Shopping When You Are Deafblind: A Pre-Technology Test of New Methods for Face-to-Face Communication—Deafblindness and Face-to-Face Communication

: This article presents the ﬁrst-year results of a project that aimed to explore the feasibility of using a braille display and a smartphone in society to improve face-to-face communication for a person living with deafblindness, using a simulated communication situation. An applied experimental development design was implemented, followed by a pre-test in the community. Two clinicians and an engineer conducted communication tests with three communication partners with normal vision in a shopping mall. A blind clinician acting as deafblind bought an iPhone case and asked for the location of two stores. Communication partners did not report any difﬁculties, understood the exchanges, and were proud to have helped a person living with deafblindness. No communication breakdowns or keyboard input incidents occurred. Speech turns were not optimal but can be improved. Clinicians proposed a sequence of three training modules: (1) prior knowledge (basic operations for iPhone, software, and braille display), (2) methods for preparing a face-to-face discussion, and (3) processes during a face-to-face discussion. Results demonstrate the feasibility of using a tactile technological solution coupled with a smartphone to interact with unknown interlocutors. Technology trials form the groundwork for a 9-month case study, involving two individuals with deafblindness. detailed written recommendations training [20]. mall Place Versailles three face-to-face


Introduction
Communication is a basic human right, and this article helps to highlight support for communication in society for people who become deafblind in their early fifties. There is a great need for technological solutions for individuals who are profoundly deaf from birth and communicate in sign language when they lose their sight as they get older. These individuals are no longer able to use their usual technology aids that are mainly based on visual communication. Faced with this problem, they often find themselves socially isolated, even from their own family members. It is therefore essential to combine clinical efforts with research to generate solutions that can reduce barriers to social participation [1]. This article presents the first-year results of a research project that aimed to measure effectiveness, impact on social participation, and cost of communication technology alternatives proposed to two people newly living with deafblindness, focusing on the selection of a communication technology and the pre-technology testing in a common communication setting.  As shown in Figure 2, the technology environment integrates two main devices, a braille notetaker (used by the person with deafblindness) connected to Bluetooth and a smartphone (used by a sighted communication partner). Configurations initially concerned the settings of software systems/applications running on an iPhone X, in particular: the iOS operating system, the VoiceOver screen reader, and the note-editing Notes app. This app is available only on the App Store for iPhone and iPad. This configuration was supplemented Societies 2021, 11, 131 4 of 12 by creating alternate texts associated with keyboard shortcuts running on the iOS operating system. Figure 2, the technology environment integrates two main devices, a braille notetaker (used by the person with deafblindness) connected to Bluetooth and a smartphone (used by a sighted communication partner). Configurations initially concerned the settings of software systems/applications running on an iPhone X, in particular: the iOS operating system, the VoiceOver screen reader, and the note-editing Notes app. This app is available only on the App Store for iPhone and iPad. This configuration was supplemented by creating alternate texts associated with keyboard shortcuts running on the iOS operating system. Braille display used was the Focus 40 Blue 5th gen (14.5 × 3 × 0.75 po, 1.24 lbs, $3295 USD). Copyright © Freedom Scientific Inc. Clearwater, United States and Barendrecht, The Netherlands. It is a black braille keyboard with the 8 dots in color blue, 40 cells, and good Bluetooth connection reliability. It was chosen for its adequate number of cells, robustness, USB type C connection, and Bluetooth ability. An iPhone X (iOS 13+) was selected for the smartphone. VoiceOver, the screen reader on iOS, is free. Notes, the face-toface communication solution, is free because it is included in Apple iOS. Notes was chosen for its accessibility (e.g., turns of speech) and its ergonomics as it works like a word processor. SMS (Short Message Service) apps, such as Messenger or fake chat apps [19], were not retained because it was not possible to actualize turns of speech in face-to-face communication. Mail, the solution for remote communications, was selected for its accessibility through VoiceOver.

Technology Pretest in the Community (2nd Design)
In the last two months, the technology pre-test took place in a shopping mall near the rehabilitation center, followed by a detailed written report including the recommendations for training [20]. In the shopping mall Place Versailles (in Montreal, Quebec, Canada), three trials for face-to-face communication were conducted. Test 1-at a smartphone accessory sales kiosk, the person with deafblindness addresses the attendant to ask for an iPhone case; Test 2-in the corridor, the person with deafblindness addresses a person from the public to ask for the location of a one-price store (Dollarama); Test 3-in an information booth, the person with deafblindness addresses the security guard to ask them for the location of a particular female clothing store (Le Garage). Exchanges with Notes were saved on the iOS device. Sighted communication partners were questioned after each test about (1) understanding the invitation message, (2) the occurrence of difficulties, (3) the level of satisfaction with the exchange, and (4) their feelings after exchange. Braille display used was the Focus 40 Blue 5th gen (14.5 × 3 × 0.75 po, 1.24 lbs, $3295 USD). Copyright © Freedom Scientific Inc. Clearwater, United States and Barendrecht, The Netherlands. It is a black braille keyboard with the 8 dots in color blue, 40 cells, and good Bluetooth connection reliability. It was chosen for its adequate number of cells, robustness, USB type C connection, and Bluetooth ability. An iPhone X (iOS 13+) was selected for the smartphone. VoiceOver, the screen reader on iOS, is free. Notes, the face-to-face communication solution, is free because it is included in Apple iOS. Notes was chosen for its accessibility (e.g., turns of speech) and its ergonomics as it works like a word processor. SMS (Short Message Service) apps, such as Messenger or fake chat apps [19], were not retained because it was not possible to actualize turns of speech in face-to-face communication. Mail, the solution for remote communications, was selected for its accessibility through VoiceOver.

Technology Pretest in the Community (2nd Design)
In the last two months, the technology pre-test took place in a shopping mall near the rehabilitation center, followed by a detailed written report including the recommendations for training [20]. In the shopping mall Place Versailles (in Montreal, Quebec, Canada), three trials for face-to-face communication were conducted. Test 1-at a smartphone accessory sales kiosk, the person with deafblindness addresses the attendant to ask for an iPhone case; Test 2-in the corridor, the person with deafblindness addresses a person from the public to ask for the location of a one-price store (Dollarama); Test 3-in an information booth, the person with deafblindness addresses the security guard to ask them for the location of a particular female clothing store (Le Garage). Exchanges with Notes were saved on the iOS device. Sighted communication partners were questioned after each test about (1) understanding the invitation message, (2) the occurrence of difficulties, (3) the level of satisfaction with the exchange, and (4) their feelings after exchange.

Participants
There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-of-concept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. Table 1. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness and the communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal (translated from French [20]) 1 .

Test 2-Passer-by in the Corridor in front of the Dollarama Test 3-Security Agent in an Information Kiosk
1 Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready.
since it is not a question of having a representative sample but of establishing a proo concept in social context. Since there were no deafblind people in the development ph a clinician with no vision simulated one. The three partners with normal vision in shopping mall were chosen spontaneously on the site, upon their availability. This project was approved by the research ethics board of the Centre for Interd plinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid translated from French to English with all the mistakes (see Table 1). This was neces for analysis of the exchanges between the communication partners and the simulated son with deafblindness. The observational field notes taken by the engineer were also alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.
Hello (invitation message) Write "ok" when a-you are ready.
shopping mall were chosen spontaneously on the s This project was approved by the research eth plinary Research in Rehabilitation of Greater Mont

Data Analysis
The text message that appeared on the iOS No translated from French to English with all the mist for analysis of the exchanges between the communi son with deafblindness. The observational field not alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sig Return button corresponds to the symbol "  " in blue and red and defines row bre Hello (invitation message) Write "ok" when a-you are ready.
shopping mall were c This project was plinary Research in R

Data Analysis
The text message translated from Frenc for analysis of the exc son with deafblindne alyzed by the R&D te It's a pleasure Note: 1 The texts of the person with deafblindness a Return button corresponds to the symbol "  " in b 2 Ok Hello how are y Montreal area. The low-vision therapist, who is also blind, simulated the p with deafblindness in the shopping mall. The special educator, competen guage, participated in the test planning and on-site analysis and discussion The engineer took notes on the events occurring during and after the tests. Th participants were an attendant at a kiosk, a passer-by, and a security agent. T three communication partners (interlocutors) with normal vision that were after the tests in the shopping mall. Given the type of research design (app and experimental development), the same participants that adapted the tech tion in clinics volunteered for the pre-test. This means that "selection bias" is since it is not a question of having a representative sample but of establishin concept in social context. Since there were no deafblind people in the develop a clinician with no vision simulated one. The three partners with normal shopping mall were chosen spontaneously on the site, upon their availabilit This project was approved by the research ethics board of the Centre f plinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 mu

Data Analysis
The text message that appeared on the iOS Notes app was transferred in translated from French to English with all the mistakes (see Table 1). This w for analysis of the exchanges between the communication partners and the si son with deafblindness. The observational field notes taken by the engineer alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activ Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.

Ok 3
There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. exts of the messages exchanged between the member of the team playing the role of a person with deafblindness mmunication partners with normal vision during the interaction tests carried out in place Versailles in Montreal d from French [20]) 1 .

Test 2 Test 3 t at a kiosk artphone accessories
Passer-by in the corridor in front of the Dollarama Security agent in an information kiosk deaf and blind. Use this device to comwith me. Write on the keyboard, but avoid long, swiping your finger and do not use ache end of your messages, double-tap on rese, make short sentences. Write "ok" when ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. e texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the tton corresponds to the symbol "  " in blue and red and defines row breaks in the table.

ou?
There were three R&D participants, employed by two rehab centers located in Montreal area. The low-vision therapist, who is also blind, simulated the person liv with deafblindness in the shopping mall. The special educator, competent in sign l guage, participated in the test planning and on-site analysis and discussions in the m The engineer took notes on the events occurring during and after the tests. The commun participants were an attendant at a kiosk, a passer-by, and a security agent. They were three communication partners (interlocutors) with normal vision that were interview after the tests in the shopping mall. Given the type of research design (applied resea and experimental development), the same participants that adapted the technology so tion in clinics volunteered for the pre-test. This means that "selection bias" is needed h since it is not a question of having a representative sample but of establishing a proof concept in social context. Since there were no deafblind people in the development pha a clinician with no vision simulated one. The three partners with normal vision in shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdi plinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid a translated from French to English with all the mistakes (see Table 1). This was necess for analysis of the exchanges between the communication partners and the simulated p son with deafblindness. The observational field notes taken by the engineer were also alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.
There were three R&D participants, employed by two Montreal area. The low-vision therapist, who is also blind with deafblindness in the shopping mall. The special edu guage, participated in the test planning and on-site analysi The engineer took notes on the events occurring during and a participants were an attendant at a kiosk, a passer-by, and a three communication partners (interlocutors) with normal after the tests in the shopping mall. Given the type of resea and experimental development), the same participants that tion in clinics volunteered for the pre-test. This means that " since it is not a question of having a representative sample concept in social context. Since there were no deafblind peop a clinician with no vision simulated one. The three partne shopping mall were chosen spontaneously on the site, upon This project was approved by the research ethics boar plinary Research in Rehabilitation of Greater Montreal (CRI

Data Analysis
The text message that appeared on the iOS Notes app w translated from French to English with all the mistakes (see for analysis of the exchanges between the communication pa son with deafblindness. The observational field notes taken alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted perso Return button corresponds to the symbol "  " in blue and red and defines row breaks in the 4 I would like a case for my iphone please three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability. This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. Table 1. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness and the communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal (translated from French [20]) 1 .

Security agent in an information kiosk
1 Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.
Fine thanks! can you bring me to the entrance of the Dollarama please? participants were an attendant at a kiosk, a passer-by, and a securit three communication partners (interlocutors) with normal vision after the tests in the shopping mall. Given the type of research de and experimental development), the same participants that adapte tion in clinics volunteered for the pre-test. This means that "selectio since it is not a question of having a representative sample but of e concept in social context. Since there were no deafblind people in th a clinician with no vision simulated one. The three partners with shopping mall were chosen spontaneously on the site, upon their a This project was approved by the research ethics board of the plinary Research in Rehabilitation of Greater Montreal (CRIR-1399

Data Analysis
The text message that appeared on the iOS Notes app was tran translated from French to English with all the mistakes (see Table  for analysis of the exchanges between the communication partners son with deafblindness. The observational field notes taken by the alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.
is Le Garage store here? three communication pa after the tests in the sho and experimental develo tion in clinics volunteere since it is not a question concept in social context a clinician with no visio shopping mall were cho This project was ap plinary Research in Reha

Data Analysis
The text message th translated from French t for analysis of the exchan son with deafblindness. alyzed by the R&D team It's a pleasure Note: 1 The texts of the person with deafblindness appe Return button corresponds to the symbol "  " in blue 5 The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability. This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. Table 1. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness and the communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal (translated from French [20]) 1 .

Security agent in an information kiosk
1 Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.

Yes
Societies 2021, 11, x FOR PEER REVIEW There were three R&D participants, employed by t Montreal area. The low-vision therapist, who is also bli with deafblindness in the shopping mall. The special e guage, participated in the test planning and on-site analy The engineer took notes on the events occurring during an participants were an attendant at a kiosk, a passer-by, and three communication partners (interlocutors) with norm after the tests in the shopping mall. Given the type of re and experimental development), the same participants th tion in clinics volunteered for the pre-test. This means tha since it is not a question of having a representative samp concept in social context. Since there were no deafblind p a clinician with no vision simulated one. The three par shopping mall were chosen spontaneously on the site, up This project was approved by the research ethics bo plinary Research in Rehabilitation of Greater Montreal (C

Data Analysis
The text message that appeared on the iOS Notes app translated from French to English with all the mistakes ( for analysis of the exchanges between the communication son with deafblindness. The observational field notes tak alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted p Return button corresponds to the symbol "  " in blue and red and defines row breaks in t 6 For which iphone There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.
Societies 2021, 11, x FOR PEER REVIEW There were three R&D participants, employed by two Montreal area. The low-vision therapist, who is also blind with deafblindness in the shopping mall. The special edu guage, participated in the test planning and on-site analysi The engineer took notes on the events occurring during and a participants were an attendant at a kiosk, a passer-by, and a three communication partners (interlocutors) with normal after the tests in the shopping mall. Given the type of resea and experimental development), the same participants that tion in clinics volunteered for the pre-test. This means that " since it is not a question of having a representative sample concept in social context. Since there were no deafblind peop a clinician with no vision simulated one. The three partne shopping mall were chosen spontaneously on the site, upon This project was approved by the research ethics boar plinary Research in Rehabilitation of Greater Montreal (CRI

Data Analysis
The text message that appeared on the iOS Notes app w translated from French to English with all the mistakes (see for analysis of the exchanges between the communication pa son with deafblindness. The observational field notes taken alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted perso Return button corresponds to the symbol "  " in blue and red and defines row breaks in the 7 the one in your hands There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team.
. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal ted from French [20]) 1 .

Test 2 Test 3 ant at a kiosk smartphone accessories
Passer-by in the corridor in front of the Dollarama Security agent in an information kiosk I am deaf and blind. Use this device to comte with me. Write on the keyboard, but avoid g long, swiping your finger and do not use act the end of your messages, double-tap on release, make short sentences. Write "ok" when are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the button corresponds to the symbol "  " in blue and red and defines row breaks in the table.

Ee f behindinfrontyes
Societies 2021, 11, x FOR PEER REVIEW There were three R&D participants, Montreal area. The low-vision therapist, w with deafblindness in the shopping mall. guage, participated in the test planning an The engineer took notes on the events occu participants were an attendant at a kiosk, a three communication partners (interlocuto after the tests in the shopping mall. Given and experimental development), the same tion in clinics volunteered for the pre-test. since it is not a question of having a repres concept in social context. Since there were a clinician with no vision simulated one. shopping mall were chosen spontaneously This project was approved by the res plinary Research in Rehabilitation of Grea

Data Analysis
The text message that appeared on the translated from French to English with all for analysis of the exchanges between the c son with deafblindness. The observational alyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those Return button corresponds to the symbol "  " in blue and red and define 9 do you have one with a hole or ring to hang a rope?
There were three R&D participants, employed by two rehab centers located in t Montreal area. The low-vision therapist, who is also blind, simulated the person livi with deafblindness in the shopping mall. The special educator, competent in sign la guage, participated in the test planning and on-site analysis and discussions in the ma The engineer took notes on the events occurring during and after the tests. The commun participants were an attendant at a kiosk, a passer-by, and a security agent. They were t three communication partners (interlocutors) with normal vision that were interview after the tests in the shopping mall. Given the type of research design (applied resear and experimental development), the same participants that adapted the technology so tion in clinics volunteered for the pre-test. This means that "selection bias" is needed he since it is not a question of having a representative sample but of establishing a proofconcept in social context. Since there were no deafblind people in the development pha a clinician with no vision simulated one. The three partners with normal vision in t shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdis plinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid a translated from French to English with all the mistakes (see Table 1). This was necessa for analysis of the exchanges between the communication partners and the simulated p son with deafblindness. The observational field notes taken by the engineer were also a alyzed by the R&D team.  1 .

Security agent in an information kiosk
1 Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" wh a-you are ready. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.
ok thank you very much There were three R Montreal area. The low with deafblindness in t guage, participated in t The engineer took notes participants were an att three communication p after the tests in the sho and experimental devel tion in clinics volunteer since it is not a question concept in social contex a clinician with no visi shopping mall were cho This project was ap plinary Research in Reh

Data Analysis
The text message th translated from French for analysis of the excha son with deafblindness. alyzed by the R&D team There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. Table 1. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness and the communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal (translated from French [20]) 1 .

Security agent in an information kiosk
Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready.  1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table.

11
I have three models what color the 2?
Societies 2021, 11, x FOR PEER REVIEW 5 of 12 There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table. 12 Blue and red 13 is rubber too?
Societies 2021, 11, x FOR PEER REVIEW 5 of 12 There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table. There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team.  There were three R&D participants, employed by two rehab centers located in th Montreal area. The low-vision therapist, who is also blind, simulated the person livin with deafblindness in the shopping mall. The special educator, competent in sign lan guage, participated in the test planning and on-site analysis and discussions in the mal The engineer took notes on the events occurring during and after the tests. The communit participants were an attendant at a kiosk, a passer-by, and a security agent. They were th three communication partners (interlocutors) with normal vision that were interviewe after the tests in the shopping mall. Given the type of research design (applied researc and experimental development), the same participants that adapted the technology solu tion in clinics volunteered for the pre-test. This means that "selection bias" is needed her since it is not a question of having a representative sample but of establishing a proof-o concept in social context. Since there were no deafblind people in the development phas a clinician with no vision simulated one. The three partners with normal vision in th shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisc plinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid an translated from French to English with all the mistakes (see Table 1). This was necessar for analysis of the exchanges between the communication partners and the simulated per son with deafblindness. The observational field notes taken by the engineer were also an alyzed by the R&D team. Table 1. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness and the communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal (translated from French [20]) 1 .

Test 1 Test 2 Test 3 Attendant at a kiosk selling smartphone accessories
Passer-by in the corridor in front of the Dollarama Security agent in an information kiosk 1 Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" whe a-you are ready. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table. There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. Table 1. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness and the communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal (translated from French [20]) 1 .

Security agent in an information kiosk
Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. Table 1. Texts of the messages exchanged between the member of the team playing the role of a person with deafblindness and the communication partners with normal vision during the interaction tests carried out in place Versailles in Montreal (translated from French [20]) 1 .

Security agent in an information kiosk
Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching long, swiping your finger and do not use accents. At the end of your messages, double-tap on return. Please, make short sentences. Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. Hello (invitation message) Write "ok" when a-you are ready. There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. It's a pleasure Note: 1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the Return button corresponds to the symbol "  " in blue and red and defines row breaks in the table. 19 It's a pleasure ieties 2021, 11, x FOR PEER REVIEW 5 of 12 There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team. There were three R&D participants, employed by two rehab centers located in the Montreal area. The low-vision therapist, who is also blind, simulated the person living with deafblindness in the shopping mall. The special educator, competent in sign language, participated in the test planning and on-site analysis and discussions in the mall. The engineer took notes on the events occurring during and after the tests. The community participants were an attendant at a kiosk, a passer-by, and a security agent. They were the three communication partners (interlocutors) with normal vision that were interviewed after the tests in the shopping mall. Given the type of research design (applied research and experimental development), the same participants that adapted the technology solution in clinics volunteered for the pre-test. This means that "selection bias" is needed here since it is not a question of having a representative sample but of establishing a proof-ofconcept in social context. Since there were no deafblind people in the development phase, a clinician with no vision simulated one. The three partners with normal vision in the shopping mall were chosen spontaneously on the site, upon their availability.
This project was approved by the research ethics board of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR-1399-0319 multi).

Data Analysis
The text message that appeared on the iOS Notes app was transferred into a grid and translated from French to English with all the mistakes (see Table 1). This was necessary for analysis of the exchanges between the communication partners and the simulated person with deafblindness. The observational field notes taken by the engineer were also analyzed by the R&D team.   1 The texts of the person with deafblindness appear in blue and those of the sighted person are in red. Activating the rn button corresponds to the symbol "  " in blue and red and defines row breaks in the table.
" in blue and red and defines row breaks in the table.

Quality of Communicational Exchanges on iOS Notes
Analysis of the results in Table 1 showed that spelling and punctuation errors, as well as non-compliance with the instruction to press the "Return" key twice after individual messages, did not have an impact on communications. This instruction was intended to organize messages that make a distinction between the texts of the two communication partners aimed at rereading the discussions. Indeed, as shown in Figure 4a, on the interface of iOS Notes, the texts all have the same color, the paragraph break marks did not appear, and the messages were not separated and arranged in cells of a grid. Tracing the texts of the discussions (turns of speech) a posteriori on the interface of iOS Notes was a much more difficult task. Table 1 shows that communication partners had received and understood the invitation message. There were no communication breakdowns or keyboard input incidents (long touching and finger swipes) during the three tests. We noticed that the participants did not always consider the instruction to touch the Return button twice at the end of each message (Test 1-lines 6 to 19, Test 2-line 3, Test 3-lines 4 and 7). In Test 1, two exchanges took place without the "Return" button being touched (lines 11 and 17). The question mark was missing (lines 6 and 7). In Test 3, the answer was contradictory and without space between the words (line 8). Since the respondent thanked the security agent (line 9), maybe he guided the person tactilely by answering behind (the person is turning) in front.

Level of Satisfaction with the Exchanges and Feelings after Exchanges
After the interaction, the communication partners with normal vision did not report any difficulties, had understood everything about the exchanges, and above all, were proud to have helped a person with deafblindness. In this regard, the person simulating deafblindness let the sighted participants know that this was indeed a simulation and that she could hear and speak.

Clinical Recommendations for Eventually Training
A technology solution for people with deafblindness is only possible if a training program is actualized for new users of tactile technologies. The clinicians had to become familiar with how technologies work and how to ensure their interconnectivity. They also suggested that it is essential to ensure that a new user has a minimum of braille as well as French grammar, wishes to communicate using an iPhone, and can afford the internet costs. The training in the clinic with the equipment may take between 9 and 12 sessions to complete (once or twice per week, 1 to 2 h per session). After the experimentation, clinicians using tactile sign language proposed a sequence of three training modules [20], which are presented in Table 2.

Discussion
The purpose of the present study was to explore the feasibility of an innovative communication technology for persons living with deafblindness when wanting to exchange information with a member of the public. We compared our experience to the only study-Cantin et al.-available with a technology test in society (e.g., in a restaurant). The waitress already knew the participant [14] while in our study the attendant at a kiosk, the passer-by, and the security agent were strangers. Here, our results indicate an added value to the scientific literature on the use of tactile technology with "unknown" communication

Discussion
The purpose of the present study was to explore the feasibility of an innovative communication technology for persons living with deafblindness when wanting to exchange information with a member of the public. We compared our experience to the only study-Cantin et al.-available with a technology test in society (e.g., in a restaurant). The waitress already knew the participant [14] while in our study the attendant at a kiosk, the passer-by, and the security agent were strangers. Here, our results indicate an added value to the scientific literature on the use of tactile technology with "unknown" communication partners. In both studies, the waitress and our communication partners in the shopping mall were happy to help. The participant was deafblind and a super user of technology with a braille display [14] while our participant was a blind clinician simulating deafness using a braille display and an iPhone. Technical problems occurred with the manipulation of the iPhone and HumanWare software in the restaurant [14] while there were no technical problems with the iPhone, VoiceOver, and Notes, but our participant was not a new user. Here, our results indicate an added value to the scientific literature on the use of tactile technology that is already marketed or commercialized. Our preliminary results propose technical recommendations for training adults over 50 years old with USH1 with communication alternatives. Here, our results are applications of available knowledge for the scientific literature and, for clinicians, to limit device abandonment in deafblindness [8]. Satisfaction of the communication partner with normal vision in the trials also demonstrates that the use of discrete technologies for communication may facilitate social inclusion, instead of other technologies as suggested in a study regarding individuals living with deafblindness, stigma, and the use of communication and mobility assistive devices [21]. The deafblind person in one study [14] confirmed in a subsequent paper [22] that using generally available applications provides access to a normalized life and results in better self-esteem, among other things. Lead users such as this person facilitate future professional interventions in the field by providing positive experiences and successes that make the general public aware of the situation of persons using adapted technologies.
The results of our study (without a deafblind person) show that spelling and punctuation errors, as well as failure to follow the instructions to press the "Return" key after messages, did not affect communication. These results suggest that the face-to-face communication solution we developed is suitable with communication partners with normal vision. However, we must consider that only three tests were carried out and that the communication partner playing the role of the person living with deafblindness was very experienced in the operation of devices and software integrating the communication solution. Nonetheless, her sentences were simple (e.g., "is Le Garage shop here?"), and she never sent incomplete, meaningless sentences to the communication partner.
Even with these limitations of the technology, the tests revealed opportunities for improvements of the interface with the communication partner. These improvements concern the sign that invited potential communication partners into dialogue and the organization of textual exchanges.

Dialogue Invitation Sign
Even though all the communication partners understood and reacted well to the sign used in this study in Figure 1, experience showed that it could be more specific to the expected purpose, i.e., to invite a person from the public to a face-to-face conversation. While keeping the current presentation style and icon, we propose a sequence of more specific sentences: I am DEAF and BLIND/I would like to communicate with you/Please TOUCH MY ARM (see Figure 3-in French).

Organization of Textual Exchanges
An important opportunity for improvement concerns the organization of messages from both participants (deafblind and communication partner) in the editing area of iOS Notes. As shown in the screenshot in Figure 4a, the rereading of the discussion of Test 1, with the messages of different origins all mixed together, is not easy. The instruction to touch Return at the end of a message aims to introduce a blank line between the texts and ensure a more obvious separation. Its purpose is to facilitate the rereading of discussions, either during or after exchanges.
Strict adherence to the instructions to touch Return after messages would make it easier to replay discussions, both for a person with deafblindness and for a sighted person (see Figure 4b). Without the ability to control the behavior of the communication partner, we propose that during their training, the person with deafblindness needs to be instructed to touch on the return BEFORE and AFTER his messages. Being freed from this task, the initial instructions that would be presented to the communication partner would be simplified.  Strict adherence to the instructions to touch Return after messages would make it easier to replay discussions, both for a person with deafblindness and for a sighted person (see Figure 4b). Without the ability to control the behavior of the communication partner, we propose that during their training, the person with deafblindness needs to be instructed to touch on the return BEFORE and AFTER his messages. Being freed from this task, the initial instructions that would be presented to the communication partner would be simplified.
"Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching for a long time, swiping your finger and do not use accents. Please, make short sentences. Write "ok" when you're ready"

Strengths and Limitations
The strengths of this study lie in the rigor of its qualitative research methodology, given the use of reflexivity, peer debriefing, and using the participants' direct quotes [23], all available in the French research reports [17][18][19][20]. We extracted, translated, and synthetized some data to write this article. In addition, we believe that we demonstrated dependability and trustworthiness, given that the findings appear to be consistent and repeatable [23]. A technology review was carried out and then scrutinized by 15 experts in vision and hearing rehabilitation, research, and engineering to select the best technologies. The entire R&D component utilized an integrated knowledge translation approach [24] by engaging partners in a sensory rehabilitation center, and three reports [18][19][20] were written in French by the engineer and two clinicians, including the description and justification of the tech- "Hello, I am deaf and blind. Use this device to communicate with me. Write on the keyboard, but avoid touching for a long time, swiping your finger and do not use accents. Please, make short sentences. Write "ok" when you're ready"

Strengths and Limitations
The strengths of this study lie in the rigor of its qualitative research methodology, given the use of reflexivity, peer debriefing, and using the participants' direct quotes [23], all available in the French research reports [17][18][19][20]. We extracted, translated, and synthetized some data to write this article. In addition, we believe that we demonstrated dependability and trustworthiness, given that the findings appear to be consistent and repeatable [23]. A technology review was carried out and then scrutinized by 15 experts in vision and hearing rehabilitation, research, and engineering to select the best technologies. The entire R&D component utilized an integrated knowledge translation approach [24] by engaging partners in a sensory rehabilitation center, and three reports [18][19][20] were written in French by the engineer and two clinicians, including the description and justification of the technological choices, operational strategies to ensure the interconnection between the equipment, and the carrying out of communicational exchanges with them. The technological pre-test presented in this article was carried out in an ecological environment, representing a microcosm of the society, in this case, a shopping center near the rehabilitation center. The tests suggest that the face-to-face communication solution we developed is suitable for communication partners with normal vision. The last report [20] was written following the experiment, including all observations as well as recommendations for improvements and for training with USH1. We believe that the figures illustrating communication and the table with typical communicational exchanges are sufficiently detailed to allow the transferability of data from the use of technologies to another similar social context [23].
The limitations of this study are inherent in the choice of the research designs (R&D and pre-test) and concern external validity. A limited number of tests were conducted and only in one setting. Because no keyboard input incidents had occurred, we were unable to test the recovery procedure for this type of incident. The user playing the role of a person with deafblindness in the tests perfectly mastered the technology integrating the communication solution. She did not commit any faults that could cause a possible breakdown of communication. There is possible bias here about simulated hearing impairment as her hearing was not blocked during the experiment.

Future Research
For the practical dimensions of training (with what personal, financial, and other resources can carry out the recommendations indicated by the clinicians), the second year of our project aims to measure effectiveness, impact on social participation, and cost of a communication technology alternative proposed to two clients newly living with deafblindness. A case study is ongoing with members of our research team in two different rehabilitation centers with different clinicians, involving two adults with USH1 and their caregiver. Data collection starts 3 months before the delivery of the technologies and at 0, 3, and 9 months. Questionnaires and interviews focus on social participation, communication exchanges, experience with training and technologies (facilitators and barriers), costs (personal, technology), and comparison with scenarios with old technologies and without technologies. Future research should document face-to-face communication with more than two adults with USH1 in different societal contexts (e.g., command a meal in a restaurant): how effective and efficient is the technology solution compared to persons without disability? Future research should demonstrate barriers and facilitators for assistive technologies that influence social participation in adults with deafblindness [25].

Conclusions
Three communication trials in a shopping center demonstrated that it is possible to use a tactile technological solution coupled with a smartphone to interact with unknown communication partners with normal vision, request the location of specific shops, and purchase a product. Due to the involvement of clinicians in research and development with an engineer, technology training modules are recommended to people with USH1 who live with a vision impairment, who have basic knowledge of braille, and who want to communicate face-to-face by means of an iPhone and a braille keyboard. Clinicians proposed a sequence of three training modules in 9 to 12 sessions: prior knowledge (basic operations for iPhone X, VoiceOver, Notes, and Mail, braille display Focus 40) and methods for preparing a face-to-face discussion (with Notes). This training is currently in the validation phase in the second part of an on-going case study over a period of 9 months. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.