By Lee Vander Loop
For many children with cerebral palsy, communication is a struggle. Some may have a limited ability to learn and understand speech due to cognitive impairment. Others may have difficulty speaking clearly because of poor control over their tongues, lips, and mouths because of motor control issues.
Although children vary in language development, there are certain speech milestones that indicate if a child is on track in this area. Any child not meeting these goals should be tested for speech or hearing problems.
Children with hearing impairments may experience difficulties with speech since they can’t hear to mimic sounds in their environment. A child normally reacts to sounds starting from birth, and begins looking in the direction of sound between 4 and 6 months of age. Any infant who doesn’t seem to react to sound should be screened for hearing problems.
A number of techniques and devices have been developed to help children with severe speech impairments to communicate. Augmented and Alternative Communication (AAC) devices and strategies range from low-tech approaches using pictures, to high-tech systems that use computer software to generate speech.
Although some parents may fear that introducing technology will deter their child’s motivation to attempt speech, research has found that AAC can improve communication skills.
How Does a Parent Choose?
With the mind-boggling amount of information on the internet involving augmentative communication, assistive devices, and brain-computer interface (BCI) technology, how can a parent determine what intervention or technology is appropriate for a child?
The first step is to talk to your child’s pediatrician about what resources may be available locally or in a nearby city. Many large teaching hospitals and rehabilitation hospitals offer evaluation and help with choosing an AAC system that will best suit your child. They may offer an assistive technology clinic. The best of this type of facility will:
- Offer a team of professionals made up of specialists in AAC, speech pathology, occupational therapy, and physical therapy, who will work directly with AAC technology vendors to provide services to your child. Importantly, they will work under one roof, not only because this makes it more efficient for you and your child, but also because this will make it more likely they will be communicating effectively with each other.
- Match and customize any AAC system or device to meet your child’s abilities and needs.
- Assess your child’s practical options, including computer access and environmental control issues.
- Evaluate any seating and power mobility issues associated with a communication system. This service often involves a wheelchair and occupational and physical therapy evaluations and recommendations.
- Provide the proper training on the device for both you and your child. Studies show that simply knowing how to operate the device isn’t enough to ensure improvement in conversation. For this, a child must have direct conversational treatment to ensure she is engaged in conversation on a regular basis. Parents can be trained to initiate and encourage this kind of interaction.
A World of AAC Options
It’s truly amazing what science has achieved in this field in the last decade. Many laboratories are developing brain-computer interface systems that provide communication and control capabilities to people with severe motor disabilities. Brain-computer interfaces can translate brain activity into signals that control external devices and can provide communication and control capabilities to people with severe motor disabilities. For a look at examples of educational tools and games using this technology, visit
Speech generating devices known as voice output communication aids (VOCA) are electronic systems that enable people with severe speech impairment to verbally communicate. These systems can be installed onto existing laptops, desktops or PDA systems. One notable user of a speech generating device is Dr. Stephen Hawking, the world’s foremost living theoretical physicist. Hawking, who is unable to speak due multiple severe disabilities, has used a DECtalk DTC01 voice synthesizer for several years and has come to be associated with the unique voice of the device. He is now said to be using NeoSpeech’s VoiceText speech synthesizer
What’s New in the Field Today
There is insurmountable evidence that the quality of life of people with severe motor and speech disabilities is being positively impacted as a result of these amazing new discoveries in the field of assistive technology and alternative/augmentative communication. Here is an overview of some of the newer AAC devices on the market today, according to their websites:
Proloquo is a multilingual speech and communication solution for Mac OS X that provides a full-fledged communication system for people who cannot speak, including speech feedback in any application while typing for children and people with learning disabilities. The system can also serve as a talking word processor; provide an advanced, multilingual speech engine for KeyStrokes on-screen keyboard and SwitchXS switch access.
Proloquo2Go is an Augmentative and Alternative Communication application for iPhone, iPad, and iPod Touch for people who have difficulty speaking. It offers natural-sounding text-to-speech voices, a default vocabulary of more than 7,000 items, and expandability in a convenient, mobile solution. The system also includes natural-sounding Infovox iVox voices for a language of choice.
TouchChat Suite for iPod/iPhone/iPad is a full-featured communication application for iPod/iPad technology. It enables Apple iPod, iPad, and iPhone devices to play a role in providing an alternative voice to individuals who cannot speak.
KeyStrokes is a fully functional advanced virtual on-screen keyboard that allows use of a mouse, trackball, head pointer, or other mouse emulator to type characters into any standard Mac application. KeyStrokes offers word prediction, word completion, next word prediction, and even multi-word prediction in a number of languages.
TouchStrokes is a virtual keyboard that works by drawing a keyboard image on the display and allows you to type characters into any normal application using a mouse, touch screen, graphic tablet, trackball, head pointer, or other mouse emulator.
SwitchXS is a switch-based computer access solution. A downloadable application that provides complete access to Mac OS X and all standard Mac applications for people who can only use one or more switches, it is intended for individuals with very limited limb movement.
LayoutKitchenis an editor for SwitchXS scan panels, KeyStrokes keyboards, and Proloquo speech panels. SwitchXS users can use LayoutKitchen to create their own scan panels specific to their needs to create customized panels.
VisioVoiceis an application that enhances access to Mac OS X for users who are blind and visually impaired.
GhostReader is a multilingual speech solution for Mac OS X that allows individuals to listen to their own documents with natural-sounding voices. Uses include converting documents to audiobooks to listen to on an iPod or iPhone. It also converts text from news sites and e-mails to audiobooks to listen to on iPod or iPhone.
Digit-Eyes enables people without vision to read barcode labels. It is used with an iPhone to scan UPC/EAN codes and then hear the names of more than 7.5 million products. Barcodes can be printed from the Digit-Eyes website on ordinary labels and placed on items. Digit-Eyes barcodes may contain text that VoiceOver reads or that can be used to record audio on a phone that’s played when the label is scanned.
Pictello is a universal application that runs on iPad, iPhone, and iPod Touch to create talking photo albums. Developed for all ages and skill levels, it requires no reading skills to locate and read stories.
Closing the Gap is a resource for parents and educators about how to find, compare, and implement assistive technology.
USA TechGuide is a guide to wheelchairs, mobility scooters, and assistive technology.
rehabtool.com offers a line of products and provides general information and a newsletter.
ClinicalTrials.gov lists ongoing studies relating to BCI and cerebral palsy.