Last updated 8/28/23
Take a look at the links below for ideas on ways to be proactive about speech and communication symptoms of ALS.
Note that the Susan Mast ALS Foundation will no longer have a speech language pathologist on staff and this post is presented for general informational purposes only. Jim’s Voice program updates are here. Please direct individual questions and concerns to your own medical team, which may include your neurologist, speech language pathologist, ALS clinic, physician, and other professionals.
- General ALS Speech & Communication Information
- DIY Communication Tools
- Personal Voice Amplifiers
- Voice and Message Banking
- Augmentative & Alternative Communication Apps
- Speech Generating Devices with Eye Gaze
- Low Tech Speech Generating Devices
- Other Low- and Mid-Tech AAC
- Alerting & Call Bells
- Assistive Technology Resources
General ALS Speech & Communication Information
Many pALS experience some degree of speech/voice impairment, which can range from fatigue with talking to being unable to produce speech that others can understand. The following resources provide information on possible speech changes and overviews of communication supports matched with the stages of speech change a pALS may experience. Some pALS have shared that it can be overwhelming to take in information about the full range of speech impairment and equipment. If this is the case for you, talk with your speech language pathologist about your individual situation and consider enlisting the support of a trusted person to preview and read this information with you.
- Les Turner ALS Communication Guide
- Les Turner Communication & Assistive Technology Webinar (Youtube)
- FYI: Suggestions and Information about Speech Changes & Augmentative Alternative Communication (AAC) – ALS Association
- ALS Communication Devices – Your ALS Guide
- ALS/MND – AAC Institute
DIY Communication Tools
Regardless of your primary communication method, becoming familiar with easy access tools and strategies is an essential part of being prepared for any communication situation. Some pALS prefer to use these tools regularly, while others simply learn about them and keep them easily accessible just in case.
Free Printable Communication Boards
- Susan Mast ALS Foundation Communication Boards and Communication Book: These printable communication boards were created by our 2022 interns from the Kent Career Tech Center Graphic Design program.
- BCH Jay S. Fishman ALS Augmentative Communication Program: Free printable alphabet and flipbooks with video instructions
- AlphaCore: Free printable PDF of the AlphaCore board at the bottom of the page
Low-Tech Eye Gaze Communication
- Vocal Eyes: An explanation of the homemade eye gaze communication system created by musician Jason Becker and his father
- Vocal Eyes Video Demo
- E-Tran DIY Tutorial: E-tran is a low-tech eye gaze communication board that can be made at home or purchased.
- Speakbook: Free printable eye gaze communication book with video tutorial. This was invented by a pALS.
- Eye link: Another low-tech eye gaze alphabet board that can be made at home or purchased
Online Tools for Custom Communication Boards
- Board Builder: Free online board maker that works with CBoard or Cough Drop communication apps or printable boards
- CBoard: Free icon-based communication board and app. Has voice output, printable, browser based.
- Noun Project: Free and paid icons and photos for creating communication boards
Personal Voice Amplifiers
Personal voice amplifiers can boost the loudness of natural speech, which can help to reduce fatigue associated with talking, increase volume, and sometimes help listeners to understand mildly impaired speech. Personal voice amplifiers come in a range of power, volume, size, and prices, and different microphone options are available. These are some examples of products available that range from low-cost items commercially available to higher-cost amplifiers designed for speech impairment.
- Winbridge Portable Voice Amplifier
- Shidu Waterproof Portable Voice Amplifier
- Hi-Gain 3-Way Microphone
- Spokeman Personal Voice Amplifier
- Speax Amplifier for NIV: This new amplifier allows users of non-invasive ventilation to be heard and understood better with a full face mask.
Voice and Message Banking
Many pALS choose to digitally preserve their voices and recorded messages in their own voice and intonation in case they later experience voice or speech changes requiring the use of a speech device or app. Voice banking is a method of creating a custom synthesized voice for use in speech apps and speech generating devices. Different companies/organizations offer services to create these custom voices for voice banking. Message banking is a free process of recording personally meaningful phrases and saving them in a format that can later be played exactly as recorded on a speech device or app.
- Digital Voice Preservation Overview: The Boston Children’s Hospital Jay S. Fishman ALS Augmentative Communication Program created the Message Banking process and have excellent videos and information on both voice and message banking.
- Team Gleason Voice Banking: Team Gleason provides pALS with funding and support for voice banking.
Voice Banking Services (not an exhaustive list)
- My Message Banking: A free website for uploading and saving your banked messages
Augmentative & Alternative Communication Apps
Some pALS use or purchase personal “smart” devices such as smartphones, tablets, and laptops as communication devices. These apps can be accessed through using the built-in touchscreen or keyboard, or by adding alternative access tools such as switches and eye gaze. This is not an exhaustive list. Search for “AAC” or “text to speech” in the app stores. Talk with an SLP to get a recommendation that’s right for you. This Youtube playlist from the Boston Children’s Hospital ALS Augmentative Communication Program gives previews of many of the available apps.
- Predictable (paid): A text-to-speech app. Compatible with voice banking (Acapela and ModelTalker) and message banking.
- Proloquo4text (paid): A text-to-speech app. Compatible with voice banking (Acapela only) but not message banking
- TouchChat (paid): A grid-based communication app with multiple premade page sets. Includes picture/symbol-based grids. Compatible with voice banking (The Voice Keeper only) but not message banking.
- Dialogue AAC (paid): A text-to-speech app. Compatible with voice banking (The Voice Keeper only) and has ability to record messages in the app.
- Grid for iPad (paid with subscription option): Communication app with multiple premade page sets with grid-based or text-based options. Compatible with message banking only
iOS/Apple $50 or less
- Speech Assistant AAC (low-cost)
- Clarocom (low-cost or free lite)
- Voice4u TTS (low cost)
- TD Snap (low-cost)
- TD Talk (Free)
Android Paid & Low-cost
- Predictable (paid): A text-to-speech app that is compatible with voice banking (Acapela and ModelTalker) and message banking.
- Speech Assistant AAC (free with paid upgrade)
- Voice4u TTS (low-cost)
- Project Relate (free beta testing): A Google app in beta testing for speakers with speech impairment to access dictation and Google Assistant. Must record 500 phrases in the app to use it. More info here.
Speech Generating Devices with Eye Gaze
Speech generating devices are AAC devices that are typically funded through insurance. They require an evaluation with a speech language pathologist, a physician prescription, and insurance approval for funding. Medicare typically funds one device every five years and covers 80% of the cost of the device and one mount; however, Medicare does not cover devices for patients in nursing homes or on hospice. Other insurance coverage will vary. Most often for pALS, having a device that has the option for eye gaze to be critical to ensure that the device will be accessible throughout the disease. There are various companies and models of speech generating devices, and a thorough evaluation will include the opportunity to try multiple options to find the best match. Often device companies will work with speech language pathologist and patients to provide demo devices to try out. These are some of the companies that produce devices that have eye gaze capabilities (listed in alphabetical order):
Low Tech Speech Generating Devices
Low tech devices can serve as robust AAC options (it’s what people used before some of the high-tech options available now were invented). Some pALS use them as back-ups, during certain situations when high tech tools wouldn’t be practical (bathroom, car, night) and others as their sole method of communication. Note that while insurance funding may be available for some of these devices, Medicare only funds one SGD every 5 years (in the best-case scenario), so it may be worth considering purchasing some of these options out-of-pocket or finding a loaner to save the insurance-funded device for something with more features such as eye gaze technology.
- TextSpeak: Keyboard with a speaker that speaks typed messages out-loud. No screens, options for voices.
- Allora2: Keyboard speech generator that also has a detachable message display and switch access capabilities.
- Ablenet AAC: Recordable AAC boards and buttons
- GoTalk AAC: Recordable AAC boards and buttons
Other Low- and Mid-Tech AAC
- Say It With Symbols: Low tech tools for communication, such as communication books
- Low Tech Solutions: Communication boards and head mounted lasers.
Alerting & Call Bells
Depending on your fine motor skills, call bells or door bells can be used for alerting others within your own house. Adaptive options are also available using switches.
Portable Alarm with ¼ inch phone plug switch
Standard Switch Activated Bells – REQUIRES SEPARATE SWITCH
- RJ Cooper Switch Adapted Call Chime
- Adaptive Tech Solutions Switch Adapted Call Chime
- Adaptive Tech Solutions Deluxe Switch Adapted Call Chime
- AdaptAbilities Switch Adapted Call Chime
Alternative Access Methods
If traditional methods of using touchscreens, mice, and keyboards are not working, tools such as switches, styluses, and non-traditional styles of mice may help make computers, smart devices, and speech generating devices more accessible.
- Shape Dad Adaptive Stylus Store: Bendable styluses, mouth stick styluses & dock/holders, head/hat styluses, etc.
- Mouth Stick ($50) – adaptable for stylus, pencils, etc.
- Universal Cuff ($13)
- T-shaped Stylus ($29)
- Head pointer stylus ($169)
Computer Access – Mouse Options
- Vertical Mouse
- Right Handed Trackball Mouse
- Ambidextrous Trackball Mouse
- Handheld Trackball Mouse w/ “trigger” click
- Big Trackball
- Lap Mousepad
This page has a great overview of various adaptive tools for computer access as well.
Assistive Technology Resources
Assistive technology is an umbrella term for tools that can help a person to be as independent as possible. While AAC is one type of assistive technology, there are many more technologies that can aid pALS with greater independence in areas outside of communication, including self-care, mobility, participation in hobbies/leisure activities, and more. Various people can help you to learn more about assistive technology, including your ALS clinic, occupational or physical therapist, or an assistive technology professional. For Susan Mast ALS Foundation patients, see more information about our loan closet program, Brian’s Locker. Steve Gleason, ALS philanthropist/advocate and former New Orleans Saints football player, once said about ALS, “Until there is a cure, technology is the cure.”
- ALS Technology Guide – Every 90 Minutes
- Team Gleason
- Michigan Disability Rights Council Assistive Tech Program
Susan Mast ALS Foundation Blog Communication Archives
- Connecting and Communicating During the Holidays (10/26/22)
- Technology Your Way (8/3/22)
- Your Stories Your Voice (5/14/22)
- Contributing for Communication (Nov 2021)
- Cultivating Communication Success (Sept 2021)
- Be Proactive and Follow Up
- Communicating Independently with the Help of Technology
- Spotlight on Safety
- Evolving Technologies: A Growth of Options for Voice Banking
- No Travel Required: Using a Communication Passport to Ease Interactions
- Augmentative Communication: A Way to Support (Not Replace) Speech
- Communication Strategies for Speech