I Wish You Could Make the Camera Stand Still: Envisioning Media Accessibility Interventions with People with Aphasia
Alexandre Nevsky, Filip Bircanin, Madeline N. Cruice, Stephanie Wilson, Elena Simperl, Timothy Neate · 2024 · Proceedings of the 26th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS 2024) · doi:10.1145/3663548.3675598
Summary
This paper presents the first study aimed at envisioning accessibility interventions for audiovisual media specifically designed for people with aphasia — a language disorder typically caused by stroke that affects the production and comprehension of speech, reading, and writing. Despite the prevalence of aphasia (affecting roughly one third of stroke survivors) and the central role of television and streaming media in daily life, media accessibility research has largely overlooked this population in favour of sensory disabilities. The researchers conducted two exploratory workshops and a postcard probe activity with six people with aphasia and their significant others. Workshop 1 used an innovative method of "diegetic prototypes" — short clips of real TV content modified to demonstrate potential accessibility interventions such as simplified subtitles, keyword highlighting, slowed speech with lip-sync adjustment, picture-in-picture sign language interpreters, and visual annotations. Workshop 2 employed mid-fidelity tablet prototypes to further explore these ideas. The probe activity involved participants sending postcards describing their viewing experiences over several weeks. The study identified key barriers that people with aphasia face when consuming audiovisual content: fast-paced speech and subtitles, complex or unfamiliar language, rapid camera movements, multiple concurrent speakers, and information overload. Participants expressed a strong desire for highly personalised interventions that could be tailored to their individual language abilities, which vary significantly among people with aphasia.
Key findings
The research revealed several important findings about how people with aphasia engage with audiovisual media. First, participants described a process of "domesticating" content — wanting to translate media into aphasia-friendly versions at the point of production rather than through post-hoc modifications. One participant captured this need vividly: "The camera must stand still, it does not matter what way we... the front, the back, the everything, but it just stands still." Second, the social dimension of viewing emerged as critical — participants stressed the importance of shared viewing experiences and worried that accessibility interventions might fragment social viewing by requiring separate screens or different content versions. The concept of "parallel viewing" was identified as a promising strategy, where viewers can engage with supplementary content on a second screen without interrupting the shared experience. Third, participants expressed mixed feelings about automated AI-driven interventions, with some wanting transparency about content modifications and others preferring manual control. The study also highlighted the importance of cross-disciplinary engagement, arguing that speech and language therapy insights should inform media accessibility design for this population. The researchers proposed "bespoke co-design" — working individually with people with aphasia to create highly targeted personalised interventions rather than one-size-fits-all solutions.
Relevance
This paper opens an important new research direction by focusing on media accessibility for people with complex communication needs, a group largely absent from accessibility technology research despite representing a significant population. The concept of content personalisation for accessibility — adapting media at runtime to meet individual viewer needs — has broad implications beyond aphasia, potentially benefiting anyone with cognitive or language-related access needs. The study's discussion of flexible media approaches (assembling content from modular components at runtime) points toward a future where accessibility is built into media production rather than bolted on afterward. For practitioners, the finding that social viewing must be preserved alongside individual accessibility needs is crucial for designing inclusive media experiences. The paper's methodological contributions, particularly the use of diegetic prototypes to make abstract accessibility concepts tangible for participants with communication difficulties, offer valuable approaches for inclusive participatory design.
Tags: aphasia · audiovisual media · media accessibility · television accessibility · content personalisation · participatory design · envisioning · diegetic prototypes · complex communication needs · subtitles · content domestication