Captions-Human Generated (CART)

A CART provider, stenography machine, laptop, and "Vibe" board on wheels.
CART on portable "Vibe" board on wheels
CART captions, with professional CART provider to the side, at the Simon & Garfunkel Story

Live, Human-Generated Captions 

(Institution provided)

Captions are invaluable for people with hearing loss. Captions provide visual accommodations to supplement the spoken word.

CART (Communication Access Realtime Translation). CART is an accurate, verbatim, near-instantaneous conversion of the spoken language into text by a stenographer using a stenotype machine, a laptop, and software to produce the text. In addition to capturing the speaker’s communication, CART providers also include environmental cues and are sensitive to the consumer’s needs.

For technical accuracy, CART is preferred over automatic captions when there is technical information, such as medical, legal appointments, and court proceedings.

  • In-person CART professional: usually preferable to have the best access to sound.
  • Remote CART professional: has improved immeasurably. Remember to prioritize how the mic(s) are used effectively.
  • It’s ok for anyone, including the CART provider, to say, “Hold up – words matter, and _(insert name)_ deserves every one of them.”

Text can be displayed on a wall, projector screen, computer screen, or on a smartphone. Text can also be embedded in virtual meeting platforms (see below for links).

CART Stenograph Equipment
CART setup
CART-Eye appointment showing stenography equipment. From Gibson Reporting
CART at eye appointment. Image credit: Gibson Reporting
Opening stage for Shucked with the Open Caption display to the right
CART Captions (on LED screen to the right) by professional CART provider at Shucked

ADA and Requesting Accommodations

Consumers with hearing loss can be hesitant to ask for accommodations, and these accommodations are rarely offered without requests. It is imperative that staff realize the high prevalence of hearing loss in all populations and proactively offer services that enable people with hearing loss to understand the information.

CART provides equal access. CART meets the criteria for an “auxiliary aids and services” under Effective Communication with the Americans with Disabilities Act (ADA).

  • Institutions need to maintain a list of CART providers.
  • Find providers through NCRA, state agencies, and searching for CART provider small businesses.  

CART in Healthcare

Telehealth

  • Both CART and speech-to-text captions can be integrated into telehealth platforms, or can be shown on a second device (more complex for the patient)
  • Telehealth platforms are required to have captions by the end of 2026, under the “interoperable video conferencing” section in the FCC.

HIPAA compliance in healthcare settings. CART providers will need to sign a business associate agreement with the covered entities that they provide services for.

Handouts

pdf
(1 page) Overview of CART, which benefits people who have …
pdf
587 KB
Frazier, et al. January 8, 2024. Committee for Communication Access …
pdf
343 KB
(2 pages) Overview information on assistive listening systems and captions. …
pdf
336 KB
(2-pages) Patients with hearing loss can be hesitant to ask …

Resources

Virtual Conferencing Resources

Professional Organizations and Resources

Please email the Center for Hearing Access with photos, videos, corrections, ideas, or additional products. Contact us (this website)

CART Videos

These videos show how CART can be used in other settings. 

Live Captioning (CART) on Any Device for your Accessible Event

Source: Inclusive Communication Services (35 seconds)

Employment Solution Showcase: CART.

Source: AskJAN (3:27)

Follow along with the lyrics in real time, with CART closed captioning services

Source: Rochester Public Music (0:39)

Sample of CART (Communication Access Real-time Translation) services during statistics class at University of Delaware (1:55)

CART Assists the Deaf and Hard-of-Hearing in Joining the Conversation (4:27)

CART Services for Deaf and Hard-of-Hearing People

Source: Washington State DOITCenter (7:34)