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 available in recent years. Craig Hospital’s specially trained speech-language pathologists work with patients in the Assistive Technology Lab to find the communication option that works best to meet their individual needs and capabilities.

Communication options include:

1. No-Tech Options: These are communication methods that involve only the person's body. Facial expressions, body language, use of gestures and sign language are all forms of no-tech AAC. No-tech options are the first area of AAC explored because of their immediate access. However, if no-tech options prove to be too limiting for a patient, the following options can be considered.
2. Low-Tech Options: These are communication methods that require basic equipment. Examples of low-tech options include writing on paper or a whiteboard, pointing to icons on a picture or window board, using an alphabet board to spell out words, and using partner-assisted scanning with a needs list. Low-tech systems offer more breadth of communication than most no-tech options, but are also limited by the need for a communication partner to interpret the alternate form of communication. These communication options do not provide voice output.
3. High-Tech Options: These communication methods are electronic and provide the user with access to pre-programmed choices and/or the ability to create novel words and phrases. Most of these devices also offer voice output. Examples of high-tech options include talking switches, tablets with AAC apps and dedicated speech-generating devices (SGDs).

Access to AAC

For those who are candidates for low-tech or high-tech AAC, it is critical to determine the best way for the person to access the communication option. At Craig, occupational therapists also participate in patient evaluations to help determine the best access method.

Users can access AAC options in two ways:

1. 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 Capacitive Styluses and Mouth Sticks section). 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 resources below).
2. Switch Selection: Switch selection 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).

Resources for Commercially Available Low-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 companies that provide AAC options for adults with acquired injuries:

• Ablenet
• Adaptivation
• Adaptive Tech Solutions
• Forbes Rehab
• LC Technologies
• Prentke-Romich
• Saltillo
• Tobii-Dynavox
  

AAC Apps

The use of personal tablets and AAC apps is now a feasible option for many people. The following is a list of apps that are used frequently at Craig Hospital with individuals who have acquired injuries.

Picture Based

App2Speak		https://app2speak.com/ Available on Google Play and Apple App Store
GoTalk NOW		https://www.attainmentcompany.com/gotalk-now Available on the Apple App Store
Grid for iPad		https://thinksmartbox.com/product/grid-for-ipad/ Available on the Apple App Store Monthly subscription option available.
Proloquo2go		http://www.assistiveware.com/product/proloquo2go Available on the Apple App Store
Snap+Core		https://www.tobiidynavox.com/en-US/software/windows-software/snap/ Available on the Apple App Store Monthly subscription option available.
TouchChat HD		http://touchchatapp.com/apps/touchchat-hd-aac Available on the Apple App Store
TouchChat HD With WordPower		https://touchchatapp.com/apps/touchchat-hd-aac-with-wordpower Available on the Apple App Store

Text Based

Predictable		https://play.google.com/store/apps/details?id=com.tbox.predictable_4&hl=en Available on Google Play and Apple App Store
Proloquo4Text		https://www.assistiveware.com/products/proloquo4text Available on the Apple App Store
Text to Speech!		https://itunes.apple.com/us/app/text-to-speech/id712104788?mt=8 Available on the Apple App Store Free and paid versions available.
Verbally		http://verballyapp.com/ Available on the Apple App Store Free and paid versions available.

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