2001 Conference Proceedings

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Trygve Andersen, SLP Consultant (ta@hmi.dk)
Michael Bo Nielsen, Head of Dept. (mb.nielsen@netjob.dk) 
NetJob/ Danish Centre
Soren Frichs Vej 40
DK 8230 Aabyhoj, Denmark
TEL + 45 86 75 36 66
FAX + 45 86 75 36 67


Accessing and using the Internet is a matter of using a browser and an e-mail system. In general, the Internet is accessible to people with disabilities if it can be used in a variety of ways that do not depend on a single sense or ability. For example, a system that provides output only in audio format would not be accessible to people with hearing impairments, and a system that requires mouse actions to navigate would not be accessible to people who cannot use a mouse because of a dexterity or visual impairment. The concept of Accessibility to the Internet in terms of people with learning or cognitive disabilities also includes issues regarding the content of any given service provided through the Internet.

A lot of effort has been made to make the Internet accessible for people with disabilities, particularly people with sensory dysfunction. Much of the base work on web accessibility has been initiated by the Web Accessibility Initiative of the W3C. For the past several years they have researched, codified, and encouraged people to make their Web sites accessible. They have produced guidelines that help to produce accessible Web sites and they continue to conduct research into how to make Web sites accessible. They have extensive references on their Web site. (W3C Web Accessibility Initiative http://www.w3.org/WAI/)

However, only little has been done to address people’s suffering from the sequela of acquired brain damage, e.g. aphasia and cognitive disabilities. Part of the difficulty lies in the tremendous diversity that this category of persons with disabilities represents. It includes individuals with general processing difficulties (developmental disabilities, brain injury etc.), people with very specific types of deficits (short term memory, inability to remember proper names etc.), learning disabilities, language delays, and more. In addition, the range of impairment within each of the categories can (like all disabilities) vary from minimal to severe, with all points in between. Sequela of acquired brain damage often produces a very complex picture of compromised functions which differs from person to person, including the ability to coordinate movements, speak, remember, reason or modulate behavior. A compromised global mental function such as consciousness, energy and drive is often diagnosed in the assessment of cognitive functions following brain damage. Overall changes can be seen in the physical, intellectual, emotional, social and vocational functions of the individual.

Project overview

The challenge to provide people with cognitive disabilities access to and utilization of the services of the Internet were addressed by Danish Centre in two projects: ARNIT and "IT and Rehabilitation"

It was a central issue in both projects to exploit and investigate the potential of the Internet in a communicative and educational perspective. At the end of 1999 Information technology – IT – has made its impression on everyday life in Denmark. At work as well as in leisure activities, in public administration and in private companies, in offices, in living-rooms and children's bedrooms. More than half of all Danish households own a PC and almost one in three has access to the Internet. Two out of three small companies and all companies with over fifty employees make use of IT.


IT understood as a cultural technique is something of a two-edged sword. On the one hand, IT facilitates independent transactions in the real world, e.g. banking, shopping, making travel arrangements, accessing information etc. But current Internet software turned out to generate a new set of problems for our target group. The complexity and interdependencies of the above mentioned parameters produce a pronounced risk of something going wrong when people with deficits in attention and concentration try to maneuver conventional browsers or e-mail systems. This major obstacle was the challenge in the two studies producing the results that lead to our new concept of myZiteEdit (R)

The ARNIT I & II projects

Persons suffering from aphasia due to sickness or brain damage have difficulties communicating and speaking. The rapid development of information technology threatens to exclude people with aphasia from daily life. The aim is to give these persons the same possibilities of communicating and utilizing services and the Internet as others.

The Nordic Council on Aphasia carried out the ARNIT I project in 1999 and 2000. As a result of the project an adaptable Internet platform and web site for persons with aphasia was developed. Furthermore, a program for e-mail and the web, as well as basic material on Aphasia and Information Technology was launched. A test concept for evaluating user interface for Internet has also been developed.

The aim of ARNIT II is to carry out a larger user evaluation with persons with different types of aphasia. The adaptable Internet platform will be complemented and finished by making adaptations and alterations. An important goal is to spread information about the results of the ARNIT project to users, professionals and others.

IT and Rehabilitation

Danish Centre and Vejlefjord Center for Rehabilitation aimed to investigate the use of the Internet integrated as a tool in the rehabilitation process. In addition to Vejlefjord’s traditional cognitive rehabilitation program, a cognitive rehabilitation program was designed to show if the quality of treatment and education could be improved by the use of computers and Intra/Internet with e-mail service. The intensive rehabilitation period (11 weeks) could be prolonged upon completion of a client’s stay at Vejlefjord: By providing them with laptops with Internet connection to be used at home as an e-learning platform, daily contact with the center could be maintained. The concept is to provide the client with a 24-hour link to the rehabilitation center by use of myZiteEdit (R) combined with Vejlefjord’s e-learning lab. By using the system the client will receive access to:

  1. immediate counselling which supports motivation
  2. a proposal for working further with the problem, thus strengthening metacognitive understanding
  3. tasks with proposals for direct retraining of the client’s deficits or suggestions to compensatory strategies
  4. chat room for clients and peers
  5. Method

    Through a systematic dissemination of knowledge of functioning and disabilities according to standard systems like MS Explorer or MS Outlook a requirement for a universal Internet system was drawn.

    According to a survey of literature the first draft of specifications of requirements for the Internet and e-mail system was developed. Sensory and cognitive known deficits in accordance with acquired brain damage correlated to an activity analysis of MS Explorer and MS Outlook – Product analysis Choice of participants (sex, medical record etc.) Beta testing The testing aims to validate the proposed technical solutions to the requirements and to the pedagogical / therapeutic set up (e.g. Vejlefjord the training objectives) Instructional course Testing according to UserFit methodology Usability evaluation Product adjustments myZiteEdit (R) Iterative user-centred development life cycle The figure below illustrates the iterative development life cycle enabling adjustments to the methods and solutions meeting the requirements and goals set-up. Fig. 1. Iterative lifecycle Technical description (System Requirements) Standard PC Internet connection Standard web browser (Internet Explorer) No special software or local programs required No downloading or installation necessary Functionality and complexity myZiteEdit (R) is built on the assumption that for every individual there exists an optimal balance between functionality (what are a program’s capabilities?) and complexity (how difficult is it to use?) when using a given computer program. Especially characteristic of individuals with brain damage is that users tend to become confused and thereby make an increasing number of mistakes when a program’s difficulty level is too excessive. Conversely, there is often seen a marked cognitive improvement in the course of rehabilitation, with individuals regaining—to some extent—the ability to utilize a computer as before being injured. Figure 2 illustrates the curve of development for an individual or given target group. Axis O1 shows the optimal combination of functionality and complexity as F1 and C1. A user can accomplish F1 functionality level tasks at the aggregate complexity level C1. Figure 2: Functionality and complexity Should the number of functions increase, so too does the level of complexity, in which case the user finds it difficult to use the respective software. The curve also shows that through training one can achieve the ability to accomplish increasingly difficult functionality and complexity level tasks from O1 up to O2. If this combination is equivalent to the difficulty level of typical software, then there is no need for customized software programs. But should the combination be insufficient—and this is often the case with regard to brain damaged user’s application of standard software like e-mail programs—a system such as myZiteEdit (R) then becomes very useful. To put it another way, myZiteEdit is an effort to deliver technology to its user at his or her individual capability level—a system that can adapt to a user’s development process, whether it be improvement or deterioration.

    How it works

    MyZiteEdit (R) essentially consists of two interconnecting web sites.

    From one site a therapist or assistant can—based on their knowledge of the user—determine the appearance of the user’s site.

    If, for example, the user has need for sound augmentation, one simply checks the box marked "sound". When the user then visits his or her site, the text from each button will be read aloud by the system when the mouse nears.

    In this manner an assistant is likewise capable of creating a photo-assisted address book, bookmarks with icons, special web sites for things like entertainment, bus schedules, operating instructions, sentence libraries, and so on-- and it doesn’t require super user expertise to do so. Most learn to use the administration module after only a few hours of instruction.


    The presentation covers several issues related to accessibility and use of the Internet for people with impaired mental functions, i.e. people with acquired brain damage or people with language, learning or cognitive disabilities (e.g. reading disabilities, thinking, remembering, sequencing disabilities). MyZiteEdit (R) customizable to people with cognitive deficit will be presented as an unique tool and solution to overcome the barriers when using e.g. MS explorer/Outlook.


    USERfit – A practical handbook on user-centred design for Assistive Technology, European Commission, DGXIII TIDE Project 1062 – 1996.

    Handbook of User-Centered Design, Telematic Applications Project IE 2016; ver.1.1. July 1997

    RESPECT User Requirements Framework Handbook © RESPECT Consortium 1997; Ver. 2.2. 22.April 97

    Andersen T: Hjerneskadede på internettet? HIT, saernummer, 26-29, 1999

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