**3. Approach**

*touch with restraint* we propose here draws attention to minimal interactivity to be respectful toward the human interactions they help facilitate. The strong concept is explored in this paper through the case of Fuzzy Bird, a tangible interactive object that supports children with

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

Meet Tommy (**Figure 2**). Opening up and connecting are hard for Tommy every day. Many of the one in 70–100 children diagnosed with autism like Tommy struggle to connect socially [2, 3]. We wanted to help Tommy dare to be more open in new and unexpected situations at home and outside the home, so he can feel more socially connected. Social self-exclusion arises from overwhelmedness [4]: it is a challenge for many children with autism to integrate many sensory impressions. They frequently withdraw or get stressed in social interaction. Yet, engaging socially is beneficial and desirable to them: "*social skill interventions are important to the successful outcomes of youth on the autism spectrum"* [5]. Focused interventions can help [6], as "*children with autism appear to behave based on the same mechanisms (e.g., reinforcement, punishment, extinction) that control the behavior of children without autism"* [7]. Interactive objects can address various conditions [4, 8–10]—could one enable Tommy to feel more socially connected? This project sought to develop a support for children with autism to engage in social interaction. The main design question we posed was: how can we facilitate social connection for children on the autistic spectrum? To address this question, we sought to answer the research question: what are the effects of specific interaction qualities of an interactive object on such children's ability to engage in social interaction?, as a contribution to the debate of

autism in involving themselves in social interaction (**Figure 1**).

**2. Design and research challenges**

**Figure 1.** A user in interaction with the Fuzzy Bird prototype.

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how we live with interactive technology.

**Figure 2.** Tommy, a boy with autism (scenario of using Fuzzy Bird).

We used a *constructive design research* approach, in which construction, in this case of an interactive object, is central and becomes the key means in constructing knowledge [11]. We developed Fuzzy Bird using a design approach of rapid, iterative prototyping. "*Prototypes let the designer communicate the (design) concept […] and give him insight on how well the designed features of the interactive product concept match the design brief. The iterative process was built up out of three main activities: prototyping (build in order to try out); concurrent reflection and testing; and theorizing (engage with literature)"* [12] (**Figure 3**).

**Figure 3.** Iterative process of constructive research.

### **4. The design case**

We developed a first idea and mocked it up as a rough prototype: "Eggy", an interactive object that would teach coping by demonstrating the child's own behavior, thus prompting the child to develop calming responses and thus become more ready to engage in social interaction. Eggy would move at certain moments in a distressed fashion, and by stroking it, the child could calm it down. The Eggy prototype is shown in **Figure 4**.

We tested this initial prototype in action ourselves, immersing in the Tommy persona. When held, Eggy moved as if it wanted to get away. This movement felt violent and jerky, like that of a stressed child with autism. We interpreted that the experience of other in distress would not facilitate learning but rather risk triggering distress in the child itself. The interpretation was strengthened by findings from literature, where recommendations include to "give (children with autism) a feeling of being in control," "provide a structured situation," "let them create a structure themselves," "reward them with sensory experiences," and "let them use their whole

**Figure 4.** A schematic illustration of the Eggy prototype's actions and the Eggy prototype.

body" [13]. Eggy facilitated only the last of these but obstructed the others. Having experienced the Eggy prototype in our hands and being pointed toward sensory experiences, the importance of touch came into view. Touch, in contrast to the other senses, is an inherently *interactive*, reciprocal experience and "forms the basis for the *feeling* of being in contact" and for "the development of feelings of affection and intimacy" [14]. Touch is an important aspect of *transitional objects*, which facilitate childhood development of social connectedness. These are "objects that are not part of the infant's body yet are not fully recognized as belonging to external reality. They facilitate the initiation of an affectionate type of object-relationship (…), the handling of truly 'not-me' objects. Such a material or object (blanket, soft toy) serves as a "defense against anxiety" [15, 16]. In the case of disabilities like autism, objects can have important transitional roles way beyond the toddler age. As a psychotherapist concluded from therapy with a 9-yearold child with autism, "objects can help those children who find it hard to firstly conceptualize a relationship and then go on to feel safe and free to express the full range of feelings within that relationship" [17]. Affective touch, while an excellent means to communicate emotion, has not yet been explored widely in robot design, due to its complexity with regard to, e.g., gender, social status, and culture, yet further exploration is recommended [8].

### **5. Touch with restraint: Fuzzy Bird**

In a next and final iteration, we drew on the above insights regarding touch, "not-me" objects, and objects that could help a child conceptualize a relationship and express feelings. In that, we focused on the principle of mirroring, which provides structure and is a key part of social interaction, and one that many children with autism find particularly hard to learn [18]. We conceptualized a support as a soft, nonthreatening, inviting, and above all, passive object inviting *touch* while also exercising *restraint*.

Fuzzy Bird is a fuzzy, cuddly, and soft baby bird. The instantiation was chosen for its huggable round shape with little definition and few but distinct movements (flapping little wings). The overall appearance and feel of Fuzzy Bird passively invite interaction, thereby *exercising restraint* and providing the reward of *touch*. An initially stressed child can squeeze and hug Fuzzy Bird ruggedly or even throw it about, absorbing initial anxiety or distress and involving the whole body. The simple responses gradually convey structure. Once calmer, or if the Fuzzy Bird Helps Me Calm Down and Connect: Touch with Restraint in an Interactive Object… http://dx.doi.org/10.5772/intechopen.71132 83

**Figure 5.** Fuzzy Bird's interaction possibilities.

child is already calm, Fuzzy Bird offers three direct, predictable, and minimal responses, each discoverable by touch and depending on the first move from the child, thus facilitating a feeling of control. This enables the child to create structure of its own and discover the object's response without overload. These are Fuzzy Bird's responses: its wings sport colored patches, one green and one pink; on its belly, there is a yellow patch. A child can squeeze or hit the patches. If Fuzzy Bird's green or pink wing is squeezed, its head tilts to that side and a green or pink LED light up on the belly. The yellow patch on the belly also lights up on touch, and Fuzzy Bird shakes its head left and right gently (**Figure 5**). Fuzzy Bird responds to each action with only one direct, simple response, which in turn invites a direct, simple response from the child. Fuzzy Bird mirrors and takes on the child's actions, but no longer its distress, and invites mirroring in turn, with subtle guidance toward calm.

#### **6. Test**

body" [13]. Eggy facilitated only the last of these but obstructed the others. Having experienced the Eggy prototype in our hands and being pointed toward sensory experiences, the importance of touch came into view. Touch, in contrast to the other senses, is an inherently *interactive*, reciprocal experience and "forms the basis for the *feeling* of being in contact" and for "the development of feelings of affection and intimacy" [14]. Touch is an important aspect of *transitional objects*, which facilitate childhood development of social connectedness. These are "objects that are not part of the infant's body yet are not fully recognized as belonging to external reality. They facilitate the initiation of an affectionate type of object-relationship (…), the handling of truly 'not-me' objects. Such a material or object (blanket, soft toy) serves as a "defense against anxiety" [15, 16]. In the case of disabilities like autism, objects can have important transitional roles way beyond the toddler age. As a psychotherapist concluded from therapy with a 9-yearold child with autism, "objects can help those children who find it hard to firstly conceptualize a relationship and then go on to feel safe and free to express the full range of feelings within that relationship" [17]. Affective touch, while an excellent means to communicate emotion, has not yet been explored widely in robot design, due to its complexity with regard to, e.g., gender,

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

In a next and final iteration, we drew on the above insights regarding touch, "not-me" objects, and objects that could help a child conceptualize a relationship and express feelings. In that, we focused on the principle of mirroring, which provides structure and is a key part of social interaction, and one that many children with autism find particularly hard to learn [18]. We conceptualized a support as a soft, nonthreatening, inviting, and above all, passive object

Fuzzy Bird is a fuzzy, cuddly, and soft baby bird. The instantiation was chosen for its huggable round shape with little definition and few but distinct movements (flapping little wings). The overall appearance and feel of Fuzzy Bird passively invite interaction, thereby *exercising restraint* and providing the reward of *touch*. An initially stressed child can squeeze and hug Fuzzy Bird ruggedly or even throw it about, absorbing initial anxiety or distress and involving the whole body. The simple responses gradually convey structure. Once calmer, or if the

social status, and culture, yet further exploration is recommended [8].

**Figure 4.** A schematic illustration of the Eggy prototype's actions and the Eggy prototype.

**5. Touch with restraint: Fuzzy Bird**

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inviting *touch* while also exercising *restraint*.

Five children aged 6–10 years and diagnosed or suspected to be on the autistic spectrum tested the prototype at a school for special children. We let the children explore the prototype without much interference (**Figure 6**).

The children tested the prototype in a room, one by one, with a teacher present in the background and a researcher on hand to guide the child through. Each test took ca. 15 min. Children and parents consented to the test ahead of the day. The prototype was fully functioning and attached to wires on a table. The child could pick it up and hug it. The moderator introduced Fuzzy Bird and then maintained respectful verbal contact with the child, while it was free to explore the prototype. The test showed that the principle of *touch with restraint* had the intended effect. We saw a transformation in the children's social interaction with Fuzzy Bird and the moderator: upon entering the room, the children appeared to be closed, shy, and distant. This changed throughout the session: they became more open and relaxed, with more deliberate and calm actions and starting to interact with the researcher freely and trustfully (**Figure 7**).

**Figure 6.** The prototype test situation: interaction, hugging Fuzzy Bird. Parental and child permission given for publication.

**Figure 7.** Children's reactions in the test: from stressed to open.

One child picked up Fuzzy Bird to hug it without being asked to do so (**Figure 6**). Another child said that the sound (of the stepper motor) sounded like little farts, and most children commented freely after the test on how we could improve Fuzzy Bird: indications that the children were at ease. All but one activated the prototypes' possibilities. The children discovered the direct response of the prototype and in turn mirrored the prototype's actions. The teacher who observed the test commented that Fuzzy Bird engaged the children better than other toys. However, the test method has some limitations. The children encountered an unknown researcher and object: enough reason to be tense. One of the children was too tense to physically interact with Fuzzy Bird. The researcher's satisfaction at seeing the other children interact with the prototype probably contributed to their relief. Even the teacher's response may have related to the test situation more than to the prototype.

### **7. Discussion**

We developed the concept of *touch with restraint* through constructive design research. The concept describes specific interaction qualities of an interactive object to support the ability of children on the autism spectrum to engage in social interaction. The test showed that Fuzzy Bird supported the children in engaging in social interaction (so far, only with Fuzzy Bird itself and with the researcher) and hopefully feel more socially connected, by responding to touch with restraint, specifically mirroring, and reward. This enables the child to develop trust, learn the principle of a direct response from another, and discern structure. These are key aspects in overcoming the overwhelmedness of children with autism in social interaction [4]. However, they should still be tailored carefully to each child, since children may differ strongly [7]. One part of our contribution is that the principle allows the child to itself initiate the beneficial effect of *touch* that has earlier been demonstrated for communication devices [9]: calming down, even physiologically reducing cortisol levels. Our contribution moreover shows how *restraint* contributes to structure and involvement of the body for the child [4, 10].

### **8. Conclusion: touch with restraint for social connectedness**

The goal of the project was to develop a support for children with autism to engage in social interaction and thus facilitate felt social connection. We have shown an application of interactive technology to achieve this and contribute to the debate of how we will live with technology. The strong concept proposed here, *touch with restraint,* is still at an early stage and has not yet been applied or evaluated beyond the case presented. Still, we believe the case is laid out clearly enough to engender discussion on its value, novelty, grounding, and relevance in terms of generativeness [1]. Fuzzy Bird is an instance embodying the strong concept. Rather than creating special environments or products for children with autism as members of a specific group, a design applying a *touch with restraint* concept can enable the child to develop the skills to include himself in social interaction and to feel socially connected.

### **Acknowledgements**

One child picked up Fuzzy Bird to hug it without being asked to do so (**Figure 6**). Another child said that the sound (of the stepper motor) sounded like little farts, and most children commented freely after the test on how we could improve Fuzzy Bird: indications that the children were at ease. All but one activated the prototypes' possibilities. The children discovered the direct response of the prototype and in turn mirrored the prototype's actions. The teacher who observed the test commented that Fuzzy Bird engaged the children better than other toys. However, the test method has some limitations. The children encountered an unknown researcher and object: enough reason to be tense. One of the children was too tense to physically interact with Fuzzy Bird. The researcher's satisfaction at seeing the other children interact with the prototype probably contributed to their relief. Even the teacher's

**Figure 6.** The prototype test situation: interaction, hugging Fuzzy Bird. Parental and child permission given for

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

We developed the concept of *touch with restraint* through constructive design research. The concept describes specific interaction qualities of an interactive object to support the ability of children on the autism spectrum to engage in social interaction. The test showed that Fuzzy Bird supported the children in engaging in social interaction (so far, only with Fuzzy Bird itself and with the researcher) and hopefully feel more socially connected, by responding to touch with restraint, specifically mirroring, and reward. This enables the child to develop trust, learn the principle of a direct response from another, and discern structure.

response may have related to the test situation more than to the prototype.

**Figure 7.** Children's reactions in the test: from stressed to open.

**7. Discussion**

publication.

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We acknowledge the helpful suggestions of the anonymous reviewers. We also want to thank the staff of the course Interactive Technology Design and Jakob Nielsen and Jeremy Jobling of Microsoft for helping guide the development of Fuzzy Bird as part of the Microsoft Design Expo challenge 2015. studiolab.ide.tudelft.nl/studiolab/msrdesignexpo2015.

### **Author details**

Stella Boess\*, Astrid Smoorenburg, Minsung Kim, Max Rijken, Thomas Latcham and Sophie Kelder

\*Address all correspondence to: s.u.boess@tudelft.nl

Delft University of Technology, Delft, The Netherlands

### **References**

[1] Höök K, Löwgren J. Strong concepts: Intermediate-level knowledge in interaction design research. ACM Transactions on Computer-Human Interaction (TOCHI). 2012;**19**(3):23

	- [2] Autism Europe. About Autism: Improving Quality of Life for People with Autism [Internet]. Undated. Available from: http://www.autismeurope.org/about-autism. [Accessed: June 01, 2017]
	- [3] Autism Speaks. What is Autism? [Internet]. Undated. Available from: https://www. autismspeaks.org/what-autism. [Accessed: June 01, 2017]
	- [4] Van Rijn H. Meaningful encounters: Explorative studies about designers learning from children with autism. [doctoral dissertation], Delft University of Technology, 2012
	- [5] Bellini S, Gardner L, Markoff K. Social Skill Interventions. Handbook of Autism and Pervasive Developmental Disorders. 4th ed. Vol. 2; 2014. p. 37
	- [6] McConnell SR. Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders. 2002;**32**(5):351-372
	- [7] Horner RH, Carr EG, Strain PS, Todd AW, Reed HK. Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders. 2002;**32**(5):423-446
	- [8] Yohanan S, MacLean KE. Design and assessment of the haptic Creature's affect display. In: HRI '11: Proceedings of the 6th ACM/IEEE International Conference on Human-Robot Interaction, Lausanne, Switzerland, March 6-9 2011, pp. 473-480. DOI: 10.1145/1957656.1957820
	- [9] Salminen K, Surakka V, Lylykangas J, Raisamo J, Saarinen R, Raisamo R, Rantala J, Evreinov G. Emotional and behavioral responses to haptic stimulation. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems 2008 Apr 6, ACM. pp. 1555-1562
	- [10] Özcan B, Caligiore D, Sperati V, Moretta T, Baldassarre G. Transitional wearable companions: A novel concept of soft interactive social robots to improve social skills in children with autism spectrum disorder. International Journal of Social Robotics. 2016;**8**(4):471-481
	- [11] Koskinen I, Zimmerman J, Binder T, Redstrom J, Wensveen S. Design Research through Practice: From the Lab, Field, and Showroom. Elsevier; 2011
	- [12] Aprile WA, van der Helm A. Interactive technology design at the Delft University of Technology—A course about how to design interactive products. In: DS 69: Proceedings of E & PDE 2011, the 13th International Conference on Engineering and Product Design Education, 8-9 September 2011; London, UK. p. 1
	- [13] Van Rijn H, Stappers PJ. The puzzling life of autistic toddlers: Design guidelines from the LINKX project. Advances in Human-Computer Interaction. ACM. 2008
	- [14] Sonneveld MH, Schifferstein HNJ. The tactual experience of objects. In: Schifferstein HNJ, Hekkert P, editors. Product Experience. Amsterdam: Elsevier; 2008. p. 41-67

[15] Winnicott DW. Transitional objects and transitional phenomena. International Journal of Psycho-Analysis. 1953;**34**:3-6

[2] Autism Europe. About Autism: Improving Quality of Life for People with Autism [Internet]. Undated. Available from: http://www.autismeurope.org/about-autism.

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

[3] Autism Speaks. What is Autism? [Internet]. Undated. Available from: https://www.

[4] Van Rijn H. Meaningful encounters: Explorative studies about designers learning from children with autism. [doctoral dissertation], Delft University of Technology, 2012 [5] Bellini S, Gardner L, Markoff K. Social Skill Interventions. Handbook of Autism and

[6] McConnell SR. Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders. 2002;**32**(5):351-372

[7] Horner RH, Carr EG, Strain PS, Todd AW, Reed HK. Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental

[8] Yohanan S, MacLean KE. Design and assessment of the haptic Creature's affect display. In: HRI '11: Proceedings of the 6th ACM/IEEE International Conference on Human-Robot Interaction, Lausanne, Switzerland, March 6-9 2011, pp. 473-480. DOI:

[9] Salminen K, Surakka V, Lylykangas J, Raisamo J, Saarinen R, Raisamo R, Rantala J, Evreinov G. Emotional and behavioral responses to haptic stimulation. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems 2008 Apr 6, ACM.

[10] Özcan B, Caligiore D, Sperati V, Moretta T, Baldassarre G. Transitional wearable companions: A novel concept of soft interactive social robots to improve social skills in children with autism spectrum disorder. International Journal of Social Robotics.

[11] Koskinen I, Zimmerman J, Binder T, Redstrom J, Wensveen S. Design Research through

[12] Aprile WA, van der Helm A. Interactive technology design at the Delft University of Technology—A course about how to design interactive products. In: DS 69: Proceedings of E & PDE 2011, the 13th International Conference on Engineering and Product Design

[13] Van Rijn H, Stappers PJ. The puzzling life of autistic toddlers: Design guidelines from

[14] Sonneveld MH, Schifferstein HNJ. The tactual experience of objects. In: Schifferstein HNJ, Hekkert P, editors. Product Experience. Amsterdam: Elsevier; 2008. p. 41-67

the LINKX project. Advances in Human-Computer Interaction. ACM. 2008

Practice: From the Lab, Field, and Showroom. Elsevier; 2011

Education, 8-9 September 2011; London, UK. p. 1

autismspeaks.org/what-autism. [Accessed: June 01, 2017]

Pervasive Developmental Disorders. 4th ed. Vol. 2; 2014. p. 37

[Accessed: June 01, 2017]

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Disorders. 2002;**32**(5):423-446

10.1145/1957656.1957820

pp. 1555-1562

2016;**8**(4):471-481


#### **Investigating and Designing the Appearance of a Device for Facilitating Pelvic Floor Exercises: A Case Study on Design Sensitivity for Women's Healthcare** Investigating and Designing the Appearance of a Device for Facilitating Pelvic Floor Exercises: A Case Study on Design Sensitivity for Women's Healthcare

DOI: 10.5772/intechopen.71128

Edgar R. Rodríguez Ramírez, Mailin Lemke, Gillian McCarthy and Helen Andreae Edgar R. Rodríguez Ramírez, Mailin Lemke,

Additional information is available at the end of the chapter Gillian McCarthy and Helen Andreae

http://dx.doi.org/10.5772/intechopen.71128 Additional information is available at the end of the chapter

#### Abstract

Pelvic floor disorder (PFD) refers to a weakened or damaged muscle structure affecting the self-esteem, confidence and social participation of affected women. With appropriate training, the weakened muscles can be strengthened, but for a long-term improvement the women need to be actively engaged in the process. While there exists a range of devices that can intra-vaginally measure pelvic floor activation and help women do their exercises, it is unclear how the appearance of the devices may affect women's willingness to use them. We believe that a further understanding around the appearance of these devices may help women feel more comfortable using them, therefore helping them care for their health. We carried out interviews and online questionnaires with women (n:70) who use the devices and clinicians (n:4). We report on identified areas where the appearance of devices is important for women. We present the iterative design process and evaluation of a system aimed at facilitating self-directed pelvic floor management based on this research. We suggest that discrepancies in the responses from participants call for personalisation of the device to meet individual user expectations and increase the design sensitivity when designing for smart devices that help women care for their health.

Keywords: pelvic floor disorder, PFD, iterative design, design system, health, engagement, pelvic floor muscle training, PFMT, appearance, design and emotion, semantics of form

### 1. Introduction

Pelvic floor disorders (PFDs) can affect up to 44% [1] of all women and symptoms like urinary incontinence (UI) can have a significant effect on self-esteem, confidence and social

© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

participation [2]. Pelvic floor muscle training (PFMT) is the first-line conservative management programme for women experiencing PFD.

The condition is a significant healthcare concern for the affected women and has a variety of causes such as childbirth and ageing. A recent study showed that even women who do not show any symptoms do not always know how to contract the muscles correctly [3]. Reports suggest that 70% of women are unable to perform correct voluntary PFM contractions and 97% of them showed low PFM strength [3]. PFMT can increase strength and endurance, particularly when coupled with behavioural training [4–6].

There are some devices in the market that help women carry out their PFMT. The devices detect the pressure applied by the pelvic floor muscles through an intra-vaginal physical device with pressure sensors that communicate via Bluetooth to a mobile app [7]. Existing devices include the LOOP [8], the SKEA [9], the KGoal [10], the PeriCoach [11], Elvie [12] and the Kegel smart [13]. While the use of these devices has been reported as helpful, their uptake has been slow and there seem to be barriers to their adoption [7]. Currently, there is no literature that reports on how the appearance of the devices may help women feel more comfortable in using them or help them understand its use, particularly in this area where education about its correct use is essential.

There are models that can be used to increase the patient's engagement to therapies. The IMS model recommends three steps: (1) information about the condition and how to adhere, (2) motivation to participate in the training and (3) a strategy to overcome practical treatment barriers to treatment adherence and incorporate the training into a daily routine [14]. We used this model to assess women's experience with PFMT and how they perceive the appearance of devices.

### 2. Methods

We analysed online commentary from PFD forums, carried out semi-structured interviews (45 min) and questionnaires (A, 20 min) with health professionals (three pelvic floor physiotherapists and one urogynecologist) and women with self-reported PFD (n:70; New Zealand = 24, USA = 22, UK = 13, Australia = 5, Canada = 4, Taiwan = 1, France = 1), ages 20–69 (median 35). A total of 54 women had children. We asked clinicians to describe the process for prescribing and monitoring PFMT and the main issues they have found for women using PFD devices. We asked women to describe their overall experience of using PFD devices, including how and how often they use them and any issues they have found with them.

We defined a set of design criteria through a thematic analysis of all the data and we used an iterative research-through-design process [15] to arrive to a testable physical device and mobile app. We asked women to watch a 5-min presentation that explained our design concept through video and to answer a second online survey (B, 15 min).

### 3. Results

participation [2]. Pelvic floor muscle training (PFMT) is the first-line conservative manage-

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

The condition is a significant healthcare concern for the affected women and has a variety of causes such as childbirth and ageing. A recent study showed that even women who do not show any symptoms do not always know how to contract the muscles correctly [3]. Reports suggest that 70% of women are unable to perform correct voluntary PFM contractions and 97% of them showed low PFM strength [3]. PFMT can increase strength and endurance, particularly

There are some devices in the market that help women carry out their PFMT. The devices detect the pressure applied by the pelvic floor muscles through an intra-vaginal physical device with pressure sensors that communicate via Bluetooth to a mobile app [7]. Existing devices include the LOOP [8], the SKEA [9], the KGoal [10], the PeriCoach [11], Elvie [12] and the Kegel smart [13]. While the use of these devices has been reported as helpful, their uptake has been slow and there seem to be barriers to their adoption [7]. Currently, there is no literature that reports on how the appearance of the devices may help women feel more comfortable in using them or help them understand its use, particularly in this area where

There are models that can be used to increase the patient's engagement to therapies. The IMS model recommends three steps: (1) information about the condition and how to adhere, (2) motivation to participate in the training and (3) a strategy to overcome practical treatment barriers to treatment adherence and incorporate the training into a daily routine [14]. We used this model to assess women's experience with PFMT and how they perceive

We analysed online commentary from PFD forums, carried out semi-structured interviews (45 min) and questionnaires (A, 20 min) with health professionals (three pelvic floor physiotherapists and one urogynecologist) and women with self-reported PFD (n:70; New Zealand = 24, USA = 22, UK = 13, Australia = 5, Canada = 4, Taiwan = 1, France = 1), ages 20–69 (median 35). A total of 54 women had children. We asked clinicians to describe the process for prescribing and monitoring PFMT and the main issues they have found for women using PFD devices. We asked women to describe their overall experience of using PFD devices, including how and how often they use them and any issues they have found

We defined a set of design criteria through a thematic analysis of all the data and we used an iterative research-through-design process [15] to arrive to a testable physical device and mobile app. We asked women to watch a 5-min presentation that explained our design concept

through video and to answer a second online survey (B, 15 min).

ment programme for women experiencing PFD.

when coupled with behavioural training [4–6].

education about its correct use is essential.

the appearance of devices.

2. Methods

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with them.

We coded the findings from the literature review, online forums, semi-structured interviews and questionnaires with health professionals and women with self-reported PFD using NVivo (Figure 1). Below we present a deductive thematic analysis based on the IMS model and the responses from participants.

#### 3.1. Information barriers

### 3.1.1. Female anatomy

A lack of information about female anatomy can be a significant barrier in the process of women carrying out PFMT or using devices. Women often do not understand their own anatomy, are unable to locate genital openings correctly, and may feel unreceptive to looking and touching their own genitals.

For many ladies that area of their body is still quite sort of shameful and unknown and so I take the view that for a lot of women they have not learnt anything about their body anatomically since year 7 science when it was embarrassing to say the words penis and vagina at school. (Clinician 04)

I show them what their anatomy is like cause a lot of women have never looked at themselves. They don't know where the muscles are – so I point out the hip bone the pelvic bone and the

Figure 1. Initial codes from analysis of interviews with health professionals and women with PFD.

tailbone, I show them that the pelvic floor sits down here and wraps around inside and that it's not just some muscles sitting down there. Then I've got fairly basic pictures. Unless they have a medical background then I'd show them a more anatomical one. (Clinician 02)

#### 3.1.2. Appearance: clinical or like a sex toy?

Even though some clinicians use medical equipment that they rent out to women, one mentioned that sometimes sex toys get already used to relax the pelvic floor: "I buy the devices and then people borrow them off of me – I will give them out." (Clinician 01); "there are some people who actually use vibrators to relax the pelvic floor." (Clinician 02). The women favoured discreteness in form along with ease and simplicity of use. Comments given about the performance of the devices included, "good enough to lessen physical symptoms" and in turn reduce psychological distress. Some disliked their devices being too "clinical" in appearance. However, some women expressed that they did not want their device to appear too much like a sex toy because if features were too strongly associated with it, this would create a sense of psychological awkwardness for the user: "Don't like that it's so clinical, something more shapely [sic] without crossing into sex toy territory would perhaps make it less of an awkward experience." (Participant 04).

#### 3.1.3. Muscle awareness and metaphors

Being able to contract the right muscles is determined by a muscle awareness that the women need to establish [4]. This muscle awareness can be difficult to develop due to the 'hidden location' of the muscles and lack of intrinsic feedback. Clinicians often use metaphors to teach women how to locate and move those muscles: "Going up in the lift… Puddle of water – sucking it in…" (Clinician 01).

#### 3.2. Motivation barriers

#### 3.2.1. Stigma and emotional responses

Clinicians pointed out that women can feel uncomfortable using an internal device. Reasons are the location where the device needs to be placed as well as the associated stigma with PFD conditions such as UI and faecal incontinence. Some women say: "Oh I don't like to poke those things inside of me in case I get an infection" (Clinician 01).

It was mentioned that women tend to be hesitant to talk about the condition and that once they have developed a feeling of trust they start opening up and talk about their symptoms:

And their GPs had sort of brushed them off. 'Oh, you know, it's just you. You just have to put up with it' you know, they trivialised it to them whereas, it's not trivial." (Clinician 03). Also, "It's just developing trust as well, people trusting you enough to say whatever the problem is, and I think when I realised there were so many people with those issues". (Clinician 01)

As expected, more negative feelings than positive tend to be associated with the experience of having a PFD. Words such as "embarrassed" and "frustrated" were commonly used. Negative feelings contribute to the development of stigma as well as perpetuating these feelings when a condition has a stigma attached to it. Some women were worried their children might play with the device if they found it.

#### 3.2.2. Ease of use

tailbone, I show them that the pelvic floor sits down here and wraps around inside and that it's not just some muscles sitting down there. Then I've got fairly basic pictures. Unless they have

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

Even though some clinicians use medical equipment that they rent out to women, one mentioned that sometimes sex toys get already used to relax the pelvic floor: "I buy the devices and then people borrow them off of me – I will give them out." (Clinician 01); "there are some people who actually use vibrators to relax the pelvic floor." (Clinician 02). The women favoured discreteness in form along with ease and simplicity of use. Comments given about the performance of the devices included, "good enough to lessen physical symptoms" and in turn reduce psychological distress. Some disliked their devices being too "clinical" in appearance. However, some women expressed that they did not want their device to appear too much like a sex toy because if features were too strongly associated with it, this would create a sense of psychological awkwardness for the user: "Don't like that it's so clinical, something more shapely [sic] without crossing into sex toy territory would perhaps make it less of an

Being able to contract the right muscles is determined by a muscle awareness that the women need to establish [4]. This muscle awareness can be difficult to develop due to the 'hidden location' of the muscles and lack of intrinsic feedback. Clinicians often use metaphors to teach women how to locate and move those muscles: "Going up in the lift… Puddle of water –

Clinicians pointed out that women can feel uncomfortable using an internal device. Reasons are the location where the device needs to be placed as well as the associated stigma with PFD conditions such as UI and faecal incontinence. Some women say: "Oh I don't like to poke those

It was mentioned that women tend to be hesitant to talk about the condition and that once they have developed a feeling of trust they start opening up and talk about their symptoms:

And their GPs had sort of brushed them off. 'Oh, you know, it's just you. You just have to put up with it' you know, they trivialised it to them whereas, it's not trivial." (Clinician 03). Also, "It's just developing trust as well, people trusting you enough to say whatever the problem is, and I think when I realised there were so many people with those issues". (Clinician 01)

As expected, more negative feelings than positive tend to be associated with the experience of having a PFD. Words such as "embarrassed" and "frustrated" were commonly used. Negative

a medical background then I'd show them a more anatomical one. (Clinician 02)

3.1.2. Appearance: clinical or like a sex toy?

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awkward experience." (Participant 04).

3.1.3. Muscle awareness and metaphors

sucking it in…" (Clinician 01).

3.2.1. Stigma and emotional responses

things inside of me in case I get an infection" (Clinician 01).

3.2. Motivation barriers

Respondents mentioned how some existing devices are difficult to learn to use:

The instructions are not clear. I have used this thing only once. A diagram would be helpful to show the correct way to insert the probe. Does it matter if the metal part is against the pelvic floor or to the wall of the vagina? (Participant 04)

#### 3.3. Design process

#### 3.3.1. Design criteria

We defined set of design criteria for the form of the device and the app based on the different IMS themes. The form of the device should:


The app should:


#### 3.3.2. Design experiments

We developed different prototypes in an iterative process to address the criteria above (Figures 2–10).

Figure 2. Early form iterations that investigate criteria (a): forms to insert and position the device (bottom sides) and to hold it (top parts). For instance, the first form on the left has an elongated loop at the bottom that is slightly open, and closes when inserted and when applying pressure to it. The second and fourth shapes from the right intend to indicate that the bottom part is insertable by having shapes at the top that would be very difficult to insert.

Figure 3. Form iterations based on the shape of a tampon to indicate how to insert the device through the form of a familiar object (criteria (a)).

#### 3.3.3. Testable design

The app and device we tested through online survey B is part of a system (Figure 11). The physical device has two parts. The slim top part is insertable and contains the array of sensors that had been developed by our engineering collaborators (Figure 12). This part has two states: a slim and minimally intimidating form for the insertion and an expanded form to secure the device once inserted that activates through bending the device into place (Figure 8). The wider part contains the electronic components. The app teaches women about their anatomy and Investigating and Designing the Appearance of a Device for Facilitating Pelvic Floor Exercises: A Case Study… http://dx.doi.org/10.5772/intechopen.71128 95

Figure 4. Colour variations based on devices that are currently available.

Figure 5. Experiments with an outer part that can be placed between the body and underwear to secure a stable position once the device is inserted.

creates an individualised programme based on the initial calibration of the device, which works as an assessment of the condition too.

#### 3.4. Assessment of the testable design

3.3.3. Testable design

familiar object (criteria (a)).

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The app and device we tested through online survey B is part of a system (Figure 11). The physical device has two parts. The slim top part is insertable and contains the array of sensors that had been developed by our engineering collaborators (Figure 12). This part has two states: a slim and minimally intimidating form for the insertion and an expanded form to secure the device once inserted that activates through bending the device into place (Figure 8). The wider part contains the electronic components. The app teaches women about their anatomy and

Figure 3. Form iterations based on the shape of a tampon to indicate how to insert the device through the form of a

Figure 2. Early form iterations that investigate criteria (a): forms to insert and position the device (bottom sides) and to hold it (top parts). For instance, the first form on the left has an elongated loop at the bottom that is slightly open, and closes when inserted and when applying pressure to it. The second and fourth shapes from the right intend to indicate

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

that the bottom part is insertable by having shapes at the top that would be very difficult to insert.

Our initial findings suggested that the appearance of a device does not only involve a sense of aesthetics, but it should also communicate important issues for women that included: how

Figure 6. Iterations of regular and irregular patterns that guide the user during the insertion through tactile feedback offered by the form of the device and its texture. The textures also intend to mimic jewellery to minimise stigma (criteria (b) and (d)).

Figure 7. Once the device is placed at the right position it needs to be stable during the training. One of our iterations investigated how small wings appear once the top is bent to stabilise the device.

intuitive it is to use, how professionally it will treat women and their condition, how the sensors work and where they should be placed.

Positive feedback included the quantifiable results ("quantifiable results would be incredibly helpful", participant 4), ease of use, and the immediate assessment and feedback that the system offers during training. Some participants requested a colourful appearance while others found the paler colour more appealing. Participants understood the value of Investigating and Designing the Appearance of a Device for Facilitating Pelvic Floor Exercises: A Case Study… http://dx.doi.org/10.5772/intechopen.71128 97

Figure 8. Bending of the bottom part to stabilise the sensors (by becoming wider) while looking as little threatening as possible (small and thin) when it needs to be inserted (criteria (b)).

including sensors: "[I like] that it shows how strong the muscles are and if you're using the wrong ones" (participant 6). Other participants liked its discreetness: "I like that it is discrete and quite private, with the training times set to suit the user" (participant 1). A participant was worried about whether the device would sit on her clitoris.

#### 3.5. Final design

intuitive it is to use, how professionally it will treat women and their condition, how the

Figure 7. Once the device is placed at the right position it needs to be stable during the training. One of our iterations

Figure 6. Iterations of regular and irregular patterns that guide the user during the insertion through tactile feedback offered by the form of the device and its texture. The textures also intend to mimic jewellery to minimise stigma (criteria

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

Positive feedback included the quantifiable results ("quantifiable results would be incredibly helpful", participant 4), ease of use, and the immediate assessment and feedback that the system offers during training. Some participants requested a colourful appearance while others found the paler colour more appealing. Participants understood the value of

sensors work and where they should be placed.

investigated how small wings appear once the top is bent to stabilise the device.

(b) and (d)).

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We used the feedback to define a final iteration of the design (Figure 13).

Figure 9. 3D printed prototype to test bending.

Figure 10. Tests with different materialities looking for a high performance and professional feeling (criteria (c)).

Investigating and Designing the Appearance of a Device for Facilitating Pelvic Floor Exercises: A Case Study… http://dx.doi.org/10.5772/intechopen.71128 99

Figure 11. User scenario.

Figure 10. Tests with different materialities looking for a high performance and professional feeling (criteria (c)).

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Figure 9. 3D printed prototype to test bending.

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Figure 12. The physical device we tested with participants.

Figure 13. A render of the final design based on feedback from users.

### 4. Discussion

Women who experience PFD are a diverse user group. Depending on the severity of the disorder they can have different symptoms, be from different age groups, experience a significant degree of shame and stigma, and the dimensions of the human vagina can differ significantly. All of these questions the assumption that one device fits all [16].

Women reported different expectations on how such an intimate device should look. User feedback indicates a discrepancy of expectations concerning the visual aesthetic of such an intimate device. There were some women assessing our design who wanted it to look like a medical device while other would prefer it to be more playful and even resemble and be used as a sex toy. We suggest that further research is necessary to investigate the motivations behind these preferences and how designs may address it. Further studies could investigate from a design perspective where form-wise lies the tipping point between clinical device and sex toy; build functional prototypes and test them with women in order to assess the usability and interaction with the device over long-term use.

### 5. Conclusion

Figure 12. The physical device we tested with participants.

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Figure 13. A render of the final design based on feedback from users.

This paper reports on what factors should influence the physical appearance of an intravaginal device to help women carry out pelvic floor exercises. A review of the literature, interviews and questionnaires with clinicians and women with PFD helped us develop a set of criteria that we used to design a device and app for PFMT. User feedback indicates that there are different expectations about the aesthetics of such an intimate device. This discrepancy in expectations and the fact that the range of disorders and users can differ rather significantly suggest that individualising the device might be an appropriate strategy to address the demands of this diverse user group.

### Acknowledgements

This project was sponsored by the Center of Research Excellence in Medical Technologies (CoRE MedTech), New Zealand. We thank the overall project leaders Dr. Jenny Kruger, Professor Dr. Poul Nielsen and Dr. David Budgett from the Auckland Bioengineering Institute for inviting us to collaborate in this project.

### Author details

Edgar R. Rodríguez Ramírez\*, Mailin Lemke, Gillian McCarthy and Helen Andreae

\*Address all correspondence to: edgar.rodriguez@vuw.ac.nz

Victoria University of Wellington, Wellington, New Zealand

### References


[13] Intima. KegelSmart: The Smart Kegel Exerciser [Internet]. 2015 [cited 2017 Jan 2]. Available from: https://www.youtube.com/watch?v=WnLhY-PyOro

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vimeo.com/119571913

LHo

[1] Talasz H, Himmer-Perschak G, Marth E, Fischer-Colbrie J, Hoefner E, Lechleitner M. Evaluation of pelvic floor muscle function in a random group of adult women in Austria.

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

[2] Hunskaar S, Vinsnes A. The quality of life in women with urinary incontinence as measured by the sickness impact profile. Journal of the American Geriatrics Society.

[3] Tibaek S, Dehlendorff C. Pelvic floor muscle function in women with pelvic floor dysfunction: A retrospective chart review, 1992–2008. International Urogynecology Journal.

[4] Laycock J. Concepts of neuromuscular rehabilitation and pelvic floor muscle training. In: Baessler K, Burgio KL, Norton PA, Schüssler B, Moore KH, Stanton SL, editors. Pelvic Floor Re-education [Internet]. London: Springer London; 2008 [cited 2016 Mar 2]. p. 177-183.

[5] Perucchini D, DeLancey JOL. Functional anatomy of the pelvic floor and lower urinary tract. In: Baessler K, Burgio KL, Norton PA, Schüssler B, Moore KH, Stanton SL, editors. Pelvic Floor Re-education [Internet]. London: Springer London; 2008 [cited 2016 Mar 1].

[6] Marques A, Stothers L, Macnab A. The status of pelvic floor muscle training for women.

[7] Nygaard I, Norton PA. Devices. In: Baessler K, Burgio KL, Norton PA, Schüssler B, Moore KH, Stanton SL, editors. Pelvic Floor Re-education [Internet]. London: Springer London; 2008 [cited 2016 Mar 7]. p. 201-207 Available from: http://link.springer.com/10.1007/978-

[8] Loophealth. LOOP: Interactive Pelvic Floor Exerciser for Women [Internet]. 2014 [cited 2017 Jan 2]. Available from: https://www.youtube.com/watch?v=QHq\_gzwhf8k

[9] Qingyue C. Skea, Smart Kegel Exercise Aid [Internet]. 2014 [cited 2017 Jan 2]. Available

[10] Minna Life. How to use kGoal [Internet]. 2015 [cited 2017 Jan 2]. Available from: https://

[11] ZoneMedicalPtyLtd. Exercising with The PeriCoach System [Internet]. 2015 [cited 2017

[12] CURRENTBODY.com. Elvie: Your most personal trainer by CURRENTBODY [Internet]. 2016. [cited 2017 Jan 2]. Available from: https://www.youtube.com/watch?v=IeJVYYVq

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Canadian Urological Association Journal. 2010;4(6):419-424

from: https://www.youtube.com/watch?v=8YyUI0SRAbg


**Adaptation to Interactive Technologies - Domestic Digitization**

#### **Designing for Embodied and Rich Interaction in Home IoT** Designing for Embodied and Rich Interaction in Home IoT

DOI: 10.5772/intechopen.71130

### Joep Frens Joep Frens

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.71130 Additional information is available at the end of the chapter

#### Abstract

Internet of things (IoT) artifacts form systems where touchscreen and speech interaction is the norm. As IoT systems are inherently open (artifacts can be added or removed, software can be updated), we observe that the natural state of an IoT system is changed, "growth." This chapter describes a designerly experiment exploring how to design for embodied and rich interaction in these "growing" IoT systems. We present four design cases showcasing four approaches to the design challenge: a hybrid, a modular, a shape changing, and a service approach. We describe and appraise the four approaches and discuss insights from the designerly experiment. We conclude that it is indeed possible to design for embodied and rich interaction in "growing" IoT systems and see our work as a first step toward diversifying IoT interaction styles.

Keywords: rich interaction, embodied interaction, growing systems, internet of things, design

### 1. Introduction

The design of socio-technical systems receives an increasing amount of attention. Systems concepts that have been explored in literature over the past 2 decades (e.g., ubiquitous computing [1], pervasive computing [2], ambient intelligence [3]) are now brought to the market as the "internet of things" (IoT) [4].

The primary interest of this chapter is the human-product interaction within IoT systems in home and we feel inspired by research areas like tangible interaction [5], embodied interaction [6], or rich interaction [7]. The academic community gives a range of arguments for the value of tangible, embodied, and rich interaction: Ullmer [8] argues that we have a familiarity with the physical world around us that we can capitalize on when making interfaces tangible. The field of embodied cognition adds the argument that we make sense of the world and its complexity through the physicality of it and the situatedness of our actions [9], for the latter also see [10].

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

Hummels and van der Helm [11] makes the argument for resonant interaction and argues that different people prefer (resonate with) different interaction styles, including tangible interaction styles. Finally, van Campenhout [12] argues that the value of tangible, embodied, and rich interaction must be sought in esthetics (the esthetics of the third stand). This esthetic cannot be either in the physical or in the digital alone; it only exists in the coupling of the two. Making physicality an important prerequisite for esthetics of interaction.

Despite this compelling rationale, these interaction styles are not landing in industry; neither in the interactive products on the market, nor in home IoT that is dominated by (touch)screen and speech interaction (e.g., Philips Hue [13], Reality Editor [14], IFTTT [15], Amazon Echo [16]).

Where academics and industry are currently operating in their own world, we feel that home IoT can be crucial in bridging the gap between them. IoT revolves around "things": artifacts that stand in the tradition of the objects that we used before the world was interactive (e.g., coffee mugs, kitchen appliances, lamps, or stereo equipment). These artifacts inherit interaction styles from this tradition; interaction styles that are familiar, situated, and that resonate with specific people because of their esthetics in interaction. As electronic "intelligence" pervades our living rooms through home IoT, we can capitalize on these qualities and explore how tangible, embodied, and rich interaction can be made to fit these IoT systems. At the same time, we consider home IoT to be an inherently complex phenomenon and see opportunity to help people make sense of it by adopting a more embodied and rich interaction style.

This leads us to explore what it takes to design for embodied and rich interaction for home IoT. In what follows, we introduce a designerly experiment and present a student design challenge that was setup to explore embodied and rich interaction in home IoT. We present four different design approaches to solve the design challenge. After discussing the approaches, the chapter concludes with a brief look into future work.

### 2. A designerly experiment

In this section, we introduce our designerly experiment and its theoretical backdrop.

#### 2.1. Internet of things as a growing system

At present, the internet of things [4] is promising us a connected future, where IoT artifacts produced by different manufacturers form networks of products in the home, IoT systems. There are ongoing efforts both in academia (e.g., Semantic connections [17], Reality Editor [14]) and on the market (e.g., Home kit [18], IFTTT [15]) to truly make the connected future in home IoT, a reality, but these are not yet fully adopted.

We see IoT systems as inherently open (IoT artifacts can be added or taken away and software can be updated) and we observe that the natural state of an IoT system is a change (we label this as "growth" indicating that home IoT grows to match the preference of its user). This means that the functionality in IoT systems is not stable. The consequence of adding or updating IoT artifacts means that on a system level, functionality can emerge in unpredictable ways because of how the IoT artifacts are combined by their users. We feel that when IoT systems become truly connected, forming actual "growing" systems, emergent functionality becomes one of its more fascinating features. At the same time, emergent functionality will be a challenge to design for. This has consequences for the design process [19, 20] and the interaction solutions in IoT.

#### 2.2. Embodied and rich interaction

Hummels and van der Helm [11] makes the argument for resonant interaction and argues that different people prefer (resonate with) different interaction styles, including tangible interaction styles. Finally, van Campenhout [12] argues that the value of tangible, embodied, and rich interaction must be sought in esthetics (the esthetics of the third stand). This esthetic cannot be either in the physical or in the digital alone; it only exists in the coupling of the two. Making

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

Despite this compelling rationale, these interaction styles are not landing in industry; neither in the interactive products on the market, nor in home IoT that is dominated by (touch)screen and speech interaction (e.g., Philips Hue [13], Reality Editor [14], IFTTT [15], Amazon Echo [16]).

Where academics and industry are currently operating in their own world, we feel that home IoT can be crucial in bridging the gap between them. IoT revolves around "things": artifacts that stand in the tradition of the objects that we used before the world was interactive (e.g., coffee mugs, kitchen appliances, lamps, or stereo equipment). These artifacts inherit interaction styles from this tradition; interaction styles that are familiar, situated, and that resonate with specific people because of their esthetics in interaction. As electronic "intelligence" pervades our living rooms through home IoT, we can capitalize on these qualities and explore how tangible, embodied, and rich interaction can be made to fit these IoT systems. At the same time, we consider home IoT to be an inherently complex phenomenon and see opportunity to

help people make sense of it by adopting a more embodied and rich interaction style.

In this section, we introduce our designerly experiment and its theoretical backdrop.

At present, the internet of things [4] is promising us a connected future, where IoT artifacts produced by different manufacturers form networks of products in the home, IoT systems. There are ongoing efforts both in academia (e.g., Semantic connections [17], Reality Editor [14]) and on the market (e.g., Home kit [18], IFTTT [15]) to truly make the connected future in home

We see IoT systems as inherently open (IoT artifacts can be added or taken away and software can be updated) and we observe that the natural state of an IoT system is a change (we label this as "growth" indicating that home IoT grows to match the preference of its user). This means that the functionality in IoT systems is not stable. The consequence of adding or updating IoT artifacts means that on a system level, functionality can emerge in unpredictable

This leads us to explore what it takes to design for embodied and rich interaction for home IoT. In what follows, we introduce a designerly experiment and present a student design challenge that was setup to explore embodied and rich interaction in home IoT. We present four different design approaches to solve the design challenge. After discussing the approaches, the chapter

physicality an important prerequisite for esthetics of interaction.

concludes with a brief look into future work.

2.1. Internet of things as a growing system

IoT, a reality, but these are not yet fully adopted.

2. A designerly experiment

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We position the design challenge in embodied and rich interaction. Embodied interaction is defined as: "the creation, manipulation, and sharing of meaning through engaged interaction with artifacts" [6,p. 126]. Embodied interaction is a perspective on interaction that emphasizes that one can meaningfully interact with the world through doing rather than through knowing, resonating strongly with Gibson's work on ecological perception [21], and the research area of tangible interaction (e.g., [5]). Rich interaction [7] shares this theoretical basis and can be regarded as a product centric exponent of embodied interaction.

The rich interaction framework is aimed at designing for meaningful interaction by respecting all human skills (i.e., perceptual-motor, cognitive, and emotional skills [22]) and by designing for a unity of form, interaction, and function. This results in strong-specific [23] interactive products that express in their form what can be done with them, both from an action point of view and from a functional point of view: they give feed-forward. Below we give two examples.

#### 2.2.1. Rich actions camera

The rich actions camera features rich action possibilities that express their functionality in form and interaction (Figure 1). For example, to take a picture with this camera, the user pushes the "trigger" at the side of the screen. The form of the "trigger" invites the thumb to push. The trigger

Figure 1. Rich actions camera by Joep Frens [7, 24].

Figure 2. Third stand payment terminal by Lukas van Campenhout [25, 26]. (Photo courtesy of Lukas van Campenhout.).

is also shaped such that it keeps the screen in place. When the "trigger" is pushed, it releases the screen. The screen flips away from the lens on a hinge and a photo is taken (also see [24]).

#### 2.2.2. Third stand payment terminal

This payment terminal (Figure 2) is designed to bring digital monetary transactions back to the physical. The vendor (right hand side) enters the price of a purchase and pushes the "traveler" (i.e., the construction with the round screen) toward the customer side. In turn, the customer places a payment token (not shown) on the physical drawer and pushes it into the terminal, simultaneously pushing some of his (digital) money toward the vendor. The traveler accepts the digital money and (physically) moves back to the vendor side [25, 26]. The payment terminal expresses in its form and behavior how the transaction plays out and invites for different actions during the process of payment.

#### 2.3. Research question and research aim

When we look at embodied and rich interaction through the lens of "growing" IoT systems, they seem to be incompatible at first glance. As already mentioned, there are preciously few (if any) examples of IoT artifacts that offer an embodied and rich interaction style. Arguably, redesigning the IoT artifacts could easily solve this. But this is not where the incompatibility and hence the complexity lies. As argued above, we consider truly connected IoT systems to be "growing" systems where functionality is inherently dynamic and emergent. The result of this is that functionality is undetermined at the time of designing, the connected artifacts that live within IoT systems. This is an ill fit with the rich interaction paradigm that aims for meaningful interaction by expressing functionality in form and interaction; it is problematic to express in form and interaction that what is not known yet. To understand this better, we formulated two research questions. Our first research question approaches this "looking forward" and asks: "how to design for embodied and rich interaction in 'growing' home IoT systems." Our second question "looks back" and asks: "how does the concept of rich interaction needs to change when applied to 'growing' IoT systems."

Figure 3. A media center with dedicated remotes.

This research aims to inform interaction design within a home IoT context by example and reflection. We intent to find approaches to this design challenge but also learn from these approaches how rich interaction itself changes.

#### 2.4. Design challenge

is also shaped such that it keeps the screen in place. When the "trigger" is pushed, it releases the screen. The screen flips away from the lens on a hinge and a photo is taken (also see [24]).

Figure 2. Third stand payment terminal by Lukas van Campenhout [25, 26]. (Photo courtesy of Lukas van Campenhout.).

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

This payment terminal (Figure 2) is designed to bring digital monetary transactions back to the physical. The vendor (right hand side) enters the price of a purchase and pushes the "traveler" (i.e., the construction with the round screen) toward the customer side. In turn, the customer places a payment token (not shown) on the physical drawer and pushes it into the terminal, simultaneously pushing some of his (digital) money toward the vendor. The traveler accepts the digital money and (physically) moves back to the vendor side [25, 26]. The payment terminal expresses in its form and behavior how the transaction plays out and invites for

When we look at embodied and rich interaction through the lens of "growing" IoT systems, they seem to be incompatible at first glance. As already mentioned, there are preciously few (if any) examples of IoT artifacts that offer an embodied and rich interaction style. Arguably, redesigning the IoT artifacts could easily solve this. But this is not where the incompatibility and hence the complexity lies. As argued above, we consider truly connected IoT systems to be "growing" systems where functionality is inherently dynamic and emergent. The result of this is that functionality is undetermined at the time of designing, the connected artifacts that live within IoT systems. This is an ill fit with the rich interaction paradigm that aims for meaningful interaction by expressing functionality in form and interaction; it is problematic to express in form and interaction that what is not known yet. To understand this better, we formulated two research questions. Our first research question approaches this "looking forward" and asks: "how to design for embodied and rich interaction in 'growing' home IoT systems." Our second question "looks back" and asks: "how does the concept of rich interaction needs to change when

2.2.2. Third stand payment terminal

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different actions during the process of payment.

2.3. Research question and research aim

applied to 'growing' IoT systems."

We chose an IoT media center as the context for our design challenge (Figure 3). This media center was a small media server with a range of input and output devices in a home context. At present, each (software or hardware) component that is added comes with its own dedicated remote control. These remote controls were to be replaced by a new "growing" remote control offering an embodied and rich interaction style. The "growing" media center is easily recognized as an IoT system and has a clearly visible way of how it can "grow": by adding new (software or hardware) components. Which components are added was up to the students. Finally, the challenge sets the stage for functionality to emerge as new components combine with existing parts of the media center to create functionality that is neither present in the existing components nor in the new components alone.

### 3. Four approaches to design for growth

Starting in 2010 and ending in 2014, we gave our students the challenge to design a "growing" embodied and rich interface for a media center. The semester long design challenge was open to industrial design students doing their final bachelor project, first year master project and final master project. The challenge yielded over 20 cases that we have analyzed for differences and similarities. We found four patterns with clear differences regarding approach.

In what follows, we present these patterns by means of four design cases. We chose to present recent cases that demonstrated the patterns best.

#### 3.1. Hybrid approach

Hybrid solutions are perhaps the simplest route to success in this design challenge. It comprises combinations of screen-based interaction with rich action possibilities. Typical for this

approach is that it employs a screen to deal with the aspects of "growth" and change and that it makes use of rich action possibilities for the aspects of the interface that are not subject to change.

#### 3.1.1. Ball remote

Joep Elderman showed a design for a remote control for a media center that features a ballshaped token that is placed on top of a horizontally placed screen (Figure 4a). The position of the token is tracked. The user can move the ball token, but it can also move autonomously. On top of the screen, a template is mounted that has two indents and a round track where the ball can be placed to access the functionality. The ball can be loaded with multi-media content and will playback this content when placed in the circular track. Playhead control is achieved by manually moving the ball in the track (after which it moves autonomously) or by stopping the ball (Figure 4d). When the ball is taken from the circular track, the whole surface of the remote control shows GUI elements, by placing the ball on these elements a menu structure is entered to access more complex or emergent functionality (Figure 4b, c).

#### 3.1.2. Appraising the hybrid approach

The benefit of this approach is that it offloads the complexity of dealing with emergent functionality to the screen and to conventional menu structures. These are good at adapting to new content or incorporating new functionality [27]. On the other hand, the potential of embodied and rich interaction to offer a more direct and less mediated interaction style that emphasizes man as a whole rather than just his cognitive skills is only partially met. The promise of a physical interaction style literally giving handles on the complexity of systems is not completely fulfilled. In this approach, it is crucial that the coupling between the physical action possibilities and that what happens on the screen is designed to fit each other specifically. Generic menu structures need to be avoided.

Figure 4. Ball remote by Joep Elderman, 2014 (Photos courtesy of Joep Elderman). (a) Song playback, ball is moving in a circular track; (b, c) Placing the ball on GUI elements accesses menu structures; (d) Playhead control by manually manipulating the ball on the circular track.

#### 3.2. Modular approach

approach is that it employs a screen to deal with the aspects of "growth" and change and that it makes use of rich action possibilities for the aspects of the interface that are not subject

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

Joep Elderman showed a design for a remote control for a media center that features a ballshaped token that is placed on top of a horizontally placed screen (Figure 4a). The position of the token is tracked. The user can move the ball token, but it can also move autonomously. On top of the screen, a template is mounted that has two indents and a round track where the ball can be placed to access the functionality. The ball can be loaded with multi-media content and will playback this content when placed in the circular track. Playhead control is achieved by manually moving the ball in the track (after which it moves autonomously) or by stopping the ball (Figure 4d). When the ball is taken from the circular track, the whole surface of the remote control shows GUI elements, by placing the ball on these elements a menu structure is entered

The benefit of this approach is that it offloads the complexity of dealing with emergent functionality to the screen and to conventional menu structures. These are good at adapting to new content or incorporating new functionality [27]. On the other hand, the potential of embodied and rich interaction to offer a more direct and less mediated interaction style that emphasizes man as a whole rather than just his cognitive skills is only partially met. The promise of a physical interaction style literally giving handles on the complexity of systems is not completely fulfilled. In this approach, it is crucial that the coupling between the physical action possibilities and that what happens on the screen is designed to fit each other specifi-

Figure 4. Ball remote by Joep Elderman, 2014 (Photos courtesy of Joep Elderman). (a) Song playback, ball is moving in a circular track; (b, c) Placing the ball on GUI elements accesses menu structures; (d) Playhead control by manually

to access more complex or emergent functionality (Figure 4b, c).

3.1.2. Appraising the hybrid approach

manipulating the ball on the circular track.

cally. Generic menu structures need to be avoided.

to change.

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3.1.1. Ball remote

An approach that is very prominent in the work of our students is the use of modularity. By creating inter-connectable interactive modules, each offering dedicated rich interaction, remote controls can be "composed" that "grow" together with the system that they live in. This approach takes cues from early work on modular interfaces like DataTiles [28] or more recent work on generic and modular tangibles [29, 30].

#### 3.2.1. Tiled remote control

Jordy Rooijakkers created a series of interactive tiles (Figure 5a, b) that can be used to layout a specific multi-media system and through which multi-media content can be moved by means of an interactive viewer/selector tile that sits on top of the other tiles (Figure 5c). The interactive viewer/selector tile has different behavior depending on which tile it rests. It offers a rotary control at the side (Figure 5d) that can be used to make a media selection. If desired, this selection can be "grasped" and brought to a different tile by squeezing it (Figure 5b). Adding new tiles to the remote control can open up new media center components.

#### 3.2.2. Appraising the modular approach

The modular approach is capable of responding to the "growth" in "growing" IoT systems: when the media center gets a new component, this can be matched by adding a new component to the remote control and it can do this while offering embodied and rich interaction where each component of the remote control can be designed to express its function in its form and interaction. Still, there is one challenge that it does not solve: the challenge of dealing with emergent functionality. Interactive modules open up dedicated functionality of specific components. Emergent functionality is in the combination of components and not in a specific component and that makes it difficult to grasp emergent functionality by means of a modular approach.

Figure 5. Tiled remote by Jordy Rooijakkers, 2014 (Photos courtesy of Jordy Rooijakkers). (a) Music player, library, and broadcasting tile and the viewer/selector; (b) A more extensive set of tiles; (c) Moving media from the library to the music player; (d) When the viewer/selector is attached to the broadcasting tile it can be used to choose a TV channel.

#### 3.3. Shape changing approach

A promising approach is that of shape change. Where the modular approach "grows" through addition, the shape change approach is self-contained and changes shape under computational control: an interactive node could present new, rich action possibilities in response to "growth" of the systems. That our students are not alone in seeing this is clear from the abundance of literature on the subject (e.g., [31–33]).

#### 3.3.1. Adaptive remote control

Paul van Beek designed an adaptive remote control (Figure 6a) for controlling a video on demand system. His remote control offered basic interactions for navigating a screen-based menu structure in its default shape (Figure 6b). When more specific controls were needed, the remote control responded by sliding open and offering more (physical) controls (Figure 6c–e), which controls and the amount of controls visible on the slider could be varied as a response to the activity of the user by sliding the remote further open or closed.

#### 3.3.2. Appraising the shape changing approach

If we share Ishii's vision on Perfect Red [31], a programmable material that can take any shape, shape change potentially solves the "growing" IoT systems challenge. Yet, at present technology has not advanced to the point that matter is truly under computational command. Till that moment, the shape changing approach relies on mechanical solutions. These mechanical solutions toward "growing" IoT systems share a problem with the modular approach in how to deal with emergent functionality: it is difficult to design for shape change if it is not known

Figure 6. Adaptive remote control by Paul van Beek, 2014 (Photos courtesy of Paul van Beek). (a) The adaptive remote control in context (closed state); (b–e) Depending on the requirements of the task the remote control opens en gives context dependent controls on the slider in the middle.

what the desired changed shape needs to be. That is not to say that in constrained situations, this approach cannot be of value: shape changing controls can be designed that do offer changing forms to express changing functionality and accommodate changing interactions.

#### 3.4. Service approach

3.3. Shape changing approach

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3.3.1. Adaptive remote control

literature on the subject (e.g., [31–33]).

3.3.2. Appraising the shape changing approach

context dependent controls on the slider in the middle.

A promising approach is that of shape change. Where the modular approach "grows" through addition, the shape change approach is self-contained and changes shape under computational control: an interactive node could present new, rich action possibilities in response to "growth" of the systems. That our students are not alone in seeing this is clear from the abundance of

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

Paul van Beek designed an adaptive remote control (Figure 6a) for controlling a video on demand system. His remote control offered basic interactions for navigating a screen-based menu structure in its default shape (Figure 6b). When more specific controls were needed, the remote control responded by sliding open and offering more (physical) controls (Figure 6c–e), which controls and the amount of controls visible on the slider could be varied as a response to

If we share Ishii's vision on Perfect Red [31], a programmable material that can take any shape, shape change potentially solves the "growing" IoT systems challenge. Yet, at present technology has not advanced to the point that matter is truly under computational command. Till that moment, the shape changing approach relies on mechanical solutions. These mechanical solutions toward "growing" IoT systems share a problem with the modular approach in how to deal with emergent functionality: it is difficult to design for shape change if it is not known

Figure 6. Adaptive remote control by Paul van Beek, 2014 (Photos courtesy of Paul van Beek). (a) The adaptive remote control in context (closed state); (b–e) Depending on the requirements of the task the remote control opens en gives

the activity of the user by sliding the remote further open or closed.

A final approach to deal with rich interaction in "growing" systems that we present is a service approach. This approach responds to the challenge by means of updating the interactive nodes by replacing its interaction surfaces in short cycles as a service, creating opportunities for "hyper-personalization" of embodied and rich interfaces, somewhat similar to commercial approaches like NikeID [34] and such. Strictly speaking, it is a variation of the modular approach, but it offers much more integrated solutions and hence is singled out as a separate approach.

### 3.4.1. Generated remote control

Tom Fejèr presented a remote control for the "growing" media center that revolved around personal media use (Figure 7a, b). He proposed a design that would follow a user's preferences in media, giving direct access to his favorite songs or series. The rationale was that as media use changed, the remote control would need to change in shape and action possibilities (Figure 7c). This would be done by printing new, parametrically generated shapes on a regular basis. His remote control featured a touch sensitive core where the 3D–printed shells were placed over. While the example shows a faceted touch surface, the premise was that also rich interfaces could be algorithmically generated.

Figure 7. Generated remote control by Tom Fejèr, 2014 (Photos courtesy of Tom Fejèr). (a) A working prototype of the generated remote control in context; (b) A render of the design, the surface can be touched to access multi-media context; (c) Three different shells that can all be attached to the same sensing hardware.

#### 3.4.2. Appraising the service approach

When interactive nodes can be updated by replacing its interaction surfaces with newly designed interaction surface, the "growing" IoT systems challenge is solved as a unity of form, interaction, and function can be guaranteed. The service approach has a solution for the changing of form and interaction to open new functionality but the challenge of designing these interaction surfaces remains. The example shows a parametrical implementation and these have similar problems as the shape change approach: the software needs to be designed to generate expressive geometry without knowledge of what sort of expressivity is needed. If the service approach follows the template of the example (i.e., a high-tech core with customizable interaction surfaces), the question also remains how to design the "interface" between the technology and the interaction surfaces flexible enough that the remote as a whole can deal with the dynamics of "growing" IoT systems.

### 4. Discussion

Here, we take the time to look back at the designerly experiment and reflect on our research questions: (1) "how to design for embodied and rich interaction in 'growing' home IoT systems" and (2)"how does the concept of rich interaction needs to change when applied to 'growing' IoT systems."

#### 4.1. Designing for embodied and rich interaction in growing home IoT systems

In answering our first research question, we first look back at the design processes of our students. Our students particularly stumbled over the "openness" of the challenge that is caused by the requirement of having "growing" interfaces. It seemed that the complexity of the challenge paralyzed them and made them try and out-think the challenge rather than to tackle it through designerly exploration. A successful design strategy proved to be to artificially constrain the challenge and harness the openness by starting to design "loci of interaction" for three or four pre-defined states of "growth" (Table 1). In this manner, grip on the phenomenon of "growth" and emergent functionality could be acquired by studying the state transitions in a controlled manner to generalize a strategy to deal with "growth" when the artificial constraints were lifted.

Next, we look at the benefits of the four approaches toward solving the challenge that we presented. We feel that there is not one approach that can be singled out as the ultimate solution to the challenge, let alone that a "recipe" can be formulated, more research is necessary. At the same time, we feel confident in saying that it is not impossible to design for embodied and rich interaction in a home IoT context as the four approaches show promising


Table 1. States of growth.

directions. The four approaches act as "templates" (to be used singularly or combined) to inform the design process of designing for embodied and rich interaction in home IoT (growing systems) and provide more grip on the "openness" of the design challenge.

#### 4.2. Reflecting on the changes in embodied and rich interaction

It is clear that the openness (caused by "growth" and emergent functionality) in the design challenge goes against the grain of the designed unity of form, interaction, and function that is one of the defining features of rich interaction (as a product centric operationalization of embodied interaction). As a result, this designed unity needs to be reconsidered; the unity should be released but not left. The hybrid approach proposes to have a standard set of rich and specific controls, designed as a unity but releases the unity through screens that offer more generalized controls. The modular approach offers rich and specific modules that each can be designed as a unity but the unity is compartmentalized in modules. The shape changing approach potentially offers a unity but necessarily releases it in the design process due to the openness of the challenge. Finally, the service approach can potentially offer rich and specific controls that are designed as a unity, but this unity is likely released due to the compromises that need to be made in mating the rich and specific interface to the generic technological parts (this is particularly true in the design example that is given).

### 5. Concluding remarks

3.4.2. Appraising the service approach

with the dynamics of "growing" IoT systems.

4. Discussion

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artificial constraints were lifted.

Table 1. States of growth.

State 1 streaming video

State 2 streaming video + hard-disc recording

When interactive nodes can be updated by replacing its interaction surfaces with newly designed interaction surface, the "growing" IoT systems challenge is solved as a unity of form, interaction, and function can be guaranteed. The service approach has a solution for the changing of form and interaction to open new functionality but the challenge of designing these interaction surfaces remains. The example shows a parametrical implementation and these have similar problems as the shape change approach: the software needs to be designed to generate expressive geometry without knowledge of what sort of expressivity is needed. If the service approach follows the template of the example (i.e., a high-tech core with customizable interaction surfaces), the question also remains how to design the "interface" between the technology and the interaction surfaces flexible enough that the remote as a whole can deal

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

Here, we take the time to look back at the designerly experiment and reflect on our research questions: (1) "how to design for embodied and rich interaction in 'growing' home IoT systems" and (2)"how does the concept of rich interaction needs to change when applied to 'growing' IoT systems."

In answering our first research question, we first look back at the design processes of our students. Our students particularly stumbled over the "openness" of the challenge that is caused by the requirement of having "growing" interfaces. It seemed that the complexity of the challenge paralyzed them and made them try and out-think the challenge rather than to tackle it through designerly exploration. A successful design strategy proved to be to artificially constrain the challenge and harness the openness by starting to design "loci of interaction" for three or four pre-defined states of "growth" (Table 1). In this manner, grip on the phenomenon of "growth" and emergent functionality could be acquired by studying the state transitions in a controlled manner to generalize a strategy to deal with "growth" when the

Next, we look at the benefits of the four approaches toward solving the challenge that we presented. We feel that there is not one approach that can be singled out as the ultimate solution to the challenge, let alone that a "recipe" can be formulated, more research is necessary. At the same time, we feel confident in saying that it is not impossible to design for embodied and rich interaction in a home IoT context as the four approaches show promising

State 3 streaming video + hard-disc recording + distributed audio

4.1. Designing for embodied and rich interaction in growing home IoT systems

Lastly, we discuss the contribution of this chapter and come back to the value of embodied and rich interaction for "growing" IoT systems. We see value in the exploration of alternative interaction styles in the context of home IoT as we give interaction designers the tools and exemplars to design IoT interfaces appropriate for their functionality, context of use, and fitting the preference of its user (s). This diversify the interaction styles in IoT but also implies the promise of multi-specific IoT artifacts (amplifying the notion of strong-specific products [23]) that can be tuned to different tasks and that stay relevant and meaningful while the IoT systems "grow." Next to this, we see value in the framing of IoT systems as "growing" systems and the consequences this has on the design process of embodied and rich interactive IoT artifacts in four approaches.

### 6. Future work

The next step is to further investigate the four design approaches. The approaches themselves, with all of their idiosyncrasies, need to be better understood. Next to this it is well possible that more approaches to accommodate "growth" in IoT systems can be formulated. We imagine combinations of the existing approaches but we are also searching for new approaches.

Next to this, we are particularly interested in exploring distributed approaches toward designing for interaction in "growing" IoT systems. While the centralized approach has had its use in this research driven design challenge by offering constraints to make the approaches comparable, it

is not to say that it should be copied to any IoT systems design challenge. In fact, the argument could be made that particularly embodied and rich interaction (informed by tangible interaction) takes a spatially distributed approach, necessitating the consideration of distributed schemes or mixed schemes.

### Acknowledgements

We thank the master students and faculty who have kindly provided photos of their work: Lukas van Campenhout, Joep Elderman, Jordy Rooijakkers, Paul van Beek, and Tom Fejèr.

### Author details

Joep Frens

Address all correspondence to: j.w.frens@tue.nl

Department of Industrial Design, Designing Quality in Interaction Group, Eindhoven University of Technology, Eindhoven, The Netherlands

### References


[9] van Dijk JJ. Creating traces, sharing insight: Explorations in embodied cognition design. Unpublished Doctoral dissertation, Eindhoven University of Technology, Eindhoven, the Netherlands; 2013

is not to say that it should be copied to any IoT systems design challenge. In fact, the argument could be made that particularly embodied and rich interaction (informed by tangible interaction) takes a spatially distributed approach, necessitating the consideration of distributed schemes or

Proceedings of the Conference on Design and Semantics of Form and Movement - Sense and Sensitivity, DeSForM

We thank the master students and faculty who have kindly provided photos of their work: Lukas van Campenhout, Joep Elderman, Jordy Rooijakkers, Paul van Beek, and Tom Fejèr.

Department of Industrial Design, Designing Quality in Interaction Group, Eindhoven

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[2] Satyanarayanan M. Pervasive computing: Vision and challenges. IEEE Personal Commu-

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[5] Ishii H, Ullmer B. Tangible bits: Towards seamless interfaces between people, bits and atoms. In: Proceedings of the ACM SIGCHI Conference on Human Factors in Computing

[6] Dourish P. Where the Action Is: The Foundations of Embodied Interaction. MIT press;

[7] Frens JW. Designing for rich interaction: Integrating form, interaction, and function. Unpublished Doctoral dissertation. Eindhoven, the Netherlands: Eindhoven University

[8] Ullmer BA. Tangible interfaces for manipulating aggregates of digital information. Unpublished Doctoral dissertation, Massachusetts Institute of Technology, School of Archi-

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[3] Marzano S. The New Everyday: Views on Ambient Intelligence. 010 Publishers; 2003

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Address all correspondence to: j.w.frens@tue.nl

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Systems. ACM; 27 March 1997. p. 234-241

University of Technology, Eindhoven, The Netherlands

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**Provisional chapter**
