Universal Design with Mobile App Development:

Universal Design with Mobile App Development: Bridging the Gap for the Forgotten Populations

Martine Nezerwa, Tony Chen, Jacob Fried-Stahl, Nivedita Joshi, Jake Terranova, Robert Wright

Christopher Carlson, Daniel Citardi, Michael DiMattia, Stefan Howansky, Dr. Jean F. Coppola

School of Computer Science & Information Systems, Computer Science Pace University New York, NY 10038 USA

Seidenberg School of Computer Science & Information Systems, Information Technology Pace University Pleasantville, NY 10038 USA` [email protected]

Abstract—In the last decades, the world has witnessed a record in the use of mobile technologies where there is almost as many mobile subscriptions as people in the world. In addition, almost two-thirds of smartphone users access the internet through their phones. The progression in mobile communications has spurred high interest in developing applications for this crucial market. Everyday millions of applications are developed and made available through the different appstores, i.e., Google Play, Apple store, BlackBerry World, etc. With 91% of Americans owning one or more cellphones, this is a crucial market to tap into for application developers. Due to progress in the health sciences and people awareness of the importance of following a healthier lifestyle, people are living longer leading to a demographic change where more and more nations have rapidly growing aging population. Thus, there will be a shortage of doctors to care for this fast growing aging population. Moreover, as the population ages managing multiple chronic diseases becomes a daily challenge. Also, given the size of the population, many more people will be diagnosed with dementia and Alzheimer’s disease. Hence, proper measures are needed to encourage this population to act and think independently while taking advantage of what current technologies are offering. This paper will focus on developing mobile applications targeted for assisting select underserved audiences with affordable emerging technologies on Android and iOS platforms. These mobile apps address areas such as medical, social, and practical needs of the consumers, as well as their caregivers. Additionally, college computing students need to learn to create applications that are universally designed for all ages in terms of fonts, colors, buttons, etc. Keywords: Alzheimer’s disease, Android, busy boards, caregivers, Cerebral Palsy, dementia, iOS, Multiple Sclerosis, older adult, senior citizen, sundowning, technology

978-1-4577-1343-9/12/$26.00 ©2015 IEEE

I.

INTRODUCTION

According to the International Telecommunication Unit (ITU), as of 2014, there were almost 7 billion mobile-cellular subscriptions worldwide; this is as much as the total number of people on earth [1]. According to the same report, almost 40% of the world’s population is using the internet in one form or another. In addition, because of progress in health and people leading healthier lives, the number of older adults has also been increasing [2]. The caregiver support ratio in 2010 was more than 7 caregivers per person in the high-risk years aged 80 and above [3]. Even though progression in health has been tremendous, there are still a great number of impairments and illnesses that are still incurable, in addition to many prevalent chronic diseases. These conditions affect people in different ways; mobile developers need to tap in the design of mobile applications that are catered to specific audiences such as the cognitively impaired and the physically challenged. Undergraduate and graduate students have dedicated their coding time to developing mobile applications that are targeted for select audiences: people struggling with Alzheimer’s disease (AD) / dementia, Multiple Sclerosis (MS), Cerebral Palsy (CP), and caregivers to lessen their burdens. Currently the team is developing multiple mobile apps for audiences including: • Injectify is a mobile application being developed for MS patients and other users that require daily or repeated self-injection of one or more drugs. The user will be reminded of the spot that was last injected and will be given options on where to inject for the day. • Pictural is an application geared toward AD and dementia patients assisting them with reminiscence therapy through the use of familiar pictures, family photos, and familiar voices. • Memory Box is another reminiscence therapy mobile application that reminds users of important incidents and events in their lives.

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Silver Cross is a one-of-kind mobile app designed specifically for the wellbeing of the elder caregiver. The app will function as a guardian angel, thus always vigilant and ready for action alerting loved ones when trouble might be threatening. Total Eclipse of the Heart is a developed for late stage dementia patients containing familiar scenes and sounds to help with sundowning anxiety.

This paper explores and reports on the development process of the apps, the students’ experiences throughout the development, the challenges of designing for a select group of individuals, and future work. II.

INJECTIFY

Injectify is the first app in a series of apps that are being developed to make smart devices more accessible to people with MS and ultimately anyone with similar disabilities. This is truly a community-to-community project involving students and people who suffer from MS. People with MS not only navigate this world with increasing physical and cognitive challenges, they must also face the emotional toll of the loss of independence, as well as social isolation. Technology in many cases can help overcome these challenges and improve the quality of life for those willing to embrace it. Unfortunately, the majority of smart devices and apps on the market are not designed to be accessible to those who are disabled. As health declines and diseases progress, people often can no longer use a computer or smart device, thus have to rely heavily on others. The Injectify App is a step towards self-care, independence, and long-term tracking of symptoms in a simple discreet userfriendly manner.

Figure 1: Setting up reminder frequency The Injectify mobile app is an application that provides users who suffer from MS or other injection-based medical issues with an inconspicuous and innovative way to keep track of their medication, as well as maintain personal medical notes as a reference for their next doctor visit.

The students had the desire to aid the elderly and those suffering from various ailments with an application that not only simplifies the user’s schedule, but also provides them with a better quality of life. The application enables users to track when and where they need to inject their medications. Injectify is unique because it is designed for both Android and iOS platforms, updated regularly, and universally designed for all users supporting those with cognitive and physical impairments. In order to design this app, a qualitative research approach was utilized, meeting and interviewing people who suffer from MS, in addition to market research on apps that are available to people with MS and other similar disabilities. To start, the student developers visited the local MS Society chapter to hear first-hand the technology needs and take a research approach. The idea to develop Injectify was generated from members that participated in focus group at a local MS Chapter meeting. During the development process, the team focused on usability, as well as customization. Some of the assumptions employed in designing and developing the app include: •

Reminders to help with memory issues;

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Large buttons to help with hand / eye coordination issues;

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Simple and uncluttered screens;

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No more than three clicks to do common functions;

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Intuitive screens for processing difficulties; and

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Good color contrast, bold fonts, font size, etc.

The app includes built in reminders, high color contrast, larger images, and minimized number of clicks. The built-in reminders are accessed through a calendar that records date and injection areas, displaying discreet and customizable injection reminders for pre-set times throughout the day. The app is also used to track information reported over time- such as symptoms reported in order to be able to share with caregivers and medical professionals.

Figure 2: Reminder for next injection Developing a cross-platform app involves more than developing for one platform because the presentation of the app would be different. The Android version of the application was developed using the Java programming language while the iOS was implemented using C#. The challenges for the developers also differ depending on the platform. Some trials the android team faced were implementing the use of an Application Program Interface (API) as this was a new concept to the developers. They had to learn how to use APIs in order to gather the necessary information and save it to an outside source. For the iOS development team, Objective-C, the language used in iOS programming, is hard to learn, and while documentation on small scale applications is plentiful, larger application documentation is scarce. Also, to get an application to the Apple Store, one has to go through a lot of parameters set by Apple, as well as time consuming process.

III.

PICTURAL

Pictural is an application that was designed with accessibility and mental engagement in mind. The primary purpose of this application is to serve as a form of reminiscence therapy for those that suffer from dementia and AD. Through the use of customizable image boards, a patient or a caregiver has the ability to create different arrays of images that can help serve as a trigger for a patient's memory. Along with these images, additional information can be provided as captions through text or vocal recordings about the image. In doing so, the patient is given further information and stimulation while looking and clicking through the images.

Figure 3: Pictural boards With other applications for the same field of patients, they are not given the same stimulation and engagement that is provided through Pictural. Primarily, this is because of the fact that Pictural engages both hemispheres of the brain through visual and audial stimulation. As a result, the patient is given a more in-depth and engaging experience that can help stimulate their memory. The developers of Pictural decided to undertake this project due to a variety of reasons. One of these reasons was that the developers had prior knowledge on the struggles that patients with dementia and Alzheimer’s have to endure, and believed that they could use this knowledge to help patients with these struggles. In the past, the developers had worked on similar applications for telemedication therapy, such as Alive Inside an application that provides music therapy for patients who suffer from the same conditions. Along with being knowledgeable of the cognitive disabilities they were working with, the developers also have had experience creating applications that were used to treat patients in these same conditions. Because of this, they decided to take on this project to use their knowledge in order to try and further aid those with cognitive disabilities. Currently, Pictural is being developed for tablets that run the Android operating system. The choice to use Android was made for a variety of factors; however the main reasons are that the developers are fairly fluent in Java. Having worked on various other telemedication applications, the developers have had plenty of time to get to know the system and how it all works. Along with this, Android also allows for further customization than can be achieved on other operating systems.

Figure 5: Memory box vocals Figure 4: Zoom on one of Pictural’s board Various system events can be hooked into, and the customization of the applications functionality and visual design is seemingly endless. Lastly, by using Android, the developers were able to make use of the Google Play Store, which hosts every published Android application. While this is the same concept as the Apple Store for iOS applications, the ease of working with the Google Play Store versus the Apple Store is monumentally greater. Primarily, this is due to the regulations on publishing an application being less strict for Android, which provides for quicker, easier development of the application. As such, all of the programming for this application was done in the Eclipse IDE with a plugin for Android Studio being used in tandem.

IV.

During conception and development, “older adults” with cognitive impairments or memory loss were the primary target of the developer, as well as their family members and their caregivers. Similar to the other mobile apps mentioned, the design focuses heavily on usability and developers kept in mind the following traits: •

Simple to use,

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User-friendly design,

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High-contrast colors;

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Touchscreen;

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Tactile and;

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Versatile.

MEMORY BOX

Memory Box is another reminiscence therapy app that helps the user in remembering incidents and other important events in their lives. The app will allow the user to travel to points in their subconscious where they encountered different experiences. The app has images that the user can interact with by clicking on different images and see them come to life. Different settings (Forest, Family Room, Beach, etc.) allow the user to experience different events that might have happened in that particular setting. The app also focuses on providing accurate vocals from the wild to help the user remember loved ones and essential information about them.

Figure 6: Memory Box side bar with different settings The idea to develop Memory Box was conceived after a review of the literature revealed that there are not many apps that can ping users reminding them about their relationships and entities around them. Therefore, the developers utilized

their prior knowledge on frustrated Alzheimer’s patients’ faces and their mobile application past experiences to create a reminiscence therapy app where the user interacts with the app in a fun way. V.

SILVER CROSS

While all the other apps described so far have focused on the patient, this app focuses on the caregivers and attempt to lessen their load of work. Silver Cross is a mobile application designed to help care for patients with dementia and Alzheimer’s, while also supporting caregivers themselves. Silver Cross is designed to make caregivers’ experience a little less stressful while making sure someone is watching out for them. Silver cross helps the caregiver keep track of basic things related to the elder they are caring for. This includes keeping track of medications, appointments, mood and more. In order to do so, Silver Cross is bundled with a substantial amount of features to store and share information, but most importantly the mood tracker. Caregivers have the option to select from a list of emotions so caregivers who share profiles can view how each other are feeling; this will permit consistent teamwork as another caregiver can temporarily take over. Family members who watch over an elderly parent will also be able to reduce work and stress load. This is crucial in keeping caregivers to be mentally alert and emotionally stable. It is important to note and remember than, sometimes, even caregivers need to be cared for! The application is designed with simplicity in mind. While designing this application, developers have taken into consideration their own experiences from developing previous applications for these target audiences and also their experiences with working directly with those who suffer from these diseases. Silver cross greatly improves the daily tasks associated with caring for someone. This application can provide medication reminders and allows for multiple calendar scheduling. For example if two people, John and Susan, are taking care of their grandmother and she has an appointment on Tuesday, the application will provide a calendar showing both John and Susan’s commitments and they can see who is available to take their grandmother to her appointment. The main feature of this application is that it will attempt to monitor the caregiver for signs of distress and depression. Through monitoring daily tasks such as how often they are using the app, how long it takes them to complete their regular tasks and how often they are checking in, can show early signs of depression. If the application detects any of these signs, it can alert others within the caregiver circle discreetly and can

also present the user with relevant resources and information in an unobtrusive way. This app is unprecedented in its monitoring features and is created with caregivers and the elderly in mind. Silver Cross has the potential to change the entire way we think about caring for others and could change the lives of anyone who regularly cares for others. The app primarily utilizes the touch screen. Caregivers can input information by typing in everything they need to. Information will be shared amongst caregivers who share their profiles with one another - caregiver’s circle. Anything shared will be synced throughout devices as long as they are online and this will improve consistency between users. VI.

TOTAL ECLIPSE OF THE HEART

Total Eclipse of the Heart app was developed to aid users who suffer from late-stage dementia and AD. The basis of the app is the creation and easy usage of a soundboard, or a board with pictures of animals that produce sound when touched by the user. Keeping simplicity and effectiveness as the highest priorities, the app has a multitude of pictures and sounds for users to choose from and ease their suffering. This app was developed mainly for with those who have late-stage dementia or AD. It incorporates the ideas of music therapy for patients with these illnesses, for music and sounds help those with dementia or Alzheimer’s evoke feeling and sensation in the user that they normally cannot feel due to their sickness. The sounds produced from the animals, when pressed, aim to help evoke such feelings from the patients and bring about a positive change in their lives. Experiencing the sundowning effect first hand was one of the major reasons that it was decided to put time into creating this app. The grandma of one of the developers had Alzheimer’s and lived in the same house for the last two months of her life. Always before dinner time, the grandmother would get very antsy and just start walking around. Family member remember turning on the television with the hope that she would sit down and watch. For this family, watching over her was not as big a problem because there were always at least two people in the house to watch. However, for most homes, especially for a caregiver who is alone, it could be a lot harder. It is hoped that by creating an app could this could potentially be a way to help the caregiver. VII. CONCLUSION Progress in health has been tremendous in the last decades but it is also leading (positively) to an older population where the number of adults of 65+ years of age is higher than ever before. In a world run by technology, the majority

norm and allowed them to explore new grounds. Many thanks also go to Ms. Dana Zahavi and the National MS Society for their continuous support in the development of the Touch MS applications and assistive technologies. Without them, the team would not have been able to gather crucial information that enabled them to create mobile applications that are user-friendly and customized for the targeted audience in the realm of service-learning.

of these elders are feeling left out, overwhelmed by all these technologies and by how fast they are changing. These adults are also suffering from ailments that come with age such as Alzheimer’s, dementia, memory loss, loss of vision, etc. There is also a number of individuals that are have physical and cognitive impairments such as MS. The purpose of the team is to bring the technology to these underserved populations by conducting research and developing applications that aim at bridging the gap between the underserved and the fast technology. In addition to helping these individuals, this turn out to be beneficial to the students as well since they get to participate in real-world projects and gain experience by doing instead of being onlookers. VIII. ACKNOWLEDGEMENTS The team would like to thank Dr. Jean F. Coppola for her tireless work with the students on the different projects presented in the paper. She has pushed students beyond the

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