Ask Our Experts
By Alisa Brownlee, ATP
Clinical Manager, Assistive Technology Services, ALS Association Greater Philadelphia Chapter and Assistive Technology Consultant to the National ALS Association.
The Greater Philadelphia Chapter implemented an innovative Assistive Technology Program in 1993. I have been with the Chapter since 1996 and for the past fourteen years, have seen assistive technology significantly improve the lives of those living with ALS. Technology has continued to change and morph as the years pass and now people with disabilities have many choices that can help them communicate.
The information below is to help you have a better understanding of Augmentative Communication and techology.
Do you have questions about assistive technology (AT) or any of our AT programs? Then ask our AT team:
Amarja Desai, MS OTR/L
Assistive Technology Specialist
Rachell Westby, M.C.D., CCC-SLP
Assistive Technology Program Manager
DC and Northern Virginia:
Assistive Technology Specialist
DC/MD/VA chapter and Assistive Technology
Our AT team’s job is to use technology to aide in getting a person with ALS actively and independently participating in day-to-day activities including: communicating with family, friends, community, and medical staff as well as controlling their environment. Most persons with ALS experience difficulty with speech and movement during the course of their illness. Some will completely lose their ability to speak and to use their hands. The inability to speak and or move independently is frustrating and emotionally devastating. There are many different forms of assistive technology on the market that allow for aides to communication, environmental controls, and computer access. Our team provides training on these high tech, lite tech, and low tech devices. In addition to training, our team loans out assistive technology equipment via our loan library to those who need finical assistance in getting equipment.
What is AAC?
The term “Augmentative/Alternative Communication” (AAC) refers to any mode of communication other than speech. When Medicare began paying for communication devices in 2001, they decided to refer to AAC devices as SGD’s—Speech Generating Devices. The acronyms are interchangeable). AAC includes systems such as sign language, symbol or picture boards, and electronic devices with digitized and synthesized speech. Although the same systems can be used for either augmentative communication or alternative communication, there is a difference between the two. Augmentative systems are used by people to supplement what the person is able to say verbally because their speech is either limited or unintelligible to others. Alternative communication is the term used when a person has no speech. These people must completely rely on another method to make all of their ideas, wants, or needs known.
Electronic communication devices are used by anyone that cannot make themselves verbally understood. Many different electronic communication systems are available. Some communication systems are custom designed for a specific user or can only be used in specific situations. For example, a communication system that works through a desktop computer cannot travel with the patient to doctor visits, but a laptop or notebook computer is more portable and will allow the patient to travel with the system.
Electronic communication devices can be broken down into two categories: dedicated and undedicated systems. A dedicated device is strictly a communication device—the only thing it does is speak. Undedicated devices, which are computer based, not only speak, but also feature all the functions of a regular PC or laptop—word processing, e-mail, web surfing, etc.
Voice output on a device is either digitized or synthesized. A digitized voice utilizes recorded human speech. Synthesized speech devices use computer- generated speech. Digitized devices, although more “normal” sounding, are limiting because they can only say the words or phrases programmed on the device. They do not allow for free- thinking. Synthesized devices allow the user to have pre-programmed phrases or words and also have the ability to spell out novel thoughts. There are devices that allow for both.
Communication devices and computers can be accessed several ways. The term “access” refers to the way the individual will operate the communication system. For example, one individual may use fingers for typing, with another moving the eyes to point at letters, thereby spelling words. An access method for an individual will often change as the disease progressively leads to weakening of different areas of the body. This means that a patient who at one point uses hands for communication may lose this ability and eventually have to use another access method. It is important for each individual to know that communication does not have to stop simply because hands become weak and typing is no longer possible. Direct access refers to “touch”; switch access refers to special tools “switches” that comes in various shapes, sizes, and varying sensitivity to touch. Switches are strategically placed for various body movements, and they are not always placed for hand operation. They can be used with someone’s hand, face, foot, elbow, knee etc. Some switches require only proximal movement, so there is no pressure needed for touch to activate it. Higher tech access methods include head tracking, eye gaze, and EMG signal.
Head tracking is an access method for a communication device, computer, and some tablets in which head movements are tracked by an infrared camera, webcam camera, and/or a gyroscope and then translated into mouse movement on the screen. Special software allows the user to "dwell" on an icon to “open” or select an item on screen or select a letter. When “dwell” (timed stoppage on a letter) is used with an onscreen keyboard, the computer will then type the letter they are dwelling on. There are several products on the market that use head tracking technology and they are about $500-$2,000 and are not covered under insurance for computer use. (They would be covered if they were part of a communication system but if the user simply wants computer access through a head tracking, that is not covered). Web cam head tracking software are often free to low cost software for PC and MAC use.
Eye Gaze Technology
For higher tech computer access there are several “eye gaze” computer systems on the market. These high priced specialty computers relay strictly on eye movement for activation. This type of machine is used by people that have little or no muscle movement left on their bodies. In order to use eye gaze systems, the user remains still and moves their eyes to use this computer. A special camera using infrared technology tracks your retina movement. Special software is loaded into the computer and allows the user to have full access by simply moving their eyes around the screen. This equipment ranges around $10,000-$25,000.00. There are some drawbacks though—most of the systems can’t function in natural light so the individual must live/work with shades down and minimum natural light. Producers of eye gaze systems are:
Eye Gaze: used for computer access and/or communication device access
a. Computer access:
i. The PC Eye Go (not paid for by insurance) http://www.tobiiati-webshop.com/products/tobii-pceye-go
ii. The PC Eye Go mobile unit (not paid for by insurance) http://www.tobiidynavox.com/eyemobile/
b. Both communication and computer access:
i. I series plus by TobiiDynavox http://www.tobiidynavox.com/iseriesplus/
ii. Eye gaze edge by LC technologies http://www.eyegaze.com/eye-tracking-assistive-technology-device/
iii. Accent with NuEye by PRC http://www.prentrom.com/
iv. FRS solutions: http://www.frs-solutions.com/content/ALS
(no local reps)
In the past, communication devices were not a covered item under insurance policies. In 2001, Medicare and most private insurances will only pay 80% of that cost leaving a 20% co-pay for families. Not everyone gets a communication device because of insurance issues, lack of interest, and/or late initiation of the evaluation process needed to obtain one.
EMG Signal Technology
One product on the market is bionic in that EMG signal technology uses EMG signals that your brain sends to the muscles for movement. This technology taps into that signal and translates it to movement on the computer screen that allows one to operate all of the computer functions as well as communication software. One product on the market is bionic in that it can adjust to the ability to pick up the signal no matter how strong or weak it is:
Control bionics: Neuroswitch - http://www.controlbionics.com/ used on a MAC with apple switch control and is not currently covered by insurance
ALS Assistive Technology Blog
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