"Good morning," says the computer. "Are you ready?"
The patient at the other end of the telephone line--the computer has placed the call--pushes a button designating readiness. (Or if not, a different button is pushed and the computer will call back later.)
For most of us, talking to computers can be a pain. Much, much worse, though, is not being able to talk at all.
The computer saying good morning has a name and a gender. He is REMATE, for Remote Machine-Assisted Treatment and Evaluation, a major piece of a project conceived by audiologist and speech pathologist Gwenyth Vaughn. Until now REMATE has been primarily the diagnostic and therapeutic plaything of the Veteran's Administration, for which Vaughn is chief of the audiology-speech pathology service at the VA Hospital in Birmingham, Ala. (A spirited feminist, Vaughn, 65, says she only made REMATE male because he followed a project she named SARA.)
For about 10 years Vaughn has been conceiving ways REMATE could be used to communicate with veterans who have difficulty speaking. She would dream up the ideas and tell, as she puts it, her cadre of "mad scientists" to produce the equipment. It's been a matter of what-Gwenyth-wants-Gwenyth-gets, and in the last three years REMATE and its components--touchtone telephones with computer or with clinician--have diagnosed and/or treated some 8,000 veterans. She also has put her conceptual genius to work on communicating devices for the hard-of-hearing, especially the elderly.
Gwenyth Vaughn would like to see the system made available to many of the 22 million or so Americans who have some sort of communicative disorder, as well as to school speech pathologists and their hundreds of thousands of speech-, hearing- or language-disabled pupils.
Once the computer has called a patient, a pre-arranged communication occurs, the kind depending upon needs and extra telephonic equipment in the home. Some examples:
* For those needing speech therapy, the computer provides words and phrases for the patient to repeat. Speech is recorded by REMATE and played back so the patient can hear his own voice compared to the computer's.
Later on a speech pathologist or clinician in a central location will listen to the tapes and either call the patient directly or make needed adjustments in the computer program. When one VA clinician was reviewing tapes, he spotted a telltale speech flaw often caused by a laryngeal cancer. The patient was hospitalized immediately and operated on within 24 hours. It had, indeed, been cancer.
* For patients needing writing therapy, one attachment permits simultaneous handwriting tests.
* Most impressive are devices for long-distance therapy in language disabilities, or the aphasia often suffered by stroke victims. (There is understanding and comprehension within the brain, but no apparent way for it to be communicated.)
Vaughn says she brooded for seven years before she and her army of technicians finally came up with TEL-plus, a touch-tone telephone with a device that lights up when buttons are pushed next to pictures or words. The clinician, via long distance, says a word and tells the patient to press the correct button.
"There is no end of its potential, in the diagnosis, the measurement of comprehension . . . Imagine," says Vaughn, "if you can provide it for an aphasic, what you can surely provide for school kids."
Vaughn, who also teaches at the University of Alabama Medical and Dental schools, has had little time to worry about electronic ways to ease her own problems. She is essentially paraplegic as the result of a neurological illness some 20 years ago, and a series of recent falls.
Although she sees infinite potential for her speech and hearing projects in classrooms, private clinics and hospitals, her immediate concern is convincing first the VA, then the government itself and eventually the entire health establishment of the devices' "extraordinary economy."
For one thing, she notes the huge reduction in travel costs for audiology home, hospital or school visits, or for the patient to come to centers--often in other cities--for the appropriate therapy.
Says Vaughn, "I can envision in a classroom a corner where you would have several telephones and kids scheduled to work with REMATE or local speech pathologists . . . and you'd have the best treatment available, locally, statewide, nationally or internationally, also in all medically oriented facilities--rehabilitation centers and hospitals, nursing homes, clinics . . ."
Vaughn, who was here recently to discuss her projects at an American Speech-Language-Hearing Association (ASHA) conference, is now applying her talents to communications problems of the elderly, an outgrowth of her own experience.
"My mother," she says, "was about 90, and was coming to live with me. She had a moderate hearing loss, wonderful discrimination and a fine hearing aid. She had seen a good audiologist, was an absolutely fantastic speech reader, was intelligent, alert--everything you need to be a good hearing-aid user. So she came.
"And we couldn't communicate.
"Hearing losses are terrible for the persons who have them, but they are absolutely devastating to those who want to communicate with them."
Vaughn's mother moved back to the retirement home, but Vaughn was compelled to find out what was wrong. "Finally," she says, "I realized we live in an environment so polluted by noise that you cannot utilize a hearing aid satisfactorily."
Back to the drawing board. Back to the "mad scientists."
Vaughn and her scientists have come up with a series of devices designed to augment and screen extraneous noises. Some are inexpensive and with simple instructions can be put together with about $100 worth of equipment from Radio Shack. Others, involving infrared transmission, are slightly more complicated and expensive. Probably the most effective and wide-ranging hearing-aid augmentation involves the use of FM equipment and costs up to about $700.
None of the devices should replace the hearing aid itself.
"No more," says Vaughn, "should anyone be told that, 'After all, you can't expect a hearing aid to be as good as your own hearing.' Or that 'you'll just have to go home and live with it.' That should be a closed chapter."