在首届线上旧金山设计周期间，frog 携手合作伙伴一同参与了热烈的线上讨论。我们讨论了包容性设计的理念和益处，以及其他围绕着包容性设计展开的话题。


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为用户设计包容性体验

在首次线上进行的旧金山设计周期间，我们的团队探讨了如何通过设计为客户们创造包容性体验。Charles Yust 和 Tammy Baird 同两位合作伙伴，即 Corey Timpson 和 Sina Bahram 一起探讨了包容性设计的理念，以及如何通过不断推动自己从过去的经验中学习，确保我们在不断前进的同时做出更好的设计。

frog and our partners joined a robust digital crowd at the first ever virtual SF Design Week to discuss the ethos, benefits and assumptions around inclusive design

<h2>什么是包容性设计？</h2>
这个问题的答案似乎非常显而易见——包容性设计就是对所有人而言都具有包容力的设计。尽管自诩为“包容性设计”，很多产品往往并不能为尽可能多的用户群体带来良好体验，而是止步于满足其作为商品的最低要求。包容性设计的目的便是克服这些问题，使尽可能多的人获得温暖且无障碍的体验。
以下概念的定义将有助于您更好地理解包容性设计的目标和理念：
 
<ul>
<li>无障碍性：无论用户身体是否有残疾，（产品，场所和服务）都具备让其自由使用的能力。</li>
<li>残疾：指因生理，认知，精神和感官等方面存在缺陷所造成的后果。</li>
<li>他者化：使特定个体或群体认为自身与他人存在本质上不同的行为和后果。</li>
<li>包容性设计：包容性设计即不限于界面和技术的设计过程。在这个过程中，产品、服务或环境会针对有特定需求的特定人群进行优化。</li>
</ul>
有鉴于此，Sina 指出，设计师有必要区分医学语境下和社会语境下对“残疾”的不同定义。主流医学语境下的残疾，暗指个体身上存在一些需要修复或纠正的地方。然而对大多数人来说，我们所理解的“残疾”是无法被治愈或纠正的。相反，我们应该以社会语境下的残疾来理解它。社会语境下的残疾认为残疾的是环境，而不是个体。
 
<h2>包容性设计的理念</h2>
以“残疾的是环境，而非个体”为出发点，我们必须思考自己作为设计师能够为此做出的贡献。正如 Sina 指出的那样：“包容性设计的设计过程有考虑到，我们的同胞会以她/他们自己的特殊方式同我们创造的物品进行互动。因此，我们不应该对他们的互动方式设置障碍。”
这是一种真正以人为本的设计理念，因为它切实的将所有人的需求摆在了最前面，而不是假定一个“平均值”或“规范”来限定其适用群体。为了创造出具有包容性的体验和产品，我们必须从现在开始做出改变：“与其在设计和开发出产品后再考虑如何让其具备无障碍性，不如从设计的时候就将所有的受众和人类差异纳入考虑范围，这样我们就不必在之后的道路上做出妥协。” Corey 如是说。
Sina 和 Corey 的包容性设计启示：
包容与排斥：当设计师意图与用户意图不匹配时，排斥就发生了。作为包容性设计的实践者，我们有义务知道设计师意图是如何影响、回应和推进用户意图的。解决两者间的矛盾不但意味着包容，而且能提高用户的沉浸式体验并推动创新。
具有包容性的生态系统：如今，我们的用户既存在于物理空间，又存在于数字空间，我们不能再割裂的看待他们。正如 Corey 所说：“只有当每个部分都独立具备包容性时，整个生态系统才能具备包容性。”
包容性设计的特点：包容性设计为不同喜好、不同接受风格和能力水平的人提供了多个切入点。这一点正如 Corey 所说，是至关重要的：我们提供的选择越丰富，“用户参与和体验的机会就越多，我们就能为她/他们建立越强的参与感。”
 
<ul>
<li>混合交互设计（被动的，主动的，交互的）</li>
<li>模拟与数字的结合（混合&#038;跨媒体）</li>
<li>风格多样化</li>
<li>沉浸式体验</li>
<li>多感官体验</li>
<li>战略性冗余</li>
<li>决策过程经过深思熟虑</li>
</ul>
 
<h2>后知后觉</h2>
为了更好的理解未来该如何持续推进包容性设计，我们花费了一定的时间从过去的经验中寻找答案。其中一个用来评估包容性设计进步空间的项目，是我们与旧金山摩登艺术博物馆合作的<a href="https://www.frog.co/work/augmented-reality-meets-fine-art">马格利特解释性画廊</a>。
通过这次的对话，我们要回答的核心问题有：
 
<ul>
<li>我们要如何挑战以往的规范和包容性理念？</li>
<li>我们能否在设计过程中更具同理心？</li>
<li>我们该如何确保团队和研究人员更具代表性？</li>
</ul>
解释性画廊是一个沉浸式增强现实空间。它由 frog 与旧金山摩登艺术博物馆的策展人、数字工作人员、营销和游客体验专家团队合作设计，用来捕捉勒内•马格利特的艺术灵感。与此同时，解释性画廊能在不依赖任何个人设备的情况下以互动体验的形式解释马格利特的创作主旨。为了能使这次的展出适用于博物馆的全部观众，我们在设计展出流程和软件时考虑了不同年龄、身高、肤色、戴眼镜以及不戴眼镜的参观者们可能的需求。
在回顾这个项目的过程中，我们通过寻找以下问题的答案，思考了如何在未来设计出更具包容性的体验：
 
<ul>
<li>我们该如何通过音频展现参观体验？</li>
<li>我们该如何提示参观者使用 &#8220;隐藏功能”，或创造出让不同观众都更易发掘隐藏内容的界面？</li>
<li>这些增强功能如何让观众们更加深入地了解马格利特作品的主旨与奥秘？</li>
</ul>
正如 Sina 所指出的那样，每个设计中存在的问题都有一系列束缚了它的条件，而每个杰出的互动性展览都会鼓励人们去发现或发掘一些值得注意的东西。这从本质上而言就是个谜。要想设计出真正具有包容性的体验，其诀窍在于通过不同的方式看待问题，这样就不会因为单一的认知方式产生局限性。举例而言，如果观众在看到图像随着自己的身体移动而产生变化时感到“喜悦”，那么也许也存在着一个触觉上与之相等的事物，能让人们调动起其他的感官进行体验。这种触觉或听觉元素的加入并不会剥夺用户在视觉方面的互动，但是能让观众的互动体验上升到全新的层面：一个能让更多的人更加深入地参与体验的层面。

以下是确保产品的设计和开发流程从开始时便具备包容性的五大关键点：
 
<ul>
<li>聘用来自不同背景的员工团队并鼓励团队成员从不同的角度发表观点</li>
<li>征聘来自不同背景的研究参与者</li>
<li>设计不他者化的、从一开始就具有包容性的体验</li>
<li>以增加包容性为目的使用科技。</li>
<li>将包容性纳入产品代理、营销和推广的考量中</li>
</ul>
包容性设计的真正意义在于，它不但能让人们有更多的机会获得产品、服务和体验，还能在不限定个人能力的情况下尽可能多地为所有人拓展创新、创意和设计的视野。

Charles Yust

Tammy Baird

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Best practices for developing low-cost VR to support burn patients receiving wound care.

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Designing Virtual Reality for Pain Reduction

Imagine suffering a serious burn. The pain is unlike any you have ever felt. As you are rushed to the hospital for stabilization, in the throes of one of the worst moments of your life, you are only at the beginning of an agonizing journey.
After your initial treatment, you arrive at a hospital burn center for weeks or months of ongoing care. Especially in the beginning, this treatment can be just as excruciating as the initial injury. It includes removing the bandages from the burns and scrubbing them, before applying ointment and replacing the dressing. The process can last for up to two hours and it must take place every day, sometimes twice a day, in order to protect your burned flesh from infection. In addition, you will likely need operations. The pain is relentless, and even as it slowly improves, mental scars remain.
The acute injury of a burn — followed by the days, weeks, or months of frequent wound care and dressing changes — is one of the most painful things a patient can experience. Opioid pain medications, the mainstay of pain management, have well known short and long-term side effects. Despite these medications, pain often remains inadequately controlled in burn patients.
Alternative measures for pain control, including distraction, are known to be effective. Numerous studies have demonstrated that the immersive environment of virtual reality is a highly effective method of distraction for burn patients receiving wound care. However, virtual reality is not widely used in clinical practice outside of research studies, because many of these systems are customized and expensive. Emerging systems such as the Samsung Gear VR and Oculus Rift dramatically increase access to virtual reality, but even these may be too expensive for clinical settings, particularly if they are only used with a single-patient to minimize infection control concerns.
Google Cardboard presents an opportunity to pair nearly ubiquitous smartphones with an inexpensive cardboard box and lenses, in order to create a virtual reality system suitable for healthcare. However, existing Google Cardboard headsets are not designed for a moist burn wound care environment. Furthermore, most existing games are designed with the assumption that the user is upright and able to move about in an environment allowing for six degrees of freedom, which is not feasible in patients receiving burn wound care.
At frog we saw this as a design challenge: understand the opportunities and constraints involved with burn wound care and design a low-cost headset and VR game experience suitable for these conditions. Together with Dr. Brian Pridgen, a healthcare design fellow at frog and a Stanford Plastic and Reconstructive Surgery resident, we approached this challenge as a multidisciplinary team. The outcome of this passion project will be an inexpensive headset concept that is extremely affordable, easy to assemble, and feasible for use in the burn wound care environment. In addition to the headset, we are developing an open-source game concept, “Ēpiónē”, for use by burn patients. Our hope is that it can serve as a platform or template that other developers could use to build additional VR experiences for patients. The game will allow the patient to remain appropriately positioned for burn wound care while being immersed in a distracting virtual reality environment.
While working on this concept, the project team assembled a list of design principles that we share in detail below. The principles emerged through design and development of both the hardware and software, and they take into consideration the design constraints we documented through on-site research, interviews with nurses and patients, and user testing. The principles may be generally applicable to VR use in healthcare applications, but they were created with burn patients in mind. In the spirit of making healthcare solutions accessible as widely as possible, we’re sharing them below for anyone who is designing or building solutions in this space.

<h2 style="text-align: center;">Headset</h2>
A number of design constraints dictated the need to explore a custom VR headset solution. It needed to be very low-cost, built using a durable and water-resistant material, and comfortable for the patient. Ideally the design would be easy to assemble from pieces that would allow it to be flat-packed for efficient distribution. The following are specific principles that guided our headset design.
Cheap to manufacture – Hospitals have limited funding, and relying on insurance companies for funding creates a barrier. If headsets are $30 or less (we aimed for $10 or less), hospitals are more likely absorb the cost for the patient benefit. If the cost is low enough, the headsets can be provided to each patient, minimizing infection control concerns that might otherwise be a barrier to adoption.
Water Resistant – Before removal, the patient’s bandages are soaked with slow moving warm water from a hose, which is controlled by a nurse. There may be some indirect contact with water. It is okay if the headset gets wet, but the device inside should be protected.
Patient Comfort – The most painful part of the cleaning procedure can last up to two hours. The patients are often lying down, but may sit up as well. Materials, weight, form, and adjustability to head sizes should be carefully considered.
Accessible to nurses – It should be easy for a nurse to access the device inside the headset while the patient is wearing it, without having to remove the entire headset.
Device Agnostic – Since each patient may receive a headset, it should accommodate a wide range of devices. A desired range might include devices with 4-inch to 6-inch screens.
Intuitive assembly and operation – Assembly and phone insertion should require as little instruction as possible. Devices of any size must be properly aligned/centered to avoid double vision while looking through lenses. A guideline on the headset, combined with alignment cues in the app could help with centering the device.
Eco-friendly – Where possible, environmentally friendly materials should be used to reduce environmental impact. Easily replaceable parts should be considered to avoid having to replace the entire headset.
Delightful – Burn patients undergo severe physical pain and emotional stress. Any way to induce positive feelings throughout the entire experience — from assembly to after the patients return home — should be explored. Consider personalization.

<h2 style="text-align: center;">Software</h2>
The most important design principles for the game software address the lack of functional VR applications that work when someone is lying down, as many burn patients do while undergoing wound care. As the patient prepares for their procedure, they may have little opportunity to start the game experience themselves because they are connected to IVs, monitoring devices, and oxygen, so they will require assistance from nurses. The game experience must also be forgiving to allow for different types of players that have varying levels of familiarity with VR, and games in general.
Admin for Nurses or Doctors – An admin mode should allow nurses to adjust game settings, volume, brightness and alignment before the procedure starts. After assisting with these settings, the staff should be able to easily initiate the VR experience as they align the device in the headset, so the patient can avoid exiting gameplay during the procedure.
Allow for supine position – Most VR games will not play correctly if the player is lying down, because the device assumes the player is standing/sitting and looking up.
Calibration – Burn patients are often lying down, which the device’s accelerometer must accommodate. Once the phone has been inserted in the headset, the game should allow the user a moment to hold their head still while pointed forward, in order to establish a reference point for rotation.
Accommodate limited head mobility with head-tracking-only controls – Patients lying down can only comfortably move their head slightly to the left and right. Vertical up/down head movement is more restricted.
Age-friendly – Patients will be of all ages, demographics, and interests. Game content, including visual style and story, should be as inclusive as possible.
Challenging for all experience levels – Patients may have no video game experience, or a lot. Pain medication may also impair the patient’s ability to concentrate. After the initial difficulty level is selected from the admin menu, difficulty should continue to increase over time.
Reduce eye strain – Long exposure to bright colors will cause eye fatigue, so limit use of bright colors in the game world. Setting hardware brightness correctly before gameplay is key.
Forgiving gameplay – Gameplay should be forgiving across all difficulty levels. Players should be given second chances to correct their mistakes (which may be out of their control due to wincing from pain, or a nurse asking them to move). A regenerating shield is an example of a useful game mechanic that accomplishes this goal, and even produces unpredictable periods of suspense that add to the interest of the game.
Audio – Place sounds in physical locations around the player position. Make sure audio includes appropriate and immersive sound effects and background music loops. The audio should be nearer to higher frequencies since low bass tones are sometimes inaudible on standard mobile device speakers.

<h2 style="text-align: center;">Conclusion</h2>
frog assembled these principles during active development and testing of the VR Care headset and custom game experience, which is <a href="https://github.com/frog/vr-care/">available here as an APK file and an open source Unity package</a>. The headset is now being used as part of an ongoing study with burn patients. This work is an example of the power of partnerships between medicine and design, with the potential to produce solutions that increase access to affordable virtual reality for patients. We hope that this work will serve as a model for future medicine-design partnerships to identify clinical needs, design practical solutions, and bring these solutions back to patients and the healthcare system. Feel free to leave us questions in the comments section and <a href="https://www.frog.co/contact">click here to get in touch about working with frog</a>.

Andrew Haskin

Brian Pridgen

Brian is a Visiting Healthcare Specialist at frog and a plastic surgery resident at Stanford. While at frog, he has developed his interest in merging human centered design with novel applications of technology to improve healthcare delivery and patient care.

Charles has over 15 years of experience implementing compelling digital experiences across a range of platforms at various scales, from mobile and web applications to spatial installations. He conducts research, develops software in a range of languages, and builds interactive prototypes utilizing cutting-edge technologies.

Andrew is an interaction designer in San Francisco who excels at finding order and meaning in the complex and abstract. His raw enthusiasm for the power of design is infectious as he blends craft and process-oriented pragmatism to execute ideas that innovate and disrupt.

Charles Yust

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