Outline for Module 3: Access Engineering & Telerehabilitation
- Motivation and Aims
- Additional Reading Materials:
- Draft document on Accessibility for AAMI HE 75 (Human Factors of Medical Devices) standard, as pdf
- Winters, J.M., Future Possibilities for Interface Technologies that Enhance Universal Access to Health care Devices and Services, Chapter 25 from Medical Instrumentation: Accessibility and Usability Considerations, as pdf
- Chapters from Emerging and Accessible Telecommunications, Information and Healthcare Technologies (Winters et al, eds.), RESNA Press, 2002 (e.g., Chapter 13 by Tran et al.)
- Terms and Concepts
- Accessibility, or ability to access
- Rooted in human rights, often a legal pillar
- Strategies of direct access and indirect access
- Usability, or ability to use
- Rooted in human factors/ergonomics
- Universal Access
- The ability of all people to have equal opportunity and access to a service or product from which they can benefit, regardless of their social class, ethnicity, background or physical disabilities.
- Spans many fields, including education, disability, telecommunications, and healthcare
- definitions of "universal access" or a "universal service" by US Access Board, Office for Adv. of Telehealth, International Telecommunications Union (ITU), FCC, Rehab
- Domains include: encounter/interface, cost, distance (tele-)
- Universal Usability
- Process of designing interfaces to a service or product so that they are usable by the widest range of people operating in the widest range of situations as is commercially practical.
- Vision of Universal Access
- Technology and changes in societal perspectives on access
- Federal/State laws Mandating Accessibility (web pages from US Access Board)
- Barriers of interface, distance and cost
- Universal Usability plus consideration of the barriers of distance and socioeconomic status?
- Universal Access and Universal Design market potential
- 15% have functional limitation; aging society; similar prices with front-end design
- "Universal Design" and "Personalized Design" strategies
- Direct access, indirect access
- Telehealth as a Tool for Improving Universal Access
- Engineering perspective: maximizing access, with telehealth changing constraints
- Healthcare systems perspective: maximizing outcomes by adding alternatives to and timely integration within the plan of care
- So why isn't telerehab flourishing?
- RERCs Involved in Telecom/Information Technology Access
- RERC on Telerehabilitation (U Pittsburgh)
- Approaches for remote clinical tele-services
- Interactive tele-training tools (combining tele- with virtual reality)
- RERC Telecom Access (UW-Madison, Gaulladet)
- Legal Definition (Telecom Act of 1996): "the transmission,
between or among points specified by the user, of information
of the user's choosing, without change in the form or content
of the information as sent and received."
- Primary focus on technologies for persons with hearing deficits
- Classifications:
- Tele-conversation
- near-real-time, time sensitive, minimal delay)
- two-way language-based conversation
("talking" and "listening")
- Tele-messaging: back-and-forth message blocks
- Emergency alerting (urgent notification) and communication
(interactive)
- RERC Information Access (UW-Madison)
- Primary focus on changes in mainstream products
- User Interface Socket / Universal Remote Console (UI-Socket/URC) standard
- RERC Augmentative and Alternative Communication (Duke etc)
- Innovation in provision of augmentative/alternative communication services, including across distance
- RERC on Accessible Medical Instrumentation
- Accessibility and usability evaluation tools
- Emerging approaches for access (tele-, personalized design via UI-Socket/URC standard)
- RERC on Wireless
(Georgia Tech)
- Large focus on use of mobile/hand-held devices such as cell phones
- Also working on UI-Socket/URC standard, with focus on home-based mobile controllers
Overview of AMI Accessibility Chapter for Emerging HE 75 Standard
- Perspective of access barriers, and why conventional usability evaluation is not enough
- data on disability, aging
- Interface technologies
(see also Winters 2006 reading material)
- Physical layer
- Interfaces on sensory side ("displays"): display/output technologies
- Monitor displays: flat panel more common, dropping
cost of large displays
- LCD touch screen/paintable panels (low-cost, flexible,
appearing everywhere)
- Heads-Up/Eyeglass displays (worn by user, projected
virtual display)
- 3-D displays, Virtual Reality technologies
- immersive worlds and
avatars (user can move in virtual world)
- Virtual altered reality (move in unrealistic environment)
- Augmented reality (projection mapping to augment
information or objects)
- Kinesthetic feedback devices (force feedback joysticks,
mice)
- Speech output improvements:
- better quality of synthesized speech, automatic pronunciation, standards
- low-cost chips (e.g., $10 text-to-speech)
- incorporation of speech-capable products into
standard products
- Audio displays: added audio cues to info on screens
- Tactile displays (of lower resolution), olfactory displays
- dynamic: vibrotactile, electro-tactile
stimulation
- Permanent physical: variable-height pinds, ferro-electric
fluids, wax
- Interfaces on the Motor Side - novel input (and modality translation) technologies
- Speech recognition, lip reading, gesture recognition
- Pen-based: handwriting recognition & digital pens/ink
- Special keyboards (one hand, small keyboards, glove
which senses, etc.)
- Direct brain control (e.g., for simple switches), Biometrics (bio-identification)
- Extended Physiological Proprioception (EPP) Approaches
- Conceptual layer (e.g., usability considerations)
- Types of Assistive Technologies
- "Direct access" vs "Indirect access"
- Guidance based on Section 508 (visual, hearing, fine motor, etc)
- Guidance based on Universal Design
- Guidance for physical positioning
- Guidance on use of telecommunication and information technologies with medical device products
- History
- Telemedicine in the 1960's and 70's
- Telemedicine in the 1980's
- Societal technology: POTS phone, broadcast TV, LAN, computer modem
- Telemedicine/Telehealth and Telerehab in the 1990's
- Societal technology: Internet, 2G cell phone, wireless, broadband, instant messaging
- Telehealth and Telerehab in the 2000's
- Societal technology: now cable modem/DSL, cellphone, VoIP, merging of technologies
Process Models for Telehealth
- List of "Tele-..." terms
- General process models
- Community telemedicine (teleconsultation), telemonitoring, telehomecare, teletherapy
- Conceptual Framework for Scientific Study of Telerehab
- Science of optimizing rehabilitative bioprocesses
- Science of optimizing human-technology interface
- Science of optimizing behavioral modification
- Practical Aspects in Designing Telerehab Systems
- Room-based systems (desktop, group)
- Key implications and considerations (group vs individual, cameras, mics, lighting, background)
- Mobile systems (wireless, wearable)
- Key advantages
- Key challenges
Videoconferencing and Multimedia Standards (overview)
- Terminology
- H.320 Standard & Technical/User Approaches
- H.324 Standard & Technical/User Approaches
- H.323 / SIP Standards & Various IP-Based Technical Approaches
- Wireless Standards (and Medical Implications)
- IP Multimedia Sessions and Node Management Approaches
- Glossary of Conferencing Terms
- General Considerations (e.g., telerehab and rehab optimization strategies)
- Areas of Large-Scale Need (and Potential Opportunity)
- Adult neurorehabilitation from trauma
- Children with neuromotor Impairment
- Cardiopulmonary rehabilitation
- Supportive telehomecare
- Clinical Telerehabilitation Research Involving Rehabilitation Practitioners
- Telemedicine: Rehab Teleconsults (examples from physiatrist, PT, OT, SLP)
- Telehomecare/telemonitoring (e.g., cardiopulmonary rehab)
- Telehomecare/telemonitoring (e.g., wound care (pressure ulcer) management)
- Telemonitoring/teletherapy (e.g., stroke)
- Insights from review of research presented at Telerehab State of the Science conference
New Paradigms for Clinical Telerehab Research?
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