Optimizing communication devices for children with dyskinetic cerebral palsy

描述（由申请人提供）：有严重语言或写作障碍的儿童每天都在与我们大多数人认为理所当然的最简单的沟通任务作斗争。在美国，超过50万名儿童需要辅助技术来进行交流，其中20-60%的儿童可能需要专用键盘，屏幕或软件来与计算机和计算机控制的辅助设备进行交流。对于患有运动障碍性脑瘫（CP）和严重手臂运动障碍的儿童，诸如适配键盘、可编程触摸屏和操纵杆界面等设备可能是他们与家人、朋友、老师和照顾者最重要的沟通纽带。然而，这些设备很难使用，以至于通信通常非常缓慢和费力，并且经常导致使用它们的儿童的高度沮丧。此外，由于每个患有CP的儿童表现不同，因此没有一种设备针对特定儿童的损伤进行优化。因此，本研究的目标是解决改善辅助通信设备的关键需求，并优化每个儿童的界面设计。两种最常见的基于计算机的接口设备是触摸屏和操纵杆控制器。我们建议使用一组最近开发的技术，基于信息论和贝叶斯信号处理，以优化设计的触摸屏界面和操纵杆控制器的运动障碍性脑瘫儿童，损害手部运动。触摸屏设备的优化将基于对单个儿童到达不同大小、间距和数量的目标时的速度、准确性和错误率的测量。操纵杆设备的优化将利用儿童接近目标时操纵杆的完整路径。我们已经开发出一种新的算法，可以有效地使用贝叶斯非线性滤波估计的预期目标的操纵杆在运动的早期。这种估计显著提高了性能，但当儿童具有可变运动时，它会在速度和准确性之间进行权衡。因此，我们必须测量速度，精度和错误率作为目标大小和操纵杆间距的函数。运动迟缓（缓慢运动）和运动过度（可变运动增加）是运动障碍性脑瘫儿童的常见损伤，会影响两种器械的性能。我们将量化这些损害，并确定它们对通信设备使用和优化的影响。最后，我们将测试改进接口的实现是否可以提高通信速率。这项研究将提供运动障碍和辅助沟通障碍的脑瘫儿童运动障碍形式之间的重要定量联系。公共卫生相关性：高达60%的运动障碍性脑瘫儿童依赖基于计算机的辅助通信设备与父母或朋友交谈，并参与学校活动。目前还没有可靠的方法来确定最佳的触摸屏布局为个别儿童。我们将对个别儿童进行详细的测试，并将结果与信息处理模型相结合，以找到最佳的触摸屏或操纵杆界面设计，从而最大限度地提高运动障碍性脑瘫儿童的沟通速度。

DESCRIPTION (provided by applicant): Children who have serious speech or writing impediments struggle every day with the simplest of communication tasks most of us take for granted. Over 500,000 children in the US require assistive technology to communicate and 20-60% of these children may require special-purpose keyboards, screens, or software to communicate with computers and computer-controlled assistive devices. For children with dyskinetic cerebral palsy (CP and severe arm movement disorders, devices such as adapted keyboards, programmable touch-screens, and joystick interfaces may be their most important communication link to their families, friends, teachers, and caregivers. However, these devices are so difficult to use that communication is often extremely slow and laborious and often results in high levels of frustration for the children using them. Additionally, because every child with CP presents differently, no one device is optimized for a particular child's impairments. Therefore, our goal for this study is to address the critical need for improved assisted communication devices and to optimize the interface design for each individual child. Two of the most common computer-based interface devices are touch- screen and joystick controllers. We propose to use a set of recently-developed techniques based on information theory and Bayesian signal processing to optimize the design of touch- screen interfaces and joystick controllers for children with dyskinetic cerebral palsy that impairs hand movement. Optimization of the touch-screen device will be based upon measurement of the speed, accuracy, and error rate of individual children as they reach to targets of varying size, spacing, and number. Optimization of the joystick device will make use of the complete path of the joystick as the child approaches the target. We have developed a new algorithm that can efficiently use Bayesian nonlinear filtering to estimate the intended target of the joystick early in the movement. This estimation significantly improves performance, but it introduces a tradeoff between speed and accuracy when children have variable movements. Therefore we must measure speed, accuracy, and error rate as a function of target size and spacing for the joystick as well. Bradykinesia (slow movement) and Hyperkinesia (increased variable movement) are common impairments of children with dyskinetic cerebral palsy that will affect performance on both devices. We will quantify these impairments and determine their affect on communication device use and optimization. Finally, we will test whether implementation of improved interfaces can increase the rate of communication. This study will provide essential quantitative links between disorders of movement and disorders of assisted communication for children with the dyskinetic form of cerebral palsy. PUBLIC HEALTH RELEVANCE: Up to 60% of children with dyskinetic cerebral palsy depend on computer-based assistive communication devices to talk with parents or friends and to participate in school. There is currently no reliable method for determining the best touch-screen layout for individual children. We will perform detailed testing of individual children and combine the results with a model of information processing in order to find the best possible design of a touch-screen or joystick interface that will maximize the speed of communication in children with dyskinetic cerebral palsy.