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Americans with Disabilities Act paved the way for CapTel and Web CapTel

Endres, Frank

doi: 10.1097/01.HJ.0000348525.75461.1d

When the Americans with Disabilities Act (ADA) was passed in 1990, it seemed overdue. Equal access for people who are disabled had long taken a back seat to the more visible fights that included equal rights for women and minority groups.

The ADA literally changed the landscape. It paved the way for many of the advancements we now take for granted, including handicapped parking spaces and wheelchair-accessible ramps. In addition to closed-captioning (CC) on television programs, perhaps the most important benefit for those with hearing loss was the development of relay and captioned telephone (CapTel®) services.

Title IV of the ADA recognized that there are approximately 55 million people in the United States with some degree of hearing loss. This groundbreaking legislation sought to provide people with assistive technology, and services, that would be available in any state, at any time, and, most importantly, at no cost to the end user.

“...The Commission shall ensure that regulations prescribed to implement this section encourage... the use of existing technology and do not discourage or impair the development of improved technology...”

Americans with Disabilities Act, Title IV

When Title IV was enacted, the telecommunications device for the deaf (TDD) or teletypewriter (TTY) was the primary assistive technology available to help those with hearing loss communicate with people at a distance. TTY users typed their conversations with one another using this special equipment. The text was transmitted over a telephone line and made viewable on the LED screen of the TTY phone. The device provided assistance to many individuals who were profoundly deaf. However, it was not ideal for a much larger group of people—those with mild, moderate, or severe hearing loss.

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As technology advanced, TTY use was expanded to include telecommunications relay services (TRS), which enabled people with profound hearing loss to contact hearing individuals who use standard telephones. With TRS, a communication assistant (CA) reads aloud the relay user's typed conversations for the hearing individual. Then the CA types the hearing party's side of the conversation for the relay user to read.

In 2000, Internet relay and video relay were added to the portfolio of available relay services. Internet relay is similar to TRS, except that the text portion of conversations is conducted over the Internet. With video relay, an interpreter facilitates the conversation through American Sign Language and spoken language that is relayed over the Internet.

Title IV of the ADA mandated that by mid-1993 telecommunications relay service be made available at no cost to qualified users in every state. The costs for relay calls are covered by a surcharge assessed on all telephone service. Payment for in-state calls is administered by the providing state, while interstate calls are administered by the National Exchange Carrier Association, acting on behalf of the Federal Communication Commission (FCC).

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Originally, ADA Title IV was a catalyst in the development of many new technologies, including assistive listening devices. Title IV was designed to encourage technological growth in an ever-changing world.

In the last 20 years, however, technology has significantly out-paced legislation. Where legislation once set the standard, technology advanced so rapidly that those standards became outmoded. For example, in 2002 the ADA mandated that pay telephones located in public areas such as stadiums, convention centers, and malls provide access to those with hearing loss. However, even then—and much more so now—pay phone usage has declined, largely because cell phones, instant messaging, and e-mail have taken its place.

Title IV also required that captioning services be provided on television screens that were 13 inches or larger. Today, CC service is not only available on television screens of all sizes, it is also available on computer screens and even cell phone displays as compact as 4 inches.



Technology has enabled some of the most advanced devices imaginable, from digital hearing aids to cochlear implants. The challenge is that, even with these devices, persons with hearing loss may still experience feedback and other high-frequency interference during telephone conversations.

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In 2003, Hamilton CapTelwas introduced. This service allows those with hearing loss to listen to and read captions of the other party's words through the use of a specially designed CapTel phone. Captions appear on the CapTel phone display screen in nearly real time.

This service requires either a standard analog telephone line or a DSL line with an analog filter. Two platforms were initially available:



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(1) Two-line CapTel

The CapTel user can make outgoing calls and receive incoming calls that are automatically captioned. Both incoming and outgoing calls are directed through the captioning service, whereby the CA re-voices the other party's words. Using the latest voice-recognition technology, captions are generated and transmitted to the CapTel phone display screen. Because the transcription and voice services are carried on two separate lines, either party is able to connect directly to the other.

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(2) One-line CapTel

The CapTel user is able to make an outgoing call that includes captions to anyone at anytime. If the other party wants to call the CapTel user, he or she must first call a toll-free number to connect to the captioning service. The caller is then directed to dial the CapTel user's telephone number and the connection is made.

CapTel phones are available through numerous state assistive equipment distribution programs as well as through individual purchase. Hamilton CapTel service is available in English 24 hours a day, 7 days a week. In addition, Spanish captioning services are available from 7 am to midnight CST, 7 days a week.

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A new approach

Last year, Hamilton introduced Web CapTel, which makes captioning service available to captioned telephone users virtually anywhere, anytime. By means of a computer with a high-speed Internet connection and a standard or mobile telephone, users can place and receive captioned telephone calls from almost anywhere. Captions are displayed on the user's computer screen, which allows for larger type display and printing capabilities. The other party's words can also be saved for future reference.

Web CapTel service is provided at no cost to users. As an Internet-based service, it eliminates long-distance telephone charges, and no special equipment or software is required.

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One of the greatest obstacles facing persons with hearing loss is that many are unaware of the wide range of assistive technology available to them.

Audiologists, hearing instrument specialists, and other hearing professionals are integral to the education process. Since patients rely on them to help them hear and communicate better, hearing professionals are ideally positioned to advise patients about the technologies that best fit their individual needs.

To encourage hearing professionals to take a more active role in recommending CapTel services to their patients, providers such as Hamilton CapTel have created informational brochures, support materials, and educational presentations (which hearing professionals can request from Frank Endres at

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As essential as ADA Title IV was in 1990, it has become obsolete. Disability advocates agree that 21st-century revisions were necessary to maintain the quality and availability of services for all individuals with disabilities.

The Coalition of Organizations for Accessible Technology (COAT), an alliance of 170 organizations representing people with disabilities, introduced legislation to reflect the technological advances that have occurred since ADA was enacted. Referred to as the 21st Century Communications and Video Accessibility Act of 2008, this legislation was presented for discussion last May. The measure required that:

  • Television and video devices with screens smaller than 13 inches display captioning.
  • Hearing aid compatibility be mandated on Internet-enabled PDAs or smart phones.
  • Consumers with hearing loss be eligible for a Universal Service Fund (USF) discount. This applies to the use of high-speed Internet services, including broadband.

Congressional response to these recommendations was positive; the ADA Amendments Act of 2008 was passed and went into effect on January 1.

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CapTel Moving Forward

With the passage of stronger legislation, new products on the horizon, growing support from audiologists and other hearing professionals, and the unlimited potential of advanced technology, individuals with hearing loss have much to look forward to.

As one user put it, “CapTel makes a huge difference in both my professional and my private life. Communicating over the phone would be impossible without it.”

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The latest step forward in captioned telephone technology is Hamilton Mobile CapTel.™ Available on a single mobile device using a 3G Network service or Wi-Fi connection, Mobile CapTel allows persons with hearing loss to access the captioning service on the go.

It is currently available using the Apple® iPhone™ 3G device and a wired or Bluetooth headset. Users read word-for-word captions of what a caller is saying right on the iPhone 3G screen. Simultaneously, with their residual hearing, users listen to what they can of the conversation through the headset.

Similar to Hamilton's original CapTel and Web CapTel services, Mobile CapTel service is available free to those with hearing loss. All they need is an iPhone 3G, a compatible wired or Bluetooth headset, and a 3G Network service or Wi-Fi connection that supports simultaneous voice and data transmission.

While Mobile CapTel was initially available only on the iPhone 3G, Hamilton expects to make it available on a variety of devices and networks in the coming months.

© 2009 Lippincott Williams & Wilkins, Inc.