Professor Clark's development of the cochlear implant for deaf patients

Technology for the Deaf

His Enduring Passion

But a passion for science, his father's inspiration to help the less fortunate and his own desire to improve the quality of life of the hearing impaired drove him to nothing less than work a miracle. The failed attempts of Alessandro Volta in 1790, Duchess of Boulogne in 1855, the French-Algerian partners Andre Djourno and Charles Eyries in the 1950s and the success of an American surgeon in enabling a profoundly deaf to hear through electrical stimulation in 1966 provided the direction of his research, which began in 1967. His objective was to enable the deaf to hear through an implanted receiver-stimulator, which would receive signals from and through intact skin. The receiver-stimulator would transmit stimuli to the electrodes in the cochlea. The question he sought to answer was -- can electrical stimulation of the auditory nerve reproduce the frequency of speech through temporal or place coding and coding of intensity?

Taking the First Steps

Professor Clark's work was guided by specific conditions, mechanisms and safety concerns surrounding the electrical stimulation of the cochlea. Right then, he was aware that those with damaged higher auditory centers could not be helped. Only those with some residual hearing would benefit from the intervention. The type of electrodes, the method of implantation and whether the patient can hear and understand speech were determining factors of successful electrical stimulation. The mechanics involved the ear as a transducer, the stimulation of hair cells by vibrating basilar membrane, and crude hearing sensation by direct stimulation. And safety concerns included the avoidance of significant damage to ear structures, required mechanical properties through these structures in transmitting frequencies, the toxicity of electrode materials, damage to the cochlea and auditory nerves by electrical currents, and middle ear infection. Professor Clark began his work alone at first, then with two assistants. With additional funding support, he recruited two undergraduate students, then by more assistants. By the time they produced the first prototype, Professor Clark had approximately 20 full-and-part-time assistants. In the last 30 years of continued work, he has been assisted by more than 100 scientists and clinicians.

Bionic Ears Created

On August 1, 1978, Professor Clark created and successfully embedded the first implant into his patient, Rod Saunders. Professor Clark called the implant "bionic ears." The first implant was developed in 1982 by Telectronics, later renamed into Nucleus and then into Cochlea Limited. It was approved by the U.S. Food and Drug Administration in December 1984 but for adult use only. Professor Clark and his team worked on this defect by progressively decreasing the age to two years in 1990, 18 months in 1998, 12 months in 2002 and as young as 6 months with special approval. An implant costs $45,000 to $70,000. Health insurance, however, can cover the costs of evaluation, surgery, the implant device and rehabilitation. As of 2009, there are approximately 125,000 users of Professor Clark's invention throughout the world. It signals the victory of medical bionics, a new discipline he coined, in the field of bionics engineering devices that model brain mechanisms. His invention is the product of long, careful, painstaking and precise experimentation that has proved to be a boon to the deaf of all ages and classes. As the first neural prosthesis to effectively and safely bring electronic technology in contact with the central nervous system and the human consciousness, the "bionic ear" is, indeed, a scientific miracle of unsurpassed value to the deaf of all ages, sectors, and classes, especially to those in the workforce. It promises to be the first among new and developing innovations to solve the problem created among deaf workers by earlier technologies.

The Working Deaf before Technology

Before the advent of technology, the deaf held jobs, such as printing, which people with normal hearing could not tolerate because of the noise. Moreover, new and swift economic and social conditions after World War II called for new housing and new jobs, which displaced deaf worker further. Soldiers returned from battle, the workforce grew and the population increased. These returning soldiers took the factory jobs of deaf workers and those who worked from home in support of the war. And in workplaces where the deaf were retained, disparity in income and rights developed in comparison with hearing employees. This put deaf workers even closer to the edge.

New Technology Enables Deaf Workers

Technology, like the telephone, television, and more sophisticated printing equipment, initially took their jobs away. The deaf cannot make or answer phone calls. Watching television without hearing what was said was useless. And new printing equipment became virtually noiseless so that hearing people can now take the job over from the deaf. More recent technologies, however, are turning to the advantage of deaf workers. The modern version of the crude teletype machine or TTY of the 80s enabled them to obtain and share information in the workplace. In the same decade, hearing ads were improved and decreased in size and weight. Deaf workers could bring them to work and function like hearing people. These were convenient to use as pins in their underclothing or pockets, simply clipped to their belt or kept behind the ear almost inconspicuously.

at Sears Roebuck and IBM

Statistics say that there are now 54 million Americans with disabilities and that two out of three of them are unemployed, representing 26%, the highest rate in the various sectors. Sears Roebuck and Company Recruitment Director Bill Donahue remarked that the disabled workforce is a very huge opportunity for employers. The disabled are loyal and committed workers and it would be a mistake to ignore them, he said. IBM adopted the same viewpoint and policy. It began Project Able in 1990 to hire and retain disabled workers. Since then, the company has hired more than 200 disabled employees. IBM employees with hearing defects have been using diverse products, which eliminate communication barriers. These include the oldest assistive product, the teletypewriter or TTY, which has been further enhanced recently. TTY now functions as an answering machine and has caller identification, directory listing and auto dial features, among others. Deaf employees at IBM also extensively use the video relay service and the VRS videoconferencing setup with the help of a sign language interpreter to translate. The communication access real-time translations or captioning are useful during lectures, web-casts and on TV. Words are placed on a screen for the deaf to follow. Captioning can be done remotely or through the internet. A vibrating text pager is like a small typewriter with a small screen. It can receive and send email and voice-to-text messages for the deaf and hard-of-hearing. Personal and phone amplifiers are also beneficial to these disabled workers.

Hiring the Hearing Impaired Applicant

Skip Simonds, director of UnumProvident's Corporate Return-to-Work Program Development, believed that human resources managers can now afford to ignore the disabilities of applicants and just look for the best candidate. This is because technology has been reducing the gap between disability and productivity in the workplace. The Americans with Disability Act or ADA said it is the job applicant's choice to bring up the matter of disability and accommodations. Then the manager or employer decides the step-by-step approach needed for the new disabled employee to perform his or her tasks well. If HR handles each issue to be accommodated, a lot of emotionality and prejudice is taken out and the new employee feels treated fairly.

Accommodations Costs and Value

Studies conducted by the federal Job Accommodation Network revealed that 15% of accommodations cost nothing; 51% was between $1 and 500; 12% between $501 and $1,000; and 22% was above $1,000. The substantial use of technology reduced a lot of these costs, reports said. For example, voice recognition software that would cost up to $7,000 10 years ago now costs only around $250. UnumProvident said that 550 of its 12,000 employees suffer from some disability and 10% of them use assistive technology. The company spends around $50,000 every year on the products but saves much more in productivity. It found that the real and primary obstacle to productivity in most cases is attitudinal rather than physical or technological. Its management is convinced that it is only a mind-set issue.

Successful companies like UnumProvident realize that accommodations costs are a good investment on disabled employees who are allowed to contribute to raising the company's competitive levels. It is not incur large financial losses and state and federal funding programs may be availed of. Employers, however, must come to terms with social and cultural barriers in the process. The strongest barrier is the misconception that disabled employees will not be productive.

More Technology for Deaf Workers

Another recent technology is an avatar, which can translate spoken works into sign language. Created by IBM Corporation, this technology is intended for the real world in the absence of an interpreter for the deaf or for confidential conversations. It is, however, in prototype form and is compatible only with the British sign language. It is known as SiSi or "Say It Sign It." It uses speech recognition to convert a conversation into text. Sisi then translates the text into gestures of sign language. An avatar then animates and carries it out. SiSi is designed to allow incorporation into other vendors' deaf-accessibility products and other countries' sign.

Support Programs

Sign language translation uses visual finger-spelling of words and phrases. It translates text into sign language images or animations in communicating or obtaining information. Voice transmission in mobile devices and mobile phones is an example. Sign language recognition consists of gestures and/or sign language made through the computer. Automatic speech recognition or ASR is an independent computer-driven transcription of spoken language into readable text in real time. The computer identifies the words spoken into a microphone and converts these into written text, which the deaf can read. And the i-phone has a built-in camera and a wifi connection. The deaf user can call an interpreter from the i-phone to interpret what he says to a hearing party or vice-versa.

Distance Technology for the Deaf in Rural Areas

Work with the deaf and hard of hearing people in the rural areas in the past was limited by certain conditions.. A lack of interpreters, social resources and cultural, language and legal understanding by the service provider were among them. The Utah Deaf Videoconferencing Model offers to fill the voids. This distance technology is used for tele-health, tele-medicine and tele-education through electronic communications and information technology. Deaf tele-psychiatry has been in use in South Carolina since 1994. A psychiatrist innovator was unable to drive to distances to provide the service to 300 clients on account of pregnancy. The State built a videoconferencing network from her home to the sites where her clients lived. The application proved quite successful in that State.

The CAP for Disabled Federal Employees

Employees at the U.S. Department of Defense with hearing problems can now do their work better through the Computer/Electronics Accommodation Program or CAP. This technology helps in the hiring process of employees with long-term disabilities, such as deafness and blindness. The technology is also helpful to employees who experience repetitive stress injuries in later life, loss of sight or wounds that make it hard for them to work on the computer screen throughout the day.

CAP provides speech recognition software, computer screen magnification programs and talking dictionaries. The speech recognition software is for employees who find it hard to use a keyboard. Computer screen magnification programs are for those visual impairments. And talking dictionaries are those with cognitive problems.

In Search of a Telecommunication Standard

The Barriers

Title 4 of the Americans with Disabilities Act requires telephone companies to make interstate and intrastate telecommunications relay services available all hours of the day and all days of the week. Telecommunications relay services, or TRS, enable the deaf to communicate with one another through a third-party assistant. But the large gap between typing speed and the speed of signing or receiving interpretations remained a problem. Alexander Graham Bell's invention evolved from his desire to help the deaf communicate but telephone standards had for years been established with little consideration for its use precisely by the deaf. The result was that millions of them confronted substantial barriers in using the telephone. They must constantly contend with changing designs and features of assistive devices and in different locations. As these cost a lot, the deaf are confined to a few choices and at higher prices.

A Universal Design

The best would be a universal design approach. From the concept to the development and manufacture phases, the product would be usable by as many prospective persons as possible. This design is within the purview of the ADA, which mandates the provision of technological support for people with disabilities with reasonable accommodations. However, some employers are apprehensive about the bother and the costs of accommodations such support may incur. And deaf or disabled employees or applicants are reluctant to seek out such technology in fear of the employer's disfavor. A compromise becomes necessary. Technology must be available in the workplace and more inclusively designed after the needs of the disabled. At the same time, it must be consumer-directed so that the decision-making aspect moves from the employer to the consumer. The private sector, thus, must be motivated to develop and market such technology. A fund should be crated to finance the accommodations, such as through payroll tax deduction.

The Shape of the Future

Contemporary times demand that appropriate technology be developed for the use of disabled employees so that they are not left out of the benefits promised by civil rights laws. Implementing civil rights or encouraging a market-based approach is not enough to fulfill this goal. What alone can is a combination of new technology and civil rights with the precise market-based approach. In solving discrimination and compensating for limited opportunities for deaf or disabled employees, nothing less than innovative and inclusively-designed and consumer-directed technology is needed. This is the truly responsive option.

The Deaf Culture, a Chronic Brunt

One obstacle to the complete success of technology for the deaf is the deaf culture. That the deaf have a culture of their own is something recognized only in 1965 with the publication of the Dictionary of American Sign Language. Hearing people saw the deaf only as having hearing loss without realizing that the deaf have their own learning behaviors, values, rules and a shared language. Thus, they naturally resist technology, which will breach their culture of deafness. But the reality is that no one can escape or resist the power and influence of technology. Protectors of the deaf culture only need to become more aware of the advantages and benefits of technology and that it need not destroy their culture.

More Miracles on the Way

Every few minutes today, an innovation is created. Science will always endeavor to make life easier and more enjoyable as well as correct past errors or negligence. There is no way to stop it. Future technology will restore what it took away from the working deaf in the past. Professor Clark accomplished the first major step in that direction in the form of a technological miracle, the "bionic ear." #