29th Annual RESNA Conference Proceedings

Development of Telemonitoring Architecture for Childrens' Communication Skills

Amy J. Brisben*, Bambang Parmanto**, Ellen R. Cohn**, J. Scott Yaruss**, and Corinna E. Lathan*

RERC on Telerehabilitation-AnthroTronix, Inc.*, Silver Spring , MD 20910 and the University of Pittsburgh **, Pittsburgh , PA 15260


The telerehabilitation architecture is designed to monitor speech/language, computer-based activities via video, audio, and software data collection capabilities. The details of the proposed system components are presented. Virtual CosmoBot 1 is a motivating, computer-based character designed to enhance children's communication skills and stimulate verbal interaction during the remediation of speech and language disorders via telerehabilitation, using the Mission Control human interface device and Cosmo's Play and Learn software, featuring CosmoBot that targets educational goals for children aged 3-5 years. The telerehabilitation infrastructure links distant speech-language pathologists and child participants in online and store-and-forward modes of communication.


Telerehabilitation, pediatric, speech/language therapy, developmental goals, age-appropriate communication


Children with a range of disabilities such as autism, ADHD, cerebral palsy, and learning and cognitive disabilities can be impacted by disorders of communication. According to the Department of Education, approximately 3.4 million students with disabilities are affected by either learning disabilities or communication impairments. Across a wide range of communication disorders, there is evidence that early difficulties with speech and language development are associated with later difficulties in communication, social interaction, reading and writing, and educational success (e.g., 1). It is vital for children with disabilities who also have communication delays to receive early intervention and effective treatment through age- appropriate activities that target specific aspects of speech and language development.

T he field of speech-language pathology is growing in its use of evidence-based methods for minimizing the impact of speech and language disorders (2). Several factors impact availability of treatment, such as remote location and transportation difficulties, lack of available clinicians and specialists, and funding and payment concerns (e.g., 1). Fortunately, disorders in communication development can often be successfully ameliorated through speech-language therapy activities that can be adapted to a telerehabilitation framework (1). This project offers a unique therapeutic intervention that targets specific communication goals and integrates fun and therapy for speech and language disorders with the use of teletherapy.

The proposed architecture provides two types of telemonitoring: (a) simultaneous monitoring, where the therapist monitors the child "live"-the child and therapist are communicating via telemedicine technology, and (b) store-and-forward monitoring, where the therapist monitors the child after the child has completed a therapy session. Simultaneous monitoring is a substitute for onsite monitoring, providing a solution for no therapy or infrequent therapy, due to location, transportation, or clinician availability issues. Store-and-forward monitoring provides the therapist with a means of evaluating the child's progress in performing at-home therapy exercises. This type of monitoring allows for the therapist to accurately, objectively assess the child's ability, dedication, and interest in performing therapy exercises at home, as opposed to relying on the child's and/or the parents' reporting of therapy homework. This type of monitoring allows for the therapist to add to the body of evidence based practice and to adjust therapy to better suit the needs and interests of the particular child.

In this paper we describe our proposed teletherapy architecture for speech/language therapy, the current state of the architecture, and describe future efforts in development and evaluation.


Cosmo’s Play and Learn screen shots.  The game’s main screen (upper left) is the “hub”—here, the child chooses which planet Cosmo will visit (remaning screens).  There are various activities and levels of difficulty on each planet, providing a variety of skill levels, targeted goals, and interests.

Figure 1: Cosmo's Play and Learn game (click image for larger view)

Under the RERC for Telerehabilitation, AnthroTronix and the University of Pittsburgh are developing telerehabilitation tools to motivate and integrate therapy, learning, and play. These technologies are developed in conjunction with therapists, educators, parents, and children. Virtual CosmoBot is featured in our first computer game, "Cosmo's Play and Learn," designed for use in rehabilitation and educational settings. Children of developmental ages 3-5 years work on their developmental goals while playing interactive software games featuring Virtual CosmoBot. "Cosmo's Play and Learn is designed to work on pre-literacy and pre-numeracy, with the particular learning objectives including receptive and expressive language goals, listening and attending, spatial awareness, recognizing sets and numbers, cause & effect, word recognition, recognizing symbols, and active working memory. In pilot tests with children with disabilities and typically developing children, the potential for learning has been shown to be high as is the child's motivation in participating in the activities.

Game setup and data collection and evaluation screens.  Left: student management: select a student, adjust settings for that student.  Right: data collection within an activity, across multiple sessions.Figure 2: Cosmo's Play and Learn setup and data evaluation screens (Click image for larger view)

The software includes automatic data collection, so that the clinician/educator can objectively evaluate the child's performance for one session and across sessions with the software. The game settings for the particular child can be set and are saved, to customize the software for the child's performance level, interests, and targeted goals.

a photograph of Mission Control, an alternative interface device consisting of four colored, analog buttons and a microphone.Figure 3: Mission Control (Click image for larger view)

The interface to the Virtual CosmoBot games is Mission Control, an interactive control station. Mission Control consists of four pressure sensing buttons and a microphone. Mission Control is expandable through external ports - four mono-plug jacks for external binary switches and two USB ports for external USB devices. The goal of this project is to expand the infrastructure of the Mission Control system to demonstrate its applicability for treating children with communication disorders.

The telerehabilitation infrastructure is outlined in Figure 4 . The child-side features contain the software content of the speech-language therapy, and consist of three important elements: Virtual CosmoBot, the Mission Control interface, and CosmoWeb. CosmoBot is a virtual friend on the computer screen who interacts with the child during each session. The child can use the child-friendly Mission Control interface to easily interact with CosmoBot. The CosmoWeb application then collects the assessment data recorded during each session and stores them temporarily in a secure local database.

Telerehabilitation architecture design showing the participants’ computer with Virtual CosmoBot, Mission Control, and CosmoWeb software.  This computer is connected to the server via HTTPS, and so is the Therapist’s computer.  Features listed are: allows therapists to enter goals, personalized goals and planning for individual child, will receive individual progress from home client’s computers, and capable of sending individual course therapy to home client’s computers.Figure 4: teleassessment architecture. (Click image for larger view)

The server-side components of the teleassessment infrastructure consist of a database server and an application program that manages educational and assessment data. Data, automatically collected while the child plays the software game, are sent to the server's database. Once the session data are sent to the server, the therapist is then able to access the child's data sets. With the information provided by the database application on the server, the therapist can then assess the progress of the child and adjust the game settings to his/her progress and abilities. Once completed by the therapist, these settings are sent from the server to the child's computer and presented the next time the child has a play session with CosmoBot. The server hosts a database system that stores the educational database, demographic and clinical data of the participants, and individual progress of the participants. Based on the progress, the therapists then can tailor the individual course of therapy for each child. He/she can also send encouragements, suggestions, and other educational materials to the child over the connection channel. This system supports the use of evidence-based practice, and the evaluation of treatment outcomes (e.g., via single subject research protocols), for it facilitates the collection and evaluation of data from each therapy session. The infrastructure employed for this project has been developed under the Information Technology Infrastructure topic of the RERC on Telerehabilitation.


The described architecture provides the means for telerehabilitation of communication skills, for children in the home setting, interacting with speech/language therapists in a clinical or educational setting. The architecture accommodates simultaneous monitoring, where the therapist is online at the same time as the child, and store-and-forward monitoring, where the therapist evaluates the child's performance in a home-therapy exercise, after the therapy session has been completed. Cosmo's Play and Learn software and Mission Control provide the means for children, with a wide range of abilities and developmental levels, to target their communication skills. Particular goals to target are outlined below:

  • Receptive language: understand size differences, recognize (nouns) manipulable objects, understand adjectives to describe objects and people, understand meanings of prepositions, understand comparatives/superlatives, increase pre-literacy skills.
  • Expressive language: vocalize sound, increase mean length of vocalization

Future goals include user-centered design evaluation of the developed system's effectiveness in targeting these communication skills and making any changes necessary to the architecture that are necessary to better serve our clients: the children and their therapists.


•  American Speech-Language-Hearing Association. (in press). Speech-language pathologists providing clinical services via telepractice: Position Statement. ASHA Supplement 25 .

•  Frattali, C. (Ed.). (1998). Outcome measurement in speech-language pathology . New York : Thieme Medical Publishers.


Funded by the National Institute on Disability and Rehabilitation Research RERC on Telerehabilitiation, H133E040012. Funding for the development of Cosmo's Play and Learn software and Mission Control were provided by SBIR grants from Dept. Education and the NSF, respectively.

Author Contact Information:

Amy Brisben, PhD, PE
AnthroTronix, Inc.,
8737 Colesville Rd,
Silver Spring, MD 20910
Office Phone (301) 495-0770 x104
EMAIL: abrisben@atinc.com

1 CosmoBot and Mission Control are trademarks of AnthroTronix, Inc.


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