Alternative Telephony: Communication Devices for Hearing and Speech Difficulties

What Is Alternative Telephony?

Alternative telephony refers to specialized communication devices and services that enable telephone calls for people with severe hearing loss, deafness, deafblindness, or difficulty speaking or understanding spoken language. These assistive technologies include video phones, text telephones, total conversation systems, and relay services that ensure equal access to telecommunications.

For the approximately 1.5 billion people worldwide living with some degree of hearing loss, according to the World Health Organization, standard telephone communication can present significant barriers. Alternative telephony solutions have evolved to address these challenges, providing diverse options that accommodate different communication preferences and abilities. The fundamental goal of these technologies is to ensure that everyone can communicate effectively by phone, regardless of their hearing or speech abilities.

The development of alternative telephony has been driven by both technological advancement and accessibility legislation. In many countries, laws require telecommunications providers to offer equivalent services to people with disabilities. This has led to the creation of sophisticated relay services and the widespread availability of assistive communication devices. These services are typically provided at no additional cost to users, recognizing that communication access is a fundamental right rather than a luxury.

Alternative telephony encompasses several distinct technologies, each designed to meet specific communication needs. The choice of which technology to use depends on individual preferences, the nature of the communication disability, and the context in which the device will be used. Many users benefit from having access to multiple types of devices, allowing them to choose the most appropriate method for each conversation. Understanding the full range of available options is essential for making informed decisions about communication support.

The Importance of Accessible Communication

Access to telephone communication is vital for participation in modern society. From scheduling medical appointments to maintaining social connections, staying in touch with employers, and accessing emergency services, the telephone remains a critical communication tool. For people who cannot use standard phones effectively, alternative telephony devices provide essential accessibility, enabling full participation in personal, professional, and civic life.

Beyond practical necessity, accessible communication supports mental health and social wellbeing. Isolation and loneliness are significant concerns for people with communication disabilities, particularly older adults who may have acquired hearing loss later in life. Alternative telephony technologies help maintain social connections that are vital for emotional wellbeing and quality of life. By enabling real-time communication with family, friends, and community, these devices support independence and social integration.

What Types of Alternative Telephony Devices Are Available?

The main types of alternative telephony devices include video phones for sign language communication, text telephones (TTY/TDD) for text-based calls, total conversation systems combining video, text, and audio, and relay services that connect assistive device users with standard phone users. Each technology serves different communication needs and preferences.

The landscape of alternative telephony has expanded significantly with technological advances, offering users more choices than ever before. Understanding the characteristics, benefits, and limitations of each type of device helps users and their healthcare providers make informed decisions about the most appropriate solutions. Many modern implementations are software-based, running on standard computers, tablets, or smartphones, making them more accessible and cost-effective than earlier dedicated hardware devices.

The interoperability between different types of devices and services has also improved substantially. International standards, such as those developed by the International Telecommunication Union (ITU), ensure that devices from different manufacturers can communicate with each other and with relay services. This standardization has been crucial for expanding the reach and utility of alternative telephony, allowing users to communicate with anyone regardless of what technology they use.

Video Phones

A video phone displays a real-time video image of the person you are communicating with, making it possible to use sign language during telephone calls. This technology has transformed communication for deaf and hard of hearing individuals who use visual languages as their primary mode of communication. Video phones capture facial expressions, hand shapes, and body movements that are essential components of sign language, enabling natural and fluent conversations.

Modern video phones are typically applications installed on computers, tablets, or smartphones rather than dedicated hardware devices. This software-based approach has made video communication more accessible and affordable, allowing users to leverage devices they may already own. High-quality video compression and widespread broadband internet access have made video calling reliable enough for everyday use, with minimal delay that could otherwise disrupt the flow of signed conversation.

Video phones can be used directly between two sign language users, but they also integrate with relay services for communication with hearing individuals who use standard telephones. In this configuration, a qualified sign language interpreter facilitates the call, translating between signed and spoken language in real-time. The interpreter is bound by strict professional confidentiality obligations, ensuring that all conversations remain private. This relay service is typically available 24/7 and is provided at no cost to users in many countries.

The video quality and stability of modern video phone applications have improved dramatically in recent years. Many applications now support high-definition video, which is particularly important for sign language communication where fine motor details are significant. Features such as automatic bandwidth adjustment help maintain call quality even when internet connections are variable. Some applications also offer recording capabilities, closed captioning, and integration with other accessibility features.

Text Telephones

A text telephone, also known as TTY (teletypewriter) or TDD (telecommunications device for the deaf), displays text in real-time as it is typed, enabling both making and receiving calls for people with significant hearing loss, deafness, deafblindness, or difficulty speaking on the phone. Unlike standard text messaging where messages are sent after completion, text telephones show characters as they are typed, creating a more natural conversational rhythm similar to spoken dialogue.

Text telephones have a long history in accessibility services and remain important tools for many users. They feature a keyboard for typing messages and a screen or display for reading incoming text. Traditional hardware text telephones still exist and are valued for their reliability and simplicity, but software applications that provide text telephone functionality on computers, tablets, and smartphones have become increasingly common. These applications often offer additional features such as conversation logging and integration with other communication tools.

Relay services for text telephones allow users to communicate with people who use standard voice telephones. When a text telephone user calls through the relay service, a trained operator reads the typed text aloud to the hearing party and types their spoken responses for the text telephone user to read. Like video relay services, text relay operators are bound by confidentiality requirements and are available around the clock in most regions. The relay service is designed to be transparent, with the operator conveying messages exactly as they are received.

For individuals with deafblindness, specialized text telephones with braille displays are available. These devices convert incoming text to braille that can be read tactilely, providing communication access for people who cannot see a visual display. Refreshable braille displays show one line of text at a time, updating as new characters are received. This technology ensures that alternative telephony remains accessible even for those with combined sensory impairments.

Total Conversation

Products with total conversation technology combine video phone and text phone functionality in a single device, allowing users to communicate using video, text, and audio simultaneously or in any combination. This flexibility enables users to choose the communication mode that works best for them in each situation, adapting to changing needs and contexts. Total conversation represents the most versatile approach to alternative telephony, accommodating a wide range of preferences and abilities.

The total conversation standard was developed by the International Telecommunication Union (ITU) to ensure interoperability between different implementations and across international boundaries. When calling other users with total conversation devices, you can freely combine video, text, and audio to communicate in whatever way is most natural and effective. This might mean using sign language for most of the conversation but switching to text for spelling names or technical terms, or supplementing audio with lip-reading via video.

Total conversation devices maintain compatibility with both video phones and text phones, as well as with relay services for video and text communication. This broad compatibility means users are not limited in who they can contact. The system automatically negotiates the appropriate communication modalities based on the capabilities of both parties, ensuring the best possible connection is established. Users can also manually select their preferred modes if automatic selection is not appropriate for a particular call.

The implementation of total conversation has evolved from dedicated hardware to software applications that run on standard devices. Many total conversation applications are available for computers, tablets, and smartphones, making this sophisticated technology accessible to a wide range of users. Cloud-based services handle the complex signaling and media processing required to support multiple simultaneous communication streams, while the user interface remains simple and intuitive.

Alternative Communication Solutions

Depending on your specific needs, other communication methods may also be appropriate. Some individuals require specially adapted assistive devices to contact the people they need to reach. These might include modified SMS and email systems configured to accommodate particular physical or cognitive requirements. The goal is always to find the communication solution that best matches individual abilities and preferences.

Augmentative and alternative communication (AAC) devices, which generate speech from text input or symbol selection, can sometimes be integrated with telephone systems. This allows individuals who cannot produce speech to make voice calls using synthesized voice output. Modern speech synthesis has become remarkably natural-sounding, making these calls comfortable for all parties. Some AAC devices also support video calling with sign language or picture-based communication.

How Do Relay Services Work?

Relay services connect alternative telephony users with standard phone users through trained operators or interpreters. For video relay, sign language interpreters translate between signed and spoken language in real-time. For text relay, operators read typed text aloud and type spoken responses. All relay personnel have strict confidentiality obligations, and services are typically available 24/7 at no cost.

Relay services are the bridge that enables alternative telephony users to communicate with anyone, regardless of what type of phone the other party uses. Without relay services, video phones and text telephones would only be useful for communication with other users of the same technology. By providing real-time interpretation between different communication modalities, relay services ensure that people who use alternative telephony have equivalent access to telecommunications as everyone else.

Video relay services employ qualified sign language interpreters who can see the calling party through the video connection and hear the called party through an audio connection. The interpreter signs what the hearing party says and speaks what the deaf party signs, enabling natural conversation. High-quality video and audio connections are essential for effective video relay, as the interpreter needs to see signs clearly and hear speech accurately. Modern video relay services use sophisticated technology to maintain quality even under challenging network conditions.

The interpreters who work in video relay services are professionally trained and certified. They must demonstrate fluency in sign language and spoken language, understand the ethics and protocols of interpreting, and maintain confidentiality about all calls they handle. Relay interpreters process calls on thousands of different topics, from casual conversations with family to complex business negotiations and sensitive medical discussions. Their professionalism ensures that users can trust relay services with any type of communication.

Text relay services work similarly but use typed text instead of sign language. When a text telephone user initiates a call through the relay service, an operator connects to the called party by voice. The operator types everything the hearing party says, and the text appears on the caller's text telephone. When the caller types a response, the operator reads it aloud to the hearing party. Like video relay interpreters, text relay operators are trained in confidentiality and professionalism.

How Can I Obtain Alternative Telephony Devices?

Alternative telephony devices are typically provided through healthcare systems, disability services, or rehabilitation centers. The process begins with contacting your audiologist, hearing center, or disability services organization. You will undergo an assessment to determine which device best meets your needs, and the device is often provided at no cost through loan programs. Training on device usage is included.

The process for obtaining alternative telephony devices varies by country and region, but generally follows a similar pattern. The first step is to contact the relevant service provider in your area. This might be a hospital audiology department, a community hearing center, a rehabilitation center, or a government disability services agency. These organizations can explain what services are available locally and guide you through the application process.

Once you have contacted the appropriate organization, you will typically be scheduled for an assessment. This evaluation helps determine which type of alternative telephony device will best meet your communication needs. The assessment considers factors such as the nature of your hearing or speech difficulty, your preferred communication methods, your technical abilities and preferences, and the contexts in which you will use the device. The goal is to find the solution that will be most effective and comfortable for you.

Many regions offer alternative telephony devices through loan programs at no cost to qualifying individuals. These programs recognize that communication access is essential for independence and quality of life. The devices remain the property of the lending organization and may need to be returned if your needs change or you no longer need the equipment. Some programs also provide ongoing technical support and equipment replacement as technology evolves.

After receiving your device, you will be offered training on how to use it effectively. This training covers the technical operation of the device, how to access relay services if applicable, and practical tips for successful communication. Many organizations offer refresher training or additional support as needed. Do not hesitate to request additional help if you encounter difficulties or if your needs change over time.

Devices for Family Members and Close Contacts

A family member or other close contact may also be eligible to receive alternative telephony devices. You typically choose who should receive this equipment. Having compatible devices allows you and your close contacts to communicate directly without using relay services, which can make conversations more personal and spontaneous. This is particularly valuable for frequent communications with family members or caregivers.

When family members have compatible devices, communication becomes simpler and more immediate. There is no need to schedule relay interpreter time or wait for operator connections. Video calls between sign language users flow naturally, and text conversations proceed without intermediaries. For many users, the ability to communicate directly with loved ones is one of the most valuable aspects of alternative telephony.

What Technology Do I Need?

Most modern alternative telephony solutions are software applications that run on devices you may already own, including computers, tablets, and smartphones. You will need a reliable internet connection for video calls. Dedicated hardware devices are also available for those who prefer them or have specific needs that software solutions cannot meet.

The technology requirements for alternative telephony have become much more accessible as these services have moved from dedicated hardware to software applications. Many video phone and text telephone solutions now run on standard computers, tablets, and smartphones. This means you may be able to use alternative telephony without purchasing any new equipment, simply by downloading appropriate applications to devices you already own.

For video communication, a reliable broadband internet connection is essential. Video calls require more bandwidth than audio calls, and unstable connections can disrupt the clarity of sign language communication. Most video phone applications work well with standard home broadband connections, but very slow or unreliable internet service may cause problems. If you plan to use video telephony, ensuring adequate internet connectivity should be a priority.

The devices you use for alternative telephony should have appropriate displays for your needs. For video phones, a screen large enough to see signs clearly is important. For text telephones, a readable display is essential. If you have visual impairments in addition to hearing loss, features such as adjustable text size, high contrast displays, or braille output may be necessary. Discuss your specific requirements with the organization providing your equipment to ensure you receive appropriate solutions.

Dedicated hardware devices remain available for users who prefer them or have needs that software solutions cannot address. These specialized devices may offer features such as direct connection to telephone lines, integration with home alerting systems, or enhanced durability. Some users prefer the simplicity and reliability of dedicated devices, while others appreciate the flexibility of software applications. The best choice depends on individual preferences and circumstances.

How Do Alternative Telephony Users Access Emergency Services?

Alternative telephony users can access emergency services through text-to-911, video relay emergency services, or specialized emergency applications. Many countries have implemented direct text and video access to emergency dispatchers. Relay services also provide emergency access, with calls to emergency numbers receiving priority handling.

Access to emergency services is a critical function of alternative telephony. Recognizing that people with communication disabilities need equal access to emergency assistance, many countries have implemented specialized emergency access systems. These systems allow alternative telephony users to contact emergency services directly or through relay services, ensuring that help is available when it is needed most.

Text-to-911 services, available in many regions, allow people to send text messages to emergency dispatchers. This service is particularly valuable for people who are deaf, hard of hearing, or have speech disabilities. The service works from standard mobile phones as well as from text telephones and other devices. When texting 911, provide your location and the nature of your emergency as clearly as possible, and be prepared to answer questions from the dispatcher.

Video relay services also provide access to emergency services. When you call emergency numbers through video relay, your call receives priority handling. The interpreter will convey your emergency to the dispatcher and facilitate the communication until help arrives. It is helpful to be familiar with the emergency calling procedures for your specific devices and services before an emergency occurs.

Some regions have developed specialized emergency applications for alternative telephony users. These applications may offer features such as GPS location sharing, pre-stored medical information, and direct video connection to emergency dispatchers. Check with your local emergency services and disability services organizations to learn what emergency access options are available in your area and how to use them effectively.

What Are the Benefits of Alternative Telephony?

Alternative telephony provides equal access to telephone communication, supporting independence, employment, social connection, and safety. Benefits include 24/7 relay service availability, flexible communication options, emergency service access, and the ability to communicate directly with other users without intermediaries. These technologies significantly improve quality of life for people with communication disabilities.

The benefits of alternative telephony extend far beyond simply being able to make phone calls. These technologies support independence by enabling users to manage their own affairs without relying on others to make calls on their behalf. From scheduling appointments to handling banking, resolving problems with service providers, and participating in conference calls for work, alternative telephony empowers users to handle their own communications.

Employment opportunities improve significantly when people with communication disabilities have reliable telephone access. Many jobs require telephone communication, and alternative telephony makes these positions accessible. Video phones enable participation in video conferences, which have become increasingly common in modern workplaces. Text telephones and relay services allow participation in calls that would otherwise be inaccessible. These capabilities expand career options and support economic independence.

Social connections are maintained and strengthened through alternative telephony. Keeping in touch with family and friends is easier when you can call them directly or through relay services. This is particularly important for maintaining relationships with people who do not know sign language or who live far away. Regular communication supports emotional wellbeing and combats the isolation that can affect people with communication disabilities.

Safety is enhanced when people can contact emergency services, healthcare providers, and support networks independently. Alternative telephony ensures that help is available when needed, whether for emergencies or for routine healthcare communication. The peace of mind that comes from knowing you can communicate effectively in any situation is invaluable.