The Power of Augmentative and Alternative Communication Day to day communication involves various modes of expression. People are known for thier facial expressions and/or hand gestures, others are wonderful writers and singers, some people mime or sign. In our current technologically driven society, people carry blackberries, palm pilots, and have cellular phones that take pictures. We all rely on the ability to convey feelings, ideas, thoughts, and needs throughout the day no matter what the mechanism. Communication is essential to living. Individuals who experience bulbar ALS symptoms ~ muscle weakness in the mouth and throat may become less capable of expressing themselves verbally due to the progressive loss of oral muscle strength and movement. Consequently, they must then rely on other means to express themselves. Augmentative and Alternative Communication (AAC) refers to any means of communication used to supplement existing speech or act as an alternative to natural speech. A speech generating device (SGD) is a term used to identify a system that provides voice output. We can consider AAC as a means of “aiding” verbal output. AAC is an important aspect of the speech and language pathologist's work with ALS patients. AAC is incorporated into patient's plan of care early into speech change. The goal is to help supplement voice activity and communication so as to help conserve muscle energy (keep the muscles of speech stronger) as well as meet one's communication needs in many areas of their lives. Certain aids are considered to be non-"tech"nology based, e.g., using speaking strategies in order to enhance your intelligibility, use of gestures, or facial expressions. Others are considered low-tech aids such as writing and communication boards containing letters, numbers, pictures, and/or key words. Some individuals use eye-link, a means of spelling via eye movements. Based on context and external cues, a listener can often predict what the speaker is beginning to say or spell. This facilitation reduces the work of the individual who is trying to conserve energy. Voice amplification is a simple means of empowering your voice in order to eliminate vocal intensity and strain. Use of a small amplifier and microphone selected for your comfort, allows even a whisper like voice to become audible. A common theme among our staff is the encouragement for our patients to conserve energy. Voice use expends energy and the louder we speak or the more effortful speaking becomes, the more energy is required and used. A circular pattern develops when fatigue occurs and speaking demands continue. High-Tech aids include electronic devices that range from small hand-held devices to computer based systems. There are numerous companies that offer AAC options for individuals with a variety of technology skills. Devices that are appropriate for people with ALS typically include ones that offer spontaneous speech as well as preprogrammed messages. Input to a device is usually composed from a spelling method. In some cases, picture based selection is used. Additional features include word prediction and abbreviation expansion. The former provides the speller with choices for completing a word. This decreases the amount of keystrokes and thus, can help reduce fatigue. The latter term, abbreviation expansion, refers to preprogrammed messages accessed by selecting one or two characters. This feature is an efficient way of using frequently needed messages, e.g., your name, address. Devices can be as simple as a standard keyboard with a screen and voice output or as advanced as computer use via eye movement or even brain activity to access the system. Some patients use touch screens or scanning features. For individuals who are unable to type, there are different switches that can be placed near a muscle that can provide even the slightest movement. Switches may be in the form of a touch pad, button, lever, or infrared use. Some of our patients access a device via eye blink, chin movement, foot movement or head control. Devices can be mounted to a wheelchair and positioned to accommodate various sitting positions. The choice of a device can be overwhelming, especially for someone who does not have much experience with computers and technology. A speech language pathologist trained in AAC can assist you in choosing an appropriate device suited for your needs. Knowledge about ALS is critical when gathering information regarding selection methods, scanning needs, portability of the device, adaptability of the device, and other possible uses of the device, e.g., environmental control, Internet access, word processing. While the concept of AAC use can be a difficult adjustment and thinking about “robotic” speech seems artificial, it is amazing to see how comfortable people become using AAC and how their lives flourish. Like anything, AAC use takes practice, patience, and comfort. The benefits are tremendous and the gift of communication is preserved. There are certain programs that are available through the Internet for free downloading. These allow people to use their home computer (with a speaker) as a communication device. An AAC specialist and technology expert can modify a current system with a different mouse for easier control. Listed below are some of the free services available online. www.etriloquist.com --- free speech software www.readplease.com ---- free speech software www.march-of-faces.org -- free onscreen keyboard www.inference.phy.cam.ac.uk ---- a means of typing without use of keyboard Currently, Medicare approves certain dedicated communication devices for patients with ALS, and the Muscular Dystrophy Association (MDA) has a special grant program to assist ALS patients in obtaining communication devices or portions there of that insurance does not cover. Call your local MDA office to find out more. Keep communicating! For more information on augmentative communication devices and evaluation centers contact your ALS speech therapist or local MDA office for a referral.