New Mobile and Web Usability based upon Cognitive Accessibility Designs

Cognitive Accessibility accommodations er CognitiveAccessibility.org

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.

Prosperity is based on sound information.

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.

My Critique on Usability & Accessibility of this CA Lotto 2016 Vending Machine in my area Pavilions Grocery Store

Here’s a close up of the vending machine’s operating panel.

Critique of Usability & Accessibility of this CA Lotto 2016 Vending Machine in my area Pavilions Grocery Store

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.”

Critique on Usability & Accessibility of earlier 2012-13 CA Lottery Vending Machine in an area Liquor Store

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.

Original DiaCeph Test slide and software panel

And a DiaCeph Test screenshot from about 2001 taken from a Power Point presentation.

DiaCeph Test Hydrocephalus App Clinical Markers

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.

mHealth Technology, are we there yet?
Stephen Dolle invented his DiaCeph Test following his 1996 FDA petition that was then used to direct this 1998 shunt surgery

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.

Stephen Dolle speaking on STEM3 Educational Techniques with Drums and Rhythm at Wright State University in 2011.

Sports Science vs the Brain Science of Basketball

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.

Great Brain Anatomy Image

Cognitive Neuroscience page at Dolle Communications

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.

Incorrect Installation Instructions for Norton Security 2017 Deluxe Renewal hurt its Usability and posed unnecessary Challenges with Cognitive Accessibility.

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.

The Contact Us options at Ebay Online Retailer provides way too many Contact Options, raising Usability and Cognitive Accessibility Challenges

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!

Time Warner Cable’s Internet Telephone Web Panel for screening Telemarketing Calls may someday allow users to screen Loud TV Commercials.

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.

Blog on use of eWeather HD App for Management of Migraine

And finally, my blog on my DiaCeph Test as a mobile app.

DiaCeph Test hopes to be a mHealth Mobile App

Mobile App for Hydrocephalus improves care and medical outcomes worldwide

CognitiveAccessibility.org

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!

Cognitive Accessibility.org
Cognitive Accessibility.org

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.

The poor Cognitive Accessibility of the Colgate Toothpaste section at this Target store in Fountain Valley, CA, will make anyone’s head spin.

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

5. Autism

6. ADHD

7. PTSD

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.

Please contact me per the information below.

Stephen Dolle

Email: contact[at]dollecommunications[dot]com
http://www.DolleCommunications.com
Newport Beach, CA

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Mobile Sound Level apps Helpful in Managing Sensory Processing Disorder

Android Apps Image
Android Apps

Decibel meter apps are helpful in managing the ill effects of sound exposure in brain injury, hydrocephalus, ADHD, PTSD, and related sensory processing disorders. Sound Meter is best app on Android. The Pro version is $.99. Though either is good. SPLnFFT is said to be best app on iPhone. Many are accurate enough for these purposes. Plus, what you really need, is comparative analysis of sound to medical sequela in the same app.

The science in support of monitoring sound level exposure comes amid findings that “sound” can trigger medical sequela, and result in a combative child or even adult out in public. The sequela typically ares headache, nausea, decreased cognition, irritability, and behavioral outbursts, and occurs in persons suffering from a variety of neurological injury & disorders. Light, motion, and scents are also triggers. The sensitivity, and type of trigger, does vary somewhat from person to person.

The medical condition for this is termed “sensory processing disorder” or SPD, and sometimes termed “sensory integration disorder,” and these tend to follow brain injury, neurological surgery (numerous ones including hydrocephalus and tumor), and many types of neurological disorders.

Brain Diagram of the Cranial Nerves
Brain Diagram of the Cranial Nerves

At any given time, the effected person is vulnerable to a range and type of sound triggers. Yet, this sensitivity and vulnerability often may not be known until AFTER the exposure. Often all it takes is 30 secs of problematic sound exposure to set off a sequel of SPD complaints. Then, you’re dealing with a medical problem.

Certainly the big ones like loud machinery, music, and room noise are predictable. But it is the not so loud and obvious exposures that’ll get you. And NOT knowing at any given time what your sensitivity or threshold is. And this comes from trial & experience.

I recommend downloading one of these apps and using it regularly for a couple of weeks to learn of your LOWEST threshold decibel levels – for when you’re not feeling well, and for various venues. Then, you can do things with more confidence in that you know your thresholds and can take the necessary interventions SOONER to avoid an ill spell or “melt down” in public. Today I learned too late, after being near a store playing loud overhead music. It was registering over 80 db on my Sound Meter app. I had not checked the sound level when I arrived. Once your system is triggered, it is often too late for other interventions or measures, and you’re likely going to have to leave that venue.

Unfortunately, current apps do not measure frequency distribution or sharp spikes in sound. Sound between 5000 Hz – 10,000 Hz is often problematic for individuals suffering with SPDs. The other causative elements includes sharp spikes in decibel level, and disordered sound presenting as “white noise.” If you, or a family member, suffers from sensory processing disorder, you know what I mean.

I undertook a sound sensory study in 2002 using a metronome to evaluate SPD complaint responses to various rhythmic patterns, and I was able to show that the component in sound most responsible for SPD complaints was “lack of rhythmic pattern.” My findings explain why white noise, or room noise, is so problematic. Read my full study below:

Study on Sound, Cognition and Sensory Processing

Boss BR-8 includes a full 50 selection Metronome
Boss BR-8 includes a full 50 selection Metronome

There are many treatments today that have found varying degrees of success in raising a person’s threshold to SPDs. They include: EMDR therapy, music therapy, group drumming (in which I have conducted research), bio feedback, mindfulness, basketball, meditation, occupational therapy. A variety of mild barbiturate medicines find use as well. I can’t say enough about the importance of proper rest & diet, managing stress, and drinking plenty of water. Vestibular exercises, meditation, mindfulness, and biofeedback therapies seem to help raise an affected persons sound intolerance.

New Dolle Communications Web Page on Cognitive Neuroscience

The brain and sensory system during cognition.
The brain and sensory system during cognition.

Once an exposure and SPD medical sequel has begun, your options include:

1) have the individual stay focused & “engaged” in an activity

2) insert quality ear plugs (suggest musician’s ear plugs)

3) remove the affected person from the triggering noise source

4) administer barbituate, pain or calming medication

5) force hydration preferable with water

On June 4, 2015, I published an extensive blog on basketball – which includes methods in shooting baskets, mindfulness, biofeedback & relaxation, and including drumming with basketball – which helps the brain, movement disorders, intolerance to sound, post concussion syndrome, and relieves stress.

(Dolle Blog) Sports Science vs Brain Science of Basketball

Basketball allows participants to feel and move rhythmically with a touch sensitive ball
Basketball allows participants to feel and move rhythmically with a touch sensitive ball

Understanding Sound Sensory Processing & your Intolerance Level

If you suffer from sound sensory processing difficulties, I suggest you try one of the available decibel meter apps. I use the Smart Tools Pro Sound Meter pictured below. It also has a built in Vibrometer to evaluate motion say on a boat or car. You need to become familiar with your sound threshold range and intolerance, and screen typical levels at places you visit. You’ll need to add further consideration if there is machinery or other problematic noise that the individual would normally not process very well. All it takes is 30 secs of a problematic sound exposure to set off a sequel of SPD complaints. Develop good rules of practice.

Decibel Meter by Smart Tools
Decibel Meter by Smart Tools

Call for a Sound Sensory Processing Scale & Algorithm of Measurement

The decibel sound scale is now more than 50 years old. Its time we create a Sound Processing Scale & Algorithm for Measurement
The decibel sound scale is now more than 50 years old. Its time we create a Sound Processing Scale & Algorithm for Measurement

The current challenge is that these apps only measure level of volume. What we need, is a sound distribution EQ scale to equate how the brain processes sound (along with volume), which would require a convening of neurologists to scientists study this relationship, and establish a new sound scale to include the difficulty of processing of sound distributions. Sound engineers already know a great deal about the distribution or EQ of sound. To establish a sound processing scale, we would only need to equate various EQ sound patterns with the level of difficulty of processing by the brain. There are already sound identification apps that can identify patterns in music and ID them by song name. Two very popular apps are Soundhound and Shazam. We could use these existing sensors and algorithms to ID sound as very unforavorable vs acceptable in terms of ability to be processed by the brain. Persons with brain injury, learning and neurological disorders, and SPD (sensory processing disorder) have a diminished capacity to process sound, which I believe pares the degree and location of deficits in the brain. So, I have proposed the development of a sound processing scale and algorithm.

This new sound processing scale would encompass:

1. decibel volume and rate of change between volume levels (i.e. spikes)

2. EQ frequency distribution of the sound

3. rhythmic distribution and synchronization of the sound (i.e. white noise)

I host a larger blog on sensory processing challenges with examples of problematic sounds of machinery, etc. Just follow the link below.

(Blog) New Insights in Sound Sensory Processing Disorder

If any app developers are reading this, I’d love to collaborate with you on building an SPD intollerance sound EQ app for screening of problematic sound. I can advise scientifically and in the UI (user interface, I have a good tech bkg-see page below). I’d like to couple an app with a Melon or NeuroSky EEG headband to try and correlate changes on EEG waveform with reported SPD complaints. SEE my extensive work in hydrocephalus monitoring and DiaCeph Test app design.

ADA laws with respect to sound protection for persons with SPDs is termed “cognitive accessibility.” There is an interesting legal case between families of children with autism and Disney, regarding Disney’s cancellation of the handicap pass to circumvent affected visitors standing in long lines, thereby forcing affected children to stand in line amid commotion and noise, which is unhealthful and can trigger behavioral outburst and a number of medical sequela in SPDs.

Deadline.com: Disney sued by Families with Autism over Handicap Pass

Cognitive Accessibility in SPDs.Hulk Destroys Tree Shredder
Cognitive Accessibility in SPDs.Hulk Destroys Tree Shredder

I am advocating for a new sound processing standard to encapsulate the brain’s role in processing sound. Persons suffering neurological disorders and from SPDs have a diminshed capacity to process sensory information, sound being the most common issue.

I host a related web page on sensory processing and cognitive or intellectual disabilities at www.CognitiveAccessibility.org.

Please visit my web site and contact me accordingly. Best method of contact is email.

Stephen Dolle
Neuroscientist, mHealth Inventor & Drum Circle Facilitator
Email:  contact[at]dollecommunications[dot]com
Hydrocephalus Survivor w/ 12 Shunt Revisions
DolleCommunications.com