The Brave New World of the Cyber Speech and Hearing Clinic

I teach a speech sciences course at Northern Arizona University. The course includes a section on the history of speech and hearing inventions and scientific advances. There is a review of the contributions of early pioneers such as Hermann Von Helmholtz and his work on speech resonance and Henry Sweet, who reportedly was the model for George Bernard Shaw ’s Professor Henry Higgins in the play " Pygmalion. " The major contributions of Ilse Lehiste, Grant Fairbanks, Karl S. Lashley, Franklin Cooper, Alvin Lieberman, and Melville and Alexander Graham Bell are also detailed.

We spend considerable time discussing the explosion in scientific and technological advances that occurred during the latter part of the 20th century as a result of the computer revolution. I conclude this historical review with informed speculation about what the next 10, 20, or 50 years may bring to the study and treatment of human communication and its disorders.

During these lectures, I am always mindful that this type of musing is fraught with pitfalls of overgeneralization, excessive optimism, and blind ignorance. Predicting the future is difficult. I also am aware that this intellectual exercise is necessary if students and practitioners are not to be caught off-guard by advancing technology. It also is essential if they are to intelligently plan their professional futures. Scientific and technological advances can cut a wide swath in traditional professional values and practices. They can bring the best of times with marvels that baffle the mind, but they can also devastate or even eliminate a profession.

Virtual Clinics

A major change that speech and hearing professionals will embrace or endure in the future is an end to traditional clinic-based diagnostic and therapeutic services. Although there will always be situations where face-to-face, patient-clinician contact will be necessary, clinicians will provide many services via the Web. This trend is already affecting other professions. There are virtual pharmacies, medical clinics, travel agencies, and counseling centers. The convenience of instant and inexpensive computerized stock trades has already limited the employment opportunities in the stockbroker profession. Several universities offer all or part of their academic training in communication sciences and disorders via the Web.

In the future, patients will log on to cyber speech and hearing clinics from the comfort of their homes. Three-dimensional and holographic imaging will continue to improve, creating viewing situations similar to face-to-face contact. Surrounding ceiling-to-floor screens will be constructed with keyboard or voice recognition capabilities, embedded digital cameras, bio assessment and feedback devices, and earphones. Virtual reality headsets will provide further options for interaction and give the patient more freedom and mobility. In the future, hurried nighttime trips to the doctor for a croupy or fevered child will be infrequent, as will be regular car trips to speech and hearing clinics. Speech and hearing professionals will also benefit from this technology by providing synchronous and asynchronous services from their home cyber centers.

At the time of this writing, a computer company in California ’ s Silicon Valley announced the development of a computer chip that can complete 400 million computations in 1/50th of a second. In the past four decades, home computers have gone from the limited speed and power of the Commodore and Apple II to today ’ s home computers, which have more capabilities than the ones used to launch the first astronauts into space. Soon, there will be unlimited memory and near-instantaneous calculations that will dramatically alter the profession of communication sciences and disorders.

The Revolution in Diagnostic Procedures

Clinically competent clinicians will still perform speech and hearing diagnostics in the future, but the computer will revolutionize the process. Many evaluations will be completely conducted via the Web. Parents or spouses of the patient will complete intake forms by answering questions of a computer-generated composite face and voice. Research will show this person to be comforting and professional. Today in Britain, a similar computer composite provides daily newscasts.

The hearing evaluation will be completed in less than a minute. The patient will simply sit in his or her cyber center with headset and earphones snugly in place while the function and status of the hearing mechanism are tested. Clicks, tones, buzzing sounds, and the sensation of pressure changes will be the only things heard or sensed by the patient. On a data frame, the completed hearing evaluation report will be created, including colorful graphic charts of the brain and the external, middle, and inner ear. The patient ’ s hearing will be tracked and evaluated from external ear to temporal lobes. Hearing testing, which in the past took hours and involved soundproof booths and complicated testing protocols, will be completed rapidly, accurately, and largely automatically.

Speech articulation will be acoustically analyzed. Each sound will be compared with norms for intelligibility and precision for the patient ’ s particular language. Each phoneme of the 10,000 languages and dialects of the world will have its specific acoustic parameters analyzed. The speech articulation of a patient will be instantly acoustically compared with norms and given a " deficiency value. " These scores will be provided for static and dynamic speech.

In addition, technology will permit analysis of the articulation of people suffering from brain damage and neurological diseases and not only acoustically determine the precision and intelligibility of their motor speech, but also identify the site and nature of the peripheral or central nervous system damage. Although phonetics courses will still be taught, clinicians will rarely use their ears to make judgments about a patient ’ s articulation. The computer will simply be faster and more accurate. The late Dr. Oscar I. Tosi at Michigan State University created algorithms to determine individual phoneme acoustic precision and provided initial research into clinical application.

The computer will also automatically profile voice parameters. The patient ’ s pitch, loudness, emphasis, shimmer, jitter, spectral characteristic, voice onset times, and other parameters will be automatically assessed and analyzed in seconds. The computer will detect early signs of progressive neurological diseases such as ALS, MS, and Parkinson ’ s disease, as early symptoms of these disorders sometimes show up as minor voice irregularities.

Tests for language delay and disorders will be automatically chosen by the computer and adapted to the patient ’ s interests. For children, these interactive tests will use colorful cartoon characters who playfully ask questions and probe for responses. Talking dogs, rabbits, cats, and chipmunks will have the child remember, repeat, name, discuss, describe, and point, while the computer analyzes and categorizes each response. The child ’ s cognitive, linguistic, and social-communicative abilities will be assessed using the latest tests. Phonological process will be identified, as well as the speed and accuracy of motor responses and visual scanning times. Length of utterances and vocabulary will be computed in every possible way and charted in three-dimensional bar, pie, and line graphs. Everything from the patients ’ cognitive-linguistic functioning to their metalinguistic awareness will be assessed by fun-loving cartoon characters. Aphasia, apraxia, and fluency tests will be similarly conducted and structured around the patient ’ s age and interests.

The oral facial examination will also be assessed via the Web. The talking cartoon characters will have children open their mouth widely and face the embedded camera. The computer will note salient facts about tongue, lips, teeth, and palatal vault using pattern recognition algorithms. Everything from tongue tremor to speed of ongoing oral-muscular movement will be assessed. A three-dimensional picture of the child ’ s oral structures will be created and added to the ongoing report. The computer will highlight structures and functions found to be irregular or deficient.

The Revolution in Treatment Approaches

Today, for better or worse, millions of children learn the art of war and practice it on computer video games. They learn stealth technology, marksmanship, military tactics, and how to fly everything from A-10 Warthogs to strategic bombers. Major airlines and the military use elaborate flight simulators to train student pilots and to keep active pilots current. (Tragically, they too can be used for evil, as was seen on Sept. 11.) In the future, people with communication disorders will benefit from variations of the same technology. Even today, computers are used in treatment, but to the clinicians of the future, they will be analogous to the primitive game " Pong " in the early 1970s.

In the future, a simple click of the computer keyboard or voice command will load the appropriate treatment program for each objective listed on the evaluation and merge them into a comprehensive treatment protocol. Goals will be chosen from thousands stored in treatment banks. The treatment program chosen by the computer will be specifically adapted to the patient ’ s age, gender, education level, and interests. Daily suggestions and recommendations will automatically be sent to the patient ’ s family, home health agency, or teachers for their assistance in meeting goals. Via the Web, the clinician will regularly review improvement with parents, physicians, nurses, and teachers and adjust the treatment programs when required.

All types of treatments will take place in the cyber clinic. In cyberspace, people who stutter can present speeches to huge audiences or fluently try to convince a police officer not to issue a ticket. Biofeedback devices will provide immediate information about brainwaves, muscle tension, and galvanic skin responses. In language treatment for children, the same fun-loving cartoon characters used in the evaluation will systematically move them to progressively higher levels of competence and performance with unlimited patience. In articulation, voice, and dysarthria treatment, precision, quality, and intelligibility will be measured acoustically and the clinician and patient will have instant access to improvement values.

The cyber clinic will provide objective measures of improvement that will be determined on a task-by-task basis. No longer will improvement be subjectively judged. Of course, just as the student pilot must eventually take the controls of a real airplane, so too will the patient need to leave the world of cyberspace. However, it will be in cyberspace that the majority of learning and relearning will take place. Cyber clinics will provide the foundation to many treatments.

Cyber Speech and Hearing Clinics: The Good, the Bad, and the Ugly

Trying to stop these inevitable technological and scientific advances in communication sciences and disorders is as futile as trying to stop the wind from blowing. Could Helmholtz or Sweet have blocked the development of the sound spectrograph or Visipitch? Science and technology will march on. Some people will bemoan cyber speech and hearing clinics and the loss of physical, face-to-face contact they will bring. Nevertheless, the Web has already proven its ability to enable intimacy and to provide psychological comfort. Millions of teenagers and adults develop and maintain long-lasting relationships on the Web that even lead to marriage, as portrayed in the movie " You ’ ve Got Mail. "

Using these inevitable scientific and technological advances optimally will require the profession to plan for them and to direct their application based on clinical utility. When used properly for the benefit of the patient and the profession, cyber clinics will become an extension of the clinician ’ s eyes, ears, memory, problem-solving skills, and caring professionalism. Undesirable usage of these scientific and technological advances will result in speech and hearing professionals being relegated to positions of technicians and observers. It would be most devastating for this profession to resist change and to attempt to block these marvels from improving the lives of people with communication disorders.

Dennis C. Tanner is professor of communication sciences and disorders at Northern Arizona University. He is one of two recipients of the Association of Schools of Allied Health Professions ’ " Outstanding Educator Award " for 2001 – 2002.

This article is based on Tanner ’ s original short story, " Welcome to the Cyber Speech and Hearing Clinic, " to be published in Communication Disorders: A Literature and Media Perspective in 2002 by Allyn & Bacon.

The author acknowledges the following people and resources in the preparation of this article:

William Culbertson, Northern Arizona University, and Wayne Secord, University of Cincinnati.

Borden, G., and Harris, K. (1994). Speech Science Primer (3rd ed.). Baltimore: Williams and Wilkins.

Lehiste, I. (1967). Readings in Acoustic Phonetics. Cambridge: The M.I.T. Press.



Copyright Dennis C. Tanner