Persons with cognitive disabilities experiment with a new way to participate in the digital economy

Posted on Tuesday, August 10, 2021

Author: Prof. Lundy Lewis and Prof. Andre Vellino

Past Fulbright Research Chair, ISSP, uOttawa
Professor of Computer Information Systems, Southern New Hampshire University

Faculty Affiliate, ISSP
Associate Professor, Faculty of Arts, uOttawa

The Government of Canada established an Accessible Technology Program (2017 – 2022) to foster inclusive participation of Canadians with disabilities in the digital economy. The Program aims to allow Canadians with disabilities to obtain better access to digital services and increase their participation in the digital economy as well as providing Canadians with the necessary skills and tools required to engage socially online, or assist them in their work and educational environments while also enhancing their employability and marketability.

Under this program, the Minister of Innovation, Science and Economic Development Canada provided a financial contribution to the ISSP to develop and test smart voice technology as a way for persons aged 18 to 64 with a cognitive disability or mental health-related disability (CMD) to engage with digital services more easily. The rationale is that laptops, tablets, smartphones, not to mention the services they provide, can be overwhelming and thus frustrating for this target population. Smart voice technology such as Alexa, Siri, and Google Home on the other hand possibly can provide better access.

The project ran from May 1 2020 to September 1 2021. In our roles as members of the ISSP, we collaborated with a social enterprise, led by Virginie Cobigo from the uOttawa Faculty of Social Sciences—Open Collaboration for Cognitive Accessibility (Open). The mission of Open is to provide a platform for technology developers, accessibility specialists, researchers, businesses, and public organizations to collaborate with persons of all cognitive abilities and co-create solutions for an inclusive community. To this end, Open provided ISSP with baseline requirements, recruitment of testers, and data collection.

The Amazon Echo Dot (a.k.a. Alexa) was the base platform due to its programmability and affordability. We set a self-imposed limit of $50 CAD as the price of the solution, excluding an Internet connection. At the time of this writing, the Echo Dot Generation 3 is $40 and the Generation 4 is $45. 

Open recruited twenty-four Advisors in Cognitive Accessibility (4 Francophone, 7 Anglophone, 13 bilingual; 10 female, 14 male) aged 18 to 64 with a cognitive disability. They were given Echo Dots free of charge to use in their environments, plus installation instructions and guidelines for testing and exploration. Two advisors were given a Dot with a screen (Echo Show 5) because they could not communicate verbally. After a month of use, each advisor was interviewed up to 4 times or until they were able to articulate likes, dislikes, intentions, and any new ideas they had for improving the Dot applications. Video recordings of interviews with advisors and/or caregivers were collected for offline analysis. 

Our examination of these interviews yielded the following observations and recommendations:

All the advisors liked the experience and the use of Alexa, even if some were limited to very basic uses. They found value in the Dot for a variety of reasons:

  1. The performance of simple information-retrieval tasks by asking common questions such as “what time is it?”, “what is the weather tomorrow?”, “how many days until my birthday?” 
  2. Serious question-answering such as health-related questions like "I can't sleep" or "I feel sick" or "I have a fever"
  3. Setting reminders (e.g. to take medicine, attend meetings, wash hands every hour and walk through “routines”, a list of tasks at a specified time of day)
  4. Setting alarms
  5. Playing music
  6. Telling jokes and having fun, (e.g “will you marry me?”) 
  7. Serving as a social companion (in one case, a Francophone advisor who was experimenting with an Echo Dot Show, which also has a display screen, used it as an educational tool to learn arithmetic)

The views of their caregivers were consistent with these assessments. Caregivers found the Dot useful as a tool to assist in routine support (e.g. providing consistent, periodic reminders of routine tasks). Further, they found the Dot to be a more safe and trustworthy environment than laptops, tablets, and other devices. No specific concerns were raised regarding invasion of privacy or exploitation. Finally, we observed that neither the type of cognitive disability nor the age impacted the use of the Dot; rather, the level of communication skills and digital literacy skills impacted its use. In some instances, a mixed-mode (voice-screen) method of interaction is preferable to a voice-only mode.

Given the affordability, simplicity, and potential value of the Dot for our target population, we recommend that the Dot be made available to persons aged 18 to 64 with a cognitive disability, albeit with the following considerations to help set expectations:

  • Although the Dot can understand and speak both Canadian French and English, it is better at understanding English. For either language, we recommend saying “Alexa, learn my voice” upon which the Dot will ask 5 common questions. The answers are used as a baseline to help the Dot understand the speaker’s voice and begin to learn the nuances in the voice over time.
  • For persons with a speech impairment but with good verbal comprehension, an effective use of Alexa is as an assistant to the caregiver who can program alarms, schedules, and routines.
  • While the Dot is fairly straightforward to use and learn and the documentation we provided for setting up the devices and experimenting with them were adequate, we believe that introductory video tutorials that illustrate the range of tasks that the Dot can perform would further enhance the experience. These tutorials could include instructions to ask questions as simply as possible, (e.g. “Alexa chanson”, “Alexa rappel”, “Alexa temperature”).
  • Often people with the Dot will use the word “Alexa” in ordinary conversation, thus inadvertently triggering a response from Alexa. Other people might have trouble saying the word “Alexa.” If either is the case, caregivers are advised to change the trigger word to “Echo.” It is easy to do.
  • The Alexa platform has interfaces to other devices such as light switches, vacuum cleaners and TVs. Some assistance by an experienced user would be beneficial for setting up these sometimes error-prone couplings. 
  • The Dot might offer suggestions for further use during a session. If that is disruptive or annoying, caregivers are advised to turn on “Brief Mode” in the Alexa app. It is easy to do.
  • Our study found that many caregivers themselves found value in the Dot for providing day-to-day support. In general, we recommend that caregivers become familiar with the Dot both so that they can help the target population appreciate its value and to lighten their load as caregivers. 

Lastly, the advisors and caregivers came up with some interesting applications of the Dot: 

  1. A mobile, non-tethered Dot in the form of a bracelet or necklace
  2. An ability to connect to other devices so that they can control them with voice
  3. An ability to provide local transportation information (e.g. when is the last train to Clarkesville, how much time to bus #32 arrival at this station) 
  4. The attachment of a robot body to Alexa

Studies like this show the value of in situ user participation in the design and evolution of technology. Further, it shows the value of collaboration among several kinds of experts: technology, cognitive disability, business, and care.

With financing from:


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