Communication Aids: AAC Devices & Assistive Technology

What Are Communication Aids and AAC Devices?

Communication aids are tools and devices that help people who have difficulty speaking or cannot speak to communicate with others. AAC (Augmentative and Alternative Communication) includes everything from simple gestures and picture boards to sophisticated electronic devices that generate speech. These aids can supplement existing speech (augmentative) or replace it entirely (alternative).

Communication is fundamental to human experience. It allows us to express our needs, share our thoughts and feelings, build relationships, participate in education and employment, and engage with our communities. For millions of people worldwide, communication difficulties present significant barriers to these essential life activities. Communication aids, often referred to as Augmentative and Alternative Communication (AAC) systems, provide crucial solutions that can transform lives.

The term "augmentative" refers to communication methods that supplement existing speech. Many people who use AAC have some speech but find it difficult to be understood in all situations or when fatigued. For these individuals, AAC serves as a backup or enhancement to their natural voice. "Alternative" communication refers to methods that completely replace speech for individuals who cannot produce functional spoken language at all.

AAC encompasses a wide spectrum of tools and strategies, from the simplest gestures and facial expressions that all humans use naturally, to sophisticated electronic devices that can produce synthetic speech, access the internet, and control environmental systems. The field of AAC has evolved dramatically over the past several decades, driven by advances in technology and growing recognition of communication as a fundamental human right.

The Importance of Communication Access

The United Nations Convention on the Rights of Persons with Disabilities explicitly recognizes the right to freedom of expression and opinion, including "the freedom to seek, receive and impart information and ideas on an equal basis with others and through all forms of communication of their choice." For people with complex communication needs, this right can only be realized through appropriate AAC supports.

Research consistently demonstrates that access to effective communication systems leads to improved outcomes across multiple life domains, including educational achievement, employment opportunities, social relationships, mental health, and overall quality of life. Conversely, lack of communication access is associated with higher rates of depression, anxiety, social isolation, and challenging behaviors that often represent frustrated attempts to communicate.

Who Benefits from Communication Aids

Communication aids can benefit people across the entire lifespan, from infants and toddlers to elderly adults. The conditions that may lead to AAC use are diverse and include both developmental and acquired communication disorders. Developmental conditions include autism spectrum disorder, cerebral palsy, intellectual disabilities, genetic syndromes, and developmental delays. Acquired conditions include stroke (aphasia), traumatic brain injury, progressive neurological diseases such as ALS (amyotrophic lateral sclerosis), Parkinson's disease, and multiple sclerosis, as well as cancer of the head and neck region.

What Types of Communication Aids Are Available?

Communication aids range from low-tech solutions like picture boards, communication books, and alphabet boards to high-tech speech-generating devices (SGDs) and AAC apps on tablets. High-tech options include devices controlled by touch, switches, eye gaze, or head movements, with many featuring word prediction, symbol-based communication, and text-to-speech capabilities.

The diversity of AAC systems available today means that almost everyone with communication difficulties can find an approach that works for their specific needs, abilities, and preferences. AAC systems are typically categorized as either "unaided" or "aided," and aided systems are further divided into "low-tech" and "high-tech" options.

Unaided Communication Systems

Unaided AAC refers to communication methods that do not require any external tools or equipment. These methods rely solely on the person's body to convey messages. Examples include gestures such as pointing, nodding, and shaking the head; facial expressions that convey emotions and reactions; body language and posture; manual signs from formal sign languages like American Sign Language (ASL), British Sign Language (BSL), or simplified signing systems like Makaton; and vocalizations such as sounds, humming, or partial words that convey meaning within specific contexts.

While unaided communication has the advantage of always being available without requiring any equipment, it also has limitations. The communication partner must be physically present and able to interpret the signals, and the range of messages that can be conveyed is often limited. For many people, unaided methods serve as a foundation that is supplemented by aided AAC systems.

Low-Tech Communication Aids

Low-tech AAC systems, sometimes called "no-tech" systems, include any aided communication tool that does not require batteries or electronic components. These systems have important advantages including low cost, durability, reliability, and ease of customization. Common low-tech options include:

Picture boards and communication boards display symbols, pictures, photographs, or words on a flat surface. The user points to items to construct messages. Boards can be organized thematically (food board, feelings board) or contain a core vocabulary that supports communication across contexts.

Communication books are collections of pages with symbols, pictures, or words organized by topic, activity, or communication purpose. Pages can be easily added, removed, or reorganized as needs change. PODD (Pragmatic Organization Dynamic Display) books are a popular structured approach to communication book design.

Alphabet boards allow literate users to spell out messages letter by letter. While slower than symbol-based systems, alphabet boards provide unlimited vocabulary and precise communication. Eye-pointing alphabet boards use a clear plastic frame with letters arranged around the edges, allowing users to indicate letters through eye gaze.

Choice boards present a limited number of options (typically 2-4) for specific situations, such as choosing a snack, an activity, or clothing. These simplified displays support participation and self-determination even for individuals with significant cognitive challenges.

High-Tech Speech-Generating Devices (SGDs)

High-tech AAC systems include any device that uses battery power and electronic components to support communication. The most sophisticated category is Speech-Generating Devices (SGDs), also known as Voice Output Communication Aids (VOCAs). These devices produce spoken output, allowing users to communicate with anyone, regardless of whether the listener is familiar with AAC.

Modern SGDs offer an impressive array of features designed to maximize communication efficiency and effectiveness. Symbol-based communication allows users to select pictures, symbols, or icons representing words, phrases, or concepts. Popular symbol systems include Picture Communication Symbols (PCS), Symbolstix, and Widgit symbols. Text-to-speech functionality converts typed text into spoken words, enabling literate users to type messages that are then spoken aloud by the device.

Word prediction technology anticipates what the user is trying to say based on the first few letters typed or symbols selected, significantly increasing communication speed. Message banking and voice banking allow individuals who expect to lose their voice (such as those with ALS) to record their own speech for later use, preserving their natural voice identity.

Access Methods for High-Tech Devices

One of the remarkable aspects of modern AAC technology is the variety of ways users can control their devices. This flexibility ensures that even people with significant physical disabilities can access communication technology effectively.

Direct selection is the fastest and most intuitive access method, where users directly touch the screen or keyboard to make selections. For users who cannot point precisely with their fingers, styluses, head pointers, or mouthsticks can be used. Touch screens on tablets and dedicated devices can often be adjusted for sensitivity and dwell time to accommodate users with motor control challenges.

Switch access allows users to control devices using one or more switches that can be activated by almost any reliable, repeatable movement. Switches can be positioned to be activated by hands, feet, head, eyebrow movements, or even breath control (sip-and-puff switches). Scanning techniques present options sequentially, with the user activating the switch when the desired item is highlighted.

Eye gaze technology tracks the user's eye movements and allows selection of on-screen items simply by looking at them. Modern eye-tracking systems have become increasingly accurate and affordable, opening up communication possibilities for people with severe motor impairments who cannot reliably control any body part except their eyes.

Head tracking systems use cameras or sensors to detect head movements, translating them into cursor control on screen. This access method works well for users who have reliable head control but limited use of their hands.

Who Can Benefit from Communication Aids?

Communication aids benefit people with various conditions including stroke (aphasia), ALS/motor neuron disease, cerebral palsy, autism spectrum disorder, traumatic brain injury, Parkinson's disease, multiple sclerosis, intellectual disabilities, and childhood developmental delays. Both children and adults can benefit, and AAC can be introduced at any age without waiting to see if speech develops naturally.

The population of people who use or could benefit from AAC is remarkably diverse. Communication difficulties can arise from a wide range of conditions, occurring at any point in life from birth through old age. Understanding the various groups who may benefit from AAC helps families, educators, and healthcare providers recognize when AAC assessment and intervention might be appropriate.

Children with Developmental Conditions

Autism Spectrum Disorder (ASD) affects communication in various ways. While some individuals with autism have fluent speech, approximately 25-30% remain minimally verbal or nonverbal throughout their lives. Many others experience significant communication challenges despite having some spoken language. AAC can support communication development, reduce frustration and behavioral challenges associated with communication difficulties, and provide a reliable means of expression for thoughts, needs, and feelings.

Cerebral palsy is a group of disorders affecting movement and muscle tone caused by damage to the developing brain. Many individuals with cerebral palsy experience dysarthria, a motor speech disorder that makes speech difficult to understand. Depending on the type and severity of motor involvement, people with cerebral palsy may use AAC ranging from simple picture boards to sophisticated eye-gaze speech-generating devices.

Intellectual disabilities and genetic syndromes such as Down syndrome, Fragile X syndrome, and Angelman syndrome often affect communication development. AAC can support language learning by providing visual representations of language concepts and reducing the motor demands of speech production. Many individuals with intellectual disabilities successfully use picture-based communication systems to expand their expressive communication abilities.

Childhood apraxia of speech is a motor speech disorder that makes it difficult to plan and coordinate the movements needed for speech. Children with apraxia often understand language well but struggle to produce clear speech. AAC provides an alternative means of expression while speech therapy addresses the underlying motor planning difficulties.

Adults with Acquired Conditions

Stroke and aphasia affect millions of people worldwide each year. Aphasia, a language disorder resulting from brain damage, impairs the ability to speak, understand speech, read, and write. The severity varies widely, from mild word-finding difficulties to complete loss of language function. AAC strategies for aphasia range from simple written keyword techniques to comprehensive communication systems that support both expression and comprehension.

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease, progressively affects the nerve cells controlling voluntary muscle movement. As the disease progresses, speech becomes increasingly difficult and eventually impossible. AAC intervention for ALS often involves early voice banking to preserve the person's natural voice, followed by introduction of speech-generating devices as speech becomes less functional. Eye-gaze access becomes essential when hand control is lost.

Parkinson's disease often causes hypokinetic dysarthria, resulting in soft, monotone speech that can be difficult to hear and understand. Voice amplifiers and speech-generating devices can help maintain communication effectiveness as the disease progresses. Many people with Parkinson's also experience cognitive changes that may affect their AAC needs and learning.

Traumatic brain injury (TBI) can affect communication in multiple ways depending on the location and severity of brain damage. Some individuals experience aphasia similar to stroke survivors, while others have motor speech disorders or cognitive-communication difficulties affecting attention, memory, and executive function. AAC interventions for TBI must address the specific communication challenges present in each individual case.

Head and neck cancer and its treatments can significantly impact speech production. Surgical removal of the larynx (laryngectomy) eliminates the natural voice entirely. While some individuals learn alaryngeal speech methods such as esophageal speech or tracheoesophageal puncture (TEP) with voice prosthesis, others rely on electrolarynx devices or AAC systems for communication.

How Do I Get Assessed for a Communication Aid?

To get assessed for a communication aid, start by consulting with your doctor or neurologist for a referral to a speech-language pathologist (SLP) specializing in AAC. The assessment evaluates communication abilities, motor skills, cognitive function, vision, hearing, and daily communication needs. The SLP will recommend appropriate AAC options and provide trials with different devices before making a final selection.

Obtaining an appropriate communication aid begins with a comprehensive assessment conducted by qualified professionals. This evaluation process is essential for matching individuals with AAC systems that meet their specific needs, abilities, and preferences. A thorough assessment increases the likelihood of successful AAC outcomes and helps justify funding requests to insurance companies or government programs.

Finding AAC Services

The first step in obtaining an AAC assessment is identifying appropriate professionals and services in your area. Speech-language pathologists (SLPs) with expertise in AAC are the primary professionals conducting assessments and providing intervention. Not all SLPs specialize in AAC, so it may be necessary to seek out practitioners with specific training and experience in this area.

AAC services may be available through various channels including hospitals and rehabilitation centers, which often have AAC specialists as part of their rehabilitation teams, particularly in larger medical centers. Private speech-language pathology practices may offer AAC services, especially those specializing in adult neurological conditions or pediatric developmental disabilities. Schools and early intervention programs should provide AAC assessment and services for children with communication disabilities as part of their educational programming. University clinics associated with communication sciences and disorders programs often provide AAC services under the supervision of experienced faculty.

When seeking AAC services, it can be helpful to ask specifically about the provider's AAC experience, the range of AAC systems they work with, and whether they can conduct trials with various devices before making recommendations.

The Assessment Process

A comprehensive AAC assessment typically includes evaluation of multiple areas that influence AAC system selection and implementation:

Communication assessment examines current communication methods and their effectiveness, receptive language abilities (understanding), expressive language abilities, literacy skills including reading and spelling, and communication needs across different settings and partners.

Motor assessment evaluates hand function and pointing accuracy, seating and positioning needs, head control and range of motion, eye movement control, and potential switch sites for individuals who cannot use direct selection.

Cognitive assessment considers attention and concentration, memory and learning ability, problem-solving skills, and understanding of cause and effect relationships.

Sensory assessment examines vision including acuity, visual field, and tracking abilities, as well as hearing and any sensory processing differences that might affect AAC use.

Environmental assessment considers communication settings and partners, physical positioning and mounting needs, power and charging requirements, and transportation and portability needs.

Device Trials

An essential component of the AAC assessment process is the opportunity to try different devices and systems before making a final selection. Device trials allow users and their families to experience how different systems work in real-life situations, rather than basing decisions solely on demonstrations or descriptions.

Most AAC manufacturers and distributors offer loaner devices for trial periods, typically ranging from a few days to several weeks. Speech-language pathologists often maintain demonstration equipment and can facilitate trials with various options. Some regions have assistive technology lending libraries that allow extended borrowing of AAC devices for evaluation purposes.

During device trials, it is important to try the AAC system in multiple settings with various communication partners, to practice with the access method being considered, to evaluate whether the vocabulary and organizational structure meet the user's needs, and to assess physical factors such as weight, size, and durability.

How Can I Pay for Communication Aids?

Communication aids can be funded through various sources including health insurance (many countries require coverage for medically necessary AAC), government disability programs, charitable organizations, crowdfunding, and assistive technology loan programs. A speech-language pathologist can help navigate funding options and provide documentation needed for insurance or program applications.

The cost of AAC systems varies enormously, from essentially free low-tech options to dedicated speech-generating devices costing thousands of dollars. Understanding available funding sources and application processes can help families obtain the communication aids they need without facing insurmountable financial barriers.

Health Insurance Coverage

In many countries, health insurance policies cover speech-generating devices as durable medical equipment when medically necessary. However, coverage varies significantly between insurers and policies, and obtaining approval often requires careful documentation and persistence.

In the United States, Medicare covers speech-generating devices for beneficiaries with severe speech impairments when certain criteria are met. Private insurance coverage varies by policy, but many states have laws requiring coverage for medically necessary AAC. The Affordable Care Act's essential health benefits requirements have improved AAC coverage in many marketplace plans.

In the United Kingdom, the National Health Service (NHS) provides communication aids through regional services, though availability and waiting times vary. Equipment remains the property of the health service and must be returned if no longer needed.

In Canada, provincial assistive devices programs provide funding for AAC systems, with varying eligibility criteria and coverage amounts across provinces. Many Canadians also have private insurance that may cover AAC devices.

In Australia, the National Disability Insurance Scheme (NDIS) funds assistive technology including AAC for eligible participants. Non-NDIS participants may access support through other programs depending on their state and circumstances.

Documentation Requirements

Successful funding applications typically require comprehensive documentation supporting the medical necessity of the requested device. This documentation usually includes a detailed AAC assessment report from a qualified speech-language pathologist, medical documentation from the treating physician describing the communication disorder and its functional impact, evidence of device trials demonstrating the recommended device meets the individual's needs, and a letter of medical necessity explaining why the specific device requested is required.

Working with a speech-language pathologist experienced in AAC funding can significantly improve the chances of successful funding approval. These professionals understand what documentation is required and how to present information most effectively to support the request.

Alternative Funding Sources

When insurance coverage is unavailable or insufficient, several alternative funding sources may help:

AAC tablet apps on consumer devices like iPads offer a more affordable entry point to high-tech AAC. While dedicated devices typically cost $5,000-15,000, communication apps range from about $100-400, plus the cost of the tablet itself. Some families find this option more accessible, particularly for initial AAC trials.

Charitable organizations focused on specific disabilities often provide grants or loans for assistive technology. Examples include United Cerebral Palsy, the ALS Association, autism-focused organizations, and local disability service agencies.

Crowdfunding platforms have become a popular way to raise funds for AAC devices. Campaigns that include clear explanations of the need, photos or videos, and personal stories tend to be most successful.

Assistive technology loan programs exist in many areas, allowing families to borrow money specifically for assistive technology at favorable interest rates or to borrow equipment for extended periods.

School funding in many countries requires schools to provide assistive technology needed for students to access their education. If AAC is necessary for educational participation, the school district may be required to provide and maintain the device.

How Do I Learn to Use a Communication Aid?

Learning to use a communication aid effectively requires systematic training for both the AAC user and their communication partners (family, caregivers, teachers). Training typically includes learning device operation, vocabulary location, communication strategies, and modeling techniques. Speech-language pathologists provide initial training and ongoing support as skills develop.

Obtaining an AAC device is just the beginning of the AAC journey. Successful implementation requires systematic training and ongoing support to develop both operational competence with the device and communicative competence in using AAC for meaningful interaction. Research consistently shows that outcomes are strongly influenced by the quality and quantity of training and support provided.

User Training

Training for the AAC user focuses on several key areas. Operational skills involve learning to physically operate the device, including turning it on and off, charging the battery, adjusting volume, accessing different screens or pages, and troubleshooting common problems.

Vocabulary navigation training helps users learn where vocabulary is located within the system. Even with well-designed vocabulary organization, users need practice to develop automaticity in finding the words and symbols they need. Motor planning and muscle memory play important roles in efficient AAC use, similar to how proficient typists know keyboard locations without conscious thought.

Communication strategies training addresses how to use the AAC system effectively in real conversations. This includes learning to initiate interactions, take turns in conversation, repair communication breakdowns, and express a range of communicative functions including requesting, commenting, asking questions, sharing feelings, and telling stories.

Communication Partner Training

Perhaps even more important than user training is training for the people who interact with AAC users. Communication partners—family members, caregivers, teachers, friends, coworkers—play crucial roles in supporting successful AAC use. Research indicates that communication partner training is one of the strongest predictors of positive AAC outcomes.

Modeling is one of the most important strategies communication partners can learn. Modeling involves using the AAC system to communicate with the AAC user, demonstrating how to find vocabulary, construct messages, and use the device in natural conversation. Just as children learn spoken language by hearing it used around them, AAC users benefit tremendously from seeing their communication system used by others.

Responsive interaction strategies help partners create communication opportunities and respond supportively to AAC communication attempts. These strategies include providing adequate wait time for AAC users to compose messages, acknowledging all communication attempts even if they are incomplete or unclear, following the AAC user's lead and interests, and asking open-ended questions that invite extended responses.

Expectations and attitudes also significantly impact AAC outcomes. Partners who believe in the AAC user's communicative competence and treat them as capable communicators tend to support better outcomes than those with low expectations. Training addresses the importance of presuming competence and providing appropriate communication support rather than speaking for the AAC user.

What Are the Latest Advances in Communication Technology?

Recent advances in AAC technology include improved eye-tracking accuracy and affordability, artificial intelligence for better word prediction and voice synthesis, brain-computer interfaces for communication, natural-sounding synthesized voices that can be customized, cloud-based vocabulary sharing, and integration with smart home devices. Mobile apps have made AAC more accessible and socially acceptable.

The field of AAC has experienced remarkable technological advances in recent years, with ongoing research and development continuing to expand possibilities for people with complex communication needs. These advances are making AAC more accessible, more effective, and more socially acceptable than ever before.

Eye-Tracking Technology

Eye-gaze access has been transformed by improvements in tracking accuracy, system reliability, and cost reduction. Modern eye-tracking systems can accurately detect gaze patterns even for users with glasses, various eye conditions, or involuntary eye movements. Setup and calibration processes have become faster and more user-friendly, and devices are increasingly portable.

The cost of eye-tracking technology has decreased significantly, making it accessible to more users. While dedicated eye-gaze communication devices remain expensive, some eye-tracking solutions now work with standard computers and tablets, reducing the overall system cost.

Artificial Intelligence and Machine Learning

AI technologies are enhancing AAC in multiple ways. Improved word prediction uses machine learning algorithms to learn from each user's communication patterns, vocabulary preferences, and topics of interest, providing increasingly accurate and personalized predictions that speed up communication.

Natural language processing allows some systems to accept incomplete or grammatically simplified input and generate grammatically complete output, reducing the cognitive and motor demands of message composition.

Voice synthesis has advanced dramatically, with AI-generated voices becoming increasingly natural-sounding. Importantly, voice banking and voice cloning technologies allow individuals facing voice loss to create synthetic voices that sound like their own natural voice, preserving a crucial aspect of personal identity.

Brain-Computer Interfaces

Brain-computer interface (BCI) technology represents the cutting edge of AAC research. These systems detect brain signals associated with communication intentions and translate them into device control or direct speech output. While most BCI systems remain in research stages, they hold tremendous promise for individuals with the most severe motor impairments who cannot reliably control any body part for traditional AAC access.

Recent research has demonstrated impressive results, including systems that can decode attempted speech from brain signals with increasing accuracy. As this technology continues to develop, it may eventually provide communication options for individuals currently unable to use any AAC system.

Integration and Connectivity

Modern AAC devices increasingly integrate with other technologies, expanding their functionality beyond communication alone. Environmental control features allow AAC devices to control lights, televisions, door openers, and other home automation systems. Social media and messaging apps enable AAC users to participate in digital communication channels on an equal basis with speaking peers. Cloud-based vocabulary systems allow vocabulary customizations to sync across devices and enable sharing of vocabulary pages and strategies within the AAC community.

What Is Life Like Using Communication Aids?

Life with AAC involves adapting communication strategies for different situations, advocating for communication access, and building skills over time. AAC users report improved quality of life, better relationships, and increased independence. Challenges include communication speed, others' attitudes, and access barriers. Support from family, peers, and professionals helps navigate daily life successfully.

Understanding the lived experience of AAC use provides important perspective for individuals considering AAC, their families, and the professionals who support them. While communication aids open tremendous opportunities, using AAC also involves adapting to a different way of communicating and navigating various challenges in daily life.

Daily Life with AAC

AAC users describe both the liberating aspects of having a communication method and the ongoing effort required to use it effectively. Communication via AAC is typically slower than natural speech, requiring patience from both the user and their communication partners. Many AAC users develop strategies for different situations, perhaps using quick phrases for routine interactions and taking more time for important or complex conversations.

Access to the AAC device is an ongoing consideration. Users must ensure their device is charged, positioned correctly, and available when needed. Many AAC users keep backup communication methods available, such as a simple communication board, in case their primary device is unavailable or malfunctions.

Social interactions can present both opportunities and challenges. While AAC enables communication that might otherwise be impossible, some communication partners may be unfamiliar with AAC and unsure how to interact effectively. AAC users often take on an educational role, teaching others about their communication system and how to be supportive communication partners.

Self-Advocacy and Communication Rights

Many experienced AAC users become strong self-advocates, speaking out about communication access and disability rights. The AAC community has developed a strong peer support network, with experienced users mentoring those new to AAC, sharing strategies and vocabulary resources, and advocating for improved technology and services.

Key advocacy messages emphasized by AAC users include the importance of presuming competence, meaning that communication partners should assume AAC users have something meaningful to communicate even if their messages are incomplete or unclear. The need for communication access in all settings is also emphasized, as AAC users should have their communication devices available in schools, workplaces, healthcare settings, and the community. The right to adequate time is another important principle, recognizing that AAC communication takes longer than speech, and users deserve patient communication partners who allow sufficient time for message construction.

Quality of Life Research

Research investigating quality of life for AAC users generally shows positive outcomes associated with AAC use. Studies document improvements in social participation, educational and vocational achievement, self-determination and independence, mental health and well-being, and family functioning and relationships.

At the same time, research acknowledges ongoing challenges including frustration with communication speed, experiences of communication partners who are uncomfortable or impatient, barriers to accessing appropriate AAC services and devices, and the need for ongoing learning and adaptation as technology and needs change.