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«Jury: University of Fribourg, Switzerland Prof. Dr. Jacques Pasquier, president of the jury Prof. Dr. Andreas Meier, 1st referee Prof. Dr. Marino ...»

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Requirements Elicitation and System Specification

of Assistive Systems for People with Mild


Doctoral Thesis

presented by

Joël Vogt

from Erschwil SO

on 14th May 2013

in fulfillment of the requirements for the degree of

Doctor of Economics and Social Sciences

by the University of Fribourg, Switzerland


Doctor of Science: Information Technology

by the transnational University of Limburg, Belgium


University of Fribourg, Switzerland Prof. Dr. Jacques Pasquier, president of the jury Prof. Dr. Andreas Meier, 1st referee Prof. Dr. Marino Widmer, 3rd referee Hasselt University, Belgium Prof. Dr. Kris Luyten, 2nd referee Prof. Dr. Karin Coninx Dr. Jan Van den Bergh University of Basel, Switzerland Prof. Dr. Heiko Schuldt, external referee Fribourg, Switzerland 2013 The Faculty of Economics and Social Sciences at the University of Fribourg neither approves nor disapproves the opinions expressed in a doctoral dissertation. They are to be considered those of the author (Decision of the Faculty Council of 23 January 1990).

To my parents Even though I walk through the valley of the shadow of death, I fear no evil, for You are with me; Your rod and Your staff, they comfort me.

Psalm 23:4

Acknowledgement First and foremost my deepest gratitude to my supervisor Professor Dr.

Andreas Meier for giving me this unique opportunity to work in e-health.

He also encouraged me to apply for a research stay at the Expertise centre for Digital Media at the Hasselt University in Belgium. His sincerity, knowledge and wisdom is an inspiration to me.

I express my utmost gratitude to my second supervisor, Professor Dr.

Kris Luyten, for taking his time to support and guide my work despite the distance. He and Dr. Mieke Haesen introduced me to the wonderful world of storyboarding. I also thank Professor Dr. Karin Coninx, vice-dean of the science faculty at Hasselt University, for granting me the unique opportunity to work for six months at the Expertise centre for Digital Media.

My sincere appreciation to my third supervisor, Professor Dr. Marino Widmer, whose tireless effort made the collaboration made the collaboration between Fribourg and Hasselt possible.

My special thanks to Dr. Mieke Haesen, Dr. Jan Van den Bergh and Dr. Nasim Mahmud. Their collaboration and encouragement helped to overcome many obstacles in the completion of this thesis. I also extend my gratitude to Dr. Daniel Fasel and Dr. Edy Portmann for reading my thesis and providing constructive feedback.

I thank my colleagues at the Information System Research Group in Fribourg for the many inspiring and joyful moments. My deepest thanks to my colleagues at the Expertise centre for Digital Media in Hassselt who made my two research stays such a delightful, enriching and unforgettable experience. Rarely has saying goodbye been so difficult.

Last but not least, I express deepest gratitude to my parents for their love, patience and support. Without you, this thesis would not have been possible.

–  –  –

ADL activity of daily living AT assistive technology CG caregiver DL description logic DSR design science research MCI mild cognitive impairment OWA open world assumption OWL web ontology language PwD person with dementia SWRL semantic web rule language Timisto time in storyboards UCD user-centered design UI user interface

–  –  –


1.1 Background Dementia is a syndrome of serious decline of cognitive abilities that exceed age-related decline. Alzheimer’s disease is the most common type of dementia. Forgetfulness, which is caused by episodic memory impairment, is an early symptom of dementia [1, 2]. Time in particular is an important aspect of dementia [3, 4]. There is an increased focus on early detection and diagnosis of Alzheimer’s disease [5, 6]. A recent study commissioned by Alzheimer’s Disease International [6] found that early diagnosis and intervention were beneficial to people with dementia.

The motivation for our research is to simplify the development of assistive technologies for people at the early stage of dementia. Assistive technologies can support people with dementia and their caregivers to cope with dementia. People with mild dementia can also use assistive technologies that are easy to use and not obstructive. Assistive technologies for people with dementia must therefore be tailored to individual users’ context, in order to reduce cognitive load, without burdening users [7–9]. Designers who collaborate with people with dementia face many challenges in their effort to understand the requirements and needs of their users, who can often only provide vague and sometimes conflicting information [7, 9, 10].

Dementia affects about 4% of people over the age of 65 and 40% of people over 90. In Europe, at least half of the elderly population affected by dementia, have a mild form of dementia [11]. The organization Chapter 1. Introduction Alzheimer’s Disease International estimates the cost of dementia worldwide amounts to USD 604 billion, or 1% of the global gross domestic product [12]. Unsurprisingly, Alzheimer’s disease was dubbed the “coming plague of the 21st century” [1] for its social and economical ramifications [1, 2, 6, 12]. Alzheimer’s disease has a profound effect both on the individuals who have dementia and on their social environment [2, 13– 15]. Alzheimer’s disease causes a progressive loss of higher cognitive abilities. Memory problems, especially episodic memory, are early symptoms. As cognitive impairment worsens, people with dementia can get lost in familiar places, find it difficult to recognize people they know and increasingly rely on others in their everyday life [1]. Dementia is especially devastating because it threatens the personal identity, the very core of being human [7, 13].

The availability of high speed Internet connections and the rapid dissemination of mobile computing devices is making assistive technologies viable for applications in dementia care outside medical institutions.

While early developments in dementia care supported medical staff and personal caregivers, people with dementia are also starting to use to assistive technologies to cope with their symptoms [7, 16–18]. Developing assistive technologies that people with dementia and caregivers are willing to use in their daily lives is challenging. People with dementia are not a homogeneous group and customization is needed to adapt applications to meet individual requirements and needs [7, 9, 19].

1.2 Problem Statement A characteristic of designing assistive technologies for people with dementia is the difficulty for designers to understand the users and produce an interactive system that helps people with dementia to live longer independently. People with dementia are more susceptible to change than cognitively unimpaired people. They may also be unaware of the full extend of their conditions. Furthermore, their abilities and emotional state can change. Designing assistive technologies is a challenging task for designers because what a person with dementia experiences is different from that of cognitively unimpaired users. Designers must be empathic towards the user and adapt the choice of design tools to the user’s abilities and needs [7–9].

Literature suggests that storyboards helped people with dementia to participate in the design of assistive technologies [7, 20, 21]. A storyboard

1.3. Research Questions is a visual form of story telling that is used in user-centered design depict the context in which actors use an application [22]. Unlike textual description of scenarios or engineering models, understanding storyboards comes naturally to people because images do not require specific knowledge to decode [23].

A limitation of storyboards is that the design knowledge, i.e. the description user requirements and needs, is informal. The user requirements and needs must therefore be “translated” into more precise technical specification for further usage in the development process. A manual transition has several drawbacks: Tools cannot be used that would help designers to analyze the design knowledge and create technical specifications that represent the user requirements and needs. This also means that there is no explicit relationship between the technical specifications of the interactive system and the user requirements and needs. The motivation for our research is to facilitate the transition from informal design knowledge of the users to more precise technical specifications.

We aim to 1) understand how dementia related-deficits translate into design specifications, 2) explore how extract precise information about the context of use can be extracted from existing storyboards and 3) how the precise information can help designers to analyze the user requirements and needs.

1.3 Research Questions We adopted the design science research approach to develop this thesis.

In the design science research paradigm, knowledge is gained through designing artifacts: inconsistencies in existing knowledge are identified and concepts are designed and developed to explore solutions, resulting in knowledge. This feedback-loop suggests that design science research incrementally improves the understanding of an object under study [24].

• R 1 – Designing interactive systems with people with dementia:

Literature confirms the role of assistive technologies in dementia care but warns of the challenges inherent to designing and developing assistive technologies for people with dementia. The aim of the first research question is to analyze the design properties of assistive technologies for people with dementia as well as how to facilitate the involvement of people with dementia and their caregivers in the design process. The following questions were studied by reviewing Chapter 1.

Introduction context-aware assistive technologies in literature (Chapters 3 and 4):

– R 1.1: What are the characteristics of assistive technologies for people with dementia that were successful?

– R 1.2: How do dementia related deficits translate to design specifications?

– R 1.3: How can the involvement of people with dementia and their caregivers be facilitated?

• R 2 – Representing requirements and needs of people with dementia: The results from the first research question suggest to focus on the transition from user requirements and needs to the technical specifications of an interactive system. The aim of the second research question is to investigate how the design knowledge of the users (their requirements and needs) can be described in a precise and machine-understandable way. Literature is reviewed to

address the following questions (Chapter 4 and 5):

– R 2.1: How can design knowledge be intuitively conveyed?

– R 2.2: How can informal design knowledge be captured, reused and exchanged?

• R 3 – Extracting precise time information from storyboards: The results form the second research question suggest that storyboards help people with dementia to discuss their requirements and needs.

However, storyboards contain informal design knowledge, which is not accessible to computers. However, informal design knowledge can be additionally annotated with precise information to make it machine-understandable. The aim of the third research question is to extend existing storyboarding methods for people with dementia to provide precise time information. An ontology was developed to structure storyboards explicitly according to McCloud [23]’s work on comics. Furthermore, a temporal domain ontology for storyboards was developed to transform the informal temporal information in storyboards, as defined by McCloud for comics, into formal structures. The temporal semantics is based on Allen’s

temporal interval algebra [25] (Chapter 5):

–  –  –

• R 4 – Visualizing time information storyboards: The aim of the fourth research question is evaluate and improve the concepts and

method developed for the third objective. Tool support to annotate and visualize the time as timeline was developed and evaluated with users without cognitive impairment to study the following questions:

– R 4.1: Which representation of the storyboard helps to improve the interpretation of time?

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