2002 Conference Proceedings

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Andy Lin BS
Bruce T. Fleming, BSME ATP
Molly Doyle MS CCC

Las Floristas Center for Applied Rehabilitation Technology (CART)
Rancho Los Amigos National Rehabilitation Center
Downey CA 90242
562-401-6800 (Ph)
email: alin@dhs.co.la.ca.us 
web: http://www.rancho.org/cart/

The Las Floristas Center for Applied Rehabilitation Technology (CART) at Rancho Los Amigos National Rehabilitation Center provides assistive technology (AT) services to individuals with physical disabilities. CART uses a center-based collaborative approach to service delivery. Clients typically come to the Center for interdisciplinary team evaluation or training. Caregivers and professionals accompany clients to the center to assist with the evaluation or to receive training in implementing recommended AT into the home, school, or work environment.

For several years CART and other center-based AT programs have recognized both the need and the benefit of providing AT services in the environment (e.g. home, school or work) where the client will use their AT. Conducting assessment and training in this natural environment allows a team to identify and address barriers that influence AT recommendations and usage. It helps ensure that AT is used across environments and is properly modified to meet the client's changing needs.

Many AT programs find costs and staffing limitations preclude sending an entire team of AT professionals to the client's home, school, or workplace. Upon reviewing the client's needs and abilities, a team can identify one primary clinician to travel off-site to conduct the assessment. Ideally, the chosen clinician is a senior staff member with expertise in a range of AT areas. Once on site with the client, the clinician often needs the expertise of other team members prior to making definitive AT recommendations. Subsequent off-site visits are then scheduled by other team members to address these needs. This multi-visit approach, although conducted in the natural environment, is far from optimal.

CART has explored the use of video teleconferencing (VTC) equipment to facilitate provision of off-site services. VTC capability has been available and in use for several years in private industry and more recently in the practice of medicine. Physicians use the technology to provide basic medical care to patients in rural communities (Seekins, et al.). Several AT programs are evaluating the effectiveness of this technology in conducting AT assessments remotely (Henderson, et. al). In a representative scenario, the AT experts remain at their office and instruct clients at a remote location to perform assessment tasks with guidance from a professional or family member. The center-based experts coach the remote team based on the client's performance. The real-time video component of VTC provides a more meaningful and explicit exchange of information during this process.

CART's primary goal for this project was to implement and evaluate the use of VTC technology for three primary purposes:

1. Provide a means for the off-site clinician to receive specific input from team members who remain at the Center. Team members at the Center will be able to see the clinician, client and/or family members, and communicate directly with them, without actually travelling to the remote location.

2. Provide follow-up and training to caregivers and paraprofessionals that have several AT users within the home, school, or workplace after users have received AT and completed initial training.

3. Provide assistance to clinicians based at a satellite clinic. These clinicians have less experience in AT for specific populations and often require direct assistance from the CART team.

CART's plan to meet these goals include an initial trial phase using low-cost VTC systems based on POTS (plain old telephone system) or PSTN (Public Standard Telephone Network) infrastructure, and compact, generally portable set-top boxes that connect to televisions and/or computer monitors, and video telephones. CART used the findings of this initial phase to consider investing in high-bandwidth systems that provide better video image transmission but cost more and require more sophisticated infrastructure.

This presentation will discuss the nature of CART's project and some of the benefits and drawbacks of implementing a video teleconferencing system. It will cover currently available video teleconferencing technology and discuss why CART chose specific equipment; discuss equipment setup, maintenance, and staff training needs; and evaluate the effectiveness of the program.


Burns, R.B., Crislip, D., Daviou, P., Temkin, A., Vesmarovich, S.H., Anschutz, J., Furbish, C., & Jones, M.L. (1998). "Using Telerehabilitation To Support Assistive Technology." Resna, 10(2), in press.

Field, MJ. (1996). Telemedicine: A guide to assessing telecommunications in health care. Washington, DC: National Academy Press.

Henderson J., Lariviere J. & Tran K. (2000): Optimizing Assistive Technology Service Delivery With Video Teleconferencing, Proceeding, CSUN.

Seekins, T., Clay, J., & Ravesloot, C. (1994). A descriptive study of secondary conditions reported by a population of adults with physical disabilities served by three independent living centers in a rural state. Journal of Rehabilitation, 60 (2), 47-51.

Temkin, AT, Vesmarovich, SH, Rehabs Place in the Managed Care Puzzle. A Discussion of Telemedicine in Rehabilitation presented at the 9th Annual Interdisciplinary Rehab Conference at University of Kentucky, August 1996.



Rehabilitation Technology Center, Stanford University Medical Center

Project Status (Student Technology Assessment Through Unique Strategies)

Providing Education By Bringing Learning Environments to Students (PEBBLES)

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

Telemedicine Information Exchange

TeleRehabilitation to Support Assistive Technology

Telerehab RERC Web Site

The Virtual Library

University of New Mexico Health Sciences Center - Center for Telehealth

VTEL Corporation



Orange County Online DSL pricing

Cable Access vs. DSL vs. ISDN

The DSL Center

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