Universal Access in the Information Society

, Volume 15, Issue 4, pp 659–679 | Cite as

User interface design guidelines for smartphone applications for people with Parkinson’s disease

  • Francisco NunesEmail author
  • Paula Alexandra Silva
  • João Cevada
  • Ana Correia Barros
  • Luís Teixeira
Long paper


Parkinson’s disease (PD) is often responsible for difficulties in interacting with smartphones; however, research has not yet addressed these issues and how these challenge people with Parkinson’s (PwP). This paper specifically investigates the symptoms and characteristics of PD that may influence the interaction with smartphones to then contribute in this direction. The research was based on a literature review of PD symptoms, eight semi-structured interviews with healthcare professionals and observations of PwP, and usability experiments with 39 PwP. Contributions include a list of PD symptoms that may influence the interaction with smartphones, a set of experimental results that evaluated the performance of four gestures tap, swipe, multiple-tap, and drag and 12 user interface design guidelines for creating smartphone user interfaces for PwP. Findings contribute to the work of researchers and practitioners’ alike engaged in designing user interfaces for PwP or the broader area of inclusive design.


Touchscreen accessibility User interface design Usability guidelines Designing for people with special needs  Mobile Smartphone Touch gestures Motor impairments Parkinson’s disease 



The authors would like to acknowledge the kindness and help of all persons with Parkinson’s that participated in this study. To you, we dedicate our work. We would like to thank also the specialists that participated in the interviews and were patient enough to answer all our questions. We are further in debt to the Portuguese Parkinson’s disease association, especially Josefa Domingos, the national responsible for research. We would like to thank the REMPARK consortium, in particular Àngels Bayés, Alberto Costa, and Roberta Annichiarico. We thank Roxanne Leitão for the insightful discussions and comments, as well as the designs she created for some of the usability experiments. We also thank Bryan Seeman and Martha Crosby for their comments on previous versions of this draft. This work was in part supported by the European 7th Framework Program REMPARK ( project. The first author was also supported by the Vienna PhD School of Informatics (


  1. 1.
    Alzheimer’s Society: What is dementia? Technical report, Alzheimer’s Society (2013).
  2. 2.
  3. 3.
    Apple: ios human interface guidelines. Technical Report, Apple Inc. (2013)Google Scholar
  4. 4.
    Berardelli, A., Rothwell, J.C., Thompson, P.D., Hallett, M.: Pathophysiology of bradykinesia in parkinson’s disease. Brain 124(11), 2131–2146 (2001)CrossRefGoogle Scholar
  5. 5.
    Bonnet, A.M., Jutras, M.F., Czernecki, V., Corvol, J.C., Vidailhet, M.: Nonmotor symptoms in parkinson’s disease in 2012: relevant clinical aspects. Parkinson’s Dis. (2012). doi: 10.1155/2012/198316 Google Scholar
  6. 6.
    Cancela, J., Moreno, E., Arredondo, M., Bonato, P.: Designing auditory cues for parkinson’s disease gait rehabilitation. In: 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), pp. 5852–5855 (2014). doi: 10.1109/EMBC.2014.6944959
  7. 7.
    Charmaz, K.: Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage, London (2006)Google Scholar
  8. 8.
    Dandekar, K., Raju, B.I., Srinivasan, M.A.: 3-D finite-element models of human and monkey fingertips to investigate the mechanics of tactile sense. J. Biomech. Eng. 125(5), 682–691 (2003). doi: 10.1115/1.1613673 CrossRefGoogle Scholar
  9. 9.
    de Barros, A.C., Cevada, J.A., Bayés, A., Alcaine, S., Mestre, B.: User-centred design of a mobile self-management solution for parkinson’s disease. In: Proceedings of the 12th International Conference on Mobile and Ubiquitous Multimedia, MUM’13, pp. 23:1–23:10. ACM, New York, NY, USA (2013). doi: 10.1145/2541831.2541839
  10. 10.
    Djaldetti, R., Shifrin, A., Rogowski, Z., Sprecher, E., Melamed, E., Yarnitsky, D.: Quantitative measurement of pain sensation in patients with Parkinson disease. Neurology 62(12), 2171–2175 (2004)CrossRefGoogle Scholar
  11. 11.
    Dubois, B., Pillon, B.: Cognitive deficits in Parkinson’s disease. J Neurol 244(1), 2–8 (1996)CrossRefGoogle Scholar
  12. 12.
    Duff, S.N., Irwin, C.B., Skye, J.L., Sesto, M.E., Wiegmann, D.A.: The effect of disability and approach on touch screen performance during a number entry task. Proc Hum Factors Ergonom Soc Annu Meet 54(6), 566–570 (2010). doi: 10.1177/154193121005400605 CrossRefGoogle Scholar
  13. 13.
    Edwards, M., Quinn, N., Bhatia, K.: Parkinsons Disease and Other Movement Disorders (Oxford Specialist Handbooks in Neurology) with DVD. Oxford University Press, USA (2008)CrossRefGoogle Scholar
  14. 14.
    EPDA: Life with parkinson’s. Technical Report, European Parkinson’s Disease Association (EPDA) (2011)Google Scholar
  15. 15.
    Fisk, A.D., Rogers, W.A., Charness, N., Czaja, S.J., Sharit, J.: Designing for Older Adults: Principles and Creative Human Factors Approaches, Second Edition (Human Factors and Aging Series), 2nd edn. CRC Press, New York (2009)CrossRefGoogle Scholar
  16. 16.
    Foltynie, T., Brayne, C.E.G., Robbins, T.W., Barker, R.A.: The cognitive ability of an incident cohort of Parkinson’s patients in the UK. The campaign study. Brain 127(3), 550–560 (2004). doi: 10.1093/brain/awh067 CrossRefGoogle Scholar
  17. 17.
    Göransson, B.: The re-design of a PDA-based system for supporting people with Parkinson’s disease. In: Fincher, S., Markopoulos, P., Moore, D., Ruddle, R. (eds.) People and Computers XVIII —Design for Life, pp. 181–196. Springer, London (2005). doi: 10.1007/1-84628-062-1_12
  18. 18.
    Guerreiro, T., Nicolau, H., Jorge, J., Gonçalves, D.: Towards accessible touch interfaces. In: Proceedings of the 12th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’10, pp. 19–26. ACM, New York, NY, USA (2010). doi: 10.1145/1878803.1878809
  19. 19. Tremor, loss of control (2012).
  20. 20.
    Irwin, C.B., Sesto, M.E.: Performance and touch characteristics of disabled and non-disabled participants during a reciprocal tapping task using touch screen technology. Appl. Ergonom. 43(6), 1038–1043 (2012). doi: 10.1016/j.apergo.2012.03.003 CrossRefGoogle Scholar
  21. 21.
    Jankovic, J.: Parkinson’s disease: clinical features and diagnosis. J. Neurol. Neurosurg. Psychiatry 79(4), 368–376 (2008). doi: 10.1136/jnnp.2007.131045 CrossRefGoogle Scholar
  22. 22.
    Jin, Z., Plocher, T., Kiff, L.: Touch screen user interfaces for older adults: button size and spacing. In: Stephanidis, C. (ed.) Universal Acess in Human–Computer Interaction. Coping with Diversity, Lecture Notes in Computer Science, vol. 4554, pp. 933–941. Springer, Berlin (2007). doi: 10.1007/978-3-540-73279-2_104
  23. 23.
    Kurniawan, S., Zaphiris, P.: Research-derived web design guidelines for older people. In: Proceedings of the 7th International ACM SIGACCESS Conference on Computers and Accessibility, Assets ’05, pp. 129–135. ACM, New York, NY, USA (2005). doi: 10.1145/1090785.1090810
  24. 24.
    Lazar, J., Feng, J.H., Hochheiser, H.: Research Methods in Human–Computer Interaction, 1st edn. Wiley, London (2010)Google Scholar
  25. 25.
    Lee, P.H., Yeo, S.H., Kim, H.J., Youm, H.Y.: Correlation between cardiac 123I-MIBG and odor identification in patients with Parkinson’s disease and multiple system atrophy. Mov. Disord. 21(11), 1975–1977 (2006)CrossRefGoogle Scholar
  26. 26.
    Leitão, R., Silva, P.A.: Target and spacing sizes for smartphone user interfaces for older adults: design patterns based on an evaluation with users. In: Proceeding of PLoP (2012)Google Scholar
  27. 27.
    Levy, G., Schupf, N., Tang, M.X., Cote, L.J., Louis, E.D., Mejia, H., Stern, Y., Marder, K.: Combined effect of age and severity on the risk of dementia in Parkinson’s disease. Ann. Neurol. 51(6), 722–729 (2002). doi: 10.1002/ana.10219 CrossRefGoogle Scholar
  28. 28.
    Marsden, C.D.: Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 57(6), 672–681 (1994). doi: 10.1136/jnnp.57.6.672 CrossRefGoogle Scholar
  29. 29.
    Massano, J., Bhatia, K.P.: Clinical approach to Parkinson’s disease: features, diagnosis, and principles of management. Cold Spring Harbor Perspect. Med. 2(6), 1–15 (2012). doi: 10.1101/cshperspect.a008870 CrossRefGoogle Scholar
  30. 30.
    Maziewski, P., Suchomski, P., Kostek, B., Czyzewski, A.: An intuitive graphical user interface for the Parkinson’s disease patients. In: NER ’09. 4th International IEEE/EMBS Conference on Neural Engineering, 2009, pp. 14–17. IEEE, Antalya, Turkey (2009). doi: 10.1109/NER.2009.5109223
  31. 31.
    Mazilu, S., Blanke, U., Hardegger, M., Tröster, G., Gazit, E., Hausdorff, J.M.: Gaitassist: a daily-life support and training system for Parkinson’s disease patients with freezing of gait. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’14, pp. 2531–2540. ACM, New York, NY, USA (2014). doi: 10.1145/2556288.2557278
  32. 32.
    McNaney, R., Balaam, M., Holden, A., Schofield, G., Jackson, D., Webster, M., Galna, B., Barry, G., Rochester, L., Olivier, P.: Designing for and with people with Parkinson’s: a focus on exergaming. In: Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems, CHI ’15, pp. 501–510. ACM, New York, NY, USA (2015). doi: 10.1145/2702123.2702310
  33. 33.
    McNaney, R., Vines, J., Roggen, D., Balaam, M., Zhang, P., Poliakov, I., Olivier, P.: Exploring the acceptability of google glass as an everyday assistive device for people with parkinson’s. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’14, pp. 2551–2554. ACM, New York, NY, USA (2014). doi: 10.1145/2556288.2557092
  34. 34.
    Montague, K., Nicolau, H., Hanson, V.L.: Motor-impaired touchscreen interactions in the wild. In: Proceedings of the 16th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’14, pp. 123–130. ACM, New York, NY, USA (2014). doi: 10.1145/2661334.2661362
  35. 35.
    Nicolau, H., Jorge, J.: Elderly text-entry performance on touchscreens. In: Proceedings of the 14th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’12, pp. 127–134. ACM, New York, NY, USA (2012). doi: 10.1145/2384916.2384939
  36. 36.
    Nunes, F., Fitzpatrick, G.: Self-care technologies and collaboration. Int. J. Hum. Comput. Interact. (2015). doi: 10.1080/10447318.2015.1067498 Google Scholar
  37. 37.
    Nunes, F., Kerwin, M., Silva, P.A.: Design recommendations for tv user interfaces for older adults: findings from the ECAALYX project. In: Proceedings of the 14th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’12, pp. 41–48. ACM, New York, NY, USA (2012). doi: 10.1145/2384916.2384924
  38. 38.
  39. 39.
    Paraskevopoulos, I., Tsekleves, E.: Use of gaming sensors and customised exergames for Parkinson’s disease rehabilitation: a proposed virtual reality framework. In: 2013 5th International Conference on Games and Virtual Worlds for Serious Applications (VS-GAMES), pp. 1–5 (2013). doi: 10.1109/VS-GAMES.2013.6624247
  40. 40.
    Parhi, P., Karlson, A.K., Bederson, B.B.: Target size study for one-handed thumb use on small touchscreen devices. In: Proceedings of the 8th Conference on Human–Computer Interaction with Mobile Devices and Services, MobileHCI ’06, pp. 203–210. ACM, New York, NY, USA (2006). doi: 10.1145/1152215.1152260
  41. 41.
    Park, Y.S., Han, S.H., Park, J., Cho, Y.: Touch key design for target selection on a mobile phone. In: Proceedings of the 10th International Conference on Human–Computer Interaction with Mobile Devices and Services, MobileHCI ’08, pp. 423–426. ACM, New York, NY, USA (2008). doi: 10.1145/1409240.1409304
  42. 42.
    ParkinsonsUK: Parkinson’s awareness week (2012).
  43. 43.
    Sharma, V., Mankodiya, K., De La Torre, F., Zhang, A., Ryan, N., Ton, T., Gandhi, R., Jain, S.: Spark: Personalized Parkinson disease interventions through synergy between a smartphone and a smartwatch. In: Marcus, A. (ed.) Design, User Experience, and Usability. User Experience Design for Everyday Life Applications and Services, Lecture Notes in Computer Science, vol. 8519, pp. 103–114. Springer, Berlin (2014). doi: 10.1007/978-3-319-07635-5_11
  44. 44.
    Silva, P., Holden, K., Jordan, P.: Towards a list of heuristics to evaluate smartphone apps targeted at older adults: a study with apps that aim at promoting health and well-being. In: 2015 48th Hawaii International Conference on System Sciences (HICSS), pp. 3237–3246 (2015). doi: 10.1109/HICSS.2015.390
  45. 45.
    Snedecor, G.W., Cochran, W.G.: Statistical Methods, 8th edn. Iowa State University Press, Iowa (1989)zbMATHGoogle Scholar
  46. 46.
    Stern, M.B., Doty, R.L., Dotti, M., Corcoran, P., Crawford, D., McKeown, D.A., Adler, C., Gollomp, S., Hurtig, H.: Olfactory function in Parkinson’s disease subtypes. Neurology 44(2), 266–268 (1994)CrossRefGoogle Scholar
  47. 47.
    Trewin, S., Swart, C., Pettick, D.: Physical accessibility of touchscreen smartphones. In: Proceedings of the 15th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’13, pp. 19:1–19:8. ACM, New York, NY, USA (2013). doi: 10.1145/2513383.2513446
  48. 48.
    UCB: Parkinson’s disease patient stories (2011).
  49. 49.
    Van Den Eeden, S.K., Tanner, C.M., Bernstein, A.L., Fross, R.D., Leimpeter, A., Bloch, D.A., Nelson, L.M.: Incidence of Parkinsons disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 157(11), 1015–1022 (2003). doi: 10.1093/aje/kwg068 CrossRefGoogle Scholar
  50. 50.
    Wacharamanotham, C., Hurtmanns, J., Mertens, A., Kronenbuerger, M., Schlick, C., Borchers, J.: Evaluating swabbing: A touchscreen input method for elderly users with tremor. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’11, pp. 623–626. ACM, New York, NY, USA (2011). doi: 10.1145/1978942.1979031
  51. 51.
    Weiner, W.J.: Parkinson’s Disease: Diagnosis and Clinical Management, Illustrated Edition. Demos Medical, New York (2002)Google Scholar
  52. 52.
    Windows Phone: Interactions and usability with windows phone (2013).
  53. 53.
    Zesiewicz, T.A., Sullivan, K.L., Hauser, R.A.: Nonmotor symptoms of Parkinson’s disease. Exp. Rev. Neurother. 6(12), 1811–1822 (2006)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Francisco Nunes
    • 1
    Email author
  • Paula Alexandra Silva
    • 2
  • João Cevada
    • 3
  • Ana Correia Barros
    • 3
  • Luís Teixeira
    • 4
  1. 1.HCI GroupVienna University of TechnologyViennaAustria
  2. 2.Department of Design InnovationNational University of Ireland, MaynoothMaynoothIreland
  3. 3.Fraunhofer Portugal - AICOSPortoPortugal
  4. 4.Faculdade de Engenharia da Universidade do PortoPortoPortugal

Personalised recommendations