Disability and Rehabilitation: Assistive Technology

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Assistive technologies for hearing, and speaking

impaired people: a survey

Ghassan Kbar, Akshay Bhatia, Mustufa Haider Abidi & Ibraheem Alsharawy

To cite this article: Ghassan Kbar, Akshay Bhatia, Mustufa Haider Abidi & Ibraheem Alsharawy
(2016): Assistive technologies for hearing, and speaking impaired people: a survey, Disability
and Rehabilitation: Assistive Technology, DOI: 10.3109/17483107.2015.1129456

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 DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY, 2016
http://dx.doi.org/10.3109/17483107.2015.1129456

REVIEW ARTICLE

Assistive technologies for hearing, and speaking impaired people: a survey

Ghassan Kbara, Akshay Bhatiaa, Mustufa Haider Abidib and Ibraheem Alsharawyc
a
Riyadh Techno Valley, King Saud University, Riyadh, Saudi Arabia; bFARCAMT, Advanced Manufacturing Institute, King Saud University,
Riyadh, Saudi Arabia; cIndustrial Engineering Department, King Saud University, Riyadh, Saudi Arabia

ABSTRACT ARTICLE HISTORY

This study presents a novel method for evaluating the scientific research papers in the field of Received 8 June 2015
assistive technologies pertaining to different impairment conditions. The objectives are to Revised 2 December 2015
understand the technologies used for addressing the needs of PWD by identifying relevant criteria Accepted 4 December 2015
for the assessment, explore the implications of these technologies in their lives and identify the Published online 12 January
gaps among certain technologies in assisting PWD. In this article, we reviewed around 40 research 2016
scientific papers in relation to the technologies used to assist PWD in their daily activities. A novel
KEYWORDS
quantitative assessment methodology based on Multi-weighted Scoring Model (MWSM) has been Assistive technology; hear-
developed. It is based on the judgement of clinical experts according to thirteen well-defined ing impaired; multi-
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criteria. The proposed method is useful because it assesses the scientific studies related to PWD weighted scoring method;
qualitatively according to efficient research coverage, as well as quantitatively in order to have person with disabilities;
good comparative judgment. Moreover, this method recognizes the research gap or areas which quantitative survey; speak-
need further investigation and identifies the research papers that have good coverage of the ing impaired
respective criteria.

ä IMPLICATIONS FOR REHABILITATION

 Human computer interface (HCI) solutions are critical for addressing the main issues facing
people with disabilities (PWD) in their life.
 Assessment of scientific research papers according to well-defined criteria that address PWD
needs would assist in verifying their suitability for PWDs.
 Novel quantitative assessment methodology is used for assessing these research papers using
judgment of experienced researchers according to 13 well-defined criteria that have been
weighted according to relevancy to different impairment groups.
 Identifying research papers that have good coverage of defined criteria and knowing the
research area that needs further investigation by researchers and developers, would ultimately
address the rehabilitation needs for PWD.

Introduction This number is growing each year, which becomes a

People born with disabilities or who become impaired at
some point of their life will experience many difficulties,
which can impact their quality of life in comparison with
individuals without disabilities. The World Health
Organization [1] predicted that the number of people
who will reach the age of 60 will be around 2 billion by
2020 and that the majority of them will have disabilities
and face difficulties in using computer interfaces. In
addition, older adults might also suffer from hearing loss
as well as partial visual and motor impairment. Currently,
over a billion people including children (or about 15% of
the world’s population) are estimated to be living with
disabilities and 3.8% of these have severe disabilities.[1]
greater concern to researchers, governments and deci-
sion makers. The lack of service support can make
individuals with handicaps overly dependent on their
families, which prevents them from being economically
active and socially included. In Kingdom of Saudi Arabia
(KSA), it is estimated that 3.73% of the population has a
functional disability including cognitive or physical
impairment.[2] More than 74.2% of this group experi-
ence physical, visual or hearing disabilities, but still can
participate in knowledge creation.
An inaccessible environment creates additional bar-
riers for people with disabilities by making it hard to
function independently and to cope with the surround-
ing objects. The legislation and policy in regards to

CONTACT Ghassan Ali Kbar gkbar@ksu.edu.sa Innovation Tower, 5th Floor Riyadh Techno Valley, King Saud University, Riyadh, 12373, Saudi Arabia
Supplemental data for this article can be accessed http://dx.doi.org/10.3109/17483107.2015.1129456.
ß 2016 Taylor & Francis
 2 G. KBAR ET AL.
supporting the requirements of people with disabilities
has been changed in many countries to improve health
conditions and outcomes for persons with disabilities.[1]
Almost all people with disabilities need assistance to
participate in social and economic life, and this support
typically comes from family members, caregivers and/or
technology solutions that facilitate interaction with the
environment through relevant Human Computer
Interaction (HCI).
Over the past decade, ubiquitous computing-based
technologies have emerged that provide a foundation
for researchers and developers to provide technologies
that assist individuals with overcoming or compensating
for their disabilities and improving their quality of life at
home, work and all everyday settings. HCI is one
particular technology that can assist people with
disabilities with effective user interaction support.
People with disabilities often require supervision and
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helps assistance to perform their daily activities, a role
which family members typically assume. Assistive tech-
nology helps Persons with Disabilities (PWD) to be
socially included and to become or remain independent.
Information and communication technologies have a
key role in providing accessibility and inclusion for PWD.
Ongoing advances in Information and Communication
Technologies (ICT) are increasing the scope for
IT-desktop and mobile assistive technologies to
improve participation, independence, safety and
improved quality of life of for PWD in the workplace.
Developing relevant solutions will help PWD in KSA and
around the world to exercise their creativity and
contribute to the workplace, instead of being idle and
frustrated.[3]
There can be a number of different approaches to
carry out a research review. According to the Grant and
Booth,[4] an analytical framework, including the search,
appraisal, synthesis and analysis (SASA), is required to
select the type of the review method. Therefore, among
the fourteen analyzed review methods, the authors of
the current article has adopted the mixed studies review
(or the mixed methods review) method. Although, a
comprehensive review is not carried out in this paper,
but it provides a mixed review of scientific contributions
to the topic of assistive technology for PWDs. Actually,
the focus in this work is on the particular area (selective
or purposive research). Furthermore, a formal quality
assessment and the appraisal instrument and process
have been adopted as the appraisal criteria since, a
systematic process is needed. A narrative commentary,
tabular and Graphic, quantitative and qualitative studies
are used which defines the synthesis criteria. The
quantitative assessment helps in evaluating research
projects that are intended to be complete products as
well as evaluating existing solutions with commercial
products. The research gap and the limitations of the
various papers have also been identified in this review,
but to have a thorough evaluation across a range of
articles that have relevant knowledge to offer in the
pursuit of improving technology for the targeted
disability groups a comprehensive literature review or
systematic review is required which can be done in the
future. The review covers selective research articles from
multiple academic disciplines most notably science,
technology and health. The purpose of this literature
review is to understand the technologies used for
addressing the needs for people with disabilities, the
implication of each technological solution to their life
and to identify the gap or lack of coverage of certain
technologies that can assist in providing relevant solu-
tions in order to address the needs of these people. We
use both a qualitative approach that focuses on the
contribution of each technology to address the needs of
people with disabilities, and a quantitative approach to
assess these papers using a Multi-weighted Scoring
Model according to a set of well-defined criteria. The
qualitative and quantitative approaches allow us to
assess the impact of the research in providing relevant
solutions to the impairment conditions of PWD. The
criteria used for the assessment of different impairment
group has been generalized with 13 criteria but with
different weights according to their relevancy to a
particular group, where the very relevant criteria would
have a weight of 3 and the non-relevant criteria would
have the Weight of 0 as will be described later in the
analysis section.
In this article, we restrict our attention to population
groups that have physical impairments, rather than
cognitive impairments. We classify impairment condi-
tions into eight groups: Speaking Impairment (SI),
Hearing Impairment (HI), Visual Impairment (VI), Motor
Impairment (MI), Speaking and Motor Impairment (SMI),
Visual and Motor Impairment (VMI), Hearing and
Speaking Impairment (HSI) and Hearing and Motor
Impairment (HMI). In this article, we review papers for
the impairment groups of SI, HI and SHI while other
impairments groups related to VI, VMI and MI will be
covered in separate articles.
Assessing research papers using
MULTI-weighted scoring model
In order to assess the suitability of each paper for
providing a relevant solution for assisting PWD users, we
provide qualitative and quantitative evaluations that are
based on well-defined criteria. Hence, we used a Multi-

weighted Scoring Model (MWSM) to assess and evaluate
approximately 40 research papers.
A novel assessment model based on nine steps has
been used to assess the research papers quantitatively
using MWSM. The different steps are described in
Figure 1 of Appendix 1 in the supplement document.
A brief description of the activities at each step is
described below.
Identify the criteria for assessing the technologies
and their additive weight
The technology performance criteria (Ctx) used for
assessing the required technologies needed for PWD
are determined and rated according to the importance
level as described in Table 1 of Appendix 1 of the
supplement document.
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Identify the technologies relevant for PWD
The lists of technologies that can be used to assist PWDs
in interacting with a computer system are defined (see
Table 2 of Appendix 1 of the Supplementary material).
Assess technologies using MWSM applied to Step
1 criteria
The MWSM is applied to the identified technologies
which determine their score based on the technology
performance criteria (Ctx) as described in Tables 3–13 of
Appendix 1 of the Supplementary material. We note that
all of the technology ratings were performed by the
authors. In order to ensure that the ratings are consistent
with the needs of PWDs, the committee consulted with
experts who have specialization in PWD accessibility for
more than 20 years. The ratings represent the result of
extensive discussion within this committee.
Identify the technological criteria for assessing
research papers
The MWSM is applied to determine the weight of the
technological criteria (Cx) that can be used for assessing
the papers as described in Table 3. The scores are
elicited from three experienced researchers, who fol-
lowed a clear methodology for the assessment through
checking for evidence of supporting technologies
associated with the criteria in the research paper, to
report the average scores.
Conduct literature review and classify papers
Evaluators conduct a literature review to identify papers
and classify them according to topics Visual Impairment
(VI), Hearing Impairment (HI), Speaking Impairment (SI),
ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 3
Motor Speaking Impairments (MSI), Hearing Speaking
Impairment (HSI), Motor Hearing Impairment (MHI) and
Motor Visual Impairment (MVI), where the large number
of HI, HSI and SI papers are further assessed in this
article.
Assess research papers using guideline and
criteria
Evaluators followed the well-defined guidelines for
assessment and the results thus obtained are presented
in the following sections.
Review of the assessment results
Multiple meetings are conducted to reduce the variance
between different evaluator results.
Assessment analysis MWSM
The results for assessing the identified research papers
for HI, HSI and SI are analyzed and presented in the
following sections.
Identify the gaps in research coverage
The results found in steps 6, 7 and 8 are analyzed to
determine the lack of research coverage for the average
criteria that have weights above our specified thresholds.
The above technique for the assessment model is
similar to the Assistive Technology Assessment (ATA)
process model proposed by Federici and Scherer.[5]
During the phase 1 of the ATA model (steps a–d), a
quantitative assessment technique based on 13 criteria
involving the use of technology and the author’s insight
and experience was proposed. The rating of these
criteria have been verified by experts who have partial
impairment condition and authors’ committee team, and
they have also been verified through a set of question-
naire used to collect data from PWD users to know the
importance of technologies that can help them in doing
their job easily. A multidisciplinary team guided by the
committee collected the data from PWD users (see
Appendix 2 of the Supplementary material). At phase 2
of the ATA model (step e), the multidisciplinary and
Committee team has evaluated the result associated
with technologies’ needs for PWD and ranked them
numerically to determine the priority of these technol-
ogies for the specific group of PWD and then link them
to technological criteria that can be used to assess the
technological solutions (see Tables 3–12 of Appendix 1
of Supplementary material). The results from survey
were consistent with experts opinion as described in
Appendix 1 and Appendix 2 of the Supplementary
material.
 4 G. KBAR ET AL.
Table 1. Assessment criteria description.
Criterion
Essential system input C1
C2
C3
Supporting system input C4
C5
Essential system output C6
C7
C8
C9
Supporting system output C10
C11
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Supporting system processing C12
C13
Table 2. Criteria weightage.
Substitute/Very important
Impairment type (Weight ¼ 3)
HI C1: speech to text
C6: text to speech
C9: display system
C11: vibrate, flash
C12: mobility
Partial SI (PSI) C2: keyboard, mouse
Person can hardly C3: gesture control
speak with difficulties C6: text to speech
to explain C9: display system
C11: vibrate, flash
C13: noise filtering
Full SI (FSI) C2: keyboard, mouse
Non-speaking person C3: gesture control
C6: text to speech
C9: display system
C10: speaker control
C11: vibrate, flash
HSI C1: speech to text
C2: keyboard, mouse
C3: gesture control
C9: display system
C12: mobility
The scientific databases including the ScienceDirect,
Scopus, IEEE Xplore Digital Library, Google Scholar,
Emerald and Springer Link were used to collect the
research studies. The keywords that were used to search
for citations are as follows: assistive technology, hearing
impairment, motor impairment, speaking impairment, a
combination of these terms and persons with disabilities.
Although, the keywords like ‘‘person with disabilities’’
were used, but the research work that focus on
impairments other than hearing, motor and speaking
have been filtered out. This is because ‘‘person with
Explanation Relevance to PWD
Speech to text Helps others to communicate with
PWD; Helps in controlling
interfaces
Keyboard or touch screen or Helps enter messages and control
remote interfaces
Gesture control using sensor or Helps observe the environment
camera
Tracking location using sensors or Helps in determining location of
WIFI or RFID PWD for decision-making
Sensors for behavior Helps in tracking PWD movement
for analysis and prediction
Text or digital mapping to speech Helps PWD communicate with
other people
Magnification of font and window Helps in reading messages and
size seeing pictures
Color control Helps in seeing frames and
interfaces
Display system Helps interact with systems
Auto adjustable Speaker and Helps with hearing and speaking
Volume control
Haptic or visual feedback (vibra- Help with sensory interfaces
tion or flashing)
Mobile support Helps in carrying smart system for
interfacing with environment
Noise Filtering Improves hearing quality
Assist/Important Could assist/Less important Not applicable
(Weight ¼ 2) (Weight ¼ 1) (Weight ¼ 0)
C2: keyboard, mouse C3: gesture control C10: speaker control
C5: sensors behavior C4: tracking location
C13: noise filtering C7: magnification
C8: color control
C1: speech to text C8: color control
C4: tracking location
C5: sensors behavior
C7: magnification
C10: speaker control
C12: mobility
C4: tracking location C8: color control C1: speech to text
C5: sensors behavior C13: noise filtering
C7: magnification
C12: mobility
C5: sensors behavior C4: tracking location C6: text to speech
C7: magnification C8: color control C10: speaker control
C11: vibrate, flash C13: noise filtering
disabilities’’ is a very broad term, and it covers a large
number of different research domains. Therefore, this
survey mainly focuses on the research papers involving
the assistive technologies pertaining to hearing, speak-
ing and motor impairments that have been published
for last 10 years. Other impairments and their combin-
ations, such as visual impairment, visual-motor impair-
ment, etc. will be covered in the subsequent work.
Moreover, the articles have filtered out a particular
impairment condition by obtaining direct evidences
from the article. However, if direct evidences for

Table 3. Weightage for different criteria (criteria with weight ¼ 3 are important).
Relative criteria weight
Criteria C1 C2 C3 C4 C5 C6
HI 3 2 1 1 2 3
SI Partial Impairment 2 3 3 2 2 3
SI Full Impairment 0 3 3 2 2 3
HSI 3 3 3 1 2 0
an assistive technology application are not provided in
the article, then it is discussed by the research team for
its application and usability.
We introduce 13 criteria, as shown in Table 1, that
address different aspects of challenges facing the eight
impairments described earlier. The criteria have been
divided into different categories, including Essential
System Input (includes different technologies where at
least one is needed to provide input signal to the system
in order for the PWD user to communicate with the
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systems, and other people), Supporting System Input
(assists in utilizing relevant extra input technologies to
communicate with other people, systems or the environ-
ment, and is useful to have for supporting additional input
signal to the system), Essential System Output (includes
different technologies where at least one is needed to
provide output signal to PWD users to observe the
environment), Supporting System Output (assists in inter-
acting with interfaces and observing the environment, and
is useful to have for supporting additional signal to PWD
user) and System Processing (improves the accuracy of
results that will be sent to or read by PWD users). Each
criterion is assigned a weight according to its importance
level as shown in Table 2, and according to the group of
impairment conditions summarized in Table 3.
We assign each reviewed paper a score value in the
range of 0–10 for every criterion, based on the extent to
which the paper addresses this criterion. The scores are
elicited from experienced researchers, who follow a
clear methodology for the assessment through checking
for evidence of supporting technologies associated
with the criteria in the research paper, and we report
average scores. The following assessment guidelines
were to the researchers or evaluators for assessing the
reviewed papers: papers that have clear evidence of
the technologies associated with the criteria with
enough explanation and example can have score
between 8 and 10. Papers with clear evidence, but
with less description can have a score between 5 and 7.
Papers that might support technologies associated with
the criteria can have a score between 3 and 5. Papers
that have little support of the technologies associated
with the criteria can have a score between 1 and 2, and
papers that have no evidence of the criteria would have
a score of 0.
ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 5
C7 C8 C9 C10 C11 C12 C13 Total Weight
1 1 3 0 3 3 2 25
2 1 3 2 3 2 3 31
2 1 3 3 3 2 1 28
2 1 3 0 2 3 1 24
The weighted sums are then computed for each paper,
as shown in the ‘‘Assessment analysis’’ section. Using
these screening criteria, research papers belonging to the
same group of impairment conditions can then be
compared using the weight scores. We have used three
approaches for the weight scores and these are explained
in the following section: (1) percentage of essential
criteria score, which presents the coverage of essential
technologies needed for each paper in order to satisfy the
input/output requirements of PWD users, and determine
how well a particular paper fulfills the essential conditions
of that group; (2) percentage of important criteria score,
which presents an overall coverage of the important
technologies needed for certain impairment groups,
where papers based on the most significant criteria that
have weight of 3 would be considered to determine how
well a particular paper fulfills the important conditions of
that group; (3) percentage of overall criteria score, which
presents an overall coverage of the technologies related
to all criteria, where papers with high-weighted scores
would be considered appropriate in terms of meeting the
overall needs for a particular impairment group. In
addition, two other approaches are used to find the
overall assessment results of the important criteria relative
to other important criteria and relative to each other, and
it can be understood in the ‘‘Assessment analysis’’ section.
Using MWSM with multiple discussions to reduce the
variance in expert scores would have the benefit of
accurate quantitative and qualitative evaluation that
leads to better judgment of the quality of research
papers in covering the research criteria.
Assessment analysis
Let us assume that Xi is the score of paper x against
Criterion i (Ci), [which has a value between 0 and 10, and
depends on how well the paper supports the features
for criterion (i)].
Wi: is the relative Weight of Criterion-i (Ci), [that has a
value of 0 (not relevant), 1 (low importance), 2 (import-
ant), 3 (very important)]
X
13
Total assessment score for Paper-x ¼ Wi  xi ð1Þ
i¼1
 6 G. KBAR ET AL.

For example, the total weight of HI paper ¼ The fourth method is to find the overall percentage
P13
i¼1 Wi ¼ 25 as shown in Table 3, and the total score score of an important criterion for all researched papers
of paper: relative to others’ important criteria, using the following
formula.
x ¼ X1  3 þ X2  2 þ X3  1 þ X4  1 þ X5  2
þ X6  3 þ X7  1 þ X8  1 þ X9  3 þ X6  0 VðCjÞ=Max½VðCjÞ ð5Þ
þ X11  3 þ X12  3 þ X13  2 where V(Cj) is the total value of important criteria
The assessment methodology used in this paper is Cj that has a value ¼ 3, for n papers using for-
P P
based on five assessment approaches. mula ¼ ni¼1 ifðWj ¼ 3Þxj Þ= ni¼1 if ðWj ¼ 3Þ, and
Pn P
The first method is to find the paper’s percentage Max½VðCxÞ ¼ i¼1 if ðWj ¼ 3Þ10Þ= ni¼1 if ðWj ¼ 3Þ.
score against all criteria, which gives a comprehensive The fifth method is to find the overall percentage
idea of the paper’s coverage, using the following score of an important criterion for all researched papers
formula. relative to each other’s important criteria using the
formula.
X
13  X13
¼ Wi xi = Wi ð2Þ .X m .X m hX n i
i¼1 i¼1 ¼ VðCrÞ Cj ¼ VðCrÞ xi wi ð6Þ
j¼1 j¼1 i¼1
The second method is to find the paper’s percentage
where Cr is the criteria that have maximum weight ¼ 3,
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score against important criteria, which explains how the P

important criteria are addressed, using the following and m j¼1 Cj is the total score of all criteria, m is the total
number of important criteria and n is the total number
formula.
of research papers.
X
13  X13
¼ if ðWi ¼ 3Þxi = if ðWi ¼ 3Þ ð3Þ
i¼1 i¼1
Assumption
The score in Formula 3 is considered only, if the
Three different threshold measures were used to assess
logical weight of criterion i ðWi ¼ 3Þ is true or equals 1,
the satisfactory level for the different category (essential,
and ignored if the logical weight equals 0.
important and general) of the criteria. For essential
The third method is to find the paper’s percentage
criteria, the threshold should be 75% to have satisfac-
score against essential criteria, which explains how
tory level since, the evidence of the substitution
essential criteria are addressed, using the following
technologies associated with these criteria must be
formula.
high. While for important criteria, the threshold should
X
13  be 50% since the technologies associated with these
¼ ½if ðWi ¼ 3Þ&Wi 2 fEssentialListgxi =
criteria are needed to assist this group but are not
i¼1
ð4Þ essential. In addition, the threshold for general criteria is
X
13  chosen to be 35% since the technologies associated
½if ðWi ¼ 3Þ&Wi 2 fEssentialListg with these criteria are supplementary which can have
i¼1
additional benefit but are of less importance than other
essential or important criteria.
To determine the score of Essential criteria for system
input or output that have multiple technologies
associated with multiple important criteria, one would
Assistive technologies for hearing and speech
need to consider the maximum score of the related
impaired (HSI)
criteria. For example, if a research paper of Full HI Deafness and hearing impairment affects an individual’s
supports 2 essential important input criteria (C1, C6), ability to communicate with a companion at every
then we need to consider the maximum of these criteria stage in their life, especially when attending classes
as Max(C1, C6) while computing the score. Similarly, if and official meetings. According to the World Health
we have two essential important output criteria Organization,[1] around 360 million people, or 5.3% of
(C9, C11), then we need only the maximum of the world’s population, are suffering from disabling
these criteria Max(C9, C11) while calculating the score. hearing loss. The figure is around 11 million in the
Then the percentage score of the essential criteria Middle East and North Africa region including Saudi
of paper x would be: [Max(C1, C6)*3 + Max(C10, C11)*3]/ Arabia.
Total-Selected-Max-Score ¼ [Max(C1, C6)*3 + Max(C10, As described in the ‘‘Assessing research papers using
C11)*3]/10*(3 + 3). multi-weighted scoring model’’ section, this article
 ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 7

Table 4. Relevant criteria of HSI.

C1 C2 C3 C9 C12
Speech to text Keyboard or touch screen or remote Gesture control using sensor or camera Display system Mobile support

Table 5. Assessment table of HSI.

Input Output Processing Percentage of
Percentage of Percentage of essential criteria
important criterion. all criterion using (C1 or C2 or C3, and C9)
C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13 using formula 3 formula 2 using formula 4
Weightage 3 3 3 1 2 0 2 1 3 0 2 3 1
HSI-1 0 0 8 0 0 7 0 0 6 2 1 0 0 28% 18% 70%
HSI-2 7 1.5 8.5 0 0 7 0 1 7.5 3.5 0 0 0 49% 31% 80%
HSI-3 0 0 7 0 1.5 1 0 0 8 1 0 0 0 30% 20% 75%
HSI-4 5 2.5 9.5 0 0 9 0 0 5.5 0 0 8 0 61% 38% 75%
HSI-5 5 3 10 0 0 3 0 0 4.5 0 0 4 0 53% 33% 73%
HSI-6 0 1.5 8 0 0 6 0 0 0 3 0 0 0 19% 12% 40%
HSI-7 7 4.5 5 6 7 8 0 0 8 0 0 7 0 63% 48% 75%
HSI-8 0 1.5 7.5 5 0 9 0 0 10 3 5.5 7.5 0 53% 40% 88%
HSI-9 0 0 1 9.5 9 0 0 0 9 0 0 0 0 20% 24% 50%
HSI-10 0 0 1 10 9 0 0 0 0 0 0 0 0 2% 13% 5%
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Average percentage result 38% 28% 63%

identified 13 criteria to assess research papers based on
different impairment conditions. The relevant and most
important criteria (with weight ¼ 3) for the assessment
group HSI (hearing and speech impairment) are high-
lighted in brown in Table 4, where C1, C2, C3, C9 and
C12 would be valuable technologies that can assist this
group.
We applied the assessment method described in
Table 5 by computing the average assessment of 2–3
experienced researchers. Table 5 lists the average scores
of those researchers for the 10 papers we assessed and
that are related to HSI according to the multi-weighted
scoring method discussed in the ‘‘Assessing research
papers using multi-weighted scoring model’’ section.
This table also presents the percentage of all criterion
using formula 2, the percentage of important criterion
using formula 3 and the percentage of essential criteria
using formula 4.
Researchers in the past have developed and imple-
mented various technologies to assist people with
hearing and speech impairments for communicating
with others. Paper HSI-1 in Table 5 [6] developed a sign
recognition system where the input sign language
gesture is fed to a camera. The signal is then processed
by a computer which already has a pre-defined database
to match and recognize the input gesture. The system
provides output as verbal word and text on a screen to
send to non-impaired receiver. The system does face a
number of limitations. Considering criterion C12, where
the served individuals cannot be mobile because it
works with a computer and stationary camera, it
recognizes only Arabic language, and it requires a
huge pre-defined database and lot of training for the
user. The paper proposes a new device for deaf and
dumb but it is lacking basic support features also for the
hearing disabled as it does not provide features from the
defined criteria C1 and C2 to enable deaf to communi-
cate with others.
Paper HSI-2 of Table 5 [7] also proposed a similar
solution to M. Al-Rousan where the user would need to
prepare a database for themselves. The computer
employed on this system will be trained to recognize
the color of skin of the user which will then process
through a series of complicated procedures of skin
detection, extraction, calibration and comparison. The
skin color is detection is used for differentiating it from
the background color. An algorithm called Support
Vector Machine handles all the processing. The system
was not found to be efficient in recognizing too many
and complex gestures because of technical constraints
in the system. The paper addresses C1, C3 and C9 with
low complexity but is lacking the support of C2 and C12
which are important for inputting commands and
offering mobility to the user.
Another type of gesture recognition system using a
camera was developed by paper HSI-3 of Table 5 [8].
Their system was built to recognize only 32 gestures
where the user would build a database by storing a
particular word with each gesture before using the
system. The system was made to recognize the up/down
position of fingers in one hand and then convert the
signal to binary numbers of 5 characters (e.g. 1,0,1,1,0). It
would then be converted to a decimal number and the
associated word is played and displayed as output. The
 8 G. KBAR ET AL.
system attained high accuracy but it was limited to
recognition of only 32 words, which will have to be
remembered always by the user making it difficult to be
practical. In this paper only C3 and C9 are addressed
significantly whereas research gaps could still be
reduced to deliver other support from relevant criteria.
A system for mobile phones has also been developed
to recognize hand gestures by paper HSI-4 of Table 5 [9].
An Android application was developed where the
camera would identify the gesture and the phone
would generate audio as well as text output previously
associated with the gesture. Hence, it removes the
requirement of special equipment to be carried. The
system lacks any functionality for the hearing disabled,
though it claims to be serving both deaf and dumb. This
article was evaluated to have strongly addressed C3 and
C12 but did not provide much support for input like
speech to text or keyboard.
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Researchers in this field have also implied neuro-fuzzy
system for detection of sign language as described by
paper HSI-5 of Table 5.[10] This system uses a camera for
video input and converts the image into devanagari
spoken language as audio output. It detects and
compares extreme points of fingers to the existing
database. This article got high score on C10 but was not
found strong in all other criteria for easing communica-
tion for the hearing disabled, providing display system
or mobility. However, the system was evaluated to have
addressed the necessary criteria on a medium scale
which means there is still scope of advanced research in
this technology.
Another project targeted at gesture recognition
where the user does not have to stay in front of
camera is presented by paper HSI-6 of Table 5.[11] The
user would just remain in a specified range of the Wi-Fi
network and make a gesture. The gesture would be
detected by the system using Doppler shift phenom-
enon and played on a speaker after matching with a
predefined pattern. Only C3 criterion is served in this
article while all others are ignored, and the paper does
not offer any relevant feature for the hearing impaired as
claimed.
Other technologies have been used and developed by
researchers for gesture generation and recognition.
Some have employed flex sensors. Paper HSI-7 of
Table 5 [12] created a prototype for deaf and dumb.
The speech disabled would wear flex sensors that
change resistance according to a degree of finger
bend. Different voices were pre-stored in the system
and played on a speaker with associated gestures. For
the deaf people, communication is established through
an Automatic Speech Recognition System (ASR). A non-
disabled person needs to train the system using Hidden
Markov Models (HMM) and the output is displayed as
text at a screen on the system itself. In our assessment,
the paper has covered fairly in overall criteria and
specifically C1, C9 and C12, which can be good example
for HSI group. Some researchers worked on tracking the
movement and performance of the disabled automatic-
ally using various technologies.
Paper HSI-8 of Table 5 [13] used flex sensors as the
input device to make gestures. The system contains a
microcontroller that encodes the incoming sign and
converts it into text and audio signal. The paper strongly
addressed criteria C3, C9 and C12 where it could still be
improved by providing speech to text and touch screen
input facility.
Paper HSI-9 of Table 5 [14] demonstrated the use of
wearable sensors for observation of daily routine
activities of disabled. The sensors monitor the move-
ment of users continuously. The technology was built
upon a behavior modeling method based on HMMs. The
system claimed to detect even small movements while
sleeping and could display and activity pattern on the
screen. Nevertheless, our assessment found the paper
has covered well C9 but it has limitation in serving deaf
and dumb specifically for communication.
Different approaches for monitoring PWD was
adopted by paper HSI-10 of Table 5.[15] They used
several wide angled cameras installed around a home.
Five routine activities like standing, sitting, etc. were
targeted to be monitored. Support Vector Machines
(SVM) and hybrid classifiers were used for formulating a
detection algorithm. Despite being successful in detect-
ing movements, these papers did not meet any of the
essential criteria defined by us as it did not offer any
features for the deaf and dumb. This paper covered C4
(tracking location) and C5 (sensor behavior) well, which
could be an example for tracking behavior that is not
critical for HSI but it is relevant for the general criteria
defined for HSI.
As shown in Table 5, the average of overall percent-
age covering the essential criteria was 63%. Coverage of
important criteria was 38%, and coverage of overall
criteria was 28%. By applying the terms explained in the
‘‘Assumption’’ section, the number of papers covering
 75% of essential criteria on an average is 5 out of 10 or
50%. The number of papers covering  50% of import-
ant criteria on an average is 4 out of 10 or 40%. And the
number of papers covering  35% of all criteria on an
average is 3 out of 10 or 30%. These results indicate that
not all papers covered the essential criteria well for HSI
group which would not satisfy the needs of this group.
In addition, since 40% of the papers covered important
criteria reasonably, there is a room for further research to
cover multiple technologies for system input/output to

Table 6. Assessment results of HSI group.
Assessment parameters
Total value of important criteria
Percentage of coverage level of important criteria relative to maximum
of specific criteria by applying Formula (5)
Percentage of coverage level of important criteria relative to each
other by applying Formula (6)
provide extra flexibility to PWD users in choosing
relevant technology for them to substitute missing
sensation caused by their impairment conditions. There
is low percentage of the 10 research papers in providing
a comprehensive solution to address all criteria.
Covering all criteria would add a great flexibility to
PWD users in practicing multiple technologies in one
solution. Hence, further research should be done to find
more comprehensive solutions that can address the
need of HSI group through the support of multiple
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technologies associated with important criterion as well
as overall relevant criterion which make HSI group more
comfortable in utilizing such solution. The technologies
associated with relevant criteria for HSI people that need
further investigation would be analyzed and determined
in the next section.
Level of coverage of the features associated with
important criteria for HSI group
In this section, we described the coverage of different
criteria in relation to the sum of maximum scores of
important criteria, as well as comparing the coverage of
each criterion in relation to other criteria (Table 6). In
addition, the percentage of coverage for the overall
criteria of the 10 papers is also presented where the
average of overall percentage of all criteria for HSI is 28%
[by applying Formula 2], as shown in Table 5. This result
indicates that further research is required to improve the
coverage of all criteria relevant to the HSI group; the
specific criteria that require further research are
explained in the sub-sections below.
Assess the coverage or relevant criteria in
relation to the maximum value for HSI
Table 6 illustrates the results by applying formulas (5)
and (6) to determine the average percentage for
covering each criterion in relation to the accumulated
sum of all criteria, as well as in relation to each other.
For hearing and speech impaired, criteria C3 (gesture
control) and C9 (display system) are covered well among
these 10 papers while criteria C1 (speech to text), C2
(keyboard or touch screen) and C12 (mobile support) are
not addressed well. To get more accurate result in
ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 9
C1 C2 C3 C9 C12
72 43.5 196.5 175.5 79.5
24% 15% 66% 59% 27%
13% 8% 35% 31% 14%
relation to essential criteria for HSI and identifying the
research gaps for this group, a more comprehensive
review of the literature need to be done. Table 6 shows
that C3 and C9 have highest coverage among these
relevant criteria relative to maximum score with values
of 66 and 59%, respectively. These are followed by C1,
C2 and C12 which have a coverage value of 24, 15 and
27%, respectively which are considered low. This leads to
the conclusion that further research in relation to C1, C2
and C12 should be conducted to improve the conditions
for HSI individuals.
Assess the coverage of important criteria for HSI
relative to each other’s score
Table 6 shows that C3 and C9 have the highest coverage
among the relevant criteria with values of 35 and 31%,
respectively. These are followed by C12, C1 and C2
which have relatively low scores with value of 14, 13 and
8%, respectively. This low coverage of C1, C2 and C12
leads to the same conclusion as stated above that these
criteria need further research.
Assistive technologies for hearing impaired
For hearing impaired (HI) individuals, we defined some
important technological parameters which are necessary
for this individual to behave normally in a public
environment. We define the parameters as: Speech to
text (C1) to understand spoken text, Text to Speech (C6)
to type and convert text to audible voice, Display System
(C9) to read system input/output and Haptic Feedback
(C11) which helps HI to receive alert signals through
vibration in the device or a flashing light as shown in
Table 7. In addition, importance of having a mobile
support (C12) using phone, tablet or any wearable
equipment has been identified for free movement of the
user.
Table 8 lists the average scores of those researchers
for the 17 papers we assessed, and that are related to HI
according to the multi-weighted scoring method dis-
cussed in the ‘‘Assessing research papers using multi-
weighted scoring model’’ section. This table also pre-
sents the percentage of all criterion using formula 2, the
 10 G. KBAR ET AL.

Table 7. Relevant criteria for HI.

C1 C6 C9 C11 C12
Speech to text Text or digital mapping to speech Display system Haptic or visual feedback Mobile support

Table 8. Assessment table of HI.

Percentage of
Percentage of Percentage of essential criteria
Input Output Processing important criterion. all criterion (C1, and C6 or C9)
using formula 3 using formula 2 using formula 4
C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13
Paper HI-1 9.5 10 0 0 0 0 6 0 9 0 1.5 0.0 0.0 40% 34% 93%
Paper HI-2 0.0 7.7 0.0 0.0 0.0 0.0 7.7 4.7 9.0 0.0 0.0 0.0 0.0 18% 22% 45%
Paper HI-3 0.0 7.5 0.0 0.0 0.0 0.0 0.0 0.0 10.0 0.0 0.0 0.0 0.0 20% 18% 50%
Paper HI-4 10.0 1.5 0.0 0.0 0.0 0.0 0.0 0.0 10.0 0.0 0.0 1.5 0.0 43% 27% 100%
Paper HI-5 9.7 0.0 10.0 0.0 0.0 6.0 0.0 0.0 10.0 1.0 3.3 0.0 0.0 58% 39% 98%
Paper HI-6 9.7 10.0 0.0 0.0 0.0 8.7 0.0 0.0 8.7 9.3 9.3 10.0 9.7 93% 71% 92%
Paper HI-7 4 4 0 0 3 5 1 0 4 5 4 3 0 41% 30% 45%
Paper HI-8 0 6 1 0 9 0 0 0 9 0 0 0 0 17% 23% 43%
Paper HI-9 0.0 1.5 0.0 0.0 0.0 0.0 0.0 0.0 1.5 6.5 0.0 0.0 10.0 3% 11% 8%
Paper HI-10 8.0 1.5 0.0 0.0 5.0 8.0 0.0 0.0 2.0 5.5 0.0 0.0 8.0 24% 26% 50%
Paper HI-11 6.5 2.0 0.0 0.0 7.5 7.0 0.0 0.0 0.0 7.0 0.0 0.0 8.0 16% 24% 40%
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Paper HI-12 0.0 2.0 0.0 0.0 7.5 4.0 7.5 7.5 10.0 6.5 0.0 0.0 2.5 28% 32% 50%
Paper HI-13 10 0 0 0 0 0 0 0 10 4.0 0.0 0.0 0.0 40% 24% 100%
Paper HI-14 0 0 0 0 10 0 0 0 1 6.5 0.0 4.0 0.0 10% 14% 5%
Paper HI-15 8 0 0 0 7 8 0 0 0 9 10 0 7 50% 41% 75%
Paper HI-16 0 6 0 0 8 0 0 0 10 10 10 0 8 40% 41% 50%
Paper HI-17 0 0 0 0 8 0 0 0 0 5 9 0 0 18% 17% 0%
Average percentage result 33% 29% 55%

percentage of important criterion using formula 3 and
the percentage of essential criteria using formula 4.
Software was developed to work on a computer that
converts speech to text and enables deaf people to talk
over VoIP calls as described by paper HI-1 (Table 8).[16]
The user would normally speak and receive text
messages from the other end at every pause in
speech. According to HI parameters, this article scored
high on C1 and C9 but it did not serve the individuals
with disabilities on the remaining parameters C6, C11
and C12 where there is an opportunity to develop this
software for mobile phones with an added feature of
text to speech conversion. This allows the user to just
type the message in a noisy environment and the
receiver can listen to it synthetically.
Paper HI-2 of Table 8 [17] studied the effect of
using graphical icons instead of hypertext links in
accessing a website. They designed a website using
graphical icons for the hearing disabled. They analyzed
the system by measuring response time and disorienta-
tion accomplishment time of the users. This paper
addresses only one essential criterion C9 whereas all
other criteria were ignored. The limited coverage of
important criteria could be related to focusing on web
interface only to evaluate interaction with HI user which
is fine for addressing less important criteria to assist
further the HI group.
Another research group developed a website espe-
cially for the deaf with sign language and icons to
enhance motivation for a hearing impaired person while
navigating virtual environments as described by paper
HI-3 of Table 8.[18] The system had pre-designed stories
that would display text and play videos with sign
language for the learning of students. This article was
also found to be addressing only parameter C9. Again a
limited coverage of all important criterion could be
associated to limited scope of interfacing of HI user to
web application.
Other types of systems were created where speech
would be converted to sign language for the hearing
disabled. Paper HI-4 of Table 8 [19] developed software
to capture speech through a recognition mechanism
and convert it to Arabic sign language. The system
worked on a PC where avatars making sign language
gestures would be displayed for the deaf. It contained
pre-defined databases of images of words of sign
language and another one of avatars to match with
corresponding word and play to the user. This article
addresses C1 and C9 significantly but it could be
improved further by supporting C6 and C12.
A system called Tessa was fabricated and tested paper
HI-5 of Table 8 [20] to aid communication between a
deaf person and a post-office clerk. It would convert the
clerk’s speech to British sign language and be played by
an avatar on a screen. The speech recognition could be
trained for the speaker’s voice, which would increase the
system’s recognition performance. The paper addressed
C1 and C9 significantly and covered C6 reasonably.

Instead of introducing new technologies some
researchers focus on evaluating existing works. Paper
HI-6 of Table 8 [21] evaluated main utility features of 10
mobile applications that claimed to assist as replace-
ment of hearing aids. The applications were evaluated
on services offered like hearing tests, possibility of
creation of personal profile, mic support etc. The paper
ignored user feedback in usage of applications. All
parameters were assessed to be significantly addressed
in this paper including C1, C6, C9, C11 and C12. This
article presents a good example for addressing the need
for HI people.
Other researchers evaluated effect of environment
factors such as inadequate support systems such as
hearing aids on people’s career choices and develop-
ment as described by paper HI-7 of Table 8.[22] The
survey was done by using forced choice and open-
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ended questions about disabled’s work experience since
leaving their university. The average score of this article
is related to the purpose of having survey instead of
providing relevant solution to HI.
A concept was built to study an online community
that provides education support for individuals with
hearing impairment as described by paper HI-8 of
Table 8.[23] Factors were grouped into categories
including hearing loss and education to link to aspects
such as identity, community building and connections
between communities. The aspects and factors were
aligned into the model in a way that the aspects were
built upon each other, whereas the impacts of the
factors were also investigated. This article was found to
address only C9 and neglecting others.
Paper HI-9 of Table 8 [24] studied the usage of a
certain noise reduction algorithm to improve sound
quality for the partial-severely impaired disabled. It was
found that output of noise reduction algorithm was not
significantly affected by degree of hearing impairment of
the user. This article focuses only on noise reduction
effect and not on whole solution for HI. This article did
not cover well the all relevant criteria but addressed C10
and C13.
Another investigation was done by paper HI-10 of
Table 8,[25] to assess whether auditory training in noise
would improve speech recognition in noise for chil-
dren with hearing impairment. The disabled were
divided in 3 groups and trained in Auditory Training
Interrupted (ATI), Auditory Training Continuous (ATC)
and Control. It was found that people trained on ATI
performed better than other groups. This paper
addressed C1, C6 and ignored C9, C11 and C12 where
these features could provide additional support for the
disabled person.
ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 11
Paper HI-11 of Table 8 [26] also analyzed the
magnitude of problems in listening with various types
of background noises. The paper found some factors
that contribute to difficulty beside natural ailment like
Reduced Frequency selectivity and Loudness recruit-
ment. It was also attempted to compensate the effect of
these problems using signal processing and amplitude
compression methods. The paper covered C1 and C6 as
it focused more on C5, C7 and C10 which are non-
relevant criteria for HI but it could be relevant for HI with
low vision.
Another study was conducted by paper HI-12 of
Table 8 [27] on response of phrases played to HI people
masked by noise on pupil of human eye. Significant
dilation in the pupil was observed by the study when the
user listened to the phrases with fluctuating noise or
disturbance by a single-talker. The paper provided an in-
depth analysis on pupil response of HI people while
having conversation in noisy environment. This article
focused on studying the behavioral effect of noise on
eye pupil dilation. This article did not address all relevant
essential criteria except C6 and C9 and focused its
research on non-relevant less-relevant criteria C5, C7, C8
and C10 as this paper focused on studying the behav-
ioral effect of noise on eye pupil dilation.
Paper HI-13 of Table 8 [28] created a video watching
system for the hearing disabled by generating word-by-
word scripts so that HI could track the speech. The voice
is also controlled by the system so that the user can
understand the emotion of played character. Solution of
this article would be improved by providing this system
on mobile devices or by supporting text entered by user
to be converted to speech so user can see their spoken
words. The paper covered C1 and C9 significantly but
did not address other relevant criteria as these were not
covered by its scope.
A study on children’s use of and attitudes towards
hearing devices was conducted by paper HI-14 of
Table 8.[29] The study found out that males view
hearing technology more positively than do females.
Having severe haring loss also promoted positive
attitudes toward hearing aids and cochlear implants.
As this article just surveyed the attitudes of users, it was
not able to properly address any of the relevant essential
criteria for HI. However, it covered C5 significantly which
is behavior analysis.
Paper HI-15 of Table 9 [30] proposed music hearing
system for partially deaf. The system was fitted on a chair
which also gave haptic feedback according to the beats
and notes in the music to enhance the disabled person’s
listening experience. Along with haptic feedback, visual
display was provided that played abstract animations
 12 G. KBAR ET AL.
Table 9. Assessment results of HI group.
Assessment parameters
Total value of important criteria
Percentage of coverage level of important criteria relative
to maximum by applying Formula (5)
Percentage of coverage level of important criteria relative
to each other by applying Formula (6)
from the components of music which offered better feel
of hearing to the deaf person. This article addressed C9
and C11 significantly for offering a display system and
haptic feedback. However, covering other relevant
criteria C1, C6 and C12 would make this solution more
relevant for HI users.
Another research by paper HI-16 of Table 9 [31]
featured a chair with haptic feedback that helped in
providing speech therapy to the person with partial
hearing impairment. The chair produced vibrations with
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voice of user as well that of speech therapist. Also, the
disabled would hear amplified voice through head-
phones. The system tended to improve the vocal ability
of the user in a few weeks. Among relevant criteria, C1, C6
and C11 were covered reasonably leaving gap for further
research in C9 and C12 where user could use feature of
mobility and a display system for improving accessibility.
Paper HI- of Table 9 [32] developed a prototype
system of a haptic chair to assist the speech therapy
process for deaf and hearing impaired people. The chair
produces the vibrotactile stimulation to certain body
parts (palms and fingers) based upon the sound
produces by the impaired person. The authors tried to
evaluate that how much the haptic chair will have
positive effect on deaf individuals during speech therapy
process. A performance evaluation study on 20 students
were performed, and it was found out that the students
who used the haptic chair give better result with
significant differ starting from week 12.
As shown in Table 8, the average of overall percentage
covering the essential criteria was 55%, covering the
important criteria was 33%, and covering all criteria was
29%. By applying the terms explained in the
‘‘Assumption’’ section, the number of papers covering
essential criteria by average 75% is 6 out of 17 or 35%,
the number of papers covering important criteria by
average 50% is 3 out of 17 or 18%, and the number of
papers covering all criteria by average  35% is 4 out of
17 or 24%. These results indicating that the majority of
the 17 papers did not covered the essential criteria well
with 35% for HI group which would not satisfy the needs
of this group. In addition, since 18% of the papers
covered important criteria reasonably, there is a need for
further research to cover multiple technologies for system
input/output to provide extra flexibility to PWD users in
C1 C6 C9 C11 C12
209 119.5 311.5 141.5 56.5
41% 23% 61% 28% 11%
28% 14% 37% 17% 7%
choosing relevant technology for them to substitute
missing sensation caused by their impairment conditions.
There is low percentage of the 17 research papers of 18%
in providing a comprehensive solution to address all
criteria that add great flexibility to PWD users in practicing
multiple technologies in one solution. Hence, further
research can be done to have more comprehensive
solution that can address the need of HI group through
the support of multiple technologies associated with
important criterion as well as the overall relevant criterion
which make HI group more comfortable in utilizing such
solution. The technologies associated with relevant
criteria for HI that needs further investigation would be
analyzed and determined in next section.
Level of coverage of the features associated with
important criteria for HI group
In this section, we described the coverage of different
criteria in relation to the sum of maximum scores of
important criteria, as well as comparing the coverage of
each criteria in relation to other criteria (Table 9). In
addition, the percentage of coverage for the overall
criteria of the 17 papers is also presented where the
average of overall percentage of all criteria for HI is 29%
(by applying formula 2) as shown in Table 8. This result
indicates that further research is required to improve the
coverage of all criteria relevant to the HI group; the
specific criteria that require further research are
explained in the sub-sections below.
Assessing the coverage or relevant criteria in
relation to the maximum value for HI
Table 9 illustrates the results by applying formulas (5)
and (6) to determine the average percentage for
covering each criterion in relation to the accumulated
sum of all criteria, as well as in relation to each other.
For hearing impaired, C1 (speech to text) and C9
(display system) are covered well among these 17 papers
while criteria C6 (text to speech), C11 (haptic feedback)
and C12 (mobile support) are not addressed well.
Table 9 shows that C1 and C9 have highest coverage
among these relevant criteria relative to maximum score
with values of 41 and 61%, respectively. These are

followed by C6, C11 and C12 which have a coverage
value of 23, 28 and 11%, respectively. This leads to the
conclusion that further research in relation to C6, C11
and C12 should be conducted to improve the conditions
for hearing impaired people.
Assess the coverage of important criteria for HI
relative to each other’s score
Table 9 shows that C9 and C1 have the highest coverage
among the relevant criteria for HI with values of 37 and
28%, respectively. This are followed by which have low
scores with value of 14, 17 and 7%, respectively. This low
coverage of C6, C11 and C12 leads to the same
conclusion as stated above that these criteria need
further research, as supporting these criteria for HI
would be beneficial for utilizing the text to speech
facility, for providing haptic feedback and for supporting
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mobility application for these people.
Assistive technologies for speech impaired (SI)
Speech impairment is a condition in which the ability to
produce speech sounds that are necessary to commu-
nicate with others is impaired. Speech impairments can
be mild, such as occasionally mispronouncing a couple
of words, to severe, such as not being able to produce
speech sounds at all.
We have assessed seven articles concerned with the
technological solutions developed for supporting peo-
ples with speech impairments.
The significant criteria that are relevant to full SI and
partial SI group which have maximum weight value of 3
and value of 2 for C1 for SI are as following (Tables 10
and 11, respectively):
The rest of criteria are of less importance for the
speech impairment group such as ‘‘C1: Speech to text,
C4: Tracking location using sensors, etc. The assessment
of each paper of this impairment group has been done
by at least two researchers. Table 12 lists the average
scores of those researchers for the seven papers we
Table 10. Relevant criteria for full SI.
C2 C3 C6
Keyboard or touch Gesture control using Text or digital
screen or remote sensor or camera mapping to speech
Table 11. Relevant criteria for partial speech impairment.
C1 C2 C3 C6
Speech Keyboard or Gesture control Text or
to text touch screen using sensor digital mapping
or remote or camera to speech
ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 13
assessed and that are related to SI according to the
multi-weighted scoring method discussed in the
‘‘Assessing research papers using multi-weighted scoring
model’’ section. This table also presents the percentage
of important criterion using formula 3, and the percent-
age of essential criteria using formula 4.
Paper SI-1 of Table 12 [33] presented an artificial
speaking mouth for speech impaired persons. PWDs
with speech disabilities wear flex sensors for commu-
nicating by making gestures which gets converted into
text and then be played as voice. The gestures are
English Alphabets only. It is a standalone system. The
system is based on motion sensor. It works in coaching
mode and operation mode. In coaching mode, a
database was created with template motions using
alphabets and stored in a microcontroller. The user
needs to remember particular finger angles for each
alphabet, where there are total 256 gestures to be
learned. The PWD can benefit by using this system for
communication with normal person. In addition, the
system is compact and can be carried around. The
criterion that allows PWD with SI to use adjustable
speaker level and getting visual feedback are not
covered well in this article.
Paper SI-2 of Table 12 [34] presented a new form of
augmentative and alternative communication (AAC), as
well as the Voice-Input Voice-Output Communication
Aid (VIVOCA). The proposed VIVOCA recognizes dis-
ordered speech and converts it into synthetic speech
used to communicate with normal person. They used a
new methodology for building small vocabulary and
speaker dependent Automatic Speech Recognition (ASR)
with reduced amount of training data. The system was
developed on a PDA and is in prototype stage. The
processing consists of speech recognition, message
building, speech synthesis and audio output. The user
speaks disordered speech into a mic and speech is
recognized and processed by speech synthesizer. The
recognized words are sent to a message building
module. The module sends feedback to synthesizer
where the audio is played. Small vocabulary is required
C9 C10 C11
Display Auto adjustable Haptic or visual
system Speaker and feedback (vibration
Volume control or flashing
C9 C11 C13
Display Haptic or Haptic feedback
system visual feedback (vibration or flashing)
(vibration or flashing
 14 G. KBAR ET AL.

Table 12. Assessment results of SI.

Input Output Processing
Criteria Total scores for each paper
Weight (PSI) 2 3 3 2 2 3 2 1 3 2 3 2 3 Percentage Percentage percentage of percentage of
Weight (FSI) 0 3 3 2 2 3 2 1 3 3 3 2 1 coverage coverage essential coverage essential coverage
of important of important (C1 or C2 or C3, and (C1 or C2 or C3, and
criteria for PSI criteria for FSI C6 or C9), PSI C6 or C9), FSI
SI-1 0 0 8.5 0 0 8.5 0 0 7.5 3.5 0 8 0 37% 47% 85% 85%
SI-2 9.5 7.5 0 0 0 9 0 0 9 1.5 0 8 1.5 50% 45% 92% 83%
SI-3 0 0 8.5 0 0 7 0 0 0 2 0 0 0 23% 29% 78% 78%
SI-4 0 1 8.5 0 0 0 0 0 4.5 0 0 0 0 21% 23% 43% 43%
SI-5 0 0 10 0 0 9 0 0 0 10 1.5 0 6 40% 51% 95% 95%
SI-6 0 10 0 0 0 10 0 0 10 6.5 0 6 5 53% 61% 100% 100%
SI-7 0 1 8.5 0 0 0 0 7 7.5 0 0 0 0 26% 28% 43% 43%
Average percentage result 36% 41% 76% 75%

to be stored by each user. These samples were used to
train the system using Hidden Markov Models with an
algorithm named Baum–Welch algorithm. The advan-
tages include the ease with which the device can
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touch screen, while at the same time it lacks the support
of feedback to user and mobility which are important for
SI people.
Paper SI-4 of Table 12 [36] tried to build a neural

facilitate the communication between persons with
speech disorder by allowing them to build phrases
using word-by-word recognition system. However, the
disadvantages include: low accuracy of 67%, the inter-
face can hold only few words at one time, and that the
system was not found user friendly by all participants in
testing. A switch had to be pressed each time the user
wanted to start communicating. This article has a good
coverage for partial SI, whereas still relatively acceptable
for full SI, the other relevant criteria to full SI, like (C3,
C10 and C11) are not covered well. Supporting Haptic or
visual feedback as well as vibration in this article would
make the solution friendlier.
Paper SI-3 of Table 12 [35] proposed a new device
called ‘‘Virtual Voice’’ that makes use of a sensor which
the user fits on their lips. The user then would just speak
the word without any sound. The device utilized AG-500
Articulograph sensor. The sensor tracked the space
between several predefined points on the lips and fed
this data to a software for processing and generating
output voice. The space was plotted with its corres-
ponding Speech Assessment Methods Phonetic
Alphabet (SAMPA) code. The software was called
PHONWEB to which the SAMPA code was fed in as
input. The main advantage of the proposed system is
that it can be used by illiterate person. However, the
limitation of the system is that, to make it friendlier by
developer, it was developed for PC only. Also, the
algorithm is not available for JAVA mapping. The
coverage of important criteria for this PSI and FSI are
relatively low since some of the relevant criteria to
partial SI, like (C1, C2, C9, C11 and C13) are not covered
well, and also, the relevant criteria to full SI, like (C2, C9,
C10 and C11) are not covered well. The papers focuses
on sensors as input instead of supporting keyboard and
network that could be used to recognize only static
hand gestures of Japanese sign language. They used
data gloves with flex sensors for each finger. For testing
purpose, a data glove was worn by an expert Japanese
sign language user. The glove was fitted with five
sensors and was used as the input device for the system.
Three experts were asked to wear the gloves and make
static Japanese sign language gestures. The neural
network was built by the authors using commercially
available neural network development tool. The input
data from gloves was used to train the system. Training
was conducted 10 times per training set of particular
gestures. Total 25 gestures out of 41 were used for
training purpose. Testing was conducted after prepar-
ation of each training set. The testing gestures were not
used for training. The disadvantages of the proposed
system associated with the system that works on static
gestures only. That is, the user has to hold the gesture
for the system to read, in addition to very low accuracy
of 45% of recognition. Furthermore, the sensors failed to
recognize the differences in gesture directions. Finally,
the technology is still in early stages of development
and also does not hold any special feature over other
existing technologies such as flex sensors. This article
developed a prototype for training and testing purpose
and not for providing a comprehensive solution for SI.
The coverage of important criteria for PSI and FSI are
relatively low since some of the relevant criteria to
partial SI, like (C1, C2, C6, C9, C11 and C13) are not
covered well, and also, the relevant criteria to full SI, like
(C2, C6, C9, C10 and C11) are not covered well.
Paper SI-5 of Table 12 [37] developed a glove system
for deaf and dumb persons, which can convert the sign
language to synthesized speech. The system consists of
a leather glove, flex sensors, AVR ATMEGA32L

microcontroller, SpeakJet sound synthesizer and LM386
sound amplifier. Software used to develop the system
are; AVR Studio 4, Magnevation Phrase Translator for
SpeakJet V1.4, OrCAD 10.0 and ISP Programming. The
glove that equipped by flex sensors need to be worn by
user’s finger in order to generate input signal even with
small bend of the finger. The signal is handled by circuit
for amplification and signal processing, and then fed to
AVR microcontroller for digital conversion. The output
signal of the AVR is sent to Speak-Jet that has
Mathematical Sound Architecture (MSA) and predefined
spoken words according to the received signal from
AVR. The spoken words are combined to make sentence,
where the SpeakJet uses synthesizer to enhance its
volume. The benefits of the proposed system are that it
is easy to use, portable and requires low power. Among
the systems’ disadvantages, are that the system is not
water resistant and relatively, few number of messages
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(32) had been programmed for 32 gestures with
maximum 243 messages can be programmed. The
paper could provide additional benefit to SI group if a
display system (C9) and the support of feedback (C11)
are supported well. In addition, the input method using
sensor could complement other technology needed for
SI group such as keyboard and touch screen as well as
speech to text for partial SI.
Paper SI-6 of Table 12 [38] designed a speech
synthesizer, which could receive text input through a
touch screen or a cell phone keypad and convert the
text into a speech to help speech impairment individuals
to speak. The system consists of a cell phone keypad to
input text and a screen to monitor the input text by user,
a speech synthesizer IC is used to process the data to a
speech signal and a speaker to produce the speech
output of the system, and microcontroller board is
responsible for the communication between the hard-
ware boards. The authors designed an algorithm that
processes each letter symbol of input text at a segment
and then compounds each phoneme to generate the
final speech as one signal. The system could help the
speech impairment to make conversations with others.
The disadvantage is that the system has no option to
save templates for the user and each time the user has
to enter all text he needs to convert to a speech. This
article has a very good coverage for the relevant criteria
for both partial and full SI.
Paper SI-7 of Table 12 [39] presented a design of three
action recognition algorithms for gaming consoles for
public places. They also proposed the design of gesture
based interface for a game for public setting. Algorithms
were developed for recognition of the complex actions
using a webcam only. The system is claimed to have fast
and robust interpretation of hand gestures which can
ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 15
support SI people. The proposed system has the benefit
of supporting gesture control that was found to be user
friendly and beneficial, especially for SI. The algorithms
presented in this article could be integrated with other
solutions to improve the support of input control for
people with SI that would be helpful for SI people to use
sensor for gesture control along with keyboard and
touch screen.
As shown in Table 12, the average of overall
percentage covering the essential criteria for PSI and
FSI were 76 and 75% consecutively, and covering the
important criteria for PSI and FSI were 36 and 41%,
respectively. By applying the terms explained in the
‘‘Assumption’’ section, the number of papers covering
essential criteria by average  75% for PSI is 5 out of 7 or
71%, and for FSI is also 5 out of 7 or 71%. The number of
papers covering important criteria by average  50% for
PSI and FSI are 2 out of 7 or 29%. These results indicate
that the majority of the seven papers for PSI and FSI
covered the essential criteria well for SI group which
would satisfy the needs of this group. However, since
29% of the papers covered important criteria reasonably,
there is a need for further research to cover multiple
technologies for system input/output to provide extra
flexibility to PWD users in choosing relevant technology
for them to substitute missing sensation caused by their
impairment conditions. The low percentage of covering
important criteria by average of 29% indicate that
majority of the papers did not provide a comprehensive
solution to address important criteria that add great
flexibility to PWD users in practicing multiple technol-
ogies in one solution. Hence, further research can be
done to have more comprehensive solution that can
address the need of SI group through the support of
multiple technologies associated with important criter-
ion which make SI group more comfortable in utilizing
such solution. The technologies associated with relevant
criteria for SI that needs further investigation would be
analyzed and determined in next section.
Level of coverage of the features associated with
important criteria for SI group
In this section, we described the coverage of different
criteria in relation to the sum of maximum score of
important criteria, as well as comparing the coverage of
each criteria in relation to other criteria. In addition, the
percentage of coverage for the overall criteria of the
seven papers is also presented. where the average of
overall percentage of all criteria for FSI is 75% (by
applying Formula 2), and the average of overall percent-
age of all criteria of PSI is 76% (by applying Formula 2) as
shown in Table 12. This result indicates that further
 16 G. KBAR ET AL.

Table 13. Assessment results of SI.

Relative important criteria for full SI and partial SI
Assessment parameters C1 C2 C3 C6 C9 C10 C11 C13
Total value for important criteria for FSI 58.5 132 130.5 115.5 70.5 4.5
Total value for important criteria for PSI 19 58.5 132 130.5 115.5 4.5 37.5
Percentage of coverage level of important criteria relative 28% 63% 62% 55% 34% 2%
to maximum value for FSI by applying Formula (5)
Percentage of coverage level of important criteria relative 14% 28% 63% 62% 55% 2% 18%
to maximum value for partial SI by applying Formula (5)
Percentage of coverage of important criteria relative to each 11% 26% 26% 23% 14% 1%
other FSI by applying Formula (6)
Percentage of coverage of important criteria relative to each 6% 12% 26% 6% 23% 1% 7%
other Partial speaking by applying Formula (6)

research is required to improve the coverage of all criteria
relevant to the SI group; the specific criteria that require
further research are explained in the sub-sections below.
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and 11% consecutively. While the coverage of other
criteria C11 of SI is very low of 1%, C1 (speech to text)
and C13 (noise filtering) have low percentage for partial
SI. This leads to the same conclusion as stated above
that the criteria C2, C11 (haptic feedback) for SI, and C1

Assessing the coverage or relevant criteria in

relation to the maximum value for SI and
partial SI
Table 13 illustrates the results by applying formulas (5)
and (6) to determine the average percentage of covering
each criterion in relation to the accumulated sum of all
criteria as well as in relation to each other.
For both full SI and partial SI, criteria C3 (Gesture
Control), C6 (Text to speech) and C9 (display) are
covered well among these seven papers, while criteria
C11 (Feedback to user), C2 (Keyboard or touch screen)
and C10 (auto speaker volume) are not addressed well.
Criteria C3, C6 and C9 have the highest coverage among
these criteria in relation to the maximum score for full
speech impairment, with values of 63, 62 and 55%,
respectively, as shown in Table 13. These are followed by
C10, C2 and C11 (haptic feedback) which have a
coverage value of 34, 28 and 2%, respectively. For
partial SI, C3, C6 and C9 are followed by C1, C2, C11 and
C13 which have coverage value of 14, 28, 2 and 18%,
respectively, and therefore are not covered well. This
leads to a conclusion that further research in relation to
C2, C10 as well as C11 should be conducted to improve
the conditions for people with SI, and further research in
relation to C1 and C13 is also required for partial SI.
Assess the coverage of important criteria for SI
and partial SI relative to each other’s score
We can see from Table 13 that C3 (gesture control), C6
(text to speech) and C9 (display system) has the highest
coverage among these relevant criteria for SI and partial
SI with value of 26, 26 and 23% consecutively. These
followed by C10 (auto volume control), C2 (keyboard or
touch screen) for SI which has a coverage value of 14
and C13 for partial SI need further researches to support
better the conditions for SI and partial SI.
Discussion
In this article, we surveyed around sixty scientific papers
related to the use of technologies for addressing the
needs for different impairment groups of PWD by
reviewing and evaluating these papers using Multi-
weighted Scoring Model. Three impairment groups of
PWD have been assessed in this paper, which are HI, SI
and HSI, where the other impairment groups of Visual
Impairment, Motor Visual, Motor Impairment, Motor
Hearing and Speech Impairments are covered in separ-
ate article. The assessment methodology of this litera-
ture survey is based on qualitative assessment according
to general criteria that are associated with relevancy to
the use of technology for disable people, paper
credibility, the practical applicability of these papers’
solution in meeting the people needs, and the evidence
in supporting their claims. In addition, the methodology
also includes quantitative assessment based on Multi-
weighted Scoring Model according to defined 13 criter-
ion that are weighted and mapped to different impair-
ment groups, as well as they have been assessed by
three researchers. Thirteen criteria related to system
input, system output and system processing have been
identified that cover the technological requirements of
the various combinations of impairment conditions of
the PWDs. We have assessed these papers based on
essential criteria to satisfy at least one technology for
system input and one for system output. We also
assessed the papers base on the overall percentage of
important criterion to have more comprehensive solu-
tion that would add extra flexibility to PWD in having

multiple input and output technologies to serve their
needs. Furthermore, we also assessed these papers for
full comprehensive solution that apply the 13 criteria at
different weight according to their importance level. This
will give us more comprehensive approach and higher
flexibility for PWD users to utilize multiple technological
solutions that can enhance the performance of the
system input, system output and system processing. This
analysis enabled computing in overall the level of
coverage of individual assessment criteria with respect
to each group of impairment, and which represent the
main target information of this article assessment. In
order to improve the assessment results, few meetings
have been conducted to discuss the survey results, in
order to verify the ratings of technologies and their
associated criteria, as well as discussing the results of the
assessment. This series of meetings led to reduction in
the variance between the assessment’s results of differ-
Downloaded by [Gazi University] at 22:00 19 February 2016
ent researchers for the same paper.
Conclusions
The assessment result of HSI indicates that there is still
scope of more research in HSI according to the
important criteria (C1, C2, C3, C9 and C12), and that
are related to text to speech, gesture control, display
system and mobility support. The assessment result of HI
indicates that average score of all-important criteria for
HI of the 17 papers is 33%. This score for HI is not high,
which indicates that more research is required to
address the requirements needed for HI conditions
according to the important criteria. The criterions that
have low score for HI are C6, C11 and C12, and are
related to text to speech, visual feedback and mobility
support. In terms of covering the essential criterion, both
FHI and SHI papers indicate acceptable results of
average greater than 55%. The assessment result of SI
indicates that the total score of all important criteria of
the seven papers is between 36 and 41%. This value is
relatively low, which indicates that more researches are
required to address the requirements needed for FSI and
PSI conditions according to the important criteria. These
important criterions that have low score are C2, and C11
for SI, and C1 and C13 for P SI, and are related to speech
to text, keyboard or touch screen, visual feedback, and
noise filtering. In terms of covering the essential
criterion, SI papers indicate a very good results of
average greater than 75%. Hence, the common criteria
among this six impairment group that need further
research are C1, C2, C4, C5, C11, C12, C13 and the
specific criteria for HSI and HI that needs more research
and investigation are C6 and C9. It becomes obvious that
the quantitative assessment allowed us to clearly
ASSISSTIVE TECHNOLOGY REVIEW FOR DISABLE PEOPLE 17
determine the focus research area needed to improve
the technological solution for the six impairment groups
of PWDs.
Declaration of interest
The authors whose names are listed in the first page certify that
they have no affiliations with or involvement in any organiza-
tion or entity with any financial interest (such as honoraria;
educational grants; participation in speakers’ bureaus; mem-
bership, employment, consultancies, stock ownership, or other
equity interest; and expert testimony or patent-licensing
arrangements), or non-financial interest (such as personal or
professional relationships, affiliations, knowledge or beliefs) in
the subject matter or materials discussed in this manuscript.
This Project was funded by The National Plan for Science
Technology and Innovation (MARRIFAH), King Abdul-Aziz City
for Science and Technology, Kingdom of Saudi Arabia, Award
Number (12-ELE3220–02).
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