The Field Evaluation of a Mobile Digital Image Communication Application Designed for People with Aphasia
Meredith Allen, Joanna McGrenere, Barbara Purves · 2008 · ACM Transactions on Accessible Computing · doi:10.1145/1361203.1361208
Summary
This paper presents PhotoTalk, a mobile application designed to help people with aphasia capture and manage digital photographs for face-to-face communication. The research addresses a significant gap: while AAC devices exist for aphasia, very few have been evaluated through field studies in real-world settings. PhotoTalk runs on an HP iPAQ PDA with an integrated camera, featuring an image-based interface with minimal text, six categorical folders (New, People, Places, Events, Things, Personal), and a custom large soft keyboard for optional captions. The research followed a three-phase participatory design process. First, speech-language pathologists (SLPs) contributed to initial design through participatory sessions, bringing expertise in aphasia and AAC. Second, five people with aphasia participated in a usability study that identified interface problems—leading to redesigns of folder organization, photo management, and keyboard layout. Third, a one-month field evaluation was conducted with three participants with varying aphasia profiles, assessed using the Western Aphasia Battery (WAB) and Quality of Communication Life (QCL) scale. Participants met weekly with researchers and kept photo diaries. The field evaluation methodology itself represents a contribution, as conducting longitudinal research with people who have communication impairments presents unique challenges—including difficulty recruiting participants and potential misunderstandings during meetings due to participants' communication difficulties.
Key findings
All three field study participants successfully used PhotoTalk independently, though in different ways reflecting their individual impairment patterns and communication goals. P1 (severe speech and writing impairments) used PhotoTalk specifically to communicate garden information to his wife—a targeted enhancement of existing communication patterns. P2 (fluent speech with word-finding difficulties) primarily used PhotoTalk for language rehabilitation, practicing spelling and pronunciation with photo captions. P3 (experienced PDA user) used it for specific communication purposes, having already developed strong coping strategies over five years with aphasia. Usage was substantial: P1 used PhotoTalk on 20 of 28 days, taking 218 photos; P2 used it 21 of 30 days, taking 151 photos. Customizability emerged as a critical issue—P1 wanted larger interface elements and struggled with screen sensitivity, while P2 and P3 were satisfied with defaults. Hardware limitations proved significant: the iPAQ is designed for right-handed users, but many people with aphasia have hemiparesis affecting their right arm and hand. Notably, none of the participants used the researchers' folder-category mapping, instead creating their own organizational schemes—demonstrating both the flexibility of the design and the importance of user-determined structures. The researchers also discovered a protocol glitch: participants didn't mention using PhotoTalk for communication until the final meeting, despite doing so throughout the study.
Relevance
This research provides a model for field evaluation of assistive technology with users who have communication impairments. The challenges encountered—recruiting difficulties, potential misunderstandings during data collection, and the value of involving family members early—offer practical guidance for accessibility researchers planning similar studies. For AAC practitioners, the findings highlight that people with aphasia use the same tool in very different ways based on their impairment patterns, coping strategies, and personal circumstances. A tool designed for communication may also serve rehabilitation purposes. The importance of customizability is clear: one-size-fits-all interfaces won't work across the diverse presentations of aphasia. The hardware accessibility insight about handedness and hemiparesis applies broadly to mobile AAC design—device manufacturers and app developers should consider left-handed operation modes. The study also demonstrates that even relatively simple image-based communication tools can provide meaningful support when designed with user input and evaluated in real contexts rather than laboratory settings alone.
Tags: aphasia · AAC · mobile devices · field evaluation · participatory design · image-based communication · PDA