Rehabilitation and Prosthetic Services

Device Review: Apple iPod Touch by Apple

Reviewed on March 1st, 2010

by Carmen DiGiovine, PhD, Roger Little, MS, ATP, & Ed LoPresti, PhD, ATP

The review of the iPod Touch by Apple is the first in a series of device evaluations. We will focus on devices specifically aimed at assisting individuals with a cognitive disability. The criteria described by Batavia and Hammer will be utilized to review each of the assistive technology devices reviewed in this series. Though each of the criteria may not directly apply to each device, the list provides a consistent framework for comparison across technologies.

The Touch has accessibility features designed primarily for individuals with low and no vision. However, we will focus on the features and 3^rd party applications that have the potential to improve the function of individuals with a cognitive disability. Professionals with clinical experience in the field of assistive technology will produce the reviews. We recognize that the consumer must provide the ultimate evaluation of the device in terms of user satisfaction; yet, these reviews provide a level of consistency given that the reviewers evaluate these devices for individuals with disabilities on a regular basis.

The iPod Touch is a consumer electronic device that has a suite of productivity tools that allow individuals to manage their day-to-day activities. The core features of the device include contact management, calendaring, email and internet applications, along with a music player. The flexibility of the system is limitless given the adjustability of the system itself and the expanse of 3^rd party applications that are available for the device. However, the flexibility produces the potential for extreme complexity for all potential users, especially individuals with a cognitive disability. The review below, investigates the characteristics of the Touch, with regards to increasing the functional capabilities of individuals with a cognitive disability.

Indications

As an external cueing system, the Touch can benefit individuals with limitations in prospective memory, self-initiation, and orientation to time through standard Calendar and Clock applications (“apps”). Using these apps, the Touch has the ability to remind the individual to perform a task at the appropriate time. The Touch can further benefit individuals with impairments in attention, concentration, sequencing, organization, and planning through third-party apps such as “ToDo” and “Notebook” which provide support for creating and following lists, including static step-by-step tasks. The Touch can further benefit individuals with memory impairments through “Notebook” and Digital Recorder apps which support entering typed or recorded voice notes.

The greatest asset of this device is that it is a mainstream consumer electronic device, which lowers the price through large volumes, provides a well-defined architecture for future development, and has significant aesthetic appeal. The device was designed with concept of universal design in mind, because it limits the number of shortcuts that are possible with the device. This reduces the number of paths an individual must learn to access an application, and makes it difficult to get “lost” within the program. Use of a mainstream device also removes any stigma associated or perceived with a “rehabilitation” device.

Contraindications

Given that the iPod Touch is not designed specifically as a device for individuals with cognitive disabilities and physical disabilities, it has significant limitations in terms of application to meet the functional requirements of these individuals.

In terms of physical layout, the system utilizes “virtual” buttons and a “virtual” keyboard on a touch screen. The buttons cannot be resized, and the keyboard has only 2 sizes. Furthermore the system does not provide tactile feedback. This can limit the effectiveness of the system for individuals with limited fine motor control.

In terms of features for individuals with cognitive impairments, the system does not include any “artificial intelligence” features to re-direct the individual (aka replanning) if they do not complete each instruction in sequence when performing an activity. The system does not have a sleep feature, and does not provide constant reminders until the “alarm” is turned off. Finally, and potentially most importantly, the system does not provide a simple interface as a distributed system, which would allow caregivers and rehabilitation professionals to easily interact with the scheduling, reminders, and task management systems. A distributed system can be created, for example through a Microsoft exchange account, a Mobile ME account, or via syncing with the host computer, but they are not turn-key solutions, and create an added level of complexity for a device that is being utilized to reduce the complexity within an individual’s activities of daily living.

Based on the feature set, the device could be considered for individuals who only need activity planning via a text-based system and prospective memory without constant reminders. This includes individuals with mild cognitive impairments (e.g. mild traumatic brain injury). The Touch is not recommended for individuals who require distributed systems, interactive task guidance or adaptive planning. Finally, the system is not recommended for individuals who required a tactile keyboard and have difficulty with a dynamic display.

A comprehensive review of the iPod Touch follows below:

1. Affordability – The Touch is currently available for $199.00, $299.00 or $399.00 for the 8 GB, 32GB and 64GB models. We will only consider the 32GB and up models, given key features, including the accessibility features, are only included on these models. This pricing structure is comparable to other general market PDAs. The Touch costs much less than other handheld devices designed specifically for the disability community. Though, the Touch is relatively inexpensive, it has the potential for large hidden costs given the cost of software applications, hardware add-ons (e.g. pointing device, case, external microphone) and the potential to lose the device.
2. Compatibility – The device does not need to interface with other devices, however, a number of its features are enhanced when it is attached to a PC or Mac. The device requires the utilization of iTunes for connecting to a computer. The device utilizes Wi-Fi technology for interfacing with the internet. The potential for obsolescence is consistent with other general market consumer electronic devices.
3. Consumer Repairability – The repairability of the device is comparable with other consumer electronic devices. Online and brick and mortar options exist. As a last resort, the system can be reset to its original “out-of-the-box” configuration. Assuming that the device is synced regularly with a PC or Mac, the process to re-initialize the device to its most recent settings is relatively easy. Given the history of the hardware and software, and control of the applications, the system should function well. Given the population of users, repairs may require the assistance of personal assistants.
4. Dependability – The device is very dependable and functions the same way over repeated uses.
5. Durability – The Touch is very durable. The software is very stable. The system can typically withstand drops from table height (e.g. 3’). The screen is scratch resistant. The software is very stable given that Apple tests all applications prior to inclusion in the app store on iTunes.
6. Ease of Assembly – iTunes running on a PC or Mac is required in order to set-up the device prior to use. Therefore, the device does not run right out of the box.
7. Ease of Maintenance – The Touch is easy to maintain on a daily basis. The key maintenance for the end-user is re-charging the device on a daily basis. The other key maintenance requirement is syncing the device with a computer on a regular basis. The frequency of syncing will depend on the type of apps that are installed and the need to update contacts, events, tasks, and individual apps. It is feasible to set-up the device 1 time, and never sync with a computer again. This is not recommended, given that a back-up of the software and data is performed every time the device is synced with the computer.
8. Effectiveness – The Touch platform is extremely effective, given the proper configuration and training. Therefore, for individuals with cognitive disabilities, the Touch is configurable to meet each individual’s unique requirements assuming a trained professional with experience in cognitive devices is available to aid in the proper set-up. However, out-of-the-box, and without any assistance, the device can be very confusing and ineffective. A unique feature of the device is the home button, which can be activated at any time to bring the user back to the home screen. Therefore, this can make the device very effective for individuals with cognitive disabilities, as they only have to remember a single button if they get “lost” in any single application. A therapist can monitor effectiveness by asking the user to take screen shots (pictures of the screen) while using the device. This can also be used to aid in troubleshooting, as the user can take screen shots of problems to share with the therapist later. The screen-shot feature requires significant timing and fine motor skills, as the individual must simultaneously activate the home and off keys. This goes above and beyond those required for data entry and navigation. Also, the individual must remember that this feature is available, as cues do not exist via the applications on the Home screen.
9. Flexibility – The Touch platform is extremely flexible in the sense that a variety of apps can be loaded onto the device to suit the individual’s needs. There are also some accessibility features which can be customized. The flexibility can aid in matching the features of the device to the individual, but can also create significant issues when the changes are made to the standard configuration. Flexibility is somewhat reduced because the device itself (underlying any apps) is strongly controlled by the manufacturer.
10. Learnability – The amount of effort required to learn the Touch is consistent with other consumer electronic devices. Given the flexibility of the system, and appropriate training opportunities, the potential exists to introduce various apps over an extended period. Given the fact that this is a general market device, help can be obtained from other consumers.
11. Operability – The display and controls are easily accessible and usable for the majority of individuals. The size of the app icons are relatively small, the keys on the keyboard are very small. Data entry can be very difficult given that the iPod Touch utilizes virtual keys on the display, thereby negating tactile feedback that can be found in other consumer electronic devices. Pointing devices are available for individuals who prefer utilizing a pointer to their own finger. Though the operating system utilizes word completion to compensate for accidental keyboard hits, this feature can become confusing, and generate inaccurate spellings for words within the custom dictionary. The turn-on/ turn-off cycle is extremely easy for this device. The layout of the screen is customizable by pressing and holding any icon on the screen. This causes the icons to “wiggle”, and then it is possible to rearrange the individual icons on the screen. However, if an individual accidentally enters this mode (by pressing too long), it can become very confusing, because they will not be able to access any of the applications until the individual taps the “Home” button. On the other hand, there is very little tactile feedback related to pressing buttons; which may reduce operability for some users.
12. Personal acceptability – Given the broad acceptability of the Touch (and iPhone) in the consumer market, the personal acceptability of the device is extremely high. Even if voice output is utilized, it is not unusual for individuals to utilize headphones.
13. Physical Comfort – The device is extremely comfortable
14. Physical Security – The device is not likely to cause physical harm to the individual.
15. Portability – The device is extremely portable. The device is 4.3” x 2.4” x 0.33” and weighs 4.05 oz. It has a 3.5” (diagonal) widescreen display with a resolution of 480x320 (163 pixels/inch). The system runs on battery power and has a 30 hours of music playback or 6 hours of video playback.
16. Securability – The device is not very securable and definitely has the potential for loss or theft. The device has a pass code option to protect data, but then requires that the user enter the pass code on a regular basis, which creates an additional challenge for many individuals with a cognitive impairment.
17. Supplier Repairability – Numerous options exist for repairability of the system given that it is designed for the consumer market. These include the Apple support (website, email, phone, store), various blogs and discussion groups, and third-party websites. Apps designed specifically for assistive technology applications may not have as many service options; phone and/or e-mail technical support are typically available from the distributers of the app, and availability will vary.

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