29th Annual RESNA Conference Proceedings

Information Technology Infrastructure for Supporting Telerehabilitation

Bambang Parmanto, PhD, Andi Saptono, MS, Wayan Sugiantara, MS, David Brienza, PhD and Bart Nnaji, PhD
RERC on Telerehabilitation, University of Pittsburgh , Pittsburgh , PA 15260


In this project, we designed and developed an information technology (IT) infrastructure that can support various project tasks within the RERC Telerehabilitation. We applied systematic steps to identify and evaluate components of the IT infrastructure required to support telerehabilitation. Subsequently, we designed and developed the IT components and weaved them together to form a cohesive system. We believe that methods used in this development are applicable to IT infrastructure development in other RERCs. We have confidence that the infrastructure we developed can be used as the foundation for common current and future telerehabilitation applications.

Keywords :

Telerehabilitation, computer, information technology, videoconferencing, database


The field of telerehabilitation exists under the assumption that the barrier of distance can be minimized to enhance access that will open new possibilities for delivering intervention strategies across the continuum of care (1). Information technology (IT) is very central to telerehabilitation in minimizing the barrier of distance, both of patients to rehabilitative services and of researchers to subject population.

Minimizing the barrier of distance can be accomplished through several modes of human telecommunication: voice, video, images, textual/numerical, and virtual reality. In the last decade we have witnessed the growing importance of the Internet as the primary infrastructure for telecommunication that is capable of combining various modes of telecommunication into single channel (multimodal telecommunication). Despite its drawbacks (e.g. lack of guaranteed service), Internet has tremendous potentials for the de-facto standard for future multi-modal telecommunications. Increasingly, even voice telecommunication, that requires high level guaranteed of service, is carried out through the Internet (voice over IP/Vo-IP).

In the 2001 report to Congress, the Office of the Advancement of Telehealth identified telecommunication/informatics infrastructure among the five key issues affecting telehealth industry (2). The report also singled out the Internet as the dramatic force that changes the way consumer access health information, receive diagnostics and purchase pharmaceuticals. Typically, telerehabilitation involves direct communications between therapist/care provider and consumers over a longer period of time. Telemedicine usually involves communications between clinician to clinician (and clinic- to clinic) over shorter periods of time and uses high bandwidth (such as in telepathology or telesurgery).

The goal of this project is to develop an information technology infrastructure that can support various project tasks within the RERC Telerehabilitation. The model and methods used in this project for developing the IT infrastructure can be used in other RERCs. The infrastructure is intended to support a general Telerehab environment, not only specific tasks within the RERC. To achieve this goal, we need to find common applications/components that are generalizable across Telerehab applications.


In order to develop a common model IT infrastructure for telerehabilitation that is generalizable across various telerehab applications, as well as providing a model for an IT infrastructure for RERC in general, we design the infrastructure using the following guiding principles:

  • The infrastructure will be developed on top of off-the-shelf technology popular on the market and use of proprietary technology only if no other alternatives are found. Preference will be given to open-source technology or products that are based on open-source.
  • The infrastructure will be based on the Internet protocol (TCP/IP) for multimodal telecommunications, including it's derived technologies (IM, HTTP/HTML/XML, video-conferencing, Internet-2, etc)
  • The components used in the infrastructure should be cost-effective, using free components from open source whenever possible.

Using this principles, we ruled out alternative technologies such as ISDN or videophones over the standard phone line as the backbone of the multimodal telecommunication. This principle also eliminates proprietary videoconferencing technology which most of current high-end technologies are.

Design and development of an information system usually follow certain methodology to systematically evaluate all components and design an architecture that blends the components into an optimally working system. The development of the infrastructure in this project follows these systematic steps:

  • Identify IT infrastructure components/application across the telerehabilitation project tasks
  • Develop a matrix that describes which components/application is used in what project, and how the component/application will be used
  • Identify which tasks require task-specific applications
  • Identify common components/applications that will be shared across different projects
  • Design basic infrastructure for supporting common components/applications
  • Develop and weave the common infrastructure into a cohesive system
  • Develop task-specific interface layer (skin) in top of the common layer
  • Deploy the infrastructure and conduct usability study

The first result of this method is a matrix of components and application for each task within the RERC Telerehabilitation:

Table 1. Matrix of Tasks and Infrastructure
IT infrastructure Projects
Type of Infrastructure Application D2: Clinical Assessment D3: Cosmobot Speech Therapy D4: Remote Job Coaching R1: Wheelchair Prescription R2: Wheelchair Accessibility
Multimodal Telecommunication and Document Sharing Web Conferencing
Multimodal and multipoint online conference, utilizing video, sound and instant messaging
  Conference between Therapist - Patient's Parent Video conference for remote monitoring Conference between clinics Conference between Therapists - patient / patient's family
Document Sharing
Project-related document access such as multimedia, presentation, spreadsheet and word documents
  Part of the conference, curriculum, therapy progress, etc   Specification of wheelchair Environment images, office files, and 3D models
Data Sharing
Accessing patient-related record and data
  Part of the conference, child's record, achievement, etc   Patient's data and record Patient's personal data
Database Multimedia Data          
Video Video for online survey Video captured from conference Optimized video, project specific format Video captured from conference  
Image, Models Image for online survey     Images to help custom-tailor the prescription Environment images and 3D models
XML-based Data       Data to build wheelchair prescription  
Regular Data Set
Demographical, etc
Survey result Cosmobot play session data, Therapist's treatment course Survey Result Wheelchair prescription Survey result
Personal Health Record   Child's Personal Health Record   Patient's Personal Health Record Patient's Personal Health Record
Portal Technology Portal for Entry Point          
Project Specific Portal   Portal to initiate webconference      
Form-based Web Application Advanced online survey   Post-session questionnaires Online Prescription Online Survey
Project Specific Application     Cosmobot, a Flash-based client application. Remote Monitoring Video Conference Intelligent Wheelchair Prescription System Web-based Multimedia Remote Assessment Support System

As shown in the table, four types of infrastructure will serve as the backbone of the RERC Telerehab: multimodal webconferencing and document sharing, database & archiving, portal technology, and client-server data transmission. Multimodal webconferencing includes video, voice, and textual conversation using Instant Messaging (IM). Document sharing is used to refer to any interactive sharing of any documents including Office documents (Powerpoint, Word, spreadsheet, etc), as well as sharing of patient record. Database and archiving will form the backbone for back-office technology for supporting all other infrastructure components. All interactions in multimodal telecommunication, portal, and client-server data transmission will be supported by a database technology for storage and archiving. Portal technology is used to support survey (for researchers to reach patient) and for supporting portal-like web for consumer information.

One of the first major tasks in the infrastructure development is evaluating and testing several multimodal telecommunication platforms. We evaluated and tested five platforms: e/pop from WiredRed, WebDemo from Linktivity from DataConnection, Meeting Server, PolyCom and ConferenceXP from Microsoft. The results of the evaluation are presented in the following table:

Table 2. Comparison between multimodal webconferencing systems
  e/Pop WebDemo MeetingServer PolyCom ConferenceXP
Conference Archiving Available at a low quality, doesn't utilize database to store the archive Available, doesn't utilize database to store Available, doesn't utilize database to store Not available Available, utilizes SQLServer to save the stream
Document Sharing Integrated inside the webconference Integrated inside the webconference Integrated inside the webconference Need additional device to provide document sharing Integrated inside the webconference
Hardware Requirement PC based running Windows OS PC based running Windows OS PC based running Windows or Mac OS Proprietary devices PC based running Windows OS
Quality of Communication Medium quality Medium quality Medium quality Very high quality Adaptable to bandwidth size
Price $3000 for 1 year license $3000, one time fee $2500-$5000 per year Depends on functionality needed, $2000-$10000 Free

We are looking for a webconferencing system that can support all the required activities (archiving, document sharing, etc), is platform independent, and cost-effective. We decided to use ConferenceXP because it has all features that we need, and is free. ConferencXP is based on AccessGrid, an open source webconferencing system grown out of the Internet2 project. The only drawback of ConferenceXP is that it only runs on the Windows system. This monolithic platform is not preferable in the long run since some of our researchers are Mac users. To mitigate this problem, we plan to link ConferenceXP back to the AccessGrid client that can run on any platform.

Figure 1. Telerehabilitation Research Portal (Click image for larger view)

Among the first system that we developed is the RERC Telerehabilitation Portal due to the needs to collaborate from the onset of the project. We developed the portal using Sharepoint, a portal platform system from Microsoft. The system provides all features that we need, and is also inexpensive.

The next important platform to select is the database system for storage and archiving. We evaluated several systems, including: Microsoft SQL Server, Oracle, Microsoft Access, OpenSQL, and FileMakerPro for Macintosh. We have experienced in all of these platforms. FileMakerPro and Microsoft Access were eliminated from the consideration because they don't have features that we need (capability of handling large and multimodal data sets). Microsoft SQL Server was selected for the following reasons: it can be tightly integrated with the Portal (Sharepoint) and the web conferencing system (ConferencXP), it is economical (not free like OpenSQL, but relatively inexpensive for a big databases system) and provides a good support.

Figure 2. Online Mulltimodal Webconference (Click image for larger view)

The two other types of IT infrastructure (client-server data transmission and project-specific application) are tailored-made programs specifically developed for the project.


The following is an illustration of the systems that we have deployed for the RERC Telerehab. Figure 1 illustrates the Portal for Telrehabilitation. This portal is used as a collaboration (data sharing, news, mailing list, etc) for researchers within the RERC.

Figure 2 illustrates the webconferencing portal for multimodal video/text conferencing and document sharing



  1. Winters, J. M. (2003) Telerehabilitation Research: Emerging Opportunities. Annu. Rev. Biomed. Eng. 2002. 4:287-320.
  2. Office for the Advancement of Telehealth (2001). Report to Congress on Telemedicine. Health Resources and Services Administration (HRSA), Department of Health and Human Services. Available at. http://telehealth.hrsa.gov/pubs/report2001/exectxt.htm


Bambang Parmanto, PhD
6026 Forbes Tower
School of Health and Rehabilitation Sciences
University of Pittsburgh
Pittsburgh, PA 15260.

This should be in the right column.