Touch or click friendly: Towards adaptive user interfaces for complex applications

This study evaluated the usability of a direct manipulation device (touchscreen) vs. indirect manipulation devices (mouse and touchpad) on the selected Microsoft (MS) Word tasks as per ISO-9241-11 standard. MS Word was taken as an example of a complex application. The tasks were evaluated in terms of touch-friendly or click-friendly using efficiency, effectiveness, and satisfaction parameters to propose a customized task menu. The experiment was conducted with fifty-four participants, divided into three MS Word usage-based expertise groups. Each participant performed fifty-six tasks using a mouse, a touchpad, and a touchscreen. To assess task-level usability, individual one-way ANOVAs were performed for each task to gauge both efficiency and effectiveness. It's worth noting that the touchscreen significantly outperformed other input methods in just one specific task regarding effectiveness. Consequently, an ANCOVA was employed, with task completion time as the independent variable and the number of errors as a covariate, to further investigate effectiveness. A total of 19 (34%) of the total tasks were found to be significantly efficient with a mouse, while 21 (37.5%) were significantly efficient with a touchscreen. Based on the results, a customized menu is recommended for MS Word-like applications that combine actions in touch-friendly tasks and mouse-friendly tasks separately.

Measurement System for Unsupervised Standardized Assessments of Timed Up and Go Test and 5 Times Chair Rise Test in Community Settings—A Usability Study

Comprehensive measurements are needed in older populations to detect physical changes, initiate prompt interventions, and prevent functional decline. While established instruments such as the Timed Up and Go (TUG) and 5 Times Chair Rise Test (5CRT) require trained clinicians to assess corresponding functional parameters, the unsupervised screening system (USS), developed in a two-stage participatory design process, has since been introduced to community-dwelling older adults. In a previous article, we investigated the USS’s measurement of the TUG and 5CRT in comparison to conventional stop-watch methods and found a high sensitivity with significant correlations and coefficients ranging from 0.73 to 0.89. This article reports insights into the design process and evaluates the usability of the USS interface. Our analysis showed high acceptance with qualitative and quantitative methods. From participant discussions, suggestions for improvement and functions for further development could be derived and discussed. The evaluated prototype offers a high potential for early detection of functional limitations in elderly people and should be tested with other target groups in other locations.

Meta-analysis of the effects of game types and devices on older adults-video game interaction: Implications for video game training on cognition

Video game training can effectively improve the cognition of older adults. However, whether video game types and game devices influence the training effects of video games remains controversial. This meta-analysis aimed to access and evaluate the effects of video game types and game devices in video game training on the cognition of older adults. Interestingly, results indicated that mouse/keyboard was superior over other video game devices on perceptual-motor function. The effect size (Hedge's g) for perceptual-motor function decreased by 1.777 and 1.722 when the video game training device changed from mouse/keyboard to driving simulator and motion controller. The effects of cognitive training game and conventional video game were moderated by session length. More well-designed studies are required to clarify the unique efficacy of video game types and devices for older adults with video game training.

A Comparison of Touchscreen and Mouse for Real-World and Abstract Tasks with Older Adults

Computer technology is increasingly being used to facilitate the timely identification of cognitive impairment in older adults. Our Cognitive Testing on Computer (C-TOC) project aims to develop a self-administered online test for older adults to take at their home. Due to the freedom of devices they can use, it is important to investigate whether different input devices can impact test performance. We compared touchscreen and mouse input on both abstract and real-world pointing and dragging tasks: classic Fitts’s Law tasks and tasks drawn from C-TOC. The abstract and real-world tasks were designed to require equivalent motor skills. Our research goals were to determine (1) if performance on computerized cognitive tasks are affected by input device, and (2) if performance differences due to input device can be explained by those observed on Fitts’s Law tasks. Sixteen older adults completed both types of tasks using a touchscreen and a mouse. We found that input device affected speed on three out of four cognitive tasks while only affecting accuracy on one task. Secondarily, our results suggest that Fitts’s Law results of differences in mouse and touch cannot be used to predict device differences in the performance on C-TOC tests. As an additional research goal, we looked into the movement patterns of one real-world dragging task—the C-TOC Pattern Construction task—to see if they could provide richer performance measures, beyond speed and accuracy. Such measures could compensate for the lack of a clinician observer who is typically present in comparable paper-based cognitive tests. We found that older adults naturally adopted different movement patterns on the two devices: they tended to make shorter moves and a greater number of moves on a touchscreen than with a mouse. Altogether, our results suggest that careful device-based performance calibration will be needed in computerized tests.

Digital neuropsychological assessment: Feasibility and applicability in patients with acquired brain injury

INTRODUCTION

Digital neuropsychological assessment (d-NPA) has several advantages over paper-and-pencil tests in neuropsychological assessment, such as a more standardized stimulus presentation and response acquisition. We investigated (1) the feasibility and user-experience of a d-NPA in patients with acquired brain injury (ABI) and healthy controls; (2) the applicability of conventional paper-and-pencil norms on digital tests; and (3) whether familiarity with a tablet would affect test performance on a tablet.

METHOD

We administered a d-NPA in stroke patients (n = 59), traumatic brain injury patients (n = 61) and healthy controls (n = 159). The neuropsychological tests were presented on a tablet and participants used a pencil stylus to respond. We examined the completion rate to assess the feasibility, and a semi-structured interview was conducted to examine the user-experience. The applicability of conventional norms was examined by the number of healthy controls performing <10^th percentile, which was expected to be no more than 10%. The effect of tablet familiarity on test performance was examined with a regression-based model.

RESULTS

Overall, 94% of patients completed the d-NPA. The d-NPA was considered pleasant by patients and healthy controls. Conventional norms that exist for paper-and-pencil tests were not applicable on the digital version of the tests, as up to 34% of healthy controls showed an abnormal performance on half of the tests. Tablet familiarity did not affect test performance on a tablet, indicating that participants who were more experienced with working with a tablet did not perform better on digital tests.

CONCLUSIONS

The administration of a d-NPA is feasible in patients with ABI. Familiarity with a tablet did not impact test performance, which is particularly important in neuropsychological assessment. Future research should focus on developing norms in order to implement a d-NPA in clinical practice.

A computerized, self-administered test of verbal episodic memory in elderly patients with mild cognitive impairment and healthy participants: A randomized, crossover, validation study

Introduction

Performance of “Revere”, a novel iPad-administered word-list recall (WLR) test, in quantifying deficits in verbal episodic memory, was evaluated versus examiner-administered Rey Auditory Verbal Learning Test (RAVLT) in patients with mild cognitive impairment and cognitively normal participants.

Methods

Elderly patients with clinically diagnosed mild cognitive impairment (Montreal Cognitive Assessment score 24–27) and cognitively normal (Montreal Cognitive Assessment score ≥28) were administered RAVLT or Revere in a randomized crossover design.

Results

A total of 153/161 participants (Revere/RAVLT n = 75; RAVLT/Revere n = 78) were randomized; 148 (97%) completed study; 121 patients (mean [standard deviation] age: 70.4 [7.84] years) were included for analysis. Word-list recall scores (8 trials) were comparable between Revere and RAVLT (Pearson's correlation coefficients: 0.12–0.70; least square mean difference [Revere-RAVLT]: −0.84 [90% CI, −1.15; −0.54]). Model factor estimates indicated trial (P < .001), period (P < .001) and evaluation sequence (P = .038) as significant factors. Learning over trials index and serial position effects were comparable.

Discussion

Participants' verbal recall performance on Revere and RAVLT were equivalent.

Effects of cursor freeze time on the performance of older adult users on mouse-related tasks

This study determines the optimum range of cursor freeze time (CFT) for basic target acquisition tasks. The effect of five levels of CFT was measured on double-clicking, clicking, and drag-and-drop operations, along with the inconvenience perceived by users at these levels. Older adult users find these standard mouse operations challenging because of slipping and accidental cursor movement. In this study, 24 older adult participants (13 males and 11 females) performed the abovementioned tasks repeatedly across five levels of CFT (0, 200, 400, 600, and 800 ms) and rated their perceived inconvenience at each level. CFT was found to have a significant effect on the three basic target acquisition tasks as well as the inconvenience perceived by participants. Performance on the drag-and-drop task was negatively influenced when the CFT was increased from 600 to 800 ms. The analysis suggests that a CFT of 200-400 ms is the optimum range for improved performance on the tasks.

Assessing the use of immersive virtual reality, mouse and touchscreen in pointing and dragging-and-dropping tasks among young, middle-aged and older adults

This study assessed the use of an immersive virtual reality (VR), a mouse and a touchscreen for one-directional pointing, multi-directional pointing, and dragging-and-dropping tasks involving targets of smaller and larger widths by young (n = 18; 18-30 years), middle-aged (n = 18; 40-55 years) and older adults (n = 18; 65-75 years). A three-way, mixed-factorial design was used for data collection. The dependent variables were the movement time required and the error rate. Our main findings were that the participants took more time and made more errors in using the VR input interface than in using the mouse or the touchscreen. This pattern applied in all three age groups in all tasks, except for multi-directional pointing with a larger target width among the older group. Overall, older adults took longer to complete the tasks and made more errors than young or middle-aged adults. Larger target widths yielded shorter movement times and lower error rates in pointing tasks, but larger targets yielded higher rates of error in dragging-and-dropping tasks. Our study indicated that any other virtual environments that are similar to those we tested may be more suitable for displaying scenes than for manipulating objects that are small and require fine control. Although interacting with VR is relatively difficult, especially for older adults, there is still potential for older adults to adapt to that interface. Furthermore, adjusting the width of objects according to the type of manipulation required might be an effective way to promote performance.

Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics

BACKGROUND

With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge.

OBJECTIVE

The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research.

METHODS

Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases.

RESULTS

According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies.

CONCLUSIONS

Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

Role of information and communication technology in promoting oral health at residential aged care facilities

Information and communication technology (ICT) can provide knowledge and clinical support to those working in residential aged care facilities (RACFs). This paper aims to: (1) review literature on ICT targeted at residents, staff and external providers in RACFs including general practitioners, dental and allied health professionals on improving residents’ oral health; (2) identify barriers and enablers to using ICT in promoting oral health at RACFs; and (3) investigate evidence of effectiveness of these approaches in promoting oral health. Findings from this narrative literature review indicate that ICT is not widely used in RACFs, with barriers to usage identified as limited training for staff, difficulties accessing the Internet, limited computer literacy particularly in older staff, cost and competing work demands. Residents also faced barriers including impaired cognitive and psychosocial functioning, limited computer literacy and Internet use. Findings suggest that more education and training in ICT to upskill staff and residents is needed to effectively promote oral health through this medium.

Virtual reality and neuropsychological assessment: The reliability of a virtual kitchen to assess daily-life activities in victims of traumatic brain injury

Traumatic brain injury (TBI) causes impairments affecting instrumental activities of daily living (IADL). However, few studies have considered virtual reality as an ecologically valid tool for the assessment of IADL in patients who have sustained a TBI. The main objective of the present study was to examine the use of the Nonimmersive Virtual Coffee Task (NI-VCT) for IADL assessment in patients with TBI. We analyzed the performance of 19 adults suffering from TBI and 19 healthy controls (HCs) in the real and virtual tasks of making coffee with a coffee machine, as well as in global IQ and executive functions. Patients performed worse than HCs on both real and virtual tasks and on all tests of executive functions. Correlation analyses revealed that NI-VCT scores were related to scores on the real task. Moreover, regression analyses demonstrated that performance on NI-VCT matched real-task performance. Our results support the idea that the virtual kitchen is a valid tool for IADL assessment in patients who have sustained a TBI.

Performance of the CogState computerized battery in the Mayo Clinic Study on Aging

INTRODUCTION

The feasibility and validity of brief computerized cognitive batteries at the population-level are unknown.

METHODS

Nondemented participants (n = 1660, age 50-97 years) in the Mayo Clinic Study on Aging completed the computerized CogState battery and standard neuropsychological battery. The correlation between tests was examined and comparisons between CogState performance on the personal computer (PC) and iPad (n = 331), and in the clinic vs. at home (n = 194), were assessed.

RESULTS

We obtained valid data on greater than 97% of participants on each test. Correlations between the CogState and neuropsychological tests ranged from -0.462 to 0.531. Although absolute differences between the PC and iPad were small and participants preferred the iPad, performance on the PC was faster. Participants performed faster on Detection, One Card Learning, and One Back at home compared with the clinic.

DISCUSSION

The computerized CogState battery, especially the iPad, was feasible, acceptable, and valid in the population.

Visuomotor Control in Continuous Response Time Tasks across Different Age Groups

The goal was to examine whether visuomotor control and choice response time shared age-related developmental trajectories, and if prior computer experience played an important role in control processes. Children (6–7, 8–9, 10–11 yr.), younger adults (24 yr.) and older adults (76 yr.) performed the cursor pointing and choice response time (CRT) tasks with a computer mouse. Participants moved the mouse cursor back and forth to click two targets on the screen as fast and accurately as possible. In the CRT, based on visual stimuli, participants moved and clicked one of the three targets on the screen as fast and accurately as possible; the time between stimulus onset and clicking the correct target was recorded as the choice response time. Visuomotor performance increased with age to younger adulthood but was worse in the older adult group. CRT performance was also positively related to age among the groups of children, with scores leveling off in the young adult group. Computer experience was statistically significantly related only to visuomotor control, but not to CRT. Optimal CRT performance required only sub-optimal visuomotor control. Cognitive and sensory age declines may be related to the poorer CRT performance in the oldest age group.

Computerized neuropsychological assessment in aging: testing efficacy and clinical ecology of different interfaces

Digital technologies have opened new opportunities for psychological testing, allowing new computerized testing tools to be developed and/or paper and pencil testing tools to be translated to new computerized devices. The question that rises is whether these implementations may introduce some technology-specific effects to be considered in neuropsychological evaluations. Two core aspects have been investigated in this work: the efficacy of tests and the clinical ecology of their administration (the ability to measure real-world test performance), specifically (1) the testing efficacy of a computerized test when response to stimuli is measured using a touch-screen compared to a conventional mouse-control response device; (2) the testing efficacy of a computerized test with respect to different input modalities (visual versus verbal); and (3) the ecology of two computerized assessment modalities (touch-screen and mouse-control), including preference measurements of participants. Our results suggest that (1) touch-screen devices are suitable for administering experimental tasks requiring precise timings for detection, (2) intrinsic nature of neuropsychological tests should always be respected in terms of stimuli presentation when translated to new digitalized environment, and (3) touch-screen devices result in ecological instruments being proposed for the computerized administration of neuropsychological tests with a high level of preference from elderly people.

Detecting everyday action deficits in Alzheimer's disease using a nonimmersive virtual reality kitchen

Alzheimer's disease (AD) causes impairments affecting instrumental activities of daily living (IADL). Transdisciplinary research in neuropsychology and virtual reality has fostered the development of ecologically valid virtual tools for the assessment of IADL, using simulations of real life activities. Few studies have examined the benefits of this approach in AD patients. Our aim was to examine the utility of a non-immersive virtual coffee task (NI-VCT) for assessment of IADL in these patients. We focus on the assessment results obtained from a group of 24 AD patients on a task designed to assess their ability to prepare a virtual cup of coffee, using a virtual coffee machine. We compared performance on the virtual task to an identical daily living task involving the actual preparation of a cup of coffee, as well as to global cognitive, executive, and caregiver-reported IADL functioning. Relative to 32 comparable, healthy elderly (HE) controls, AD patients performed worse than HE controls on all tasks. Correlation analyses revealed that NI-VCT measures were related to all other neuropsychological measures. Moreover, regression analyses demonstrated that performance on the NI-VCT predicted actual task performance and caregiver-reported IADL functioning. Our results provide initial support for the utility of our virtual kitchen for assessment of IADL in AD patients.

Effects of Target Expansion on Selection Performance in Older Computer Users

Point and click interactions using a mouse are an integral part of computer use for current desktop systems. Compared with younger users though, older adults experience greater difficulties performing cursor positioning tasks, and this can present limitations to using a computer easily and effectively. Target expansion is a technique for improving pointing performance where the target grows dynamically as the cursor approaches. This has the advantage that targets conserve screen real estate in their unexpanded state, yet can still provide the benefits of a larger area to click on. This article presents two studies of target expansion with older and younger participants, involving multidirectional point-select tasks with a computer mouse. Study 1 compares static versus expanding targets, and Study 2 compares static targets with three alternative techniques for expansion. Results show that expansion can improve times by up to 14%, and reduce error rates by up to 50%. Additionally, expanding targets are beneficial even when the expansion happens late in the movement, that is, after the cursor has reached the expanded target area or even after it has reached the original target area. The participants’ subjective feedback on the target expansion are generally favorable, and this lends further support for the technique.

Investigation of the performance of trackpoint and touchpads with varied right and left buttons function locations

This study investigates the relationships of the following 5 factors with commonly-used task patterns: 4 (2 existing and 2 newly-designed) built-in cursor input devices of notebook PCs, usage experiences, genders, sensitivity of cursor movements, and 5 tasks of input applications (including click, drag-drop, click-select, select-drag-drop, and type-select-click). This experiment reveals that there are significant differences among these factors in the operating times and/or error rates of particular tasks. Although somewhat influenced by the task patterns, the results show that the touchpad with the cursor-tracking pad located on the bottom-center and the right and left buttons on the bottom-left beneath the keyboard, which avoids ulnar and radial deviation and hindrance of text-entry-pointer-manipulation switching, leads to higher performance and preference, while the trackpoint leads to lower performance and preference. In addition, the touchpads with sensitivity values of 10 and 12 for cursor movement are preferred over those with the value of 8.

Design of an interactive digital nutritional education package for elderly people

Designing a system for the elderly is crucial, as aging is associated with physiological changes that may impair perception, cognition and other social aspects; therefore, many aspects need consideration, especially in interface design. This study was conducted to develop a digital nutritional education package (WE Sihat) by following appropriate guidelines for elderly people to achieve better design interface and interaction. Touch-screen technology was used as a platform for user interaction. The nutritional content was based on previous nutrition studies and a lifestyle education package on healthy aging, which contains four modules. The questionnaires were distributed to 31 Malay subjects aged 60-76 years old, containing an evaluation about the overall content, graphics, design layout, colour, font size, audio/video, user-perceived satisfaction and acceptance levels. The findings showed positive feedback and acceptance. Most subjects agreed that the digital nutritional education package can increase their nutritional knowledge for a healthy lifestyle and is easy to use. The touch-screen technology was also well accepted by elderly people and can be used as a kiosk for disseminating nutrition education for healthy aging.

Enhancing computer self-efficacy and attitudes in multi-ethnic older adults: a randomised controlled study

Several studies have documented the health-related benefits of older adults' use of computer technology, but before they can be realised, older individuals must be positively inclined and confident in their ability to engage in computer-based environments. To facilitate the assessment of computer technology attitudes, one aim of the longitudinal study reported in this paper was to test and refine a new 22-item measure of computer technology attitudes designed specifically for older adults, as none such were available. Another aim was to replicate, on a much larger scale, the successful findings of a preliminary study that tested a computer technology training programme for older adults (Laganà 2008). Ninety-six older men and women, mainly from non-European-American backgrounds, were randomly assigned to the waitlist/control or the experimental group. The same six-week one-on-one training was administered to the control subjects at the completion of their post-test. The revised (17-item) version of the Older Adults' Computer Technology Attitudes Scale (OACTAS) showed strong reliability: the results of a factor analysis were robust, and two analyses of covariance demonstrated that the training programme induced significant changes in attitudes and self-efficacy. Such results encourage the recruitment of older persons into training programmes aimed at increasing computer technology attitudes and self-efficacy.

Advanced practice registered nurse usability testing of a tailored computer-mediated health communication program

This study tested the usability of a touch-screen-enabled Personal Education Program with advanced practice RNs. The Personal Education Program is designed to enhance medication adherence and reduce adverse self-medication behaviors in older adults with hypertension. An iterative research process was used, which involved the use of (1) pretrial focus groups to guide the design of system information architecture, (2) two different cycles of think-aloud trials to test the software interface, and (3) post-trial focus groups to gather feedback on the think-aloud studies. Results from this iterative usability-testing process were used to systematically modify and improve the three Personal Education Program prototype versions-the pilot, prototype 1, and prototype 2. Findings contrasting the two separate think-aloud trials showed that APRN users rated the Personal Education Program system usability, system information, and system-use satisfaction at a moderately high level between trials. In addition, errors using the interface were reduced by 76%, and the interface time was reduced by 18.5% between the two trials. The usability-testing processes used in this study ensured an interface design adapted to APRNs' needs and preferences to allow them to effectively use the computer-mediated health-communication technology in a clinical setting.

Usability testing by older adults of a computer-mediated health communication program

Failure to adhere to an antihypertensive regimen and interactions between antihypertensives and other medicines represent serious health threats to older adults. This study tested the usability of a touch-screen-enabled personal education program (PEP). Findings showed that older adults rated the PEP system usability, system usefulness, and system-use satisfaction at a moderately high level for prototype-1 and at an exceptionally high level for prototype-2. A 201.91% reduction in interface errors and a 31.08% decrease in interface time also were found between the two trials. This participatory usability design was highly successful in tailoring its program interface design to accommodate older users to enhance their health communication and technology use efficacy.