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Life-Long Communication

Communication is something we tend to take for granted. It is the means by which we build relationships, learn, share experience, and generally take our place in society. Older people, as well as people with disabilities, who experience difficulties with communication can feel, and be, left out of society. Today however, we have access to such a wide range of different assistive technology solutions to facilitate communication, none need be excluded.

Communication Devices

A communication aid is anything that helps an individual communicate more effectively with those around them. Augmentative and Alternative Communication (AAC) is the term used to describe the different methods of communication which can be used to supplement or enhance the more usual methods of speech and writing when these are impaired. There are various ways of breaking down communication aids, for example text-based or picture-based, aided or unaided. However, one of the simplest ways is to divide them into two groups:

  • Low-Tech Communication Devices.
  • High-Tech Communication Devices.

A user will probably have a preference for the type of aid they want to use but it is important that as many factors are considered as possible, e.g. portability, appearance, physical access and control, the situation in which the aid will be used, and the number of symbols or amount of text the aid will contain. This will help ensure the right communication aid is selected. The assessment and selection of equipment should be a consultation process involving the user, their family or carer, and an appropriate professional, e.g. assistive technology expert or speech and language therapist.

Low-Tech Communications Aids

Communication Boards

A communication board is a very simple aid which can use picture symbols (picture boards) or alphabet symbols (alphabet boards) or a combination of both. The message is communicated by the user indicating the symbols, e.g. cup (I want a drink) or letters (t-u-e-s-d-a-y) appropriate to convey the message. The user may indicate using finger/hand/foot pointing or may use their eyes to indicate a target word or symbol. All the symbols or text are displayed at the one time so the user is able to view and use the full range of symbols or text at all times without having to turn pages or access different screens of a more complicated electronic device. Communication boards are very portable, light and are often used fixed to a lap tray if the user is a wheelchair user.

Single Message Devices

Single message speech output devices are often the first experience a child will have of using a communication aid. Essentially they are like a single message tape recorder or a very simple switch but they can be very effective as they are easy to use and give the user verbal feedback. They are often first used to teach the concept of cause and effect and from this, often more complex communication solutions can be introduced. Single message devices such as the BigMack or One Step Communicator come in different colours with a large surface area for the user to make contact so they are easy and fun to use. They can also be accessed via a switch. They can record short messages which can be changed easily so the device can be adapted in seconds for whatever the situation. There are other devices which can record a sequence of different messages and this means that the user is able to communicate more complex or a range of different messages.

Switches

A switch can also be used to replace the use of a keyboard and/or mouse with a computer. Switches enable an individual who has reliable control of one or more movements to control any electronic device which is equipped with an appropriate switch interface/connection. Careful switch selection and switch location are essential if the user is to make optimal use of their switch or switches. There are a range of different ways in which a switch can be operated. For example, the user may depress the switch continuously until the target item is highlighted on screen, or they may use the switch to activate an automatic scanning function, with a further switch selection at the moment when the target item is highlighted on screen.

Telephones

Telephones have been included in low-tech communication aids because they are such an important and probably the most widely used communication aid of all.

There are some services available specifically for people with disabilities and older people in regard to telephones and textphones, for example, the Free Directory Enquiry Service.

Today there are more types of phones with more different features to choose from than ever before. A telephone can provide a vital link for someone or to someone, so it is worth considering what features would be useful to ensure the telephone is as effective a communication device as possible for the user.

Telephones and equipment for people with hearing impairment.

People with a hearing impairment may find one or a combination of the following features useful:

  • Outgoing speech amplifiers enable the speech volume passing through the mouthpiece to be increased.
  • Incoming speech amplifiers enable the speech volume passing through the earpiece to be increased.
  • An additional earpiece may enable incoming speech to be listened to with both ears, or it may be used by a third person who is able translate into 'sign' the incoming speech, or repeat the message for lip-reading.
  • Incoming call indicators, for example, a bright flashing light as a visual alert when the telephone rings.
  • Variable tone control allows the pitch of the ringing tone to be adjusted.
  • Ringer volume control allows the loudness of the ringing tone to be varied.
  • Inductive couplers improve the clarity of sound by cutting out background noise. They do not amplify sound. Inductive couplers are used in conjunction with hearing aids when the aid is switched to the 'T' position.
  • Text communication (textphones) involves incoming and outgoing messages being typed onto a screen enabling people who experience profound deafness and/or speech impairment to communicate with each other. In order for the text conversation to take place, the person on the other end of the line must also have a text telephone.

Telephones & Equipment for People With Visual Impairment

People with a visual impairment may find the following features useful:

  • Raised dot on the number 5.
  • Memory buttons which can store the most frequently called numbers for one-touch dialling.
  • Big button telephone with high contrast large buttons, e.g. black buttons with large white numbers.
  • Talking caller ID lets you hear who is calling you before you answer. You can also find out whose calls you missed and the date and time of calls.
  • Voicemate, a full speech output device which stores telephone numbers, addresses and appointments that can be accessed using voice recognition and numbers can be dialled automatically using the built in auto-dialler.

Telephones and equipment for older people

Older people may find one or a combination of the following features useful:

  • Incoming speech amplifiers enable the speech volume passing through the earpiece to be increased.
  • An additional earpiece may enable incoming speech to be listened to with both ears.
  • Variable volume control allows the volume of the ring to be made louder or quieter as required.
  • Variable tone control allows the pitch of the ringing tone to be adjusted.
  • Large keypad buttons which are well spaced that are easy to see and touch.
  • High contrast numbers and symbols.
  • Keys which require little force to operate, with a feedback feature so the user knows the button has been pressed.
  • Hands-free telephone allowing the user to speak and listen without having to lift the handset.
  • Caller display which shows the number of the person calling so the user can decide whether they want to answer it or not.
  • Memory buttons which can store the more frequently dialled numbers for one-touch dialling.
  • Last number redial.

High-Tech Communication Aids

An accurate and detailed assessment is essential before any steps are taken to select an appropriate high-tech communication device. Careful consideration of literacy skills, physical access abilities, portability etc should result in the selection of a device which matches the user's needs and expectations.

Ideally, a speech and language therapist should undertake a detailed assessment with the individual user and their family/carers in order to optimise the match between the user and the device. Training for the user, family, carer and very importantly, speech and language therapist is vital and technical support from the supplier essential. These must be considered so that:

  • Family/carers are confident and willing to support the user with the regular daily updating of the device (where necessary).
  • Sufficient funding is secured to ensure the user receives appropriate training in the use of the device.
  • Adequate repair/technical support (usually from the supplier) is available from the beginning to avoid frustration and disappointment.

Does the device need to be portable or mounted on a wheelchair?

A key consideration is to define what degree of portability, if any, is required by the user. It is important to note that some devices are promoted for their portability, but in practice, can prove to be too heavy to be carried around throughout the length of the day. Many portable devices can be mounted if necessary.

Communication devices, just like computers, vary considerably in size and weight. Devices currently available range from desktop-style communication aids designed for mounting onto wheelchairs/other mobility devices, to hand-held devices such as palmtops which are highly portable and lightweight. In between these two extremes, there are a range of other options which can be carried using shoulder straps, wrist bands and waist straps.

What Kind of Speech is Best?

Communication devices are designed to operate using either:

  • Synthetic speech (using a speech synthesiser).
  • Digitised or recorded speech.

Synthetic Speech

There are a number of synthetic speech engines commercially available but the two which are most commonly used in Ireland are: DECtalk© and the Microsoft© SAPI speech engine. These speech engines convert text into speech, and recent years have seen considerable advances in the quality of the speech produced by them.

DECtalk is an American speech engine which is widely used in Ireland. It has a choice of nine voices in total, four adult male, four adult female and one child's voice.

SAPI speech is available free to users of Microsoft software products.

To date, there are no Irish-accented speech synthesisers available but work is ongoing in the Centre for Language and Communication Studies in Trinity College Dublin to develop one.

Digitised or Recorded Speech

Recorded speech is usually used in devices with a limited number of messages available to the user. Using different people's voices to record messages on the same communication aid will be distracting for both the speaker and the listener, and will undermine the user's attempts to identify with the recorded voice. Using the same person's voice for all recorded messages is important for another reason: our identity is closely allied with our voice. So consistency in recorded message is essential. In addition, it is important that the recorded voice matches the user in gender and approximate age.

Dedicated Devices vs Computer-based Options

What is the difference between a dedicated device and a communication software programme which will run on a standard computer or laptop?

The best way to answer this question is to understand firstly what the user wants to be able to do with the device, and then to explore what hardware and software options are available which will meet the user's needs.

Dedicated communication devices are designed specifically with communication as their primary goal, although recent advances in infra-red and bluetooth technologies have led to environmental control options being added in an increasing number of cases.

Dedicated devices tend to be more stable than PC-based software programmes, but are also more expensive. They are available with both text-based and picture-based programmes, and many are wheelchair mountable.

In recent years, a wide number of manufacturers have developed software programmes which can be installed on to a standard Windows computer. These programmes have the advantage of being more affordable than dedicated devices, but they can sometimes be unstable, and this is a significant drawback since access to communication should be available to the user at all times. Nonetheless they offer a more affordable choice to the user, and consequently, more flexibility to change or adapt the system as the user's needs change over time.

Communication software programmes come in a range of styles, and vary in complexity. Some are largely 'content-free', and allow the user and his/her family/carers to programme words and messages to suit the user's specific requirements. Others come with templates consisting of vocabulary sets which enable the user to communicate straight away, without the need for immediate programming. However, all software should be customised to meet the user's needs, and should be updated on a regular basis as needs change and expand.

As with dedicated devices, communication software programmes can be text-based or picture-based. Examples of communication software programmes include:

The Grid

The Grid is a picture-based computer access communication programme. The user can build their own grid with content relevant or suitable for their individual communication needs. It works in conjunction with any Windows programme such as Word, Outlook or Explorer and supports speech technology such as Microsoft SAPI speech and DECtalk. It features symbol communication, text communication and word prediction, and can be used as an on-screen keyboard. It can be controlled using a range of input devices including mouse, touchscreen, head pointer and switches and even can be used with environmental control systems to control equipment in the home, e.g. lights, TV.

EZ-Keys

EZ-Keys is a text-to-speech word prediction software for users who require adapted computer access. It includes standard and adapted computer access, dual word prediction (current word and next word), abbreviation expansion, and has thousands of pre-programmed phrases. The user can choose from a variety of software voices to communicate messages, as long as the voice conforms to standardised Microsoft speech (SAPI).

This information has been reproduced from the website www.assistireland.ie with permission from the Citizens Information Board. Assist Ireland is an online resource providing information on assistive technology and a directory of products available from Irish suppliers for older people and people with disabilities.