ASSISTIVE LISTENING AND ALERTING DEVICES

Assistive listening devices (ALDs) can be thought of as Binoculars for the ears. They increase loudness of specific sounds by bringing sound directly into the hearing aid or ear. ALDs solve 3 problems:
-Minimizing background noise
-Reducing the effect of distance between hard of hearing people and the sound source
-Override poor acoustics
ALDs are used in large areas, one-on-one, in restaurants and for television viewing. ALD Applications include: social, educational, entertainment and home/personal.
There are 3 types of assistive listening system technologies: FM, Infrared and Inductive Loop. Each one:
-is cordless
-works well, generally speaking
-works with or without hearing aids
-can experience interference
-comes in wide area or personal versions
ALDs vary in price so comparison-shopping is wise. For effective use, staff who dispense them need to be trained on their use including the need to recharge and check batteries. ADA guidelines specify the number or percentage of receivers needed for an ALS. Consumers cant be charged to borrow devices from public facilities
Infrared systems work by transmitting sound via light waves to receivers worn by users. IR is commonly used in courtrooms, movies, and live performance theaters, conventions and with TVs. It allows privacy. It is susceptible to interference from bright sunlight. IR can effectively reflect off some surfaces.
FM or radio systems work by transmitting radio waves to receivers. They are Commonly used in classrooms and where movement of speaker is required. They are not affected by light, can cover 200+ feet, are portable. They can be set to multiple frequencies to allow several uses in same place. FM systems are susceptible to radio interference
Sound field systems are essentially speaker boxes to bring sound closer to listeners. They are often used in classrooms. They are helpful to people with mild to moderate loss. They offer a secondary benefit to those who are not HOH. Sound field can be used with FM receivers that connect to the ear.

Inductive or audio loop systems transmit through an electromagnetic field. No receivers are necessary for hearing aid wearers with a telecoil. Loop listener s or receivers can be provided for others. Loops are often permanently installed. Reception can vary and thy are susceptible to EMI interference.

Corded ALDs such as the Pocketalker, Soundirector and Sound Wizard are relatively inexpensive compared with a hearing aid. Sometimes they are a helpful investment by those considering amplification for the first time. They are small and convenient. They are often used by those with no hearing aids.

A variety of coupling devices are available to bring the sound into the ear. These include headsets, ear buds, neckloops and silhouettes. Some listening attachments are more appropriate or effective than others.

Microphones can make a big difference in quality of sound. They are often the most expensive part of a system. Directional mics might be good for focusing on picking up the speech from a talker. Am omni directional mic picks up sound from various angles and might be helpful during a conference. Consideration needs to be given to number and placement. Microphones ideally should not be stretched for more than 3 people to a mic. Programers need to realize when a pro audio sound contractor needs to perform an assessment. Sometimes consumers cannot set up an effective ALS using parts obtained from catalogues for residential use.

If a consumer experiences problems with an ALD, troubleshooting is indicated. Many things can go wrong including a dead battery, the system not turned on; a broken receiver, consumers T-switch is not on, interference or a break in cords.

CART, which stands for computer assisted real-time transcription is a visual display of a speakers words. It utilizes court reporters who type on stenographic keyboards. CART provides a verbatim readout on monitor or screen. It can be used with both individuals or groups. It is ideal for lectures, classroom, courtroom or meeting. An edited printout or disk can be made available. A remote version of CART service is also available. This type of service provides CART utilizing the service of a person off site.

C Print is a version of CAN - computer assisted notetaking. A visual display or summary of a speakers words is provided. It utilizes a notetaker with specialized training who types on a standard computer keyboard but with special software that speeds up the process. A fast, accurate typist who can summarize performs it. Writing is displayed on a projection screen or laptop computer monitor. It is not as fast or accurate as CART. An edited printout or disk of notes can be made available. It is less expensive than CART.

Alerting Devices
Alerting devices can indicate the presence of any sound in the environment through any of three different ways: louder sound, light flash or vibration. Examples of sounds that can be signaled include: telephone, door bell, baby cry, smoke alarm, and security alarm. Some devices, such as a vibrating watch or wake-up clock, are designed to signal your attention, but do not necessarily indicate the presence of a sound.

Alerting systems can be simple of complex. The advantage of more elaborate systems is that they can indicate the presence of a sound at the places other than where the sound occurred. In other words, they use a system of transmitters and receivers to flash lights throughout the home. They might even use ring burst patterns to help you differentiate types of sounds. For example, if the lamp goes FLASH FLASH pause, that might indicate the door bell as opposed to a phone call.

Telecommunications

Television
There are two ways to understand communication on TV: hear it or read it: You can read it by turning on using closed captions, a menu option ability built into most TVs (TVs over 13 inches in diameter sold after 1993).
Assistive listening devices (ALDs) enable you to turn up the volume on a personal receiver, instead of blasting the TV sound across the room. They are usually cordless and utilize different types of technologies. Some are marketed specifically for TV use. Hearing aid users and non hearing aid users can use them.

Telephone
Hard of hearing people basically have two needs on the phone: understanding conversation on the phone and knowing the phone is ringing. Signaling devices for knowing the phone is ringing will be covered separately later.
There are two ways to understand the conversation on the phone: hear it or read it. There are four basic types of telephone amplifiers: portable, handset, inline and phone set. Portable amplifiers are generally not recommended for regular use. They are inconvenient, as they need to be strapped onto a phone handset and need to be turned off after use or the battery runs dead. They might be helpful on wireless phones that do not have amplification. Some people might use them to make a phone hearing aid compatible. Some people may enjoy the peace of mind of having it available for use while traveling.
Amplification handsets are less popular than they used to be. They have an adjustment control in the handle that can be used to turn the volume up or down. They clip-on in place of the original phone receiver. In some cases they may not be electrically compatible. In that case, a universal amplifier (battery or A/C powered) will usually solve the problem.

In-line amplifiers are in-between devices that connect to the jack in the phone where the curly handset cord plugs in. These boxes may be inconspicuous. They may be a good value, as some go as high as 40 dB. They usually work with most phones, home and business.

Amplified phones come with many features. Some are very powerful in terms of amplification. They may go as high as 50 dB. However, a louder sound is not always helpful enough to consumers seeking clarity. Some phones provide a separate tone control that might help. These phones may offer additional helpful features such as variable ringer sounds, built-in ringer light flash, big buttons for dialing, and an audio jack for connection to an alternative listening device. Some will require connection to an electrical outlet. There are a few cordless amplified phones to select from as well.

TTYs are data terminals that allow hard of hearing or deaf people to read information typed to them. These would be used by hard of hearing or deaf people who do not feel that they understand well enough to rely on hearing alone.
Some TTYs have a keyboard for typing a response. That might be helpful to consumers who do not have clear speech. However, the majority of hard of hearing people speak clearly and prefer to voice their response. Therefore styles of TTYs that are designed specifically to support VCO (voice carry over) may be appealing. One portable version is the size of a deck of cards and can be strapped onto most phone receivers.

TTYs do NOT use voice recognition. The way the words appear is that they are typed in. That means a TTY user would either be communicating directly with another TTY user or a relay service would be used to help type the spoken word to the TTY user. VCO users find this type of communication very appealing because they can read & talk, read & talk, and not worry about missing what the other party is saying. With VCO, the TTY is then used for reading only.
If you have a computer, it is possible to purchase software and modems that enable it to emulate TTY signals. This might a wise choice for an office that can network several user stations to a central modem.

Other telecommunications devices that consumers find helpful include: pagers, cellular phones, fax machines, email and Internet chatting, and text-based intercoms. A number of phone company custom calling features may also be helpful. They include: caller ID (for calling back the person through relay who just called you), distinctive ringing (for differentiating voice and TTY calls) and voice mail (to listen to voice messages with amplified phones or via the relay service).

Technology
The SHHH National Center on Assistive Technology, in Bethesda, Maryland, just outside Washington D.C, provides information about equipment, services and programs that help individuals cope with hearing loss. The Center publishes articles, delivers presentations to consumers, trains advocates, and works with professionals and the industry to develop products that consumers can use to hear better and policies that increase their rights and improve their quality of life.

Among other things, the Center maintains information on assistive listening devices that consumers can use to stretch the performance of their hearing aids. SHHH does not endorse any companies or sell equipment.
The Center developed a nationwide directory of assistive device demonstration centers where individuals can try out HAT (hearing assistive technology) before buying it. The directory lists over 200 demonstration centers throughout the United States. To find out the location of a demonstration center near you the directory can be ordered through the SHHH Publications Catalogue.

SHHH also maintains a local demo center at its National office. A large variety of devices are available for all kinds of situations such as TV listening, telephone, visual alerts for fire alarms, baby cry, personal listening devices for use in restaurants and at work, and many others.

The Center staff is available to give presentations on assistive technology bringing along the devices for demonstration. The Center staff has visited 25 states over the past three years.

The Center staff is available to advise entities covered by state and federal laws on what assistive technology would be appropriate to provide access to hard of hearing people.

The SHHH National Center on Assistive Technology was founded and initially supported by by the Johns Hopkins Center for Hearing and Balance, which receives grant funding from the National Institute on Deafness and Other Communication Disorders, National Institutes of Health.

Policy Statement on Hearing Assistance Technologies
Hearing Loss, Nov.-Dec., 1996
Beyond Hearing Aids: Other Hearing Assistance Technologies (HAT)

Hearing aids are the most effective and potent therapeutic tool available for the vast majority of hard of hearing people. It is agreed that they are a crucial and necessary component in any effort designed to mitigate the consequences of a hearing loss. But some problems caused by a hearing loss either cannot be helped by a hearing aid, or the aid by itself may be inadequate, as the two following examples will illustrate:

(l) Many hard of hearing people have difficulty understanding a lecture or a sermon, or following the dialogue in a theater performance or movie house. In these types of locations, any large-area assistive listening device can further improve comprehension beyond that possible with hearing aids.

(2) Hearing aids are not designed to serve as an alarm clock, and unless the hard of hearing sleeper wears the hearing aid all night (not a good idea), an audible alarm may not wake this person up. Hearing aids, in other words, while necessary for hard of hearing people, cannot serve purposes for which they were not designed.

In recent years, a entirely new class of Hearing Assistance Technologies (HAT) have been developed. These include the three major types of large-area assistive listening systems (Induction Loop, Infra-Red (IR), and FM Radio), personal FM systems, telephone amplifiers and TTY's, TV listening devices and captions, various types of conference and hand-held microphones, and a large number of signaling and warning devices (e.g. visual or vibratory alarm clocks and smoke alarms, telephone and doorbell lights, motion detectors, etc.). Some HAT are separate units from hearing aids (e.g. signaling and warning devices, FM and IR receivers) and can stand alone, while others are designed to work with or through a hearing aid (e.g. telecoil or direct audio input capability). Direct audio input (DAI), for example, is a way of avoiding electromagnetic interference while accessing assistive listening devices (e.g. the audio output from a computer). There are many types of HAT; one only has to consult one of the catalogs available (check the SHHH Journal) to appreciate their full range.

Chances are that many hard of hearing people have need for such a device, at least at some times and for some purposes. However, hard of hearing people are not generally aware of the existence of these devices nor understand how their effective use can improve awareness and accessibility to acoustic signals, either through substitution (i.e. converting the sound into light, vibration, or text) or sound enhancement (e.g. a personal FM or TV listening system ). SHHH suggests that all hard of hearing people receive a careful "needs assessment" during the hearing aid selection process. This should include a check-list of various kinds of communication situations to ensure that no important ones are overlooked. It is necessary to determine a person's communication needs at home, on the job, during recreational, social, and religious activities, while traveling for fun or business, or any other kinds of situations unique to the individual. Such check lists have already been developed and are being used by leading audiologists. Whether a detailed interview technique or a check list is used, the goal is to ensure that the possible usefulness of HAT be thoroughly explored with each potential hearing aid candidate.

Furthermore, SHHH suggests that dispensers make specific HAT recommendations, in much the same way they do with hearing aids, and assist their patients to learn how to use them, again in the same way they do with hearing aids. The introduction to, and assistance with HAT can, SHHH suggests, be included into the hearing aid selection process, most logically during the hearing aid trial period (see 1 below) and within the subsequent hearing aid orientation period see 2 below). Because of the potential benefits of HAT for hard of hearing people, SHHH recommends that all hearing aid dispensers incorporate the evaluation and dispensing of HAT as an integral component of their practice.

1) In a previous position paper, SHHH has recommended that dispensers provide their clients with a minimum of a 60 day trial period.

2) In a previous position paper, SHHH has recommended that all hearing aid dispensers offer their clients the opportunity to participate in a group.