29th Annual RESNA Conference Proceedings

Telerehabilitation and Vocational Rehabilitation: Supported Self-employment using Web-based Applications

Michael Pramuka, Ph.D 1., Susan L. Chase, M.A, CCC/SLP 2, Nick Danilko, B.S 1-2., Michael McCue, Ph.D 1 ., Linda van Roosmalen, Ph.D 1., Barb Demuth, RN, MSN 3
1Dept. of Rehabilitation Science and Technology, University of Pittsburgh
2 Working Order, Pittsburgh, PA


There are numerous advantages to self-employment, especially for individuals with disabilities living in rural locations, but successful preparation requires extensive exploration, planning, and a feasible business plan. This paper describes the provision of remote support for the development of a self-employment feasibility plan to five individuals with disabilities in rural locations via multiple web-based applications including email and web-based document sharing as well as the use of teleconferencing and phone calls. Results indicated that remote coaching made the most use of emails and phone contact and that a completed feasibility plan could be completed successfully in one to three months. Participant surveys indicated positive experiences overall with the process.


Telerehabilitation, vocational rehabilitation, web-based applications, self-employment, disabilities


Individuals with disabilities are unemployed or underemployed at a rate significantly higher than individuals without disabilities, and 31% of Americans with disabilities report inadequate access to transportation compared to 13% of Americans without Disability (1). One option to improve employment outcomes for individuals with disabilities is self-employment, yet this appears to be an underutilized option (2). Numerous advantages arise from self-employment including easier accommodation of environment, tasks, and schedule to ability levels, reduced need for transportation, and ability to generate a "work" outcome based on individual values and needs rather than institutional needs (3). In addition, self-employment was an unexpected but frequent outcome of choice (15-20% of participants) in the RSA-funded CHOICE grants (3).

In the past, the concept of self-employment or working out of the home was not strongly encouraged by state vocational rehabilitation (VR) counselors due to perceived "risk" of self-employment, and rates of self-employment were meager among individuals with disabilities supported through state vocational rehabilitation (4). Models for exploring the feasibility of self-employment so have been successfully developed and implemented (5) but have been conducted face to face with state vocational rehabilitation counselors over several months time, allowing for participants to complete homework tasks that ultimately answer questions about the practicality and feasibility. This process prohibits individuals living in remote locations from benefiting even though employment and transportation options are often more limited for people living in remote locations than in urban areas.


Participation by prospective subjects was solicited through state VR counselors who received a flyer about the program from their district administrators. If interested, study staff then contacted participants, explained the study, answered questions and obtained informed consent.

The feasibility planning through web-based coaching protocol was a standardized intervention designed to help participants identify an employment goal, evaluate it for "goodness of fit" by completing trial work activities and soliciting feedback from experts in the field, and developing an action plan to reach goals that are the most feasible. This protocol was based on work done in the area of functional assessment (6) with a special emphasis on trying out real life work activities. The protocol was delivered using telerehabilitation technology including web-based teleconferencing with application sharing, phone, email contact, and traditional mail. The final product was a user friendly feasibility assessment delivered to each participant and their state VR counselor.

Participants worked with their coach via phone, email and web based application sharing. This software allowed participants to see the screen of the coach's computer. The coach could use this to demonstrate a specific task such as sending an email attachment. It also allowed the participant to see the feasibility plan as it was being created based on their discussions with the coach and community contacts. In each session, the coach and participant would agree on tasks that each would complete by the next session. The coach initiated regular phone and email contact, and scheduled web based conferencing and teleconferences as much as possible. Not every participant had a working computer that allowed them to utilize the web based portion of the program readily. The coach could also be reached easily by the participants. Phone calls and emails from participants were answered within one working day.


Nine participants were referred by six state VR counselors. All of the individuals referred lived in rural areas and/or had limited transportation resources, so a service that they could access from home was desirable. Six of the participants followed up with coaches to begin participation in the program. One found a job immediately after entering the program and neither pre nor post data was available.

Table 1: Summary of Telerehabilitation Interventions
Participant Total number of sessions Total time in program (weeks) Phone hours Web-conference hours Number of emails Total session hours (participant) Total hours (coach)

Five individuals (3 males and 2 females) participated in the study over periods ranging from 7 to 14 weeks. Quantitative data on the amount and type of service delivery are included in Table 1. Participants took part in an average of 10.4 sessions. Total session hours averaged 4.9 per participant. Coaches documented an average of 5.8 hours on each participant.

Table 2: Participant Characteristics and Outcomes of Employment Feasibility Plan
Participant Disability Employment Goal Outcome  
1 Depression and anxiety Medical Transcription Feasible to work at home as medical transcriptionist
2 Post-liver transplant endurance issues, stress, visual impairment Consultant Not likely to succeed as consultant due to stress of ongoing interactions with clients
3 SCI/transportation issues Graphic artist Feasible self-employment as graphic artist as long as final portfolio meets professional quality standards
4 Orthopedic/ upper extremity weakness Outdoor worker Employment as youth worker in residential school more feasible than initial goal
5 Osteoarthritis Customer service Home-based customer service business feasible

Participants had a variety of conditions and functional problems and identified a range of employment goals, as seen in Table 2. Participants either successfully identified a self-employment goal or an alternative employment goal through the telerehabilitation support process.


While only a small pilot, the diversity of participant goals and types of disabilities and the relative success found in identifying relevant employment goals over a fairly short time period suggests that telerehabilitation offers a viable method of supporting individuals with disabilities in identifying feasible employment goals and specific action steps toward those goals. Of note, the issues identified through the process that might impede successful employment were not directly related to working at home but were more general characteristics of the individual's professional ability or characteristics of the disability. This pilot work offers these suggestions for future efforts at telerehabilitation to support self-employment:

  • Maintain contact with participants over a longer timeframe to complete additional action steps
  • Capture time spent in email and telephone contact in "real-time" for better accuracy; these often occurred in the context of other tasks and may not have been adequately timed.
  • Request that participants maintain a log of their own activities and time needed for each related to feasibility assessments outside of coaching/support time
  • Request referring state VR counselors be more involved via completion of pre and post interviews with referred participants regarding vocational goals and employment options.
  • Conduct post-support interviews with referring counselors to determine any impact the process has had on counselor perceptions of self-employment options and on telerehabilitation services.
  • Clinical vignettes highlighting telerehabilitation applications of VR can maximize their usefulness through public dissemination, allowing future referencing on web-based databases or other venues accessible to clinicians and researchers working in other organizations.


  1. National Organization on Disability. (2004). Harris survey of Americans with disabilities. Harris Interactive Inc.
  2. Rizzo, D.C. (2002). With a little help from my friends: supported self-employment for people with severe disabilities. Journal of Vocational Rehabilitation, 17, 97 - 105.
  3. Callahan, M., Shumpert, N., & Mast, M. (2002). Self-employment, choice, and self-determination. Journal of Vocational Rehabilitation, 17, 75-85.
  4. Doyel, A.W. (2002). A realistic perspective of risk in self-employment for people with disabilities. Journal of Vocational Rehabilitation, 17, 115-124.
  5. Arnold, N.L, & Seekings, T. (2002). Self-employment: a process for use by vocational rehabilitation agencies. Journal of Vocational Rehabilitation, 17, 107 - 112.
  6. McCue, M., Pramuka, M. (1994). F unctional assessment procedures for individuals with severe cognitive disabilities. American Rehabilitation, 20(3), 17-28.


This study was funded by the Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA) through Grant #04-NTSTM215-04

Author Contact Information:

Michael Pramuka, Ph.D.
5044 Forbes Tower-Atwood
University of Pittsburgh
Pittsburgh, PA 15260
EMAIL: mpramuka@pitt.edu

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