TY - JOUR
AU1 - Olivares, Marisnel
AU2 - Pigot, Hélène
AU3 - Bottari, Carolina
AU4 - Lavoie, Monica
AU5 - Zayani, Taoufik
AU6 - Bier, Nathalie
AU7 - Le Dorze, Guylaine
AU8 - Pinard, Stéphanie
AU9 - Le Pevedic, Brigitte
AU1 - Swaine, Bonnie
AU1 - Therriault, Pierre-Yves
AU1 - Thépaut, André
AU1 - Giroux, Sylvain
AB - Abstract User-centered design (UCD) facilitates the creation of technologies that are specifically designed to answer users’ needs. This paper presents the first step of a UCD using a persona, a fictitious character representing the targeted population, which in this case is people having sustained a traumatic brain injury (TBI). The persona is used to better understand the possible interactions of a TBI population with a prototype of a technology that we wish to develop, namely the Cognitive Orthosis for coOKing (COOK). COOK is meant to be an assistive technology that will be designed to promote independence for cooking within a supported-living residence. More specifically, this paper presents the persona’s creation methodology based on the first four phases of the persona’s lifecycle. It also describes how the persona methodology served as a facilitator to initiate an interdisciplinary collaboration between a clinical team and a computer science team. Creation of personas relied on a clinical model (Disability Creation Process) that contextualized the needs of this population and an evaluation tool [Instrumental Activities of Daily Living (IADL) Profile] that presented a wide range of cognitive assistance needs found in this same population. This paper provides an in-depth description of some of the most frequent everyday difficulties experienced by individuals with TBI as well as the persona’s abilities, limitations and social participation during the realization of IADL, and an evaluation of the manifestations of these difficulties during IADL performance as represented through scenarios. The interdisciplinary team used the persona to complete a first description of the interactions of a persona with TBI with COOK. This work is an attempt at offering a communication tool, the persona, to facilitate interdisciplinary research among diverse disciplines who wish to learn to develop a common language, models and methodologies at the beginning of the design process. RESEARCH HIGHLIGHTS |$\bullet $| Personas as a communication tool to facilitate interdisciplinary design research. |$\bullet $| The use of personas as a means of developing common knowledge and vocabulary among interdisciplinary team members. |$\bullet $| Personas as a UCD representation of the common characteristics of a population with complex cognitive needs. |$\bullet $| Use of personas as a means of representing how deficits experienced by persons with traumatic brain injury can impact independence in instrumental activities of daily living. |$\bullet $| A scenario as a means of establishing the main functionalities and user interactions of an assistive technology named COOK, based on a persona’s assistance needs. 1. INTRODUCTION It is well known that User-Centered Design (UCD) is a favoured approach for designing technologies that will respond to users’ needs and, more importantly, be used by them once they are developed [Abras et al., 2004]. To this end, computer scientists need to explore various ways of developing an in-depth understanding of the populations they aim to serve, their preferences, habits and specific environments. When designing for individuals with specific needs, such as individuals with cognitive impairments or in the case of the population being addressed in the current project, traumatic brain injury (TBI), their needs are important and vast but not clearly visible to the naked or untrained eye. Hence, designing technologies that will provide appropriate assistance in their everyday lives presents a unique set of challenges for designers and the need for a specific methodology. On their own, computer scientists cannot apprehend a clientele as complex as TBI. They must work in partnership with clinical specialists who have developed, over the years, knowledge and experience in assisting this clientele on a daily basis. The design of assistive technologies specifically dedicated to TBI can only be interdisciplinary and intersectoral as fields as far apart as computer sciences and health must work collaboratively. However, though interdisciplinary research is greatly valued by funding agencies and developers, it lacks the means to be put into action. The challenges are especially vast in terms of communicating together with each discipline using different terms, models and methods. Interdisciplinary UCD design must therefore develop not only a specific approach to designing for such complex clienteles as TBI but also a specific method for two diverse fields such as health and computer sciences to be able to work together to achieve a common goal. As a first step to understanding the complex needs of this population by the interdisciplinary team, this article proposes the development of personas or fictional characters designed by computer scientists based on the knowledge extracted from a literature review, along with the knowledge provided by experts in the field of TBI. This first phase of the design process of this assistive technology relying on the use of personas lays the groundwork for the subsequent design steps and requires iterative knowledge exchange between health specialists and computer scientists. However, specific examples of how to initiate this dialogue and concretely complete this knowledge exchange process is lacking in the literature [Song et al., 2009]. Hence, this article will detail the set-up of an interdisciplinary collaboration established between computer scientists and occupational therapists specialized in TBI rehabilitation. These two areas of expertise are brought together for designing a technology that enhances the ability of individuals with severe cognitive impairments to complete a complex everyday activity with many safety implications, that is preparing hot meals using a stove. To determine which complex everyday activity would be targeted by the assistive technology, previous research examined the participation needs of seven individuals with severe TBI living in a supported-living residence, where a formal caregiver is present 24 hours a day, in the context of a future collective smart home [Levasseur et al., 2016]. Several needs were identified regarding various dimensions such as nutrition, fitness, mobility, organization, etc. Among them, residents expressed how cooking is a foremost activity for feeling independent. However, cooking is complex and persons with TBI may need assistance to decide which meal to cook, to plan the steps involved in carrying out the activity, to organize their environment to avoid distractions during the meal preparation, to safely cook the meal and to evaluate their own performance. Therefore, our research team decided to design the Cognitive Orthosis for coOKing (COOK), an assistive technology for meal preparation that would be context-aware and aim to support the safety and functioning of people having sustained a TBI in a smart home environment. More specifically, as a first step in the development process, the proposed aim of COOK is to promote independence for cooking in a residence for 10 people with severe TBI. Since an in-depth understanding of people with TBIs needs and capabilities is necessary to determine which actions and errors [Bottari et al., 2014] are crucial for the smart home to detect and which type of assistance should be provided and how it should be delivered, the adoption of a UCD was unavoidable to ensure the acceptance and usage of the cooking assistant by people with TBI and their caregivers. UCD is an iterative approach that puts the user at the centre of the design and development during the various stages of the process (e.g. participation in the design, evaluation of the prototypes; De Vito Dabbs et al., 2009, Heim, 2007). In the overall context of the development of COOK, various stakeholders would be solicited when designing COOK, including residents with TBI and their proxies, residence caregivers who had cared for the residents on a round-the-clock basis and a support staff of clinicians of a rehabilitation centre who had been supporting the residence. However, at this early stage in the design process, our team chose to initiate the conception process using personas that translated the needs of this clientele and facilitated our overall thinking of how a technology could address their needs. This allowed our team to avoid soliciting TBI clients with severe cognitive and behavioral deficits too early on in the design process; a stage requiring too much abstraction for these future users. Personas have been previously used in the literature as a first step of the UCD to create an evidence-based representation of a specific population (e.g. LeRouge et al., 2013, Turner et al., 2013). The main contributions of this study are as follows: |$\bullet $| The creation of a profile of the TBI population using personas that include an in-depth description of some of the most frequent TBI everyday difficulties, the persona’s abilities, limitations and social participation during the realization of instrumental activities of daily living (IADL) and an evaluation of the manifestations of these difficulties during IADL performance as represented through a scenario; |$\bullet $| The set-up of interdisciplinary collaboration using the persona as support for a knowledge-exchange process at the earlier stages of our project; |$\bullet $| The utilization of persona profiles created during our interdisciplinary meetings to carry out prospective studies, by sketching interactions between personas and our ideas of the assistance that would be provided by COOK into a scenario. The strengths of our design of the assistance that would be provided by COOK are (i) the creation of a structure of assistance based on the 4 operations of a clinical tool called the IADL Profile Bottari et al., 2010b and (ii) the integration of evidence-based clinical interventions to provide personalized and contextual assistance to the user. More specifically, a persona is a fictitious character that represents the targeted population that assists the team throughout the design process of a product. It highlights the population’s main goals, needs and ambitions in order to help the designers predict the use of a new device in real settings [Cooper, 2004, Nielsen, 2002]. According to Pruitt & Adlin [2006], persona creation follows a methodology that corresponds to the metaphorical framework of the persona’s lifecycle [Pruitt & Adlin, 2006], similar to the reproduction and development phases in humans (see Fig. 1). During the |$\ll $|1. Family Planning phase|$\gg $|⁠, the persona design team is assembled and the role of each member is defined. The targeted population is also identified, along with the theoretical models that will underpin data collection and persona characteristics. The |$\ll $|2. Conception and Gestation phase|$\gg $| involves collecting information, creating the skeleton and, finally, building and validating the personas. This phase is critical, and the data collection must cover the entire targeted population and its characteristics to ensure representativeness for the resulting personas. The |$\ll $|3. Birth and Maturation phase|$\gg $| consists of introducing team members to the resulting personas, giving the personas life through scenarios and, finally, validating the scenarios. During the |$\ll $|4. Adulthood phase|$\gg $|⁠, which continues for the duration of the product creation, the personas play an integral role in the design team as they take part in meetings to ensure team coherence while providing a common vocabulary. When the design is completed, the personas are allowed to retire in the last phase of their lifecycle, the |$\ll $|5. Lifetime Achievement and Retirement |$\gg $|⁠. They may, however, be solicited once more to assist in product design, leading to their rebirth. FIGURE 1 Open in new tabDownload slide Persona’s lifecycle. FIGURE 1 Open in new tabDownload slide Persona’s lifecycle. Like humans, personas have their own characteristics (see Table 1). The design challenge is to create persona descriptions that are sufficiently complex to encourage designers to deeply understand the persona’s motivations and main goals [Nielsen, 2002], without getting lost in unnecessary or irrelevant details. Even if there is no general consensus emerging from the literature on the main features for describing a persona [Brangier & Bornet, 2011, Nielsen, 2019], Brangier & Bornet [2011] propose that personas be defined according to three categories: (i) identity, (ii) attitude and behaviour and (iii) the product’s usage context. Moreover, several authors introduce two types of personas: primary personas, for whom the product is intended, and secondary personas, for whose needs the product is not intended, but whose environment and preoccupations will be impacted by the technology [Blomquist & Arvola, 2002, Brangier & Bornet, 2011]. The number of personas depends on the scope and diversity of the targeted population. Most authors agree that the number of personas must be kept relatively small to facilitate the team’s identification with each persona [Blomquist & Arvola, 2002, Brangier & Bornet, 2011, Cooper, 2004, Nielsen, 2019]. Table 1. Persona characteristics. Components . Description . Identity Individual, sociological, psychological and socio-ethnic variables Attitude and behaviour Life objectives, desires and emotions, attitudes toward the tasks and product, anecdotes Usage context Usage environment and constraints Components . Description . Identity Individual, sociological, psychological and socio-ethnic variables Attitude and behaviour Life objectives, desires and emotions, attitudes toward the tasks and product, anecdotes Usage context Usage environment and constraints Open in new tab Table 1. Persona characteristics. Components . Description . Identity Individual, sociological, psychological and socio-ethnic variables Attitude and behaviour Life objectives, desires and emotions, attitudes toward the tasks and product, anecdotes Usage context Usage environment and constraints Components . Description . Identity Individual, sociological, psychological and socio-ethnic variables Attitude and behaviour Life objectives, desires and emotions, attitudes toward the tasks and product, anecdotes Usage context Usage environment and constraints Open in new tab One of the major advantages of using the persona is its ability to represent a complex clinical population. In TBI, sequelae can vary depending on the severity of the TBI, thus resulting in a wide range of clinical profiles. Cognitive impairments often include memory and attention difficulties, slowing of information processing, executive function disorders (e.g. Baguena et al., 2006) and decreased verbal fluency [Bittner & Crowe, 2007]. Behavioural impairments mainly include impulsivity, disinhibition, aggressive behaviors, anger and social isolation (e.g. Rochat et al., 2013); emotional problems such as anxiety and depression [Morton & Wehman, 1995] are also frequently reported. Moreover, individuals with TBI often have difficulties with abstract thinking (e.g. Scherzer et al., 1993, Vas et al., 2015) and experience fatigue (e.g. Ashman et al., 2008, Duclos et al., 2015, Juengst et al., 2013), thus collaborating with them using a UCD is a challenge. Therefore, the use of a persona allows the team to complete an in-depth analysis of the needs of the population before actually meeting the real users. When working with such a complex population, personas also have the potential of establishing a common vocabulary and facilitating knowledge translation between various stakeholders implicated in the design process (e.g. computer scientists, healthcare professionals) in order to achieve interdisciplinary work. Interdisciplinary work involves combining the expertise of one or more disciplines to find a solution to a complex problem [Klein & Newell, 1997]. According to Schulz et al. [2015], interdisciplinary work is crucial to achieve a successful technological design. The main objective of this study was therefore to complete the first step of a UCD for the design of an assistive technology named COOK, by designing personas in order to (i) better explore the potential of COOK with specific scenarios and (ii) facilitate interdisciplinary work with a complex population in the design of COOK. In this research, personas were used to facilitate the UCD approach for three reasons: first, to avoid over solicitation of people with TBI; second, to provide an in-depth comprehension of a population that lacks abstraction; and third, to provide a tool for interdisciplinary research. 2. Methods The persona’s creation methodology was inspired by the first four phases of the persona’s lifecycle (see Fig. 2). FIGURE 2 Open in new tabDownload slide Persona’s methodology. FIGURE 2 Open in new tabDownload slide Persona’s methodology. 2.1. Phase 1: persona family planning The persona’s family planning set-up the direction of the UCD design. This phase was performed in three steps. First, we identified the team members that would be involved in the creation of the persona, along with their roles. Second, we specified the target population. Third, we selected the theoretical models to help with the development of the persona. 2.2. Phase 2: persona conception and gestation During the conception and gestation phase, researchers in computer science investigated the characteristics of the TBI population through various activities, which are summarized in four steps (see Table 2). We initially reviewed the literature to identify TBI-related issues. This review focused on cognitive deficits, but proved insufficient to fully understand the difficulties that individuals with TBI encounter in their daily lives. This review was thus completed with other sources that deal with the repercussions of TBI on independence in everyday activities. Hence, team members composed of TBI researchers in occupational therapy (C.B. and S.P.) supported the computer scientists (M.O. and T.Z.) by answering TBI-related questions throughout the study. C.B. also trained the computer scientists in identifying inappropriate behaviours during a workshop (M.O., T.Z., H.P. and S.G.) and video analysis sessions (M.O. and T.Z.). At the end of this phase, the personas and one scenario had been created. The scenario included information pertaining to how the occupational therapist provided assistance to TBI individuals. It also sought to determine how dysfunction impacted meal preparation and which interventions were required to help the persona complete the task. 2.3. Phase 3: persona birth and maturation The goal of this phase was to confirm the persona’s ability to realistically represent the daily limitations faced by the TBI population. First, the COOK design team performed an internal validation with expert researchers in TBI rehabilitation. A second external validation took place with clinicians with an expertise in TBI rehabilitation unfamiliar with the COOK project. The evaluators were introduced to the persona methodology, including the theoretical models underlying the persona creation, the organization of documents and a brief description of each persona and the scenario. Table 2. Conception and gestation phases. Conception steps . Objectives . 1. Literature review |$\bullet $| Review web sites and scientific articles to identify the main limitations of TBI individuals in their daily  lives |$\bullet $| Define the number of personas to create 2. IADL Profile training |$\bullet $| Understand the IADL Profile [Bottari et al., 2009a,b, 2010a,b, 2011] evaluation tool by following a  workshop reserved to OT |$\bullet $| Familiarize computer scientists with TBI behaviour through video recordings of IADL Profile  evaluations |$\bullet $| Familiarize computer scientists with occupational therapy interventions 3. Video analysis |$\bullet $| Observe the functional limitations faced by TBI individuals during the execution of different IADLs |$\bullet $| Identify the diversity of TBI profiles |$\bullet $| Study the selection and use of cognitive strategies employed by Occupational Therapists to support TBI  individuals during the IADL Profile evaluation 4. Persona formalization |$\bullet $| Create a persona skeleton adaptable to any individual with TBI |$\bullet $| Create personas to be used during interdisciplinary meetings |$\bullet $| Create a scenario to highlight the dysfunctions impacting the meal preparation of the persona Conception steps . Objectives . 1. Literature review |$\bullet $| Review web sites and scientific articles to identify the main limitations of TBI individuals in their daily  lives |$\bullet $| Define the number of personas to create 2. IADL Profile training |$\bullet $| Understand the IADL Profile [Bottari et al., 2009a,b, 2010a,b, 2011] evaluation tool by following a  workshop reserved to OT |$\bullet $| Familiarize computer scientists with TBI behaviour through video recordings of IADL Profile  evaluations |$\bullet $| Familiarize computer scientists with occupational therapy interventions 3. Video analysis |$\bullet $| Observe the functional limitations faced by TBI individuals during the execution of different IADLs |$\bullet $| Identify the diversity of TBI profiles |$\bullet $| Study the selection and use of cognitive strategies employed by Occupational Therapists to support TBI  individuals during the IADL Profile evaluation 4. Persona formalization |$\bullet $| Create a persona skeleton adaptable to any individual with TBI |$\bullet $| Create personas to be used during interdisciplinary meetings |$\bullet $| Create a scenario to highlight the dysfunctions impacting the meal preparation of the persona Open in new tab Table 2. Conception and gestation phases. Conception steps . Objectives . 1. Literature review |$\bullet $| Review web sites and scientific articles to identify the main limitations of TBI individuals in their daily  lives |$\bullet $| Define the number of personas to create 2. IADL Profile training |$\bullet $| Understand the IADL Profile [Bottari et al., 2009a,b, 2010a,b, 2011] evaluation tool by following a  workshop reserved to OT |$\bullet $| Familiarize computer scientists with TBI behaviour through video recordings of IADL Profile  evaluations |$\bullet $| Familiarize computer scientists with occupational therapy interventions 3. Video analysis |$\bullet $| Observe the functional limitations faced by TBI individuals during the execution of different IADLs |$\bullet $| Identify the diversity of TBI profiles |$\bullet $| Study the selection and use of cognitive strategies employed by Occupational Therapists to support TBI  individuals during the IADL Profile evaluation 4. Persona formalization |$\bullet $| Create a persona skeleton adaptable to any individual with TBI |$\bullet $| Create personas to be used during interdisciplinary meetings |$\bullet $| Create a scenario to highlight the dysfunctions impacting the meal preparation of the persona Conception steps . Objectives . 1. Literature review |$\bullet $| Review web sites and scientific articles to identify the main limitations of TBI individuals in their daily  lives |$\bullet $| Define the number of personas to create 2. IADL Profile training |$\bullet $| Understand the IADL Profile [Bottari et al., 2009a,b, 2010a,b, 2011] evaluation tool by following a  workshop reserved to OT |$\bullet $| Familiarize computer scientists with TBI behaviour through video recordings of IADL Profile  evaluations |$\bullet $| Familiarize computer scientists with occupational therapy interventions 3. Video analysis |$\bullet $| Observe the functional limitations faced by TBI individuals during the execution of different IADLs |$\bullet $| Identify the diversity of TBI profiles |$\bullet $| Study the selection and use of cognitive strategies employed by Occupational Therapists to support TBI  individuals during the IADL Profile evaluation 4. Persona formalization |$\bullet $| Create a persona skeleton adaptable to any individual with TBI |$\bullet $| Create personas to be used during interdisciplinary meetings |$\bullet $| Create a scenario to highlight the dysfunctions impacting the meal preparation of the persona Open in new tab A total of 5 members of the COOK design team took part in the internal validation, including 3 occupational therapists (C.B., S.P. and N.B.) with 5 to 20+ years of experience with the TBI population, 1 speech and language pathologist (G.L.) with over 25 years of experience with the TBI population and 1 researcher with over 15 years of expertise in human–computer interaction (HCI) assistive technology for cognitive deficits (H.P.). The internal validation was conducted with each individual separately. The personas and one scenario illustrating the impact of deficits on IADLs were sent to each participant who documented their comments. Finally, individual discussions were held with each evaluator to clarify and integrate comments within a revised version of each persona and the scenario. A total of 3 clinicians with over 15 years of experience with the TBI population took part in the external validation, including 1 occupational therapist, 1 neuropsychologist and 1 social worker. The validation took place during a 60-minute focus group meeting composed of the 3 external evaluators, 1 internal evaluator (S.P.) and 2 persona designers (M.O., T.Z.). After the persona presentation, a persona and a scenario evaluation grid (see Appendix A) were distributed to each evaluator, who filled them out individually over a 20-minute period. The individual evaluation was followed by an open discussion between the evaluators and the persona designers. 2.4. Phase 4: persona adulthood The persona adulthood phase was used to determine COOK’s basic functionalities and user interactions, through concrete situations. In this phase, another scenario was created in which personas performed a meal preparation activity (see Appendix B). This scenario included assistance from COOK. In the scenario with COOK, we detailed how the persona interacted with COOK during meal preparation, what information COOK would gather through the sensors installed in the smart home and which cues would be delivered incrementally to help the persona complete the meal preparation. Clinical team members, along with clinicians not involved in our project, validated the two scenarios. 3. Results The results are presented below according to the four phases of the persona’s lifecycle. 3.1. Phase 1: persona family planning Designing a cognitive assistant for a specific population requires vast knowledge that includes the TBI population’s strengths, limitations, needs, cognitive rehabilitation best practices, along with ubiquitous computing and HCI expertise. Phase 1 allowed us to determine that our interdisciplinary team should be mainly composed of two sub teams, including one specialized in clinical research, and one specialized in computer science. The role of each sub-team involved the following: (i) Computer science team: designing the personas and scenarios. Most of its members had no experience with the TBI population. (ii) Clinical team: providing information about TBI and their functioning and validating personas and scenarios. Some members had experience in assistive technology, but most had no experience in UCD. The target population consisted of individuals having sustained a TBI with limited physical disabilities. As our project is focused on providing cognitive support, we hence focused on all individuals having sustained a TBI with cognitive disabilities of varying levels of severity. The team members selected and agreed upon the following clinical evaluation tools and rehabilitation theoretical models to frame the persona: (i) The IADL Profile [Bottari et al., 2010b] was chosen to assess independence in everyday activities in consideration of the impact of executive functions. The IADL Profile is an observation-based assessment used by occupational therapists to determine the level of independence of an individual with TBI and measure his or her limitations in IADLs. It provides a portrait of independence at home and in the community for specific IADLs, including meal preparation. Observed behaviours are analysed according to four operations: (i) Formulating a goal: the individual’s capacity to find a solution to satisfy a need; (ii) Planning: the individual’s capacity to identify the initial conditions before performing the task, and identification and selection of the most pertinent alternative to attain the task goal; (iii) Carrying out the task: the individual’s capacity to initiate and carry out his or her plan, as well as to modify it according to any problems that may arise during task execution; and (iv) Verifying goal attainment: the individual’s capacity to carry out an activity as planned and verify that the initially identified goal has been achieved. A five-level rating scale of independence (independence, independence with difficulty, need for physical or verbal assistance, need for physical and verbal assistance, dependence) is applied to each operation for every activity performed. (ii) The Disability Creation Process (DCP; Fougeyrollas et al., 1998) was used as a taxonomy to categorize the persona’s abilities and limitations that contribute to facilitating or limiting one’s social participation. The DCP focuses on a comprehensive understanding of the individual’s social participation, resulting from the interaction between personal factors (impairments, disabilities and other personal characteristics) and environmental factors (physical or social, facilitators and obstacles). Social participation is then defined as a person’s involvement in a life situation that is influenced by individual and environmental factors. This model, which has many similarities with the International Classification of Functioning, Disability and Handicap [Üstün et al., 2003] was selected because it has the advantage of more explicitly highlighting the impact of the interactions between the individual’s abilities and their environment on task performance. This was deemed facilitating for the development of a cooking assistant that would be used in interaction with the user’s home environment. Impact on interdisciplinary collaboration and final product: This phase of the persona development required that the clinical team select a conceptual model and an evaluation tool pertinent for prototype development. Here, experts selected a conceptual model used by all TBI teams in Quebec to facilitate the holistic care of these individuals in interaction with all of the complexities of their environments. Moreover, an evaluation administered in people’s everyday environments and focusing on the repercussions of executive function deficits was deemed most pertinent for an understanding of the key needs of this population to be addressed with the prototype. This focus on the impact of cognitive deficits on everyday activities helped the computer science team understand that it’s not so much the person’s deficits that are key to the development of the prototype but more so the impact of these on the person’s functioning in everyday activities. 3.2. Phase 2: persona conception and gestation The outcomes of the persona conception and gestation phase are presented according to the four steps involved in its methodology. 3.2.1. Literature review The literature review helped establish the more common cognitive, behavioural, emotional, communicational and physical disabilities that result from a TBI [Baguena et al., 2006, Rode et al., 2005]. It helped determine the number of personas to design: three personas according to mild, moderate and severe TBI severity. Also, two secondary personas were designed based on the suggestions of the clinical team. These included an occupational therapist persona who cares for the three TBI personas and an informal caregiver that is the mother of the persona with a severe TBI. The characteristics of each of these reflect some typical characteristics of people encountered in their clinical practice. 3.2.2. IADL Profile training Four members of our research team specializing in computer sciences (M.O., T.Z., H.P. and S.G.) attended a 3-day IADL Profile training workshop with 20 occupational therapists. This workshop consisted of (i) a presentation of the IADL Profile evaluation tool, (ii) practice of behavioural observations of IADL Profile evaluation sessions using videos of individuals with TBI and (iii) elaboration of interventions to address the observed difficulties through simulated experiences. During this training, several exchanges occurred between the computer scientists and occupational therapists that helped the former develop the ability to observe and identify atypical behaviours in everyday activities carried out by individuals with TBI. Rating the independence in IADLs of these individuals trained the computer scientists to identify some correct and incorrect actions that people do during IADL. During the workshop, various simulations were also used to illustrate how occupational therapists provide assistance to individuals with TBI during IADL performance. By analogy, we identified the critical situations in which COOK may assist, that is, where to pay attention, how to structure the cognitive assistance when such assistance is required to help the person progress in the task, and how to interact with individuals with TBI. 3.2.3. Video analysis During the video analysis, two members of our research team specialized in computer science (M.O. and T.Z.), under the mentorship of a senior occupational therapist specialized in TBI (C.B.), observed four subjects with TBI performing three IADLs: shopping for groceries, preparing a meal and obtaining information. These four subjects had been evaluated by an occupational therapist using the IADL Profile. These videos illustrated how the occupational therapist adapts his or her intervention according to the individual’s abilities and deficits. For instance, one individual with TBI had needed only few verbal prompts to prepare his meal in a reasonable amount of time. In contrast, another individual required several very explicit prompts, several repetitions, and more time to accomplish the same IADL. As a result, this video analysis provided valuable insights to identify some critical situations in which the persona should be involved and which require cognitive assistance to help the persona pursue the task to goal attainment. 3.2.4. Persona formalization Finally, the primary persona’s skeleton was designed by combining the characteristics that emerged from the persona literature (see Table 1) and the DCP model used in describing impairments and handicap situations [Fougeyrollas et al., 1998]. This skeleton was organized into three main sections: Personal Factors, Environmental Factors, and Life Habits, according to the DCP taxonomy. The first section of the skeleton was divided into two parts: (i) Personal characteristics (i.e. photo, name, gender, age, etc.) and the persona’s pre-accident information (i.e. family situation, personality, occupation; Jameson et al., 2008); (ii) Information, including clinical information (i.e. Glasgow Coma Scale; Teasdale & Jennett, 1974; post-traumatic amnesia, etc.); socio-economic information (i.e. type of compensation, income); risk factors, including type of accident and causes (i.e. car crash caused by high-speeds driving and alcohol consumption); along with abilities and limitations in the following spheres: cognition, language, behaviour, and motor skills. Consequently, we determined the persona’s gender and age, along with the cause of TBI, in order to target the demographic and the most frequent characteristics of TBI. Scientific knowledge proposes to divide the TBI population into mild, moderate and severe trauma, in accordance with the severity of the injury. We therefore used this classification to create three primary personas (see Fig. 3): (i) Jacques1 , with a mild TBI; (ii) Alexandra2 , with a moderate TBI; and (iii) Frederic2, with a severe TBI. FIGURE 3 Open in new tabDownload slide Primary personas. The ``1'' is related to the Copyright © image courtesy of Ambro at FreeDigitalPhotos.net. FIGURE 3 Open in new tabDownload slide Primary personas. The ``1'' is related to the Copyright © image courtesy of Ambro at FreeDigitalPhotos.net. We also designed two secondary personas to represent the occupational therapist and the caregiver. The main characteristics of these personas stem from information extracted form Sections 3.2.1, 3.2.2 and 3.2.3 (see Fig. 4): (i) Anne2, the occupational therapist, who takes care of the three primary personas; and (ii) Alexa2, Frederic’s mother. The other two primary personas do not necessitate the interventions of a caregiver. FIGURE 4 Open in new tabDownload slide Secondary personas. The ``1'' is related to the Copyright © image courtesy of Ambro at FreeDigitalPhotos.net. FIGURE 4 Open in new tabDownload slide Secondary personas. The ``1'' is related to the Copyright © image courtesy of Ambro at FreeDigitalPhotos.net. 3.2.5. Scenario without COOK assistance To understand the impact of deficits on IADLs, and how an occupational therapist interacts with people with severe TBI, we designed a scenario similar to the evaluation an occupational therapist would perform with Frederic using the IADL Profile. For the scenario without assistance, we described the following three tasks: |$\bullet $| Preparing a hot meal; |$\bullet $| Obtaining the bus schedule to go from Montreal to Toronto; |$\bullet $| Making a budget. According to the IADL Profile, an occupational therapist came to Frederic’s house and asked him to do these IADLs. This scenario describes how Frederic’s mother often intervenes during these activities, how he expresses inappropriate behaviour with the occupational therapist and how the accomplishment of IADLs takes an excessive amount of time, forcing the occupational therapist to stop the evaluation (see Fig. 5). FIGURE 5 Open in new tabDownload slide Summary of the scenario without COOK assistance. FIGURE 5 Open in new tabDownload slide Summary of the scenario without COOK assistance. Three occupational therapists, all members of our team, validated this scenario. They found it credible, despite noticing a few flaws which were then corrected. The personas’ behaviors were found to adequately reproduce what would be seen in clinical practice. The external clinical teams read the scenario and confirmed its clinical relevance. Impact on interdisciplinary collaboration and final product: The development of three personas (mild, moderate and severe) helped the conception team understand the broad range of severity that can result from a TBI, their most prevalent presentations (TBI more frequent in men than in women) and the main causes of TBI. This led our team to focus on the needs of individuals with severe TBI in direct relation to their activities. Further work on the prototype could look at adapting COOK to the needs of people with mild and moderate TBI. The inclusion of secondary personas did not immediately influence the design of COOK, but did lead the design team to consider the complexity of implementing COOK within a family, a supported-living environment and with a team of professionals, as of the initial stages of development. It was deemed important from this initial stage of development to consider the needs of these individuals in further development of the technology. For example, the mother of Frederic was illustrated as being over protective, not allowing her son to cook, and the use of the technology would not in the end be deemed successful unless the mother’s needs were considered in the design of the technology. Due to the analytic nature of computer scientists and the need for a highly detailed logical elucidation of the occupational therapist’s evaluation of individuals with TBI and the proposed interventions, this required that occupational therapists examine their clinical reasoning and their decisions in great depth so as to make these explicit for computer scientists. These exchanges between the two disciplines facilitated a greater understanding and communication of knowledge to be translated into the persona and into the development of an assistance prototype. 3.3. Phase 3: persona birth and maturation The birth and maturation phase presents the outcome following the internal and external validations. 3.3.1. Internal validation The first concern during internal validation involved the specific profile of the personas that could benefit from the use of COOK. Personas with a mild or moderate TBI were initially developed and then later put on the back burner because it became clear with the creation of these personas, and this internal validation process, that the most complex needs to be addressed were those of the severe TBI persona. It is also this persona who is most likely to require the compensation that can be provided by COOK to be able to manage this cooking activity. Hence, future steps of the study focused exclusively on addressing the needs of Frederic, leaving the needs of the mild and moderate personas to be considered in ulterior studies. During the internal validation, we also added and modified certain characteristics to reinforce the impairment and behavioural coherence of the severe TBI persona and represent their impact on activities of daily living. Among the major additional characteristics were impairments related to executive functions (i.e. initiation, planning and specific carrying out difficulties), along with other cognitive characteristics, such as judgment and self-awareness impairments. Other major modifications included details on social participation (i.e. relationships with family and friends and the use of social networks), as well as the impact of cognitive impairments on life habits (i.e. difficulty in using electrical appliances without supervision). 3.3.2. External validation External evaluators found Frederic’s persona to be believable and representative of the severe TBI population. They approved the persona’s template organization, the coherence between the cognitive deficits and their repercussions on behaviour. They emphasized the variety of roles played by clinicians during the rehabilitation process. They also named the physical deficits that can be present in a person with severe TBI such as dizziness, paralysis, slowed gait, etc., all of which would need to be considered in the overall design of the persona. As a result of the external validation, we modified some information to script a more realistic severe TBI persona based on the clinicians’ comments and the rating of the persona evaluation grid. The final result was Frederic Chauvin, a persona representative of the severe TBI population (see Fig. 3). After a car accident caused by high-speed driving and alcohol consumption, Frederic’s life changed dramatically. He was no longer able to go to school and was forced to return to live at home with his parents. According to the DCP, Frederic presented some cognitive, communicational, behavioural and physical impairments (see Table 3). His cognitive abilities were impaired, which led to a difficulty adapting to new or dangerous situations. He also had difficulty understanding complex language and became aggressive and disinhibited. His movements were slow. While living at his parents’ house, he lost his girlfriend along with many of his friends. Frederic’s life habits were disrupted as a result of his TBI (see Table 4). Post-injury, he was relatively independent in simple ADLs, but was no longer able to perform complex activities. Table 3. Persona post-accident cognitive capabilities and environmental factors. Personal factors . Capability Criteria Description Cognitive Attention He can perform only one activity at a time. Memory He is able to perform basic activities, such as eating, brushing his teeth and dressing himself. He needs constant reminders of task objectives and the steps required to perform the activity. Judgment He has difficulty recognizing dangerous situations (i.e. leaves the kitchen while he is using the stove. This can burn the food or cause fires). Executive functions  |$\bullet $| Difficulty initiating a task (i.e. distracted by the environment), planning a sequence of   actions to reach an objective (i.e. verifying the ingredients and time available to prepare a   recipe). Moreover, when carrying out an IADL, he may forget to perform certain steps,   such as washing the vegetables before cutting them, changing the order (i.e. switching on   a hotplate and letting it heat up before looking for a sauce pan);  |$\bullet $| He is seldom aware of his mistakes. He has problems with self-awareness;  |$\bullet $| He has adaptation problems (difficulty with new situations and respecting the rules   imposed by his family). Language Expression He talks a lot; his speech is loud and tangential. He frequently uses rude and at times aggressive language. He lacks facial expressions; even when angry, his facial expression remains neutral. Comprehension He has difficulty understanding more than three simple instructions at a time; he frequently forgets what he has been asked to do. Behaviour Indifference He does not show any interest in what is happening around him (i.e. community and family). Motivation He only wants to watch TV. His parents encourage him to do activities, like taking walks, going to the grocery store, and fishing. He prefers to rest at home, pretending to be tired. Emotional control He has sudden and aggressive reactions. He used to shout and insult the people around him. Disinhibition He is disinhibited in social contexts. He used to say everything that crossed his mind (i.e. “Lady, you are really fat!”). Motor skills Mobility His displacements are slow. He uses a cane. Object manipulation He has difficulty manipulating objects with his two hands due to a spastic upper-left limb. He cannot perform activities requiring fine motor skills. Environmental factors (facilitator obstacle) Factor Criteria Description Social Health system He finished his rehabilitation 1 year ago. Family structure  |$\bullet $| He lives in a house with his mother and father. His mother is always at home (housewife)   and his father returns home every evening (employee);  |$\bullet $| His sister lives in Vancouver. She calls him once a week; His mother supports him most of   the time. She is overwhelmed by her son’s aggressive reactions;  |$\bullet $| His parents have had disagreements about how to help their son. Social network He had few contacts with his friends after his accident. His girlfriend left him 6 months after his accident. His two best friends visit him from time to time. He receives few messages at Christmas. Physical Electronic appliances His parents have a variety of electronic devices at home, such as smart phones, tablets, televisions, laptops, radios, etc. He enjoys using Facebook, listening to music and watching TV. Vehicles His family owns two cars. He constantly expresses his wish to drive again. Personal factors . Capability Criteria Description Cognitive Attention He can perform only one activity at a time. Memory He is able to perform basic activities, such as eating, brushing his teeth and dressing himself. He needs constant reminders of task objectives and the steps required to perform the activity. Judgment He has difficulty recognizing dangerous situations (i.e. leaves the kitchen while he is using the stove. This can burn the food or cause fires). Executive functions  |$\bullet $| Difficulty initiating a task (i.e. distracted by the environment), planning a sequence of   actions to reach an objective (i.e. verifying the ingredients and time available to prepare a   recipe). Moreover, when carrying out an IADL, he may forget to perform certain steps,   such as washing the vegetables before cutting them, changing the order (i.e. switching on   a hotplate and letting it heat up before looking for a sauce pan);  |$\bullet $| He is seldom aware of his mistakes. He has problems with self-awareness;  |$\bullet $| He has adaptation problems (difficulty with new situations and respecting the rules   imposed by his family). Language Expression He talks a lot; his speech is loud and tangential. He frequently uses rude and at times aggressive language. He lacks facial expressions; even when angry, his facial expression remains neutral. Comprehension He has difficulty understanding more than three simple instructions at a time; he frequently forgets what he has been asked to do. Behaviour Indifference He does not show any interest in what is happening around him (i.e. community and family). Motivation He only wants to watch TV. His parents encourage him to do activities, like taking walks, going to the grocery store, and fishing. He prefers to rest at home, pretending to be tired. Emotional control He has sudden and aggressive reactions. He used to shout and insult the people around him. Disinhibition He is disinhibited in social contexts. He used to say everything that crossed his mind (i.e. “Lady, you are really fat!”). Motor skills Mobility His displacements are slow. He uses a cane. Object manipulation He has difficulty manipulating objects with his two hands due to a spastic upper-left limb. He cannot perform activities requiring fine motor skills. Environmental factors (facilitator obstacle) Factor Criteria Description Social Health system He finished his rehabilitation 1 year ago. Family structure  |$\bullet $| He lives in a house with his mother and father. His mother is always at home (housewife)   and his father returns home every evening (employee);  |$\bullet $| His sister lives in Vancouver. She calls him once a week; His mother supports him most of   the time. She is overwhelmed by her son’s aggressive reactions;  |$\bullet $| His parents have had disagreements about how to help their son. Social network He had few contacts with his friends after his accident. His girlfriend left him 6 months after his accident. His two best friends visit him from time to time. He receives few messages at Christmas. Physical Electronic appliances His parents have a variety of electronic devices at home, such as smart phones, tablets, televisions, laptops, radios, etc. He enjoys using Facebook, listening to music and watching TV. Vehicles His family owns two cars. He constantly expresses his wish to drive again. Open in new tab Table 3. Persona post-accident cognitive capabilities and environmental factors. Personal factors . Capability Criteria Description Cognitive Attention He can perform only one activity at a time. Memory He is able to perform basic activities, such as eating, brushing his teeth and dressing himself. He needs constant reminders of task objectives and the steps required to perform the activity. Judgment He has difficulty recognizing dangerous situations (i.e. leaves the kitchen while he is using the stove. This can burn the food or cause fires). Executive functions  |$\bullet $| Difficulty initiating a task (i.e. distracted by the environment), planning a sequence of   actions to reach an objective (i.e. verifying the ingredients and time available to prepare a   recipe). Moreover, when carrying out an IADL, he may forget to perform certain steps,   such as washing the vegetables before cutting them, changing the order (i.e. switching on   a hotplate and letting it heat up before looking for a sauce pan);  |$\bullet $| He is seldom aware of his mistakes. He has problems with self-awareness;  |$\bullet $| He has adaptation problems (difficulty with new situations and respecting the rules   imposed by his family). Language Expression He talks a lot; his speech is loud and tangential. He frequently uses rude and at times aggressive language. He lacks facial expressions; even when angry, his facial expression remains neutral. Comprehension He has difficulty understanding more than three simple instructions at a time; he frequently forgets what he has been asked to do. Behaviour Indifference He does not show any interest in what is happening around him (i.e. community and family). Motivation He only wants to watch TV. His parents encourage him to do activities, like taking walks, going to the grocery store, and fishing. He prefers to rest at home, pretending to be tired. Emotional control He has sudden and aggressive reactions. He used to shout and insult the people around him. Disinhibition He is disinhibited in social contexts. He used to say everything that crossed his mind (i.e. “Lady, you are really fat!”). Motor skills Mobility His displacements are slow. He uses a cane. Object manipulation He has difficulty manipulating objects with his two hands due to a spastic upper-left limb. He cannot perform activities requiring fine motor skills. Environmental factors (facilitator obstacle) Factor Criteria Description Social Health system He finished his rehabilitation 1 year ago. Family structure  |$\bullet $| He lives in a house with his mother and father. His mother is always at home (housewife)   and his father returns home every evening (employee);  |$\bullet $| His sister lives in Vancouver. She calls him once a week; His mother supports him most of   the time. She is overwhelmed by her son’s aggressive reactions;  |$\bullet $| His parents have had disagreements about how to help their son. Social network He had few contacts with his friends after his accident. His girlfriend left him 6 months after his accident. His two best friends visit him from time to time. He receives few messages at Christmas. Physical Electronic appliances His parents have a variety of electronic devices at home, such as smart phones, tablets, televisions, laptops, radios, etc. He enjoys using Facebook, listening to music and watching TV. Vehicles His family owns two cars. He constantly expresses his wish to drive again. Personal factors . Capability Criteria Description Cognitive Attention He can perform only one activity at a time. Memory He is able to perform basic activities, such as eating, brushing his teeth and dressing himself. He needs constant reminders of task objectives and the steps required to perform the activity. Judgment He has difficulty recognizing dangerous situations (i.e. leaves the kitchen while he is using the stove. This can burn the food or cause fires). Executive functions  |$\bullet $| Difficulty initiating a task (i.e. distracted by the environment), planning a sequence of   actions to reach an objective (i.e. verifying the ingredients and time available to prepare a   recipe). Moreover, when carrying out an IADL, he may forget to perform certain steps,   such as washing the vegetables before cutting them, changing the order (i.e. switching on   a hotplate and letting it heat up before looking for a sauce pan);  |$\bullet $| He is seldom aware of his mistakes. He has problems with self-awareness;  |$\bullet $| He has adaptation problems (difficulty with new situations and respecting the rules   imposed by his family). Language Expression He talks a lot; his speech is loud and tangential. He frequently uses rude and at times aggressive language. He lacks facial expressions; even when angry, his facial expression remains neutral. Comprehension He has difficulty understanding more than three simple instructions at a time; he frequently forgets what he has been asked to do. Behaviour Indifference He does not show any interest in what is happening around him (i.e. community and family). Motivation He only wants to watch TV. His parents encourage him to do activities, like taking walks, going to the grocery store, and fishing. He prefers to rest at home, pretending to be tired. Emotional control He has sudden and aggressive reactions. He used to shout and insult the people around him. Disinhibition He is disinhibited in social contexts. He used to say everything that crossed his mind (i.e. “Lady, you are really fat!”). Motor skills Mobility His displacements are slow. He uses a cane. Object manipulation He has difficulty manipulating objects with his two hands due to a spastic upper-left limb. He cannot perform activities requiring fine motor skills. Environmental factors (facilitator obstacle) Factor Criteria Description Social Health system He finished his rehabilitation 1 year ago. Family structure  |$\bullet $| He lives in a house with his mother and father. His mother is always at home (housewife)   and his father returns home every evening (employee);  |$\bullet $| His sister lives in Vancouver. She calls him once a week; His mother supports him most of   the time. She is overwhelmed by her son’s aggressive reactions;  |$\bullet $| His parents have had disagreements about how to help their son. Social network He had few contacts with his friends after his accident. His girlfriend left him 6 months after his accident. His two best friends visit him from time to time. He receives few messages at Christmas. Physical Electronic appliances His parents have a variety of electronic devices at home, such as smart phones, tablets, televisions, laptops, radios, etc. He enjoys using Facebook, listening to music and watching TV. Vehicles His family owns two cars. He constantly expresses his wish to drive again. Open in new tab Table 4. Persona participation. Life habits and social participation . Criteria Description Nutrition Diet plan and meal preparation His mother takes care of planning menus, shopping for groceries and preparing meals. For safety reasons, the occupational therapist recommended that Frederic avoid using electrical kitchen appliances without supervision. He used to eat a bowl of cereal each morning. Afterwards, he would forget to put the milk back in the refrigerator. Body condition Rest He sleeps about twelve hours on a daily basis. This includes two one-hour naps. He wakes up at around 10:00 am. Before the accident, he would wake up early to study. Personal care Bathing He is able to shower independently with technical aids, such as a shower seat, wall-mounted bars and a long handle brush. Excretal hygiene He is independent with his hygiene. Dressing He is able to dress himself. He seldom changes the clothes he is wearing. Health Care  |$\bullet $| He has difficulty cutting his food. His mother avoids this situation by providing him with   pre-cut food;  |$\bullet $| He takes his medication independently, using a Dispill. He takes it every morning after his   coffee. Nevertheless, his mother always checks to make sure he has taken them correctly. Communication Oral and non-verbal  |$\bullet $| He has difficulty talking with more than 2 people at a time (attentional problems). He gets   lost during conversations and starts talking about himself;  |$\bullet $| He shows no interest in other peoples’ conversations. Written He is able to write, but slowly. He enjoys writing comments under the profiles of his Facebook friends. Telecommunication He is able to use the Internet for simple tasks, such as browsing Facebook, or “adult” and sports sites, like he did before his accident. However, he is not able to use the Internet functionally to search for new information. Home Home activities  |$\bullet $| He cleans his bedroom after repeated requests from his mother;  |$\bullet $| He is allowed to use electrical appliances, but only under supervision. Mobility Transport His outdoor activities depend on the availability of his family. Responsibilities Finances He does not manage his finances. He receives 50 dollars each week for personal use. Interpersonal relationships Affective His girlfriend left him 6 months after his accident because she could not accept his disinhibited and aggressive behaviour. Social relationships He has difficulty establishing social contacts due to his disinhibited, aggressive and self-centred behaviour. Social Education The rehabilitation team recommended that he cease his studies due to his physical, cognitive and behavioural problems. Leisure Socio-recreational activities He spends a lot of time listening to music and watching sports on TV. His parents frequently encourage him to take walks. He goes fishing with his father during the fishing season. Life habits and social participation . Criteria Description Nutrition Diet plan and meal preparation His mother takes care of planning menus, shopping for groceries and preparing meals. For safety reasons, the occupational therapist recommended that Frederic avoid using electrical kitchen appliances without supervision. He used to eat a bowl of cereal each morning. Afterwards, he would forget to put the milk back in the refrigerator. Body condition Rest He sleeps about twelve hours on a daily basis. This includes two one-hour naps. He wakes up at around 10:00 am. Before the accident, he would wake up early to study. Personal care Bathing He is able to shower independently with technical aids, such as a shower seat, wall-mounted bars and a long handle brush. Excretal hygiene He is independent with his hygiene. Dressing He is able to dress himself. He seldom changes the clothes he is wearing. Health Care  |$\bullet $| He has difficulty cutting his food. His mother avoids this situation by providing him with   pre-cut food;  |$\bullet $| He takes his medication independently, using a Dispill. He takes it every morning after his   coffee. Nevertheless, his mother always checks to make sure he has taken them correctly. Communication Oral and non-verbal  |$\bullet $| He has difficulty talking with more than 2 people at a time (attentional problems). He gets   lost during conversations and starts talking about himself;  |$\bullet $| He shows no interest in other peoples’ conversations. Written He is able to write, but slowly. He enjoys writing comments under the profiles of his Facebook friends. Telecommunication He is able to use the Internet for simple tasks, such as browsing Facebook, or “adult” and sports sites, like he did before his accident. However, he is not able to use the Internet functionally to search for new information. Home Home activities  |$\bullet $| He cleans his bedroom after repeated requests from his mother;  |$\bullet $| He is allowed to use electrical appliances, but only under supervision. Mobility Transport His outdoor activities depend on the availability of his family. Responsibilities Finances He does not manage his finances. He receives 50 dollars each week for personal use. Interpersonal relationships Affective His girlfriend left him 6 months after his accident because she could not accept his disinhibited and aggressive behaviour. Social relationships He has difficulty establishing social contacts due to his disinhibited, aggressive and self-centred behaviour. Social Education The rehabilitation team recommended that he cease his studies due to his physical, cognitive and behavioural problems. Leisure Socio-recreational activities He spends a lot of time listening to music and watching sports on TV. His parents frequently encourage him to take walks. He goes fishing with his father during the fishing season. Open in new tab Table 4. Persona participation. Life habits and social participation . Criteria Description Nutrition Diet plan and meal preparation His mother takes care of planning menus, shopping for groceries and preparing meals. For safety reasons, the occupational therapist recommended that Frederic avoid using electrical kitchen appliances without supervision. He used to eat a bowl of cereal each morning. Afterwards, he would forget to put the milk back in the refrigerator. Body condition Rest He sleeps about twelve hours on a daily basis. This includes two one-hour naps. He wakes up at around 10:00 am. Before the accident, he would wake up early to study. Personal care Bathing He is able to shower independently with technical aids, such as a shower seat, wall-mounted bars and a long handle brush. Excretal hygiene He is independent with his hygiene. Dressing He is able to dress himself. He seldom changes the clothes he is wearing. Health Care  |$\bullet $| He has difficulty cutting his food. His mother avoids this situation by providing him with   pre-cut food;  |$\bullet $| He takes his medication independently, using a Dispill. He takes it every morning after his   coffee. Nevertheless, his mother always checks to make sure he has taken them correctly. Communication Oral and non-verbal  |$\bullet $| He has difficulty talking with more than 2 people at a time (attentional problems). He gets   lost during conversations and starts talking about himself;  |$\bullet $| He shows no interest in other peoples’ conversations. Written He is able to write, but slowly. He enjoys writing comments under the profiles of his Facebook friends. Telecommunication He is able to use the Internet for simple tasks, such as browsing Facebook, or “adult” and sports sites, like he did before his accident. However, he is not able to use the Internet functionally to search for new information. Home Home activities  |$\bullet $| He cleans his bedroom after repeated requests from his mother;  |$\bullet $| He is allowed to use electrical appliances, but only under supervision. Mobility Transport His outdoor activities depend on the availability of his family. Responsibilities Finances He does not manage his finances. He receives 50 dollars each week for personal use. Interpersonal relationships Affective His girlfriend left him 6 months after his accident because she could not accept his disinhibited and aggressive behaviour. Social relationships He has difficulty establishing social contacts due to his disinhibited, aggressive and self-centred behaviour. Social Education The rehabilitation team recommended that he cease his studies due to his physical, cognitive and behavioural problems. Leisure Socio-recreational activities He spends a lot of time listening to music and watching sports on TV. His parents frequently encourage him to take walks. He goes fishing with his father during the fishing season. Life habits and social participation . Criteria Description Nutrition Diet plan and meal preparation His mother takes care of planning menus, shopping for groceries and preparing meals. For safety reasons, the occupational therapist recommended that Frederic avoid using electrical kitchen appliances without supervision. He used to eat a bowl of cereal each morning. Afterwards, he would forget to put the milk back in the refrigerator. Body condition Rest He sleeps about twelve hours on a daily basis. This includes two one-hour naps. He wakes up at around 10:00 am. Before the accident, he would wake up early to study. Personal care Bathing He is able to shower independently with technical aids, such as a shower seat, wall-mounted bars and a long handle brush. Excretal hygiene He is independent with his hygiene. Dressing He is able to dress himself. He seldom changes the clothes he is wearing. Health Care  |$\bullet $| He has difficulty cutting his food. His mother avoids this situation by providing him with   pre-cut food;  |$\bullet $| He takes his medication independently, using a Dispill. He takes it every morning after his   coffee. Nevertheless, his mother always checks to make sure he has taken them correctly. Communication Oral and non-verbal  |$\bullet $| He has difficulty talking with more than 2 people at a time (attentional problems). He gets   lost during conversations and starts talking about himself;  |$\bullet $| He shows no interest in other peoples’ conversations. Written He is able to write, but slowly. He enjoys writing comments under the profiles of his Facebook friends. Telecommunication He is able to use the Internet for simple tasks, such as browsing Facebook, or “adult” and sports sites, like he did before his accident. However, he is not able to use the Internet functionally to search for new information. Home Home activities  |$\bullet $| He cleans his bedroom after repeated requests from his mother;  |$\bullet $| He is allowed to use electrical appliances, but only under supervision. Mobility Transport His outdoor activities depend on the availability of his family. Responsibilities Finances He does not manage his finances. He receives 50 dollars each week for personal use. Interpersonal relationships Affective His girlfriend left him 6 months after his accident because she could not accept his disinhibited and aggressive behaviour. Social relationships He has difficulty establishing social contacts due to his disinhibited, aggressive and self-centred behaviour. Social Education The rehabilitation team recommended that he cease his studies due to his physical, cognitive and behavioural problems. Leisure Socio-recreational activities He spends a lot of time listening to music and watching sports on TV. His parents frequently encourage him to take walks. He goes fishing with his father during the fishing season. Open in new tab Impact on interdisciplinary collaboration and final product: Both the internal and external validation processes were beneficial to the overall design process as it helped the team clarify the main population for whom the technology to be developed would benefit. Based on this process, the team decided to prioritize the development of a technology to address the needs of people with a severe TBI, leaving the idea of addressing the needs of milder injuries to a later date. This process also confirmed for the computer scientists that they had developed a correct understanding of the needs of the population under study. It also reaffirmed that they could now confidently dialogue with clinicians about the clinical needs of individuals with TBI. In the end, this phase also helped the team move to the next stages of development of the persona, where we conceptualized how the persona could use this technology. 3.4. Persona adulthood During the persona’s adulthood phase, Frederic prepared a meal with the help of COOK. Scenario with COOK assistance The scenario with COOK assistance stages the persona as it interacts with COOK (see Fig. 6). From a computer science perspective, COOK will be composed of three subsystems that highlight its functioning: Supervision Subsystem, Assistance Subsystem and Communication Subsystem. The Supervision Subsystem aims to gather information on actions performed in the home; the Assistance Subsystem plans the assistance needed when errors are detected; and the Communication Subsystem displays cues via appropriate devices dispatched throughout the home. An icon is used to represent each player in the scenario (see Table 5). Table 5. COOK Actors. Actor Icon Role Actor Icon Role |$^{*}$|Copyright © Icon courtesy of PNGGuru |$^{\dag }$|Copyright © Icon courtesy of CBS Corporation |$^{\ddag }$|Copyright © Icon courtesy of clipart.me |$^{\dag \dag }$|Copyright © Icon made by Freepik from www.flaticon.com Open in new tab Table 5. COOK Actors. Actor Icon Role Actor Icon Role |$^{*}$|Copyright © Icon courtesy of PNGGuru |$^{\dag }$|Copyright © Icon courtesy of CBS Corporation |$^{\ddag }$|Copyright © Icon courtesy of clipart.me |$^{\dag \dag }$|Copyright © Icon made by Freepik from www.flaticon.com Open in new tab Figure 6 Open in new tabDownload slide Summary of the scenario with COOK assistance. Figure 6 Open in new tabDownload slide Summary of the scenario with COOK assistance. The meal preparation task is described according to the four operations contained in the IADL Profile (excerpts of the scenarios with COOK assistance for each operation are provided in Appendix B): (i) goal formulation, (ii) planning; (iii) carrying out the task and (iv) verifying goal attainment. An extensive document specifies Frederic’s actions and the role of each subsystem. Assistance is provided according to the typography of cognitive strategies, such as modality-specific strategies, stimuli reduction, etc. [Toglia et al., 2012]. Assistance is provided if |$\bullet $| An error is detected by COOK. More specifically the Supervision Subsystem detects errors through the information gathered in the smart home and the Communication Subsystem through the lack of user interaction; |$\bullet $| The Assistance Subsystem infers, from these facts, a situation that necessitates the simplification of a task; |$\bullet $| The persona makes an explicit request for assistance. Table 6. COOK interaction. Problem . Strategy . Means . Example . IADL structure Task specification Trail of breadcrumbs Providing an action plan with a logical sequence of actions. Planning Self-guidance |$\bullet $| Virtual agent |$\bullet $| Visual|$\bullet $| Vocal message Communicating with Frederic when choosing a recipe according to the available ingredients at home. Attention to doing |$\bullet $| Visual display |$\bullet $| Cue within smart environment|$\bullet $| Sound Displaying message on TV. Execution Task simplification and modality-specific strategies |$\bullet $| Visual display |$\bullet $| Vocal message |$\bullet $| Light cue within smart environment Splitting the complex task into a sequence of simple steps. Stimuli reduction |$\bullet $| Visual display |$\bullet $| Virtual agent Limiting the number of available recipes to choose from. Organization and finger pointing Check list Requesting acknowledgment for each ingredient assembled using a check list. Self-questioning |$\bullet $| Virtual agent |$\bullet $| Check list Helping to verify that each ingredient has been assembled. Execution of a specific task Rote scripts |$\bullet $| Video|$\bullet $| Image |$\bullet $| Playing a video explaining the required action; |$\bullet $| Displaying an image illustrating the required steps to carry out. Attention Pacing Toolbox Presenting a toolbox containing strategies to cope with fatigue (taking a break) or to relieve distracting thoughts (noting in a pad), and manage stress. Time management Organization |$\bullet $| Agenda |$\bullet $| Touch screen display Planning a weekly meal schedule. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing an alert to inform when the cake is ready; this timer is automatically pre-set and modifiable. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing pre-set reminders for activities that could be performed simultaneously, such as laundry. Safety Task specification modification Automatic control Providing a reminder to switch off the stove when the cooking time has expired, or when heating elements have been left unattended. Task specification Toolbox Presenting a toolbox containing allergy risks; education on allergies. Anticipation |$\bullet $| Oral messages |$\bullet $| Visual messages Providing messages prior to the person making use of dangerous equipment; education on hygiene and risk situations. Confidence Self-coaching Virtual agent Complimenting the user when the recipe is completed. Problem . Strategy . Means . Example . IADL structure Task specification Trail of breadcrumbs Providing an action plan with a logical sequence of actions. Planning Self-guidance |$\bullet $| Virtual agent |$\bullet $| Visual|$\bullet $| Vocal message Communicating with Frederic when choosing a recipe according to the available ingredients at home. Attention to doing |$\bullet $| Visual display |$\bullet $| Cue within smart environment|$\bullet $| Sound Displaying message on TV. Execution Task simplification and modality-specific strategies |$\bullet $| Visual display |$\bullet $| Vocal message |$\bullet $| Light cue within smart environment Splitting the complex task into a sequence of simple steps. Stimuli reduction |$\bullet $| Visual display |$\bullet $| Virtual agent Limiting the number of available recipes to choose from. Organization and finger pointing Check list Requesting acknowledgment for each ingredient assembled using a check list. Self-questioning |$\bullet $| Virtual agent |$\bullet $| Check list Helping to verify that each ingredient has been assembled. Execution of a specific task Rote scripts |$\bullet $| Video|$\bullet $| Image |$\bullet $| Playing a video explaining the required action; |$\bullet $| Displaying an image illustrating the required steps to carry out. Attention Pacing Toolbox Presenting a toolbox containing strategies to cope with fatigue (taking a break) or to relieve distracting thoughts (noting in a pad), and manage stress. Time management Organization |$\bullet $| Agenda |$\bullet $| Touch screen display Planning a weekly meal schedule. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing an alert to inform when the cake is ready; this timer is automatically pre-set and modifiable. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing pre-set reminders for activities that could be performed simultaneously, such as laundry. Safety Task specification modification Automatic control Providing a reminder to switch off the stove when the cooking time has expired, or when heating elements have been left unattended. Task specification Toolbox Presenting a toolbox containing allergy risks; education on allergies. Anticipation |$\bullet $| Oral messages |$\bullet $| Visual messages Providing messages prior to the person making use of dangerous equipment; education on hygiene and risk situations. Confidence Self-coaching Virtual agent Complimenting the user when the recipe is completed. Open in new tab Table 6. COOK interaction. Problem . Strategy . Means . Example . IADL structure Task specification Trail of breadcrumbs Providing an action plan with a logical sequence of actions. Planning Self-guidance |$\bullet $| Virtual agent |$\bullet $| Visual|$\bullet $| Vocal message Communicating with Frederic when choosing a recipe according to the available ingredients at home. Attention to doing |$\bullet $| Visual display |$\bullet $| Cue within smart environment|$\bullet $| Sound Displaying message on TV. Execution Task simplification and modality-specific strategies |$\bullet $| Visual display |$\bullet $| Vocal message |$\bullet $| Light cue within smart environment Splitting the complex task into a sequence of simple steps. Stimuli reduction |$\bullet $| Visual display |$\bullet $| Virtual agent Limiting the number of available recipes to choose from. Organization and finger pointing Check list Requesting acknowledgment for each ingredient assembled using a check list. Self-questioning |$\bullet $| Virtual agent |$\bullet $| Check list Helping to verify that each ingredient has been assembled. Execution of a specific task Rote scripts |$\bullet $| Video|$\bullet $| Image |$\bullet $| Playing a video explaining the required action; |$\bullet $| Displaying an image illustrating the required steps to carry out. Attention Pacing Toolbox Presenting a toolbox containing strategies to cope with fatigue (taking a break) or to relieve distracting thoughts (noting in a pad), and manage stress. Time management Organization |$\bullet $| Agenda |$\bullet $| Touch screen display Planning a weekly meal schedule. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing an alert to inform when the cake is ready; this timer is automatically pre-set and modifiable. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing pre-set reminders for activities that could be performed simultaneously, such as laundry. Safety Task specification modification Automatic control Providing a reminder to switch off the stove when the cooking time has expired, or when heating elements have been left unattended. Task specification Toolbox Presenting a toolbox containing allergy risks; education on allergies. Anticipation |$\bullet $| Oral messages |$\bullet $| Visual messages Providing messages prior to the person making use of dangerous equipment; education on hygiene and risk situations. Confidence Self-coaching Virtual agent Complimenting the user when the recipe is completed. Problem . Strategy . Means . Example . IADL structure Task specification Trail of breadcrumbs Providing an action plan with a logical sequence of actions. Planning Self-guidance |$\bullet $| Virtual agent |$\bullet $| Visual|$\bullet $| Vocal message Communicating with Frederic when choosing a recipe according to the available ingredients at home. Attention to doing |$\bullet $| Visual display |$\bullet $| Cue within smart environment|$\bullet $| Sound Displaying message on TV. Execution Task simplification and modality-specific strategies |$\bullet $| Visual display |$\bullet $| Vocal message |$\bullet $| Light cue within smart environment Splitting the complex task into a sequence of simple steps. Stimuli reduction |$\bullet $| Visual display |$\bullet $| Virtual agent Limiting the number of available recipes to choose from. Organization and finger pointing Check list Requesting acknowledgment for each ingredient assembled using a check list. Self-questioning |$\bullet $| Virtual agent |$\bullet $| Check list Helping to verify that each ingredient has been assembled. Execution of a specific task Rote scripts |$\bullet $| Video|$\bullet $| Image |$\bullet $| Playing a video explaining the required action; |$\bullet $| Displaying an image illustrating the required steps to carry out. Attention Pacing Toolbox Presenting a toolbox containing strategies to cope with fatigue (taking a break) or to relieve distracting thoughts (noting in a pad), and manage stress. Time management Organization |$\bullet $| Agenda |$\bullet $| Touch screen display Planning a weekly meal schedule. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing an alert to inform when the cake is ready; this timer is automatically pre-set and modifiable. Modality-specific strategies |$\bullet $| Sound |$\bullet $| Touch screen display Providing pre-set reminders for activities that could be performed simultaneously, such as laundry. Safety Task specification modification Automatic control Providing a reminder to switch off the stove when the cooking time has expired, or when heating elements have been left unattended. Task specification Toolbox Presenting a toolbox containing allergy risks; education on allergies. Anticipation |$\bullet $| Oral messages |$\bullet $| Visual messages Providing messages prior to the person making use of dangerous equipment; education on hygiene and risk situations. Confidence Self-coaching Virtual agent Complimenting the user when the recipe is completed. Open in new tab This scenario emphasizes the use of multiple communication media (see Table 6). The touch screen centralizes information for the completion of the recipe. It provides visual and verbal information to help assemble the ingredients and utensils and to help the persona follow the various steps involved. It provides safety instructions and displays various ways to cope with stress. This information is presented via pictures and videos, along with a virtual agent that communicates with Frederic. Occasionally, information must be displayed within Frederic’s environment; his attention must be drawn to specific elements. The smart home therefore provides environmental cues, including vocal messages, lights aimed at specific objects and a scrolling text on a TV monitor or LED panel. Impact on interdisciplinary collaboration and final product: At this stage, the development of a persona helped the team determine how assistance provided by COOK should be structured according to the four main components of the task (goal formulation, planning, carrying out, verifying goal attainment). Computer scientists and clinicians easily developed a common perspective on the hierarchical nature of the task to be analysed. The strength of the collaboration between computer scientists and occupational therapists for the development of these personas was that both of these disciplines are highly focused on task analysis and on developing appropriate interventions to facilitate task progression. It also led the team to identify key situations in which assistance could be needed, and further, how this assistance should be provided in a progressive manner to allow the person to use his residual abilities to the utmost. A novel impact of this interdisciplinary collaboration was to integrate evidence-based clinical interventions recommended for use with this clientele into the design of COOK. From the point of view of clinicians, this step helped them understand the limits of assistive technology. For example, ideas were exchanged regarding how a technology perceives what a person does (via sensors), how it interprets information (via rules), and how it can assist the person (via oral and visual prompts). In short, clinicians were exposed to the fact that technology does not have all of the know how, expertise and empathy of a clinician and it must be seen as a complement to this expertise and not as a replacement of it. 4. DISCUSSION The aim of the present study was to use the persona approach as a first UCD step to facilitate interdisciplinary work for designing an assistive technology. This innovative methodology supported by clinical rehabilitation models and tools allowed the interdisciplinary team to go far beyond a simple systematic review aimed at identifying the cognitive and functional deficits in TBI. Indeed, by co-creating a persona, we were able to observe these deficits directly in a scenario staging a meal preparation task. Moreover, this approach allowed the team to visualize the potential interaction between the persona and COOK, a cognitive assistive technology aimed at supporting safety and functioning, during meal preparation, of a person who sustained a TBI. Finally, the persona also served as an important facilitator to the interdisciplinary work between the clinical team and the computer science team, to attain the first, and likely most important, common objective which was to consolidate the team. The first significant achievement of this study was the conception of a persona describing Frederic, a young adult with severe TBI, through an internal and external validation process. A secondary persona representing his mother was also created. Then, two scenarios were developed. The first one involved meal preparation without COOK assistance and staged the dynamic interactions between Frederic and his surrounding environments, especially how he established relationships with his mother and the occupational therapist. The second scenario involved meal preparation using the cooking assistant, thus transferring the assistance developed in occupational therapy to automatic assistance provided by COOK. Our results showed the interactions between the three subsystems inside the COOK infrastructure (i.e. supervision, assistance and communication), which highlighted the role of each subsystem and the information they must share to elaborate an effective assistance. Thus, the persona achieves a prospective objective, as identified by Robert & Brangier [2012]. It allows the team to grasp the interactions between individuals with TBI and COOK. More specifically, it helps anticipate a new artefact that could be useful and integrated in a smart home dedicated for people with TBI. Moreover, we presented the category of interactions offered by COOK based on cognitive strategies and show the relevance of this cognitive assistant to support Frederic. In our study, the persona approach offered a dynamic way to understand the interactions between the persona and assistance, either given by caregivers or via COOK, by staging the evidence-based knowledge about TBI deficits in a scenario representing a complex IADL. So far, personas have been mostly used to mass-market products, such as mobile communication or Internet designs [Bornet & Brangier, 2013]. In this context, persona features are increasingly used to describe social status and customs more than abilities and behaviours. In our case, TBI so radically changes physical and cognitive abilities that behaviours, habits and environments must be described to illustrate these changes. Furthermore, heterogeneity of the deficits, pre-traumatic level of functioning and the combination of deficits make each person with TBI unique. Indeed, research reports that the principal characteristic of an individual with TBI is his uniqueness, thus leading to a difficulty in expressing the needs of the clientele [Pigot et al., 2005]. Moreover, since people who sustain a TBI suffer from extensive fatigue (e.g. Ashman et al., 2008, Juengst et al., 2013) and have difficulties with abstract thinking (e.g. Scherzer et al., 1993, Vas et al., 2015), the use of the persona allowed our team to develop and validate the utility of COOK, as a first step of a UCD, without direct contact with the population of interest. In a UCD approach aimed at developing a new technology dedicated to people with special needs, interdisciplinary work is crucial. One of the most original aspects of the methodology used in this study was indeed the knowledge transfer that occurred between two disciplines, that is occupational therapy and computer science, through the use of the persona. Indeed, to create a representative persona, both needed to be on the same page in understanding the repercussions of brain injury on everyday activities, at the macro and micro levels. To achieve this understanding, various novel means were used, such as an extensive workshop and video analysis offered to the computer science team by the clinical team. This interprofessional experience resulted in a more shared and in-depth understanding of the real needs of the population for whom this technology was being developed. Moreover, the computer science team needed to very specifically understand task breakdown and to think of ways of operationalizing cognitive strategies used by the occupational therapists within the cognitive assistant. Alternately, the clinical team needed to be aware of how assistance provided by an occupational therapist may be operationalized in automatic prompts. This required that the clinicians very specifically describe inappropriate behaviours and the assistance needed to address the situation. This in-depth clinical evidence-based description of personas and its novelty, contributes a novel way of designing assistance technologies that can be adapted to the particular cognitive needs of an individual. However, attempts at establishing a common vocabulary between the technical and clinical work teams also highlighted several different perceptions amongst the multiple partners involved in attaining the project’s goal of developing a persona. Mollo & Falzon [2008] stated that a technical object’s design process must be controlled, known and shared by every stakeholder involved. Throughout our process, however, it quickly became clear that the creation and usage of objectives regarding the persona differed for the clinical and computer science teams. For the computer science team, a prerequisite to their ability to create a persona was for them to acquire an understanding of the target population. Moreover, their intent was to create a persona that would illustrate numerous behavioural traits reflective of the severe TBI population as a whole so as to develop a persona that would anticipate the needs of as many future users of the technology as possible. The process of developing the persona therefore allowed the computer science team to provide the cooking assistant with a wide spectrum of functionalities, potentially useful for numerous future users of the technology. For the clinical team, however, these behavioural traits could hardly co-exist in a single persona, making the end goal of the creation process less clear for them. For the clinical team, the persona had to resemble a singular case of severe TBI to the utmost. Therefore, the changes that were proposed by members of the computer science team were initially rejected, as these did not represent the reality of the specific person with severe TBI for whom they thought the cooking assistant was being designed for. At this stage, it became clear that both teams had to be integrated into a single working group using a transdisciplinary approach with an integrated vision and with the same comprehension of the problem [Boger et al., 2017]. Hadorn et al. [2010] proposed that the strategies used to facilitate the integration of knowledge in transdisciplinary work should be dialogue-based, model-based, product-based, vision-based or common metric-based. The persona approach can certainly be used to achieve these methods but future studies should propose mechanisms to enhance collaboration and communication between very diverse research cultures with the help of this approach. In our study, it was decided to merge the two teams and also, to pursue our UCD with future studies, i.e. the participation of the residents themselves in design meetings. Therefore, the personas were a way to structure from the outset our collaboration and move forward with the design. A UCD training for the clinical team could have facilitated the acceptance of generic (persona) versus specific vision (real) of the persona creation process. 5. CONCLUSION To conclude, the persona-based method used in the present study allowed us to (i) understand the specific needs of the population of interest, (ii) learn about the rehabilitation strategies that should be used, (iii) specify when these strategies are appropriate to be used; (iv) define the core functionalities of COOK and (v) operationalize these strategies in the cognitive assistant using a scenario, all while creating a common vocabulary within the interdisciplinary team. The results from this study show the high potential of the persona approach to represent complex and varied populations and the utility of scenarios to understand how a specific population can interact within a specific context, which is of great importance in a needs analysis UCD process. This work established the foundations for generic functionalities of COOK which were refined, extended and personalized to the particular assistance needs of three real users in a subsequent study [Pinard et al., 2019]. It provides also a methodology to co-construct a persona by an interdisciplinary team and illustrates the relative advantages for supporting team work. This methodology follows one of the UCD processes proven in design as well as a reference framework used in health sciences. This work thus contributes to the construction of interdisciplinary work tools by proposing, through a persona, a communication medium between two disciplines. In this way, this work provides a demonstration of a working tool to feed interdisciplinary research that lacks systematic means to be moved forward. 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TI - Use of a Persona to Support the Interdisciplinary Design of an Assistive Technology for Meal Preparation in Traumatic Brain Injury
JF - Interacting with Computers
DO - 10.1093/iwcomp/iwab002
DA - 2021-04-29
UR - https://www.deepdyve.com/lp/oxford-university-press/use-of-a-persona-to-support-the-interdisciplinary-design-of-an-eB4tn39RnK
SP - 435
EP - 456
VL - 32
IS - 5-6
DP - DeepDyve
ER -