# Presentation: 037086

## Cognitive Impairment and Accessibility

- Clayton Lewis
- University of Colorado
- February 7, 2007

## Outline

- Basics of cognitive impairments
- Forms
- Impact on IT use
- Demographics
- Improved regulatory support for cognitive accessibility
- Regulatory logic and approaches
- Recommendations

## Cognitive impairments can arise in many ways:

- brain injury or stroke
- aging
- abnormal chromosomes
- eg Down syndrome
- severe mental illness
- unknown causes

## They can affect many aspects of cognitive function (Francik, 1999):

- executive functions
- memory
- attention
- visual and spatial perception
- language (including reading)
- mathematical thinking
- emotional control, expression, understanding
- speed of reasoning
- solving new problems
- solving problems based on experience

## Some impairments are quite specific in their effects

- so-called “learning disabilities” may impact reading or mathematical skills and not other functions
- some people with learning disabilities function at a very high level in other areas

## Using EIT products can involve nearly all of these functions

- emotional control, etc., may be exceptions

## Examples

- executive functions:
- carrying out a sequence of operations
- managing a stack of goals and subgoals
- memory:
- memorizing a sequence of actions
- learning a new task
- attention and perception:
- interpreting a complex display

## Examples (cont.)

- language:
- understanding Medicaid programs described on a public Web site
- understanding error messages and prompts
- spelling a search term
- speed of reasoning:
- responding to a timed voice menu

## Examples (cont.)

- solving new problems:
- troubleshooting

## Two kinds of impact

- (1) Studies suggest that many barriers to cognitive *accessibility* are the same as *usability* problems for a general user audience... *but more severe*.

## Example: Searching on the Web

- Models of Web searching show how a *small* decrease in the ability to interpret link labels on a Web site has a *large* (exponential) impact on search time
- Pirolli, 2005
- Data show that increased search time translates to decreased success
- Bottom line: a site that is a little frustrating for you may be impossible for me.

## Two kinds of impact

- (2) Other barriers are more specific:
- interfaces that require speeded responses
- interfaces that require accurate spelling
- interfaces that require extensive vocabulary

## Note on vocabulary demands

- Some vocabulary in an interface may be required by the *work* someone is doing.
- Other vocabulary may be imposed by the *tool*.
- It’s the latter we especially need to control... no one should face a barrier in their work because of a tool.
- Designers are bad about this: compass, shortcutted

- These general and specific barriers call for different regulatory approaches.

## Demographics

- People with cognitive disabilities are well represented in the EIT audience.
- Computer users: 16% (Microsoft survey)
- >1300 federal white collar workers have developmental disabilities... an unknown additional number have “learning disabilities”

## Regulatory Logic

- Regulations have to bind my competitors as well as me.
- They must prevent shamming.
- A product that *looks* as if it is compliant must *actually be* effective.
- (Regulations have to be enforced.)
*If these conditions aren’t met, I can’t afford to comply.*

## Regulatory Approaches

- Require specific accessibility features (508)
- Require accessibility issues to be addressed (255)
- Require user testing (HAVA Voting System Guidelines)

## Note

- User testing is <<called for>> in 255, but it is bracketed by language that makes it *discretionary*... ineffective regulatory logic.
- HAVA makes user testing mandatory

## Cognitive Accessibility Features

- Some features are appropriate to require:
- (alternatives to speeded responses)
- word lookup, or compatibility with word lookup tools
- text reading, or compatibility with text reading tools
- spelling correction for spelling-sensitive interactions
- provision for suppressing unneeded functions

- Most of cognitive accessibility, like most of usability, can’t be reduced to features.

## Use of Images

- Appropriate use is subtle.
- Images can be useful to set a context
- But only some kinds of content can be conveyed with images

## One size does not fit all

- most users do better with *wider* interfaces, but some may do better with *narrower* interfaces (Lewis, 2006)

## a b c d

- e f g h

- a b

- c d

- e f

- g h

-  P
- Q

- M
- N

- X
- Y

## It’s not appropriate to mandate wide or narrow interfaces.

- (It *is* appropriate to mandate suppression of unneeded functions, which permits reduction of width *and* breadth.)

## Broader Case: Understandability of Web Site Contents

- Example: Descriptions of Medicaid programs (Nancy Ward)
- Readability formulas are *not workable* for assessing understandability (Redish, 2000)
- short sentences are often less comprehensible
- grade level vocabularies are not appropriate for adults
- formulas are not adapted for technical material
- not sensitive to text organization

-   The methodology that allows you to deal with the complexity of a real document for real users is usability testing.
- 						--Redish (2000)

## Usability in VVSG Regulation

- 3.1.1 Usability Testing (previously 2.2.7.3.1)
- This requirement was revised to make usability testing mandatory for vendors: “The vendor shall conduct summative usability tests on the voting system using individuals representative of the general population. The vendor shall document the testing performed and report the test results using the Common Industry Format. This documentation shall be included in the Technical Data Package submitted to the EAC for national certification.”

## Common Industry Format

- http://zing.ncsl.nist.gov/iusr/ “ISO/IEC 25062:2006 provides a standard method for reporting usability test findings. The format is designed for reporting results of formal usability tests in which quantitative measurements were collected, and is particularly appropriate for summative/comparative testing.”

- The format includes the following elements (Scholtz and Morse, 2003):
-  the description of the product,
-  the goals of the test,
-  the test participants
-  the tasks the users were asked to perform,
-  the experimental design of the test,
-  the method or process by which the test was conducted,
-  the usability measures and data collection methods, and
-  the numerical results.

## Proposal

- Add features as suggested above, and...
- For 508, add a slot to the VPAT for user test results.
- Require that these tests include representation of all supported disabilities.
- For 255, modify existing language so as to require tests that are now only recommended.

## Note re WCAG

- WCAG includes some cognitive accessibility issues (and discussions are continuing)
- WAI has educational materials on user testing
- For the Web at large, consider promoting an “accessibility tested” certification program for Web sites, to supplement the technical testing for WCAG conformance.
- This could help with other forms of accessibility, not just cognitive

## Onward and Upward

- There are many issues to be explored in pursuing this path (understatement?)
- HAVA regulation provides a valuable precedent and example.
- There is also some European work that can provide some background.

## Francik, E. (1999) Telecommunications Problems and Design Strategies for People with Cognitive Disabilities. http://www.wid.org/archives/telecom/.

- Pirolli, P. (2005 ) Rational Analyses of Information Foraging on the Web. *Cognitive Science*, 29, pp. 343–373.
- Microsoft (n.d.) The Market for Accessible Technology—The Wide Range of Abilities and Its Impact on Computer Use. Online at: http://www.microsoft.com/enable/research/phase1.aspx .
- United States Equal Employment Opportunity Commission (2005) Annual Report on the Federal Work Force: Fiscal Year 2004. Table 6. http://www.eeoc.gov/federal/fsp2004/aed/table6.html.
- US Election Assistance Commission (2005) Voluntary voting system guidelines. see http://vote.nist.gov/.
- Redish, J. (2000) Readability formulas have even more limitations than Klare discusses. *ACM Journal of Computer Documentation*, 24, pp. 132-137.
- Lewis, C. (in press) Simplicity in cognitive assistive technology: A framework and agenda for research. To appear in *Universal Access in the Information Society*.  Online at http://www.springerlink.com/content/881h660p6u1766h4/
- Scholtz, J, and Morse, E. (2003) Using Consumer Demands to Bridge the Gap between Software Engineering and Usability Engineering. *Software Process Improvement and Practice*, 8, pp.89-98.