Motor Neurone Disease (MND)
AAC devices for people with Motor Neurone Disease (MND) MND refers to a group of neurological disorders that affect the motor neurones. For a person diagnosed with MND, the control of voluntary muscles reduces over time. Speaking, walking, swallowing and general movement may be affected. Cognitive changes may or may not become evident. Different forms of these conditions exist and progression varies. Communication changes may first be evident in reduced speech clarity; affected voice quality and reduced breath support for speech.
For communication there is a range of strategies and tools available for people diagnosed with MND.
Supplementary to speech: Speech can be used together with techniques to clarify and rectify communication breakdown.
- An alphabet card can be used to point to the first letter of words to supplement speech
- A topic card or booklet can be used to identify the topic being discussed verbally
- A voice amplifier may be useful in cases where speech remains intelligible but low volume, for example Zavox Reo Speech amplifier. Outgoing breath and relatively clear articulation is required for effective use. The speech clarity is not increased with use of the amplifier,only the volume is amplified.
Future planning for loss of speech may be considered at any time. Message Banking (as distinct from Voice Banking or Voice Building) is a process of recording messages for storage and later use. The recordings need to be organised and labelled so they can be imported into software which can be used for communication using a Speech Generating System. Zyteq offers Message Banking service. (Voice banking is a different process where the natural voice is converted to a synthesised voice, and Zyteq does not offer this service).
Alternative and Augmentative Communication
Options may be discussed at any time, but once the speech rate slows (clinical tests are available) research has shown that timely referral for AAC services is important. Low tech communication charts or books may be introduced and used. The letters or words can be selected by a range of methods including pointing with a finger, knuckle or other part of hand, hand–held pointer or eye-pointing. There are many high-tech options for people with MND and the choice will depend on:
- The functions the individual requires in a system and
- The accommodation of physical changes so that the system can be operated using a variety of accessing methods.
Typing a message.
Several devices offer the basics – typing a message and speaking it out. This function of a device is called “text-to-speech”. The typed text in converted to synthesised speech. Typing is much slower than the average speed of speaking so “speed enhancement” techniques are usually included features of the software or interface. Stored phrases and word predation are standard features in most text-to-speech systems. Selection guide: What size device is best – will it be carried around or attached to a wheelchair or placed on a tray or lap? What size keys should the device have? Keyboard type: is a physical keyboard or a touch screen best? Will be keyguard be useful now or in the future? Is the standard computer layout (QWERTY) suitable or would ABCDE be preferable? We find people who have never had keyboard experience and are not likely to may prefer the ABCD layout. Accessing: Should the device offer alternative access such as switch/scanning, eye-gaze control or head-tracking access? Other functions: would it be essential or desirable for the device to perform additional functions such as – Environment control – controlling appliances such as TV, Hi-fi, air conditioning. - Notebook – for writing tracts of text such as stories, meeting notes, speeches, poetry - SMS – facility to text message from the communication device - Voice call – to use the speech of the device to make or receive a phone call. - Other computer functions – access internet, email, post to facebook or twitter, Skype, run work or education software, play games, listen to music Suggestions:
AAC devices providing text-to-speech
More functions
If other functions or accessing options are required there are a range of touchscreen devices available. A number of devices a based on Windows 7 tablets so offer general computer functions in addition to assistive technology features.
It is best to think about what is required first, and then try to find the device to meet the requirements.
Here are some of the considerations to work out which options are required.
Selection guide:
- What size device is best – will it be carried around or attached to a wheelchair or placed on a tray or lap?
- What size keys should the device have?
- Keyboard type: is a physical keyboard or a touch screen best?
- Will be keyguard be useful now or in the future?
- Is the standard computer layout (QWERTY) suitable or would ABCDE be preferable? We find people who have never had keyboard experience and are not likely to may prefer the ABCD layout.
- Accessing: Should the device offer alternative access such as switch/scanning, eye-gaze control or head-tracking access?
- Other functions: would it be essential or desirable for the device to perform additional functions such as –
Environment control – controlling appliances such as TV, Hi-fi, air conditioning.
Notebook – for writing tracts of text such as stories, meeting notes, speeches, poetry
SMS – facility to text message from the communication device
Voice call – to use the speech of the device to make or receive a phone call.
Other computer functions – access internet, email, post to facebook or twitter, Skype, run work or education software, play games, listen to music
AAC systems offering many or all of these functions:
Computer Adaptation can be achieved using: