UNIT-5

Use of technology: Hardware and software (applications) in the

intervention for children and adults with communication disorders

Hardware technologies are readily available components that can be purchased and
assembled into systems. This includes everything from simple mouth sticks to computer
hardware. The main distinguishing feature of hard technologies is that they are tangible. On
the other hand, software technologies are the human areas of decision-making, strategies,
training, concept formation, and service delivery (Odor, 1984).

Hardware Components

Input devices:
● Input devices provide the physical connection between the user and the system.
● Conventional input devices include keyboards, touch screens, and the mouse.
● However, such devices require physical dexterity to manipulate them.
● For some users with restricted movement, a wide range of alternative input solutions are
used including switches, eye-gaze, voice, brain computer interfaces and bio-feedback.

Keyboards:

● A variety of adapted keyboard options are available to literate users, such as enlarged
keyboards, miniature keyboards, keyboards with key guards and one-handed keyboards.

● In some cases keyboard labels (e.g., some keys might be marked in a bright colored label)
can act as a visual cue for a person with visual challenges such as a restricted visual field.

Mouse:

● Different mouse emulators exist, eg, smaller mouse options that can help with control, or
options that require minimal hand or wrist movement and light touch (Koczur, Strine,
Peischl, Lytton, Rahman, & Alexander, 2015).

● A range of vertical wireless mouse options that capitalize on an ergonomic relaxed neutral
wrist and hand position as well as on the higher processing abilities of the small muscles and
joints of the fingers as opposed to the arm (eg, the DXT Fingertip Vertical Wireless Mouse)
are commercially available (City Ergonomics, 2018).

● Trackball: operates as an upside-down mouse so rather than rolling the ball on the table by
sliding the mouse around, the ball is moved directly by the user.

● The trackball does not need to be held, but the ball only needs to be nudged gently using
a hand, chin, elbow, foot, or stick held in the mouth.

● Buttons are used to select left and right button clicks as well as supporting click and drag
functionality.

● Moreover, trackballs come in many sizes, including ones that can be operated by a single
finger. As they remain in a stationary position on the desk or mounted on a stand, it can be a
good option for a person with a limited range of motion.

Touch Screens:

● The screens are sensitive to pressure and a user interacts with the computer by touching
graphic symbols (ie., pictures or words) on the screen using a finger, infrared beams or a
stylus.

● Despite advantages to some individuals (e.g. persons who experience difficulty using
keyboards and mouse because of physical or cognitive disabilities), touch screens can present
barriers to some persons with physical disabilities who are unable to touch the device, as well
as persons with low vision and blindness for whom the device does not provide tangible
controls that can be appreciated by a sense of touch (Kane, Morris, Perkins, Wigdor, Ladner,
& Wobbrock, 2011).

● The way in which touch screens are controlled can be customized to meet the physical
abilities of the user.

Switches

● Switches (Judge & Colven, 2006) are used by persons with complex physical
impairments that restrict their ability to access keyboards or touch screens.

● Switches come in different shapes and different methods of activation. For instance, a
'button switch' is pressed and released for activation, while a 'sip/puff switch requires the user
to suck (t.e.. negative pressure) and puff (ie, positive pressure) to operate the switch.
● More complex switch systems are used when individuals can access more than one
switch. These input devices can range from a multiple-switch array (e.g., one switch to move
another to select an item) to systems such as the Tongue Drive System.

● This minimally invasive wireless device enables individuals with high-level spinal cord
injuries to operate a computer (and electric wheelchair) by moving their tongues (Huo &
Ghovanloo, 2012).

● The device is placed in a dental retainer embedded with an array of magnetic sensors that
can wirelessly detect the individual's tongue movement using a small magnetic tracer secured
on the tongue.

● It then translates the movements into a set of user-defined commands in real time, which
can in turn be used to communicate with the devices in the individual's environments.

Eye-Gaze

● Eye-gaze tracking is a non-invasive technological solution to estimate eye-gaze direction.

As natural eye-gaze is often used by emerging communicators to make choices, eye-gaze
tracking provides a powerfully intuitive way of providing access to technology.

● Eye movement alone allows the user to directly select a choice on a visual array. As such,
eye-gaze provides hands-free access to communication without requiring any further body
movement, allowing users to independently navigate their communication program of choice.

“Input devices can be configured in the way in which they are activated”

Timed activation:

● The input device will only register an activation when contact is sustained for a particular
length of time.

● This is the most frequently used activation strategy and is particularly important if users
have restricted coordination which affects their control in terms of activation and release.

● This type of activation can be achieved with pressure (e.g., finger pressing down a
physical or on-screen key) or by dwelling on an on-screen target (e.g., using eye gaze or an
infrared light beam).

Release activation

● A selection is activated only when contact is removed.

● This type of activation helps users with restricted movement who prefer to maintain
contact with the device, so that they can ensure that the correct choice is made before
selecting it by releasing their hand or finger, etc., from the device.

Filtered activation

● The device filters and dampens random or uncontrolled movements to determine the
target activation.

● The device identifies the target area which has registered the most activity, eg., the keys
that are pressed most often or where the user fixates (e.g., using eye gaze) for the longest
period of time.

Display

- Those AAC system components used to present the language components to the person
with communication needs are commonly referred to as the display.

- AAC displays generally are of one of four types: fixed, dynamic, visual scenes, or hybrid
(Beukelman and Mirenda, 2013).

Fixed display:

- In fixed, or static, displays, graphic symbols are displayed in fixed locations, typically in a
grid layout with symbols shown in cells that have fixed locations (Drager et al., 2003).

- The number of symbols or messages that a fixed display can present to the individual is
limited because each available item is visible at all times; as a result, some AAC systems
utilize multiple, often hierarchical displays to accommodate various communication needs,
environments, and listeners (Bruno and Trembath, 2006; Hochstein et al., 2003).

- Nonelectronic-aided AAC systems and most digitized AAC technologies employ fixed
displays.

Dynamic display:

- AAC technologies typically employ computer-based dynamic displays that change to a

new set of symbols (pages) automatically when activated.

- Multiple levels of displays accommodate myriad individual vocabulary and linguistic

needs (Drager et al., 2003).
- As with fixed displays, the majority of dynamic displays are presented in a grid or matrix,
with items arranged in rows and columns.

- In contrast with fixed displays, however, the number of symbols or messages that a
dynamic display can present to the individual is not limited by what is visible; such displays
offer symbols that are not visible but can be accessed through page linking (Drager et al.,
2003).

- Dynamic displays provide a range of organizational strategies that make complex

language constructions possible (Bruno and Trembath, 2006; Drager et al., 2003).

- Some digitized AAC technologies and most synthesized devices employ dynamic displays
(Beukelman and Mirenda, 2013).

Visual scene display:

- In contrast with the grid format of many dynamic displays, visual scene displays provide
context for the user by integrating a picture, photograph, or virtual environment within a
visual image (e.g., showing people, objects, and events against the background in which they
occur) (Beukelman et al., 2015).

- Visual scene displays may be used across a wide range of AAC technologies (e.g.,
photographic images placed on a digitized device, digital images placed on devices that
support programming “hot spots”). The visual scene displays support interactive
communication across a variety of ages and disability groups (Beukelman et al., 2015; Brock
et al., 2017).

Hybrid display:

- Hybrid displays typically consist of a fixed display with a dynamic component (e.g.,
indicator lights that highlight items, word prediction on alphabetic displays) (Beukelman and
Mirenda, 2013).

- In other cases, a visual scene display may be embedded with dynamic hotspots that move
the display away from the visual scene to a text or grid display (Gevarter et al., 2016).

- Hybrid displays may be used across the full range of AAC technology types
Output Capabilities

● Aided AAC systems provide a variety of message output modes, including

- digitized and synthesized speech,

- nonelectronic-aided symbols, and

- print (Beukelman & Mirenda, 2013).

● Visual output (e.g., aided symbols or text viewed on a display) is used primarily to
support messages when natural, digitized, or synthesized speech is not understood or
available.

● Individuals with impaired natural speech may use synthesized or digitized speech to gain
listeners' attention, produce utterances at a distance, communicate in group conversations,
and talk on the telephone, among many other activities (Alamsaputra et al., 2006; Hanson et
al., 2016; Hill, 2010).

- Digitized speech:

● Digitized speech refers to human voice stored as segments of sound waves (Schlosser,
2003).

● It consists of natural speech that has been recorded with a microphone, converted to a
digital signal, and stored and retrieved in word or message form (Beukelman and Mirenda,
2013).

● Message banking, a strategy that involves storing digitized speech, is used primarily by
individuals who, retaining intelligible speech but anticipating its loss (e.g., because of
degenerative disease or head/neck cancer), want to record their own voice for use in future
communication systems (Costello, 2011, 2014).

● Although most technology-based AAC systems provide a feature for digitally recording a
message, many provide a limited amount of storage space for such recordings.

- Synthesized speech:

● Synthesized speech is computer-generated according to a set of rules in a mathematical

algorithm (Drager et al., 2010).
● Text-to-speech synthesis, a common method for generating synthetic speech for AAC
technologies, involves extracting speech sound components from words and then combining
them to form natural-sounding synthetic voices (Beukelman and Mirenda, 2013; Drager et
al., 2010).

● In contrast with the stored messages from digitized speech, synthesized speech systems
allow the user to generate speech for each utterance and therefore provide greater novel
message flexibility.

- Automatic Speech Recognition (ASR):

● Voice and sound can be used to control technology. Sound activation can be used as a
rudimentary switch while automatic speech recognition technology can convert spoken words
into text.

● ASR technology such as Dragon Dictate could be trained to recognize individual speakers
and has been used for many years to enable people with consistent speech patterns to operate
environmental control systems, software and word processors.

● Software algorithms can adapt to improve the accuracy of recognition of the speaker and
research has demonstrated successful use of ASR to recognize unintelligible dysarthric
speech (Sriranjani, Reddy, & Umesh, 2015).

LCD Writing Tablet: A lightweight, portable, paperless writing tablet that can be erased by
pressing a button

Alphabet Board: A portable chart that can help you communicate by pointing, gesturing, or
gazing at words, letters, symbols, and pictures.

Amplifier: A device that amplifies your voice so that people can better understand you, both
in person and over the phone.

Dry-Erase Board: A lightweight, portable, erasable board that you use with a marker and
eraser.

Go-Talk:

This easy-to-use AAC device supports those with limited to no speech throughout their daily
activities.

● Records and stores up to 100 messages in five levels, up to 15 minutes in total

● 20 programmable buttons allow the user to personalize each level with pictures and vocal
recordings.

● Includes five additional core buttons for frequently used words or phrases across levels

● Offers sequential recording for quick set-up and re-recording

MegaBee Assisted Communication and Writing Tablet

- This AAC device is designed specifically for users who, due to ALS, a traumatic brain
injury, stroke, ALS, muscular dystrophy, etc. are unable to use most of their body’s voluntary
muscles.

Tactile Symbol Communicator

- This portable symbol communicator, which can store up to 36 messages, has a total of six
removable tactile symbols that allow the user to push a button to relay a message.

Indian devices

➔ “KAVI” is a tablet based device that supports multiple

AAC software and can be used for communication, or recreation. The key innovation is a two
speaker system that would allow the user to create a sentence on a headphone and then play
the completed sentence over a speaker. This arrangement would permit the use of AAC
software in a public setting such as a classroom, or a playground.

➔ “GUPSHUP” is an essential and useful handy Voice Output Communication Aid, for the
children affected with Cerebral Palsy, developed in association with Indian Institute of
Cerebral Palsy, Kolkata. The gadget is useful as icon based educational tool and also for
communicating requirement of daily needs. GUPSHUP is available in three (1/2/4) key
configurations.

➔ “Vaneeshree” is a speech synthesizer useful to the vocally disabled and/or spastics.

- It has been developed at IIT Kanpur by G.C. Ray.

- Vaneeshree has, in its memory, most of the useful sentences needed for communication in
normal day-to-day life.
- The users may select any sentence using two switches and by pressing "talk" (a third
switch), the sentence becomes audible in a nearby speaker. Model-1 It is the simplest in
operation.

- It has 56 sentences, each having a duration of 3.5 to 7 seconds. Its speaker (including
audio-amplifier) lies mounted somewhere in the house and a thin 3-wire connection is
provided between the speaker and Vaneeshree.

AAC Software

Important features of AAC software include;

(1) language/message representation methods,

(2) vocabulary selection and organization based on communication needs and personal
preferences, and

(3) language/message generation options (Hill & Corsi, 2012).

Software Message Management Features

● A variety of software options are used to manage and generate messages, including

- spelling letter-by-letter,

- using symbols to represent words and messages,

- sequencing icons to represent words and messages,

- selecting individual words from a display to generate word-by-word messages, and

- selecting partial and full messages that have been programmed and stored for retrieval.

Although a wide array of strategies is used with communication software, methods for
representing language or messages can be identified as;

(1) alphabet- or text-based methods,

(2) single-meaning picture symbols,

(3) visuals scenes, or

(4) multimeaning icons or semantic compaction (Beukelman et al., 2015; Ganz et al., 2015).
Applications for children

Touch Chat:

- This app was created by Saltillo which is a company that makes dedicated AAC devices as
well as communication apps.

- This same software comes installed on their durable devices that are designed to be used
specifically as an AAC device and nothing else.

Proloquo2Go:

- It is an easy-to-use communication app for people who cannot speak or need help being
understood.

- Featuring natural sounding voices, including real children’s voices, Proloquo2Go is a

simple yet powerful AAC tool.

- The app is fully customizable and can be utilized to build language skills and grow with a
person’s communication, supporting both beginning and advanced communicators.

LAMP Words For Life®:

- It is designed to meet the communication needs of children with autism and other
developmental disabilities.

- Based on the Language Acquisition through Motor Planning (LAMP) methodology, its
consistent motor plan enables early success and allows the client's vocabulary and
communication skills to grow.

Leeloo AAC- Autism speech app for nonverbal children:

- Leeloo is an app that helps non-verbal children communicate with their careers, teachers
and friends.

- In the app, there is a card and image for words your child might need for daily
communication.

- Leeloo also has voice capability.

- When a card is pressed it provides options of phrases, and the chosen phrase will be read
by a text-to-speech robot. One can choose from over 10 voices you like in AAC Speech app
Leeloo.
Quick talk:

- It is designed to be the most flexible, accessible, and affordable AAC solution available.
Quick Talk AAC has been effectively used by individuals with autism, down syndrome,
cerebral palsy, apraxia, and other special needs, both at home and in a school environment.

Key Quick Talk AAC features:

● Includes Smarty Symbols library of 11,000 symbols

● Quick access to Yes/No from every screen (iPad)

● Ability to personalize all Profiles, Categories, and Pages.

Avaz:

- Avaz is a picture and text-based AAC app that empowers children and adults with
complex communication needs to express themselves and learn.

- Avaz India contains a built-in vocabulary that is optimized for India, and has a vocabulary
in 7 languages - Tamil, Hindi, Telugu, Kannada, Malayalam and Marathi. Avaz allows
children to choose from an extensive list of core words and research based vocabulary to
maximize their ability to communicate.

- Designed for children with Autism, Avaz helps improve communication through
interactive speech therapy sessions.

- It is also a great learning and speech therapy tool for children with Down Syndrome,
Angelman Syndrome, Aspergers and other non-verbal conditions.

- Set vocabulary with photographs and voice recordings help your child create messages.
Avaz also includes save text features, a special keyboard with picture-assisted text prediction
as well as a vocabulary search bar.

- The app has more than 15,000 symbols, 4 voices and custom photos, ensuring that your
child has everything they need to communicate.

Jellow Basic AAC Communicator:

- Jellow Basic AAC Communicator, Giving a Voice to Speak - is a freely downloadable

friendly AAC system that uses icons/images to enable aid communication in children learning
to speak or with difficulty with speech and language.
- It helps non-verbal children to communicate and gradually learn to speak - especially
those with Autism, Cerebral Palsy, Down’s syndrome.

KAVI-PTS:

- A picture to speech Android application for people with cerebral palsy or autism spectrum
disorders, in early levels of literacy.

- The software is customizable and allows the user to change the pictures and the audio
files.

Applications for adults:

For aphasia

CommunicAide:

- This AAC app allows to speak out words and phrases by pressing words and pictures.

- It is available for iOS, Android, Mac and Windows.

Small Talk Aphasia (Free):

- This app is designed to give a voice to people struggling with aphasia.

- It allows users to carry with them commonly spoken words and phrases, and to practice
frequently used words. There is a vocabulary of pictures and video that when you click on
them, speak in a human voice.

- The app comes with a so-called starter set of icons, but it’s possible to expand these if
used with Lingraphica’s speech-generating device.

Spoken – Tap to Talk AAC:

- Spoken is an app designed for literate teens and adults unable to use their voice due to
aphasia, nonverbal autism, stroke, or other speech and language disorders.

- Simply download the app on a phone or tablet and tap on the screen to build sentences
quickly.

- Spoken speaks them automatically, with a wide variety of natural-sounding voices to

choose from.
Let Me talk:

- A free AAC talker app which supports communication in all areas of life and therefore
providing a voice to everyone.

- Suitable for ASD, aphasia, speech apraxia, articulation/phonological disorder,

Amyotrophic Lateral Sclerosis (ALS), Motor Neuron Disease (MND), cerebral palsy, down
syndrome.

Voice banking apps for ALS

Acapela:

- Acapela allows you to record directly onto your computer using a standard headset.

- You will need to read 350 sentences out loud to enable the software to create your
personalized voice.

- It is available in multiple languages. With Acapela, you can “double dip,” which means
recording your voice for message banking, and then using that recording for voice banking.

Model Talker:

- It is a voice-banking program that you can use either on your computer or through a web-
based recording tool.

- Model Talker suggests reading 400 short sentences out loud, but gives you the option of
reading up to 3,155 to further optimize your voice quality. The software will let you know if
you need to re-record any sentences for better clarity.

BCH Message Banking™ :

- Message Banking™, developed at Boston Children's Hospital, is similar to voice banking

in that you record your voice before you lose it so your future communications will be more
personal.

- But with Message Banking™, you choose and record specific, common phrases that will
play in your own voice instead of a synthetic version of your voice.

- It plays your actual recording, which means that you can only use it for the specific words
and phrases that you record ahead of time.
Study:

Dada et al., 2023 aimed to determine and compare the attitudes of adolescents with physical
disabilities when an unfamiliar peer with complex communication needs used a general
consumer-level mobile technology device with an AAC application (iPad™ with
Proloquo2Go™) versus a low-technology communication board. A non-experimental
descriptive survey design was used involving 35 adolescents with physical disabilities. The
participants were divided into two groups using paired randomization. Group A viewed
DVD-1 showing an unfamiliar peer with complex communication needs in a scripted
conversation with a communication partner using an iPad with Proloquo2Go. Group B
viewed DVD-2, which showed the same interaction using a communication board.

The participants completed the Communication Aid/Device Attitudinal Questionnaire

(CADAQ) after watching the DVD. The results indicate the unfamiliar peer was viewed more
positively by adolescents with physical disabilities when using the iPad with Proloquo2Go as
compared to the communication board, with a statistically significant difference in the
affective/behavioural and cognitive/belief components of the CADAQ. The use of general
consumer-level mobile technologies with AAC applications should therefore be considered
for use by adolescents who use AAC.