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Inspecting the Quality of Educational Video Artefacts Employed in Speech-Language Pathology Telerehabilitation: A Pilot Study

Part of the Lecture Notes in Computer Science book series (LNISA,volume 9739)

Abstract

Information and communication technology, particularly multimedia technology and the Internet, are commonly employed in the assessment, treatment and education of speech-language and communication disorders. Considering that video artefacts supplement or replace the speech therapist and can be used in both synchronous and asynchronous settings, they represent an important part of an online therapy. This paper presents a part of an ongoing research regarding the use of video in speech-language online therapy. The aim of the paper is threefold. First, we describe how video artefacts have been designed in accordance with the principles of multimedia learning and subsequently employed in telerehabilitation of pediatric speech disorder (dyslalia). Second, we introduce a set of quality attributes which significantly affect the success of the implementation of educational video artefacts in speech-language pathology (SLP) online therapies. Finally, we present and discuss the results of a pilot study carried out with an objective to examine the perceived quality of educational video artefacts applied in SLP telerehabilitation.

Keywords

  • Quality evaluation
  • Educational video artefacts
  • Speech-language pathology telerehabilitation
  • Dyslalia

1 Introduction

Relevant literature on telerehabilitation in speech-language pathology (SLP) provides a lot of evidence of applying information and communication technology, particularly multimedia technology and the Internet, in the assessment, treatment and education of speech-language and communication disorders. In recent systematic review of 103 papers that investigated the use of telehealth in speech, language and hearing sciences, 85.5 % of the studies indicated that SLP telehealth has advantages over the non-telehealth procedures [15]. There are an increasing number of research studies that support the effectiveness of remote assessment (e.g. [9, 28]) or online SLP therapy that is equal to or better than face-to-face service (e.g. [4, 12]). Some studies also indicated user satisfaction with applied online SLP services (e.g. [28]).

Delivery of SLP remote services is provided by combining synchronous and asynchronous technologies such as e-mail, photos, audio, video, etc. Video presents an important part of an online therapy since it supplements or replaces the therapist and can be used in both technologies’ settings. It can be used for synchronous real-time interactions between the patient and the therapist by employing videoconferences, or asynchronously presented as video recordings of therapy demonstrations during treatment or post-treatment. Our previous study had shown that activities that include engagement of video in SLP online services are among top three preferred activities for both clients and therapists [25].

Video is gaining more attention in recent years in educational settings, particularly with the introduction of massive online courses like those implemented in Coursera or Udacity e-learning platforms. When direct tutoring and mentoring of an online teacher is not available, video is used as a replacement for face-to-face lesson delivery, enabling multiple playbacks of a lesson. Video also increases student’s motivation to continue with the lesson [3]. Studies had shown that the appropriate design of multimedia learning materials, including educational video, has positive effects on learning (e.g. [1, 7, 11]). The same premise could be applied to educational video employed in speech-language telerehabilitation: design and creation of a video demonstration of a particular therapy (exercise) according to design principles should promote learning of concepts and foster automatization of skills, whether it is a case of learning how to pronounce a sound/word or how to breathe while speaking. Thus the ultimate goal of any educational video design should be a delivery of high-quality instructional videos that achieve their purpose.

Over the years, video quality has been measured from various aspects. Technical aspect of the quality includes factors like video resolution, bitrate, compression, buffering ratio or bandwidth [5]. User aspect includes factors such as user perceived quality, user engagement, content popularity, etc. [5]. Pedagogical aspect of video quality is particularly important in educational videos and is related to video length, content type, speaking rate, production style, etc. [8] as well as video design that includes factors like animation, narration, integration of pictures, type and position of on-screen text or integration of subtitles [1, 2].

According to the recent international standard [10], quality in general refers to the degree to which a piece of software meets stated and implied needs when used under specified conditions. In that respect, quality is considered to be one of the essential factors that contribute to the acceptance of software applications including artefacts resulting from their use. Since it is a systematic process of measuring the relevance of software features [6], the process of quality evaluation is commonly applied with an objective to determine whether any usability issues are appearing during the interaction with the software as well as for the purpose of inspecting diverse facets of user experience. While recent HCI literature offers a number of different advances in the field in terms of models, methods, and standards meant for evaluating different dimensions of quality in the context of social web applications [16, 21, 22], games [19] and educational artefacts created with Web 2.0 applications [24], studies related to the quality assessment in the SLP environment are in general fairly scarce. The set forth findings encouraged us to initiate a research on the design of the framework that would facilitate the design of educational artefacts and quality evaluation of educational artefacts employed in SLP telerehabilitation.

The aim of this paper is threefold. First, we will describe how video artefacts have been designed in accordance with the principles of the cognitive theory of multimedia learning [13] and subsequently employed in telerehabilitation of pediatric speech disorder (dyslalia). Second, we will introduce a set of quality attributes which significantly affect the success of the implementation of educational video artefacts in online SLP therapies. Finally, we will present and discuss findings of an empirical pilot study conducted with an aim to explore the perceived quality of educational video artefacts applied in SLP telerehabilitation.

The remainder of this paper is structured as follows. The next section offers a brief overview of recent and relevant studies in the field. Details on employed research methodology are provided in the third section. The results of the conducted pilot study are presented in the fourth section. Contributions, limitations, and future research directions are discussed in the last section.

2 Background to the Research

Mayer’s Cognitive Theory of Multimedia Learning (CTML) offers the foundation for efficient design of multimedia learning materials. CTML is based on three scientific assumptions about how human minds works [13]: (1) dual-channel assumption which states that humans possess two separate channels: visual/pictorial channels for processing visual input and auditory/verbal channels for processing auditory input, (2) limited-capacity assumption which states that humans’ working memory is limited in the amount of information it can process in each channel at one time, and (3) active-processing assumption which states that active learning happens when humans actively pay attention, organize incoming information and integrate them with other knowledge. These assumptions were the basis for the creation of twelve principles of multimedia learning, i.e. instructional features of multimedia lessons that underpin meaningful learning. For instance, multimedia principle states that learning is better when pictures are presented together with the spoken words, while the signaling principle states that learning is better when essential material is highlighted in the multimedia lesson [13, 14].

Meaningful learning requires substantial learning processing that also involves building connections among visual and verbal information. For example, learning material can show an animation during which a narrator explains what is happening in the animation, so both visual and verbal channels are occupied. Since the capacity of working memory is limited for processing information in each channel at one time, cognitive load can occur when total intended processing of information exceeds the learner’s cognitive capacity [14]. If cognitive processing does not serve instructional goal, e.g. lesson contains interesting but irrelevant information, or is caused by confusing instructional design or layout, an extraneous cognitive overload takes place [13, 14]. Typical example for this is a background instrumental music during auditory presentation of essential learning information, which results with overload in auditory channel and possible inability of learner to pay attention to learning material.

Mayer has proposed five principles to reduce extraneous cognitive load in multimedia presentations [13, p. 86]: (1) coherence principle – exclude extraneous words, sound or graphics, (2) signaling principle – highlight essential words or graphics, (3) redundancy principle – exclude redundant captions from narrated animation, (4) spatial contiguity principle – place essential words next to the corresponding graphics, and (5) temporal contiguity principle – present the corresponding words and pictures simultaneously. These principles can also be applied in the design of educational videos. Bouki et al. have been exploring redundancy principle in videos and how redundant information in videos, e.g. on-screen text and subtitles affects learners’ attention and comprehension [2]. One of the results from their qualitative research with eye-tracking method indicates that if the textual information, handled by the visual channel, does not conflict with the auditory information, handled by the auditory channel, then subjects can easily process both visual and auditory messages. A research by Arguel and Jamet shed light on spatial contiguity principle: they examined the influence of video on learning outcomes and found out that students who had been learning from a combination of video and static pictures performed better in the assessment than those learning only from video presentations [1]. This suggests that it is better to design videos with static pictures in the vicinity of videos, in contrast to videos without them, particularly when pictures emphasize the key stages of a procedure presented in the video.

Video is also recognized as the essential part of speech-language telepractice [25, 27], but to our knowledge, there are no researches on the video design employed in SLP online therapy. Recommendations on a video design are mainly oriented towards technical aspects of recording and delivering video online, e.g. usage of video formats that can be viewed on various devices, operating systems and browsers; short video length; customization of video regarding its size on the screen, or recommendations on services for video upload [27]. Thus, one of the goals of this paper is to present how principles of multimedia learning can be applied in the design of instructional videos employed in SLP therapy of pediatric speech disorder, with emphasis on principles that reduce extraneous cognitive load.

3 Methodology

In order to inspect the quality of educational video artefacts employed in speech-language pathology telerehabilitation, the following sub-goals of our research were defined:

  • design and development of educational video artefacts for the therapy of pediatric speech sound disorder (dyslalia) according to the principles of CTML,

  • design and implementation of an instrument for measuring the quality of educational video artefacts applied in SLP therapy,

  • conducting a pilot study to examine the perceived quality of educational video artefacts for telerehabilitation of dyslalia,

  • conducting the main study with control and experimental group to examine the video quality and outcomes of online SLP therapy of dyslalia employing educational videos.

This paper presents the methodology for and findings of the first three sub-goals.

3.1 Design and Development of Educational Video for SLP Therapy

Recording, design and development of the video artefacts have been accomplished at the Faculty of Organization and Informatics of the University of Zagreb, Croatia, in cooperation with two speech-language therapists from the local SLP centre. The SLP therapists have suggested dyslalia therapy since it is feasible to be prepared in the form of educational video artefacts. Dyslalia is a speech sound disorder which is often present in a native language of preschool or early years school child, but sometimes in adult age as well. The disorder is manifested as sound or phoneme that is either not produced, not produced correctly, or not used correctly, e.g. pronunciation of the sound R in the word “rabbit” might be produced like “wabbit”. The SLP therapists included in the pilot research suggested preparation of educational videos for the sounds S upon the availability of the test participants with that sound disorder. Together with a research leader, they have prepared storyboards for video recording and editing.

A typical SLP therapy for correcting the sound S (and many other sounds) consists of a set of exercises in which the client (child or adult) repeats the sound in all positions in the word - at the beginning, in the middle, at the end and close to a vowel. During the exercise (or therapist’s assessment), incorrect pronunciation can be observed, so a special case exercise should be performed to correct the mispronunciation before continuing to the next exercise. In order to cover all cases for the sound S, twelve videos have been recorded or the following four videos for each sound position: (1) demonstration of the sound S at the beginning/in the middle/at the end of the word, (2) repeating exercise of the sound S at the beginning/in the middle/at the end of the word, (3) demonstration of errors when pronouncing the sound S at the beginning/in the middle/at the end of the word, and (4) demonstration of the sound S used in a combination with the vowels at the beginning/in the middle/at the end of the word.

In order to produce professional like videos, video recordings were made in an improvised recording studio with two speech-language therapists, one of whom has served as a demonstrator and the other as a narrator. The demonstrator was recorded against a green backdrop with three digital video cameras placed on the tripods using different close-up shots: enface close-up, enface extreme close-up and profile extreme close-up, in order to record all the necessary details of the mouth and tongue position while pronouncing the sound S. Post-production was made in Adobe Premiere CS6 video editing software. For the purpose of the pilot research, only three videos with the sound S at the beginning of the word were edited.

Every video consisted of the following logical parts: introductory part with copyright information and the project’s logo; title of the video; announcement part narrated by the demonstrator who explained the content of the video; the main content with a demonstration or exercise shown in various close-up shots; the demonstrator’s wrap up with the announcement about the next video; and scrolling credits part at the end of the video.

Video editing was done in accordance with five CTML principles to reduce extraneous cognitive load:

  • Coherence principle: copyright information about the video is important from the aspect of video creators, but are not directly associated with the instructable content. In order to avoid diverting an attention from the exercise, copyright information, logo graphics and short music were not added throughout the video, but only at the beginning and/or the end of the videos.

  • Signaling principle: visual and auditory signaling were added to guide viewer’s attention to the key elements of performing the pronunciation of the sound S. Visual signaling was provided in the form of arrows, accented text or other visual clues (see Fig. 1), while auditory signaling was provided in the form of vocal emphasis and music during the introductory and credits parts.

    Fig. 1.
    figure 1

    Signaling and spatial contiguity principles

  • Redundancy principle: concurrent video/animation and on-screen text are considered redundant information that overloads the visual channel, so this combination was avoided in most parts of the video. However, the redundancy principle was violated in two cases: when transcribed narration was placed next to the narrator’s face in order to give additional information to parents on how to produce a specific sound (see Fig. 2), and when enface extreme close-up and profile extreme close-up were placed in the same scene; both for the reason to allow pausing of the video playback in key position moments.

    Fig. 2.
    figure 2

    Violation of redundancy principle

  • Spatial contiguity principle: visual clues are presented near the corresponding parts of the video in order to avoid visual cognitive load (see Fig. 1).

  • Temporal contiguity principle: the narrator simultaneously explains the demonstration of the position of mouth or tongue, so information is processed in both visual and auditory channel.

3.2 Design of an Instrument for Measuring Quality of Educational Video Artefacts Applied in SLP Therapy

Drawing on the literature review related to the assessment of various dimensions of quality including usability [21, 22, 24], user experience [18, 21], quality in use [17, 21], and success [20, 21], an initial set of 26 attributes was generated. In order to examine their adequacy for measuring the quality of video artefacts employed in SLP therapies, an empirical study was carried out [23]. Seven attributes which have not met the cut-off values of two content validity indicators were omitted from further analysis. The remaining pool of 19 attributes was enhanced with additional attribute that deals with particularities of video artefacts. The final post-use questionnaire was composed of 110 items designed for measuring facets of 20 quality attributes in the context of video artefacts used for the purpose of SLP therapies. Considering the items assigned to attributes accessibility and portability, they were renamed flexibility and displayability, respectively. The answers were scored on a four-point Likert scale (1 – strongly agree, 4 – strongly disagree). Each attribute was measured with between three and nine items. For the purpose of data analysis, the value of a particular quality attribute was operationalized as a sum of responses to the assigned items.

3.3 Research Design of the Pilot Study

Nine parents who had an appointment with their children in the local SLP centre have agreed to participate in the pilot study after they were briefly introduced with the idea of online SLP therapy and a research goal to examine video quality. They have signed an informed consent and filled out the web questionnaire about their usage of ICT and preferences regarding SLP therapies provided online. The children were previously examined by a speech therapist, who had determined dyslalia disorder with the sound S. After the therapist’s evaluation, the therapy started with the therapist’s demonstration of pronouncing the sound S at the beginning of the word. Nowadays, many parents, with the therapist’s approval, record (by means of the smartphone, camera or camcorder) the therapist’s demonstration and the way he/she sets the sound. That was also the case with all parent participants in the pilot study. Finally, the therapist wrote down the prescribed therapy on practicing the pronunciation in the child’s notebook and once more informed the parents about the whole procedure and how they are going to work with the child at home. Parents were instructed to practice pronunciation with a child on classical way at least for 2–3 days before accessing online SLP therapy. The therapy with edited videos was embedded into a learning management system and all parents received login information along with the instructions how to use the video by means of e-mail. Parents were also asked to fill-out the post-questionnaire after using the videos with their children for at least two times.

4 Results

Participants.

Five out of nine parents have accessed online SLP therapy with their children. The majority of parents (80 %) were female, whereas all the children were male. The children ranged in age from five to eight (M = 5.40, SD = 1.517). At the time the pilot study took place, the participants originated from three different Croatian counties. When the employment of information and communication technology is considered, 60 % of them are using desktop computers, 60 % of them are utilizing laptops, 40 % are applying tablets, 80 % are employing smartphones, 40 % are using web cams, 40 % are utilizing headphones, 20 % are applying microphones, 60 % are employing digital cameras whereas 20 % of them are using digital camcorders. The majority of respondents (60 %) are using computers at their homes for up to two hours. The same percentage of parents are consuming the Internet on a daily basis.

When the reasons for attending the speech-language therapies are taken into account, all the children were diagnosed with dyslalia disorder, 20 % of them also had undeveloped speech disorder, and 20 % of them also had stuttering disorder. The majority of parents (80 %) expressed their readiness to perform occasional online therapies at their homes. Regarding the manner in which parents are willing to take part in online therapies, 20 % of parents are willing to carry out online exercises only for the duration of the therapy and only if speech therapist is going to monitor the activities of their child, 60 % of parents are ready to conduct online exercises during and upon completion of the therapy, with or without the speech therapist’s supervision, and only 20 % of parents are willing to continue to perform online exercises after the end of the therapy without the speech therapist’s supervision.

Considering the form of online therapies, all pilot study participants reported they would like to use it in the form of video artefacts, 20 % of parents are interested in therapies in the form of an online game, 40 % of them would like to practice it in the form of a game installed on a smartphone or a tablet, 60 % of them are willing to conduct online therapy through interaction with the speech therapist via video link, and 40 % of parents want to use the calendar with appointments with the therapist.

When the parents were asked how they would like to monitor their child’s progress in online speech therapy, all of them answered they want to have an insight into the conducted therapies and into the assignments the child needs to complete until the next appointment with the speech therapist, also 60 % of them are willing to help their child improve his speech skills by playing a computer game which monitors progress over a certain period of time, and 60 % of them are ready to check the completion of the assignments executed at home until the next appointment with the therapist.

Findings.

The analysis of the collected data revealed that study participants strongly agreed (92 %) and agreed (8 %) on items which indicate that video artefacts precisely and accurately display how to pronounce particular sounds (correctness). It was also discovered that parents strongly agreed (73.33 %) and agreed (26.67 %) on items which denote that the content of video artefacts is complete and clear (coverage). According to the results of the pilot study, respondents strongly agreed (90 %) and agreed (10 %) on items designed for evaluating the level to which the content of video artefacts is trustworthy and reliable (credibility). Parents also strongly agreed (80 %) and agreed (20 %) on items which imply that video artefacts are beneficial in terms of treating speech and language disorders (usefulness). The results of data analysis indicate that pilot study subjects strongly agreed (90 %) and agreed (10 %) on items which denote they have a positive stand on the employment of video artefacts in SPL therapies (attitude). On the other hand, parents strongly agreed (65 %), agreed (32.50 %), and disagreed (2.50 %) on items which imply that they intend to continue to use video artefacts for speech disorder rehabilitation purposes and recommend them to others who have some kind of speech disorder (continuance intention). It was also found that respondents strongly agreed (54.29 %) and agreed (45.71 %) on items which indicate that video artefacts have met parents’ expectations (satisfaction).

The analysis of data gathered by means of post-use questionnaire uncovered that participants strongly agreed (80 %), agreed (15 %), and disagreed (5 %) on items which denote that users can adjust video artefacts to their needs (customizability). Parents reported they strongly agreed (80 %), agreed (14.29 %), and disagreed (5.71 %) on items which imply that it is easy to become proficient in employing video artefacts (ease of use). Pilot study subjects strongly agreed (80 %) and agreed (20 %) on items which denote that video artefacts are designed in a way that users cannot make a mistake in pronouncing a particular sound (error prevention).

On the other hand, it was discovered that parents strongly agreed (28.57 %), agreed (60 %) and disagreed (11.43 %) on items which indicate that video artefacts are visually appealing (aesthetics). Moreover, respondents strongly agreed (33.33 %) and agreed (66.67 %) on items which denote that the use of video artefacts represents a unique approach to treatment of speech disorders (uniqueness). It was also discovered that parents strongly agreed (20 %), agreed (50 %), and disagreed (30 %) on items which imply that the use of video artefacts for the purpose of rehabilitating speech disorders successfully absorbs patients’ attention (playfulness). Pilot study participants reported they strongly agreed (36.67 %), agreed (33.33 %), disagreed (13.33 %), and strongly disagreed (16.67 %) on items which indicate they are using video artefacts for telerehabilitation purposes because they were recommended by the speech therapist (social influence).

According to pilot study results, parents strongly agreed (40 %), agreed (40 %), disagreed (13.33 %), and strongly disagreed (6.67 %) on items which denote that the use of video artefacts enable monitoring the implementation of SLP therapies (trackability). It was also found that respondents strongly agreed (35 %), agreed (40 %), disagreed (15 %) and strongly disagreed (10 %) on items which imply that online therapies with the use of video artefacts do not differ significantly from “classical” SLP therapies (familiarity). The analysis of gathered data has shown that parents strongly agreed (56.67 %), agreed (33.33 %), and disagreed (10 %) on items which indicate that video artefacts are usable for treating various speech and language disorders (flexibility). Study participants reported they strongly agreed (56 %), agreed (40 %), and disagreed (4 %) on items which denote that the use of video artefacts does not differ significantly among web browsers and devices that have Internet connection (displayability). It was also revealed that parents strongly agreed (40 %), agreed (16 %), disagreed (12 %), and strongly disagreed (32 %) on items which imply that video artefacts are available to everyone and every time they need them (availability).

Finally, pilot study participants strongly agreed (71.11 %) and agreed (29.89 %) on items which indicate that video artefacts are professionally prepared and modernly designed (overall quality).

5 Discussion and Concluding Remarks

This paper introduced an approach to the design of educational video artefacts employed in speech-language telerehabilitation of dyslalia. Video design and production have been prepared in accordance with the principles of the cognitive theory of multimedia learning that reduces extraneous cognitive load. This approach was chosen because of the similarities of online learning that applies video artefacts and learning that happens during an SLP therapy. While four of CTML principles (coherence, signaling, spatial contiguity and temporal contiguity principle) were applied to the design of SLP video artefacts, the redundancy principle was violated. One part of the artefact was designed with concurrent video, narration and on-screen text due to the fact that video will be observed both by a child who cannot read, and a parent who might need additional written instructions on how to produce a particular sound.

Video artefacts have been examined in an empirical pilot study with five children and their parents. After interactions with video artefacts, parents have evaluated the video quality with a post-use questionnaire. The findings of the study indicate that edited videos were of very high quality and prepared professionally. However, some aspects of the quality were less favorable, like visual appeal and the quality of audio (noise and metal sound were noticeable in one video). In addition, video artefacts were found neither entertaining nor available (due to the fact that users should log in to be able to view video). Parents have expressed a strong positive attitude towards the employment of video artefacts in SLP therapies and confirmed that videos have met their expectations. However, parents’ intention to continue to use video artefacts was not that high, which might suggest the lack of motivation or the lack of time for telerehabilitation. Considering there are neither standards on the design of educational videos in general [2], nor strong evidence about the outcomes of online treatment of dyslalia [26], particularly the one that employs video, we believe that findings presented in this paper significantly add to the extant body of knowledge and establish a background for further theoretical and empirical advances in the field of dyslalia telerehabilitation.

Taking into account that reported findings emerged from an empirical pilot study, several limitations must be acknowledged. Although parents of the children with speech disorder are a representative sample of video artefacts users, a heterogeneous sample in terms of age, gender, and type of speech disorder could have importantly different perception about the quality of video artefacts used in SLP telerehabilitation. The second limitation deals with the sample size. Five individuals may be sufficient for presenting the results of the pilot study, but to draw sound conclusions, the research needs to involve more participants. The last limitation is that the results cannot be generalized to all types of speech disorders but only to those related to the pronunciation of the sound S. Having that in mind, the empirical results should be interpreted carefully.

The results of the pilot study have revealed several directions for enhancing the quality of video artefacts. However, a deeper insight into the quality and the usage of video artefacts would be achieved with a qualitative research, which would enable us to observe interactions of the child and parents with the videos and the system into which the videos were embedded. In that respect, our future work efforts will be focused on: (1) inclusion of control and experimental group of patients which would enable us to further explore the video quality in accordance with different production styles; (2) measuring the efficiency of online SLP therapy of dyslalia employing educational videos; and (3) validation of an instrument for evaluating the quality of video artefacts in SLP telerehabilitation.

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Plantak Vukovac, D., Orehovački, T., Novosel-Herceg, T. (2016). Inspecting the Quality of Educational Video Artefacts Employed in Speech-Language Pathology Telerehabilitation: A Pilot Study. In: Antona, M., Stephanidis, C. (eds) Universal Access in Human-Computer Interaction. Users and Context Diversity. UAHCI 2016. Lecture Notes in Computer Science(), vol 9739. Springer, Cham. https://doi.org/10.1007/978-3-319-40238-3_46

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