2002 Conference Proceedings

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"OPTIMIZING ASSISTIVE TECHNOLOGY SERVICE DELIVERY WITH VIDEO TELECONFERENCING" GRANT PROGRESS REPORT

Judy Henderson, MA, CCC-SLP (judy.henderson@medcenter.stanford.edu) Kevin Tran, BSME (kevin.tran@medcenter.stanford.edu) Judy Lariviere, M.Ed., OTR Rehab Technology Research Projects Stanford Medical Center

Summary

A project to develop a model for AT evaluations using Video Teleconferencing will be discussed in terms of the results of over 35 evaluations.

Background

The clinic at the Rehabilitation Technology Center has been providing AT evaluations to individuals with significant physical and speech disabilities for over 20 years. Many of those consumers and their local support teams live in rural or under served areas. The purpose of this project is to develop an interactive video teleconferencing (VTC) protocol model for use with the provision of AT evaluations in distant and rural sites. This grant project is sponsored by the U.S. Department of Education Office of Special Education and Rehabilitation Services; National Institute on Disability and Rehabilitation Research through Lucile Packard Children's Hospital, Stanford Medical Center. This report documents the final year of this grant project. Evaluations are conducted with a team of speech/language pathologist, occupational therapist and rehabilitation engineer.

Protocol Format

Participants include children and adults with a wide range of communication needs that require assistive technology. Ages range from 3 to 74 years. Disabilities include Cerebral Palsy, Traumatic Brain Injury, Down's Syndrome, Autism, Specific Learning Disability and Ataxia.

Participating VTC distant sites include four locations sponsored by two state regional centers in Northern California. Each center has video conferencing equipment that can be used for the evaluations. In addition to the distant sites, AT evaluations are also conducted at the Rehab Technology Research Project Center. Those evaluations include children and adults with a full range of disabilities.

Data being tracked also includes the time involved for the client, family and team members to travel to the center-based (Palo Alto) site for an evaluation or to the video teleconferencing distant site. Most participants at the VTC site travel 30 minutes or less. Those coming to the Palo Alto site are traveling up to 4 hours one way. Time spent by the evaluation team is tracked for both the Palo Alto and VTC evaluations. The man-hours for the full evaluation and report are averaging approximately 9 hours. The items used in each type of evaluation are also tracked.

The Palo Alto evaluation sessions take 2 to 4 hours and are done in one day. The VTC evaluations are divided into sessions. The first session is designed for intake from the entire participating team. During this session, equipment and strategies may be demonstrated for the participating team by the evaluation team. 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 for the second session. During the second session the participating team will use the technology and strategies under the direction of the evaluating team. Depending on the outcome of the second session, a third session may be scheduled. In one case a fourth session was necessary. At the completion of the sessions, a report is generated which includes specific recommendations and directions for the next steps.

To determine the effectiveness of the VTC evaluations, Service Satisfaction forms are used that have been specifically designated to measure the satisfaction of the clients and their team during the AT evaluations. These are given to each member of the team and the client at the end of the evaluation both at the center-based (Palo Alto) and the video teleconferencing distance sites.

Equipment Specifications

The basic video teleconferencing system being used 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. At this time we are requiring at least 3 ISDN lines for clarity of movement. Picture in Picture is used and then recorded using a VCR.

Successful Strategies

One of the most active regional centers has 4 ISDN lines and operates like a clinic with a physician and nurse assistant. This has been highly successful because of the clarity of picture and motion. There have been times when 2 ISDN lines were used for the initial team intake session. We have found the inclusion of the regional center caseworkers to be beneficial in the coordination and implementation phases. An 'evaluation kit' has been developed containing language boards of different size, symbolization and choice field. This is sent to each participating site. Several strategy sheets are being designed. The mailing process for the 'tool kit' has been refined. Several attempts have been made to include manufacturer's representatives in the evaluations. The logistics of scheduling have been a challenge. Our reports with the addition of the VTC heading have been recognized by funding agencies the same as standard reports.

Resources

Rehab Technology Research Projects
http://www-med.stanford.edu/lpch/rtc/ 

Telerehab RERC Web Site
http://www.hctr.be.cua.edu/rerc 

PEBBLES
http://www.ryerson.ca/pebbles/ 

CA Telehealth/Telemedicine Coordination
Telemedicine Information Exchange
http://tie.telemed.org 
http://tie.telemed.org/news/ 

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


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