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NCHAM: National Center for Hearing Assessment and Management, Utah State University

Last Modified: 05/30/2017

IV. Technology to Support Tele-Intervention

a teleintervention session in progress, administrator using two monitors

Technology for tele-intervention is constantly improving. This guide features information about hardware and software that has been used by learning community members as of 2010-2011. Readers are encouraged to review other sources of information given the quickly changing nature of technologies. Some links are provided here:

On This Page

An Overview of Technologies

The core technology used in a “videoconferencing system”—the generic term for the technology used to conduct tele-intervention—is digital compression of audio and video streams in real time. The hardware or software that performs compression is called a codec (coder/decoder).

The other components required for a videoconferencing system include:

  • Video input: video camera or webcam
  • Video output: computer monitor, television or projector
  • Audio input: microphones, CD/DVD player, cassette player, or any other source of PreAmp audio outlet.
  • Audio output: usually loudspeakers associated with the display device or telephone
  • Data transfer: analog or digital telephone network, LAN or Internet
  • Computer: a data processing unit that ties together the other components, does the compressing and decompressing, and initiates and maintains the data linkage via the network.

There are basically two kinds of videoconferencing systems:

Dedicated Systems

Dedicated systems have all required components packaged into a single piece of equipment, usually a console with a high quality remote controlled video camera. These cameras can be controlled at a distance to pan left and right, tilt up and down, and zoom. They became known as PTZ cameras. The console contains all electrical interfaces, the control computer, and the software or hardware-based codec. Omnidirectional microphones are connected to the console, as well as a TV monitor with loudspeakers and/or a video projector.

There are several types of dedicated videoconferencing devices:

  1. Large group videoconferencing is non-portable, large, more expensive devices used for large rooms and auditoriums.
  2. Small group videoconferencing is non-portable or portable, smaller, less expensive devices used for small meeting rooms.
  3. Individual videoconferencing is usually portable devices, meant for single users, have fixed cameras, microphones and loudspeakers integrated into the console.

Desktop Systems

Desktop systems are add-ons (hardware boards, usually) to normal PCs, transforming them into videoconferencing devices. A range of different cameras and microphones can be used with the board, which contains the necessary codec and transmission interfaces. Most of the desktops systems work with the H.323 standard. Videoconferences carried out via dispersed PCs are also known as e-meetings.

The information provided here reflects the variety of systems used by the learning community participants as well as technologies that are likely to become more prevalent based on current technology trends. The majority of learning community members have been using Skype or similar programs (e.g., SightSpeed). These systems are user-friendly and offer free or low cost versions (except for recording sessions, which is discussed later). Some learning community members have used more expensive systems that require specific hardware and software (e.g., Cisco Tandberg, Polycom, and Sony video conferencing systems). The table below provides an overview of some TI hardware and software options.

Document Presenters

Document presenters can be used by TI providers to make instructional objects appear larger when viewed by the parent from their home computer. Document presenters are particularly useful for sharing print materials, such as books or reports. Sound Beginnings at Utah State University uses a document presenter when needed. Here is a link to one source for document presenters.

Technology Considerations

As technology advances, some key factors need to be considered.

Up-Front Costs

Startup costs for technologies used for TI vary greatly. At the high end, video conferencing equipment can be placed in families’ homes as well as at the provider’s location (e.g., Tandberg, Polycom, Sony). On the low end, existing computers using free programs can be used with free software, such as Vsee or FaceTime for Macs. Some programs have purchased laptops for families. When this is done, they have locked down access to other programs on the computer to prevent viruses, spyware, or other programs that can hamper the laptop’s speed or functionality. Although systems such as the Tandberg system provide excellent quality, it requires very strong bandwidth and support from technology specialists and was not portable. Vidyo is a platform also being used to do tele-intervention; the monthly charges are relatively affordable and it comes with its own recording system. Given the rapid evolution of this technology for providing in-home intervention services, it is likely that technology options will become higher quality, less costly, and more widely available.

To assist new programs who are in the planning phase of a tele-intervention effort, a fillable cost calculation form has been created. This form can be filled in and changed electronically by individual programs. A sample cost calculation form is also provided.

Ongoing Service Fees

In addition to the one-time expenditure for the hardware and/or software, an ongoing service fee may be charged. As shown in Table X, these costs may range from $10 - $30 per month, and these fees may be associated with each point-to-point connection.

Bandwidth

The bandwidth of the internet connection is the KEY determinant for audio and video quality that is required for a good TI session. All technology systems, regardless of cost, are affected by bandwidth. Bandwidth can be an issue in all geographical locations, urban and rural, because there are multiple factors that impact bandwidth. Because it is traffic dependent, bandwidth can be affected by the number of people using the Internet during a particular time of day, by the weather, by technology problems that cause rerouting of information over the Internet, and by the location of computers behind network firewalls or on a high use local network. Although the infrastructure for greater bandwidth is increasing dramatically nationwide, so is internet traffic. Just think of the demands placed on bandwidth from Netflix and YouTube!

We found during our bandwidth throttling experiments, in which we controlled the amount of data traveling through a network, that various two-way video systems behaved differently with lower bandwidth. In general, most systems required at least 2.0 Mbps upload speed for reasonable quality video on the receiving end. Keep in mind that upload bandwidth is just as important as download bandwidth in regards to video conferencing, and the upload bandwidth is often lower and not included in marketing materials.

In July, 2011, Qwest DSL advertised plans ranging from 1.5 Mbps to 40 Mbps connection speed (download), but a maximum of 5 Mbps upload speed. Comcast Xfinity Internet advertised plans ranging from 12 Mbps to 50 Mbps download speeds, but only 2 to 10 Mbps upload options. Dial-up speeds are typically 0.056 Mbps, and as such are far too slow to use for tele-intervention. Cellular Internet like AT&T or Verizon 3G is generally between 0.5 and 1.5 Mbps upload, and as such, is not well-suited for high-quality tele-intervention video.

It may be necessary to purchase greater bandwidth for a family’s home in order to provide TI with adequate two-way video.

Bandwidth Reliability

Keep in mind that none of the broadband Internet providers guarantee that the speeds they advertise will be available all the time – they're advertising maximum speeds. One way to optimize the bandwidth during TI sessions is to make sure that other devices in a home are not competing for bandwidth during the TI sessions. This includes smart phones, iPods, MP3 players, blue-ray devices, video-game systems, and many other devices.

Technology Maintenance & Support

Technology support personnel or consultants, who can help maintain equipment and trouble-shoot problems with connectivity, are valuable yet not always available. Additionally, some TI learning community members used technology system specialists to set up technologies and internet connections in families’ homes and guide families through use of the technologies. Families reported that this support increased their confidence in dealing with the technology aspects of TI.

In reality, early intervention programs often don’t have funding for technology support staff. Three of the EI programs in our learning community did not have a technology support specialist – they were able to implement TI based on their own knowledge base combined with trial and error. It is expected that technologies will continue to be more user friendly. In the meantime, here are some ideas for building your own knowledge or locating assistance:

  • Product tutorials: Many distributors of technology systems have online tutorials to guide users.
  • Online courses: Free courses that you can complete as needed are available online and can be located through search engines.

Ease of Use

It is important that families find TI technologies easy to use. For that reason, families may be more comfortable using a home computer and programs such as Skype, as they might have previous experience with these programs. Likewise, many providers may feel more comfortable using some systems over others. Because technology can feel overwhelming, we recommend using a checklist of steps prior to starting each session to ensure technology is ready and working, and to have trouble-shooting procedures ready. One example is the “Technology Check Prior to a Tele-Intervention Session” checklist featured in Section III.

Quality of Equipment (Video, Image Size, Camera Pan and Zoom)

While bandwidth affects the connection quality in two-way video, the quality of equipment on both ends of tele-intervention also has an impact on video and audio quality. Newer computers and other technologies that include high quality cameras and microphones improve video and audio quality. Other recommendations to improve video and audio quality include the following:

  • High-quality directional microphone at both sites
  • Headphones to cancel echo effects and reduce environmental noise
  • Document camera to show smaller toys and books
  • Cameras that pan and zoom to capture images or behavior outside typical camera range
  • Proper lighting to include additional indoor lighting or closed blinds
  • Planned environments that reduce background distractions or interruptions (e.g., not too many pictures, books, or windows on walls behind participants)
  • Distracting noises limited (e.g., ringing phones or doorbells, TV or radio, outdoor noises, barking dogs, running water, etc.)
  • Larger materials and toys whose image can be captured on cameras and adequately viewed on computer screens.

Recording TI Sessions

Recording of TI sessions is valuable for many purposes. First, families can share recordings with other family members, and in so doing, involve them in the facilitation of their child’s language development. Second, the recordings serve as documentation of child’s progress over time. Third, recordings can be used by providers as a self-assessment tool, a source of supervisor monitoring, and for use in training other providers. Recording programs are changing rapidly, so the following summary is included for informational purposes but may be outdated quickly.

Four products for recording Skype video were reviewed based on product websites (as of November, 2010). All have a free trial that varies by number of days it can be used or the number of minutes that can be recorded. Only VodBurner was Skype certified at the time of review, meaning the product distributors are allowed to put Skype’s logo on their website as an endorsement of their product. IMCapture, VodBurner, and eCamm Call Recorder could record audio and video from both sides of a Skype conversation. Online reviews of these products from various reviewers indicate that all are dependent on broadband connection speed for video quality. IMCapture and VodBurner had the highest review ratings. IMCapture and VodBurner were tested for video recording quality using a university-based computer and network and a home computer with a typical internet connection. Recordings were typically of less quality than needed for adequate review by others at a later time. However, given how quickly these technologies are changing, higher quality should be available soon and recording capability may be added at some point to current two-way video programs.