Video-mediated communication in the classroom to support sick children: a case study
Introduction
Video mediated communication has recently gained much wider acceptance as an important and effective instructional tool (Gowan and Downs, 1994; Benford et al., 1998). Educators of all types—teachers, seminar leaders, and laboratory demonstrators—have begun to take advantage of this technology to augment traditional teaching modalities. Video mediated communication is a valuable educational resource because it provides access to otherwise unattainable learning materials, it motivates students, and helps them improve communication skills (Knight, 1998). Moreover, video mediated communication has been shown to heighten student motivation and to help them learn communication and management skills (Weiss et al., 2000).
When elementary or secondary school students are absent from school for extended periods due to illness, they are provided with a tutor or access to in-hospital classrooms. Although such instructional techniques help sick students keep up with some of the missed classroom work, they do not alleviate all of the stress generated by confinement to a hospital setting. Removal from familiar surroundings (such as the home and school environment) and a lack of control over major, and even many minor decisions concerning themselves, are factors which contribute to this stress (Bossert, 1994; Calculator and Jorgensen, 1994; Ellerton et al., 1994; Katz et al., 1992).
Moreover, traditional instructional techniques do not provide sick children with frequent contact with familiar classmates, a factor that has been reported to be of critical importance for children with cancer (Katz et al., 1992). In addition to academic gains, contact with their peers appears to result in significant non-academic benefits, particularly in social and communication skills and in the development of greater self-confidence and independence (Lipsky, 1995; Thompson, 1994).
Less attention has been given to the stress experienced by students when one of their peers is hospitalized due to a long-term serious illness. There are a number of different scenarios, each of which would be expected to require a different level of support and cause different levels of disruption to a classroom environment. In one scenario, the sick student does not return to school and classmates must deal with the issues related to their classmate's loss. In another scenario, the sick student completely recovers from the illness and must be reintegrated into the classroom, a process that may be disruptive especially if the absence has been lengthy. In a third scenario, a student may be required to attend school on an extended part-time basis due to medical considerations such as renal dialysis or physiotherapy. Little formal research has examined the impact of these situations on the students in the classroom. In all cases, little attention has been paid to the potential for technology-mediated integration of sick children in their classroom.
Research in remote communications systems has been directed primarily at studying the interactions between adults (Buxton et al., 1997). These interactions take the form of meetings with specific, goal-oriented agendas or tasks (e.g., the Montage system, and Hydra/Brady Bunch system, Tang and Rua (1994); Buxton et al. (1997)) or distance learning activities (Gowan and Downs, 1994) in which known and practiced social protocols and roles are followed. Less attention has been paid to the use of remote communication systems for children, although several projects where children collaborate with other children using technologies such as the Internet, telefax and video-conferencing to achieve academic goals (e.g., Schools of the Future project, Naujokaitis (1997) and Schools of the Helsinki 2001, Matikainen, 1998) have been carried out. Few results from these projects have been published regarding children's attitudes toward the technology, or how it affected their classroom experience and their learning behaviors.
STARBRIGHT World is a video-mediated system designed for children in hospitals. This system connects hospitalized children with similar medical conditions in a self-contained networked environment (Holden et al., 1999). The primary design objectives of this application are entertainment and the establishment of a community of individuals in similar situations. Neither academic achievement nor the maintenance of an existing social network are objectives.
A second example is “Project Caroline and Christer”, designed to link children in the hospital with their regular classroom and/or family (Perez-Bercoff, 1999). In this project, desktop video-conferencing was used to make these connections. Modifications to the software or to the physical appearance of the computer were not made. There is also little objective or subjective data on the effectiveness of the system.
Combining video-mediated communication with robotics or physical avatars has been examined by a number of researchers. Kuzuoka and Greenberg (1999) designed a physical avatar that would indicate that a videoconferencing session was requested by the second party. Personal roving presence (PRoP) is an augmented traditional videoconferencing system with mobile tele-robot to enhance the physical presence of the participant (Paulos and Canny, 1998). Finally, Ferworn et al. (1999) used high speed, low resolution videoconferencing mounted on a remotely controlled robotic system to provide visual feedback to users via the WWW. However, in each case no studies with actual users have been reported to date.
The PEBBLES project is designed to link sick children with their regular classrooms using technology-mediated communication and presence. The student in the hospital controls a robot-like communication system located in the school. The system incorporates video-conferencing technology so that there is a two-way, real-time audio and video connection between the classroom and the sick child. This paper reports on one full case study of a child using PEBBLES. Specifically, the objectives of this paper are to document the impact of PEBBLES on the communication and social interaction of the sick child with her classmates, how the sick child's classmates perceived the PEBBLES experience and how the exposure to video mediated communication influenced their attitude towards their sick classmate.
Section snippets
Description of the PEBBLES
Wayne Gretzky's Providing Education By Bringing Learning Environments to Students (PEBBLES™) is a video-mediated communication system which has been designed to link a child in the hospital with his/her regular classroom (Fels et al., 1999). In this case, one part of the PEBBLES system was located in the regular school classroom, and the other component was located in the dialysis unit of a major children's hospital. The classroom end of the system, shown in Fig. 1, is a child-size, yellow,
Subjects
The subjects in this study consisted of Naama (not her real name), a 12 year old girl suffering from acute renal failure due to chronic kidney disease, her regular classroom teacher, her hospital teacher, her dialysis nurse, and the 26 11–13 year old male and female students who attended grade 7 in the senior public school in which Naama was enrolled. Naama needed to be hospitalized as a day patient three times weekly (Mondays, Wednesdays, and Fridays) in order to receive hemodialysis. Due to
Quantitative data
The frequency of occurrence of each event category (all, all positive, and all negative) for the 46-day period is shown in Table 1. The Technical Issues category accumulated the most events (207), with about 90% of the recorded events being negative as expected (i.e., a potential indication that the video/audio quality or program function often disrupted Naama's ability to participate in activities). Scrutiny of the daily records revealed that the majority of these negative events occurred
Discussion
The quantitative data from this single case study are not suited to full statistical analysis, and will be discussed only in terms of general trends. The number of negative events for technical issues was expectedly high and is likely due to the fact that the technology for videoconferencing systems, particularly audio technology, is very much in its infancy. Sufficient bandwidth and optimized algorithm designs are not yet available for high quality signal processing and transmission over
Conclusions
With the aid of time-stamping video analysis it has been possible to define and document specific events that took place during a six-week period when a sick child was linked to her school classroom via a video mediated communication robot. The possibility of tracking changes in the student's behavior and ability to use the system has revealed a number of important occurrences and associations between them that will aid in the design and implementation of future systems. In some cases, the
Acknowledgments
The authors would like to thank The Bay, Wayne Gretzky, The Canadian Gift and Tableware Association, CANARIE, The Ontario Ministry of Education and Training (TIPPS II), The Royal Bank of Canada, NSERC grant # OGP0184220, the Ontario Provincial and Demonstration Schools, Human Resources Development Canada, Ryerson Polytechnic University, Telbotics Inc and The University of Toronto. We also would like to acknowledge the McCaul Street School, The Toronto Hospital for Sick Children and J.S.
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