**4. Accessibility of educational resources for the telerehabilitation system**

The Web [16] has revolutionized our daily life, becoming the primary source of information, knowledge, consultation, and provision of services and interaction in various areas. Services related to education as well as learning resources are increasing around the world; therefore, it is essential that users, regardless of their disabilities, have accessible learning resources. This study aims to raise awareness of any professional who develops educational applications that apply accessibility standards to generate inclusive and accessible applications. For within the group of possible users, there may be participants with some type of visual disability, such as users with low vision and elderly people. On the other hand, we must emphasize that developing an accessible application does not have to go against an attractive graphical interface, that is, an accessible application does not necessarily have to be "unsightly."

It is convenient to remember that not all visual disabilities are the same and computer management skills also depend on the age of the user, so in the article, these two variables will always be considered. Nowadays, it is necessary to consider the different levels of education, especially for elderly patients and those with

disabilities. Therefore, the educational resources of the Tele-habilitation platform must provide instantaneous and ubiquitous access to all types of services and content, including documents and digital resources.

The digital educational resources have become a valuable alternative to support the teaching and learning processes, taking advantage of the possibility of presenting the contents through different multimedia formats. Therefore, it is necessary that educational resources for learning apply accessibility features that allow the interaction of users regardless of their conditions and preferences. This document presents a proposal for the evaluation of the accessibility of multimedia educational resources, where it is suggested to apply the WCAG 2.1 in addition to a series of phases to automatically and manually assess the level of accessibility of the educational resources used in the platform of telerehabilitation of the ePHoRT project.

Accessibility is related to the degree to which people can use or access a service, regardless of their technical, cognitive, or physical abilities [17]. Web accessibility describes methods and theories to make resources, in their multiple forms, more accessible for all people especially for the elderly and people with disabilities. In general, the educational resources of any website or platform must provide universal access, that is, if it includes videos, subtitles must be placed so that the content can be interpreted by people with visual disability or low vision; if people have hearing problems, an audio description should be included, making sure that the resources are inclusive.

The United Nations [18] "Recognizes the importance of access to the physical, social, economic and cultural environment, to health and education and to information and communication, so that persons with disabilities can fully enjoy all human rights and fundamental freedoms."

According to Kurtz et al. [19], the number of people who have undergone surgery for total hip arthroplasty (THA) has increased significantly in the last 10 years, and it is estimated that it will continue to increase.

In line with Ravi et al. [20], THA is a surgery that refers to the replacement of the femoral head and acetabulum of the hip joint. This surgery is usually performed in older adults, due to degenerative joint disease or progressive wear and tear of the joint, and the demographics of patients who decide to undergo THA has become increasingly popular.

In agreement with Salavati et al. [21], the young persons may have higher functional objectives than older persons, which may modify the structuring of rehabilitation protocols. In any of the cases, what is intended after surgery is to calm the pain, restore normal function, and improve the quality of life of people.

In this study, we started with the following question: Are multimedia resources accessible to all users of the telerehabilitation platform?

It is considered an accessible multimedia resource if the content is available to all users, regardless of their disability or application context [22]. It is of vital importance that the educational resources of the platform are accessible even for people who use a screen reader. This research analyzes accessibility problems with multimedia resources, especially those related to video and audio.

According to Rybarczyk et al. [23] in the telerehabilitation platform, learning processes can be oriented in different stages of rehabilitation and include preventive, curative, and maintenance processes.

For the early recovery of the patient on the platform, instructions are included on the general consequences of the procedures and their likely risks, so it is intended to guide the patient through the rehabilitation process at all stages. Proper guidance can help the patient make the right movements to reinforce the safety of functional tasks and motivate the patient to complete the rehabilitation program. Considering that the patient should perform the exercises in a standing position and

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*Technical Contributions to the Quality of Telerehabilitation Platforms: Case Study—ePHoRt…*

at a certain distance from the computer, inclusive resources are proposed to guide the patient in the learning process. One of the main elements that have proven to be useful and efficient in education as a means of transmitting and strengthening knowledge is the implementation of multimedia teaching materials, including the use of videos, audios, and PDF files, which constitute an excellent support material. Conforming to Acosta-Vargas et al. [24], the method used to assess access to educational resources consists of identifying the type of resource, reviewing access barriers to the resource according to WCAG 2.1, combining automatic and manual methods to assess the accessibility of resources, recording identified barriers in a spreadsheet, analyzing the results, and finally suggesting possible

Baruch et al. [25] indicate that multimedia accessibility policies propose that "All multimedia elements such as audio or video, produced or published must be accessible at the time of publication." Multimedia accessibility proposes a simple text transcription, so that it is necessary to place a transcript in audio-only recordings, to meet all the success criteria suggested by WCAG 2.1. On the other hand, multimedia resources according to the World Wide Web Consortium (W3C) [26] include texts, images, graphics, animations, video, and sound to present or communicate specific information. Consequently, to cover all the parameters that intervene in the accessibility of educational resources, it is necessary to evaluate a set of dependent components such as human factors, in this case all the users of the telerehabilitation platform are considered, including users with special needs, technological factors to provide accessibility, and user interaction with the device in the environment of the platform, which include criteria to favor accessibility with the indicated components. ISO/ IEC 40500: 2012 [27] is equivalent to the Web Content Accessibility Guidelines 2.0 (WCAG 2.0), is related to the Web Content Accessibility Guidelines 2.1 (WCAG 2.1) which consists of 4 principles, 13 guidelines, and 76 compliance criteria (success), plus an undetermined number of sufficient techniques and counseling techniques.

The four principles are the same as those contained in WCAG 2.0:

must be operable. It has 5 guidelines and 29 compliance criteria.

It has one guideline and three compliance criteria.

• Principle 1—Perceptibility: information and user interface components should be presented to users in the way they can be perceived. It has 4 guidelines and

• Principle 2—Operability: the user interface and the navigation components

• Principle 3—Comprehensibility: the information and management of the user interface must be understandable. It has 3 guidelines and 17 compliance

• Principle 4—Robustness: the content must be robust enough to be based on its interpretation by a wide variety of user agents, including assistive technologies.

In March 2012, Web Accessibility Initiative (WAI) published the Methodology of Website Accessibility Conformance Evaluation Methodology (WCAG-EM) 1.0. In 2014, a new version was published [28]. The WCAG-EM methodology allows

*DOI: http://dx.doi.org/10.5772/intechopen.83686*

recommendations.

**4.1 Accessibility**

29 compliance criteria.

criteria.

**4.2 Method**

*Technical Contributions to the Quality of Telerehabilitation Platforms: Case Study—ePHoRt… DOI: http://dx.doi.org/10.5772/intechopen.83686*

at a certain distance from the computer, inclusive resources are proposed to guide the patient in the learning process. One of the main elements that have proven to be useful and efficient in education as a means of transmitting and strengthening knowledge is the implementation of multimedia teaching materials, including the use of videos, audios, and PDF files, which constitute an excellent support material. Conforming to Acosta-Vargas et al. [24], the method used to assess access to educational resources consists of identifying the type of resource, reviewing access barriers to the resource according to WCAG 2.1, combining automatic and manual methods to assess the accessibility of resources, recording identified barriers in a spreadsheet, analyzing the results, and finally suggesting possible recommendations.
