the soft qualities of interaction -...

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The Soft Qualities of Interaction

ALESSIA RULLO

University of Siena

This article provides a methodological perspective on the notion of the aesthetics of interaction in

ambient computing systems. Aesthetics of interaction is challenged by the design proposal for the

soft qualities of interaction, which is used as a tool to complement existing design methodologies.

The perspective presented is based on work conducted in the Neonatal Intensive Care Unit at Siena

Hospital in Italy, as a part of the EU PalCom project. The early outcomes provide a heuristic account

which questions the design process by fostering the novel complexity of ambient technologies in

delicate and fragile settings.

Categories and Subject Descriptors: H.4.0 [Information Systems Applications]: General; H.5.2

[Information Interfaces and Presentation]: User Interfaces—User-centered design; theory andmethods; evaluation/methodology; J.3 [Computer Applications]: Life and Medical Sciences—

Health; K.4.1 [Computer and Society]: Public Policy Issues—Computer-related health issues

General Terms: Design, Human Factors, Theory

Additional Key Words and Phrases: Aesthetics of interaction, soft qualities, neonatal care,

noninvasive and nonintrusive monitoring

ACM Reference Format:Rullo, A. 2008. The soft qualities of interaction. ACM Trans. Comput.-Hum. Interact. 15, 4, Ar-

ticle 17 (November 2008), 25 pages. DOI = 10.1145/1460355.1460359 http://doi.acm.org/10.1145/

1460355.1460359

1. INTRODUCTION

The life of a human technological system entails a complex whole of variables,which determine not just how we use such instruments (i.e., functionally), butalso how we make sense of them and how their presence in our lives manifestsitself.

Recent research in the HCI and interaction design field would suggest thatthe design space should be reconceived to allow for the introduction not only offunctional variables that affect and determine our interaction with systemsand tools, but also of the emotional variables that can be triggered by the

This research was supported by the PalCom Project.

Author’s address: A. Rullo, Communication Science Department, University of Siena, Via Roma,

56 53100 Siena, Italy; email: [email protected].

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10.1145/1460355.1460359

ACM Transactions on Computer-Human Interaction, Vol. 15, No. 4, Article 17, Publication date: November 2008.

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aesthetic values of the designed solutions [Djajadiningrat et al. 2002, 2000;Norman 2004; Petersen 2004]. Design methodologies can be seen as similar toevolutionary objects, which constantly change to adapt to the emerging needs ofdesigning human-technology interaction. The user’s needs form a complex of ex-pectations, previous usage experiences, and emotional variables that should beintegrated into the system design. It is indeed fundamental to embody the vari-ations in usage expectations, and experiences that are established among indi-viduals throughout their interactions with the tools and the environment. Thiswork adopts the notion of aesthetics of interaction in order to investigate theseissues.

In many senses, the perspective of the aesthetics of interaction can be con-sidered as a means of facilitating the way in which computation is manifestedin a system’s design, and overcoming some of the traditional problems of ubiq-uitous, ambient, and pervasive computing which cause computation to becomeinvisible, with subsequent loss of control on the part of the user [Petersen 2004;Tolmie et al. 2002; Weiser 1993, 1991; Weiser and Seely Brown 1996].

This idea of invisibility in use has been interpreted in many ways, with theobjective of exploring how computation can manifest itself and, when neces-sary, become perceptible to the user. According to Weiser’s interpretation of theconcept, “invisible” means that individuals can become so familiar with the useof certain technologies that they don’t have to think about the fact that theyare interacting with them. Technologies are readily available, and people canfocus on the task with which they are involved without concentrating on theirinteraction with the mediating device.

In reality, this idea of invisibility did not result in concrete and useful out-comes regarding the way in which people may interact with these kinds oftechnologies, and this notion of invisibility has primarily been translated intoan idea of proactive computing that makes decisions on behalf of the users[Rogers 2006]. This tendency is also reflected methodological approaches to-ward the design of ubiquitous and ambient systems. As Hook [2006] explains,in the contemporary practice of software development, less time-consuming de-sign strategies are adopted. For instance, the “proactive” computing stance as-sumed in the research fields of ubiquitous computing, affective computing, andintelligent environments significantly reduces users to mere information, pro-cessing units that can be modeled and understood, thus permitting the systemto act on their behalf [Hook 2006]. This approach can have successful resultsif the situation at hand occurs within a context that is limited enough to bemodeled in the entirety of its details and consequences. However, due to theinherent complexity of the lives of human-technology systems, in the major-ity of cases this approach dramatically oversimplifies human interaction andaffects, among other things, the inspection mechanism and the managementof the system breakdown. Therefore, one of the primary issues in contempo-rary design practice is that of understanding the role of users in the design ofhuman-technology systems which should continuously adapt to design contextsand to emerging design demands.

According to this perspective, as Rogers clearly points out [2006], ubiqui-tous computing, or UbiComp, research should begin to target rethinking the


The Soft Qualities of Interaction • 17:3

meaning of computational invisibility. To quote Rogers herself, the design ofubiquitous and ambient technologies should “shift from proactive computing toproactive people” [Rogers 2006, p. 406] and find new modalities to engage userexperiences. This concept of design demand leads to further reflection on designmethodologies and tools. In fact, in order to engage users in interaction withubiquitous and ambient technologies, new strategies for participation in thedesign process should be considered, aiming at understanding how the role ofthe user can evolve during the design process, how the user can participate andexpress her needs, and which tools can be adopted in order to capture ever-morecomplex and multifaceted user requirements.

This methodological demand raises additional issues as to how to interpretand design for specific qualities of computational material that influence userinteractions and engagement. In the domain of ubiquitous and ambient ap-plications, computational technology appears as a new type of design materialwith its expressional necessities. Computational materials present an inherentcomplexity, since computation occurs according to simultaneous and abstractprocesses which function on a logical level, and it is difficult for inexpert usersto determine what is happening and on what level. In addition, computation isimmaterial; in fact, many computational processes and resource managementtasks occur outside of the user’s perceptual range, and are thus unnoticeable[PalCom Deliverable 2008]. Specific features characterize the expressional levelof computation, for instance, the temporal dimension and therefore the possi-bility of expression throughout time [Hallnas and Redstrom 2002]. These char-acteristics delineate certain qualities that can affect and shape use [Landin2005] by defining the expressional level of interaction.

Aesthetics of interaction can, according to this perspective, be intended asone of the components of the idea of computational expressiveness. Petersen[2004] proposes that the aesthetics of interaction can be adopted as a designstrategy to make computation remarkable:

Aesthetic interaction is not about conveying meaning and direction throughuniform models; it is about triggering imagination, it is thought provoking andencourages people to think differently about interactive systems, what they doand how they might be used differently to serve differentiated goals [Petersenet al. 2004, p. 271].

According to this view, aesthetics represents the modality by which interactioncan be playful and engaging, allowing exploration of novel ways in which com-putation can become visible and noticeable, opening the design space for theusers’ emergent behaviors.

Stemming from this position and in keeping with Rogers’s proposal of design-ing UbiComp technologies to engage user experiences, in this work, aestheticsis considered an immanent quality of our experience with interactive systemsthat emerges as an interactive process and that may influence our attitudetoward the situation or activity at hand.

Thus, the notion of the aesthetics of interaction is herein defined as a pro-cess of appropriation and engagement with technologies based on interpre-tation of the experiential and subjective variables that interplay throughout


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Fig. 1. The Neonatal Intensive Care Unit, Siena Hospital, Italy.

the interaction. The possibilities for interaction can manifest themselves bybalancing the different qualities that affect ambient computing systems.

This work therefore aims at addressing the role of the aesthetics of interac-tion in ambient computing systems, with the ultimate objective of understand-ing how it can reflect on design methodologies so as to achieve a twofold intent:(1) reflecting on the significance of user participation in the design process;and (2) trying to find new strategies to allow emergence and to codify existingneeds as well as the novel demands of a specific design context in an appro-priate design format. These considerations gain a particular significance whenexamining application domains that present a particular, systematic fragility;the Neonatal Intensive Care Unit is a specific example.

2. THE NEONATAL INTENSIVE CARE UNIT

The Neonatal Intensive Care Unit (NICU) presents a particular, systematicfragility; see Figure 1.

The premature birth or occurrence of problems after childbirth is a dramaticevent, often unexpected, that amplifies the sense of separation normally asso-ciated with the delivery experience. Care of premature newborns is a compositeprocess, involving the use of complex machineries and collaboration among dif-ferent persons with varying skills and backgrounds, different objectives, anddifferent expectations (i.e., neonatal doctors, nurses, therapists, and families)[Marti and Rullo 2006; Gronvall et al. 2005]. Admissions to the NICU generallyhappen under emergency situations related to problems occurring during de-livery, or during the pregnancy if the infant’s or mother’s health status becomescritical. Premature newborns usually require complex medications, umbilicaltubes, and intubations. In particular, the incubator appears to be the main ap-paratus that medical staff can configure to adapt temperature, oxygen, andhumidity, depending on the baby’s condition.

The system is characterized by a high level of reconfigurability, since each in-cubator should be conceived as an ad hoc entity which is tailored to the baby’sconditions and that changes dynamically over time. The Neonatal IntensiveCare Unit environment should be able to support the coexistence of these di-verse necessities and afford an easy reconfiguration as these necessities change.The work practice is based on continuously combining and integrating data ar-riving from different sources. According to this perspective, what is crucial isthe way in which people make sense of what it is going on and how a continuous


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process of understanding is supported and correlations are created. This aspectis fundamental for the medical personnel, as it permits prompt intervention onthe baby’s behalf when necessary, but also for families, in order to assist themin psychologically enduring such a delicate situation and to allow them to playan active role in the childcare, offering as much as possible their presence andaffective support [Westrup 2005].

Ambient computing solutions designed for this setting could raise severalissues that would affect both the functional and subjective experience of workin this environment and influence the life of the overall system.

3. THE METHODOLOGICAL PERSPECTIVE

Aesthetics within healthcare settings has proven to be key, capable of influenc-ing medical treatment and the overall care of patients.

Recent progress made in the treatment of neonatal pathologies has signifi-cantly increased life expectancy after a premature birth or a birth with com-plications. However, the greatest successes in the medical field have led toa serious paradox: While the possibility of survival for these children is con-tinually increasing, it is not yet possible to stabilize their environmental andrelational conditions [Symington and Pinelli 2003; Sizun and Westrup 2004].The aesthetic characteristics of the environment can facilitate autoregulativebehaviors in the newborn. A variety of interventions can be adopted in order tocontrol environmental stressors known to cause physiological and behavioraldisorganization in newborns, for example, light and sound, scheduling of care-giving, integration of parents, specific supportive behavioral techniques suchas non-nutritive sucking, opportunities for grasping, swaddling, general motorcontainment, and kangaroo care [Als 1982; Als et al. 1986].

Assuming, therefore, that aesthetics has an important function in this appli-cation domain, how can the aesthetic elements be extracted and subsequentlyrendered applicable to the design? How do they relate to other variables of thedesign process? Indeed, any attempt to concretely incorporate the aesthetic con-cerns of a design into a sharable approach has scarcely been investigated, andaesthetics has been traditionally delegated to specific design sensibilities. Oneexception to this rule is exhibited in the work of Djajadiningrat et al. [2000].These scholars suggest that the aesthetics of interaction must consider therichness of appearance, the actions and the role of a design, thus moving be-yond the mere idea of usability. This perspective demands new methods for thecomprehension of design possibilities. Moreover, as Djajadiningrat et al. [2000]discuss, it is important that the latent needs of existing practices become man-ifest to designers, so that they may later be incorporated into the requirementsand design solutions.

3.1 The Soft Approach to Design

The assumption of the proposed work is that when designing for ambient com-puting applications, the design space should be opened in order to considermore variables, not only functional ones but also emotional, experiential, andaesthetic.


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In this sense, the nature of the requirements to be considered should beextended to include what in traditional architecture has been called “soft qual-ities” in the Design Primario movement [Branzi 1986] or “Quality Without aName” as proposed by Alexander [1979, 1977]. In both of these cases the de-sign demand is that of externalizing those features that define aesthetics andthat create the sense of wholeness that may characterize our relationship withcertain environments. As Alexander [1979] also points out, defining these qual-ities is quite complicated, since they are generated by those variables of thedesign that somehow escape the consideration of designers interested in purelyfunctional aspects.

According to Alexander, one of the distinguishing aspects of the quality with-out a name is that of enabling those conditions for which one town or one build-ing is “lived” and perceived as “alive”:

Things which are living may be lifeless; nonliving things may be alive. . . .Beethoven’s last quartets are alive; so are the wave[s] at the ocean shore; so isa candle flame; a tiger may be alive, because more in tune with its own innerforces, than a man [Alexander 1979, p. 29].

But life cannot be created on purpose; rather, it is the result of a process ofappropriation. This process can also be supported by the precise physical con-figurations of the space, by the specific design choice, which Alexander callsthe pattern language. The life of a space can also evolve from the occurrenceof patterns of events that allows each place to develop a precise character andhave its own life.

Compare for instance, two ways of including water in a building. Suppose, onthe one hand, that there is a concrete reflecting pool outside your room—withno purpose except to reflect the sky.

And suppose, on the other hand, that there is a stream outside your room withsmall rowing boat on it, where you can go, to row, to lie on the water, struggleagainst the stream . . . [Alexander, 1979, p. 65].

Of course, the row boat makes the most difference to the structure, since italters the entire experience of the building. Similarly, the life of our house orour town is not given directly by its geometry, ornament, or plan, but by thequalities of the events and situations we encounter there. This implies that thequalities put into place are not only fixed properties of the physical object, butare subjective values built throughout interaction.

In a more recent book, Branzi [2004] provides an additional interpretation ofthe application of soft qualities in the design of products and everyday objects.This is the idea of “blistering.”

Blisters are that kind of packaging for medicines—pills and lozenges, that pre-serve their content within the plastic and that must be broken to let each singlepill come out before it is swallowed. . . .

But blisters are not simply a kind of packaging, I think they are somethingphilosophical; a general protective cover that defends us from the products andthe products from us . . . The blister is thus a reciprocal technology, an importantenvironmental presence, a way of looking at the world through an opacity that


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surrounds a delicate part of it, and separates it from an excess of contacts andconsumptions [Branzi, 2004, trasl.].

In Branzi’s view, the concept of blistering refers to a specific quality of softdesign. The possibility of enabling different simultaneous levels of visibilitycan create a protective environment and allow novel interactions based on anew interpretative basis.1

In this work, the soft qualities of interactions offer an additional dimensionto the design space and they act in two different ways. On the one hand, theyare analytical tools that attempt to isolate specific elements of the interaction,which are related more to the way in which people construct meaning (theexpressional level of interaction) than to the way in which people do things(the functional level of interaction). On the other hand, soft qualities are in-spirational instruments that enlighten the design space with a focus on theselatent values of the interaction, which often escape design techniques [Rullo2008]. In this light, these qualities may complement design methodologies byallowing interpretion of the experiential values that emerge in the interactionand effecting the expressional level at which computation can be manifested.Indeed, it is the author’s conviction that the role of these aspects is indispens-able to the design of ambient computing systems, in which interaction does nottake place only according to the one-on-one relationship between human anddevice; it is also distributed within the setting and throughout settings, per-vading everyday objects, and enabling new relationships which arise from theenvironmental and relational conditions enabled. From this perspective, it canalso be useful to refer to the use, in the interaction design field, of the notionof “place,” intended as an entity which embodies the experiences and aspira-tions of people. This approach looks at the way in which the physical world isconstantly lived, modified, and experienced by people, and investigates thosedesign strategies that can allow a “nonplace” to become a space [Coyne andStewart 2007] that people can appropriate through interactions. This notion ofplace is adopted as a key variable in understanding the dynamic relationshipbetween human behavior and the surroundings as they are shaped at personal,social, cultural, and physical levels [Ciolfi and Bannon 2007, 2005; Ciolfi 2004].In keeping with these positions, this work aims at capturing these experien-tial aspects of human activities, focusing on the qualities that permit people toappropriate, interpret, and create meaning throughout interactions.

The concrete enablers of this methodological proposal are the soft qualitiesof interaction, the soft set of requirements, and the soft prototype as analyticaland operative tools that are used to actualize the notion of the aesthetics ofinteraction in the design practice.

The case study presented in this work will exemplify the use of these method-ological tools by presenting a design experience taken from the PalCom project(http://www.ist-palcom.org/). The PalCom project explored the challenges of theambient computing system and proposed a conceptual framework and an openarchitecture for palpable computing [Buscher et al. 2007; Ingstrup and Hansen

1For a complete review of the “Blister” collection by Andrea Branzi [2004], see http://www.

designgallerymilano.it/blister.html.


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Fig. 2. Participatory design sessions with the neonatal team, Siena Hospital (Italy): data sessions,

future laboratories, and “bricolage” workshops.

2005]. This case will present the design of palpable technologies for the Neona-tal Intensive Care Unit and will illustrate how the methodological tools hereinproposed are used to complement the design process, by focusing on particularaspects of the interaction.

4. THE FIRST DESIGN PHASE: DISCUSSION

The context of the Neonatal Intensive Care Unit requires a specific designstrategy to capture the complexity of the human activity taking place thereand to evaluate the feasibility and reliability of the envisaged solutions [Rulloet al. 2006].

Thus, a participatory approach and a high-level strategy for the evaluationhave been adopted. Different techniques have been experimented with through-out the design process, which were directly inspired by the participatory designtraditions [Schuler and Namioka 1993]; see Figure 2. User workshops and ac-tivity modeling, data sessions and “bricolage” workshops [Shapiro 1996] havebeen conducted with the neonatal team. Diaries [Gaver et al. 1999] and ques-tionnaires have been distributed and collected, interviews have been carried outwith parents and experts; as well as future laboratories workshops [Buscheret al. 2004]. Different usage scenarios have been developed interpreting theuser requirements that emerged during fieldwork activities.

The outcomes of these activities clarified the basic features of existing tech-nologies (i.e., their physical characteristics), the functional requirements, andsome drawbacks. For example, the existing devices are often connected withwires and tubes that can provoke abrasions or irritations if in contact with thebaby’s skin.

From these activities, many interesting elements emerged to inform the de-sign process. The incubator was reconsidered in order to support the creationof an environment that fully embraces the child, with abilities to sustain itsbody and to reproduce the kind of stimulation and environmental conditionsthe child had received in the mother’s uterus, supporting portability of the en-vironment through use of an ad hoc net of sensors, and providing the leastintrusive monitoring possible. Furthermore, the medical personnel suggestedthe possibility of detecting the pressure points of a newborn body from beneaththe mattress on which the baby lays. Redesigning the existing mattress with



Table I. Initial Set of Functional Requirements

GENERAL

Opening system Description: The performance of treatments on the babies, such

as intubations and the placing of sensors, currently requires

that the incubator be opened, which dramatically effects the

micro-environmental conditions inside. It should be possible in-

tervene on the baby both without opening the incubator and in

such a way that the medical staff is provided with a sufficient

degree of comfort in accomplishing their operations.

Acoustic pollution -

External noise

Description: The overall environment (the ward as such) has

acoustic pollution that can have a damaging effect and is per-

ceived as harmful for the newborn in the incubator. There is a

wish to prevent these noises from reaching the newborn. This

is also applicable when the child is undergoing an intervention,

(e.g., in today’s case, when the lid of the incubator is open).

Acoustic pollution -

Internal noise

Description: The modern-day incubator also generates noise

that disturbs and affects the child in a negative way. To pro-

vide just one example of the various types of these noises, cur-

rent models are powered by an engine that is placed within

the incubator, which produces a very high level of sound. The

new incubator should seek to limit or completely remove such

noises.

Internal temperature

control

Description: The child should be kept in a temperature-

controlled environment as much as possible. This temperature

should be set and maintained by the staff, even during all kinds

of interventions. Today the incubator is opened during some in-

terventions, thus directly changing the protective environment

that is normally maintained inside the incubator

THE COVER

Light control Description: A prematurely born child is extremely sensitive to

light and for this reason it is requested that the amount of light

inside the incubator be controlled and kept constant, regardless

of the brightness of the external light sources.

Visibility Description: The staff should be able to visually monitor the

child without difficulty or obstruction, even if the light inside

the incubator is dimmed.

THE BED

Soft mattress Description: The mattress on which the baby lies is currently

made of a hard plastic material; it is not comfortable and not

adaptable to the baby’s body. A soft, more adjustable mattress

is requested that supports the interventions and the needs of

the child.

Tilting mattress Description: To assist the child’s respiration it is necessary that

the bed can tilt the child and maintain a position in which the

head is higher than the feet and vice versa, until such a time

that the child is remanipulated.

Fixed body

position/Prevent big body

movements

Description: The medical staff would like to be able to keep the

child in particular positions for some interventions or to keep

the child in a position that supports its current needs.

Flexible body

movement/Allow small

body movements

Description: The child, even in a fixed position, should be able

to make small movements. The mattress should support this

necessity even if in a predefined position.


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Fig. 3. The first 3D model of the incubator prototype.

ambient/palpable technologies appeared a promising solution for detecting thepressure points of the newborn’s body, with the added benefit of combining thisdata with other parameters of the incubator system. This would be done in orderto avoid pressure sores and frequent postural problems, to survey the newborn’sspontaneous respiratory movements, and, in combination with a Webcam, toinvestigate the infant’s micromovements.

These early findings were elaborated into an envisioning process, directlyinvolving the neonatal team and the newborns’ families through interviews.The outcome of this activity led to the definition of the first incubator concept,namely the “water lily.” Indeed, the water lily represents a soft and protectiveenvironment composed of a layered structure of petals and smart materials.The list presented in Table I illustrates the functional requirements expressedby the users that are exemplified in this early concept with a specific referenceto the newborn’s micro-environment and to the mattress features [Rullo 2007].

Taking this list of requirements as a starting point, the main features of theincubator prototype were discussed with the medical staff. On this basis, it waspossible to sketch out the initial physical model of the incubator; see Figure 3.The incubator in this prototyped version is seen as a portable environmentthat is conceived as an assembly of devices and functions to be configured onthe basis of the baby’s conditions.

Within the micro-environment of the incubator, the baby lies on a mattresscontaining body-pressure sensors that detect the weighted areas of the baby’sbody on the mattress surface; see Figure 4. In order to avoid pressure soresand similar problems, a fine-grained modular system allows the medical staffto manipulate and change the position of the baby’s body without opening theincubator, thus preserving the micro-environmental conditions inside. This ma-nipulation is allowed by a pin-art type of system whose elements can be movedup and down directly or remotely [Rullo 2007; Rullo et al. 2006].

Different user workshops with the medical personnel at the neonatal wardfocused on the evaluation of the first model of an incubator prototype and itsassociated functionalities. A preliminary assessment of the mattress conceptwas performed by building a physical mock-up of the mattress, which nursesand physicians used by simulating on a baby doll ordinary operations duringfuture laboratory sessions. One of the main topics of discussion related to theinteraction modalities embodied in the mattress design. The main outcomescan be summarized as follows.



Fig. 4. Mattress, the first mock-up, the map of pressure sensors, the pins system, and a future

laboratory session.

— Manipulation of the Baby Through the Mattress. Medical personnel deemedit very useful to have a trace of the pressure points of the baby’s body on themattress, in order to simultaneously monitor the baby’s movements and an-ticipate pressure on high-risk areas, or just to avoid pressure sores. However,the modality of manipulation of the baby through the bed pins must be re-considered, since the baby should be handled only for therapeutic purposes.The pin-art-like system does not allow exploring the possibility to have di-rect contact with the baby, nor does it provide the child with the appropriatesensorial stimulation.

— Physical Design: The Design for Separation. The mattress itself is still similarto the original model, that is, a layer of hard, plastic material which has beenaugmented with new functionalities (pressure-point detection and automaticmanipulation), but it’s not able to contain the baby’s body. The mediation thatthe incubator structure provides is still perceived as a separation betweenthe child and the external world.

In short, the technological innovation introduced by the first design phase pro-vided new functionalities, but didn’t represent a real added value for the peopleacting in this setting.

These design solutions have also been subjected to an expert evaluation; theprototype and scenarios have been assessed by Professor Westrup, the founderof the NIDCAP approach to the care of premature newborns. NIDCAP standsfor the Newborn Individualized Developmental Care and Assessment Program[Westrup 2005], an approach that uses a range of medical and nursing inter-ventions that aim to decrease the stress of preterm neonates in NICUs and tosupport the creation of care communities around each baby [Symington andPinelli 2003]. Professors Westrup was asked to evaluate the prototype, bothfrom the NIDCAP’s perspective and while also trying to represent the needs ofthe newborns, whom obviously could not be directly involved in the design pro-cess. Professor Westrup severely criticized this first prototype. In fact, in thisdesign solution he didn’t recognize any manifestation of those environmentalqualities that are fundamental to the care of the child (i.e., support of directcontact between child and caregivers in order to enable care actions towardthe child and to minimize separation between the newborn and the externalenvironment). In fact, even if the prototype is able to support the child’s well be-ing from a functional perspective (i.e., through maintenance of environmental


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conditions inside the dome, the filtering of light and sound, and facilitation ofmedical staff intervention), from an interactive perspective, this prototype isstill no better than its predecessor. It still embodies the traditional concept ofthe incubator space, which does not allow the kind of direct contact betweenchild and care-givers that is necessary in the early development of the child.

5. SOFT QUALITIES OF INTERACTION AND SOFT REQUIREMENTS:THE SECOND DESIGN PHASE

The methodological perspective of this work is intended to complement thedesign process undertaken in the PalCom project.

As demonstrated throughout the evaluations undergone in user workshops,discussions of future laboratories at the hospital, and in interviews with theexpert, this first incubator prototype was effective in responding to the precisenecessities of newborns and of caregivers. In contrast, and particularly in ref-erence to the mattress evaluation mock-up (i.e., the pin-art-like system), theprototype was not able to interpret the more delicate variables present withinthe setting of the Neonatal Intensive Care Unit, such as: (1) the necessity ofphysical contact between child and care-givers; (2) support for different lev-els of understanding of the baby’s conditions by diverse individuals of the carecommunity; and (3) the shift of perspective that is necessary to psychologicallysupport the different emotional needs of the people involved.

In this regard the central questions are as follows. Can the design of ambientcomputing systems respond to such a complex whole of variables? What is therole of the aesthetics of interaction?

5.1 Map of Remarkable Experiences

With the aim of outlining the problem, an initial user workshop was conductedwith representatives of staff members of the Neonatal Ward at Siena Hospital.

This was intended as an explorative workshop aimed at understanding towhat extent a deeper comprehension of the aesthetic aspects of the daily expe-rience at the NICU could provide useful information for the mattress redesign.The strategic approach of this part of the work was that of distinguishing cer-tain remarkable experiences at the NICU and, by use of in-depth interviews,trying to determine which elements (functional and aesthetical) were put intoplace.

The user workshop involved three members of the medical staff: two neona-tal doctors and one physiotherapist. They were asked to describe experiencesrelated to the following topics: conflicts, participation, surprise, stimulating ex-periences, upsetting experiences, moving moments, provocation, and reactions.The rationale at the basis of the workshop was that of exploring the whole spec-trum of emotions, from negative to positive experiences, that were felt in thisenvironment, with the aim of understanding the key dynamics that affectedthese staff members’ attitudes toward their work as these emotions occurred.The data from this preliminary activity is reported in Figure 5.

This map exemplifies an attempt to represent various facets of what can beascribed to the aesthetic experience in this setting, by means of a description


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通过worksop，两个医生以及一个理疗师，被要求形容关于一些主题topics的experience

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Fig. 5. Map of remarkable experiences at the NICU.

of the subjective values associated with the experience. Because the group inquestion is limited to a very small number of participants, the map of outcomesof the activity is not meant to be exhaustive, nor was the aim to exemplify allof the aspects involved. Rather this figure gives an initial understanding ofthe subject being analyzed and of the methodological problems with which thegroup was faced. Indeed, collecting information on these aspects means askingthe users to report on dynamics of which they are often not aware.

What initially emerges from these data is that the work in the NICU hasa very strong impact on the emotional and psychological life of the subjects,affecting their motivations, their involvement, their level of satisfaction, andtheir frustration. Despite this, the contact between mother and baby, wheneverit occurs, represents the main stimulation and focal point of the aesthetic man-ifestation in this setting. This exchange is at the core of all interactions, fromwhich all the different courses of action can be carried out. In other words, thephysical relationship between family and child is the motivating factor behindthe organization of various actions that are taken in the NICU environment.The data presented in the “remarkable experiences” map has been comparedwith the data coming from previous observations at NICU and with the inter-views with the families of the newborns.

On this basis it was possible to distinguish three levels of analysis: the micro-environment, the macro-environment, and the interactions (see Tables II, III,and IV). These levels have been further elaborated eliciting the soft qualitiesof interaction.


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Table II. Micro-Environment: Interferences, Overlapping, Separation and Interpenetration

Micro-EnvironmentThe interferences are generated at this level by the co-

presence of varied and complex environmental stimuli

(e.g., the quality of light, noise level, temperature, and

air quality). Manifestations of the interference phenom-

ena that occur at the micro-environmental level can

be simplified by the creation of overlapping and sepa-

rate/interpenetrating phenomena.

Overlapping occurs any time that the light, sound, and

temperature conditions of the incubator are filtered with

the intention of sustaining the baby, which is the pre-

dominant strategy that is used to protect the baby from

the outside environment. Examples include the use of

sheets that cover the transparent glass of the incubator

to filter the light inside or the blanket in which the baby

is wrapped, which is used to maintain its body temperature.

Separation is another consequence resulting from the necessity to preserve the micro-

environment of the baby (e.g., the baby is kept separate by the incubator glass; the micro-

environment of the baby is separated by the macro-environment of the ward). Separation is

the given rule of interaction within this setting, which is enabled by the environment. It is

interesting to note that the interpenetration between the external and internal environment

of the incubator counters the separation that is typical of interactions within this setting. The

fact that the design for separation can actually be surpassed by the exchange between mother

and child is also interesting; this factor generates the strongest aesthetic phenomena in this

setting.

5.2 Soft Qualities of Interaction at the NICU

In order to better illustrate the soft qualities of interaction at play at the NICU,two different strategies have been adopted in this work: (1) a comparison be-tween various settings with the aim of finding reoccurring and dissimilar situ-ations, which can be intended as an inspirational activity; and (2) what can becalled “aesthetical isolation,” an analytical process by which the soft qualitiesof interaction in this setting are isolated from the functional aspects. In thisarticle it will not be possible to discuss at length the details of the soft qualitiesof interaction occurring at the NICU; however, a synopsis will be provided (seeTables II, III, IV). For a complete discussion of these topics, see Rullo [2007].

The occurrence of these interaction qualities is grounded on the diversityof needs and expectations of the different individuals, and is enabled by thenature of the environment and by the behavioral possibilities of the system.

5.3 The Soft Set of Requirements

Of course, the first incubator prototype cannot be intended as a finished work,but merely as a first attempt to embody some of the design issues; it shouldbe considered in light of subsequent iterative design cycles. Nonetheless, itwas decided to begin a parallel and complementary design phase that places agreater focus on some of the soft aspects of the interaction. This is in order tobetter externalize the latent needs of this application domain and to draw onthe richness of the activity outcomes and analysis of the inspiration providedby soft qualities of interaction.



Table III. Macro-Environment: Layering, Foreground/Background Effects, Different Levels

of Visibility

Micro-EnvironmentThe NICU setting enables different levels ofvisibility of the status of the babies and of

the different equipment, depending on the compe-

tence of the various individuals involved, the emotional

attitude supported in the interaction, and the physical

and behavioral design of the system. The back-ground/foreground effect is recurrent in our continuous,

everyday experience, but the nature of this setting

leads to a particular manifestation of this effect. Within

this setting, what remains in the background and what

dominates the scene represents a dynamic process

that changes as the condition of each baby changes.

This effect concerns the intangible conditions of the

environment previously discussed: Light, sound, and

temperature determine the aesthetic effects that are engendered by shaping the perception of

the events taking place in the space. The status of the child, the visual displays, visual feedback,

and noise in the ward create a space of redundancy, in which priority is given to the way in

which information can emerge from the background and be perceived by the various personnel,

both professional and nonprofessional. Each incubator system, intended as the combination

of incubator and medical equipment, would enable diverse foregrounds and backgrounds that

would be perceived in various ways by the personnel. This process is present in every exchange,

but it acquires a particular importance when occurring in an emergency situation, in which

everything should be orchestrated in order to optimize the efficacy of the intervention taking

place on the child. The coexistence of these different layers reflects on the various levels of

interaction present in the ward and the courses of action possible throughout the care of the

child. Indeed, this type of layering represents a key quality of design.

This methodological proposal adopts the notion of the soft qualities of in-teraction as an inspirational/analytical instrument to design for the aestheticsof interaction in ambient computing systems, by better focusing on the latentinteraction dynamics taking place. In greater detail, the soft qualities of inter-action have been used to re-elaborate and visualize the design concept for theincubator micro-environment, with a focus on the baby’s mattress. In fact, thishas emerged through evaluation with the expert, the members of the medicalstaff at Siena Hospital, and the newborns’ families. It was decided that the mat-tress artifact should be redesigned as a dynamic layer that protects the child,keeps the baby’s body in place, facilitates the transportation of the newborn, al-lows detection of the pressure points of the baby’s body, and can enable a moredirect and intimate contact between newborns and care-givers.

According to this summary, different graphical representations of the visionof the mattress prototype (see Figure 6) have been developed that are inspiredby the soft qualities of interaction. These various representations are the re-sult of a design workshop involving interaction with graphic designers. Thiswork has been devoted to the transformation of the abstract notion of qualityinto a design representation that is sharable with the other design-team mem-bers, including the stakeholders. The three proposals present explicit designsolutions that trigger specific interaction values on the basis of our experienceof using these everyday objects or natural elements (i.e., bag, lily flower, and


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Table IV. Relationship: Access, Separation and Interpenetration

RelationshipsThe neonatal ward is perceived as an isolated world that

is difficult to enter. Separation occurs at different levels:

between the incubator and the external environment,

between mother and child, and between the different

figures (neonatal doctors, nurses, therapists, and fam-

ilies) who act individually in the care process. It is pos-

sible to discern a sort of continuum in the passage from

separation to interpenetration in different layers of the

environment (micro and macro) and in the presence of

the various individuals in the ward, primarily between

mother and child. Interpenetration is made possible by

the nature of the access enabled by the design of the

spaces and by the tools that are available. The nature ofaccess may profoundly affect the subsequent interaction

with this environment. The incubator in its current conception presents numerous barriers for

both the medical staff and the parents, who cannot easily enter the baby’s micro-environment

without completely removing the glass that covers the device. This aspect of incubator design

not only prevents physical contact between the parents and newborns, but also influences the

way in which the incubator can be reconfigured according to emergency situations or for routine

procedures. Points of prospect are quite rare at the NICU and nonprofessionals typically feel

disoriented by the amount of data and information that must be continually processed, which

can result in errors and contradictory behavior. More importantly, the access design demon-

strates how the different interaction units (mother-child, child-nurse, child-nurse-neonatal

doctor, child-therapists, mothers-child-therapist, mother-child-nurse, mother-child-neonatal-

doctor) emerge and can be created around the incubator space.

leaf). Their role is that of transforming the soft qualities in “tangible” ways andembodying these qualities in appropriate design metaphors. They are based onour previous experience in order to exemplify the embedded interaction valuesand to open the design space to emergent usage.

Based on this rationale, the natural metaphor of the leaf has been selectedto represent in its description some of the soft qualities of interaction, namely:(1) The conditions of access and the separation/interpenetration dynamics aresupported, in the idea of the leaf, by the co-existence of a rigid structure (i.e., theleaf ’s stem) and more flexible part (i.e., the leaf itself); this also enhances thenovel conception of the newborn’s micro-environment, to be dynamically closedor opened according to necessity. (2) The possibility of manipulating the leaf ’ssurface suggests different solutions to manage the interferences and overlappingeffects at the micro-environmental level. (3) The transparency of a leaf ’s surfaceaddresses the possibility of having a different layer of visibility in order to revealor mask the baby’s status, depending on the situation, and to support the vary-ing perceptions of the caregivers, whether parents, nurses, or neonatal doctors.

The different graphical representations were then evaluated with the stake-holders at the hospital as well. In this way, specific features of the other pro-posals have been considered and transformed into specific requirements. Theseiterative evaluation cycles, both internal to the design team and with the stake-holders at the hospital, aimed at allowing an understanding of how physicalaspects of the representation (shape, size, material) could trigger specific inter-action values.



Fig. 6. The different graphical representations of the vision on mattress prototype.

This engendered a new dialog between the physical, “tangible” dimensionof those leaf metaphor and those interactions that would define the usage di-mension, stemming from the soft qualities analyzed in this setting. This effortelicited the concrete soft set of requirements.

Indeed, some of the soft requirements embody specific soft qualities that weredetermined during this inspirational and analytical phase, while the others re-formulate pre-existing functional requirements. The latter have been enrichedin light of the soft qualities of interaction [Rullo 2007].

Soft Set of Requirements— Filtering: Different Level of Opacity. Opacity will become a design quality

of this environment, acting in two different ways: firstly by creating a lightinsulation for the child, and then by supporting a smoother and softer view ofthe child for the families. Soft Quality: interferences; background/foregroundeffects.

— Open/Closed Environment. The incubator environment shall be able to befreely opened or closed to allow direct contact or protection, according todifferent needs and situations. Soft Quality: background/foreground effects;separation/interpenetration; access.

— Perceivable Output. The incubator environment shall make even small tracesof the child’s life visible. These will represent an indication of the child’s wellbeing for medical personnel, but will also be a sign that is comprehensiblefor the parents. Soft Quality: background/foreground effects; different visi-bilities.

— Granularity. The introduction of technology shall be visible at differentlevels, thus permitting an aggregated view of various data as well as anin-depth view of a particular value, with the primary objective of supportinginspection, revealing functional connections, and integrating information.


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Soft Quality: background/foreground effects; varying visibilities; interfer-ence.

Reformulated Functional Requirements

— Postural Stabilization/Embracement. The incubator environment shall beconsidered as a delicate layer which embraces the child, sustains the baby’sbody, and preserves the environmental conditions. Soft Quality: overlapping;access.

— Layering. The incubator environment shall manage different layers of in-teraction. The multilayered property of this environment shall allow theend-user configurability and simultaneous courses of action. Soft Quality:layering; access.

— Rigid Structure/Foldable Material. The incubator environment shall balancea rigid structure that creates a safe environment during interventions, witha soft and foldable material that can be easily transported and configured.Soft Quality: separation/interpenetration.

The soft set of requirements describes features of the mattress prototypethat have been informed by the soft qualities of interaction. These features canbe defined at two different levels. On the one hand, they define the physical,“tangible” characteristics of the prototype, such as the shape, material, and thefunctioning system. On the other hand the nature of these requirements definesnew interaction modalities by the specific use of sensors and smart material,which are supported by the overall infrastructure of palpable computing. Thesefeatures also define new ways to render computation visible for the users, “blis-tering” the information when necessary, or revealing it when the conditionschange. The proposed soft set of requirements is not considered exhaustive assuch; on the contrary, these should complement and reformulate the functionalrequirements of a setting or a system, based on specific technological innova-tions and user needs.

The result of this activity has been shared in a design workshop among thedesign-team members and supported by the creation of a soft prototype to testsoft requirements with the users at the hospital.

6. TOWARD A MATTRESS PROTOTYPE

The function of the soft prototype of mattress is strategic; indeed, it allowsdirect exploration of the soft qualities of the mattress by isolating the soft re-quirements in its design and providing a good balance between the supportedfunctionalities and certain aspects of its look and feel. The specific characteris-tics of the mattress soft prototype move toward the ideal of embodying the softrequirements in intermediate solutions, to be tested and evaluated with users.

In the soft prototype of the mattress, three elements play a critical role inthe successful embodiment of soft requirements in such a way that they can berendered sharable with users: the softness of the adopted material (i.e., a softrubber foam), the thickness, and the metamorphic possibilities (realized usinga matrix of copper threads inside the rubber foam; see Table V). An evaluationundertaken with various users revealed that these elements supported the way


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Table V. Mattress First Mock-Up and Mattress Soft Prototype (a comparative analysis based on

the results of the evaluation conducted with the neonatal team)

Mattress First Prototype Mattress Soft Prototype

FunctionalRequirementsOpening system

Environmental pollution

Internal temperature

control

Light control

Visibility

Soft mattress

Tilting mattress

Fixed body position/

Prevent big body

movements

Flexible body movement/

Allow small body

movements

Soft RequirementsGranularity

Rigid structure/foldable

material

Embracement

Open/closed environment

Filtering

Prototypes Features Prototype FeaturesBody pressure sensors that

detect the weighted areas

of the baby’s body on the

mattress surface.

Fine-grained modular

system/pin-art type of sys-

tem

Remote manipulation

Map of pressure-loaded

areas

Integration/assembly of

different data

Shape memory material

Material that preserves the

environmental conditions

Use of specific sensors

Integration/assembly of

different data

Visibility of data and the

system’s status/placement

of sensors

Supported Interaction Supported InteractionManipulation of the baby

through the mattress

Remote/Automated

manipulation of the baby

The mattress mediation is

perceived as a separation

between the child and the

external ward

Maintenance of

environmental conditions

inside the incubator

Facilitation of the

medical staff intervention

through bed-pins

manipulation

Direct contact between

child and caregivers

Dynamic management of a

closed/open environment

Intuitive perception of the

mattress output

Trace of the baby life

Supported soft qualitiesof Interactionseparation/interpenetrationbackground/foregroundeffects, different visibilities,interferences, access,overlapping


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Fig. 7. Experimenting the mattress soft prototype: user workshops at the NICU, Siena Hospital,

Italy.

Fig. 8. The mattress prototype: early trials at the Neonatal Ward, Siena Hospital (November

through December 2007).

in which the medical staff could experiment, with the qualities of the mattress,the possibility of embracing the child and the possibility of configuring thespace. Furthermore, the way in which the “foldable” requirement has beenrepresented proves sustainable the ways parents could differently “open” thechild’s micro-environment, passing from mediated to direct contact. Anotherimportant aspect is related to the envisioned use of sensors in this prototype.In fact, the presence of sensors on the mattress base is made visible to differentindividuals acting in this setting, which provides interaction cues for both themedical personnel and parents. In this way, the medical staff can be made awareof the functioning of the sensors and of their correct placement with respect tothe baby’s postural regulation, whereas the parents can use the visualizationof the sensors as an indication of life in the baby, and can inform themselvesabout the baby conditions by making sense of this information.

6.1 Noninvasive and Nonintrusive Environmental Monitoring System

These outcomes led to a further elaboration of the mattress prototype, intendedto be evaluated by staff members and families; see Figure 7.

The first implementation of the mattress prototype has been conducted incollaboration between the University of Siena and the Bioengineering Depart-ment of the Milan Polytechnic Institute (see Figure 8). Indeed, the specializedand reconfigurable properties of the mattress have been acquired through spe-cific use of sensors and smart material, creating a micro-environment aroundthe child that is able to provide a noninvasive and nonintrusive monitoring.A special material has been selected for implementation of the prototype. Themattress prototype has been developed in polyurethane gel with embedded



sensors intended for the recording of temperature, movements, and interfacepressures at specific anatomical points. The gel has antidecubitus properties,as it distributes interface pressures throughout a wider surface with respect tostandard foams and with isotropic behavior, in this way relieving contact pointson the body (for a complete description of the gel features, see www.technogel.it).

The gel structure also provides a soft supporting surface that is easily fold-able in order to embrace the child, thus covering and protecting the baby’sbody while providing postural stabilization and making the perception of thenewborn more delicate for the parents. The gel also has a high thermal inertiaand thus favors maintenance of body temperature. The pressure and temper-ature sensors are embedded in a distribution matrix so that they cover theentire area under the body. These permit the measurement and monitoring ofpressure, temperature, respiration (indirect measurement from the rhythmicpressure variation over time) and physical movements. The signals are collectedthrough a dedicated DAQ, and a UBS that is connected to and powered by a PCthat contains the visualization and setting software. If the PC is a notebook ora PDA, newborn portability is assured with continuous monitoring.2

A range of preliminary trials have been conducted with the neonatal teamat Siena Hospital. These trials provided some indications for the next phaseof prototyping. Among other things, the head physician of the neonatal wardsuggested that the mattress base be made of modular units with a specificdistribution of sensors, in order to be differently composed according to themonitoring necessities of the newborn.

6.2 Future Work

Introducing new technologies in a Neonatal Intensive Care Unit is a long andquite complicated task, and it is therefore necessary to perform a number ofdifferent clinical trials before testing the designed solutions with users in asetting that is as realistic as possible.

The mattress prototype made of a gel structure augmented with sensors willbe further tested with the neonatal team and the families of premature babies atthe NICU of Siena Hospital. The study will experiment with use of the mattressprototype in the Neonatal Intensive Care Unit; among other objectives it willseek to evaluate how this prototype can engender novel diagnostic possibilitiesand support the care community (i.e., the neonatal team and the families) byoffering novel opportunities for interaction and emergent usage.

7. DISCUSSION

Design methodology, as Landin [2005] clearly suggests, is one way of elaboratingknowledge about the expressional qualities of computational technologies.

This can be achieved in two ways: by following an approach by design [Landin2005; Djajadiningrat et al. 2000] that explores the aesthetics of the intended use[Hallnas 2004] in design solutions; and by an aesthetical analysis of actual use,

2The mattress prototype is one of the components of the system that reconceives the incubator

setup through the notion of palpable assemblies (for a complete discussion, see Rullo [2007] and

Gronvall et al. [2007]).


17:22 • A. Rullo

Fig. 9. The soft approach to design.

that poses the delicate issue of transforming analytical knowledge into designknowledge [Landin 2005]. The soft approach presented herein is an attempt tocombine an analytical and a design perspective in order to integrate the aes-thetics of interaction in the design of ambient computing systems; see Figure 9.This approach aims at developing new strategies to codify and represent thosedelicate and fragile situations in which computation should enter the life ofcomplex socio-technical systems. The operative tools by which aesthetics canemerge and can be designed for are described by the soft approach: the analysisand inspiration through the soft qualities of interaction, the elicitation of thesoft requirements, and the creation of a soft prototype.

From this perspective, aesthetics cannot be intended as a driving force forthe design of complex systems where computation is made available in a dis-tributed, networked, embedded way and the soft approach does not representany consolidated framework; it represents an early reflection on the operativerole of the aesthetics of interaction, aiming at raising questions rather thanproviding conclusions.

An initial consideration relates to the role of users throughout the designprocess. As discussed in the case reported herein, despite their strong partic-ipation in all phases of the design process, users are not always able to makeexplicit the latent, but fundamental, needs that affect their experience in asetting (e.g., as a doctor, parent, or a nurse). This implies that a perspectivethat is exclusively focused on user involvement does not allow for a completecomprehension and therefore for an effective representation of all of those vari-ables playing a role. Complementary design strategies should be identified toeffectively collect people’s composite needs and to transform them into accuratedesign requirements, in this way experimenting with new modalities for userparticipation and expression.

In this sense, consideration of the soft variables of interaction can revisethe design process by introducing an additional point of view on the designspace, both in analytical and in design terms. Specifically, this can be achieved



by making explicit certain latent aspects of the interaction which are also fun-damental to the explanation of the complex dynamics of this setting, by ex-ternalizing the knowledge gained throughout the design process, and by usingprototypes and different representations to share and evaluate the qualities,requirements, and design solutions.

These aspects could lead to concrete advantages, one of which is external tothe design process. In particular, making latent variables explicit can anticipateproblems occurring in the interaction with the designed system and can helpwith the process of acceptance when introducing new technological equipmentin delicate settings such as the one in consideration. The other advantage is in-ternal to the design process. The work reported in this research mainly demon-strates how the manner by which design process information passes from onephase to another is in reality a decisive factors. Systematic use of differentkinds of representation (i.e., the qualities representations, the soft prototype)sustained the design process in order to allow identifying, sharing, and eval-uating the role of soft qualities as they were progressively shaped into designsolutions. Of course, further examination of this approach in other applicationdomains will reinforce these early outcomes.

In this methodological proposal, the possibility of continuously finding newbalance points between two coexisting dimensions (manipulating functionaland soft aspects) allows designers to explore the novel implications of theirwork and users to experience a new awareness of their daily practices. Thisenhanced awareness allows to give voice to the emotional, psychological, andexperiential aspects involved in an interaction that can express specific socio-technical fragility. In this perspective, the mattress prototype, in its evaluationphase, has the potential to modify environmental conditions at the NICU inorder to adapt to the baby’s needs and to mediate the relationship between theinfant and the different care-givers, including families. In fact, the protocolsusually adopted for the care of the premature newborn strongly address theneed to re-establish a direct contact between mother and baby by promoting asmuch as possible the direct care of the mother. The initial results of the prelimi-nary evaluation suggest that the mattress developed through the soft approachcould sustain this novel meaning of mediation, which reflects directly on thepossibilities for creating contacts, establishing relationships, and supportingcollaborations in the care community.

ACKNOWLEDGMENTS

A sincere acknowledgment goes to V. Barsotti for her important contributionin the leaf design proposal, to the bio-engineering team of the Milan Polytech-nic Institute, to the neonatal team of the “Le Scotte” Hospital, and to all mycolleagues in the PalCom project. A special thanks goes to the editors and re-viewers of this special issue for their essential input and continuous support.

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