Assistive Communication Devices: Finding Your Voice With Technology

Augmentative and Alternative Communication (AAC) technology gives a voice to people who cannot speak or whose speech is not easily understood. From simple picture boards to sophisticated eye-gaze controlled speech computers, AAC devices serve people with conditions ranging from autism to ALS to stroke-related aphasia.

Types of AAC

AAC falls into two broad categories. Unaided AAC uses no technology — sign language, gestures, and facial expressions. Aided AAC uses tools, from low-tech picture boards to high-tech speech-generating devices.

High-tech AAC devices include dedicated communication computers (like those from Tobii Dynavox), tablets running AAC apps, and speech-generating devices that convert text or symbol selection into spoken output. The choice between dedicated devices and tablet-based apps involves tradeoffs in durability, insurance coverage, and features.

Dedicated AAC Devices

Dedicated devices like the Tobii Dynavox TD I-Series are purpose-built communication computers. They offer rugged construction, long battery life, multiple access methods (touch, switch, eye gaze), and are often covered by insurance or Medicaid because they are classified as medical devices.

These devices run specialized communication software with extensive symbol libraries, word prediction, and pre-stored phrases for common situations. They also include environmental control units that let users control TVs, lights, and other devices.

Tablet-Based AAC Apps

For many users, an iPad running AAC software is a more practical and affordable option. Proloquo2Go is the most popular AAC app for iOS, offering symbol-based communication with sophisticated language organization, word prediction, and natural-sounding voices. It costs a fraction of a dedicated device.

TouchChat, LAMP Words for Life, and Speak for Yourself are other leading iOS AAC apps, each with different organizational philosophies. Android users can try Predictable, LetMeTalk, or CoughDrop. For a durable AAC setup, pair an iPad 10th Gen with a heavy-duty case and a mount arm.

Text-to-Speech Solutions

For literate users who can type, text-to-speech apps convert typed text into spoken words. Predictable (iOS/Android) combines a text keyboard with word prediction and phrase storage, optimized for people who communicate primarily by typing. AssistiveWare's Proloquo offers a text-based approach with excellent word prediction.

AI voice banking is a remarkable newer option. Services like ModelTalker and Acapela let people record their voice before losing speech (due to ALS or planned surgery) and create a synthetic voice clone that their AAC device can use. This preserves the person's unique voice identity even after they can no longer speak naturally.

Getting Started With AAC

Start by consulting a speech-language pathologist (SLP) who specializes in AAC. They can evaluate communication needs, recommend appropriate technology, and help with device setup and training. Many AAC manufacturers offer trial periods and loaner devices.

Do not wait for someone to be unable to speak before introducing AAC. Research consistently shows that AAC supports rather than hinders natural speech development. Starting early, especially for children with developmental delays, leads to better communication outcomes.

Insurance, Medicaid, and many schools cover the cost of AAC devices when prescribed by a healthcare provider. The Speech-Language Pathology evaluation is typically the first step in the funding process.

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