AAC devices get faster, easier, more flexible
Beware of the "wow factor." You might be wowed and amazed when learning about the latest advances in augmentative, alternative communication (AAC) devices high-tech machines that generate speech.
Like other areas of high technology, AAC is riding an impressive wave of development, and new machines on the market make use of the latest computer technology.
That's great news for people whose ability to speak has been affected by progressive diseases like amyotrophic lateral sclerosis (ALS), Friedreich's ataxia, myotonic muscular dystrophy or some myopathies. For some examples of how people with neuromuscular diseases are putting these devices to work, see "Mind Muscle."
But, if you're considering such a device, experts say, first be sure the machine meets your individual needs.
The newest AAC devices address a wide spectrum of needs that consumers have expressed, with independence as a goal. That includes having independent access to communication, the Internet and the telephone, said John Standal, director of sales for Assistive Technology Inc.
"What the manufacturers are trying to offer is a full solution for people to give them as much independence as possible," said Standal, who is also the president of Communication Aid Manufacturers Association, a nonprofit organization representing the AAC industry.
Typing and talking
While many AAC devices on the market accommodate children by incorporating symbols and pictures for creating speech, manufacturers find that a growing number of their customers are literate adults with typing or computer experience.
For many of these AAC users, a type-and-talk device with a keyboard is the first choice, and there are now more brands to choose from. Some examples are the Link Plus by Assistive Technology Inc., the DynaWrite by DynaVox, the LightWRITER and the Polyana by Toby Churchill, and the Handheld by Enkidu Research.
Some of the newest type-and-talk devices have been designed with the ALS community in mind.
|The DynaWrite by DynaVox was inspired by people with ALS.|
The needs of people with ALS inspired the DynaWrite by DynaVox. In that device a user "can see the on/off switch, type something in, and then push the speak button," said Paul Carter, DynaVox vice president of marketing.
Simplicity was a priority since a user with ALS might not be able (and caregivers might not have the opportunity) to tinker with a computerized device, he said.
"It has to be very intuitive and easy to use," Carter said.
Although they appear simple, most of these machines offer more than meets the eye.
For example, the DynaWrite can store thousands of pages of text, and it enables a user to prepare speeches, routine conversations or lengthy statements in advance. It also allows a user who's working on a long entry to switch to chat mode, have a conversation and then go back to the longer piece, Carter said.
It can be argued that this type of device was inspired by the LightWRITER, made by British company Toby Churchill and distributed in the United States by Zygo USA. It didn't hurt the LightWRITER's popularity to be featured in movies and television shows depicting characters with ALS.
"The LightWRITER really hit the ALS market years ago, and it's kind of like the cornerstone for communication devices for people who have ALS because everyone has seen it," Standal said.
The newest edition of the LightWRITER, the SL87, also includes a scanning mode. It still has the popular forward-facing display so other people can read what a user types, said Adam Weiss, a Zygo USA sales representative.
Look ma, no hands
|The Vanguard II by Prentke Romich includes access via a head-controlled mouse.|
Another recent development in the industry combines existing AAC technology with a head-operated device to make it easier to "access" or use speech generation for those with limited movement.
Prentke Romich announced last year that its Vanguard II machine can now include a built-in head mouse camera system (the Tracker technology by Madentec). That means users who can't type or push buttons but have some head movement just need to wear a small, reflective dot on their foreheads.
The dot (a sticker) is seen by a special tracking camera built into the device. The user directs the mouse arrow by slight head movements, and "dwells" or rests momentarily to make a selection (akin to a mouse click).
The new system was so well received that in March, Prentke Romich announced that three more of its machines the SpringBoard, Vantage and Pathfinder will now include a built-in Tracker as an option. Including the Tracker adds $795 to the regular price.
Portability and power
Another trend enables users to interact with or operate their personal computers via their AAC devices, or to have wireless access to the Internet.
Examples: Several Words+ machines offer wireless capability letting users get into the Web from up to 400 feet away from a cable/DSL router. DynaVox's new Series 4 gives users access to Windows-based computers with their devices.
"If youre in a wheelchair, you can just get within a visible distance of your computer and actually run your computer with the DynaWrite itself or any DynaVox speech-generating device. That was a feature that people wanted," Carter said.
Many machines already provide "environmental control" the ability to operate household appliances like lights or TV sets through the device.
Also gaining popularity are small, handheld devices built on PDA (personal digital system) platforms. Some examples include the Say-it! SAM by Words+, the Palmtop by Enkidu, the ChatPC by Saltillo, and a device by RJ Cooper that's in the developmental stages.
|Handheld devices like the ChatPC by Saltillo are popular.|
These smaller devices have plenty of useful features such as word and phrase prediction. Most of them can't accommodate switches, but they make it easy to take your conversation on the road.
Customers have also asked the industry to extend battery power in AAC devices.
"You'll see a lot of the companies are now offering wheelchair power options. The device can be plugged right into their wheelchair battery. Instead of having eight hours of communication, they can have three days of constant power," Standal said.
Other companies offer the ability to use the wheelchair joystick or head array setup as the input method for the AAC device, he said.
Certain devices boast the ability to handle just about anything they encounter, be it liquid or gravity.
Words+ says its Freedom 2000 Toughbook machines are "ruggedized": They usually still function after being dropped from about 3 feet onto a solid surface. They also can support wireless Internet access.
That's also the story with Words+ TuffTalker Convertible, a laptop-style device that converts into a portable touch screen. (Medicare funding approval for this device was pending at press time.)
Talking with your own voice
Banking your own voice for later use is no longer a futuristic dream; many people are doing it now.
Most personal computers that use common operating systems can make a recording of your voice and store it as a digital file. Then, you can upload the file and play it back on some AAC devices, such as certain models from Assistive Technology Inc., DynaVox, Words+ and Zygo, Standal said.
For example, more recent editions of Windows can make a recording with the sound recorder located in the accessories file.
Clients who have banked their own voices find it very gratifying, as do their family members, Standal said.
"It means so much to them and to their loved ones when they can actually tell someone I love you with their natural voice. Or if they're mad, telling someone get away from me with that intensity in their voice which a computer just can't duplicate," Standal said.
A greater variety of computer-generated voices is also available across various AAC brands, meaning a larger range of ages and a choice of genders.
For example, on the Link Plus by Assistive Technology Inc. six languages come standard. Words+ uses AT&T's Natural Voices, with voices sampled from real speech known for its realistic sound. DynaVox developed its own brand called VeriVox, based on recordings of actual human voices, Carter said.
Better, faster cheaper?
The future will likely include AAC devices that can operate completely wirelessly and can use Internet-enabled wireless networks. Machines that work well with cell phones are another goal for the industry.
Rate enhancement improvements to help users create speech as quickly as possible is also a target.
And, devices tailored to specific disabilities are also possible.
|The Link Plus by Assistive Technology Inc. offers a choice of voices and languages.|
"AAC devices have been fairly generic in the past. We see a great opportunity to better meet the needs of augmented communicators by creating products that take into account the client's age, physical and cognitive abilities, diagnosis, etc.," said Carter.
AAC prices, which range from about $2,300 to $8,000, aren't likely to drop since companies need to stay in line with what Medicare and insurance companies will reimburse.
Manufacturers specifically try to offer a choice of lower-cost machines in the $2,000 range since that's what MDA will pay toward the cost of an AAC device. Standal cited as an example his companys Link Plus that sells for $2,400.
But no matter how high-tech and ooh-inspiring the machines are, those who make a living selling AAC devices remind consumers not to take on this purchase alone.
If possible, work with a speech-language pathologist whos up-to-date with technology for augmentative communication, Standal said. Your local MDA clinic and the American Speech-Language Hearing Association are great first stops.
A team of experts that includes a physical therapist and an occupational therapist is best. They can help you select a machine that you can continue to use as your abilities change, said Zygos Weiss.
"Make sure it addresses all the issues," he said, "not just the wow factor."