DEVICES AVAILABLE for ASSISTIVE, AUGMENTATIVE and ALTERNATIVE COMMUNICATION
This overview is presented by Luminaud, Inc., to give an idea of the wide range of communication assistance devices available and to acquaint you with some of the prominent names in the field of assistive communication, though we do not claim to include every company and product. We hope it will be useful as you "dig in" to assist each person in your care to develop suitable communication.
ELECTRONIC ARTIFICIAL LARYNGES (ALs or ALDs)
These battery powered devices provide a vocal tone for people who cannot produce sound for speech but who have the cognition and tongue/jaw control to shape words properly. ALs, though tending to sound somewhat mechanical or robotic, allow reasonably normal conversation in social, medical, educational and work situations, including operating voice activated computers. People who might benefit from the use of an artificial larynx include those who:
Have been temporarily or permanently tracheotomized.
Are on ventilators.
Have had laryngectomy surgery.
Have paralyzed vocal cords.
Have crushed, burned or otherwise damaged vocal cords.
Very occasionally, those affected by strokes or brain damage.
Occasionally, stutterers, to help alter speech patterns.
ALs must put electronically generated sound into the mouth so it can be formed into speech. This is done by transferring the sound energy through the tissues of the neck/throat, by ducting it through a tube inserted into the mouth or by generating the sound in a false upper palate.
ALs have many variables to consider - shape, size, weight, volume, pitch and inflection controls, off-on controls, battery type, battery recharging or replacement needs, moisture resistance, care and maintenance requirements, and cost.
Neck-type ALs allow normal pronunciation because there is no tube or extra palate in the mouth, but many people are not able to use them because of the condition of the throat or problems in placement due to other equipment being used. They require good use of at least one hand and arm. Brands readily available in the U.S. include Denrick, Bruce Medical/Jedcom, Nu-Vois, Optivox, Romet, Servox, SolaTone, SPKR, TruTone.
Mouth-tube ALs make some sounds more difficult to pronounce, but can be used by almost anyone with reasonable tongue control, since they don't require contact with the neck. Many neck-type units have oral adapters so that they can be converted from one use to the other. The Cooper-Rand is a dedicated mouth-tube device with a 2-piece design which makes it easily adaptable for those with little or no use of hands or arms.
Palate ALs do not require hand holding or neck involvement, but must be fitted to the individual by medical/dental professionals, which makes them more expensive than the other types and unsuitable for temporary use. The Ultra-Voice is a palate device with a wireless hand controlled switch that can be kept in the pocket.
PNEUMATIC ALs - Tokyo, Dutch - duct exhaled air from the tracheostoma through an external tube, containing a vibratory device, into the mouth. These are less expensive to purchase and operate, with no batteries or electronic components and more natural sound - but they require a large diameter tube in the mouth and some people find handling awkward or that use takes two hands.
Personal, portable voice amplifiers (usually battery powered) are a great help to people with weak voices and throat problems (ie: vocal nodules, esophageal speech, Parkinson's, emphysema, ALS, MS, etc.)Some are also very useful for people with regular voices who want to be heard in a large or noisy area without shouting or voice strain (teachers, tour guides, factory supervisors, people leading meetings or recreational events). The advantages of amplifier use, besides the obvious benefit of allowing the speaker to make him/herself heard more easily, include:
Resting the throat to allow healing or avoid further damage in various throat conditions.
Less fatiguing speech for those with limited lung capacity or weakened muscles in throat or chest.
Longer phrasing for esophageal speakers.
More pleasant, more natural, more accurate, less frustrating and less time consuming communication between a person with a weak voice and a relative, friend or caregiver.
Better listener understanding. People with hearing problems and those on the edges of a group can hear and understand more easily without as intense strain and concentration.
Helping develop poise/confidence in students or those not accustomed to public speaking.
Making student, senior citizen, etc. events seem more "special," enhancing the pleasure of both participants and audience.
Appropriate compliance with ADA requirements for accommodation in the workplace and at public meetings and events for people with voice volume impairment.
Personal amplifiers range from 8 oz. shirt-pocket size though purse size units with shoulder straps to suitcase size "powerhouses." Some of the larger devices include an input jack for an additional microphone and/or input for a radio or tape recorder or audio equipment, allowing amplification of broadcast or prerecorded material, singing along to music., etc. - a valuable asset for schools, churches, organizations. Larger units may also have a line power option. Prices vary from about $50 to several hundred dollars.
Many microphone choices allow hands-free use. Gooseneck mounts are often suitable for wheelchair, desk or bed positioning. Wireless microphones allow larger units to be set down while the user moves around the room unencumbered.
NOTE: In using personal amplifiers, especially if the voice is weak, it is essential that the microphone be almost touching the lower lip - this provides the best sound quality and greatest amplification with the least feedback problem. Lavaliere and lapel mics are not suitable for weak voices. Throat and bone conduction mics are not likely to be satisfactory due to poor transference of a weak voice through throat tissue and because they pick up swallowing and other body sounds, beard and hair noises, etc.
Manufacturers of personal voice amplifiers include Anchor Audio, Luminaud, Nady, Perma Power Electronics, Radio Shack, Sound Masters, Stanton Magnetics, Williams Sound.
SIGNAL, ALERT AND ALARM DEVICES can be used by anyone - weak voice, speech impairment, no voice, regular voice - to signal someone at a distance, to call for help in a medical or safety emergency, or as a vocal medical alert. Wireless Personal Pager, Speak-A-Tag, several phone related systems.
ELECTRONIC SPEECH ENHANCER An amplification system designed to assist people who have both voice volume limitations and some forms of dysarthria. Available from ESE Co.
ELECTRONIC COMMUNICATION & MESSAGE BOARDS, COMPUTER SYSTEMS are useful for people who can produce vocal tones but cannot form understandable words and for those who are unable to produce vocal tones and also unable to use an artificial larynx. Depending on need, their use may be:
Short term - post-op, post-stroke, post head injury, etc., until regular speech is regained.
Occasional - emergency room, calling for help, phone use for laryngectomees and people with aphasia or stuttering problems, backup when regular means of speech is not usable, verbal memos to and from those who are blind or illiterate.
Long term or permanent - when natural speech or use of an artificial larynx will not be possible.
Almost any level of cognition, any movement capability, any output preference can be accommodated with choices such as
Prices range from about $100 for a unit that will provide 4 programmable messages to several thousand dollars for eye-gaze operated units that will speak and type. For computers, communication aids companies can provide software systems or develop programs on a custom basis. (Also see SWITCHES). Companies providing this equipment include the members of theCommunications Aids Manufacturers Association, Cannon Communicator and many others.
SWITCHESto operate communication, leisure, daily living, educational and testing devices, are available for almost any kind of movement capability, from gross and/or spastic movement through very limited range of motion to mere touch to just close proximity. Apple, IBM and many other computers have adapter boards to allow operation with single switch input. Major sources of specialized switches include Ablenet, Don Johnson, Luminaud, Prentke Romich, Radio Shack, Speller Teller, Tash, Toys for Special Children, Zygo.
PICTURE CARDS, PICTURE BOARDS, STICKERS - NOT JUST FOR CHILDREN ANYMORE
These come in a great variety to suit age, sex, ethnic background and many kinds of activities and interests. Card holder choices allow handling and presentation according to individual capability and preference. Cards and picture boards are especially suitable for short-term needs, and for people who feel more comfortable not "making noise" with electronic devices. Can be obtained from some of the members of the Communications Aids Manufactures Assn., Attainment, Imaginart, Interactive Theraputics and many others.