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Most people living with ALS will experience difficulties with speech and movement as their illness progresses. Some will ultimately lose the ability to speak and use their hands. Learn more about devices that can help with communication.

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FAAST - Florida Alliance for Assistive Services & Technology

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Welcome to FAAST - Florida Alliance for Assistive Services & Technology

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FAAST is the state of Florida's assistive technology program. Assistive technology activities provided by FAAST include device loans, device demonstrations, device reutilization, device trainings, information and assistance, and a statewide financing program. FAAST serves Floridians who have disabilities and their family members, service providers, educators, therapists, employers, health and rehabilitation professionals, assistive technology vendors, procurement officials, and all other interested parties throughout the state of Florida.

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Team Gleason's mission is to provide assistive technology for people living with ALS. They can help cover the cost of federal insurance co-pays for speech-generating devices or provide loaner devices.

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NO WHITE FLAGS. It's the mantra that drives Team Gleason, a 501(c)(3) organization dedicated to serving individuals with Amyotrophic Lateral Sclerosis (ALS) - a terminal neuromuscular disease. When Steve Gleason, a former NFL special teams player for the New Orleans Saints, was diagnosed with ALS in 2011, he made it clear that he wouldn't give up - on himself, on his family, or on others also living with the disease.

In response to his diagnosis, Steve and his wife Michel founded Team Gleason to empower people with ALS to live purposeful lives. Team Gleason, through its diverse and broad-reaching programming, brings assistive technology, equipment, and robust support services into the hands of ALS patients - with a goal of helping individuals with ALS not just survive but thrive after a devastating diagnosis.

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NO WHITE FLAGS. It's the mantra that drives Team Gleason, a 501(c)(3) organization dedicated to serving individuals with Amyotrophic Lateral Sclerosis (ALS) - a terminal neuromuscular disease. When Steve Gleason, a former NFL special teams player for the New Orleans Saints, was diagnosed with ALS in 2011, he made it clear that he wouldn't give up - on himself, on his family, or on others also living with the disease.

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https://www.forbesaac.com/

us.tobiidynavox.com

https://www.prc-saltillo.com/

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iPad Apps for Complex Communication Support Needs

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iPad Apps for Complex Communication Support Needs

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How To: Laser Pointer with Communication Board

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How To: Laser Pointer with Communication Board

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Steps:

1. Paste large, readable communication boards on the walls around the house. Example areas include the bathroom wall, bedroom wall, dining room wall, living room wall, and more.

2. Secure laser pointer to glasses, hat, headband, or other wearable head gear.

3. Turn on laser pointer.

4. Communicate with others by using the laser pointer to indicate the desired message/symbol/letter on the communication board.

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iPad coverage is included for the duration of both the Manufacturer and Support 360 warranties.

Tobii Dynavox is committed to delivering our customers with comprehensive, high-quality solutions so that people can communicate in a way that meets their needs.  We are continuously improving our hardware, software, content and services despite the continued increase in costs.  While we will continue to absorb most of these costs, we will have a price increase on select AAC devices as of February 1, 2023.  We believe that the ongoing improvements in our solutions, including the increased coverage of our Support 360 warranty from one year to three years on select AAC devices, will benefit our customers and their communication needs. Current unexpired price quotes will be honored.

Find out more about Tobii Dynavox warranties:

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Get the most from your TD Pilot device. Find unboxing videos & tutorials to help you set up your TD Pilot and learn how to use eye gaze/eye tracking for iPad.

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Communication partner skills for AAC learners

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We expand the AAC user's message. For example, if the AAC user says "more", you can model back "WANT - MORE" on the AAC system.

We restate the AAC user's message. We show different ways of saying messages. eg. If the AAC users says "My turn", we could say "Oh! you are telling me you want a go", while pointing to "YOU" and "GO" on the AAC system.

6. Accept all forms of communication

Good communication partners accept that AAC users communicate using different ways, not just their communication device. AAC users may use a combination of vocalizations, words, word approximations, pointing to pictures or photos or objects, sign language, natural gestures, body language, and facial expressions, as well as their AAC system.

Often, AAC users will choose the fastest and most efficient means of communication available to them in the moment. Every method of communication has its place. Each one should be valued, respected and responded to.

An AAC user can choose when to use their AAC system. In some situations, they might choose to communicate in another way. They may say some words using their AAC system (e.g. "I want that"), while pointing to the desired object. They may point to a picture on their visual schedule (e.g. "library"), while pointing to the door. They are asking about when they are going to the library. Maybe they use their AAC to say something when their communication partner doesn't understand their unclear speech. There are so many combinations and solutions that can make communication successful.

Remember, AAC is not a test. Most people don't like to unnecessarily repeat themselves. AAC users are no different. Often an AAC user will give their message to us, using any means they have available to them. If we have understood them, then it is unfair to then expect them to say it again using their AAC system.

Here is an example: A child verbally attempts to say "more" and then points to the bottle of bubbles. They have clearly communicated that they want more bubbles. What do you do?

A. Push their AAC system in front of them and say "And now say it on your talker!", expecting them to generate the same message - " more bubbles ", but this time on their AAC system, or...

B. Do you use it as an opportunity to model and expand their language? You pick up their AAC system and say " Oh! You are telling me that ... you want more bubbles", while pressing "WANT MORE BUBBLES" on the AAC system. Or even model more language in a comment like "BUBBLES are such FUN", or " Let's BLOW them UP high", or " You GET the BUBBLES! ".

Of course, choice B is the best choice! Use every attempt at communication as a chance model language. And respect every mode of communication. It all plays a part in becoming an effective communicator.

Start building communication partner skills

Make small but powerful steps toward being a better communication partner. Think about how you model, prompt, respond and allow for all forms of communication.

Watch our "Communication partner skills" video on demand for an easy step by step introduction to the crucial strategies that communication partners can use to support AAC users.

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Communication partner skills for AAC learners - AssistiveWare

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What is a communication partner? This article explains why the people around the AAC user are important, and gives advice on how to best support and interact with AAC users.

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Daily conversations are highly interactive. They move very quickly over a range of topics. Conversations are so fast-paced that the only way we manage is to start planning our message while the other person is still talking. We predict what they will likely say, so we can prepare our response. We use non-verbal cues such as pauses, tone, eye gaze, intonation, and even breath, to predict our timing and add meaning to our messages.

For people who use Augmentative and Alternative Communication (AAC), starting and maintaining a regular conversation can be a challenge. Not only because of speed and timing, but also because of the limitations of communication device technology.

Conversational barriers for AAC users

AAC users have to balance demands of conversation while retrieving words manually on a communication device.

Some examples of how non-verbal cues and timing affect conversations for AAC users include:

1. Adding nonverbal cues can be out of time with the AAC message. They can even interrupt or disrupt the process of writing the message.

2. AAC users have to break eye contact to start generating their message.

3. When a speaking person begins planning their message, it is invisible to the person who is still talking. But if an AAC user starts generating their message at that same point, it could appear impolite.

4. AAC users often need to focus on their AAC, not to their communication partner.

5. Typing words, using text to speech, or selecting symbols is slower than retrieving speech, so AAC users have time pressures to compose their message.

Seven ways to support AAC users in conversations

All seven tips below come down to these important lessons: ask AAC users how they want to be supported. Work with them to find the best ways to encourage and support their contribution to conversations.

1. Be patient

Expect to take more time when having a conversation with an AAC user. Be patient: pause, wait and allow time for the AAC user to compose a message. Slowing the pace reduces some of the demands. It also improves understanding. Stop predicting what the other person is likely saying and listen to what they actually say. Wait for the completed message so you don't miss important words.

2. Conversation looks different

Expect that an AAC user cannot simultaneously provide the typical nonverbal cues while also using their device. The electronic voice will not provide the same cues.

3. Don't underestimate

Research suggests that conversation partners might underestimate AAC users due to the limitations of AAC systems. Speaking people interpret a slow pace, long pauses, broken eye contact, a blunt response, and missing nonverbal cues as poor communication skills. We need to understand these as the result of imperfect technology, not of a lack of skills or intelligence.

4. Invite the AAC user to set the topic

AAC users often respond to conversations, but research shows they rarely set the topic. Pause and be patient so they can start the conversation. Consider asking the AAC user if they have photos of what they are talking about. While you explore the visuals, the AAC user can compose their message.

5. Advocate for the AAC user

Ask others in the conversation to wait while the AAC user composes their message. Ask the AAC user how they can be best supported to contribute to the conversation, or if they want to continue a conversation online (e.g., via social media or email). Virtual conversations usually have fewer barriers because both people are using technology rather than speech.

6. Plan ahead

AAC users need time to compose their responses but also have some quick messages pre-stored ready to use when appropriate. Most AAC systems allow the user to plan phrases for different situations and conversations, then pre-store them and quickly retrieve them. Research suggests that many AAC users do not use all of these features. Experienced AAC users and mentors can share strategies.

7. Visual supports

Some AAC users, with speech impediments and disorders such as aphasia, struggle to retrieve words. Others access words very slowly in their AAC. It is often more efficient for them to use visual supports to set topics, such as photos, line drawings, images from the internet, or reference materials like maps. Research on communication disorders like autism and dementia shows that visuals enhance turn-taking and participation. Open and share articles or memes on social media. Write and tell stories in apps like Pictello. Point to images in a magazine.

Include and support

There are many ways that AAC users can be included and supported in conversations. Work together to find ways for AAC users to contribute and participate meaningfully.

Links and References

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7 ways to include AAC users in conversation - AssistiveWare

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This article provides tips to support AAC users to become valued contributors to conversations and discussions.

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We can find many online resources for free low-tech AAC materials for adults. There are a wide variety of pre-made communication boards in English and many other languages. In addition, we can use free online tools to make our own AAC materials.
Free DIRECT download: 3×4 Topic Board (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Pre-made low-tech AAC materials

Amy's Speech & Language Therapy, inc

Amy's Speech & Language Therapy offers a wide variety of low-tech AAC communication boards for adults and children. She also includes instructions on how to use AAC tools. Her boards include:

Aphasia.com

Aphasia.com offers several pre-made communication boards:

Aphasia wallet cards

Boston Children's Hospital

Boston Children's Hospital offers several great free resources for low-tech AAC communication.

A-E-I-O-U Communication Book.

Customizable tabbed communication flip book.

Training video for partner-assisted scanning.

60+ pages of common messages (last line under Legacy Messages).

Centre for Cultural Diversity in Aging

The Centre for Cultural Diversity in Aging is situated in Australia. They offer a large set of communication cards in 37 languages.

You can choose to download either four pictures per page or 12 pictures per page.

The communication pictures are organized by theme.

Food/drink/meals.

Religion and spirituality.

Medical and health specialists.

Personal care.

Clothing.

Sleep.

Recreation.

Feelings/pain.

Mobility aids.

Check out this excellent six-page topic board on the Coronavirus / COVID-19. You can use this as a topic board, or as visual support for when you educate.

Also, PrAActical AAC posted a great list of resources for children and adults about COVID-19.

And finally, check out the patient-friendly COVID-19 resources in English and some in Spanish.

Do2Learn

Do2Learn offers several free low-tech AAC communication boards on a variety of topics:

You can choose to print 1-inch or 2-inch pictures, with or without labels. You can also download full-page images with labels.

Eastern Health

Eastern Health offers free communication boards in 69 languages.

You have to input your name, organization, and email address to satisfy their grant requirement. But you don't have to check the box to receive news and updates.

Once you submit your information, you're redirected to the page with one or two download options for each language. Most languages offer a choice of four per page or a max of 20 per page.

The images are arranged by topic:

Basics.

Instructions.

Family.

Community.

Descriptions.

Medical terms.

Objects.

Professions.

Religion.

Time/Days.

Pain scale.

Dental.

Food.

Allergies.

Utensils and appliances.

Home assist / items / activities / problems.

Personal items.

Health issues.

Holidays and life events.

Institute on Disabilities at Temple University

The Institute on Disabilities at Temple University has a nice list of low-tech AAC tools. For instance:

Patient Provider Communication

Patient Provider Communication is an international collaboration of people working to improve communication in all areas of health care. They offer a wide-variety of free low-tech AAC tools, including:

Advance directives and DNR.

Alphabet boards.

Appointments.

Bedside communication tools.

Daily care.

Dysphagia icons.

Emergency Communication.

Eye-gaze boards.

Facilitation strategies.

Health symbols.

Medical procedures.

Multi-language materials.

Yes/No/Can't answer.

Speaking of Speech

Speaking of Speech offers free hospital communication boards.

Widget Health offers free low-tech AAC materials for patients and professionals.

Make your own AAC materials

ARASAAC

ARASAAC offers a large database of images and videos that you can download for free.

English, Spanish, and 17 other languages.

Large database of images and videos.

Several tools including modify images and make gifs.

Create picture boards, schedules, calendars, and BINGO cards.

PrAACtical AAC selected ARASAAC as a featured site of the month.

ConnectAbility

ConnectAbility is geared to children, but many of the photos and images would be appropriate for adults. You can also upload your own images.

1, 2, 4, 6, 12, or 16 images per page.

English, Spanish, French, and Dutch.

Search small database of photos and images or upload your own.

Print or save to PDF.

Easy on the i

Easy on the i is part of the Learning Disability Service at Leeds and York Partnership NHS Foundation Trust.

Library contains more than 3,500 symbols.

Download the symbols to use.

Open Symbols

Open Symbols is a collection of open-licensed images that you can download for to use in your own materials.

More than 50,000 images.

ARASAAC.

CoughDrop Symbols.

IcoMoon.

IconArchive.

LanguageCraft.

Mulberry Symbols.

Sclera Symbols.

Tawasol.

The Noun Project.

Twitter Emoji.

Make your own basic word art.

Pics4Learning

Pics4Learning offers collections of photographs that are permissible to use for educational purposes. There are many sets of photos, including:

Picto4Me

Picto4me is a free web app that works within Google Drive. You can easily make AAC communication pages and share to your client's mobile device by scanning a QR code.

English, French.

Can record audio.

Supports voice output and scanning.

Can choose 1 - 10 columns and 1 - 10 rows.

You should be able to download your boards as a PDF, but I wasn't able to figure that out.

Picto-Selector

Picto-Selector is an app to support creating visual schedules, and of course can be used for low-tech AAC boards. It works with Windows and Mac OS.

More than 28,000 images or upload your own.

English, Spanish, and 6 - 10 other languages.

Many editing options.

Print or download as PDF or image file.

SEN Teacher

SEN Teacher caters to special education, but their Quick AAC Photo Card tool is very suitable for adults.

More places to find free images

We have many options for finding additional free images, besides taking photos or creating our own. I've included several sites below, but see the Buffer Marketing Library. and Lyrical Host for more.

Canva

Canva is the platform I use to create the featured image banner for each blog post. The free account includes access to thousands of free photos and icons.

FreeDigitalPhotos.net

You can download free photographs and images from FreeDigitalPhotos.net. There are many categories, including:

Food and drink.

Health and beauty.

Holidays and events.

Metaphors and symbols.

Objects.

People.

Sports and leisure.

FreeImages.com

FreeImages.com offers over 300,000 free images. You can use images for personal and commercial purposes, but as always, check out the license agreement.

You can search by keyword or browse one of their 26 categories, including:

Food & Drink.

Holidays & Festivals.

People & Families.

Sports & Fitness.

Transportation.

Health & Medical.

Outdoor activities.

Religion.

Signs & Symbols.

Jopwell Collection

The Jopwell Collection is free to use as long as you visibly attribute "Jopwell". The collection features students and professionals of Black, Latino/Hispanic, and Native American backgrounds.

The images are organized by topic, including:

KaboomPics.com

KaboomPics.com is Karolina's project and offers over 15,000 images for free. She shares her content under her own license, which allows you to use it for personal or commercial purposes.

You can search by category, color, and orientation of image. You can also search by newest, oldest, most downloaded, and least downloaded.

nappy.co

nappy.co offers free photos of people from diverse backgrounds under the Creative Commons Zero license. The images are free to use however you like without attribution, although of course it's encouraged to do so. You can browse or search. Images are also grouped by topic:

Pexels

Pexels offers hundreds of thousands of free photos and videos. You can modify photos and use them without attribution (thought it's appreciated to give credit). There are a few other rules.

Search pictures by the dominant color.

Browse collections by topic or theme.

Search by keyword.

Pixabay

Pixabay shares over 1.8 million photos, illustrations, vector art, and videos. All of Pixabay's content is free to use for commercial and non-commercial purposes, although there are some rules.

You can search by image type, color, size, and orientation of image. Pixabay tags its content in 20 categories, including:

Computer/Communication.

Emotions.

Food/Drink.

Health/Medical.

People.

Sports.

Transportation/Traffic.

Unsplash

Unsplash offers over 1.5 million photos for free, unrestricted use under their own license. I've found many of the images I use on my website here.

You can search, browse, or look through collections curated by users. They have some interesting collections, including:

Women of Color in Tech (WOCinTech)

You can find over 500 images featuring WOCinTech, which are free to use as long as you give attribution. The photos are organized into three albums, or you can browse through the photo stream.

Related Eat, Speak, & Think posts
Free DIRECT download: 3×4 Topic Board (patient handout). (Email subscribers get free access to all the resources in the Free Subscription Library.)
What are your favorite low-tech AAC resources?

I'm sure that there are many other useful online resources for making low-tech AAC materials. What are your favorite resources?

Featured image is a communication board I made for a patient using SEN Teacher's Quick AAC Photo Card tool. You can download it above.

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Free low-tech AAC for adults - EatSpeakThink.com

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Find free low-tech AAC resources for adults. Find links and descriptions of sites where you can find pre-made materials or make your own.

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Planning for communication when AAC is not available

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Sofia woke up in the hospital with no memory of how she got there. She learned, later, that she collapsed at work. She woke in a hospital without her AAC and was unable to ask for it. The nurse who responded to the call bell did not seem to know that Sofia cannot speak. Sofia usually types to communicate, but she suddenly found herself barely able to control her hands and tethered to an IV and monitors.

Daniel usually types his messages or selects symbols on his AAC. Occasionally, however, he becomes very stressed and is unable to clearly form messages. Over time, Daniel and his sister developed a strategy where she lists possible messages in a specific order every time she sees him approaching this state. She starts by saying "I can see something is wrong, Daniel. Is it the noise?" She pauses, and if he doesn't respond, she continues down a list of possible problems that he needs help to resolve. At times when Daniel cannot form messages, he finds it much easier to simply respond to options. Daniel and his sister do not know there is a word for their strategy: partner-assisted scanning. They just know it works for those times when he struggles the most with communication.

AAC unavailable: make a plan

Every Augmentative and Alternative Communication user is likely to experience environments where their AAC is not easily accessed. Perhaps, the AAC system is broken or out of charge. The screen may be uncomfortably bright at night in bed, while it may not be bright enough outside on a sunny day. At worst, the AAC user could experience an emergency, and end up separated from their AAC.

Although many AAC users we interviewed described multiple tools they use to communicate - matching the right communication tool to the right task - few had a back-up plan for what they would do if they could suddenly no longer access their high-tech AAC.

Make sure you have a plan for how you will communicate if your AAC is not there. Include options in case your ability to access your AAC changes, for example, if you are suddenly unable to use your hands the way you do now.

8 Key strategies when AAC is not available

These practical tips can ensure you have a solid back-up plan for unexpected situations where AAC is unavailable.

1. Ask for AAC

If AAC is not immediately available, and if the AAC user cannot simply go get it, practice ways to ask for it.

Some strategies include:

Wrist bands or symbol cards to indicate that they need their AAC.

"Calling out" or vocalizing to get the attention of their communication partner.

A single-message button programmed to say "Please get my AAC system". Single-message buttons are even available as wearable technology, such as a single-message watch or keychain.

A laminated information page that the person carries to share how they communicate, and asking someone to get their AAC system.

2. Be a good communication partner

Communication partners need to be responsive to nonverbal signals that suggest AAC is needed, such as when the AAC user reaches towards or looks at their device. Even when the AAC user is unclear or unable to ask for their AAC, good communication partners take the initiative to invite the use of AAC. AAC should be offered, but not required.

3. Use paper-based alternatives

It is often important to have experience with light-tech paper-based versions of AAC because these can become important back-ups for when usual AAC is not available.

Create a paper-based copy of the AAC system. Print screen captures of the key pages in the AAC system and laminate them or place in a folder or binder.

Those who type on an iPad to communicate can make a print-out of the alphabet or keyboard in their AAC system.

Practice with a low-tech letter-board. This goes for both AAC users and their communication partners. A letter board might be offered in certain care environments, like the hospital. AAC users who are already familiar with using paper-based alternatives are more likely to adapt quickly in different situations when they need to communicate in a different way. In addition, paper-based boards can be helpful in environments or situations where an electronic device may not work well (bright sunlight, swimming pool).

Boards such as these can be fixed to predictable locations so they are easy to access. They can even be enlarged so they become highly visible tools to be used in the environment.

Download a core word board with a symbol-based display of common words and a letter/alphabet board.

4. Use multimodal communication

AAC users are often very strategic at learning to communicate common messages in multiple ways. These multimodal strategies include gestures and pointing, photos or pictures on a phone, drawing or writing, using Google searches, and with body language and facial expression. Any and all of these different ways to communicate help provide back up to AAC.

5. Point to real objects

It is often just as quick and easy to communicate simple wants and needs by using real objects in the environment. Parents and educators may be tempted to encourage AAC learners to "use their words" rather than point to people or objects, but indicating real objects is a helpful backup strategy when AAC is not available.

6. Include visual material

Visuals enhance communication. An AAC user might point to a photo frame on the shelf of their family home or show a photo in their camera roll to set the topic of conversation. Encourage this flexibility with visual materials.

7. Use multiple access methods

Many AAC users have complex bodies. At times this can affect their ability to access their AAC effectively in the way they do normally. For example, during sensory overload, it may be difficult for an AAC user to both look at and point to their AAC. They may benefit from using a different way to access their AAC at that time, such as partner-assisted scanning.

8. Practice Partner-Assisted Scanning

Partner-assisted scanning is a useful strategy for any AAC user. The AAC user listens to their communication partner as they list (or scan) various words, then indicate their preference when they hear or see the word they want. Partner-assisted scanning becomes more efficient and reliable as the AAC user and the communication partner become more experienced with the strategy.

More about partner-assisted scanning:

The AAC user needs to have an effective and understandable way to indicate their preference, to say 'That's the one I want'. It could be with a 'Yes' response, a head or body movement, a facial expression, or the pressing of a switch.

Any communication can be done with partner-assisted scanning. A communication partner can list the words of any topic for an AAC user to select from. This can be a crucial back-up strategy only used in moments when they are unable to access their usual AAC.

Links and References

Bertram, Mary-Louise. (2015). JW PODD auditory +visual scanning. [YouTube video]

Cincinnati Children's, (2011). Communicating with Partner Assisted Scanning. [YouTube video]

Communication Disabilities Access Canada. (2013). Making a communication access card (PDF) and blank communication access card (PDF).

Hartmann, A & Sheldon, E. (2019). Just Ask: What we can learn from AAC users. [Blog post]

Low Tech Solutions. (2011). Partner Assisted Auditory Scanning - ALS. [YouTube video]

Project Core, Partner-assisted scanning quick reference sheet, Center for Literacy & Disability Studies at UNC Chapel Hill.

We Speak PODD. (2016). Close up demonstration of PODD with partner assisted audio/visual scanning. [YouTube video]

Zangari, Carole (2017). Emergency Preparedness for the AAC Family, Praactical AAC. [Blog post]

Zangari, Carole (2012). Five Under-Used Strategies in AAC, PrAACtical AAC. [Blog post]

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Planning for communication when AAC is not available - AssistiveWare

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Help with making plans to support all forms of communication, especially when AAC is not available.