The 1960s science fiction classic "2001: A Space Odyssey" predicted that we'd have reliable shuttle service to the moon by the beginning of the 21st century. Reality hasn't quite caught up with that speculative portrayal, or with the film's depiction of supercomputers that readily and instantaneously comprehend even the subtlest nuances of human speech.

That's not to say that we haven't made some notable advances in adapting and developing technology to help us communicate better. People with disabilities have been among the first to take advantage of these new developments. And while the technology is far from perfect, many people with neuromuscular disorders are already talking to machines instead of typing on them, while others are finding ways to get the machines to speak for them.

HEAR MY VOICE

Speech recognition technology, the science that enables machines to understand and respond to human speech, is developing quickly but still has a way to go. (This technology is not synonymous with voice recognition, the science that makes it possible to confirm a person's identity by focusing on subtle characteristics of speech.)

A person using a speech recognition program works in front of a computer wearing a headset with a built-in microphone positioned close to the mouth (see photo above). As the person speaks, the words appear automatically and almost immediately as text on the screen -- at least in theory.

It's important to select a communications system that can be readily adapted to changes in the user's abilities.

In reality, the programs tend to make many errors, requiring the user to say "scratch that" or some other command that tells the computer a correction is necessary. The software will try to speed the process by offering up a menu selection of likely words. Fatigue or any factor affecting voice quality may allow more errors to creep in.

Generally, these programs need to be "trained," which means that the computer has to be given a chance to get used to the user's vocal eccentricities. The program itself will prompt users about training, which may involve repeating certain phrases or actually reading an entire short story to the PC. Each person's vocal patterns are unique, so a program trained for one user isn't meant to be used by someone else.

In addition to inputting text, speech recognition programs can allow users to issue commands that open and close other programs, move files, access e-mail and surf the Internet, all by voice alone.

A number of software developers, including Dragon, IBM, Lernout & Hauspie and Philips, are vying to create a lock on more effective speech recognition software that's user-friendly and error-resistant. Some programs, like IBM's Via Voice, seem better than others at interfacing with popular software such as Microsoft's Windows and Word.

CONVERSING WITH THE DRAGON

Speaking of science fiction, one of David Ralph's goals is to become a successful science fiction writer. But how do you make a dream like that come true when Duchenne muscular dystrophy has taken away your ability to type on a keyboard?

Ralph, 35, lives in a health care facility in Tucson, Ariz., and uses a ventilator because of his Duchenne progression. Fortunately, his vocal powers haven't been seriously compromised. For his fiction writing efforts, he relies on a speech recognition program called Dragon Dictate, and dictates his writing into a word processing program called Lotus Word Pro.

"It doesn't always get the right word but it usually has the right word on the list," says Ralph about the Dragon's correction capability.

Ralph still has sufficient dexterity to manipulate a mouse, which he uses for many commands and selections. He says it's possible to use voice commands to move the cursor in- stead of using the mouse, but the process is tedious at best.

One other problem is that the Windows interface "throws a fit" whenever Ralph tries to shut Dragon down. By and large, though, he's happy with Dragon Dictate, which he came to after trying out several other speech programs at a local technology access center. In addition to writing, Ralph uses Dragon to send e-mails and even to participate in chat rooms on the Internet.

"I've been in touch with family members and friends that I lost touch with years ago because of e-mail," he says. "I feel much freer. I can go all over the world because of e-mail."

Ralph is continuing to write and hopes to find a publisher for his stories soon.

OTHER COMMUNICATION OPTIONS

For some progressive conditions such as amyotrophic lateral sclerosis (ALS), it's likely that the powers of vocalization will become degraded over time and may eventually be lost completely. Speech recognition technology might be useful in the short term, but useless in the long run.

Dana Scroggs, a speech language pathologist (expert in speech and swallowing problems) who works with patients at the MDA/ALS Center at the Carolinas Medical Center in Charlotte, N.C., likes to talk to those with ALS about communications options early in the disease process, while the patient can still communicate using natural abilities.

The Easy Talk device from the Great Talking Box Company can store dozens of prerecorded messages in the user's own voice.

"I like them to be actively involved in the assessment and selection process," she says. Maintaining the power to communicate is vitally important to a person's morale and overall outlook.

Long-term solutions to loss of communication ability need to take into account not only the reduction in vocal powers but also the gradual loss of manual dexterity needed to operate a standard PC keyboard or mouse. Each case must be evaluated individually. Even in one disease such as ALS, the course of progression can vary greatly from one person to another.

"Some patients are computer literate and don't want to see anything that is not computer-driven, while some don't even want to hear about computers at all," says Scroggs. In some cases, "no-tech" devices such as alphabet boards or picture boards may be used.

"In a lot of patients, what they first start losing is the ability to project their voice because they are losing that respiratory capacity, but actually they articulate themselves very well," says Scroggs.

In those cases, a temporary solution might involve a relatively simple amplification system with a microphone. In addition, Scroggs says that common devices found at Radio Shack and Wal-Mart, such as baby monitors and cordless phones with paging capabilities, can sometimes be adapted to help adults with communication needs.

DEVICES GALORE

A more sophisticated technological solution might incorporate any number of devices as the core of its system. One system Scroggs has used is the LightWRITER by Zygo, a speech synthesizer that produces spoken words as they are typed on a keyboard. LightWRITER includes two output displays, one facing the user, the other facing the one being spoken to, to facilitate natural face-to-face communication.

Another possibility is the Easy Talk device from the Great Talking Box Company. It comes with changeable keypad overlays, including the entire alphabet and common words and phrases. Press a key and the box will "speak" the word, letter or phrase. A user who still has vocal capabilities can record all the selections in his or her own voice.

Yet another system is the DynaVox, which combines attractive on-screen touch selection with speech synthesis technology. The LightWRITER and DynaVox allow users to choose from a variety of preprogrammed voices, such as male, female, child, etc.

CHANGING NEEDS

Whatever device is used, it's crucial that it has the capability to easily adapt the technology to a user's changing abilities.

That could mean a user might progress from pressing keys on a keyboard or device to using a "scanning" system, which employs a signal that moves repeatedly over a range of choices. A one-touch button allows the user to select an option as the signal passes over it. Scroggs says a trainer or therapist may need to adjust the rate and the type of scanning to suit the individual.

"The device hasn't changed. All that has changed is the way you access it," says Scroggs.

In some situations, Scroggs can isolate a body part that's still capable of operating a switch, whether it's a finger, a toe or even the mouth. There are also devices that read eyeball or eyebrow movements and "head mice" that move a cursor in response to head movement.

Scroggs emphasizes that choosing the right system at the onset can spare trauma to the patients' sensibilities, especially for those who aren't technologically oriented to start with.

In addition, changing equipment in midstream can place a huge strain on finances. Scroggs warns that while some commercial health insurance policies cover communication devices, Medicare and Medicaid don't. She advises that some local independent living centers may help provide funding for equipment or at least may have a loan closet. (For other cost-efficient sources, see "Used, But Not Used Up," in Quest vol. 6, no. 3.)

One important advantage of high-tech systems is that they allow for sophisticated communication, including the ability to prepare long messages in advance and store them until they're needed.

"I had a patient come in the other day who had about three jokes programmed in there that he just had to tell me," Scroggs says.