1998 Conference Proceedings

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Kenalea Johnson, M.Ed. COMS
Herbert Janssen, Ph.D.
Bobby Green, P.E.
Darrell Clark, Engineer
Underwood Advanced Technology Center
Orthopaedic Surgery
Texas Tech University
Health Sciences Center
Lubbock, Texas, USA 79430


Access to assistive in rural America is difficult for individuals with disabilities. The geographical remoteness of areas in its vast farmlands and sparsely populated areas creates unique problems. The problem of acquiring information about assistive technology and the benefits that can be gained from its use are primary. Rural inhabitants of all ages can benefit from the use of assistive technology; however, less information is available about assistive technology in the more remote regions.


Assistive technology can allow individuals to bridge the gap created by their disability and the task they need to perform. For this to become a reality in rural areas several questions must first be answered. Where do persons with disabilities in rural America find assistance in their search to identify the most beneficial equipment to meet their assistive technology needs? Where can they acquire the needed training? Can they find support services for the assistive technology devices in the rural areas? Where can a school or employer find information that will enable them to meet accessibility needs so they can accommodate persons with disabilities?


The geographical problems can be overcome by combining new and emerging technology with our older POTS lines. This combination can allow individuals in rural areas gain information, assistance, and service irrespective of their geographic location.

As long recognized by the American Medical Association, delivery of assistive technology (AT) is most effective when assessments are performed by a team. Professionals needed for the AT teams are seldom found in rural areas. However, these professionals are present at Texas Tech University (TTU) and Texas Tech University Health Sciences Center (TTUHSC). Underwood Advanced Technology Center (UATC) has developed a method of utilizing teleconferencing to deliver AT to rural Texas. This allows the team to be at the TTUHSC and a technician to be present in the home, school, or the workplace in the rural area during the assessment. This teleconferencing is performed over POTS lines which makes any location, connected by a phone, accessible as an evaluation site. In answer to the needs of rural clients, UATC has developed a prototype that can be left in the rural setting following the delivery of assistive technology. That unit, Telly, can be used to provide training, follow-up monitoring, and troubleshooting if needed.


Teleconferencing was first explored by UATC to determine if it could be used to provide a viable link between the home, school, or work site of an individual living in a rural area who needed AT. The initial units used by UATC consisted of an adapted PC system coupled to a camcorder. The original system used software which allowed the computer at the individual's site to communicate over standard phone lines with the computer remaining in the Center. This method proved useful in increasing the amount of information that could be obtained by UATC regarding the needs of an individual in the setting where the assistive devices would be used. The movement of the individual could not be evaluated directly because of the decreased rate of frame delivery over standard phone lines; however, the subsequent evaluation of a video recorded on site provided this information in real time. Presently, the frame-per-second has significantly increased due to newer software/hardware developments. However, the frame-per-second is still not the speed of real time.

This information allowed the professionals to better visualize the needs of the individual and to make appropriate recommendations as a team. In the future it is anticipated that the computer teleconferencing unit will become an assistive device itself. As such it will be left in the individualÕs home and will provide a direct route for the individual to assess information from the professionals regarding training, health monitoring, and general health information.

The major considerations in the development of "Telly" were:

  1. easily utilized by a person who is not computer literate
  2. easy to troubleshoot when and if it needs repairs or adjustments
  3. improve the resolution of the transmitted image
  4. develop a unit that can be produced as an affordable cost
  5. the unit is expandable for use as an assistive device for the monitoring of an individual needing in-home health monitoring, information, etc.


Sparsely populated regions do not have access to professionals that are aware of the broad field of assistive technology and who are able to become members of the assessment team. The most feasible method of delivering this service is through the use of teleconferencing over standard phone lines. Satellite communication can be used to transmit high quality images; however, the cost is prohibitive and facilities are frequently unavailable. Telly accomplishes the necessary link between the individualÕs home site and the center at a more affordable cost. This link can be used to solve many of the problems that exist in the delivery of AT in rural areas. Future plans call for the continued development of systems capable of delivering better quality images and data for the home health care provider and the rehab team members. This will involve the development of video compression, improved video capture, delayed transmission techniques, and the development of a system that can be interfaced with different health monitoring devices.

Once POTS connections are established, Internet connection is possible. But at this time the Internet does not provide the same consistency of quick connections. Privacy and security are also great concerns about utilizing the Internet for assessment and training purposes. POTS connections provide the ability to have a secure connection that should the connection be accidentally broken can be immediately redialed and reconnected.


While rural areas are the most logical site for this technology, it may also be useful in metropolitan areas where individuals with disabilities or the elderly may be unable or unwilling to venture outside of their home environment. It may also be beneficial if utilized in areas such as Pacific Islands where ISDN lines are frequently disturbed by atmospheric and weather phenomena. POTS lines to these regions are not as frequently disturbed for teleconferencing. Other areas that could find Telly to be advantageous are the Northern United States, Canada, and Alaska where weather and travel conditions may keep residents from being able to regularly train clients and troubleshoot assistive technology systems.

All these aspects are being anticipated as the software/hardware connection is being developed to allow maximum delivery of services to the remote site via POTS lines. Presently new software is being developed to connect various sites with networking capabilities to allow improved troubleshooting of complicated systems. The project is working toward providing a low cost product with maximum services available to rural Americans with disabilities.


American Medical Association. (1994). Guidelines for the use of assistive technology: Evaluation referral prescription. Chicago: Department of Geriatric Health, American Medical Association.

Cook, A. M. & Hussey, S. M. (1995). Assistive technologies: Principles and practice. St. Louis: Mosby.

National Council on Disability. Improving the implementation of the individuals with disabilities education act: Making schools work for all of America’s children. (May 9,1995). Washington, DC: National Council on Disability.

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