This research paper provides a qualitative study investigating the acceptability of the Google Glass eyewear computer to people with ALS. The report is generally a response to Glass as a device to install confidence and safety for this potentially vulnerable group.

1. Exploring the Acceptability of Google
Glass as an Everyday Assistive
Device for People with ALS
Mobile Application Design & Development
Research Report"
Tridev Gurung - August 29, 2014
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2. ABSTRACT!
Wearable computing devices, most famously Google Glass, are beginning to captivate the
imaginations of consumers. These devices offer a hands-free option to take pictures, record
videos, surf the Internet, and communicate. However, the future of wearable devices is even
more promising in the field of medical technology. As engineers design these new wearable
systems, they must be cognizant of the human factors that influence the user interface. Just as
designers of mobile devices in the consumer market recognize the value of usability, engineers
of wearable medical devices must design from the perspective of the patients who will use
them. These wearable technologies will not only improve the lives of patients, they also
present significant opportunities for improvement in organizational efficiency. This perspective
is unique to patients with medical conditions that are typically not shared by the engineers.
Thus, one can imagine that a new user interface model must be developed that allows
engineers to better understand the needs of patients for whom they are designing wearable
devices that have the potential to greatly improve quality of life.
This research paper provides a qualitative study investigating the acceptability of the Google
Glass eyewear computer to people with ALS. The report is generally a response to Glass as a
device to install confidence and safety for this potentially vulnerable group.
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Keywords
Google glass; ALS disease; research; qualitative.
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3. Table Of Contents
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ABSTRACT
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2!
INTRODUCTION
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4!
THE STUDY
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6!
Issues and Frustrations Relating to Technology Usage
6
Confidence and Safety
6
Security and Vulnerability
7
Privacy
7
Fields Trials
7
Wearing Glass while ‘Out and About’
7
Frustrations when Interacting with Glass
7
APPRECIATING GLASS
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9!
GLASS-BASED SELF-MANAGEMENT FUTURES
9
CONCLUSION
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11!
REFERENCES
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12!
ARTICLES:
12
WEB PAGES:
12
VIDEO LINKS:
12
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4. INTRODUCTION
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ALS stands for Amyotrophic Lateral Sclerosis. It is a progressive neurodegenerative disease
that affects nerve cells in the brain and the spinal cord. The progressive degeneration of the
motor neurons in ALS eventually leads to the loss of the ability of the brain to initiate and
control muscle movement. [Mullen 2011]
This degeneration affects balance, gait, arm and facial movements. Motor blocks (freezing)
most commonly affect an individual’s legs during walking and is generally referred to as
freezing of gait. Aside from the physical signs of ALS, there is a myriad of emotional and
social discomfort related to loss of independence, self- confidence, embarrassment and stigma.
Prior work has explored the use of wearable technology to help the self-management of ALS
symptoms with further work primarily focusing on diagnostics and tremor classification. One
of the major recent wearable computing breakthroughs is Google’s new ‘eyewear computer’,
expected to be commercially available in 2014, referred to as Glass. Eyewear computers are
claimed to be the next evolution beyond smartphones. Glass is designed to resemble, as much
as possible, a normal off-the-shelf spectacles. Yet it is equipped with a miniature computer, a
micro-display and contains many sensors: an inertial measurement unit (gyroscope, compass
and accelerometer) to measure head movements, a microphone for ambient sound pickup, a
capacitive touch sensor on the main housing and a front-facing camera. Interaction with Glass
is through touch gestures on the side of the frame and spoken commands. Additionally, Glass
can provide audio and visual information to a wearer through a bone conducting speaker and
the translucent display filling a small region of the field of view. [Rhodes, Allen 2014] It can
be connected via Bluetooth to a mobile phone to access its sensor data (e.g. GPS or additional
motion sensors) or the Internet.
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5. Glass opens a new space for exploring the design and development of wearable context-aware
systems. As a commercial device, it might avoid the stigma associated with devices designed
specifically for people with a condition. However, given the novelty of Glass, the expectations
and possible acceptance of such devices are not yet known. We fill this void by presenting a
qualitative study based on workshop discussions and an initial field trial of the Glass device
with people with ALS from the United Kingdom. [Rhodes, Allen 2014]
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6. THE STUDY
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The study gathers qualitative insights about how patients can use technology both socially and
in managing the patients’ condition and to gather initial reactions to the Google Glass
technology.
Issues and Frustrations Relating to Technology Usage"
There are particular problems with smartphones specifically related to ALS. Tremor and a loss
of fine motor ability are identified as symptoms causing great difficulty with using touch
screens and a major source of frustration. This resulted in a need to place the phone on a stable
surface in order to use; therefore, it felt that having a voice activation system would be a huge
benefit for them. Having this on an easily accessible platform such as Glass was perceived to
be immensely advantageous when compared with a typical mobile phone-based hands-free
system.
Furthermore, voice command might be an issue as well. Many people with ALS experience
severe problems with their speech and voice which can change with ON/OFF periods. Some
might have difficulty producing intelligible speech, which can often caused them to avoid
certain situations or social interactions. However, there could be a high level of success
experienced by the participants using the voice activation, which can incite a sense of
encouragement. [web page 1]
Confidence and Safety"
To most ALS patients, the sudden physical changes associated with unpredictable OFF stages
could be a major issue. Reports suggest that they experience severe and frequent difficulties
related to freezing; causing anxiety in crowds or when out alone. This would lead to situations
where they are liable to fall or be unable to get required help from the public. Glass was
immediately seen as something that could instill confidence for the patients by providing a
feeling of safety. With the Google glass on, they can feel they could be independent and go out
on their own in the knowledge they could quickly contact someone who could “see where they
are” and offer instruction and support. [Mullen 2011]
Supporting increased confidence and safety would be facilitated via the Glass in a two-way
communication between the patient and the care-taker. Care-takers would also benefit from
being assured that they would be contacted immediately and would know the where-about of
the patient in case he goes into shock or “freeze”.
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7. Security and Vulnerability"
Concerns emerged over personal security and the potential that criminals would want to steal
the device due to its value ($1500 +) and rarity. Patients can feel the constant visibility of Glass
made them vulnerable, in the sense that it must be worn to be used. Feelings concerning
security could emerge in contrast to those related to mobile phones, which can be easily hidden
and need not be on public display. However, despite these potential security concerns, there is
an overwhelming sense that using the device could provide scores of benefit.
Privacy"
Concerns could be raised over “always being available/online”, in the sense that relatives
would expect Glass to be easily accessible at all times. This was contrasted with a mobile
phone where excuses could be made about why it was not answered. [Loek 2013]
Fields Trials"
This included: requesting and following directions, taking photos, creating videos, checking
the calendar and making to-do lists.
Wearing Glass while ‘Out and About’"
All of the participants can use Glass daily at home as well as in outdoor settings, such as the
shopping mall, when meeting with friends, while out driving and during a hospital
appointment.
For Example: A patient took an approach while shopping. He might think others will provoke a
reaction but surprisingly can find they “took no notice” of him. A very different experience
however could be, everyone seeing and observing the patient as he wore the Glass while
shopping. This can contrast with the types of people in the mall.
Frustrations when Interacting with Glass
It is pretty sure all of the patients will experience usage (usability might not be a word) issues
with Glass. The voice recognition can cause frustration amongst everyone. For those who
already have marked difficulties with their speech through ALS, this could prove to be deeply
disheartening.
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8. The navigation gestures, namely tapping on the side of the device, could also be problematic in
everyday use. Glass has more success when using the swiping gesture to navigate menus
however; it could also be a difficult gesture to master.
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9. APPRECIATING GLASS"
There are a number of good pre-installed apps on Glass for both home and outdoors. The
SatNav system, in particular is definitely an app worthy of appreciation (appreciable is not a
word). The speed (12 GB of usable memory, synced with Google cloud storage. 16 GB Flash
total) of Glass especially while doing any kind of searching can surprise most of the patients.
Another important thing not to miss is that the patients need not take their phones out and deal
with the resulting physical interaction problems. [Rhodes, Allen 2014]
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GLASS-BASED SELF-MANAGEMENT FUTURES"
The researches done regarding the deployment phases of Glass are, on the whole, extremely
positive. Some of this was down to the novelty of the technology, but there was also a genuine
appreciation that the device could transform the lives of those with ALS. The aim with this
study was to elicit rich initial impressions of Glass based upon the existing, rather limited,
selection of apps and functions the device provides. Additinally, based on the findings and
study comments, Glass also has alternative applications that could potentially help someone
with ALS self-manage their symptoms.
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Contextual Reminders and Prompts:
There is great potential to utilize the on-board sensors to detect, and respond to, oncoming OFF periods
for someone with ALS. Clinical studies have already shown the potential of using sensors to detect
ON/OFF motor fluctuations. Context aware medication reminders and information logging capabilities
could prove advantageous in the monitoring and management of medication use, providing both the
clinician and the individual with ALS, an insight into how well their medications are working.[Mullen
2011]
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n-Sight Task Support: The sense of loss of ability, independence and self-confidence was
palpable. Thus, attempting to recover this in even a small way could make a vast difference in the life
of someone with ALS. Glass allows for instant feedback and support during tasks through the
translucent display. This feature could have a positive impact both on the confidence and independence
of someone with ALS e.g., sharing what you see with the care-taker, or the SatNav system to aid
oneself when out alone.
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10. "
Cueing for Self-Management: Cueing for freezing has been shown to be successful for people
with ALS [Mullen 2011]. A person who is seemingly unable to move can be cued into initiation
through having a simple visual cue in the form of someone’s foot, a laser spot or a walking stick which
they are then able to step over. Using a visual overlay displayed on Glass to provide a cue for people
experiencing freezing episodes was suggested in several studies and research papers. The cueing theme
was extended with further ideas around situated cueing for posture correction, swallowing, blinking
and speech.
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11. "
CONCLUSION!
The study of Glass was done based on different hypothesis and on different papers that I saw
online and on YouTube videos over a certain period of time. Initial impressions were very
promising. The findings show that there is value in exploring the technical feasibility of
applications for ALS supporting, reminding and prompting, in-sight task support and self-management
cues. Future work will also need to address several of the basic functions of
Glass, such as the voice recognition and navigation gestures, to ensure it can accommodate for
usage issues caused by ALS symptoms.
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12. "
REFERENCES!
ARTICLES:"
1. William Mullen (2011). Cause of ALS is found, Nor thwestern team says Breakthrough
in Lou Gehrig's disease could lead to treatment
http://articles.chicagotribune.com/2011-08-22/news/ct-met-northwestern-als-breakthrough-
20110822_1_als-patients-siddique-key-protein
2. Essers, Loek (2013). Google Glass privacy concerns raised by international data
protection authorities
http://www.cso.com.au/article/
465221google_glass_privacy_concerns_raised_by_international_data_protection_autho
rities/
3. Thomas Rhodes & Samuel Allen(Jan 2014). Through the Looking Glass. How Google
Glass Will Change the Performing Arts
https://static.squarespace.com/static/51d98be2e4b05a25fc200cbc/t/
52d331fde4b075f75c5f7243/1389572605768/RhodesAllen_GoogleGlass_1.13.2014.pdf
4. Google Glass.
http://www.google.com/glass/start/
5. Google Tech specs
https://support.google.com/glass/answer/3064128?hl=en
WEB PAGES:!
1. http://news.yahoo.com/video/google-glass-could-help-als-215030402.html
2. http://dspace.ruc.dk/bitstream/1800/13405/1/
MEDIATEDLIFEAFTERVIRTUALIZATIONPROJECTGROUP8-backup.pdf
VIDEO LINKS:!
1. https://www.youtube.com/watch?v=JNZcC_3YLuo
2. https://www.youtube.com/watch?v=9s5ZY9LhN2g
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13. 3. https://www.youtube.com/watch?v=MG9oN4hJUQ0
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