“The Brave New World of the Cyber Speech and Hearing Clinic,” The ASHA Leader, Vol. 6, Dec. 11, 2001

Just imagine ….
A future when patients log on to cyber speech and hearing clinics from the comfort of their homes. Three-dimensional and holographic imaging enable viewing situations similar to face-to-face contact. Parents or spouses of the patient will complete intake forms by answering questions of a computer-generated composite face and voice. The hearing evaluation will be completed in less than a minute. The patient will simply sit in the 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. The completed hearing evaluation report will be created including colorful graphic charts of the brain, external, middle, and inner ear.
Speech production 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. 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.
A 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 and adapted to the patient's interests. For children, these interactive tests will use colorful cartoon characters that 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 of speech, and fluency tests will be similarly conducted and structured around the patient's age and interests.
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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.
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 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 agencies, 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.

(Taken from the prologue to Telepractices and ASHA:Report of the Telepractices Team December 2001 with permission from Dennis C. Tanner’s article, “The Brave New World of the Cyber Speech and Hearing Clinic,” The ASHA Leader, Vol. 6, Dec. 11, 2001, based on the author’s original short story ,“Welcome to the Cyber Speech and Hearing Clinic,” in Communication Disorders: A Literature and Media Perspective to be published in 2002 by Allyn & Bacon.)