Cognitive Accessibility Issue Papers: Technology-Assisted Indoor Navigation and Wayfindings

This is an early draft. The task force intends to add more research and improved discussion. We also intend to make significant editorial changes to be in line with our style guide, including for citations.
Please feel free to let us know any research we should be looking at, as well as other comments.

Original Github version is at wayfinding-indoors

This document is part of set of papers that describe accessibility issues for users with various cognitive or learning disabilities and mental health issues. See cognitive or learning disabilities issue papers for other modules.

This document is part of a set of related informative publications from the Cognitive and Learning Disabilities Accessibility Task Force (COGA TF), a joint task force of the Accessible Platform Architectures Working Group (APA WG) and the Accessibility Guidelines Working Group (AG WG) of the Web Accessibility Initiative.

Introduction

This document is an issue paper about technology-assisted navigation through indoor spaces, also known as wayfinding, for people with cognitive and learning disabilities. This paper includes discussion on geolocation and directions from place to place. Wayfinding refers to the ability to navigate to a desired location and back again. Wayfinding means people can orient themselves, explore, and navigate through buildings such as museums, hospitals, airports, and public transportation stations. It is separate from outdoor navigation, such as via global positioning systems (GPS), primarily because GPS does not function inside buildings. See [reference and link to GPS navigation issue paper] for more on outdoor navigation.

An example use case would be:

Upon entering a large hospital with multiple in-patient and out-patient departments, a user must navigate to their primary care appointment. The user enters their destination into a digital kiosk at the entrance and receives customized directions, as well as information on how to access a public webpage with an adaptive 3-D map from their smartphone. The webpage that hosts the map also contains information about different areas of the hospital and what services they provide as well as adjustable preferences (based on Upadhyay et al, 2022)
A user constructs a grocery list by identifying the aisle number and location of each item and then ordering their list to move through the store with clear directions from one item to the next (based on Antonakos, Giordani, and Ashton-Miller, 2004).
A user is planning a trip that has a short layover in a large, busy airport. The user is able to utilize the airport’s wayfinding app to plot out their connection gates with an estimated travel time (based on National Academies of Sciences, Engineering, and Medicine, 2017).

Challenges for people with cognitive disabilities

Wayfinding can produce a wide range of challenges for people with cognitive disabilities. Not all people with cognitive abilities will have difficulties with wayfinding. Some people may experience temporary cognitive issues with wayfinding due medication side-effects, mental health status, or other factors. High demands to cognitive load, negative experiences in wayfinding, and interruptions can impact both the cognitive and physical energy a person can put towards wayfinding. Issues with wayfinding can occur for people with impairments including those that impact:

Memory;
Executive function;
Attention;
Visuo-Spatial function;
Language
Perception processing/interpretation; and/or
Knowledge acquisition, retention, or recall.

Memory

People with cognitive disabilities that affect memory may have to:

recall where they have been to orient themselves to where they are (spatial awareness);
review important landmarks multiple times;
review the name/address/room number of the destination multiple times;
review a proposed route multiple times;
repeat aloud or otherwise reiterate a route multiple times; and/or
return to reviewing parts of a route.

Executive function

People with cognitive disabilities that affect executive function may have difficulty:

sufficiently processing/understanding proposed routes;
understanding part of a route if they did not understand the part that preceded it;
planning how to follow a proposed route;
reorienting themselves after having their planned route interrupted; and/or
having a sense of spatial visualization and awareness (where a person is and wants to go).

Attention

People with cognitive disabilities that affect attention may:

Miss important instructions, clues, and relevant details; and/or
Be significantly distracted by stimuli occurring around them.
Have difficulty sorting relevant and extraneous details on a cluttered interface.
lose focus after interruptions, and struggle to restore context

Visuo-Spatial

People with cognitive disabilities that affect visuo-spatial function may have difficulty:

Constructing a mental map.
Orienting or reorienting themselves.
Wayfinding without detailed directions presented with multiple dimensions (e.g. text, landmark navigation).

Language

People with cognitive disabilities that affect language may not understand a proposed route if it:

Uses specialized, complex, or unfamiliar vocabulary;
Is presented in a non-native language;
Is only presented using written text

People with cognitive disabilities may not be able to enter their desired destination on a wayfinding aid if they must write and read to do so.

Perception Processing/Interpretation

Many people with cognitive disabilities may have difficulty:

understanding instructions that are not literal and presented plainly; and/or
comprehending instructions sufficiently to adequately follow them.
understanding abstract representations such as maps or satellite images.
differentiating left and right.
Orienting themselves in a space.
Estimating distances presented in meters or feet.

Knowledge Acquisition, Retention, or Recall

Some people with cognitive disabilities that impact knowledge acquisition, retention, and recall may not be able to understand a proposed route if it:

Uses unfamiliar navigation symbols and terminology;
Necessary background concepts are not explained plainly.

Proposed Solutions Based on Current Research

Inform user of time to destination up front:

Provide real-time information about time to travel to destination along any available routes.

Integrate landmark-based navigation:

Maps and directions should integrate easily recognizable landmarks that provide additional help with wayfinding and integrate photographs of these landmarks rather than abstract representations, birds-eye view or reliance on cardinal or body-relative (left and right) directions. Where possible, allow users to customize routes with their own landmarks.

Include both digital and environmental solutions:

Include physical wayfinding aids (e.g. signs, directional arrows, color-coded pathways) as well as digital aids.

Provide multiple methods for accessing directions:

For example, provide step-by-step directions that are provided in a) text, b) audio/video, and c) a map with a directional overlay such as an arrow that also provides spoken directions.

Present directions in smallest steps possible:

Each step-by-step direction should be a single action (i.e. continue straight; turn left, etc).
Avoid providing too much information at one time.

Provide real-time directions:

Provide each step in the moment it is needed with sufficient time for user to react.

Provide textual information in clear, concrete language:

Use clear language for all written or verbal instructions.
Avoid abstract, complex, or specialized language in directions and guidance.

Provide photographs of decision-points:

When a user needs to make an adjustment in their course (i.e. turning), providing a user-level photograph of that point in the route.
Avoid using more than one type of visual representation (e.g. do not use both photographs and drawings)

Avoid changing routes without user approval:

Proposed route changes should only be implemented if the user is made aware and approves. Users should be made aware of differences in the proposed route such as more steps.

Provide methods to always access directions:

For example, instead of relying only on static kiosks, have methods for users to be able to revisit directions at any time, especially while they are moving through the route. Include ways to personalize the indication (i.e. rather than a static map, include adaptive instructions that change as the person re-orients themselves). Due to the complexity of access, QR codes are not recommended.

Allow personalization of interface:

Users should have control over options like color contrast, text size and font, and sound in order to limit distractions and/or increase usability based on their individual needs.

Allow multiple modes of input:

Users should be able to input their desired destination in multiple ways, including typing, speech, and selecting on a map.

Allow personalization of terms including directions and measurements:

Allow users to customize key terms such as distance measurements.

Provide human back-up:

Allow users to contact human support when wayfinding fails. For example, an interactive map of a hospital could have an option to call the front desk integrated into its interface.

Research Sources

This section needs cleanup.

BlindSquare - “Pioneering accessible navigation - indoors and outdoors. Know where you are, know where you're going, travel with confidence.”
Wayfindr Standard Issued to Address Exponentially Growing Indoor Audio Navigation Market (The Global Initiative for Inclusive ICTs, 2017)
Wayfinding news articles - latest research, products, etc. (John Rochford, 2011 - Now)
Accessible Way-Finding using Web Technologies (W3C, 2014)
Accessible Way-Finding Using Web Technologies Symposium Home (W3C, 2014)
Accessible Way-Finding using Web Technologies Online Symposium 3 (W3C, 2014)
Way-finding systems (W3C, 2014)
Extended Abstract for the RDWG Symposium on Accessible Way-Finding Using Web Technologies, Accessible Wayfinding Ontologies for People with Disabilities (W3C, 2014)
Geo-fencing (to address wandering, a problem for people with dementia, autism, ID, ...)
Wearable trackers, e.g., LoJack (study on how to obtain insurance coverage)
John Sanchez, IBM Engineer - Has been working on Wayfinding for years (i.e, w/ RFID)
Aura Ganz, UMass Amherst Engineer - Pilot using NFC at MBTA Arlington Street Station
Possibility: http://www.clickandgomaps.com/
https://www.w3.org/WAI/WCAG2/supplemental/patterns/o7p06-supported-wayfinding/
Harniss, M., Brown, P. A., & Johnson, K. L. (2015). Cognitive technologies for wayfinding. In B. O'Neill & A. Gillespie (Eds.), Assistive technology for cognition: A handbook for clinicians and developers (pp. 146–159). Psychology Press.
Gomez, J., Montoro, G., Torrado, J. C., and Plaza, A. (2015). An adapted wayfinding system for pedestrians with cognitive disabilities. Mobile Information Systems. http://dx.doi.org/10.1155/2015/520572
Yao-Jen Chang, Shu-Ming Peng, Tsen-Yung Wang, Shu-Fang Chen, Yan-Ru Chen, & Hung-Chi Chen. (2010). Autonomous indoor wayfinding for individuals with cognitive impairments. Journal of NeuroEngineering & Rehabilitation (JNER), 7, 45–57. https://doi.org/10.1186/1743-0003-7-45
Zach, S., & King, A. (2022). Wayfinding and spatial perception among adolescents with mild intellectual disability. Journal of Intellectual Disability Research, 66(12), 1009–1022. https://doi.org/10.1111/jir.12934
Martín-Barroso, E. (2022). Survey of indoor location technologies and wayfinding systems for users with cognitive disabilities in emergencies. Behaviour & Information Technology, 41(4), 879–903. https://doi.org/10.1080/0144929X.2020.1849404
Volosnikova, I., Shabalina, O., Davtian, A., & Moffat, D. C. (2021). Learning Indoor Navigation Skills: A Mobile Game for People with Intellectual Disabilities. Proceedings of the European Conference on Games Based Learning, 727–736. https://doi.org/10.34190/GBL.21.078
Rocha, T., Carvalho, D., Bessa, M., Reis, S., & Magalhães, L. (2017). Usability evaluation of navigation tasks by people with intellectual disabilities: a Google and SAPO comparative study regarding different interaction modalities. Universal Access in the Information Society, 16(3), 581–592. https://doi.org/10.1007/s10209-016-0489-5
KELLEY, K. R., TEST, D. W., & COOKE, N. L. (2013). Effects of Picture Prompts Delivered by a Video iPod on Pedestrian Navigation. Exceptional Children, 79(4), 459–474. https://doi.org/10.1177/001440291307900405
Gómez, J., & Ojala, T. (2015). A mobile navigation system based on visual cues for pedestrians with cognitive disabilities. In L. B. Theng (Ed.), Assistive technologies for physical and cognitive disabilities. (pp. 173–190). Medical Information Science Reference/IGI Global. https://doi.org/10.4018/978-1-4666-7373-1.ch009
Yao-Jen Chang, Yan-Ru Chen, Chia Yu Chang, & Tsen-Yung Wang. (2009). Video Prompting and Indoor Wayfinding Based on Bluetooth Beacons: A Case Study in Supported Employment for People with Severe Mental Illness. 2009 WRI International Conference on Communications and Mobile Computing, Communications and Mobile Computing, 2009. CMC ’09. WRI International Conference On, 3, 137–141. https://doi.org/10.1109/CMC.2009.134
Delgrange, R., Burkhardt, J.-M., & Gyselinck, V. (2020). Difficulties and Problem-Solving Strategies in Wayfinding Among Adults With Cognitive Disabilities: A Look at the Bigger Picture. FRONTIERS IN HUMAN NEUROSCIENCE, 14, 46. https://doi.org/10.3389/fnhum.2020.00046
Antonakos, C., Giordani, B., Ashton-Miller, J. (2004). Wayfinding with Visuo-Spatial Impairment from Stroke and Traumatic Brain Injury, Disability Studies Quarterly, 24 (3).
Vikas Upadhyay, Tigmanshu Bhatnagar, Catherine Holloway, and M. Balakrishnan. 2022. A Case Study on Improving Accessibility of Healthcare Care Facility in Low-resource Settings. In CHI Conference on Human Factors in Computing Systems Proceedings (CHI 2022), April 30–May 6, New Orleans, LA, USA. ACM, New York, NY, USA, 8 pages. https://doi.org/10.1145/3491101.3503557
Martins, L.B., de Melo, H.F.V. (2014). Wayfinding in Hospital: A Case Study. In: Marcus, A. (eds) Design, User Experience, and Usability. User Experience Design for Everyday Life Applications and Services. DUXU 2014. Lecture Notes in Computer Science, vol 8519. Springer, Cham. https://doi.org/10.1007/978-3-319-07635-5_8
National Academies of Sciences, Engineering, and Medicine 2017. Enhancing Airport Wayfinding for Aging Travelers and Persons with Disabilities. Washington, DC: The National Academies Press. https://doi.org/10.17226/24930.
McLachlan F, Leng X. Colour here, there, and in-between—Placemaking and wayfinding in mental health environments. Color Res Appl. 2021; 46: 125–139. https://doi.org/10.1002/col.22570
Dalke, H., Little, J., Niemann, E., Camgoz, N., Steadman, G., Hill, S., Stott, L. Color and lighting in hospital design. Optics and Laser Technology, 38 (4-6): 343-365.