When a person cannot use natural speech or handwriting to communicate, they may depend on augmentative and alternative communication (AAC). Difficulties may result from stroke, Parkinson 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.

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

Devices do not always require users to have function in their hands. Alternative input methods include using a headstick or other tool held in the mouth or eye blinks. Some devices can function with a switch, joystick or trackball, which may be helpful for users who have limited use of their hands.

Choosing a Communication Device

It's important to take into consideration the type of communication device that will be most helpful. Some factors to consider include:

• The user's physical and cognitive abilities
• Ease of programming the device
• Size and weight of the device
• Portability (using a desktop computer versus a laptop or tablet)
• Warranty
• Availability of rental or lease programs
• Technical support for problems using the device
• Cost of device, including available funding

Some training will be necessary no matter which type of device you choose. Basic training including turning the device off and on, recharging, etc. is necessary for all electronic communication devices. More extensive training in using the device may be needed if your device is more complex.

Process and Cost

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. Laptop computers can also be equipped with software and used as communication devices. Check with your insurance company or Medicare to find out how much of the cost they will cover.

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. Research possible funding options in your area and make arrangements to try devices before making an investment. Typically, you can borrow or rent a device for 2 weeks to 3 months.