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Telecommunications: The Missing Links for People with Disabilities

Dr John Gill
February 1996

The aim of this booklet is to highlight some of the available technologies which could benefit people with disabilities, and to stimulate discussion on how to ensure that these benefits reach the users at an affordable price.

Over the next few years, the boundaries between telecommunications, information technology and entertainment industries will blur as digital technology dominates and information services grow. Network operators will be involved in the collection, management, processing and storage of information, not just in its transportation. This will have a significant impact on the lives of many people with disabilities.


Multimedia applications will become a major driving force. The residential market will provide significant opportunities for new and growing revenues. Mass market demand for Teleworking, entertainment and information services will drive the deployment and diffusion of advanced telecommunication systems (eg ISDN narrowband and broadband) on a pan-European scale. Unfortunately many of these new services will be inaccessible to people with disabilities unless their needs are taken into account when the systems are being planned.


Provision of a complete portfolio of services will be available from independent agents or public network operators. Customers will demand access to a range of services independent of country and network operator’s boundaries, resulting in the separation of services and network infrastructure. Mobility in terms of both personal and terminal mobility will be offered on a pan-European basis. However short-term financial considerations may lead service operators to restrict their target user groups to those which produce maximum income generation and to exclude the elderly and people with disabilities.

Universal Service

With the increase in the average life expectancy in Europe, there will be an increase in the number of people with disabilities. This sector of the market is already of a size to be of commercial significance, without taking into account any regulatory or legislative requirements to provide universal access to telecommunication services. Universal service currently requires operators to provide services to people in remote areas but does not require access to telecommunications for people with disabilities.

The Numbers

In geographic Europe, the estimated number of people with impairments (such that they have problems in using standard telecommunication equipment or services) is:

Mobility Impaired

Reduced function of legs and feet leads to users depending on a wheelchair or artificial aid to walking. In addition to people who are born with a disability, this group includes a large number of people whose condition is caused by age or accidents:

Wheelchair user 3 million

Cannot walk without aid 45 million

Dexterity Impaired

Reduced function of arms and hands makes activities related to moving, turning or pressing objects difficult or impossible. This does not influence speech communication itself but makes it hard to make a phone call or use a wide range of other telecommunication equipment.

Cannot use fingers 1 million

Cannot use one arm 1 million

Reduced strength 22 million

Reduced co-ordination 11 million

Speech, Language and Cognitively Impaired

Speech impairment may influence speech in a general way, or only certain aspects of it, such as fluency or voice volume. Language impairment may be associated with a more general intellectual impairment.

Speech impaired 2 million

Language impaired 5 million

Dyslexia 25 million

Intellectually impaired 30 million

Hearing Impaired

Hearing impairment can affect the whole range or only part of the auditory spectrum which, for speech perception, the important region is between 250 and 4,000 Hz. The term deaf is used to describe people with profound hearing loss, while hard of hearing is used for those with mild to severe hearing loss.

Deaf 1 million

Hard of hearing 80 million

Visually Impaired

Blindness implies a total or near total loss of the ability to perceive form. Low vision implies an ability to utilise some aspects of visual perception, but with a greater dependency on information received from other sources.

Blind 1 million

Low vision 11 million

The Problems

The technology is already available to alleviate many of the problems faced by people with disabilities in using a public telephone, but only a few telecommunication companies provide the appropriate facilities.

The table below illustrates one set of existing problems, but advances in technology will create exciting new solutions as well as some new problems. Many of these new solutions appear likely to be economically viable, and of benefit to all customers, if appropriate marketing is employed.


It was once the case that many companies, particularly those whose products are marketed across the full spectrum of the population, considered customers with disabilities as a niche market at best, and an unwanted intrusion at worst. However many companies are now taking the view that, when properly managed, programmes which address the needs of people with disabilities can open up new market opportunities and be profit generators rather than economic burdens. Also these more enlightened companies are reaping a marketing benefit to their core business from being seen to be balancing human need against the commercial imperative.

Marketing Approach

In these enlightened companies, the customers with disabilities have been the recipients of, and have benefited from, much of the mainstream marketing activity. However market research in the disabled sector is fraught with problems, not the least of which is recruiting a sufficiently large sample of people in any one location. Then there’s the problem of communication - few market research agencies have any background knowledge of disability or staff trained in the use of sign language, or more than even a basic appreciation of how, or how not, to talk to people with disabilities.


Many people express the view that products and services for people with disabilities should be provided at low cost or, better still, free. While accepting that there is often a link between disability and disposable income, application of such a policy could be interpreted as discrimination against other groups of customers. It is preferable that the requirements of people with disabilities are considered at the early stages of any product or service development, when inclusion of special features often results in minimal or no additional cost. Another approach is to compromise slightly on product design so that, while the design retains the functionality required by people with disabilities, it still appeals to a wider audience; in this way, volume sales result in lower unit prices while recouping development and tooling costs.


It is essential not only to disseminate information to customers but to actively involve them in planning new equipment or services. However this implies producing information in a format suitable to their individual needs (eg large print or audio tape). It also implies the training of staff to be able to effectively communicate with people with disabilities, together with a basic understanding of the problems resulting from various disabilities.

Civil Rights

In many countries there is a growing movement to improve the rights of people with disabilities. In the USA, it has been found that the costs of complying with the Americans with Disabilities Act need not be overly high. Disability groups, who have been consulted by businesses, appreciate the financial implications of meeting their needs, and as a result are prepared to take a more pragmatic approach in making their demands.

Available Technology

Speech Technology

Recent developments in speech technology have led to significant improvements in quality and accuracy and a reduction in prices. This is important for people with disabilities since speech technology can be used for interpersonal communication, access to information and control of the environment.

Speech Synthesis

Although the intelligibility of the available speech synthesis systems is quite high for a number of languages, there is evidence that significantly better quality should be achievable. Research is focused on naturalness, prosody and flexibility (eg different voices). Other important research areas are modelling of emotions and speech synthesis from the meaning of the text.

Speech Recognition

Recent developments in speech recognition have been in two areas - the academic where the focus is on improved techniques such as stochastic modelling, search and neural networks, and the pragmatic where the focus is on accuracy, robustness and computational efficiency permitting real-time performance with affordable hardware.

Speech recognition is difficult because:

  • The basic units of speech are hard to recognise.
  • Continuous speech adds more difficulties.
  • Speaker and environmental differences are very important.
  • There is insufficient knowledge about the human language understanding process.

Speech Dialogue Systems

Speech dialogue systems, in which speech synthesis and recognition are used in a man-machine dialogue, have been demonstrated for applications such as bank cash dispensers and hands-free voice diallers on public telephones. Current systems are limited to vocabularies of about 100 words, but laboratory prototypes exist with vocabularies of over 1000 words.

Technology Transfer

Speech synthesis is a stable technology, but speech recognition is still substantially inadequate when compared with human capabilities. Research on speech processing has had a significant impact on the design of cochlea implants as well as digital hearing aids. However there is a need for better understanding of user needs and matching these needs to appropriate research and development. There is also a need to use current knowledge in practical situations to evaluate potential benefits.

Smart Cards

Self-service terminals are being used by the general public for an increasing range of applications. Bank cash dispensers and ticket selling machines for public transport now offer a bewildering number of choices to the user. To handle this increased number of choices, the terminal often incorporates a sophisticated interface which can cause problems for users who are elderly or have a disability. To help these users it may be possible to modify the terminal interface to meet the user’s needs (eg large characters on the screen).

Selecting Preferred Interface

To select a preferred interface, the user could simply press a button or select from a menu on the screen. Another method would be to store the information on the customer’s card. With a magnetic stripe card there is very limited spare capacity for storing this information, but this method has been used successfully for storing the user’s preference for displayed language (eg English or French). A smart card has fewer restrictions on storage capacity so appears to be ideal for this purpose, as long as an international standard is agreed for the coding of this information.

Preferred Input

The customer is often required to input information to a terminal, but many elderly customers need more time to complete the transaction before being ‘timed out’; on a public telephone, this could involve storing the number being dialled and then sending it at a press of a function key.

Preferred Operation

Some elderly and disabled customers may want the terminal to offer them a restricted number of choices, such as automatically dialling a pre-stored number on a telephone card, or the ability to store a few telephone numbers and select them by two or three key presses.

Preferred Output

Terminals often display information which some users find difficult to read or understand. These users might be helped by large characters on the screen, or speech prompts, or the ability to select a preferred frequency response to compensate for their hearing loss.

Contactless Cards

Since there is no card insertion, contactless cards would help people in wheelchairs who cannot reach the slot for the card reader, those with hand tremor or arthritis, and blind persons.

Systems for interrogating cards at distances of a few metres were developed for road charging, but this technology could have numerous benefits for blind and physically disabled persons. For instance it could trigger an audible location signal which would help blind persons find the terminal.

Relay Services

The text telephone enables customers who cannot use the phone in the normal way, because of deafness or a speech impairment, to talk to each other using a keyboard and display unit. This enables them to talk to other users of text telephones. A relay service is a real-time system which translates in both directions between text and voice and voice to text. The operation of the system is relatively simple, in that originating customers call the relay service, identify themselves and inform the operator at the relay service of the number they wish to call. The operator calls this number and when the call is connected, full translation can take place in either direction via the operator.


Many deaf people have good voices, particularly if their deafness occurs in later life, and consequently many relay services offer voice-through facilities. In this case once the through-call is established then the text-using customer can speak to the hearing customer directly and only employ the text system through the operator when the hearing customer is speaking to the deaf customer. This system saves time and increases the sense of "realism" of the call.


The charging for such a call has to be carefully considered if a relay service is to offer anything like an equivalent to a normal telephone conversation carried out in speech. Typically a text call takes six times as long as the equivalent voice call, and there are two telephone calls where there would normally only be one. It is essential that the originating customer, be it text or voice, is only billed for the same amount of money as this would have been if the call had been dialled directly. To do anything else would be discriminatory.

Service Obligation

Often, where the operator is still government owned, the operation of a relay service is seen as a social necessity. In other countries where there is a more liberalised structure, legislation or licence requirements are needed to ensure that the operators pay for the establishment of a relay service. One possibility is for text Telephony to be given the same legal status as ordinary Telephony.


One of the difficulties in there being universal access throughout the globe to relay services and individual text telephone users is the large number of line standards which exist. Even within recommended standards, such as V21, there are differences between the countries let alone the different alphabets in use. The advent of the fledgling V18 standard is likely to be the first step towards the end of this complication, and hopefully deaf people can look forward to the establishment of a world-wide network of relay services financed out of the profits of the operators, or through a levy on their customers, for many years to come.

Smart Houses

A home which can include the technology to allow for devices and systems to be controlled automatically, may be termed a smart house. The degree to which this control is exercised is determined by cost, the user’s wishes and the type of building. A smart house can be used to help people with physical, mental or sensory disabilities to live independently; the costs of installing the technology have to be compared with the costs of alternative methods of providing an appropriate level of care.

Within a traditional home, automation can assist a person to control a device in another part of the house as well as establish the status of the device (eg is the electric blanket on?). In some situations, the controller can suggest appropriate actions, which can be of great help to those with short-term memory problems. The design of the controller can be tailored to the needs of the user; for instance, a controller for use by a blind person could incorporate speech output.


Smart houses often use a central data highway which can be implemented using cable, infra-red or radio links; the choice depends on factors such as speed of data transmission, building design and cost. It is much easier to incorporate such a bus into a new purpose-built environment than to adapt an old building. A major problem is still the lack of a single standard covering home bus systems.

The User Interface

The user interface is the single component in such systems, upon which everything else will be judged. If the interface is confusing, the system will be thought of in that way. To make such systems appear simple is extremely complex, but nonetheless essential. The interface must be appropriate to the special needs of the user. For example, a person with mental impairment may require a less complex screen, presenting him or her with limited choices at one time; this may require the use of a larger number of menus, as well as greater use of pictures and icons. It is important that the user interface is consistent across all the applications.

The Future

The concept of smart houses is both exciting and extremely challenging. Much like the introduction of television, you may love it or hate it; but either way it is here to stay. The further development of smart houses as a tool to help people with disabilities is currently inhibited by a lack of clear standards and the availability of the technology. However there are indications that these problems are being overcome, and that people with disabilities may be the first to benefit from smart housing.

Alarm Systems

In everyday life, people need to be alerted to stgnals that give a warning or indication of action to be taken; a typical example is domestic smoke detectors which are now inexpensive and widely used. However people with disabilities may not be able to use existing equipment or services, and special systems are often prohibitively expensive.

Alarm systems range from the simple alarm clock to sophisticated burglar alarms and national warning systems. They may be stand-alone devices or be complete systems involving control centres to support the end user. An alarm system has two functions - the first is to draw attention to the fact that something is happening, and the second is to what is happening and consequent actions which should be done.

In many cases the signal also carries the message for what has to be done (eg when an alarm clock or telephone rings). However it is more complicated when the alarm is for a machine malfunction or a national disaster since it may require a series of actions to be undertaken (sometimes new and unpractised).

Personal Alarms

Alarm clocks, doorbells, telephone bells, timer signals and machinery warning signals are usually for individual use.

Impersonal Alarms

Horns of approaching vehicles, sirens from emergency vehicles, and fire alarms are intended for everyone who is in the physical area of the alarm.

Disaster Alarms

Major incidents, such as forest fires or poisonous discharges from industrial plants, are often indicated by acoustic sirens, loudspeaker announcements from vehicles, or verbal announcements on radio or television.

With an increasing proportion of the elderly and disabled population living alone, it is essential that they have full access to alarm systems. The technology is available but progress is hampered by political and administrative obstructions. There is a need to obtain agreement on legislative matters as well as technical standardisation of system operations in order to provide services that truly mirror those available to people who have no disabilities.


Transmitting pictures via the telephone network is not new, but very important for some groups of people with disabilities. Being able to communicate in sign language via the telecommunications network is a dream for many deaf people.

Persons who are Deaf or Hard of Hearing

Pre-lingually deaf people often use sign language and/or lip reading; for telecommunication purposes the critical question is picture quality (ie the trade off between contrast, compliance and resolution); experiments indicate that, with the improvement in codec technology, narrowband ISDN is adequate for sign language as well as lip reading.

A special and very interesting application is remote sign language interpretation. Instead of calling for an interpreter to come to a certain place, a video connection can be established and the interpretation made via video transmission; this significantly reduces the travelling and delay time.

Persons with Mental Disabilities

Many people who are mentally disabled have problems using ordinary telephones. The reasons include limited verbal skills as well as the lack of visual support to the spoken message to see who is talking or to see objects which are referred to. Pilot services have shown that videoTelephony can help overcome these problems.

Other Disabilities

VideoTelephony can help persons with brain injuries who need to express themselves in very different ways. Also, people who are speech impaired may find videotelephones useful. More surprising perhaps is that visually disabled people can benefit from videoTelephony; for example, objects and printed forms can be shown to a sighted person who can identify and describe them verbally to the blind person.

Virtual Reality

Virtual reality (VR) technology is of inherent interest to people with disabilities since:

  • It allows people with sensory disabilities to perceive what they might not otherwise be able to since it can gather information in a sensory modality in which they are impaired and deliver it to one where they are not.
  • It can render a world in a customised manner - this can help people to start learning activities in a simplified form before transferring their skills to the more complex real world. This approach has been used with children who have learning difficulties.
  • Well-design VR devices are inherently adaptable to a wide range of individual needs.
  • Users of networked virtual environments will have control over the way in which they project themselves to others. This means that those with special needs can interact with other users on an equal footing.

Rehabilitation Technology

VR techniques can be used to compensate for motor and sensory deficits, allowing a disabled person to explore and manipulate new environments. It therefore has the potential to be used as a training aid for skills such as spatial co-ordination and orientation.

Technological Hurdles

As intriguing as VR is, the enabling technology is still crude. Major technological hurdles exist in the area of tracking a person’s motion and position in a non-intrusive way, in displaying high definition stereo colour images of the scene covering the user’s peripheral vision and, in the area of image generation, speed for a smooth and realistic animation of the scene. Tactile output and the construction of physical images, to support the visual images in virtual environments, require further development to produce realistic sensations.

The Future

Virtual reality and telecommunications are both fields that will evolve and grow very rapidly by the end of the century. Applications that are currently stand-alone will be supported on high bandwidth public multimedia networks that are arising out of the integration of telecommunication and computing. In coming together, VR and telecommunication technology have much to offer people with disabilities.

The Information Superhighway

The 1990s represent a period of great technological, regulatory and commercial change in the telecommunications world. Depending on how it evolves, the emerging "information superhighway" has the potential to make possible a wide range of applications and services which can contribute to the quality of life. For people with disabilities new opportunities will be presented for interpersonal communication (eg videoTelephony), for access to remote services (eg Telemedicine), for carrying out transactions from the home (eg Teleshopping) and for new forms of participation (eg distance learning and Teleworking).

Levels of Access

These new opportunities bring a new dimension to the question of access to telecommunications, namely, will they be available for everyone who could benefit from them? For some groups, high quality videoTelephony services may be desired to support sign language and other forms of visual communication, for others, a good quality and inexpensive voice Telephony service may the main priority. For some groups, remote access to entertainment and transaction services may be the primary demand, for others, the networking and other information services provided by Internet-type facilities are likely to be of great interest and value.

What Will be Available?

Where Will it be Available?

How Much Will it Cost?

This diversity means that all levels of access, including PSTN, ISDN, mobile and broadband need to be taken into account in the development of policies to ensure that needs will be met as the information superhighway evolves. One factor of importance will be the approach to infrastructure roll-out which is adopted in Europe, and the extent to which this will be left solely to the marketplace or be incorporated within public policy. A related factor will be the geographical distribution of access to advanced services and the possibility that access will evolve in an uneven fashion between and within countries. Finally, given the limited financial means of many people with disabilities, connection and usage costs will exert a crucial influence on whether the new opportunities will be taken up.

Policy Issues

These issues are important in the context of Europe’s approach to the promotion of the information society. Consideration will need to be given to what services should be included within a definition of universal service to meet the needs of people with disabilities, how this might evolve over time and how the various sectors can best contribute to its achievement.

Further Information

The Commission of the European Union has recognised the need for co-ordination in this area by establishing COST 219 (Future telecommunications and Teleinformatics facilities for disabled and elderly people); participating countries are Austria, Belgium, Croatia, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Malta, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and United Kingdom.

COST 219 have produced a book "Telecommunications for All" which gives a general overview of issues related to accessibility and usability of telecommunications equipment and services for disabled and elderly people. The social, demographic and marketing aspects are also discussed while highlighting the significant role that can be played by standardisation and legislation. The second part of the book looks more specifically at some of the available and forthcoming telecommunications equipment and services, identifying some of the existing accessibility problems and potential solutions.

Copies of "Telecommunications for All" are available free of charge from:
Dr Jan Ekberg
COST 219
PO Box 220
Siltasaarenkatu 18C
FIN-00531 Helsinki
Tel: +358 0 3967 2091
Fax: +358 0 3967 2054


The author is grateful for the help he has received from B Allen (Ireland), N Clarkin (Ireland), K Cullen (Ireland), K Currie (UK), J Ekberg (Finland), P-L Emiliani (Italy), S Furner (UK), G Kouroupetroglou (Greece), J-I Lindström (Sweden), M Martin (UK), M Mercinelli (Italy), G Németh (Hungary), B Perrett (UK), L M Pereira (Portugal), P Roe (Switzerland) and C Willems (The Netherlands).


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