2001 Conference Proceedings

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OPTIMIZING ASSISTIVE TECHNOLOGY SERVICE DELIVERY WITH VIDEO TELECONFERENCING

Judy Henderson, MA, CCC-SLP
Judy Lariviere, M.Ed., OTR
Kevin Tran, B.S.M.E.
Rehabilitation Technology Center, Lucile Packard Children's Hospital, Stanford University Medical Center (650) 237-9200

In California, 49 of the 58 counties are entirely or partially medically under served (Telehealth/Telemedicine, 1997). As a result, individuals who would benefit from assistive technology and live in rural and/or underserved areas do not have access to a team that specializes in assistive technology evaluations. Telemedicine is proving to be an effective, cost-efficient medium for the delivery of services to rural and underserved communities.

Up until recently, video teleconferencing (VTC) has primarily been used within the field of medicine as a means for providing health care services and follow-up to patients who live a distance from a major city or medical center. There are only a few known locations where the use of VTC is being explored as an option within the fields of rehabilitation and/or education to address the issue of providing technology-based services to individuals living in remote areas.

The purpose of this project is to develop an interactive video teleconferencing (VTC) protocol to provide expert assistive technology (AT) evaluations to individuals with significant physical and speech disabilities and their local support teams, living in rural or under served areas. The VTC protocol will include methods, equipment and materials specific to the provision of augmentative communication, environmental control and computer access evaluations to improve independent functioning in daily living activities. The VTC protocol will be developed during video teleconferencing evaluations by a specialized team with extensive experience in these types of AT applications. Equipment to be used for video teleconferencing transfers visual information at a speed of 30 frames per second to attempt to provide for real time viewing of motor movements. This speed of transmission is thought to be essential due to the physical limitations and reflexive movements of the population served.

This project is sponsored by the U.S. Department of Education Office of Special Education and Rehabilitation Services; National Institute on Disability and Rehabilitation Research. The project will run over a three-year period. This presentation will cover activities implemented during the first year.

To determine the effectiveness of this mode of service delivery, outcomes of 50 evaluations using VTC will be compared to 50 center-based AT evaluations measuring individual satisfaction, local support team satisfaction and cost analysis of time and travel. 

Center-based Program

The Rehabilitation Technology Center (formerly the Rehabilitation Engineering Center), Packard Children's Hospital at Stanford has been providing AAC, computer access and environmental control evaluation, device delivery and training for over 25 years. The Center serves children and adults often operating as an umbrella throughout the life span of an individual. The Center serves individuals throughout Northern California. In addition to the AAC service, there is a service that provides customized seating systems and unique applications for power and walker mobility. Both services currently work together to integrate systems of mobility and communication to improve function for the individual. Duplication of the communication service delivery model is being implemented using VTC for this project.

Participants

Participating facilities include two state regional centers and one county school district in northern California. Each center has video conferencing equipment that can be used for the evaluations. Children and adults will be seen.

Measures

Service Satisfaction forms will be presented that have been specifically designed to measure the satisfaction of the clients and their team during the evaluation. These will be given to each member of the team and the client at the end of the evaluation both at the center-based and the video teleconferencing sites. The time involved for the client, family, and team members to travel to the Center site for an evaluation will be compared to their travel time to the video teleconferencing site.

Telemedicine Funding

Medical (California's Medicaid) funds communication devices and evaluations and will fund Speech and Language and Occupational Therapy services provided by telemedicine in California. They will not fund the transmission costs of such services or any shipping costs involved with aspects of equipment delivery.

Equipment Used for Transmission

The basic system is a V-Tel system with 4 ISDN lines, each having 2 B-Channels to carry audio and visual information. Since the client's motor function is a major characteristic being evaluated, clarity and speed of transmission is important to get a 'real time' picture of their movement. Therefore, we are using quick-frame technology at 30 frames per second video with dual 32-inch television monitors to facilitate viewing. The broadcast quality can be up to 512 kbps. In some cases, the camera can be used to zoom in to detect small motor movements or to pan to different team members speaking during the evaluation. ISDN lines are dedicated and only charged when in use. The number of lines available from each participating center varies depending on their equipment, however our system has been set up to accommodate the fastest speed of transmission.

Evaluation Format

The format used for the VTC evaluations will be different from the Center-based half-day evaluations. An initial session will consist of information intake and involve all team members from the community. Based on the first session, a 'tool box' of devices, switches, software and adapters specifically matched to the client's needs and abilities will be sent to the VTC distant site. The second session will consist of demonstration of technology by the evaluation team. The client's home team will learn to use the technology through modeling by the evaluation team. Depending on the outcome of this session, a third session will be scheduled to outline recommendations. The format will be designed throughout the project and will change based on the clients' needs and abilities.

The presentation will include a summary of recent findings. Highlights of the project will be discussed and video clips from VTC evaluation sessions will be shared.

Bibliography

Rehabilitation Technology Center, Stanford University Medical Center
http://www-med.stanford.edu/lpch/rec

Project Status (Student Technology Assessment Through Unique Strategies)
www.diversity.fayette.k12.ky.us/status.htm

Providing Education By Bringing Learning Environments to Students (PEBBLES)
http://www.ryerson.ca/pebbles

Telehealth/Telemedicine (1997), California Telehealth/Telemedicine Coordination Project, Rural Healthcare Center, Sacramento, CA.

Telemedicine Information Exchange
http://tie.telemed.org

TeleRehabilitation to Support Assistive Technology
http://www.telerehab.org

Telerehab RERC Web Site

The Virtual Library
http://telerehab.cua.edu


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