Assistive Technology Transfer Update

Abstract

The Stakeholders Forum held in Buffalo in 2000 addressed some issues faced by hard of hearing individuals. Who these individuals are, current devices used by them and the pros and cons of the current devices are all discussed in this article. Requirements for new products addressing unmet needs of hard of hearing individuals are established and a day-by-day breakdown of the forum, complete with concluding comments, is given as well.

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Who are "hard-of-hearing" people?
One of the largest constituencies of people with disabilities, with an estimated 28 million members in the United States alone, is the group of individuals who are not profoundly deaf but have a significant hearing loss. It is not easy to determine a precise number of "hard-of-hearing" (HOH) persons, as a great many do not seek assistance, denying that they have any difficulty. Instead they find themselves turning up the volume, shying away from noisy venues, and asking other people to "stop mumbling and speak up!" However, as diminishing hearing often accompanies aging, the HOH percentage of the general population is rising, as advances in medicine permit more people to live past 80, 90, or even 100 years of age.

A snapshot of the current technology
For those who do use assistive equipment to compensate for hearing loss, most of the technology can be divided into two classifications: removable devices fitted for the use of a single individual, i.e., hearing aids; and assistive listening equipment provided temporarily by a organization for an event or activity.

Hearing aids
Advances in the miniaturization of electronics have largely eliminated the traditional in-the-shirt-pocket "body box" style and eyeglass templepiece hearing aids in America, except for those who have had a very severe loss for many years. Most current devices are much less conspicuous, with the largest and strongest housing its electronics in a wedge of plastic that is tucked behind the ear, and thus is called a "BTE" hearing aid. Its amplified sounds are conveyed through a tiny tube to the individually fit earmold in the "concha" or indented bowl of the outer ear. Gaining increasing popularity are the "In The Ear" (ITE) aids, entirely contained in a plastic shell which is, itself, molded to fit in the concha. Even smaller are the "In The (ear) Canal" (ITC) devices, that are intended to be unnoticed by casual observers; not to mention the ultra-miniaturized, dime-sized "Completely In the Canal" (CIC) devices.

Besides shrinking in size, the sophistication of the electronics has advanced in an attempt to boost the ability of the aids to process the sound and adapt it to the individual's particular deficiencies. Some digital devices contain mini-computers, which can be programmed via remote control units to automatically adjust amplification volume for changing conditions. As the devices have diminished in their dimensions, their price tags have ballooned, and tend to range from $850 to over $2,500.

The problem with hearing aids
Although the percentage of users who express satisfaction with their hearing aids has increased over the last decade, instances of customer dissatisfaction and even abandonment of very expensive units is legendary in the field. Some feel that peoples' expectations were simply unrealistic. Just like the glasses or contact lenses that restored their near-sighted vision to about 20/20, they expected pricey high-tech aids to enable them to hear like teenagers again. The way in which the outer ear, its inner mechanisms, and the hearing centers of the brain work together to let a person select which ambient sounds are important and which can be ignored is complex and tricky to imitate. Plus, the hearing center's innate ability to focus on one voice in a sea of other voices and sounds often deteriorates with age. The latter problem can often be ameliorated in meetings and classrooms, auditoriums and sports venues, and other institutional and controlled settings by using a somewhat different technology...

Assistive Listening Equipment
Although the operating principles differ, and the terminology varies with assistive listening systems (ALSs) being installed in a room and assistive listening devices (ALDs) being worn or held by the speaker, the goal is the same. They permit hard-of-hearing people to participate in performances, gatherings and other communal activities by letting the voice(s) of those at the microphone(s) to predominate over the competing ambient noise. (This supplemental hardware is vital to many HOH participants, as the amplification circuitry in most hearing aids for individuals with moderate or severe loss excels at bringing background sounds up to the voice level of those addressing the group. Previously unnoticed ventilation systems, outside traffic, nearby office equipment, sidebar conversations, etc. can make understanding the speakers so difficult that aid wearers would shut the devices off in disgust and drop out of such – for them – pointless time-wasters.)

Without getting into detailed discussions or critical comparisons, these are currently the three most popular modalities for assistive listening:

• Audio inductance loop (AI Loop) in which an amplified signal is fed to a wire circling the room to create a magnetic field. Owners of telephone-compatible hearing aids can tap into this field without other devices by switching their aids to the built-in telephone pickup coil.

• Infrared Broadcast (IR), which sends the signal in a straight line through an invisible beam of light, (similar to that used in stereo systems with cordless headsets) to a "stethoscope-style" under the chin receiver. …Or to be picked up by a receiver worn on the lapel, or located at the peak of a traditional over-the-head-style headset.

• FM Broadcast (FM), which sends a low-strength radio signal (like that in a walkie-talkie or a cordless baby monitor) from a transmitter attached to the public address system (ALS) or contained in a small box worn by the teacher or presenter (ALD). The user must be given a same-frequency receiver to listen: using an earbud or headset; ... on their telephone-compatible hearing aid by replacing the earbud with an individual magnetic field transducer such as a neckloop or a behind-the-ear silhouette telecoil coupler; ... or even to cochlear implants embedded in the inner ear, via a special patch cord from the receiver to the implant's behind-the-ear antenna.
  (Note: Several companies make a "personal amplifier", usually a small hand-held box with a microphone and earbud, or all contained in a stethoscope-style headset, marketing it as an ALD for individuals with a slight hearing loss. As these require proximity to hear the speaker, and have more in common with the traditional body-box hearing aid than with these ALDs, they are not listed here.)

Problems with ALSs/ALDs
Although generally much better in group-activity settings than hearing aids alone would be, ALDs and ALSs could still stand improvement. Stray radio frequency (RF) interference is sometimes picked up by FM receivers – whose radio spectrum bands are gradually being co-opted by cellular phones, digital communications and other government-authorized intruders. AI Loops sometimes get competition from computers and other magnetism-sources that are picked up as static on the telecoil hearing aids. Being line-of-sight, the IR signal is interrupted, rather noisily, whenever something comes between the listener's infrared sensor and the IR source emitters, even the user's own arm covering a cough or adjusting eyeglasses.

Just as with hearing aids, a better technology can supplant the status quo, (e.g., the once-viable AM Broadcast ALDs are no longer found in communications equipment catalogs in the US) – but who will discover and develop the good ideas?

Getting things moving...
Companies that produce assistive listening equipment and, particularly, manufacturers of hearing aids have an incentive to improve their products to increase their share of the market, but naturally tend to concentrate on technologies in which they have patents or proprietary interests. Sometimes even more significant advances can be the result of technology transfer: a kind of "cross-pollination" from related bodies of knowledge – even those amassed in other fields and industries. Generally speaking, one cannot expect this type of broad-based interdisciplinary exchanging of ideas to occur spontaneously without someone making it happen! In recent years, for assistive technology devices serving those with various disabilities, this role of facilitator has been filled by the Rehabilitation Engineering Research Center on Technology Transfer (T²RERC).

Our response: a meeting of minds
To deal proactively with the demand for better equipment to compensate for hearing loss, the T²RERC employed a strategy known in the field as a "demand-pull technology transfer process". That is, identifying the product's end users' technology needs, and then seeking out and applying existing technologies to meet these needs. To this end, the T²RERC brought together more than 60 manufacturers, researchers, clinicians, government officials, advanced technology developers and product consumers with hearing disabilities (collectively called "stakeholders") in New York City to pool their expertise. Held for two days in June 2000, the "Stakeholders Forum on Hearing Enhancement (SFHE)" was hosted by the T²RERC's sister agency, the RERC on Hearing Enhancement (Hearing-RERC) which is based at the Lexington Center for the Deaf/School for the Deaf, in Jackson Heights, New York. The T²RERC handled the preparation of materials, discussion group facilitation, and much of the follow-up of the information gathered at the Forum, which took place at the Crowne Plaza LaGuardia Hotel in East Elmhurst, New York. The event's other sponsors included the National Institute on Disability and Rehabilitation Research (NIDRR) of the U.S. Department of Education, and the Federal Laboratory Consortium - Northeast Region.

The Forum's specific purpose was to identify and validate unmet consumer needs, business opportunities, and specifications for technology solutions that would meet these needs. The anticipated ultimate outcome for this project is the introduction of innovative products and technologies that will have a significant, positive impact on persons with hearing disabilities.

Dr. Stephen M. Bauer of the University at Buffalo, the organizer of the Stakeholder Forum and co-Director of the T²RERC, succinctly described the paradigm behind the Forum and its subsequent activities. "The technology transfer process permits us to leverage investments which have already been made in the nation's science and technical base. As it will permit us to target specific technologies which require substantial improvement, we expect the Stakeholder Forum to generate opportunities for applying breakthrough technologies to the Hearing Assistance Industry."

Laying the groundwork
Prior to the Forum, a group of stakeholders (including end-users, manufacturers, researchers and clinicians) participated in interviews and panels that reviewed the state-of-the-practice for hearing aids and assistive listening equipment. Four technology areas were deemed to have significant potential for improvement:

1. Earmolds (again, the part of the hearing aid that fills the bowl or concha of the outer ear);
2. Infrared and Inductive Loop Assistive Listening Systems;
3. Wireless Communication and FM Broadcast Systems;
4. Microphones and Directional Microphone Arrays.

An industry profile was created for the hearing aid and assistive listening system industry and markets. "White papers" were written for each of the above technology areas, drawing upon information derived from interviews, panels, the industry profile and other sources. Provided to all participants prior to the Forum, these white papers summarized customer needs, the business opportunities to be realized, and the state-of-the-practice for each technology area.

This preparation won praise from Forum attendee Russ Thoma, a representative of Etymotic Research of Elk Grove Village, Illinois, a developer of circuitry and components used in hearing aids. "The preliminary information that was gathered prior to coming to this (Forum) with some of the general backgrounds of what we wanted to cover was a starting point. And then by bringing the mix of people, the consumers, the manufacturers, the different related industries together, sorting and sifting the mix, I think it was done quite appropriately."

The guest list garners kudos
Having orchestrated another Stakeholders Forum (on Wheeled Mobility products) in 1999, the T²RERC staff knew that inviting a representative sample of stakeholder groups was key to identifying and validating critical technology needs. Several attendees expressed their appreciation for the broad mix of backgrounds of those invited to East Elmhurst, New York.

The importance of involving a number of end-users of the equipment was described by David Baquis, Director of the National Center on Assistive Technology of the grass-roots advocacy group Self-Help for Hard-of-Hearing People (SHHH). "It's very important that consumers had representation here, today, because there (are) things that professionals, both in the fields of hearing/healthcare, as well as the electronics field, the pro audio industry, don't fully understand unless they hear the consumer perspective, and specifically the perspective of hard-of-hearing people. We can talk about some of our preferences and some of our problems, things that you wouldn't know unless you had direct practice in using devices … unless you've actually experienced certain frequency losses, first-hand."

Dr. Charles Laszlo, PhD, a researcher at the University of British Columbia's Institute for Hearing Accessibility Research, in Richmond, BC and Chair of the student-run business, Assistive Listening Device Systems, Inc. was enthusiastic about the effort to achieve diversity. "It is of great interest to me to see the different viewpoints that emerge; there are manufacturers, researchers, consumers all together, talking about the same topic. And there are always some interesting aspects that emerge that we didn't think about. And so, to one it's a marvelous way of sharing my experiences and expertise and, at the same time, receiving the various viewpoints of people, all of the different stakeholders. In many ways, this is the purpose of this getting together, and I think it's very well served."

Earmold section facilitator Brian Kon, who is President of AZtech, a T²RERC member agency, shared the feeling. "It's a unique chance for equipment consumers, researchers, third-party reimbursement agencies, and company representatives who rarely meet face-to-face to understand the implications of these developments to each others' interests."

Buckling down to business:

Day One
After a luncheon and the keynote addresses that reinforced the process and energized the participants, each attendee spent an afternoon in a discussion group on one of the four technology areas (Earmolds; Infrared and Inductive Loop Assistive Listening Systems; Wireless Communication and FM Broadcast Systems; Microphones and Directional Microphone Arrays). Then they had the opportunity to casually confer with colleagues at the dinner, that evening.

After the first set of concurrent discussions, Jeanne Stiernberg, a business development consultant to manufacturers of professional audio equipment, from Sherman Oaks, California, expressed the enthusiasm many felt for the Forum. "I think that it's extremely well organized, well run, and very focused as far as what each group's mission is. And I think because of that and because of the diversity of the people participating in the group, there's going to be a lot of interesting outcomes to this. I'm curious to know if … in the overall process, the Stakeholders meeting step is to confirm or add to some assumptions that already exist. And I'm betting that there's going to be some new assumptions to validate here."

Another inflamed with Forum Fever was Richard Carmen of Sedona, Arizona, who is a clinical audiologist and Editor of the popular collection A Consumer Handbook on Hearing Loss and Hearing Aids: A Bridge to Healing. "This is a great mix and blend of professionals and consumers… My particular group, I thought, went very well. It was enlightening to hear some of the complaints of the consumers, as well as some of the idealistic solutions that we might be able to approach as professionals and scientists and researchers…

"My report of evaluation and assessment of the program yet was excellent. It's gone very well. If the technology can be transferred to manufacturers and get into production, some of these ideas are very useful, definitely. To sum my experiences up here so far, I think this is a clearly unique program, an opportunity for all involved. I think it is a very worthwhile project."

And Day Two followed…
Once rested, the next morning, each Stakeholder tackled a different topic that he/she had also pre-selected.

Robert Bellinger, the Chair of the Inventions Evaluation Board at the Naval Undersea Warfare Center at Newport, Rhode Island seemed impressed with his fellow Forum attendees. "Generally speaking, I'd say that this is a very involved group… Everyone seems to be dedicated, and I'm delighted to be here, because I hadn't seen many groups with so much dedication in a long, long time."

Corporate representative Russ Thoma was upbeat as well. "…Sometimes you need to have the different organizations that are centered around the disability (listen to) the hard-of-hearing individuals' reminders, and I truly believe that this was a very positive conference for that. I haven't always been involved in a lot of the different discussions that go on, so it was a great opportunity to hear some of the new topics that were being talked about. And so it will be an opportunity for me to take it back and share it with our staff back at the office."

Wrapping it up with a bow
After the final luncheon, designated reporters from each of the eight breakout sections gave a PowerPoint presentation before all the Stakeholders, summarizing the key issues identified for each technology area and the first draft of problem statements and solution specifications which had been generated in that group.

Dr. Charles Laszlo considered its consequences. "Most of the things that we have discussed are known, either explicitly or implicitly, but I think that the main purpose and the main value of this (event) will be that it was systematized to some extent to (clarify) what we seem to know in bits and pieces. And it helps a little bit to exchange ideas on things that concern people in different parts of this group. Our customers have a particular set of concerns and sometimes these are not fully understood by manufacturers. One of the issues that's definitely emerging in my mind is the need to ensure that consumers, hard-of-hearing people in particular, have full access to the benefits of this technology...

"We have exchanged ideas and there was some interesting information that I was not privy to, before. Now I have learned about something, and the very fact that we could talk about this in an open forum, and with the understanding and within the framework that was specified: that we look at the current technology. What are the impediments of improving it and which direction we may move? I think that this is a very important thing; something that we can take back with us and think about. I do believe that, apart from the fact that there will be an outcome of possibly a report, we all go back with some thoughts that we can discuss with others and perhaps something has been generated that wasn't there before. I think it's very positive."

An even more upbeat view was offered by the Forum's Co-host, Principle Investigator of the RERC on Hearing Enhancement, Dr. Matthew Bakke. "I was very pleased with the discussion. I thought there were a lot of great ideas that got thrown around, at least in our session. And the information has been carefully documented. It exists not only in a transcript of the meetings but also in highlighted notes about the major ideas that we wanted to preserve from the meetings. So, I think that, if the people in the Buffalo RERC are able to take these ideas and formulate them into very clear statements of need, I think the outcome could be terrific. I'd bet a lot of money that at least one very advanced technology is going to come forward that's going to help with some of these problems." The Forum exceeded all of his expectations, and "(he came in with) very high expectations."

Additional benefits accrued…
This event was also an exciting opportunity for the Forum's participants, who benefited by their:

• Participating in a review of state-of-the-science hearing assistance devices;
• Helping to define new technological specifications;
• Having access to information uncovered in preparation for the Forum;
• Identifying new opportunities in commercialization, development and research in the hearing industry;
• Networking with the other participants.

David Baquis expressed those collateral benefits quite specifically, "It was very important for consumers to hear some of the terms defined and some of the products that are available on the market, so we can bring that (encouraging) knowledge and effective solutions back to our membership. And be able to respond in new and different ways to people who bring various frustrations to us. …It's really important for engineers who are trying to develop new technologies to understand some of the very basic frustrations, about how sound can spread to a wide area, in that, we can't pick it up in a very pointed way with a beam that might be as narrow as a flashlight. … On the other hand, it was pleasing to hear how far we've already come with technology and some of the more specific ways that we think we can tweak it for ourselves."

A ringing concurrence came from Russ Thoma in the manufacturer's corner. "(Taking part in the Forum) gives us a great reminder of what it's really like for the person. Most of the conversation, from a manufacturing viewpoint, has always been with the audiologist, the person who has to deal with the patient at the frontline … we try to get the aftermath or the feedback from the hearing professionals who are dealing with the end-users and try to solve their problems. .... I don't usually get an opportunity to deal with the end-user, the individual's problems. … The different frustrations of the people who have had all different levels of hearing impairment, from the mild to moderate loss, to the person who has had a cochlear implant, the person who has had to deal with different assistive listening devices, and all the problems that they've experienced."

Taking something home…
The applications of the event to his own work was described by Dr. William Mann, Director of the RERC on Aging at the University at Buffalo and the University of Florida. "There are assembled here very knowledgeable people, consumers, those in the industry, those involved in assessment and provision of devices. I'm learning a lot about the technology and how it can be applied to older people who have hearing difficulties."

Similarly, clinical audiologist Richard Carmen noted, "It gives me a broader perspective on the needs of the consumer. (While) my own patients may be reluctant to complain about a particular system, the consumers here want to complain; that's why they're here."

The job's not over until the paperwork's done
The Stakeholder Forum plays a critical role by validating and extending our understanding of the customers' needs, the business opportunities and technology specifications identified in earlier work. Based upon Forum outcomes and all prior work, the T²RERC develops "problem statements" that are disseminated to Federal Laboratories, manufacturers in cutting-edge industries and other sources of technological innovation. Dissemination efforts include, but are not limited to: the development of a Hearing Enhancement project web site on the Internet; links to the project web site; articles in trade journals and newsletters, including the widely read NASA "Tech. Briefs"; and direct contacts to targeted technology developers.

Brian Kon describes his organization's contribution to the event. "As a partner in these technology transfer stakeholder forums, AZtech brings experience in facilitating the process of identifying and clarifying the needs of the stakeholders, in order to draw out the innovations of the Federal Laboratories, …and other cutting-edge researchers. Our role in the Forum will be translating the needs of the stakeholders into technical problem statements for use in identifying the new technologies and design ideas, which can address those needs in a commercially viable product."

Personnel from the RERC on Hearing Enhancement and the T²RERC screen innovative proposals submitted by any responding technology developers. Commercialization packages are developed for promising proposals and offered to participating manufacturers for transfer or development (various mechanisms exist to achieve this transfer). Forum Proceedings summaries are written that incorporate all work up to and including the problem statements. White papers and Forum Proceedings can be reviewed or downloaded from the T²RERC or RERC on Hearing Enhancement Internet web sites. The T²RERC address is http://cosmos.ot. buffalo.edu/t2rerc.

Dr. Charles Laszlo seemed intrigued by the promise of the problem statements. "I think they will be very appropriate and they will be of interest to people outside our own group, here, because they are of the nature that go to the care of the problems. I'm actually looking forward to the reaction, and not just of our own group, but people who will see it on the website, and see whether they can come up with some thoughts or some contributions that we didn't think about. I think the process actually is quite fascinating."

The last word...
In reflecting on posterity's view of the Stakeholders Forum on Hearing Enhancement, Dr. Matthew Bakke summed up its probable legacy. "I'd like it to be remembered for the technologies that have resulted from what we've done today, because we're (gaining) some ideas about technology needs from the consumers … People had a great opportunity to express their ideas … There are a lot of things going on, in terms of networking, that … are going to have a good effect in terms of companies and researchers and consumers talking to each other and exchanging ideas, and maybe building connections that they can work on later."

From the perspective of the Rehabilitation Engineering Research Center on Technology Transfer (T²RERC) and its finding ways to use the Demand-Pull Technology Transfer Process to commercialize assistive devices that improve peoples lives, it's practically just the beginning. So keep listening!...

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