PILOT PROTOCOL
A PROTOCOL FOR THE PILOT STUDY TO ASSESS THE FEASBILITY OF DELIVERING
AAC SERVICES REMOTELY
Initial version:
12.01.2013
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Table of Contents
PILOT SUMMARY ............................................................................................................................................................... 1
1
2
3
INTRODUCTION ........................................................................................................................................................ 2
1.1
BACKGROUND ............................................................................................................................................................. 2
1.2
VIDEO CONFERENCING TECHNOLOGY .............................................................................................................................. 2
1.3
REMOTE ACCESS TECHNOLOGY....................................................................................................................................... 3
PILOT OBJECTIVES .................................................................................................................................................... 3
2.1
PRIMARY OBJECTIVE..................................................................................................................................................... 3
2.2
SECONDARY OBJECTIVES ............................................................................................................................................... 4
PILOT DESIGN ........................................................................................................................................................... 4
3.1
4
5
6
GENERAL DESIGN ........................................................................................................................................................ 4
SUBJECT SELECTION .................................................................................................................................................. 6
4.1
INCLUSION CRITERIA..................................................................................................................................................... 6
4.2
EXCLUSION CRITERIA .................................................................................................................................................... 6
4.3
SUBJECT RECRUITMENT AND SCREENING .......................................................................................................................... 6
STUDY PROCEDURES ................................................................................................................................................ 7
5.1
VIDEO CONFERENCING PILOTS ....................................................................................................................................... 7
5.2
REMOTE ACCESS PILOTS................................................................................................................................................ 7
DATA HANDLING AND RECORD KEEPING .................................................................................................................. 8
6.1
RECORDS MANAGEMENT AND CONFIDENTIALITY ............................................................................................................... 8
6.2
FEEDBACK FORMS ........................................................................................................................................................ 8
6.3
RECORDS RETENTION ................................................................................................................................................... 9
7
ETHICAL CONSIDERATIONS ....................................................................................................................................... 9
8
REFERENCES ............................................................................................................................................................. 9
9
APPENDIX ............................................................................................................................................................... 10
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Glossary of terms and abbreviations
Aided Communication: Aided communication is a subset of AAC which refers to those methods of
communication which involve using additional equipment, such as picture, letter or word boards or books and
technology based systems such as voice output communication aids.
Augmentative and Alternative Communication (AAC): AAC covers a range of techniques which support or
replace spoken communication. It includes gesture, signing, symbols, picture, letter or word boards or books
and technology based systems such as voice output communication aids.
Video Conferencing: A video conference is a tool which allows two or more people to participate in a virtual
meeting with video and audio links – it is like a telephone call with the addition of live pictures.
Remote Access: Remote access tools allow someone, in this case a therapist, technician or equipment supplier
to connect to a suitable device for example a computer or high tech communication aid, remote to make small
changes to the software or hardware configuration of your device. This can often alleviate issues quickly
without you having to leave your home.
Communication aid: A communication aid is a piece of equipment which helps a person to communicate.
These aids range from letter, word or picture boards to any technology based system such as a voice output
communication aid.
Pan Tilt Zoom (PTZ) Camera: A camera that is capable of remote directional and zoom control
Training for people who use AAC: Training involves a period of time potentially over multiple sessions to help
those involved learn about using the device with an expected outcome of an awareness of how to operate the
device and integrate it with their current communication strategies to the extent which is useful for them.
Training for professionals working with AAC: Training for professionals includes raising awareness and
updating knowledge of AAC. This may include some or all of: information on AAC strategies, research and
practice; AAC equipment and potential customisation and access options; and how to use and prepare the
equipment for use. Training may also include information on any other aspects of providing a service for AAC
and people who use AAC.
Follow up AAC reviews: Review occurs in a separate period after an initial intervention. It is a process where a
communication strategy employed since the previous intervention is considered and evaluated. The review will
consider if this strategy is still appropriate and meets the needs of the person who uses AAC. A review may
involve further assessments of the person’s communication strategies, abilities and access methods and
address any changes that have occurred in the person’s situation.
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Ongoing support for people who use AAC: The provision of any type of support for the person who uses AAC
after the provision of the equipment or strategy. This could include further customisation, information or
advice on effectiveness of use or suggestions of alterations to meet minor changes in the needs. Where there
are more distinct changes in the needs of the person a review may be required.
Assessment for aided communication: Assessment is an evaluation of the suitability of aided communication
to match a person’s skills and capabilities for use. The assessment takes into account some or all of the
cognitive, communicative, language, speech, physical and sensory abilities and needs including those that
affect the method of accessing the devices for the person. It may also include equipment loan and trial.
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PILOT SUMMARY
Title
Protocol for pilots in the use of Video Conferencing and Remote Access to
deliver AAC services remotely
Methodology
Design attributes such as single blind, double blind or open label; Randomized,
placebo or active placebo control; cross-over design, etc.
Study Duration
December 2012 – March 2013
Study Centres
Multi-centre study – North Bristol NHS Trust, ACE Centre South, Kent
Communication and Assistive Technology Ashford and Canterbury, Chailey
Heritage Clinical Services
Objectives
To pilot the use of appropriate Video Conferencing and Remote Access
technology to perform end to end pilots from a variety of organisations with
professionals and users.
Main Inclusion
Criteria
Study Design
 Subject or proxy able to give informed consent
 Services and users meet technology eligibility criteria
The remote service delivery pilots are non-randomised trials with two parallel
streams to systematically evaluate the use of video conferencing and remote
access tools in AAC services. The pilots will evaluate a range of session
scenarios with a variety of network connections.
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1 INTRODUCTION
This document is a protocol for pilots in the use of video conferencing and remote access technology to
deliver Alternative and Augmentative Communication (AAC) services remotely. The pilots are being
undertaken by the South Consortium partners as part of the Department for Education Project Objective
7, assessing the feasibility of delivering AAC services remotely.
1.1 B ACKGROUND
The Department for Education is funding a national project to develop a model of AAC service provision
fit for the future. Eight key objectives have been created for the project which will inform the
commissioning of the 'hub and spoke' model of AAC services as recommended by the Office of the
Communication Champion and Council (ref). Four regions, North, Midlands and East, London and South
will work together to achieve the objectives. The consortium partners for the South, who are leading on
objective 7, are Bristol Communication Aid Services, ACE South, Kent Communication and Assistive
Technology (CAT), Chailey Heritage Clinical Services, and Dame Hannah Rogers Trust. The goal of
objective 7 is to assess the feasibility of using technology to deliver AAC services remotely to those who
have most difficulty accessing AAC services.
The use of technology in this way is often referenced within the field of Telehealth and more specifically
Telerehabilitation which describes the use of technology to deliver traditional rehabilitation services
remotely (ref). The use of telerehabilitation tools has the potential to provide benefits for key
stakeholders involved in AAC services including users, professionals and organisations.
The use of technology in this way could be a useful tool for some users and organisations to enhance the
way AAC services are currently delivered. Being able to deliver some services remotely could provide
improved equity to services for those who have difficulty accessing services due to distance, time, cost
and transport issues. This pilot will investigate the use of video conferencing and remote access
technology to provide remote service delivery.
1.2 V IDEO C ONFERENCING T ECHNOLOGY
Videoconferencing can be described as interactive communication using video and audio to
communicate over long distances. It combines the interactivity of the telephone with the visual
stimulation of video. Videoconferencing may also include graphics and data exchange.
A large range of commercial systems are available, an evaluation tool was developed to identify suitable
technology for use within AAC services. Following this evaluation Iocom’s Visimeet was deemed an
appropriate software application. Iocom’s Visimeet has already been installed in many NHS sites across
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the country. (IOCOM, 2009) An important aspect for the trials is for the product to work within the N3
NHS network and external to this, Visimeet meets this criterion.
Hardware requirements for video conferencing are of equal importance to ensure it meets the needs of
AAC services. For the pilots appropriate hardware was selected:

Pan Tilt Zoom (PTZ) camera (Misco)

PTZ adapter

High Definition USB camera (Logitech C920)

USB Headset (Logitech)

Echo cancellation microphone and speaker (Jabra)

Laptop (Laptop (Acer Aspire M)
1.3 R EMOTE A CCESS T ECHNOLOGY
Remote access or remote support can broadly be defined as the ability to connect to a host device or
network from another device (the client) without being physically at the location of the host device.
Once connected, remote access technology can enable various levels of control and access to data on
the host device. This can range from full control to the ability to only view the host device. Remote
access can be set up using a local area network (LAN), a virtual private network (VPN) or wide area
network (WAN) such as the internet so that resources and systems can be accessed remotely.
Typically remote access is utilised by IT professionals to connect to desktops and servers to manage
networks and provide support. It has generally been established that organisations taking advantage of
remote control technology have saved time, money and resources eliminating the need for IT staff to
travel, reducing system down time and improving the efficiency of the IT organisation. If a model for
using remote technology with high-tech communication aids can be established it could provide a useful
tool for harnessing some of these advantages for services across the country.
A large range of commercial systems are available, an evaluation tool was developed to identify suitable
technology for use within AAC services. All the systems evaluated use the internet to establish the
connection over a wide area network. Bomgar, Teamviewer and LogMeIn were three systems identified
as suitable for the pilot.
2 PILOT OBJECTIVES
2.1 P RI MARY O BJECTIVE
To assess the feasibility of delivering a range of AAC services remotely using appropriate technology.
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2.2 S ECONDARY O BJECTIVES

To assess suitability of services and users for remote sessions

To assess professional and service user acceptance of remote service delivery

To identify barriers, limitations and solutions for remote service delivery in AAC services

To assess cost comparisons of remote sessions and face to face appointments.
3 PILOT DESIGN
3.1 G ENERAL D ESIGN
The remote service delivery pilots are non-randomised trials with two parallel streams to systematically
evaluate the use of video conferencing and remote access tools in AAC services. The pilots will evaluate
a range of session scenarios with a variety of network connections. Table 1 outlines the range of trial
scenarios for video conferencing. Table 2 outlines the range of trial scenarios for remote access. Tables 1
and 2 summarise the potential activities for remote service delivery within AAC services. Due to the
variety of activities AAC services provide these may not be an exhaustive list in terms of the type of
session and interaction type. The pilots will involve several stages:
1. Identify services and users to participate in trials
2. Screen to ensure eligibility criteria for users, services and technology are met
3. Deliver trial packs to gain consent and deliver training
4. Undertake pre-trial testing for technical setup
5. Undertake trial according to trial procedures
6. Collect results for analysis
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Table 1: Trial scenarios for video conferencing pilots
Interaction Type
Type of Session
Network Connections
Training
Organisation1 LAN - Organisation1 LAN - Single point session
Meetings - catch up, client review etc
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Professional to Professional
Home BB - Home BB - Single point session
Organisation1 LAN - Organisation1 LAN - Multipoint session
Organisation1 - Organisation2 - Multipoint session
Organisation1 - Home BB - Multipoint session
Organisation1 LAN - Organisation1 LAN - Single point session
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Professional(s) to Service User
Initial Assessment
Home BB - Home BB - Single point session
Organisation1 LAN - Organisation1 LAN - Multipoint session
Organisation1 - Organisation2 - Multipoint session
Organisation1 - Home BB - Multipoint session
Organisation1 LAN - Organisation1 LAN - Single point session
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Professional(s) to Service User
Review Appointment/Follow Up Session
Home BB - Home BB - Single point session
Organisation1 LAN - Organisation1 LAN - Multipoint session
Organisation1 - Organisation2 - Multipoint session
Organisation1 - Home BB - Multipoint session
Organisation1 LAN - Organisation1 LAN - Single point session
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Professional(s) to Service User
Training
Home BB - Home BB - Single point session
Organisation1 LAN - Organisation1 LAN - Multipoint session
Organisation1 - Organisation2 - Multipoint session
Organisation1 - Home BB - Multipoint session
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Table 2: Trial scenarios for remote access pilots
Type of Session
Network Connections
Organisation1 LAN - Organisation1 LAN - Single point session
Service User Training
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Home BB - Home BB - Single point session
Organisation1 LAN - Organisation1 LAN - Single point session
Troubleshooting
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Home BB - Home BB - Single point session
Organisation1 LAN - Organisation1 LAN - Single point session
Software change/update
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Home BB - Home BB - Single point session
Organisation1 LAN - Organisation1 LAN - Single point session
Configuration Changes
Organisation1 - Organisation2 - Single point session
Organisation1 - Home BB - Single point session
Home BB - Home BB - Single point session
4 SUBJECT SELECTION
4.1 I NCLUSION C RITERIA
1. Subjects capable of giving informed consent
2. Subjects who have an acceptable surrogate capable of giving consent on behalf of the subject
4.2 E XCLUSION C RITERIA
1. Services and users who do not meet technology eligibility criteria
2. Subjects declining remote service delivery
4.3 S UBJECT R ECRUITMENT
AND
S CREENING
Users and services were recruited from investigating centres and through stakeholder days and
questionnaires distributed as part of the wider project. Services and users were given trial packs with
consent forms, handouts on equipment and training, and questionnaires for feedback and cost analysis.
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(See Appendix #). Services and users are required to meet eligibility criteria for network and data
requirements in order to participate.
5 STUDY PROCEDURES
5.1 V IDEO C ONFERENCING P ILOTS
1. The service provider identifies an opportunity to deliver a session remotely.
2. The project worker from the South region arranges a time to discuss with the service provider
the details of the project and the video conferencing system. The project worker assesses the
technical eligibility of the proposed remote session. The service provider assess the suitability of
delivering the session using video conferencing tools considering where applicable the user
suitability.
3. Following initial screening the project worker delivers trial pack information to service provider
to seek necessary consent from services and users. The trial pack also contains information for
training for the session and equipment.
4. Once the necessary permissions and consent has been granted a date for the trial session is
arranged. Prior to the trial date the project worker will work with local teams to setup and test
Visimeet and where necessary hardware for both the host and remote sites. The project worker
will document and record hardware details and network connections used.
5. On the day of the video conference session the project worker will act as administrator and
technical support for the session. The project worker will ensure accurate and optimal setup of
equipment and provide support for technical issues. The service provider will control functional
aspects of the video conferencing system e.g. camera zoom and be responsible for the content
of a session. During a session the project worker will record network statistics using tools
provided by Visimeet.
6. Following the session the project worker will gather completed feedback forms from the lead
participant at the remote and host sites.
5.2 R EMOTE A CCESS P ILOTS
1. The service provider identifies an opportunity to deliver a session remotely.
2. The project worker from the South region arranges a time to discuss with the service provider
the details of the project and the video conferencing system. The project worker assesses the
technical eligibility of the proposed remote session. The service provider assess the suitability of
delivering the session using video conferencing tools considering where applicable the user
suitability.
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3. Following initial screening the project worker delivers trial pack information to service provider
to seek necessary consent from services and users. The trial pack also contains information for
training for the session and equipment. This includes aspects of user authentication and security
for approving remote access to a device.
4. The project worker will work with local teams to establish which software solution is to be
trialled. The project worker will work with the local team to where necessary install trial
applications on existing hardware and the device to be accessed remotely. The project worker
will document and record hardware details and network connections used.
5. The service provider will determine suitable users and sessions for use of the remote access
software. Often it is anticipated remote access sessions will take place on ad hoc basis e.g.
troubleshooting an issue with a device. The project worker will provide technical assistance for
setup and support prior and during sessions where required. The service provider will control
functional aspects of the remote access session e.g. screen sharing and be responsible for the
content of the session.
6. The project worker will gather completed feedback forms from the lead participant at the
remote and host sites.
6 DATA HANDLING AND RECORD KEEPING
6.1 R ECORDS M ANAGEMENT
AND
C ONFI DENTIALITY
Information about trial subjects will be kept confidential and managed according to the requirements of
the Data Protection Act (1998). Data should be stored in line with local organisation policies taking part
in the pilot. Data should be stored in a way that permits a complete retrospective audit if necessary.
In line with local information governance guidance video and audio recording of remote sessions will be
disabled for pilots in order to ensure compliance with guidelines of medical record policy.
6.2 F EEDBACK F O RMS
The pilot feedback forms are the primary data collection instrument for the study. All data requested on
the feedback forms must be recorded. All missing data must be explained. If a space on the feedback
form is left blank because it is not applicable for this case, write “N/D”.
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6.3 R ECORDS R ETENTION
Records recorded in the study will be retained in accordance to the local service provider policy and
procedures.
7 ETHICAL CONSIDERATIONS
In accordance with guidelines set out by the NHS National Patient Safety Agency, the pilots are part of a
service evaluation and do not require Research Ethics Committee review. The pilots involve an
intervention in use only. The choice of treatment is that of the clinician and patient according to
guidance, professional standards and/or patient preference. (National Research Ethics Service, 2010)
The pilots are carried out in accordance with national regulations and local institutional policies and
procedures.
All subjects for this pilot will be provided a consent form describing this study and providing sufficient
information for subjects to make an informed decision about their participation in this pilot. See Trial
pack within appendix # for a copy of the Subject Informed Consent Form.
8 REFERENCES
IOCOM, 2009. ICOM Case Study: Extending the Reach of Stroke Care: NHS use of Visimeet in the East of
England. [Online]
Available at: www.iocom.com/docs/EOE_nhs_case_study2.pdf
[Accessed 14 February 2013].
National Research Ethics Service, 2010. Defining Research, London: NHS National Patient Safety Agency.
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9 APPENDIX
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