sound, from music, machinery, loud raucious TV commercials, and other types of sound which carries elements which are problematic to affected individuals. The affected Americans account for 15-20 percent of the population. These unhealthful sound levels for many, are often protected by years old standards of the decibel scale & chart below. But, these acceptable limits are coming under fire as I share further below.
The above chart has been coming under fire. OSHA, the primary authority over unhealthful sound in the workplace, still agrees with the more liberable interpretation above.
This next chart illustrates the decibel levels of common machinery.
Now we’re getting a little more current science with this next chart, which factors in reporting by persons exposed to what were thought of as otherwise safe decibel levels. And none of this yet takes into consideration the loss of sensory processing function by persons with neurological injury and disorders, and related SPD. When affected individuals are unable to tolerate these sound/noise levels, that raises ACCESSIBILITY to public and private facilities. Such facilities would include health clubs, restaurants, night clubs, churches, schools, malls, art & music venues and events, fairs, parks, and the like.
The image below illustrates the critical brain areas in volved in sensory processing.
In 2016, technology has made decibel meters available as mobile phone apps. I use the Smart Tools decibel app. However, what is needed is an app and new sound standard to measure the EQ mix of sound and its likely effect on sound processing. Such data would then lower the effective healthful range of sound.
In individuals such as myself, I will have good days and bad days, where my sound intolerance can vary and leave me in a pickle if I ignore the early warning signs. As an affected individual, you need to be aware at any given time of the status of your sensory intolerance, so you can make your optional adjustments as needed. However, there still needs to be new efforts in mitigating the hap-hazard broadcast of sound and noise as so many people are effected, with many more becoming affected who aren’t aware.
As for regulatory actions against noise, the only one that comes to mind is Congress 2012 ruling on the CALM Act – intended to prevent volume raising of TV commercials. But nothing has changed. Obnoxiously loud and ridiculous TV commercialscontinue on almost all channels. And on radio too. While the science in support of sensory processing disorder and affected neurological disorders exists, the U.S. government and DOJ have acted to deny the science, accommodations, and disability rights protections, while advocating for bizarre new and usual protections for special interests groups. I challenge those who deny this, to play such sounds at an official’s or company office. You will likely be thrown out! So WHY is this exposure OK for the general public? I discuss this in more detail in my 2015 blog on Tips and Information on sound related Sensory Processing Disorder below.
New sound standards and measurements must occur for there to be progress. There first needs to be a revision to current safe decibel scale, to revise it to reflect the health needs of persons with SPD disorders. Next, I am advocating a NEW decibel scale to include a “sound processing component” to account for how the human brain processes sound. Examples of difficult sounds are machinery with fast unbroken patterns, TV & radio commercials where a person is talking fast or screaming with music playing at full volume, and music with people screaming and yelling.
Since this blog was authored in 2013, I have added a new web page of information for sensory processing disorders and cognitive disabilities at CognitiveAccessibility.org, as well as several new blogs which I discuss below.
In 2015, I authored this important blog on tips and new information on sound related sensory processing disorder, or SPD, which includes updated supporting blogs and web content on this important subject. I am hoping to find the time and energy to build a complete web site for CognitiveAccessibility.org to advocate and share science on sensory processing disorder and cognitive disabilities. In this blog below, I also share some of my efforts with drumming and drum circlesthat can raise one’s level of intolerance, and improve over well being.
A most recent study of former NFL football players reports that they are on average 3 times more likely to die from Alzheimer’s, Parkinson’s, or Lou Gehrig’s disease than the general population. But, it shouldn’t surprise you based on what we know about health and longevity: take care of yourself when you are young, and you’ll likely appreciate better health in your later years.
That means, brush your teeth 1-2 times per day, eat your fruits and vegetables, don’t smoke, watch what you eat, get some exercise, don’t drink too much, limit your high risk behavior, and don’t bust yourself up.
I would have to argue that repeated blows to the head, as is common in football, goes against everything our parents and doctors told us from our youth. Though most of the attention of brain problems in football players until now focused on the condition CTE, or chronic traumatic encephalopathy, which is traced to repeated head blows. This new study looked at the three leading cause of disabilty and death among seniors.
As a youth, I suffered at least one known concussion when I was knocked unconscious during a football game. Over the years, I probably had one or more other concussions due to all the sports I participated in, including, boxing. But, it was a 1992 auto accident at the age of 37 that turned an initially viewed mild head injury and concussion, one month later into post traumatic hydrocephalus and 10 brain shunt surgeries since.
Since my 1992 injury from an auto accident, and with a health care and scientific background, I poured a great deal of my efforts into music therapy, balance & cognitive therapies, neurological testing & patenting of an AI type monitoring system, assistive cognitive technologies, hydrocephalus advocacy, FDA regulatory affairs, and now over the last seven years, drumming for your brain and health.
I believe I can say with absolute certainty that these mindful preparations and preventions will make a significant difference in your health and longevity. I feel bad for the athletes who have sustained multiple concussions and now are having long term neurological complaints. It is never too late to take on stricter controls over activities that affect your brain and health.
Exercise and challenge your brain today thru reading, art, music, and social activities! I have found termendous brain & health benefits from drumming, or drum circles, and today am a drum circle facilitator and speaker on drumming and the brain. I have undertaken research with drumming and sensory processing disorders, common in CTE, parkinson’s, post TBI, PTSD, autism, hydrocephalus, migraine, and many other neurological disorders. Check out my web site and Facebook page at http://www.dollecommunications.com
Remember also to eat right. Drink lots of water. Get proper rest. And watch what you put in your body, including, alcohol and/or drugs. If something seems like it might be bad for you, it probably is!