Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing. In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses. Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.

Ce travail se concentre sur une tâche de micro-navigation en plein air où le but est de naviguer vers une adresse de rue spécifiée en utilisant plusieurs modalités (par exemple, images, texte de scène et GPS). La tâche de micro-navigation extérieure s’avère etre un défi important pour de nombreuses personnes malvoyantes, ce que nous démontrons à travers des entretiens et des études de marché, et nous limitons notre définition des problèmes à leurs besoins. Nous expérimentons d’abord avec un monde en grille partiellement observable (Grid-Street et Grid City) contenant des maisons, des numéros de rue et des régions navigables. Ensuite, nous introduisons le Environnement de Trottoir pour la Navigation Visuelle (ETNV), qui contient des images panoramiques avec des boîtes englobantes pour les numéros de maison, les portes et les panneaux de nom de rue, et des formulations pour plusieurs tâches de navigation. Dans SEVN, nous formons un modèle de politique pour fusionner des observations multimodales sous la forme d’images à résolution variable, de texte visible et de données GPS simulées afin de naviguer vers une porte d’objectif. Nous entraînons ce modèle en utilisant l’algorithme d’apprentissage par renforcement, Proximal Policy Optimization (PPO). Nous espérons que cette thèse fournira une base pour d’autres recherches sur la création d’agents pouvant aider les membres de la communauté des gens malvoyantes à naviguer le monde. / This work focuses on an Outdoor Micro-Navigation (OMN) task in which the goal is to navigate to a specified street address using multiple modalities including images, scene-text, and GPS. This task is a significant challenge to many Blind and Visually Impaired (BVI) people, which we demonstrate through interviews and market research. To investigate the feasibility of solving this task with Deep Reinforcement Learning (DRL), we first introduce two partially observable grid-worlds, Grid-Street and Grid City, containing houses, street numbers, and navigable regions. In these environments, we train an agent to find specific houses using local observations under a variety of training procedures. We parameterize our agent with a neural network and train using reinforcement learning methods. Next, we introduce the Sidewalk Environment for Visual Navigation (SEVN), which contains panoramic images with labels for house numbers, doors, and street name signs, and formulations for several navigation tasks. In SEVN, we train another neural network model using Proximal Policy Optimization (PPO) to fuse multi-modal observations in the form of variable resolution images, visible text, and simulated GPS data, and to use this representation to navigate to goal doors. Our best model used all available modalities and was able to navigate to over 100 goals with an 85% success rate. We found that models with access to only a subset of these modalities performed significantly worse, supporting the need for a multi-modal approach to the OMN task. We hope that this thesis provides a foundation for further research into the creation of agents to assist members of the BVI community to safely navigate.

Dyslexi påverkar den kognitiva språkförmågan genom nedsättningar i det fonologiska processandet och många drabbas negativt om inte rätt stöd och hjälpmedel tillgängliggörs. För att undersöka ett digitalt hjälpmedels användbarhet deltog 5 personer med dyslexidiagnos i denna kvalitativa designstudie. Användartester på ett digitalt hjälpmedel utfördes på distans och den insamlade datan analyserades genom en tematisk innehållsanalys. En expertutvärdering enligt Nielsen’s användarheuristiker genomfördes samt en intervju med företaget bakom programvaran. Genom att jämföra våra resultat med aktuella designprinciper gällande design för dyslektiker kunde vi undersöka om programvaran är designad utefter dessa. Det vi fann var att programvaran inte utformats med desingprinciperna i åtanke samt att användbarheten till viss del kunde förbättras, specifikt inom tre områden: Ett område gällde utformningens flexiblitet, möjligheten att kunna individanpassa programvaran var mycket önskvärt enligt deltagarna och framkom som en viktigt punkt under expertutvärdering samt var stött av forskning inom området. Det andra området gällde programvarans konsekvens. De funktioner som deltagarna upplevde problematiska kunde, tillsammans med expertutvärdering, kopplas till funktioner med bristande konsekvens. Det sista vi hittade som skulle kunna öka användbarheten samt göra programvaran mer enhetlig med designprinciperna var att hålla en avskalat men samtidigt informationsrik design. Rätt information och tydlig vägledning är båda viktiga delar enligt användarheuristiker och designprinciper, vi hittade även i våra användartester att det är balansen mellan dessa två som kan vara avgörande. / Dyslexia affects the cognitive language ability through impairments in phonological processing and many are negatively affected if the right support and aids are not made available. To examine an assistive tools usability, 5 participants with dyslexia diagnosis took part in this qualitative design study. User tests on a digital assistive tool were conducted remotely and the collected data was analyzed through a thematic content analysis. An expert evaluation according to Nielsen’s usability heuristics was conducted and an interview with the company behind the software. By comparing our results with design principles for dyslexics, we examined if the software is designed accordingly. We found that the software had not been designed according to design principles and that the usability could be improved, specifically in three areas: One area was regarding a flexible design, the ability to individually adjust the software were highly desirable according to the participants and emerged as important in the expert evaluation and was supported by research in the field. Second area was in the field of consistency. The functions that the participants found problematic could, together with the expert evaluation, be linked to functions that lacked consistency. The last area that could increase the usability and make the design more according to the design principles was to keep a minimalistic yet informative design. Information and clear guidance are both important parts according to the usability heuristics and the design principles and by testing we found that it’s the balance between these two that might be crucial.

The thesis discusses how information and communication technologies (ICT or IT), nowadays transforms the form of health and social services. The specific arguments and social events are described, that leads today's health and social services closer to the use of ICT, influence and changes it. The work describes the latest trends linking ICT and social and health services in the areas of e-health, telemedicine, mobile health and assistive technologies. Specific tools and equipment and their practical use are presented. The practical part focuses on the introduction of specific- gadgets tablet care in caring for the elderly. Through direct interviews with caregivers and seniors is investigated how new technology is perceived by caregivers and seniors, how new technology equipment to care are introduced, and what positive and negative impact are the ICT has for facilities and the elderly. Key words assistive technology; eHealth; mHealth; patient engagement; population ageing; senior activation; senior care; telemedicine; touch tablets

Aim and research questions: The study examined how text comprehension of middle school students in Sweden changed depending on the modalities of reading and speech synthesis. Impact on the outcome based on factors such as decoding ability, working memory, gender and multilingualism were examined. A new text comprehension test was evaluated. Method: Questionnaires and measuring instruments including the text comprehension test were used in an in-group design. Results: In the given sample (N=94), reading generated best results on the text comprehension test in comparison to speech synthesis. The effects were strongest in the group with weaker decoding ability. No significant correlations were found when working memory or gender was taken into account. The results of the study showed that monolingual participants got better results on the text comprehension test after speech synthesis than multilingual participants. Conclusion: The study found significant differences between modalities, where reading generated better results on the text comprehension test than speech synthesis. Multilingual children scored significantly lower with speech synthesis than monolinguals. Further studies are required. / Syfte och frågeställningar: Studien undersökte hur textförståelsen hos mellanstadieelever i Sverige förändrades beroende på modaliteterna läsning respektive talsyntes. Påverkan på utfallet utifrån faktorer som avkodningsförmåga, arbetsminne, könstillhörighet och flerspråkighet undersöktes. Ett nytt textförståelsetest utvärderades. Metod: Frågeformulär och mätinstrument inklusive textförståelsetestet användes i en inomgruppsdesign. Resultat: I givet urval (N=94) gav läsning bäst resultat på textförståelsetest i jämförelse med talsyntes. Effekterna var starkast i gruppen med svag avkodningsförmåga. Inga signifikanta korrelationer hittades när hänsyn togs till arbetsminne eller könstillhörighet. Studiens resultat visade att enspråkiga deltagare fick bättre resultat på textförståelsetestet efter talsyntes än flerspråkiga deltagare. Slutsats: Studien fann signifikanta skillnader mellan modaliteterna, där läsning gav bättre resultat på textförståelsetest än talsyntes. Flerspråkiga barn fick signifikant sämre resultat med talsyntes än enspråkiga. Vidare studier krävs.

In assistive technology, there are mainly two different users that needs to be taken into account when developing products. The first, and most important, is the end-user who requires the product in order to function and live a normal life. The second is the support person who, for some products, needs to assist the end-user by preparing it to be used. This report presents the master thesis project conducted by Mattias Bygge and Sofie Strand at KTH Royal Institute of Technology in Stockholm. The client was Abilia, a company that research, develop, manufacture and sell assistive technology to people with impairments. This main goal of this project was to redesign a cognitive planning board. The product is used as a visual aid by people who has difficulties in planning daily activities and keeping track of time. In order to develop the product in a suitable way, a literature study and interviews with Abilia’s employees laid the foundation for the user studies that were conducted with end-users and support people. Several concepts were generated and five were evaluated against the original product and presented to the company. The two concepts that received the highest ranking, (1) Extra Hours and (2) Extra Hours Bistable, were further investigated and were eventually developed into one single hybrid concept. The final design proposal is Day Master, a flexible planning board intended for people with a cognitive impairment that impedes their ability to plan daily activities and keep track of time. The product visually displays time and weekdays by using coloured LED lights, which support people may program without difficulty to fit the end-user’s preference. The amount of hours is changeable with a range of 12-18 hours of daytime and with the remaining hours distributed to night-time. The accessories that have been developed for this products are a simple protective cover, and two holders, one for images and one for whiteboard markers. All accessories attaches to the planning board with magnets. / I hjälpmedelsteknologi är det fler än en användare som man måste ta hänsyn till när man utvecklar produkter. Den första och viktigaste är slutanvändaren som är den som behöver produkten i vardagen för att kunna leva ett någorlunda normalt liv. Den andra är stödpersonen som i många fall är den som förbereder produkten för användning av slutanvändaren. Denna rapport presenterar masterexamensarbetet utfört av Mattias Bygge och Sofie Strand på KTH Kungliga Tekniska Högskola i Stockholm. Kunden för projektet var Abilia, ett företag som utvecklar, tillverkar, och säljer hjälpmedel till personer med funktionsnedsättning. Målet med detta projekt var att omdesigna deras kognitiva planeringstavla. Produkten används som ett visuellt hjälpmedel av personer som har problem med tidsuppfattning och planering av aktiviteter. Projektet inleddes genom en literaturstudie och intervjuer med personal på Abilia. Detta lade grunden för användarstudierna där både slutanvändare och stödpersoner deltog. Utifrån användarstudierna så genererades ett flertal koncept varav fem stycken evaluerades mot original produkten och som presenterades för företaget under en delpresentation. De två koncept som erhöll högsta ranking i evalueringen var (1) Extra Hours och (2) Extra Hours Bistable. Koncepten undersöktes ytterligare och kom slutligen att kombineras till ett gemensamt koncept. Det slutgiltiga designförslaget är Day Master, en flexibel planeringstavla som riktar sig mot personer med en kognitiv funktionsnedsättning som försvårar för dem att hålla koll på tiden och planera aktiviteter. Produkten visar tid och veckodagar visuellt med hjälp av färgade LED lampor som stödpersonerna lätt och intuitivt kan programmera för att passa slutanvändarens individuella behov. Day Master ger möjligheten att själv bestämma antalet timmar som distribueras mellan dag och natt. Den har ett spann på 12-18 timmar för dagtid och återstående timmar läggs på natttid. Tillbehören som har utvecklats för denna produkt är ett enkelt magnetiskt plastskydd och två stycken olika ställ, ett för bilder och ett för whiteboardpennor. Alla tillbehör fästs på whiteboardtavlan med hjälp av magneter.

In assistive technology, there are mainly two different users that needs to be taken into account when developing products. The first, and most important, is the end-user who requires the product in order to function and live a normal life. The second is the support person who, for some products, needs to assist the end-user by preparing it to be used. This report presents the master thesis project conducted by Mattias Bygge and Sofie Strand at KTH Royal Institute of Technology in Stockholm. The client was Abilia, a company that research, develop, manufacture and sell assistive technology to people with impairments. This main goal of this project was to redesign a cognitive planning board. The product is used as a visual aid by people who has difficulties in planning daily activities and keeping track of time. In order to develop the product in a suitable way, a literature study and interviews with Abilia’s employees laid the foundation for the user studies that were conducted with end-users and support people. Several concepts were generated and five were evaluated against the original product and presented to the company. The two concepts that received the highest ranking, (1) Extra Hours and (2) Extra Hours Bistable, were further investigated and were eventually developed into one single hybrid concept. The final design proposal is Day Master, a flexible planning board intended for people with a cognitive impairment that impedes their ability to plan daily activities and keep track of time. The product visually displays time and weekdays by using coloured LED lights, which support people may program without difficulty to fit the end-user’s preference. The amount of hours is changeable with a range of 12-18 hours of daytime and with the remaining hours distributed to night-time. The accessories that have been developed for this products are a simple protective cover, and two holders, one for images and one for whiteboard markers. All accessories attaches to the planning board with magnets. / I hjälpmedelsteknologi är det fler än en användare som man måste ta hänsyn till när man utvecklar produkter. Den första och viktigaste är slutanvändaren som är den som behöver produkten i vardagen för att kunna leva ett någorlunda normalt liv. Den andra är stödpersonen som i många fall är den som förbereder produkten för användning av slutanvändaren. Denna rapport presenterar masterexamensarbetet utfört av Mattias Bygge och Sofie Strand på KTH Kungliga Tekniska Högskola i Stockholm. Kunden för projektet var Abilia, ett företag som utvecklar, tillverkar, och säljer hjälpmedel till personer med funktionsnedsättning. Målet med detta projekt var att omdesigna deras kognitiva planeringstavla. Produkten används som ett visuellt hjälpmedel av personer som har problem med tidsuppfattning och planering av aktiviteter. Projektet inleddes genom en literaturstudie och intervjuer med personal på Abilia. Detta lade grunden för användarstudierna där både slutanvändare och stödpersoner deltog. Utifrån användarstudierna så genererades ett flertal koncept varav fem stycken evaluerades mot original produkten och som presenterades för företaget under en delpresentation. De två koncept som erhöll högsta ranking i evalueringen var (1) Extra Hours och (2) Extra Hours Bistable. Koncepten undersöktes ytterligare och kom slutligen att kombineras till ett gemensamt koncept. Det slutgiltiga designförslaget är Day Master, en flexibel planeringstavla som riktar sig mot personer med en kognitiv funktionsnedsättning som försvårar för dem att hålla koll på tiden och planera aktiviteter. Produkten visar tid och veckodagar visuellt med hjälp av färgade LED lampor som stödpersonerna lätt och intuitivt kan programmera för att passa slutanvändarens individuella behov. Day Master ger möjligheten att själv bestämma antalet timmar som distribueras mellan dag och natt. Den har ett spann på 12-18 timmar för dagtid och återstående timmar läggs på natttid. Tillbehören som har utvecklats för denna produkt är ett enkelt magnetiskt plastskydd och två stycken olika ställ, ett för bilder och ett för whiteboardpennor. Alla tillbehör fästs på whiteboardtavlan med hjälp av magneter.

L’utilisation à long terme d’un fauteuil roulant après une lésion de la moelle épinière (LMÉ) est associée à une augmentation de la sédentarité et une diminution du niveau d’activité physique. Malheureusement, ces changements mènent à un cycle de déconditionnement qui contribue à l’augmentation de risques, au développement ou à l’aggravation de problèmes secondaires de santé touchant les membres supérieurs et inférieurs. En ce sens, 60 % de la population avec LMÉ présentent des douleurs et déficiences aux membres supérieurs. Aux membres inférieurs, l’ostéoporose est fréquente et chaque année, 10 % de la population avec LMÉ subit des fractures. Conséquemment, des répercussions sur la fonction et la qualité de vie en résultent. Pour contrer ce cycle vicieux, l’activité physique est recommandée. La marche au sol assistée par un exosquelette robotisé est une intervention prometteuse puisqu’elle nécessite des efforts musculaires aux membres supérieurs et augmente la mise en charge aux membres inférieurs. Toutefois, des cas de fractures aux membres inférieurs ont été rapportés. Ainsi, cette thèse visait à élaborer un algorithme d’entraînement préliminaire pour minimiser les risques de fractures pendant l’intervention, et à explorer les effets sur la force musculaire aux membres supérieurs, la performance et les habilités auto-rapportées en fauteuil roulant, et des marqueurs de force et de remodelage osseux aux membres inférieurs. L’algorithme d’entraînement a été développé par un consensus d’experts en suivant les critères de densité minérale osseuse de l’Organisation mondiale de la Santé. Dix individus (4 femmes, 46±11 ans) avec une LMÉ chronique (≥18 mois), qui utilisent un fauteuil roulant comme principale mode de locomotion, ont été recrutés pour suivre un programme de marche (16 semaines, 1 à 3 séances/sem). Les mesures suivantes ont été effectuées pré et post intervention : la force musculaire fonctionnelle (poussées/tirées sur une roue de fauteuil roulant, force de préhension), la masse musculaire (absorptiométrie), et la force relative (force/masse) aux membres supérieurs ; des tests de performance (vitesse de propulsion naturelle et maximale, slalom) et un questionnaire d’habilités en fauteuil roulant (Wheelchair Skills Test Questionnaire) ; l’ostéodensitométrie et la géométrie osseuse (CT-scan) aux membres inférieurs, ainsi que des marqueurs sanguins de remodelage osseux (ostéocalcine, télopeptide-C). La taille d’échantillon étant limitée (tests non paramétriques), un changement était significatif si : p<0,1 ; taille d’effet ≥0,5 ; et variation relative >5 %. D’une part, l’algorithme préliminaire a permis de moduler le volume d’entraînement en fonction du profil osseux (ostéoporose, ostéopénie et préservé) et aucun cas de fracture n’a été rapporté pendant le programme d’entrainement. D’autre part, suivant l’intervention, la force et la masse musculaire aux membres supérieurs sont demeurées stables. Néanmoins, la vitesse de propulsion naturelle a augmenté. Par ailleurs, une réponse osseuse prometteuse a été observée aux membres inférieurs (fémur : augmentation du contenu minéral osseux, et des indexes de résistance à la compression et à la flexion, mais réduction de l’épaisseur de l’os cortical ; tibia : augmentation de la section transversale corticale, et de l’index de résistance à la torsion). Ainsi, à la lumière des résultats, des interventions multimodales (ex. : combinées à des exercices plus ciblés aux membres supérieurs ou la pharmacothérapie pour l’ostéoporose aux membres inférieures) pourraient s’avérer nécessaires pour optimiser les effets potentiellement bénéfiques d’un tel programme, tant aux niveaux des membres supérieurs et inférieurs que sur la fonction quotidienne. / Long-term wheelchair use following a spinal cord injury (SCI) is associated with increased sedentary behaviour and decreased levels of physical activity. Unfortunately, these changes lead to a cycle of deconditioning that increases the risk, development, and/or aggravation of one or more secondary health conditions affecting the upper and lower limbs. In the upper limbs, pain and impairments are present in up to 60% of the SCI population. In the lower limbs, osteoporosis is commonly experienced. Further, each year up to 10% of this population experience fractures. Consequently, negative repercussions on function and quality of life are experienced. To counter this vicious cycle, physical activity is recommended. Overground exoskeleton-assisted walking is a promising intervention to help counter the cycle, since it requires muscular efforts in the upper limbs and increases weight bearing on the lower limbs. However, such an intervention is not without risk: cases of fractures in the lower limbs have been reported. Thus, this thesis aimed to develop a preliminary training algorithm to minimize the risk of fractures during the intervention, and to explore the effects of exoskeleton-assisted walking on upper limb muscle strength, performance and self-reported wheelchair skills, and strength and bone remodeling markers in the lower limbs. First, the training algorithm was developed by expert consensus following bone mineral density criteria from the World Health Organization. Thereafter, 10 individuals (4 women, 46±11 years) with chronic SCI (≥18 months), who use a wheelchair as their primary mode of locomotion, were recruited into the walking program (16 weeks, 1 to 3 sessions/week). The following measurements were taken pre and post intervention: functional muscle strength (pushing/pulling on a wheelchair wheel, grip strength), muscle mass (absorptiometry), and relative strength (strength/mass) of the upper limbs; wheelchair performance tests (natural and maximal propulsion speed, slalom) and skills (Wheelchair Skills Test Questionnaire); bone densitometry and bone geometry (CT-scan) in the lower limbs, as well as blood markers of bone remodeling (osteocalcin, telopeptide-C). Since the sample size was limited (non-parametric tests), a significant change was observed if three criteria were met: p<0.1; effect size ≥0.5; and relative change >5%. The preliminary algorithm modulated the training volume according to bone profile (osteoporosis, osteopenia and preserved) and no cases of fracture occurred. Following the intervention, strength and muscle mass in the upper limbs remained stable whereas only natural propulsion speed increased. Overall, a promising bone response was measured in the lower limbs (femur: increased bone mineral content, bone strength index, and stress-strain index, but decreased cortical bone thickness; tibia: increased cortical cross-sectional area, and polar moment of inertia). Ultimately, multimodal interventions (e.g., combining with specific upper limb exercises or pharmacotherapy for osteoporosis in the lower limbs) may be necessary to optimize the potential beneficial effects of such a program, both on the upper and lower limbs, and on function.

<h2>Abstract</h2><p dir="ltr">Currently, only 22% of high school graduates meet the basic requirements for one or more college courses in mathematics, science, reading, or English signifying fewer students with the skills to enter careers in science, technology, engineering, and mathematics (STEM) (Smithsonian Science Education Center, 2015). In contrast, science and engineering employment in the United States has grown more rapidly than the overall workforce and now represents 5% of all jobs which is projected to increase to 8% by 2029 (Khan et al., 2020). The current statistics represent a future labor force entering the labor market without the skills needed to obtain a large portion of future occupations. To bridge this gap, the U.S. Federal government outlined a vision with three goals to provide Americans access to high-quality STEM education to increase the skills of the future workforce (National Science & Technology Council, 2018). The three goals include 1) building a strong foundation for STEM literacy; 2) increasing diversity, equity, and inclusion in STEM; 3) preparing the STEM workers for the future (National Science & Technology Council, 2018). As the economy and workforce develop in future years, students will require a high-quality STEM education to enter this growing workforce to meet the goals of the federal government and the needs of future occupations. Robotic platforms are diverse and have the ability to provide students with instant feedback, integrate multiple subjects during the design challenge, and support self-efficacy development through mastery events where students practice skills until they receive a favorable result. Robotics in a life-centered context could interest a diverse range of young adults into STEM career fields. This study implements robotic learning activies in an assistive technology context which centers around improving the lives of living organisms.</p>

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