DBI World Conference 2019 Technology stream: Concurrent session 11D Presenter: Prof Claude Vincent Topic: Effectiveness of a new modality of face-to-face and distance communication in deafblindness

1. Effectiveness of a New Modality of
Face-to-Face and Distance
Communication in Deafblindness
Claude Vincent, PhD, OT, Walter Wittich, PhD,
CLVT, Bertrand Achou, PhD, economist, François
Bergeron, PhD, audiologist, Normand Boucher,
PhD, sociologist, Mathieu Hotton, PhD, audiologist
Collaborators: Sylvie Cantin and Walter Cybis,
Planning, programming and research officers
CANADA
August 12-16, 2019
17th Deafblind International World Conference

2. Introduction
Technological solutions are essential for people who are deaf
from birth when they lose their sight as they get older.
Because of their visual lost, they are no longer able to use Sign
Language or their usual technological devices.
They often find themselves socially isolated due to these
difficulties with communication.

3. Introduction
Existing technologies to support communication for people with
deafblindness:
• TTY braille (no longer available since 2018)
• Refreshable braille displays
• Electronic braille notetakers
• Computer and smartphone softwares
Needs for communication solutions vary between each person.

4. Previous technological trials
Clinicians in Quebec city (2016) tested the Deafblind
Communicator, an electronic braille notetaker.
Results: The device was not very functional for the client with
Usher 1 syndrome. It is now discontinued.
Challenges:
• high cost, $ 9,000 to $ 10,000
• very long to read and write a message
• need to reset the device in case of a bug and no warning
when the device goes to sleep

5. Previous technological trials
Challenges:
• The client could not take any calls because too many steps were
needed before he could pick up (12 rings had passed)
• Everything being in English, we had to translate words to the client,
like MAIL (message), MAIN (menu), or DIALING (composition)
• It required 3-4 face-to-face meetings to write a message of 4 to 6
sentences (8 words / sentence), which took 1 hour to achieve!
• The audiologist sent a message that said "super".  The client
understood "supper" with the vibration of braille under his fingers.
He obviously wondered why the audiologist was talking about
supper...

6. Previous technological trials
It all started in research after watching a noon talk about a
research report and later on, the publication of an article. You
could see the link to the research report in French, and the link
to their publication entitled
Cantin, S., Cybis, WA, Trudeau, S., Poncet, F., Wittich, W, Wanet-Defalque, MC.
(2019). Assessment of a Communication Assistive Technology for Individuals
with Deafblindness: A Case Study. J. of Deadblind studies on
communication. 5, 73-95 https://jdbsc.rug.nl/article/view/32575/29970
Cantin, S. et de Abreu Cybis, W. (2017). Research report (in French).
http://www.inlb.qc.ca/recherche-publ/observation-et-analyse-des-besoins-
et-des-strategies-de-communication/

7. Previous technological trials
Cantin and de Abreu Cybis (2017) tested a dedicated application
on a HumanWare BrailleNote Apex connected to an iPhone, in a
restaurant.
Results: Face-to-face communication was possible for the client
with users unfamiliar with the device.
Challenges: 5 out of 9 problems encountered with the device
over the 3 outings were related to the software.

8. Aims
1. To measure the impacts on communication and participation
of a communication technology alternative proposed to two
clients with recently acquired deafblindness
2. To compare the effectiveness and costs of 3 modalities:
– new technology (alternative proposed to two clients with
recently acquired deafblindness)
– traditional technology (discontinued TTY braille)
– no use of technology

9. Specific objectives
1. To propose new technologies of face-to-face and distance
communication, and to document the feasibility to train 2
people with Usher 1 syndrom.
2. To document the impacts on social participation and
communication before, during, and after training
3. To document the impacts for the family caregivers before,
during, and after training
4. To document the costs (equipment , resources mobilized for
training, and the associated costs for the health system)

10. Methods
Research design: Single case study and cost-effectiveness analysis
Participants (n=16) :
• 10 clinicians
• 2 research project planning officers
• 2 people who are deaf and who recently developed a secondary
blindness, related to an Usher 1 syndrom
• 2 caregivers
Procedure: 4 steps through a period of 24 months

11. • Review of all available communication technologies in a 43-
page document (including 19 notetakers/braille displays, 17
apps, 3 phones, and 8 softwares)
• Choice of the communication technologies through a
videoconference meeting with 15 experts (5 researchers, 8
clinicians, 2 research project planning officers, 1 observer
from a health funding agency)
Step 1  3 months
Selection of the communication technologies (focus group)

12. Step 1  3 months
Selection of the communication technologies (focus group)
Animation of the focus group consisted in asking questions with the
printed document, in 3 rounds :
• Can you confirm that the product in RED should not be retained?
• Can you decide whether the product in ORANGE should be retained?
• Can you confirm that the product in GREEN should be retained?
Criteria: availability, braille, weight, portability, minimum 24 braille cells,
complexity to use, connectivity, in French

13. Results for objective 1
The following refreshable braille displays were retained for
testing after the focus group:
• Brailliant BI 40
• Esys 24
• Braille EDGE 40
• Focus 40 Blue
• Vario Connect 24
The ones retained for sure:
• Roger Voice app
• iPhone model (Android
and Windows were
excluded)
• Other software

14. Step 2  7 months
Testing the communication technologies (feasibility)
• Putting together a simulated client (a certified low vision therapist
who is blind and already knows braille) and a clinician competent in
sign language. This is necessary to learn how to teach, how to train,
how to give explanations, and how to communicate face to face
and remotely.
• Adaptation, programming, and ergonomics of the new technology
to make sure it is usable for a person with deafblindness, with the
help of one engineer research project planning officer.

15. Step 2  7 months
Testing the communication technologies (feasibility)
• Evaluation of the training feasibility with the simulated client, with
the help of one Planning, programming and research officer who
has a Master’s degree in measurement and evaluation, and a
degree in psychology.

16. Step 3  6 months
Experimentation and evaluations with 2 participants
• Experimentation: Training to learn how to use the
technologies for receiving and sending text messages (2 x 45-
60 minutes per week)
• Evaluations: Questionnaires about impacts on social
participation, communication, and caregivers burden
 Measurement of the costs (interventions, technology,
maintenance, internet)
 3 months before training, just before training, during
training, 6 months after training, and 9 months after training

17. Step 4  6 months
Evaluation of objective and subjective consequences (focus group)
• Comparative evaluation of the impacts on participation and
communication 9 months post intervention (new technology
– traditional technology– no use of technology)
• Cost-effectiveness analysis: Measurement of the anticipated
costs for the 3 alternatives, and comparison with the impacts
on participation and communication

18. Step 4  6 months
Evaluation of objective and subjective consequences (focus group)
• The focus group will include the same 8 clinicians who
participated in the first meeting. They will receive: 2
participants’ files at 9 months (new technology), 4 medical
records of previous clients with the TTY braille (traditional
technology), and 2 participants’ files 3 months before training
and just before training (no use of technology)
• They will have to grade face to face and distance
communication on a scale of 3 points, and social participation
in a scale of 9 points. They will be asked to justify their grades,
and changes will be allowed at the end.

19. Discussion
July 5th - 6 weeks after focus group
• The Esys 24 was rejected based on comments from other clinicians
• The Vario Connect 24 has been discontinued
• The Braille Edge 40 will be available for test (we don’t know yet)
• The Brailliant BI 40 and the Focus 40 blue were still retained
• The Roger Voice app seemed to be the best for phone communication.
It transcripts the speaker’s voice into readable text on the braille
display, and the text on the braille display in voice synthesis.
The devices will be bought in September to begin the step 2

20. Discussion
Brailliant BI 40
This image shows
• Black braille keyboard
• Dimensions: 12.2 x 3.4 x 0.7 in
• Weight: 1.43 pounds
• Adequate number of cells
• $2995.00 US
• Connectivity (to be test)?

21. Discussion
Focus 40 Blue 5th Gen
This image shows
• Black Braille keyboard with
the 8 dot in color blue
• Dimensions: 14.5 x 3 x 0.75 in
• Weight: around 1.24 pounds
• Adequate number of cells
• $2995.00 US
• Good reliability of the
Bluetooth connection

22. Discussion
Braille EDGE 40
This image shows
• White braille keyboard; the 8-
dot are in grey and the Braille
pins are in black
• Dimensions: 12.2 x 4 x 0.9 in
• Weight: 1.73 pounds
• Adequate number of cells
• $2795.00 US
• Good reliability of the
Bluetooth connection ??

23. Discussion
There are only small apparent differences between
the three devices
– Braille Edge 40 : more tactile keys of different
shapes, the cheapest
– Brailliant BI 40 : the thinest
– Focus 40 blue : the lightest, the longest and the
narrowest

24. Discussion
Certified
low vision
therapist
(simulated
client’s
comment)
In the case of the three braille displays, the
most important issue, since they have similar
side features (number of braille cells, size,
weight, braille keyboard located behind braille
cells, etc.), is the reliability of the Bluetooth
connection. This aspect is not easy to
evaluate, however, because it is by using it
that one can know.

25. Discussion
Certified
low vision
therapist
(simulated
client’s
comment)
I have no experience with the Edge 40 and
very little with the Brailliant BI, so I cannot
comment. My experience with the Focus
Blue demonstrates a good reliability of the
connection.

26. Discussion
Certified
low vision
therapist
(simulated
client’s
comment)
Remember, however, that a Braille display is
only useful (apart from its note-taking
accessory functions, for example, if equipped
with it) to display information from another
device in Braille, example, an iPhone. Braille
displays are known devices, the challenge in
my opinion is rather to find which device and
app will be connected. It is this app that will
allow communication and not the braille
display as such.

27. Discussion
This study will help to be more aware of communication
solutions for people with deafblindness, and to know how braille
displays, softwares/apps, and smartphones can work together.
The research-clinic-technology mesh is one of the strenghts of
this study. Results could encourage health payers to recommend
these products if they are proven to be cost-effective.
The small sample size due to the research design is one of the
main limitations of the study.

28. Conclusion
We hope that for the 18th Deafblind congress, we will have
tested one of the proposed solution for distant and face to face
communication, as well as for participation.
People with a congenital deafness and acquired vision loss need
an alternative to communicate, as they cannot use visual sign
language anymore.
Health payers need to be convinced that online technologies can
be cost-effective solutions for communication and participation,
and not only human caregivers

29. Conclusion
• My Canadian research team is asking you, as you are
coming from all over the world, have you ever
experienced one of these three braille displays in French
or in another language than English...
– Braille Edge 40
– Brailliant BI 40
– Focus 40 blue
with an iPhone and a Bluetooth connexion ?
• Have you experienced success with other technologies
for face-to-face and distance communication?

30. Acknowledgements