Usability testing with AAC users

This talk was given for the role=drinks event in Amsterdam, later repeated at UNITiD in Rotterdam, and finally at Designhuis in Eindhoven. The speaker notes and slides shown are from the final time I presented this talk.

Slides

Speaker notes

AssistiveWare logo
Usability testing with AAC users by Dean Birkett

Hello all - before I start I’d just like to mention a couple of things… if you attended role=drinks a few months ago, or the Inclusive Design & Accessibility meetup at UnitD in Rotterdam then you may want to find another session as this is pretty much a repeat talk. I won’t be offended if anybody leaves!

Secondly, I like to make my talks as inclusive as possible and although you personally may not need subtitles or audio description I’m going to keep these considerations in place.

Awesome, so brief intro my name is Dean Birkett, and I’m a User Experience Designer at a company called AssistiveWare. Before I go into more detail about who AssistiveWare are, and what I actually do I’d like to play you a short video…

Sady Paulson in front of a blue slide with

Sady, the star of the video, graduated from an online University in February 2016. She has Cerebral Palsy and is non-verbal.
 

Jose, Dean, Sady, David sat together all smiling at the camera.

Sady uses one of the apps I work on and has been a friend of our CEO’s for a number of years, so later in the day a few of us attended her graduation dinner at a local Florida restaurant.
 

Sady Paulson smiling at camera.

There are two remarkable things about this story. Despite being non-verbal and having Cerebral Palsy, many of her fellow classmates were unaware. She used the same tools as everyone else, and as it was online, she was judged by her ability not her disability. The second remarkable thing is the video I showed right at the very start was edited by Sady, that isn’t camera trickery.
 

AssistiveWare human centered design process diagram, showing an idea stage going into understand, research, concept, design, develop, analyse stages before release.

I wanted to share that story with you because Sady has been using the products AssistiveWare make for a while now, she’s someone who keeps using and returning to the software we make, and as we are a company that focuses on the people who use our products, we like to make sure that we are doing things right for the people who need our software the most.

I’m not going to go into detail about the process diagram on screen, but it covers various stages of a design process and highlights the opportunities we have to test with users through the various stages.

Who are AssistiveWare?

But, who are AssistiveWare?

We develop assistive technology software for iOS and Mac OS X. We are dedicated to creating meaningful applications for people with physical, vision, communication and reading impairments.

Proloquo2Go, Proloquo4Text, and Keeble from AssistiveWare.

The reason why the word “Communication” was in bold on the previous slide is because that is the area that I primarily work in.

In the image on the screen, it shows three products, Proloquo2Go, Proloquo4Text, and Keeble. I’ll go into them in more detail later, but just to briefly introduce you to them…

Proloquo2Go and Proloquo4Text are specifically for AAC users, and Keeble is an app that can be used by a broader audience, but is used a lot by AAC users…

Wikipedia entry on Augmentative and alternative communication.

So, what is AAC?

Augmentative and alternative communication or AAC, is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language.

Stephen Hawking on a bridge in his motorised wheelchair.

AAC is used by those with a wide range of speech and language impairments, such as Cerebral Palsy, intellectual impairments, and Autism, and acquired conditions such as ALS and Parkinson’s disease.

On screen is a photograph of the most famous AAC user, Stephen Hawking in his motorised wheelchair, with a mounted communication device.

About 40% of children with autism do not speak. About 25-30% of children with autism have some words at 12 to 18 months of age and then lose them. Others might speak, but not until later in childhood.

Just to give you some idea of how many people we are talking about, 1 in 68 children in the US are diagnosed with autism, of those about 40% do not speak.

About 25-30% of children with autism have some words at 12 to 18 months of age and then lose them. Others might speak, but not until later in childhood.

In the United States it is estimated that 2 million people are severely communicatively disordered.

Including other impairments and diagnoses, it is estimated that in the US there are approximately 2 million people that are severely communicatively disordered, that is 8 per 1000.

So how do you perform Usability tests with people who use AAC apps?

So how do I perform usability tests with people who use AAC apps?

It’s definitely challenging but it is possible. I’d like to show a few examples from usability tests that I ran, with the apps I highlighted earlier.

Keeble is an iOS keyboard that allows individuals with fine-motor challenges or vision impairments to type in almost any app that supports Apple's standard keyboard.

Keeble is an iOS keyboard that allows individuals with fine-motor challenges or vision impairments to type in almost any app that supports Apple's standard keyboard.

Blurred out image of a usability test participant, who is sat in a wheelchair with an iPad in front.

On screen is a photograph of <name removed>, a teen with Cerebral Palsy. He’s sat in his wheelchair, with an iPad secured to a stand in front of him. He’s looking at a Mac with myself looking back at him. <name removed> uses his tongue to navigate his iPad. Because he lives overseas, and I’m over in the Netherlands we did this test remotely, using Skype.

Still from the usability test with a test participant with Cerebral Palsy.

I’d like to show this video showing <name removed> installing Keeble…*

The beauty of this particular test is that one of the developers was sat off-screen next to me. Watching someone use a product that you create is an extremely powerful way to make you more understanding of a particular users needs, so if you’re a developer, a designer, a CEO, or whoever… try and sit in these tests whenever an opportunity allows for it.

* clip removed.

Tip 1: Involve others

So my first tip to anybody who performs usability tests would be to ‘involve others’. The more colleagues meet the people using the products they work on, the better.

Despite at times a little difficult to understand, Tyler is literate and verbal. But what about people who have literacy, but are non-verbal?

Proloquo4Text is a text-based communication app that gives a voice to literate people who cannot speak.

Sady, for example, would fall into this category and she uses Proloquo4Text to communicate.

Proloquo4Text is a text-based communication app that gives a voice to literate people who cannot speak.

Three photographs of Sady, one with Russell Brand, one with David Copperfield, and one with her base jumping from the top of the KL Tower.

On screen are a few pictures of an Australian girl called Marlena, she is fairly well known on Youtube for her account, “AAC Journalist”, where she uses Proloquo4Text to interview celebrities and get all the juicy gossip. In the main photo she is sat joking with Russell Brand, a fairly well-known comedian and actor, her iPad sat in front of her on a table. In the top right she is sat looking at the magician David Copperfield, and in the bottom right you’ll see this awesome photo…
 

Sady strapped to a professional base jumper, leaping from the KL Tower in Kuala Lumpar.

…which I have just made full screen. It’s a photograph of Marlena strapped to a professional base jumper, as they jump together from the KL Tower in Kuala Lumpur. Marlena became the first person with cerebral palsy in the world to base jump…
 

Marlena providing feedback on Keeble and Proloquo4Text.

When she’s not throwing herself off of buildings, she’s doing far less exciting things like providing us feedback on the software that she uses. In the short clip I’m about to show, Marlena was asked to share her initial thoughts on the latest update to Proloquo4Text.*

* clip removed.
 

Tip 2: Whenever possible perform in-person testing.

Remote usability testing with literate AAC users is possible, although time-consuming and challenging to set up. So my second tip would be to perform in-person informal observations or tests whenever possible.

For a challenging audience such as this one then I also preferred to use online A/B tests or polls that can be completed in the participants own time.

 

Proloquo4Text showing the text

On screen is a photograph of Keeble and Proloquo4Text together, the same setup that Marlena was just using… the keyboard at the bottom and the top part of the display has a large play button in the middle, an x to clear the message to the right of the screen, and options, full screen, and share icons in the toolbar at the top. Written on screen are the words, “This is too good of an opportunity…”
 

Group of people all sat on stairs. The participants at last years UX Camp Eindhoven.

Because it is… I’m in a room full of UX Designers, or those interested in UX. So I have to ask… thinking back to the video, what things jumped out at you as being problematic for Marlena, and how could we solve them?

Proloquo2Go is a symbol-based communication app to promote language development and grow communication skills, from beginning to advanced communicators.

Okay, so we’ve spoken about people who are hard to understand, people who are literate but non-verbal, but what about those who are non-verbal and have no literacy? The last app I’d like to talk about is our most well-known app, Proloquo2Go.

Proloquo2Go is a symbol-based communication app to promote language development and grow communication skills, from beginning to advanced communicators.

To explain this app a little more, forgive me for playing this promotional video. 

Debbie, Callee and myself stood outside the Melbourne Star.

I’d just like to introduce you to a couple of people. On the left of the screen is Debbie, and Debbie’s daughter Callee is stood in the middle, with me just to the right of her. In the background is the Melbourne Star, a huge observation wheel. Callee is non-verbal and has a rare illness, and she uses Proloquo2Go to help her find her words.

Debbie and Callee smiling while looking at an iPad with Proloquo2Go.

I’ve been fortunate enough to hang out with Debbie and Callee a couple of times now. The first time we met for coffee, and what was remarkable to me is that I ordered a long black, Debbie ordered a flat white, then it came to Callee who pushed a number of buttons to ask for a skinny latte with marshmallows.

I’d just like to play you a short video of Callee using Proloquo2Go. Callee is at home with her mum, and Callee is putting together a felt jungle puzzle made up of different shapes. She has her iPad with Proloquo2Go on the table in front of her and moves between the puzzle and app during the video.

A little sidebar, you may wonder how Tyrone and Callee were able to learn the words and what they mean? They learn through something called modelling.

I’m just going to play you a short video of a colleague of mine Amanda, a Speech Language Pathologist showing how to model language. In this video Amanda is stood with a large poster of Proloquo2Go’s home screen behind her, there are 77 buttons with symbols and words on them. She picks up a book called ‘you can’t take an elephant on the bus’ and as she reads, she taps on some words on the poster.

More on Amanda later.

Five circles, AAC user in a red circle in the middle. Four surrounding circles with parents and family members, caregivers, teachers, speech language pathologists written inside.

<name removed> and Callee are people that you can learn from, by watching their behaviour, but to ask them to communicate problems they face, or perform tasks it would be hugely difficult, and for lower functioning kids it would be impossible. So instead of speaking directly to the actual AAC users, I perform usability tests with those who surround the user.
 

Still of a usability test.

I’m just going to play a couple of short clips highlighting how performing usability tests with the support network is also beneficial. The first example shows the Progressive Language feature in Proloquo2Go, which allows for buttons to be introduced in steps rather than all at once.*

* clip removed.

Still from a usability test of Search.

This second example shows a past searches screen in Proloquo2Go, where the button is highlighted and the path to find that button.

* clip removed.

Still from a usability test, showing a past search in Proloquo2go.

Watching somebody use a prototype ensures that we’re not creating something that is not useful, or not understood. On screen is how the search feature was implemented, with the search window at the top, and past searches underneath. What changed from the video was that a cancel button was introduced, a keyboard immediately appeared on open, and there were little arrows highlighting the pathway to the word.
 

Tip 3: Find a way to test.

My final tip would be to find ways to test, regardless of how challenging it may seem. You may be at a company that doesn’t value testing, or you may struggle to find people to test with, but please find a way.

I had many challenges with the audience I tested with, but was able to find ways to get useful feedback which has helped shape and improve the products.

Three tips, with the title of the talk removed. Tip 1: Involve others. Tip 2: Whenever possible perform in-person testing. Tip 3: Find a way to test.

This talk has been very niche, and it’s highly unlikely you’ll ever need to perform tests with non-verbal people, but if I remove the title of this talk then these three tips should hopefully still resonate with you, involve others, whenever possible perform in-person testing, and find a way to test.

I’d just like to wrap up with a little story from Amanda who I introduced you to earlier. To me it really gets across the importance of the products we build, and why ensuring you build solutions to real world problems really matters.

I’d just like to wrap up with a little story from Amanda who I introduced you to earlier. To me it really gets across the importance of the products we build, and why ensuring you build solutions to real world problems really matters.

Proloquo2Go with the share options being shown.

Amanda worked with one girl for over a year, modelling language to her so she could start to understand concepts. She was very expressive, loved hugs and cuddles, and so Amanda worked on helping her to unlock her emotions and share these with her family.

In Proloquo2Go you have the ability to create a message using buttons, and send it as a text message. I don’t know if we have any parents in the room, but we’re all empathetic UXers right, so just get into the mindset of never hearing your child’s voice, and then receiving this as a text message…
 

White iPhone with a text message saying

On screen is an image of an iPhone, with a text message saying “I love you mom”.

Aside from the three tips I shared I just want to say that design is so so important, don't forget the people that you’re designing for – get out of your bubble, meet them, the more you learn about people the more likely you will provide solutions to their actual problems.

Email: dean@deanbirkett.name. Twitter: @deanbirkett

I think we have time for questions, but before that, I’d like to say that despite working for such a great company producing great products, I actually leave next week to return into the world of freelancing. I’m available from February next year, so if you hear of any opportunities for a T-shaped designer with a strong focus on Accessibility, then my details are on screen, come get a card too! Thanks!

© 2018 Dean Birkett

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