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Center for Rehabilitation Engineering Research
Lund Institute of Technology
Ten years have passed since the first steps were taken towards what is today CERTEC,
Center for Rehabilitation Engineering Research at the Lund Institute of Technology. Most
of CERTEC's activities through the years are documented at http://www.arkiv.certec.lth.se. You
will find an introduction to our current activities on the center spread of this
The fact that the results and the scope of CERTEC's activities are well-documented does
not necessarily mean that the same holds true for our theory and method. Rather the
contrary. Just like other research units in the field of rehabilitation engineering (in
this publication the term rehabilitation" includes both habilitation and
rehabilitation) CERTEC has kept a remarkably low public profile with respect to theory and
method. Even amongst ourselves discussions about theory and method have been allowed to
remain untamed and project specific.
In the long run this is not good. Many projects may have been presented, but this does
not automatically result in improved theory formation or greater methodological awareness.
On the other hand, the converse may apply: individual projects may benefit from clearer
theories and methods. It is in this spirit and for this purpose/with this objective/ that
CERTEC's Core" has been written. When theories are made visible new thoughts
become thinkable and new knowledge possible. When the presentation of method is improved,
critical examination becomes possible.
CERTEC's core wants to combine
This seemingly impossible task has turned out to be possible in the context of case
studies. For this reason, case methodology has become one of CERTEC's
most important theoretical foundations. HMI (Human Machine Interaction) is another
essential theoretical foundation. Whether CERTEC's activities also include action
research we see mainly as a matter of interpretation, to be decided by action
researchers. Without a doubt, there is a strong element of user involvement in CERTEC,
which may, of course, be seen as an indication of action research. However, user
participation can just as easily be seen as a necessary prerequisite for achieving
relevant results. Or as a natural result of research ethics considerations.
Thus, CERTEC's theoretical profile, its core, consists mainly of case methodology, HMI
and its own theory formation. The function of the core is to make it possible to do our
work while keeping our fingers on the pulse in the world of the handicapped, and at the
same time keep a cool and clear head while hunting for new describable"
patterns, new technical solutions and, above all, new findings about the users which come
to light through their use of the new technical solutions.
The core has a strong element of iterativeness. Research projects often begin because
we, or others (preferably the intended user himself), have hypotheses about dreams, wishes
and needs which could be met by the use of a certain new or old (usually new) technology.
Next, the development of the technology requires a certain amount of time before the idea
can be tested by the indiviual in her environment. The result of this testing is often
that the dreams, wishes and needs become clearer or even turn out to be quite different
from what they were believed to be. These types of clarifications or completely new
insights are what CERTEC considers to be the actual results of its research. Their
character is different and more concrete than the results obtained by the behavioral
sciences through the use of questionnaires, in-depth interviews, etc. 1
This is Peter Anderberg. He began studying at the Lund Institute of Technology at about
the same time as the precursor of CERTEC was being created. He failed and interrupted his
studies. After this, he stayed away from Lund and his studies for many years.
In 1995, he resumed his studies with great success; used information technology; began
cooperating very closely with CERTEC. Now he is doing his final year abroad (in the United
States) and will soon have his degree in engineering. After that, he will most likely
become a doctoral student at CERTEC.
The example of Peter is used from time to time in this text to give it cohesion
and to serve as an illustration. The intention is not per se to tell Peter's story,
but to make the general text in CERTEC's Core" more concrete by providing
glimpses from Peter's development. To find out more about Peter's development, please
refer to Att kunna studera på universitet" (Making university studies
possible) (2), which is available from CERTEC. It will be broadcast by the Swedish
Educational Broadcasting Company in the spring of 1997. CERTEC will also make it available
on the Internet in the spring of 1997.
Finally, this report is based on lengthy and continuing discussions at CERTEC.
Consequently, all of CERTEC's staff, not least Peter, are co-authors of CERTEC's
Core". However, I stand as the sole author since I am the one who, through the years,
has been working on what is (or can be made) researchable" at CERTEC, and on
how the research can be carried out. I am also the one who, during the writing of this
report, has been provoking new thoughts (my own and those of others) and who is now
spreading them to a wider audience.
Table of Contents
New and relevant knowledge
The need for a language
Technology as a language and a probe
Learning/education and information
Ten years have passed since the precursor of CERTEC published its first project
Raise and Lower", which was also the first project to receive the support of
The Council for Health and Medical Care Research in Southern Sweden.
Ingvar Jönsson of the Rehabilitation Department at Lund Hospital and I carried out the
work on Raise and Lower". Later, he became one of my first colleagues at
CERTEC. He died two years ago. He was a friend of people and a friend of things. His only
formal education was 6 years of elementary school, but he was one of the greatest geniuses
and one of the best people I have had the pleasure of working with.
At about the same time (although there was no connection) as CERTEC began its work,
Peter Anderberg began studying at the Lund Institute of Technology. He tried to succeed in
his studies and to be just like other students despite a serious disability. It did not
work out very well. Or rather: it did not work at all. One of the reasons was that, at the
time, the Lund Institute of Technology was not accessible to people with disabilities. It
still is not completely accessible.
In the USA, where Peter is now, the Americans with Disabilities Act applies, making
physical accessibility mandatory. It is taken for granted that all public areas at Santa
Clara (California), the university Peter is currently attending, should be accessible to
people with disabilities. It was also taken for granted that special adjustments to his
immediate environment had to be made almost immediately when Peter began his studies at
the university in the fall of 1996.
Back to Sweden and the Lund Institute of Technology. Ten years ago there was nothing at
all to indicate that a decision would be taken about CERTEC: there were no premises, no
equipment, no grants or any intellectual infrastructure for the field of Rehabilitation
Engineering. Thus, what exists today has been built in less than a decade (initially at a
very slow pace, currently at a very fast pace). During this time CERTEC has:
But all along we have been haunted by and we have been haunting ourselves with the
question: what in this is research? The results may be good, but in what way do they
represent truly new knowledge? And how do you get at it?
A diagrammatic picture of CERTEC's dilemma. We are being pulled in one direction
by the wish (held by others and ourselves) that CERTEC should carry on purely scientific
research, and in the other by the wish to provide help and be short term problem-solvers.
If two forces, one to the right and one to the left as in the picture, are of
equal strength, the net force is zero, physics tells us. But to the person who is being
subjected to the tearing-apart it does not feel that way. The above picture is a good
symbol of the tension CERTEC has to live under. This text tries to analyze the tension
itself and not only make it possible to live with, but constructive as well.
During the past decade the attitude to interdisciplinary research has changed
considerably. Ten years ago university circles mostly looked at interdisciplinary studies
with suspicion (if it was looked at all). Now, in principle, much is made of it and it is
written up everywhere. However, those of us who have, in practice, been carrying on
interdisciplinary studies for a long period of time know that the change in attitude has
not changed the basic premise: interdisciplinary studies are difficult. Perhaps as
impossible as it is essential? There are no interdisciplinary methods, no
interdisciplinary language or interdisciplinary concepts. It is one thing for different
sciences to serve as inspiration for one another, to approach the same problem from
different angles. But if one is to pursue scientific studies, interdisciplinary,
popular or not 3, it must be explicitly possible to practise preservation of knowledge and
to work on theories and language. This is even more important when an interdisciplinary,
rather than an intra-disciplinary, approach is used .
New and relevant knowledge
The only research result worth the name is new knowledge. New knowledge is
continuously generated, inside and outside universities. However, for it to be possible to
determine what constitutes new knowledge, one has to be able to distinguish, make visible,
and cogently describe existing knowledge as well as the new knowledge. All in a manner
which can be documented.
Accordingly, CERTEC's research (like all good research) has to result in better ways of:
CERTEC insists that the knowledge we are looking for, besides being new, must be relevant
to the field. Right away, this makes things more difficult. There is an intrinsic
complexity to the chain between the individual, physical impairment, perceived handicap,
physical environment, and social context. This complexity cannot be disregarded; it has to
be brought into the research itself. If not, the knowledge will be new, but hardly
relevant to the field, and accordingly not very important.
It is delicate work trying to distinguish researchable" problems in
rehabilitation engineering. Our neighboring departments who focus on applied technology
cannot be our role models. By applied" they usually mean that the department
develops applications for technology. However, it is rare for them to study the actual
application, the actual use, outside the department. A focus such as CERTEC's - on the user
rather than the use of the technology- is unusual in the environment in which we
Originally the most user friendly aspect of Isaac, a personal digital assistant, was that it had a specific target group: people with cognitive disabilities. It was in itself remarkable that, for a period of time, we managed to make technology which is attractive to everyone available only to those who usually come last: people with cognitive disabilities. But in order for it to be possible to produce new, relevant knowledge, Isaac had to go down a long, winding road before finding its first real home at Tryckolera in Lund.
Accordingly, we do not consider the product Isaac, and its technological environment,
as a rehabilitation technological result as such. On the other hand, the changes
experienced by the users of Isaac are examples of such results: Stig Nilsson has
straightened his back. In his 40s. His co-worker, Thomas Gustafsson, of the same age, has
experienced strong language development.
The fact that CERTEC focuses on the users and their self-image makes it relatively easy
to avoid the trap of getting stuck in the type of research which concentrates on detail.
Because a person is an individual (not divisible). The difficulty lies in making visible
changes in something which is complex, thereby making the results available outside the
immediate user. Sometimes it may even be possible to arrive at what is general, common to
all, by first focusing on the specific case, the particular.
Perhaps the main reason why it will be possible to communicate the Isaac project is
that its technology, in forms different from the original one, will soon be available to
many individuals. User results, mainly from Tryckolera in Lund, have produced The
Pictorium and The Picturegraph (). With these devices, it is now possible to combine
one's own pictures to create picture messages, using Isaac's picture database (which can
be used by other digital cameras as well), pictures with individual bar codes, and a bar
Isaac's clock feature is another example. After having been developed further at
Fågel School in Lund and Georgshill School in Hörby, it will now be made available to
the public under the provisional name of Clock o'clock (5 ). Without user experience,
involving one or a small number of special people, this would not have been possible.
However, with this specific experience it is possible for the general to benefit from the
The need for a language
Nothing influences development as much as a well-developed thought
infrastructure". This is why it is always necessary to work on thought patterns, to
question their relevance and make them visible and shared. In other words, one has to
acquire a functional and revealing language, a shared way of looking at reality.
Much handicap research is done as interdisciplinary studies. There are advantages to
this in the short term, but in the long term it is difficult to take further. The most
important objection to interdisciplinary studies and projects is financing difficulties
and irregular, short term project organization. However, CERTEC believes that there is a
far more serious problem: the interdisciplinary approach falls altogether short when it
comes to language development.
With the participation of capable individuals from various disciplines it is
possible to achieve a good result, with new and relevant knowledge. If, however, the new
knowledge is abandoned out in the interdisciplinary desert when the project is finished,
it is almost certainly lost. It is not suited to being transferred to old disciplines. The
project results cannot be kept alive and be developed further without constant, continuous
work being done on theories, methods, language, and structuring. This is not detrimental
if the field in question is, and is supposed to be, ephemeral (for example a project with
the aim of solving a specific problem using a specific type of technology for a specific
period of six months). A finished project is supposed to be just that, finished. However,
if the field is more eternal (such as rehabilitation engineering, where lifespan of the
insights gained from research is far longer than that of a specific generation of
technology), it is a waste of human effort to allow interdisciplinary structures to be the
only possible ones for a project.
It is not possible to speak an interdisciplinary language. Relevant concepts, structures, strategies and solutions are not the result of work and more work in a disciplined setting. Nor will language development take place if handicap research is allowed to consist of further development of separate established disciplines on the basis of various handicap perspectives. In that event, the disciplines themselves will define the possible selection and methods, while the handicap perspective decides which ones of these will be chosen. This undoubtedly enriches the original disciplines, but people with disabilities will benefit from only a small part of the research. As demonstrated by Sweden's Parliamentary Auditors in 1996 with respect to research in general, the larger part of the research results will spread no farther than the research community. However, for ethical reasons, that is even more indefensible in this context. People with physical disabilities actually take part in the research process themselves, and their participation, or at least their permission, is an absolute condition to making the research possible in the first place. This makes it unreasonable for them not to receive a lot in return.
Technology as a language and a probe
Many people find technology fascinating and will gladly spend a lot of time on it.
This, and the fact that technology has the ability to make things visible, makes
technology a helpful tool when the user and those around her want to understand needs,
wishes and dreams, provided the individual is always shown deep respect. The following are
some of the possibilities of technology:
People with disabilities, as well as those around them, can interact with the
technology instead of waiting passively for somebody else to take the initiative.
Technology is what it purports to be, no more no less.
2. Technology is neutral
It is difficult, maybe even impossible, for a human being to be completely neutral. It
is particularly important to recognize this when people are acting as substitutes for
others with, for example, communication difficulties or other cognitive problems. In this
type of situation, the neutrality of technology may provide greater respect for the
integrity of the individual than a fellow individual, however well-meaning, is able to do.
3. Technology is concrete
With regard to people with cognitive disabilities in particular, it is essential to
have an object to show and to refer to when one is trying to understand needs, wishes and
dreams. Abstract questions or thoughts simply do not work at all.
4. Technology provokes
A thought, a conversation, or a lecture has something fleeting about it. A technical
tool, however, remains, and in the end forces a decision. Sometimes technology brings a
previously hidden contradiction to light which has to be dealt with.
5. Technology surprises
Even the most open of research approaches has limits to how far it is aiming. When
trying to use technology as a language, we have often been surprised by the way reality
has answered questions completely different from the ones we have been asking when
introducing the technology.
6. Technology liberates
There are moments when neither the user, nor the people around him, notice that he is facing obstacles. If you have not seen them, it is obviously not possible to work towards removing them. Sometimes the people around him do notice the obstacle, but take for granted that there is no technical solution. As a result, one puts a lot of effort into making living with the problem bearable instead. In other cases, the disabled person himself experiences the need but those around him do not see it. In a case like this, if the disabled person cannot express his needs, nobody else will do it for him.
In cases such as these, the use of technology can work like liberating education. The absurdity of the situation is revealed. We can discover the unknown by twisting around what is already known.
7. Technology empowers
In our experience, over the whole range from simple push-button commands to advanced
computer technology, only the technology which leads to the empowerment of a disabled
person has any profound effect. Empowerment, however, brings revolution. Peter, for
example, went from being a rather isolated disabled person who had failed at his studies,
to a becoming a top student, even abroad. Other examples include Stig Nilsson whose
posture changed and Thomas Gustafsson who developed his language.
There are many ways of providing the field of rehabilitation technology with methods
and a language which make it possible to connect and distinguish between its different
branches. One connecting aspect is that it may be functional to question, at the very
outset, whether the solution should imitate fully the solution for a non-handicapped
person (the parrot method), have the same purpose but a different form (the chameleon
method), or be completely different and only retain its fundamental feature, its very core
(the poodle method).
1. The Parrot method
If it is possible to imitate, like a parrot, the way a non-handicapped person would
handle a certain situation, this may be the best solution (at least from a social
perspective). This means that the system consisting of the disabled person and her
technology manages everything she would have been able to manage without technology and
that she chooses exactly the same approach to problems which others around her handle
without technological help. For example: glasses, prostheses, corrective medication,
This is the most common approach within rehabilitation engineering. It is good when it
works, but much better solutions could have been achieved if, early on in the process, the
researcher and the user together had asked themselves: Are we really right to try the
parrot method? Wouldn't it be better to try the chameleon method? Or maybe even the poodle
2. The Chameleon method
In this method the user wants to manage exactly the same function as her
non-handicapped friends, but she does not want to, or cannot, using her technology, solve
the problem in the same manner. Like a chameleon she has to try to maintain her intention,
but, in a figurative sense, change the color of the solution.
The act of mailing a letter is a good example. For Peter, for example, this poses so
many problems that it is hardly meaningful to keep practising the function, developing
tools for the function, etc. In this case, it is better to refrain from mailing letters
(atoms) and just send the information (bits) instead. Change media, that is, and use
electronic mail instead. This may also need to be supported by a customized user
interface, that is, special handicap technology may be needed for handling the computer.
But, if so, this has to be the real focus of rehabilitation engineering not trying to copy
other people's old letter routines in a parrot-like manner.
Examples of other chameleon solutions, for example for people with visual impairments,
include using Braille, speech synthesis or audio books instead of ordinary text (the
purpose is the same as it is for sighted people: being able to take in something that has
been documented). Guide dogs are another example (the purpose is the same as it is for
sighted people: being able to move about on one's own).
3. The Poodle method
Like Goethe's metaphor in Faust, this is about getting to the heart of the matter.
About finding the innermost part of the dream, the wish, the need. It might not be worth
it to be able to make the exact original dream come true at any cost; the dream may in
itself only be an example of something which it was important to make possible. Maybe it
would be easier to get to the heart of the matter using a different approach?
Peter used to enjoy sailing very much. He still does, but now it is impossible. And, to
him, an automatically operated sailboat which he could control simply by pushing two or
three buttons would be meaningless. Because that was not what sailing was all about. That
was not what is his dream was about. To him, sailing was about a wish to challenge the sea
and his own powers.
In this case, one has to look deeper, Was it a desire for challenge, intellectual or
physical, which was the driving force? Would it be possible to find an activity which can
be physically experienced just as much or more, which will make the body buzz with
exhaustion and joy? Maybe there is an altogether different activity which could provide an
intellectual challenge which would equal that of sailing? In that case, these are the
activities which should be supported by rehabilitation engineering, not the original
As was pointed out earlier, one advantage of this type of structure is that it can
bring out aspects which connect and distinguish between different types of rehabilitation
technology. One distinguishing factor is that a physical disability which
has been compensated for does not have to affect cognition at all, while visual and
hearing impairments often lead to different ways of using sensory impressions and
sometimes also to different cognition. A congenital neurological handicap or mental
retardation, acquired brain damage or a mental illness can lead to very special ways of
perceiving and interpreting the surrounding world, which the surrounding world may be
unable to understand, empathize with or imagine.
It is possible to refer to the parrot, chameleon and poodle analysis at this
distinguishing level too. One example is the prevailing view among neuro-typical people
(an adjective I learned from a woman with autism) of interpreting neuro-atypical people
(people with autism) as being non-empathetic. Maybe this is nothing but a parrot
projection, a way of allowing oneself to see the actions of the neuro-atypical person as
failed attempts at mimicking the neuro-typical person. Perhaps the heart of the matter is
that the autistic person interprets the situation itself in a completely different way,
but then acts logically (and empathetically) on the basis of this interpretation. Perhaps
it is the neuro-typical person, who sees the situation only from his own point of view and
measures the actions by his own yardstick, who is the least empathetic of the two?
Other methodological basics at CERTEC
1. Try to make visible the needs which people with disabilities themselves experience
In hindsight, knowing how many wrongs have been committed against people with
disabilities because of superior attitude, erroneous theories or general lack of
imagination, it ought to be easy to agree on the need for a great degree of humility in
handicap research; to agree on using, as much possible and from the outset, the needs
experienced by people with disabilities as the starting-point for the creation of a
process where the needs gradually become more concrete. However, having access to needs
experienced by individuals from the very start, is wishful thinking and hardly ever occurs
in practice. For obvious reasons. For how is one to know what one wants before having any
idea of what is possible?
It is not unusual for rehabilitation engineering projects to start out tentatively, on
the basis of technological solutions to the hypothetical needs of a user. This opens up a
dialogue with the aim of making visible the actual needs, and also includes developing and
respecting the personal integrity and the self image of people.
2. Assume responsibility for reaching results and for ensuring changes are implemented
At CERTEC it is taken for granted that a researcher can and should do his part to
ensure that results are reached and changes implemented, and that it is not just a matter
of establishing facts. Outside the world of technology this may be viewed as unscientific
and/or related to action research. But within technological research this attitude is
3. Stick to the individual person in the situation
Knowledge about human dreams, wishes and needs are by nature concrete and context-dependent.
If knowledge is deprived of this it becomes empty. This is why case studies take on such
importance. However, in order for case studies to be successful it is necessary to work on
one's ability to find good examples; good" in the sense that they are able to
bring out new knowledge which has previously been hidden. Once one has caught sight
of this kind of new knowledge in a special case, one will find it in other contexts with
remarkable frequency. See below under Case Studies".
4. Make the most of the actual use of technology as a way of making the needs, wishes and dreams visible
CERTEC's method involves developing and using technology (old and new, preferably new)
as a probe in order to understand human needs, wishes and dreams and to put them in
motion. The result of this kind of approach can be the generation of, on the one hand,
functional technological products as such, and on the other hand and maybe more
importantly, a new way of making dreams, wishes and needs visible. The technological
research process, whose premise it is that conditions must be made clear, makes visibility
essential. Questions which have never been asked before have to be posed: do you mean this
or that? In the gradual encounter with new technology, quite new sides to a personality
may appear and expose themselves through obvious a-ha" reactions. (See
5. Look for "technology-ness"
In Plato's time, the idea behind, for example, a horse, the actual
horse-ness", was considered more important than all living horses. (To Plato,
the living horses were just bad reproductions of the idea).
One cannot help but be inspired by Plato's way of thinking and therefore, in our time,
consider technology-ness", the actual idea behind a certain use of
technology, more important than the product itself. Because we know from the beginning
that every new technological product will, by definition, (day by day, at shorter and
shorter intervals) be superseded by a better one. Therefore, if a certain technology at a
certain moment suits an individual well, it is important to find out from their
interaction what the user found so special about the technology. This technology-ness
can be brought into the next generation of technology, thereby eliminating the need,
once again, to start from the beginning by analyzing needs, wishes, and dreams. The
lifespan of a piece of knowledge about the needs of an individual or a group may be short,
but compared to the life of a technological product it is almost eternal.
The following is a presentation of selected parts of three existing theories with
indications as to which parts CERTEC uses in its research.
1. Case studies
CERTEC tries to bring into its work
This seemingly impossible task has turned out to be possible in the context of case
studies. Like Bent Flyvbjerg among others, we are contending that case studies are a
widely underestimated research strategy. Interested readers may refer to Flyvbjerg's book
"Rationalitet og makt"  and above all to the brilliant "Kapitel 8.
We do not believe that we would have been able to demonstrate the importance of the
picture as language in a clearer or quicker way than we have done through our
collaboration with the very special Isaac users. Neither do we believe that we could have
come to understand the meaning of empowerment, one of the main results of the Isaac
project, in a better or faster way than in the environment at Tryckolera, where people
with intellectual disabilities are allowed to be differently abled rather than being
people with mental disabilities. Nor would we have been better able to show how
individuals with both lesser and more severe mental disabilities (even at the so-called
A-level) were able to be carried away, influenced, and uplifted by their friends' advanced
One example like this is enough to reveal deficiencies in existing theories. Some of
the results we have arrived at by using digital pictures have, for example, falsified part
of what was previously believed to be known about the picture as a means of communication.
If we had been trying to obtain a large amount of statistics from the start, if we had
been seeking general knowledge in several group homes or day centers, we probably would
not have been able to achieve these results. At least not as quickly. The fact that we
achieved these results in special conditions does not mean that the result cannot be of
general value. On the contrary, they often have a very high degree of general value. What
we have been doing is to try to make use of examples which carry a lot of information and
then, on the basis of these, go on to the more typical ones. A typical or an average case
seldom carries the most information.
We have borrowed the following outline of how an information-maximizing selection
should be constituted from Flyvbjerg:
1. Look for extreme/ aberrant cases
Freja [ 8], for example, by her whole person, her disability and her previously very
aberrant life makes visible a considerable amount of new knowledge every day. This
knowledge is valid not only for her, but it is her aberrance which has contributed to
making the knowledge visible.
2. Look for maximally divergent cases
It may be advantageous to choose 3-4 cases which are maximally divergent with respect
to a certain parameter - age, for example.
3. Look for critical cases
These are the cases where it is possible to say: If this applies to him, it
applies to everyone". Or: If this does not apply to him, it does not apply to
(A classic example to help the thought process: In physics, when one wanted to show
that a kilo of matter would fall just as fast regardless of what it consisted of, it was
enough to do one experiment with 1 kilo of lead and 1 kilo of feathers. The densities of
lead and feathers are so different that if these materials fall to the ground in the same
amount of time, the same will be true for all other materials. When the extremes have been
covered, there is absolutely no reason to repeat the experiment.
One CERTEC example of a critical case was how the example of minarets and rockets ,
and other combinations of special technology and special educational methods in a special
school, drew attention to the importance of the students' power or lack of power in the
classroom; to how great the difference can be between individualization and empowerment.
This particular teacher will never more be able to disregard this difference. She has been
very successful in communicating the approach to others as well.
4. Look for paradigmatic cases
This is what Flyvbjerg calls cases which can found a school for the field and act as a
metaphor for it. A scientific activity is recognized and acknowledged as good science on
the basis of similarities with one or more examples of good scientific work. A
paradigmatic case is precisely the type of case which founds a school for the field.
A specialist field, says Thomas Kuhn, without many good case studies, is a specialist
field without a systematic creation of models, and, consequently, a weak specialist field.
CERTEC wants to contribute to making the field of Rehabilitation Engineering a strong
specialist field, and the best way of doing this is probably to work with more case
studies which can become models. We are particularly pleased that case studies are so very
suited to being a meeting-place for people with disabilities, researchers, and other
2. HMI, Human Machine Interaction
HMI research is exceedingly important to CERTEC, but, more than is the case for general
HMI research, we need to take into consideration the social context in which the
technology is being used.
HMI has its origins in experimental psychology. Usability and adaptation were discussed
as early as 1979/80. The use of iterative prototyping was attempted, but this type of work
was often difficult to reconcile with user requirements. Usability design (with measurable
usability) began around 1985. It was criticized, however, for measuring only that which
could easily be measured, and in 1987 participatory design had to reinvented, this time as
This is how HMI research has developed, with increasing flexibility, which makes HMI
hard to define and describe what exactly is it that unites (and distinguishes from other
research) these studies of the interaction between the individual and technology which
goes by the name of human/machine interaction? Other, completely or partly, overlapping
concepts are ergonomics, human factors, human/computer interaction. CERTEC's main interest
in this is how HMI for people with disabilities can benefit from general HMI, in theory
and in practice.
There are, of course, a large number of principles for the design of usable technology.
Good technology means that the right parts are visible and that they convey the right
message. A button, for example, should convey the message press me", a lever
should say pull me" and a handle turn me". In order for technology
to be easy to use, the user has to receive confirmation that the right things are being
done. What if a seat belt did not click when being fastened correctly? What if a camera
did not click when a picture has been taken? (CERTEC has a new, otherwise high-quality,
digital camera made in 1996 where this has not been accomplished. Most irritating.) Other
ways for technology to confirm that it has received information can be lamps that light
up. HMI can speak to the need for, and the function of, these kinds of features.
Technology should help the user remember and provide cognitive support. Preferably, it
should be self-explanatory. It is important that the user does not need to use strength in
operating the technical device, that the design is such that he or she is able to
concentrate on what has to be done. The user should be able to create a good inner picture
of how the technology works. There should be a comprehensible relationship between the
functions of the device and the means of operating it. Furthermore, the technical device
should be sturdy. Preferably, it should be impossible to make a mistake, and if the user
should still manage to make a mistake, it should not have disastrous consequences.
Examples of this are electrical plugs which only fit in the right kind of outlet and cars
that will not allow you to lock the keys inside them.
HMI and disabilities
The fact that technology has to be adapted to the individual, and not vice versa, is
particularly obvious where people with disabilities are concerned. They are not able to
compensate for the deficiencies of the technology, the way other people often can, and
thereby achieve a functioning system in spite of the lack of functionality. In other
words, the technology/disabled person interaction makes it necessary to tackle the design
of the technical device in order to make it usable to people other than 18-30 year-old
Where the technology in advanced airplanes, nuclear power plants or the processing
industry is concerned, the technology itself dominates its environment. The technology
defines what is to be done - a particular task has to be carried out, and the technical
device has been manufactured to do just that. With respect to everyday technology and
rehabilitation technology, the situation is different. In this case, there is always an
environment to consider and there are people around the technology user who can influence
how well the individual/machine system works. In addition, the user himself has more say
in defining what is to be done. The focus is on the user and his/her needs, wishes and
dreams. There is a big difference between developing a personal robot to meet the needs of
a disabled person and a factory robot for industrial use .
The importance of the environment makes it difficult, if not impossible, to test
rehabilitation technology in laboratories. In order for the finished system to be usable,
the environment has to be part of the development process. The natural way of achieving
this is to let the development, in principle, take place in the environment where the
technical device is intended to be used. If this is impossible, the development process
has to at least connect with the environment as often as possible by way of tests carried
out by future users in real situations.
This type of process requires very good interaction between the engineer/developer and
the user and requires that every prototype in an iterative process can act as a means of
communication between the engineer and the user. The knowledge generated in the
development process can sometimes be transferred to other engineers and users. A
particularly effective way of transferring such knowledge is via the technology itself. As
mentioned earlier, technology itself can, at its best, function as a language.
The definition of a handicap - that it is something which arises when a disability is
confronted with a certain environment - leaves no doubt about the fact that a RehabHMI
center is needed, one which tries to deal with the whole complex of disability technology
in the interaction between individual - individual - environment. Such a center would work
on both interpersonal technology ( e.g. communication tools, learning/education, group
interaction) and individual - environmental technology (e.g. robot technology). CERTEC is
hoping to take part in the establishment of a RehabHMI center.
3. Action research
To CERTEC, the most important features of action research are its emphasis on user
influence, of the need for a shared language and the fact that it has an element of
intention: we are doing this in order to
The action perspective, which is so natural to technological research that we hardly
think about it, in other sciences is part of action research. That is where the
theoretical foundation can be found for the type of research where the object of the
research and the researcher are considered partners in a process which both of them can
influence. It is the explicit objective of action research to
give the object of the research more power to handle her opportunities and difficulties
Action research has existed for about 50 years (although the term was not used by the
original action researchers). Kurt Lewin is often mentioned as the first action
researcher. When doing research on the social work taking place in Germany after the
Second World War, he was appalled by the fact that nobody asked those in need of help how
they wanted to be helped. Consequently, he gave his research an explicit goal: to improve
the situation of those in need; and he also involved the people concerned in the research
The emphasis on participation, which is predominant in action research, is normally not
part of technological research. Rather the opposite: Technological research is by
necessity based on such a high degree of expert knowledge that other people are
automatically excluded from participation and influence. Unless very high priority is
given (the way CERTEC does) to precisely the technology user perspective (NB! this is not
the same as the technology use perspective).
The following are usually considered the central elements
of action research:
A true action research project should start with the development of shared linguistic
frames of reference concerning the nature of the problem, the reality which surrounds the
project, the concepts and assumptions of the participants, and the methods which may be
suitable for studying what is taking place. However, sometimes, in our experience, the
actual introduction of new technology can work as liberating education (c.f. above). Later
on in the process, the users themselves also take the initiative in developing new
technology. Discussion is generated; honest, focused, discussion which does not lose touch
with reality by disappearing into a vague mass of words, but which relates to a reality
which is concrete to everybody involved. Experience has also taught us that the
development of shared frames of reference is a continuous process where the inner pictures
of the participants increasingly overlap. A considerable shift of power takes place in the
discussions between disabled people and researchers it is the user, at the outset perhaps
the weaker party, who influences the direction the discussion takes. This is unusual in
Naturally, neither disabled people, nor others, can express their needs, wishes and
dreams without being helped and stimulated by knowing what the possibilities are.
Consequently, it is not possible to be dogmatic with regard to the actual start of a
research project. The initiative is often with the researcher, at least as far as the
initial development of the technology is concerned. Later, it is, in our experience, more
common than not for the development and introduction of new technology to be initiated by
the users themselves. Compare how the technological basis for the original Isaac  came
from CERTEC alone. Subsequent phases, which may be called Isaac II, Isaac III, etc., in
the form of the Pictorium, the Picturegraph and Clock o'clock, were developed through this
type of interaction between users and CERTEC, and it is impossible to distinguish which of
the ideas were generated by the users or by CERTEC respectively.
So, although action research has a lot in common with the underlying foundations of
CERTEC, and although our evaluators, as early as in our first evaluation, pointed out the
action research spiral as described by Galtung , action research has not contributed
much to our work from a research point of view. Perhaps because it belongs to the social
sciences. Perhaps because core parts of action research are some of the hidden
presumptions of technical research. We are grateful, however, for the inspiration it has
given us, and we would gladly invite action researchers to evaluate CERTEC's research from
an action research perspective.
Learning/Education and Information
Not only research but also learning/education and information are
affected by CERTEC's theory and method formation. In relative terms we are concentrating a
lot more on education and information than is usually the case in a university department.
In order for it to be possible to develop Rehabilitation Engineering as a research field,
a high education and information profile is needed. CERTEC also has a special objective:
to provide disabled people not only with handicap aids but also with knowledge. Of course,
this it not to be taken literally: it is not possible to give away knowledge".
But it is possible to be consciously striving to make it easier to acquire
knowledge, and we are doing just that by focusing on giving learning for and about
people with disabilities an honest chance. The core of our efforts with respect to
Learning and Education" has been presented earlier (see learn.net - en
introduktion"  and Att vara universitetslärare" ).
All previous changes in everyday education have had one thing in common - they have
influenced some particular aspect, perhaps a certain perspective or a minor part of a
course or a lecture or a book. Similar to the way one move in a chess game will usually
(at least temporarily) affect only the immediate vicinity of the chess piece. We are now
experiencing something which looks more like the Othello game: adding one single piece may
have global consequences. The only piece" is the Internet. The use of the
Internet can actually, although it sounds odd, from certain points of view provide greater
proximity than an ordinary lecture. (see ).
And suddenly it is possible, for example, to let the students be the ones who are
asking the questions. Whether disabled or not. Finally students are able to get to the
very source. It is not only dare to know", catchwords of the Age of
Enlightenment, which are echoing. The to the source" (ad fontes!) of the
Renaissance has suddenly become reality.
One reason why learning is one of our priorities, that is, why we are focusing
on the process of how information can turn into knowledge and on how education can
contribute to this process, is that if people with disabilities themselves acquire
knowledge about rehabilitation engineering they can in themselves unite their insights
both into the effects of the disability and into how the technology can be made to meet
their needs, wishes and dreams. Thereby, the iterative process, as described in the above
section on research, can sometimes take place inside the individual person, which
certainly reduces the risk of mistakes being made. Peter Anderberg  is an excellent
example of such a person and of the importance of such a person.
However, the majority of our students are not disabled. For these students as well, our
focus is on learning. Generally speaking, one sees things in a completely different light
when the focus is on the student's learning process rather than education. There are
similar currents in other universities (for instance, at the University of Gothenburg,
Department of Education, Professor Ference Marton and at the Luleå Institute of
Technology, Professor Henning Johansson). The university's famous bridge between research
and education could be sturdier and stronger if it was built between research and
learning instead. The latter processes are the ones that are most closely related.
Research generates knowledge which is new to the researcher and to humanity, while
learning generates knowledge which is new only to the student. However, on an individual
level, both research and learning are about human learning and therefore there are many
similarities between them .
When focusing on learning, CERTEC also wanted to look for support in research, but unfortunately there is not very much there. Educational research has been focusing on education, teaching, syllabuses, curriculums, organization, etc. For instance, learning has been the subject of fewer than 5% of all doctoral theses in education during the 20th century.
There is insufficient knowledge about the mentalizing process itself, that is, about
what happens when a person learns something (c.f. the discussion in Fria Freja part 2,
Furthermore, there is not much of a dialogue about learning within the field of
Education. When CERTEC began to see that an Internet breakthrough on a large scale was
imminent, we ourselves began an open and tentative Internet dialogue on October 31, 1995
(with Peter and myself as opening speakers, see
http://www.arkiv.certec.lth.se/learning/files/myller.html). The dialogue has already been
utilized in, for example, learn.net . Readers may wish to review the introductory
lecture on rehabilitation technology which is part of learn.net, with respect to both
contents and method. The lecture is a complementary way to learn more about CERTEC's
CERTEC is keeping a high profile with regard to information. There is an endless need
for information; we are able to meet only a fraction of public interest. This is both
encouraging and frustrating. Approximately three full time positions (20% of our time) are
devoted to information in the broadest sense. In addition to providing information about
our own activities (on the Internet and at CERTEC Information Days" twice a
year), we are engaged in something which perhaps could be called information brokering,
that is, while maintaining a certain level of quality control, we try to guide people to
the information they are looking for. On or off the Internet. Information brokering will
gain in importance as the noise level rises on the Internet. There is a need for somebody
who by their name will guarantee quality and a certain degree of accuracy in the
information being brokered. Soon the intelligent Internet search agents will spread, but
these, too, will need to be controlled, evaluated and continuously maintained. There is an
immediacy and a dynamic to the Internet which can not only make information (and perhaps
even knowledge in the form of the expert system) available in a global network, but also
treat it as the perishable that it is. It can even be provided with an expiry
A cross-fertilization takes place between research, education and information which enables the whole to become more than its parts. When CERTEC puts a lot of effort into writing books and reports, and into a strong presence on the Internet, it is mainly because that which is documented acquires a form which bridges time and space. However, documentation also has another benefit. If one is giving a lecture or a seminar, if one is looking for a sincere dialogue or wants to contribute to long-term learning, it is an invaluable advantage to be able to refer to web links, books and reports. This is the only way for the student to get an honest opportunity for meaningful learning, and the only way for him/her to give something back, immediately or later, when pursuing a career. All learning is an individual process and requires individual time, the possibility of pursuing individual interests, etc. This is possible only to a very minor degree in education which is led directly by the teacher. For this reason, documented materials are of indispensable value.
Part of the result of an Internet search on Peter Anderberg, CERTEC (Jan 16, 1997)
CERTEC's Internet home page Jan 16, 1997 (http://www.arkiv.certec.lth.se)
The book we would most like to recommend, since its approach and contents are close to
CERTEC's, is Bertil Rolf, Profession, Tradition och Tyst kunskap, Nya Doxa 1995.
Other important works are:
Donald A. Norman, The design of everyday things, Doubleday/Currency 1990,
Bent Flyvbjerg, Rationalitet og makt (see below)
Kristina Lundgren, Åkes bok, Libris 1993
Gunilla Gerland, En riktig människa, CURA 1996
Another way of presenting a research field is through its best journals. This is risky
since the quality and focus of journals sometimes change. Of the more general journals, I
would like to mention Journal of Rehabilitation Research and Development, Journal of
Intellectual Disability Research, IEEE Transactions on Rehabilitation Engineering and
Technology and Disability.
References included in the text:
1. Håkan Eftring, Bodil Jönsson, Charlotte Magnusson, Capturing better
data, User Talk, Issue 6, pp 45, Autumn -95. http://www.english.certec.lth.se/doc/capturingbetter/
2. A University for Everyone, video.
3. Sven Öhman, Svindlande perspektiv, english.En kritik av populärvetenskapen,
4. The Picture Bank and the Picturegraph
5. Clock o´clock, informationsblad från CERTEC.
6. Bodil Jönsson, learn.net - en introduktion, CERTEC 6:96.
7. Bodil Jönsson, Att vara universitetslärare, SULF XIV, 1996.
8. Eve Mandre och Bodil Jönsson, Fria Freja del 1*, CERTEC 2:96, och Fria
Freja del 2*, CERTEC 5:96,
9. Bent Flyvbjerg, Rationalitet og makt, Akademisk Forlag, 1991, ISBN
10. Bodil Jönsson, Datorns attraktionskraft, CERTEC 7:96,
11. Ruth Bauth, Bodil Jönsson och Arne Svensk, Ge oss bara redskapen,
Natur&Kultur 1995, ISBN 91-27-05827-1.
12. Carin Boalt, Håkan Lanshammar, Birgitta Odén, CERTEC 1988-1991. Utvärdering
av tre års verksamhet. CERTEC 3:91.
13. Bolmsjö, G, Neveryd, H, Eftring, H, Robotics in Rehabilitation,
IEEE Transactions on Rehabilitation Engineering, vol 3, no 1, pp 77-83, March