Rehabilitation Engineering Research -
Theoretical and Methodological Considerations


Bodil Jönsson, Ph D, Ass prof bodil@certec.lth.se
Peter Anderberg, PhD-student peter.anderberg@certec.lth.se
Center of Rehabilitation Engineering Research at Lund University,
Box 118, S 221 00 Lund, Sweden

The 4th European Conference for the Advancement of Assistive Technology (AAATE'97)
Thessaloniki, Greece, September 29 - October 2, 1997




Table of Contents

Abstract
1. Introduction
2. Main methodology
2.1 The Parrot method
2.2 The Chameleon method
2.3 The Poodle method
2.4 What connects and what distinguishes?
3. Other methodological considerations
4. Theory
4.1 Case studies
References


Abstract





l. Introduction

CERTEC, Center for Rehabilitation Engineering Research, at Lund University was established about a decade ago. The results as they appear at http://www.arkiv.certec.lth.se demonstrate that devoted and hard working researchers and educators have been involved. But all along we have been haunted by the question from fellow researchers in older and more established research areas: what in all your work is research? We have even been haunting ourselves with the same question. The results may be good, but in what way do they represent truly new knowledge? And how could we prove that the revealed knowledge is new? For sure, it does not help just to state that we strive with interdisciplinary research. There are no free interdisciplinary methods, no free interdisciplinary language, no free interdisciplinary concepts. The interdisciplinarity of the field merely strengthens than weakens the need to work on theories and language.


2. Main methodology

There are many ways of providing the field of rehabilitation technology with methods which make it possible to connect as well as 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, the very core (the poodle method).


2.1 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, wheelchairs, etc.

This is the most common approach within rehabilitation engineering. It is good when it works, but sometimes much better solutions could have been achieved if, early on in the process, the researcher and the user together had asked themselves: Wouldn't it be better to try the chameleon method? Or maybe even the poodle method?


2.2 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 colour of the solution.

The act of mailing a letter is a good example. This might pose so many problems that maybe, it is not meaningful to keep practising the function, developing tools for the function, etc. It could be better to refrain from mailing letters (atoms) and just send the information (bits) instead. Change media, that is, and use electronic mail instead. I.e. not try to copy other people's old letter routines in a parrot-like manner but focus the rehabilitation engineering on the adaptation of the computer interface that might be necessary.

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).


2.3 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 could be that it is meaningless to try to make a special old habit possible to maintain at any cost. Maybe it would be possible to get to the heart of the matter using a different approach?

Peter Anderberg is one of the coo-workers at CERTEC. He used to enjoy sailing very much. He still does, but now it is impossible, due to his muscular disease. 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 about. That was not what 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 sailing activity.


2.4 What connects and what distinguishes?

The experience at CERTEC is that the above structure (the parrot, the chameleon and the poodle) can help not only connect researchers on rehabilitation robotics with researchers on visual impairments and cognitive disabilities, respectively, but also help distinguish between differences in implementation of rehabilitation technology.


3. Other methodological considerations

There is a continuos need for keeping alive a discussion in a research group on methodological considerations of special importance. These are the recommendations that the CERTEC group have agreed upon:

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 analysing 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.


4. Theory

Among the fundamental theories that form the basis of rehabilitation engineering research (case studies, HMI (human machine interaction) and action research), I choose to comment only on case studies here. Concerning HMI, that is widely described elsewhere. The strong user involvement in rehabilitation engineering research, might be seen as an indicator that also action research is involved here and that it should be commented upon. However, we consider the question whether actions research is a vital part or not, mainly as a matter of interpretation, to be decided by action researchers. The strong user participation can just as easily be seen as a necessary prerequisite for achieving relevant results. Or as a natural result of research ethics consideration.


4.1 Case studies

CERTEC tries to bring into its work the natural sciences' striving for clarity, mechanistic causality ("because of'), and generalisation, tries to combine it with the teleological character of technology (i.e. its inbuilt "in order to" basis) and its dependence on visible specifications at all times, with respect to both conditions and intentions, and to incorporate natural science as well as technology into the emphasis on the individual aspect, which characterises the humanities.

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 magt" and above all to the brilliant "Kapitel 8. Exemplets magt".

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 picture communication. 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 care centres, 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-maximising selection should be constituted from Flyvbjerg:



References

This paper represents in itself an abstract of the experiences from a lot of research projects and separate references cannot do justice to the text above. It is rather the links between the references that would be relevant for this framework. Consequently, we recommend you to visit the web site http://www.arkiv.certec.lth.se where you might search for all the examples above (for instance Bent Flyvbjerg, Peter Anderberg, Freja, Isaac, Tryckolera), find the appropriate references, get a lot of interconnections as well as our recommended links and references to others. At the same time, you may of course get interested in the examples and the pure references per se, although this was not the main purpose of this article.