People who are unable to speak can still communicate their wants, needs, and ideas through what is called Augmentative and Alternative Communication (AAC). Sign language systems, for example, have been used for centuries while more high-tech options have become readily available in recent years. Craig Hospital’s specially trained speech-language pathologists work with patients in the Assistive Technology Lab to find the communication options that best meet their individual needs and capabilities.
Communication Options
No-Tech Options: These are communication methods that involve only the person’s body. Facial expressions, body language, and use of gestures and sign language are all forms of no-tech AAC. No-tech options are the first area of AAC explored because they are always available. No-tech AAC is almost always used as part of a person’s communication approach. However, as no-tech options alone are usually too limiting for a patient, the following options should also be considered.
Low-Tech Options: These are communication methods that require basic equipment. Examples of low-tech options include writing, making choices from a whiteboard, pointing to pictures/words on a paper or window board, using an alphabet board to spell out words, or using partner-assisted scanning with a needs list. General resources can be found at the Patient-Provider Communication Network. Low-tech systems allow for more variety in communication than most no-tech options, but still rely on a partner to help interpret the way messages are expressed. These communication options also do not provide voice output.
Mid-Tech Options: Unlike low-tech AAC, mid-tech options provide voice output with simple battery-operated devices and static buttons. These include single-message talking buttons and devices that play a variety of pre-set messages when touched. Voice output allows for communicators to gain attention and initiate communication more easily, thus increasing independence as a communicator. Here are some examples of mid-tech options.
High-Tech Options: These communication methods allow for speech generation via a computer-based system. The user can choose from pre-programmed options or create new words and phrases by typing. Examples of high-tech options include tablets, phones, and watches with AAC apps that can be tailored to support literate and non-literate users. High-tech AAC also includes dedicated speech-generating devices (SGDs), which are specialized devices designed specifically for communication.
Access to AAC
For those who are candidates for low-, mid-, or high-tech AAC, it is critical to determine the best way for the person to interact with the communiciation option. This is called the “access method,” which refers to how the individual selects or activates messages, such as using their hands, eyes, or other assistive technologies. At Craig, occupational therapists also participate in patient evaluations to help determine the best access method.
Users can access AAC options in two ways:
Direct Selection: Direct selection is often the most efficient form of access. The most basic form of direct selection is touching the device with a body part (often a finger). A stylus or mouth stick can also be used for direct access (see Styluses and Mouth Stick Styluses sections). Others may use a mouse or joystick to access their AAC modality. People who are unable to use one of these methods may need to use a specialized camera and software that tracks head or eye movement to make selections on a screen (see Hands-Free Mice section or SGD vendor resources below).
Switch Selection: A switch is a device that responds to a physical action, like pressing a button or tapping a surface. Switches come in different shapes and sizes and can be activated by various movements or body parts (such as the head, head, or foot), depending on the user’s needs.
Switch selection for communication involves the use of specialized software to scan through options on a device. The user then hits a connected switch when the scanning lands on the desired communication option (see resources below).
Mounting
It is important for any communication option to be easily accessible to the user. Often, this means considering an appropriate mount for the communication device. Dedicated SGDs will require specialized mounts from companies such as Rehadapt or Daessy. Other modalities such as tablets, phones, switches, or low-tech tools may be better suited to a more basic mount like the ones found here (see Mounts section).
Resources for Commercially Available Low-Tech, Mid-Tech, and High-Tech AAC
To determine the best AAC method for a person, a comprehensive, interdisciplinary evaluation is strongly recommended. That said, the following is a list of some of the many companies that provide AAC options for adults with acquired injuries:
- AbleNet
- Adaptive Tech Solutions
- AssistiveWare
- Attainment Company
- Control Bionics
- EyeTech
- Forbes AAC
- Lingraphica
- PRC-Saltillo
- Smartbox
- Tobii Dynavox
AAC Apps
The use of personal tablets/phones/watches and AAC apps is now a feasible option for many people. The following is a list of apps that have been used successfully by patients with acquired brain injury.
Symbol-Based Apps
| GoTalk NOW |  | Available on Apple App Store iPad only |
| GoTalk WOW |  | Available on Apple App Store Apple Watch only |
| GoTalk Everywhere |  | Available on Google Play Store, Apple App Store, and Chromebook Tablet, phone, or web-based |
| Grid |  | Available on Apple App Store and Grid website iPad and Windows 10+ PC or tablet |
| TD Snap |  | Available on Apple App Store iPad only |
| TouchChat HD |  | Available on Apple App Store iPad and iPhone |
| TouchChat HD with WordPower |  | Available on Apple App Store iPad, iPhone, and Mac Computer |
Text-Based Apps
| Dialogue AAC |  | Available on Apple App Store iPhone and iPad |
| Predictable |  | Available on Google Play and Apple App Store Tablet and phone |
| Speech Assistant AAC |  | Available on Apple App Store iPhone, iPad, and Apple Watch |
| Vocable |  | Available on Google Play and Apple App Store Tablet and phone |
Accessibility Features on Apple and Android That Support Communication
Operating systems on phones and tablets now have built-in accessibility features that can help with communication.
iOS
Live Captions provides real-time transcription of conversations, phone calls, or video calls to help with comprehension.
Live Speech allows users to type messages that are spoken aloud during conversations, phone calls, or FaceTime calls.
Android
Live Transcribe provides real-time transcription of conversations, phone calls, or video calls to help with comprehension.
How to Support an AAC User
While the use of AAC can provide alternative communicators with increased opportunities for connection with others, control over their environment, and overall independence in their daily lives, many individuals using AAC following a brain injury depend on their communication partners in some way to support their communication. You can be a supportive communication partner by:
- Making sure their low-, mid-, and/or high-tech communication supports are available and mounted correctly at all times – this is their voice!
- Creating communication opportunities for them throughout the day – this could include having them choose daily tasks, asking for their opinion, and allowing them to express their preferences.
- Being patient – AAC always takes more time than typical verbal communication.
- Training others in your family and community on how to be a supportive communication partner in order to expand the AAC-user’s opportunities for communication with others.
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