Gappa.pdf

Authentic Reality Mediation for Multihandicapped Children by
Multimedia Standard Applications
Henrike Gappa, Witha Zimmermann-Hild GMD-German National Research Center for Information Technology Tel.: +49 2241 142793, E-mail: henrike.gappa@gmd.de Abstract: Within the project CATI (Computer-Aided Therapeutic Intervention) new potentials and
limitations of computer-supported multimedia applications for the therapeutic advancement of
severely handicapped children are investigated. In this context, we are conducting a case study
involving an 11-year old severely physically handicapped child. Due to the severe physical
impairment, the child is highly mobility restricted and has little opportunity for learning about the
natural environment and social contact. For entertainment purposes, the child was very much exposed
to videos and Sega games from the world of comics during his childhood. The heroes of these comic
movies are completely dominating his thinking and influence his communicative behavior. Therefore,
a computer-supported multimedia environment was provided for use in art therapy sessions aiming at
the mediation of empirical parts of what we commonly refer to as “reality”. The multimedia
environment allows for creating artwork with “authentic” features by incorporating multimedia
objects like sounds from nature, realistic photographies or videoclips. It was the objective of this case
study to observe wether the process of creating artwork on a computer with these special features can
initiate reconstruction processes of his notion of “reality” supporting the development of his sense of
self and leading to a more age-adequate communicative behavior.

1. INTRODUCTION

The goal of investigating the potential and limits of innovative computer-supported multimedia
applications for the advancement of special needs children is pursued in the research project
CATI (Computer-Aided Therapeutic Intervention) at the Human-Computer Interaction
Department of GMD - German National Research Center for Information Technology. In
CATI several case studies are conducted dealing with a variety of educational issues in special
needs settings. In this case a multimedia environment consisting of videoclips, photographies
and standard software suitable for designing multimedia applications like the graphics program
„Corel Draw“ and the presentation maker „PowerPoint“ was employed for use in art therapy
sessions. The goal of the multimedia environment was not only to offer an additional tool for
painting and composing music but rather to mediate extracts of authentic reality to a highly
mobility restricted physically handicapped child.
In distinction to augmented reality systems which are designed to enrich the real world with a
complementary virtual world (BAJURA et al. 1995), we define authentic reality mediation as
the computer-supported presentation of empirical parts of what we commonly refer to as
„reality“. The presented empirical parts start off at the „artificial“ notion of reality the child has
developed due to the social isolation and mobility restriction he has experienced during his
childhood and connect them with events occuring in the „real“ world. This was achieved here
by using images from former art therapy sessions which were scanned into the computer as the
starting point for creating a multimedia artwork that is enriched by events occuring in „reality“
like thunder and lightening or the route of a garbage truck through the city.

The process of cognitively connecting experiences requires action, that means the child needs
to be able to actively manipulate and explore his domain of interest. Modern information
technology offers a lot of powerful multimedia tools allowing for self-controlled action, so
there is good reason that utilizing these tools to compensate for a lack of action-taking due to
a physical impairment might be successful. However, it is important to note that these
experiences are of a simulated, non-physical nature which influence the process as well as the
outcome of constructing knowledge about the „world“ in a special way. These issues will be
under concern of this case study. It is necessary to give a brief description of the background
of the child involved in this case study, in order to clarify the preconditions for the design of
the multimedia environment.
2. DESCRPITION OF THE CASE

The child participating in this case study is 11-years old, suffering from a centronuclear
myopathy causing an anomaly of muscular nuclei leading to the loss of muscular strength (see
figure 1). This loss of strength refers to the entire skeletal apparatus also affecting respiration.
Therefore the child needs to be connected to an artificial respiratory device almost all the time.
For short periods of time, he is able to sit up in a wheelchair especially designed for him. He is
able to control his forearm as well as his hands. However they are tireing rather fast due to the
loss of strength. His cognitive abilities are not affected by this disability, so he is capable of
cultural techniques like reading and writing.
Figure 1 He spent his first seven years of life on the intensive care ward of a childrens hospital until he was physically stable enough to be released home. Since then he had to reenter the hospital once in a while for instance when he had caught a cold. At home he is cared for by a nurse 24-hours-a-day and attends a special education school for a few hours a day. Due to the severe physical handicap of the child, he is highly mobility restricted and has very little social contact outside his family. Because of the socially rather isolated process of growing up, he developed an understanding of reality that was very much influenced by the
media presented to him during his childhood. For entertainment purposes he was exposed
mainly to media like video films, audio cassettes, books and Sega games presenting stories
form the world of comics. He still very much identifies himself with the heroes of these stories
so that his thinking is dominated by these characters which also influences his communicative
behavior. He has internalized their way of communication to the extent that he expresses
happiness for instance the same way the comic figure Benjamin Blümchen (an elefant) would
do it by trumpeting „Thöröh!“. This makes it difficult for others to communicate with him,
because entering a conversation is only possible if a common ground for communication is
shared. In order to develop a more appropriate way of communication, it is crucial that he
deals with the facets of real life as we all commonly experience it. Beyond this, as it is assumed
in individual psychology, construction of knowledge about reality is essential for the
development of a sense of self. One objective of the art therapy sessions was the advancement
of his communicative skills by connecting his imaginations with what we commonly call
„reality“.
3. THEORETICAL BACKGROUND

The way children usually develop an understanding of the world around them is by interaction.
Due to the severe physical impairment of the child, his possibilities to physically and socially
interact with his environment are very limited. However since the process of developing a
sense of self provokes an analysis of the individual physical and social environment, interaction
inevitably happens but is restricted in this case to the world of imagination for compensatory
needs. These circumstances lead to emotional disturbances because the child is lacking the
possiblity to control and explore actively the process of interaction. Computer-supported
multimedia environments may offer a compensatory interface in these cases, however all
experiences are mediated that means are gained on an emotionally different level than they are
in case of a non-handicapped child. It will be part of this research project to investigate the
extent to which computer supported multimedia environments can serve for compensation
purposes by authentic reality mediation. There are findings from learning theory as well as
concepts from art therapy that support this assumption and have influenced the design of the
multimedia environment.
From the perspective of the cognitive scientist Jean Piaget, who has developed the
constructivist understanding of the process of building knowledge structures, knowledge is
self-constructed that means everybody constructs his- or her own understanding of the world
(PAPERT 1993). This is an individualistic understanding of kowledge building implying that
constructing knowledge is an individual act leading to an individualistic understanding of the
world. This approach did not take into account the role of comunication, in questionning how
knowledge is communicated to others and how the communicative process influences the
construction process.
3.1. Artifacts

Seymour Papert has become known for advocating the power of computers in supporting the
process of knowledge construction by providing microworlds offering so called objects-to-
think-with (the LOGO example) (PAPERT 1993). He has enhanced the constructivist view of
knowledge construction by stressing the importance of constructing a public entity (PAPERT
1991). This might be for instance "a sandcastle on the beach", "a computer game" or in our
case "multimedia artwork", meaning that construction takes place in a social context to which
personal meaning can be attached (PAPERT 1991). Furthermore the public character of the
artifact (e.g. the artwork) as the outcome of a construction process can be discussed,
examined, tested or even simply admired by others. Papert assumes that by interacting with
artifacts, tacit knowledge becomes explicit uncovering insufficiencies of knowledge structures
requiring further differentiation of problem solving skills. This process forces the learner to
reflect upon available knowledge structures and adapt the already existing ones to new
experiences. Since the artifacts are public, they offer an opportunity to communicate individual
knowledge to others which in turn causes the presenter to look at the artifact and this way
indirectly at the internalized knowledge structures from different perspectives. In this
procedure cognitive as well as affective processes are addressed crucial for connecting old
with new knowledge (ACKERMANN 1996). The importance of enabling affective and
cognitive experiences for connecting the inner with the outer world are underlying concepts
pursued in art therapy for personality development.
3.2. Educational Regression

In the school of art therapy emphasizing educational aspects in the therapeutic process
„educational regression“ as a means of therapeutic intervention (RICHTER 1984) plays an
important role. Regression in this sense means returning to the assumed starting point of
developmental delay manifesting itself in artisitic, verbal and behavioral expressions deviating
from what in developmental psychology is assumed to be typical for a specific developmental
stage. Educational regression here refers to the construction of skills in dealing with asthetic
materials and operations in accordance to the age and developmental stage of a child the
deviation was diagnosed. The therapeutic goal is to foster the age-adequate utilization of
symbolic functions becoming apparent in the asthetic process and product. According to
Richter (RICHTER 1977) who is the founder of the educational orientation of art therapy
(„Pädagogische Kunsttherapie“), therapy means initializing and guiding processes of social
learning for the reconstruction of underdeveloped skills by activating the individual in an
especially structured educational environment which in this case is a multimedia environment.
3.3. RIGS (Representations of Interactions that have been Generalized)

The assumption of educational regression as an effective therapeutic tool was enhanced by
findings from infant research (STERN 1985). In the stage of infancy, a child already interacts
with his or her environment on a preverbal level. Infants are assumed to generalize these
experiences and represent them in an episodic memory. These representations are called RIGs
(Representations of Interactions that have been Generalized) and serve as the basis of the
episodic memory (STERN 1985). The character of the episodic memory is dynamic that
means it is constantly restructured leading to an integrated network of organized self-
experiences. By means of amodal and transmodal experiences the child incorporates
invariances of interpersonal interaction (acts and affects). The severe physical impairment of
the child concerned in this case study caused a dramatic limitation of modalities available for
experiencing his environment. Therefore traditional methods of art therapy like drawing
watercolours in a wet-in-wet technique as well as a computer supported multimedia
environment are used in art therapy with this child for compensatory purposes. The goal of the
multimedia environment is to offer a rich and engaging setting for interaction in order to
support the process of reconstruction of the episodic memory.
4. THERAPEUTIC SETTING

During the last stay of the child in the childrens hospital, he became acquainted with the
graphics program “Corel Draw” running on the personal computer on his ward. Due to the
physical impairment of the child, he is hardly able to use a standard keyboard for input,
however he can use a standard mouse for operating a computer. He easily learned how to
handle the program and designed sophisticated images. So when starting the case study, it
seemed most reasonable to build upon this knowedge. In order to allow for designing
interactive stories and incorporation of sounds and videoclips by the child himself,
“PowerPoint” was also installed. A collection of his „hand-made“ images were scanned onto
the harddisc and in the beginning he enriched them only by sounds. Very soon he then started
to create new images during his art therapy sessions. The ease by which images could be
produced on a computer particularly compared to all the effort it takes for a severely
physically impaired child to move pencils, facilitated the desire to move on an explore further.
He designed for instance a sunrise image and animated sunrise and sunset by moving the
standard scrollbar up and down. From a psychological point of view it is very important for
the development of self-esteem to be able to „make things happen“. Animating objects on a
computer screen is a means of experiencing feelings of initiating and controlling action which a
physically impaired child hardly has the chance to. So creating images with a computer offered
the child the possibility to achieve more complex images with less effort, which in turn left free
energy for action.
After some images were designed telling about how his day passes by, it became suggestive to
connect these images to a story. The images were enriched by sounds occuring in nature
(sounds of birds, ringing of the bell of a church at noon, thunder and lightning). The child was
then offered photographies of for instance a garbage truck that passes by the house the child
lives in and he accepted to enrich his story by objects from „reality“. Formerly when
confronted with realistic photographies, he did not show much interest and rather talked about
one of his Sega games. However, by studying the photography of the garbage truck, he
decided that the road signs were missing and started to draw them on the computer. Road
signs had interested him already some time before when he was taken to school by bus. So he
reacted to corresponding material (i.e. traffic sign icons) offered by the therapist with a
personal experience. Thus, a preverbal dialogue took place in the process of developing an
artistic artifact, which could later be transferred on to verbal age-adequate communication
about the purpose of road signs, traffic, people and the like.
This example underscores a general assumption of "authentic reality mediation" in art therapy:
a therapeutic process aiming at constructing knowledge about „reality“ with the goal of
developing communicative skills anyway needs to employ a client-centred approach. Only the
imagination of the child and his readiness to accept offered material (i.e. multimedia
representations of "reality") is likely to initiate motivation for connecting his inner with the
outer world.
5. CONCLUSION

The use of computers in art therapy is a new but emerging field (AATA 1999). Little is known
about the psychological aspects of the computer-supported artmaking process as opposed to
the traditional methods of artmaking in therapeutic settings. It is agreed, however, that for use
of art therapy with physically disabled people computer art therapy offers quite a few
advantages. First of all, the expressiveness of an image is no more limited by the physical
capability of the “artist”. It is only a matter of selecting the appropriate tool for drawing with
e.g. broad brushstrokes in a desired color. Furthermore, enabling a handicapped person to
create images conveys a sense of mastery and control fostering feelings of self-esteem. And,
the mutability of computer images allows for exploration and experimentation as all steps can
be undone without leaving a trace. Whereas there are first attempts reported about the use of
VR-systems in art therapy (AATA 1999), the impact of creating multimedia artwork by
enriching images with sound, videoclips, animation and branching options, facilitating the
networking process in knowledge building, is not researched yet. All these functions are of
special concern in this case study, since empowering a multi-handicapped child to create non-
static artwork with „authentic“ multimedia features makes it reasonable to assume that a
computer is a meaningful tool for constructing knowledge about „reality“ from a learning as
well as a psychological perspective. The case study presented here is in the beginning stage. It
was the goal so far to explore, wether it is possible to gain interest and foster communication
with the child about isssues of „reality“ like events in nature (sunrise, thunder and lightening)
or everyday events as trash collection. This step was taken successfully, so now we are in the
stage of developing a methodological design for observing and defining psychological
processes that can be initiated by offering a multimedia environment for therapeutically
exploring „reality“ by self-defined protagonists, e.g. an animal or comic figure as an avatar,
under the child's control.
REFERENCES

AATA (Art Therapy: Journal of the American Art Therapy Association) (1999), 16, 4
ACKERMANN, EDITH (1996): Perspective-Taking and Object Construction: Two Keys to Learning. In: KAFAI, YASMIN and MITCHEL, RESNICK (eds.): Constructionism in Practice. Designing, Thinking and Learning in a Digital World. Lawrence Erlbaum Associates, Mahwah, NJ, p. 25-37 BAJURA, M. and NEUMANN, U. (1995): Dynamic Registration and Correction in Augmented Reality Systems. Proceedings VRAIS ´95 (Virtual Reality Annual International Symposium) IEEE Computer Society Press, Los Alamitos, CA, p. 189-196 PAPERT, SEYMOUR (1991): Situating Constructionism. In: HAREL, Idit. & Papert, Seymour (eds.): Constructionism. Ablex Corporation, Norwood, NJ, p. 1-13 PAPERT, SEYMOUR (1993): Mindstorms. Basic Books HarperCollins Publishers, Inc. New PAPERT, SEYMOUR (1993): The Children´s Machine. Basic Books HarperCollins RICHTER, HANS-GUENTHER (1977): Therapeutischer Kunstunterricht. Schwann-Verlag, RICHTER, Hans-Guenther (1984): Pädagogische Kunsttherapie. Schwann-Verlag, Düsseldorf STERN, D. (1985): The Interpersonal World of the Infant. Basic Books HarperCollins

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