Captions-Human Generated (CART)
CART on portable “Vibe” board on wheels, setup next to the main PowerPoint presentation.
CART captions on LED board, with professional CART provider to the side. Taken at the Simon & Garfunkel Story live performance and included captions to songs, spoken words, and video clip audio.
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 appointments, legal appointments, technical classes, jury duty, and legal actions and services.
Text can be displayed
- In-person publicly: overlaying the main presentation. The captions can be placed at the top, bottom, side, or middle of the screen. It is sometimes called Picture-in-Picture (PIP)
- In-person publicly: separately on a wall, second projector screen, or LED board
- In-person individually: computer screen, device, or on a smartphone
- Virtually: embedded in virtual meeting platforms (see below for links)
CART setup for a discussion with 30 people. CART was projected on a single screen.
CART at eye appointment displaying captions on laptop. Image credit: Gibson Reporting
CART Captions (on LED screen to the right) by professional CART provider at ‘Shucked’ live performance.
Lt. Governor on stage with a large screen displaying the captions. Great line-of-sight.
CART captions overlaid on top of the slide.
CART displayed on an individual’s smartphone.
FCC committee meeting. CART is displayed on a screen behind the committee. To the right is second screen showing the video feed with captions overlaid.
CART at a public wildfire debrief. A laptop is displaying the captions.
CART on second screen to the left of PowerPoint, with captioner in the front. It is easy to see the captions, slides, and presenter.
How Does It Work?
The captioner can be located either
- 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.
Tips
- The line of sight is critical between the captions displayed and the person speaking. You want to avoid a ping-pong effect.
- The captioner needs to be positioned to see and hear everything, such as seating at the front of the room.
- It’s ok for anyone, including the CART provider, to say, “Hold up – words matter, and _(insert name)_ deserves every one of them.”
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.
- CART providers can be found through NCRA; state agencies for the Deaf, DeafBlind, and Hard of Hearing; and internet searching for CART provider 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
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) Visible Voices
CART Services for Deaf and Hard-of-Hearing People
Source: Washington State DOITCenter (7:34)
Templates
- Shirley, T. CART at a medical center. White paper (1 page)
- Requesting captioning. Template for Town Halls and Meeting Events (Google doc) Download and customize (Center for Hearing Access)
Resources
- Han, M. (March 30, 2026) “Don’t Wait for Misunderstandings”: Tremmel Watson on Moving Workplace Accessibility Forward. Innocaption.
- Watson T. and K. Odiwe, Esq. (February 2026) A federal settlement for self-determination and the mandate for professional CART (3 pages, pdf) Watson v. Anti-Recidivism Coalition TheJCR.com pages 24-26
- CART resources
- Real-time captioning, Minnesota Deaf, DeafBlind and Hard of Hearing State Services (webpage)
- CART Information, Colorado Division of Deaf, Hard of Hearing and DeafBlind
- U.S. Rep. Hageman and U.S. Sens. Wicker and Welch introduce legislation to ensure oversight of AI and ASR in justice system NCRA 3/19/26
- All healthcare webpages (this website)
Virtual Conferencing Resources
- Teams: CART Teams and ASR Teams
- Zoom: CART Zoom and ASR Zoom
- WebEx: CART WebEx and ASR WebEx
Professional Organizations and Resources
- National Court Reporters Association (NCRA)
- CART Consumer Bill of Rights
- CART flyer (1 page)
- CART in the Court: Setting a Standard
- The CART Captioner’s Manual (16 pg)
- CART Code of Ethics
- Captioning Matters (further resources)
- Global Alliance of Speech-to-Text Captioning
- State Relay Programs. NASRA and the specific page showing each state and its relay administrator.
Please email the Center for Hearing Access with photos, videos, corrections, ideas, or additional products. Contact us (this website)