Ebook: Assistive Technology: Shaping a Sustainable and Inclusive World

We are happy to introduce AAATE 2023, the 17th International Conference of the Association for the Advancement of Assistive Technology in Europe, taking place in Aubervilliers, near Paris, from 30 August to 1 September 2023. Since the first conference was held in Maastricht in 1990, and every 2 years thereafter except in 2021, the AAATE conference has become, together with its twin conference ICCHP (International Conference on Computers Helping People with Special Needs), the main rendez-vous for all stakeholders interested in the field of digital accessibility and assistive technologies (AT) for people with disabilities: researchers, experts, practitioners, manufacturers, AT users, decision-makers, providers of AT and accessibility, as well as anyone else working in this field.

The topics discussed at this biennial conference have continued to evolve for more than 30 years, but the constant of AAATE, to borrow a mathematical term, is its focus on research which is aimed at improving the lives of people with a disability. This could be seen as a restrictive focus, but in reality it is a universal goal. Indeed, improving the lives of people with a disability simply means improving the lives of all human beings. There are two reasons for this. The first is that most of what we, as a society, do for people with a disability will improve the lives of everyone; for example, street accessibility for wheelchair users also facilitates the lives of young parents pushing prams, elderly people, delivery workers and many more. The second reason is that if we consider a person’s entire life, and not just their situation at any given moment, disability will affect almost everybody at some point. Indeed, supporting people with a disability is part of what makes us human, that is, a species that cares about others and the future.

This last point may seem quite optimistic in the current global context, where human activities now endanger the survival of the entire species, but we are convinced that improving the lives of people with a disability – and consequently all people – is a key issue that will contribute to making our world more sustainable. In the same way, sustainability and inclusiveness are intrinsically linked, with both seeking to ensure the safeguarding of the most vulnerable members of society. This undoubtedly leads us to Assistive Technology: Shaping a Sustainable and Inclusive World.

One of the major changes witnessed in our domain of research has been the role played by end users; indeed, people with a disability should not merely be involved in the testing of prototypes designed to meet some specific need, it is essential to place them at the centre of the research and development process. Not only do people with disabilities best know their own needs, they also have great potential to be part of this process. Let us recall a certain Charles Barbier de la Serre, who invented the concept of raised-dot writing to facilitate night messaging, and whose name very few know two centuries later. There is also Louis Braille, who was blind, and who turned this tactile writing style into a reading system which revolutionised the education and lives of blind people all over the world. (Barbier’s night writing system offered only the possibility of deciphering, making its usefulness extremely limited.)

The AAATE 2023 conference is hosted by University Paris 8-Vincennes-Saint-Denis at the Centre de Conférences of the Condorcet Campus (For more information about the Condorcet Campus, see https://www.campus-condorcet.fr/). This campus was founded in 2019 to provide new research infrastructure for the humanities and social sciences, and includes several buildings housing research labs, a large documentary centre known as the Humathèque, L’Hôtel à projets, where labs can have additional temporary offices for the duration of a project, La Maison des chercheurs providing short- and long-terms accommodation for invited researchers, as well as student housing and the very functional congress centre that is hosting the conference. More specifically, the conference is organised by the THIM team of the CHArt laboratory at the University Paris 8-Vincennes-Saint-Denis. THIM stands for Technologies, Handicaps, Interaction et Multimodalités (Technology, Handicap, Interaction and Multi-modalities). The team’s research has focused on AT and accessibility for the past two decades. It is connected with the Master’s programme Technology and Disability, which has been training students in AT development and assessment, as well as digital accessibility, since 2001.

As AAATE is intrinsically multidisciplinary, the conference has an original structure. Contributors were given the choice of contributing either an oral presentation, or an oral presentation combined with a paper to be published in the conference proceedings. This choice reflects the diversity of disciplines represented at the conference, as some fields value conference papers, provided they are peer reviewed, while others will only consider the publication of articles in scientific journals. Overall, 157 scientific presentations will be delivered in four parallel sessions during the three days of the conference. In addition, an Inclusion Forum will cover 17 sessions on education, 7 on policies and 24 on innovation.

Over 240 proposals were submitted in response to the call for contributions, demonstrating the research community’s keen interest in these topics in Europe and beyond. Of these proposals, 123 were also submitted for publication in the conference proceedings. After completion of the review process, 74 of these were selected for the current proceedings, published by IOS Press in the series entitled Studies in Health Technology and Informatics. Each paper was reviewed by at least three reviewers from the International Scientific Committee, which is composed of 110 international experts from 32 countries around the world and reflecting the diversity of disciplines in our community. Many of the papers rejected for publication in the conference proceedings were subsequently reoriented to other categories of the conference, for oral presentation, or to the education, policy or innovation sessions.

At the time of writing this preface, two months before the conference, we have already registered attendees from 45 countries across five continents.

We are grateful to all the authors whose research efforts are published in this volume. We would also like to acknowledge the efforts of the International Scientific Committee, as well as that of the members of the Programme and Organisation Committees, who dedicated their time and effort to the realisation of this event. Finally, we would like to thank all conference participants for supporting the mission of AAATE.

July 2023

Dominique Archambault and Georgios Kouroupetroglou

The employment of socially assistive robotics (SAR) is increasingly being considered a credible solution to support healthcare systems in dealing with an aging society. In this contribution, we explore the experience of older adults (n = 11) living in a residential facility with a cognitive training intervention conducted with the support of a SAR. Within the HORIZON2020 Project SHAPES, a mixed-method study has been conducted to collect preliminary evidence on users’ engagement and acceptance of the proposed SAR-based intervention. The results suggest that the SAR-based cognitive training intervention conducted was accepted by all stakeholders. Data on enjoyment of participants indicate that users did not experience a “novelty effect” of the proposed innovation, but longer sessions are needed to confirm this result.

Artificial Intelligence (AI) technology is increasingly being integrated into our daily lives and many aspects of society. AI is viewed as a new opportunity to promote independent living and well-being for older adults. AI literacy plays an important role in older adults’ acceptance and use of AI-enabled products and services. However, to our knowledge, no research has investigated AI literacy among older adults. The study aims to address this gap by collecting and analysing data on older adults’ knowledge and understanding of AI and their experiences and concerns regarding AI-enabled products and services. In total, 207 older adults, aged 60 years and over, participated in the study, including 182 who answered a survey and 25 who participated in semi-structured interviews. The results show a variety levels of AI literacy among the participants. Many are interested in learning more about AI so they can make informed decisions about AI-enabled products and services. This study has not only produced insights into AI literacy among older adults but also contributed to increasing the awareness of AI among the participants and has provided recommendations on measures to enhance older adults’ AI competencies.

The successful adoption of assistive technologies for older adults requires considering and evaluating many different factors and dimensions such as effectiveness, usability, cost and equity of access, to name some of the most relevant. In line with this, the energy requirements to power such assistive technologies remains a hidden factor that might to some extent influence the success in their adoption and the user experience in a wider sense. Very often energy availability is taken for granted and its associated costs and operational requirements are mostly neglected. In this paper, the energy-related requirements of assistive technologies are analysed from a general perspective. This analysis is subsequently particularised for a use case within the SHAPES project, in the context of active and healthy ageing. This use case includes a wide variety of assistive technologies, namely: wearable devices, home sensors and a smart mirror, which provides connectivity and a set of software services. The energy requirements of all these technologies are evaluated and analysed to investigate their impact and relevance on the overall cost and user experience, following the proposed protocol.

Smart Wearables are considered a very promising solution for monitoring and helping people affected by cognitive decline or dementia and, in particular, Alzheimer Disease (AD). Nonetheless, the acceptability and wearability of such devices for AD patients pose certain challenges. To address this, an empirical study has been conducted with a group of patients with mild to moderate AD, wearing wristbands E4 by Empatica for a duration of three months. The experiment has been integrated into the regular healthcare activities, with active involvement from nurses and physicians. The paper reports the feedbacks of the caregivers and discusses wearability and acceptability issues.

Increasingly, health and social care providers are adopting technology-mediated processes to optimise the delivery of care and to influence policy- and decision-makers. However, fragmentation persists in and between health and social care, impeding the provision of rounded person-centred care. Health and care delivery for an ageing population involves many diverse stakeholders with a range of motivations and agendas. The creation of a functional and sustainable network may promote the achievement of a well-functioning and integrated health and care sector. This work-in-progress paper outlines the evolution of an optimal governance model for the SHAPES network.

Good governance—aligned with human rights and rights-based care, participation, inclusion, and person-centredness—of digital care systems is integral to their ability to meet their objectives. To gain insight into existing governance structures and processes and participation experiences across Europe and lay foundations for the SHAPES Project’s network governance (a healthy and active ageing Innovation Action consortium), our objectives included: 1) expand the list of known stakeholders, 2) explore how the range of stakeholders participate in health and social care governance, 3) develop an inventory of barriers and facilitators. Using an empirical, survey method, we consulted SHAPES Project partner organisations, with respondents invited to suggest specific participation barriers and facilitators. 16 organisations responded. Numerous additional stakeholders were identified. Circa 150 unique barriers and facilitators were reported, rationalised into 20 superordinate categories. Six cross-cutting themes were assembled: dimensionality and flux; power; opportunity and environments; interest, motivation, and choice; valuing governance participation, and duality. This work allows consideration of a wide range of stakeholders for the SHAPES collaborative governance model and future research, and for system design with the benefit of a detailed inventory of barriers and facilitators, and thematic contextualisation. Participation is modifiable and we suggest intervention targets and mechanisms.

Access to digital health and care solutions and services that promote healthy ageing, independent living, and ageing in place is limited due to significant market barriers and challenges. The SHAPES project addresses the challenge of ageing populations by developing a sociotechnical ecosystem comprising a variety of health and care digital solutions, tools and services to enable and facilitate active, independent, and healthy ageing at home. Within the SHAPES project, the SHAPES Marketplace serves as a one-stop-shop for digital solutions and services designed for the Silver Economy that target the smart and healthy ageing and independent living markets. Delivering a dynamic catalogue of health and care digital solutions and services, the Marketplace promotes a transparent expansion of a trusted market offer on digital solutions and services for healthy ageing and independent living on a pan-European scale, thereby preventing vendor lock-in and enhancing the agile and fair competitiveness of the health and care industry, particularly in Europe. This paper introduces the SHAPES Marketplace and considers its function as a market driver to raise awareness on the benefits and impact of health and care digital solutions and services, as well as to shape the healthy ageing market, upholding the Systems-Market for Assistive and Related Technologies (SMART) Thinking Matrix to stimulate transparency, trust and fair competition.

Recently, care robots are being developed that incorporate robotics into assistive products that focus on daily care for the physically disabled or elderly with reduced physical function. However, although care robots can reduce the physical burden of human intervention, they can also be dangerous depending on their situational awareness. This study describes a standardization that defines safety requirements for care robots and includes verification methods to test their safety requirements. As an example of the application of this standard, a standard for the safety and performance method of a feeding robot is shown. This standardization study is expected to contribute to the spread of care robots in the future.

This study aimed to explore the utilisation of conversational interfaces (CIs) by local care service providers (CSPs) and their potential applications in improving the quality of life for older adults. Two workshops were conducted with stakeholders to gather insights and requirements. Although currently not yet utilised by CSPs, stakeholders expressed their openness towards CIs and believed that older adults are very likely to appear receptive to them. Loneliness and isolation were identified as significant challenges, even among older adults living in care institutions. Key requirements for chatbots included complementarity to in-person interactions, user-friendliness, 24/7 availability, and seamless integration into daily life. Ethical considerations, data privacy, and security were emphasised, also highlighting the importance of transparency and limited data retention. Various use cases were discussed, such as assistance, self-management tools, and reminders. The financing issues remained inconclusive, but health insurances showed their potential interest in solutions targeting loneliness.

The demand for homecare services is on the rise, while simultaneously there is a shortage of homecare nurses who are burdened with increasingly heavier workloads. The introduction of assistive technologies has the potential to assist elderly individuals as well as (informal) caregivers. This study aims to facilitate nursing care with technology, within the framework of a proper daily structure for elderly people. Initially, a needs assessment was performed with homecare nurses to identify the most relevant daily structure patterns. Subsequently, a prototype comprising of a test setup and a mobile application was developed, followed by a case study involving participation from homecare nurses, informal caregivers, and patients. Both subjective experiences and standardized outcome measures (System Usability Scale, Usefulness Satisfaction and Ease of Use Scale and User Experience Questionnaire) revealed highly positive attitudes towards the test setup and application. Future research endeavours should focus on scaling up the technology and expanding its availability to other caregivers.

Falls are a serious problem in the hospital setting and home environments. However, this problem does not only affect the elderly, but also people who have had surgery, have disabling problems, have associated diagnoses (such as poor eyesight, confusion, etc.) or are dizzy or have walking aids. The aim of research was to find, compare and implement fall detectors especially for the hospital environment. This paper summarizes possible fall detectors. Various technological solutions were selected for testing, including wearable technologies as well as contactless technologies based on PIR detectors and mmWave technologies. The selected fall detectors were tested in living laboratory of HEALTHLab.vsb.cz and then in Hospital AGEL Třinec – Podlesí. The best result of the testing was the use of two Vayyar Home Care devices in one room, thus achieving a detection accuracy of 92.50 % and a sensitivity of 92.50 %.

Human Activity Recognition (HAR) has attracted considerable interest due to its ability to facilitate automation in various application areas, including but not limited to smart homes, active assisted living, and security. At present, optical modalities such as RGB, depth, and thermal imaging are prevalent in the field due to the effectiveness of deep learning algorithms like Convolutional Neural Networks (CNNs) and the abundance of publicly available image data. However, unconventional modalities such as radar, WiFi, seismic and environmental sensors are emerging as potential alternatives due to their capacity for contactless long-range sensing in spatially constrained environments and preservation of visual privacy. This work gives an overview of the HAR modalities landscape and discusses works that apply these emerging modalities in new and unconventional ways to inform researchers and practitioners about challenges and opportunities in the field of HAR.

As the world’s population ages, the demand for active and assisted living technologies that can support older adults maintain their independence, health, and quality of life is increasing. Video monitoring cameras can provide a sense of safety and peace of mind for both older adults and their caregivers. However, these visual sensing systems come with major privacy concerns. Researchers have developed various visual privacy preservation filters that can be used for video-based monitoring technology, such as blurring, pixelation, silhouette, or avatar. To understand the user’s needs and fine-tune the system to their preferences, the persona scenario method was employed in this study. The goal-directed approach to persona design was followed. This scenario-based technique involves creating fictitious persona archetypes that represent the unique characteristics, needs, and goals of the target user group and other stakeholders involved in the process of care provision. A set of eight personas were created based on the qualitative data collected through interviews and focus groups in Spain. Data from 62 participants were analyzed, which represented different contributor groups such as older adults, direct caregivers, healthcare experts, and other stakeholders. The final personas are accessible to the public on a Blueprint persona repository.

Active and Assisted Living (AAL) technologies offer solutions for addressing healthcare challenges associated with ageing societies and a shortage of care personnel. At the same time, these technologies raise significant privacy issues, which may constitute a barrier to the sustainable adoption and acceptance of AAL. In particular, concerns arise from the presence of cameras in intimate situations, including nudity, and the potential production and dissemination of intimate pictures, which constitutes a risk for AAL users. The paper compares the regimes of criminal liability for making and disseminating intimate pictures under EU, Irish, and Polish law. The study aims to help AAL users understand their legal protection, and give providers and developers more insight into their legal responsibilities. The paper first presents different understandings of an intimate picture in each jurisdiction, followed by a discussion of what the crime entails and who may be liable for it. The conclusion includes a checklist of rules concerning criminal liability, which may be useful for AAL users and providers, and conclusions de lege ferenda.

The majority of falls leading to death occur among the elderly population. The use of fall detection technology can help to ensure quick help for fall victims by automatically informing caretakers. Our fall detection method is based on depth data and has a high level of reliability in detecting falls while maintaining a low false alarm rate. The technology has been deployed in over 1,200 installations, indicating user acceptance and technological maturity. We follow a privacy by design approach by using range maps for the analysis instead of RGB images and process all the data in the sensor. The literature review shows that real-world fall detection evaluation is scarce, and if available, is conducted with a limited amount of participants. To our knowledge, our depth image based fall detection method has achieved the largest field evaluation up to date, with more than 100,000 events manually annotated and an evaluation on a dataset with 2.2 million events. We additionally present an 8-months study with more than 120,000 alarms analysed, provoked by 214 sensors located in 16 care facilities in Austria. We learned that on average 2.3 times more falls happen than are documented. Consequently, the system helps to detect falls that are otherwise overseen. The presented solution has the potential to make a significant impact in reducing the risk of accidental falls.

Long-term remote patients monitoring implies minimal discomfort and reliability throughout the study period. These requirements are fulfilled by portable (wearable) patient devices, with low consumption, which transmit data wirelessly, at a short distance, to a mobile communication device (GSM) and through it, to a remote end recipient - doctor, medical center or a hospital server. The data transfer technology requires the monitored person to perform a sequence of actions, such as: selecting the appropriate application on the mobile phone, establishing a connection between the patient module and the phone, recording the data in the phone’s memory, starting the data transfer from the phone to the final receiver. Practice shows that often this sequence of activities is difficult for elderly people and especially for visually impaired people, which as a result compromises the remote monitoring process. In this paper are presented an approach and conceptual implementation of a system for remote monitoring of cardiac activity, using the most popular way of remote connectivity - voice (sound) communication. In addition to the ease of use, this type of communication does not require special data protection, due to the lack of RF interfaces for short-distance data transmission. The presented results of laboratory studies, as well as conducted tests under medical supervision of patients in a cardiology clinic, confirm the workability of the proposed approach for remote monitoring of patients by audio conversion of the ECG signal.

With the increased penetration of screen reading software, effective audio rendering of equations can significantly assist in making many electronic mathematics documents accessible. However, linear syntactic rendering of equations not only creates a considerable cognitive load, even for relatively simple equations, but also becomes crucial in more advanced mathematical subjects where the precise and correct interpretation of symbols is essential. To overcome this challenge, we are working on a procedure to extract contextual semantics for mathematical expressions from the surrounding text. In this paper, we will present one of its modules: the Semantic Extractor. This module aids in extracting semantics from the concordance that contains valid mathematical definitions. This approach enables contextually aware audio rendering of complex mathematical expressions, rather than relying solely on syntactic rendering.

It is very difficult to provide dyslexic students in senior-high school or higher education with all necessary textbooks in ordinary accessible format such as multimedia DAISY. Here, a new approach to provide them with a new type of accessible textbooks named “Fixed-Layout DAISY” is shown. In it, the whole page is treated as a multi-layer picture, the front layer of which has the same form as the original PDF. A DAISY (EPUB3) player can read out any texts together with highlighting them. It does not have the reflow function. The page layout is always kept as same as the original. It does not have information either in which order texts on the page should be read out, and readers need to click a text block on a page where they want to read. Dyslexic people can see and click a place where they want to read, and obviously, Fixed-Layout DAISY should work for them. Fixed-Layout DAISY can be produced almost automatically from an original “e-born PDF” by making use of our OCR system, and it should be very helpful for the dyslexic students to get accessible version of their textbooks.

Many online educational materials for sighted students such as presentation slides, PDF materials, MP4 videos, etc. are produced with Microsoft PowerPoint (PPT). In terms of non-technical contents, accessible PPT contents can be produced in a certain level; however, as far as STEM contents are concerned, there is still a serious difficulty. Our new add-on for PPT allows users to make efficiently/easily PPT STEM contents accessible. By making use of it, alt text/aloud reading by a TTS voice can be added to any technical part such as mathematical expressions included in PPT slides. An accessible MP4 video for STEM education also can be produced efficiently. By making use of multilingual support in Infty software, this add-on has been recently improved so that users can use it for PPT contents in various local languages other than Japanese or English.