Millions of Americans cannot use natural speech or handwriting to communicate. They depend on augmentative and alternative communication (AAC). Difficulties may result from stroke, Parkinson’s disease, cancer, neuromuscular disorders, brain injuries, or a congenital condition.

Some people use simple tools, such as communication boards. But not having a voice can be frustrating. Small, portable, speech-generating computers enable many individuals to talk and work in the community. Many models exist, either with a keyboard or a touch screen. On some devices, symbols that represent food, safety, work, and other categories lead to additional layers of photos or symbols depicting more options in that category. Many units predict words when typing, which speeds the process.

“You can set your device to 'speak' after each word is entered or after the end of the sentence,” says Carly Panchura, AAC project manager at the University at Buffalo Rehabilitation Engineering Research Center on Technology Transfer. “Once you press the period, it will automatically read over the entire sentence.”

Some devices let users preprogram frequently spoken phrases. The machines come with male, female, and youth voices.

Candidates

Not everyone who has had a stroke or other impairment will benefit from a communication device. Variables include language skills, literacy, vision, motor skills, memory, and family support.

Devices can overcome the physical difficulties in producing language. But strokes may also cause cognitive language problems, such as losing the ability to understand the meaning of a word.

“A person may understand that the food symbol on the device means food, but not have sufficient categorization skills. In other words, he may want a hamburger for dinner, but he might not know to go to the food button in order to find the linked hamburger symbol,” says Bethany Diener, resource clinician and speech and language pathologist at the Rehabilitation Institute of Chicago Technology Center.

Speech may gradually improve after a stroke. So patients usually hold off learning a high-tech device for at least 4-6 months. “For an acquired disorder, like a stroke, it should be the last option,” says Jeff Edmiaston, a speech pathologist at Barnes Jewish Hospital in St. Louis.

Starting early offers benefits to someone with a progressive disease, such as amyotrophic lateral sclerosis (ALS). Prerecording phrases may be possible. Margit Robien has ALS and is learning to use a device while still able to write her thoughts on paper. The Illinois woman has programmed the device and uses it at home and out in restaurants.

Process and Cost

After a complete evaluation, a speech therapist knowledgeable about communication devices can recommend those meeting a person’s needs and budget. Some people fear such technology, but most units are user-friendly. Still, depending on one’s abilities, it may take weeks or longer to learn how to use one.

Patients often can rent a unit before making the investment. Synthesized-speech models with many options can cost thousands of dollars. These devices must be customized. Digitized-speech output units are cheaper, but people are limited to prerecorded phrases. Many units are adaptable to changing skill level. More costly add-ons allow eye input for those unable to touch a screen. Check with your insurance company or Medicare to find out how much of the cost they will cover.