AAC for Speech-Language Pathologists

AAC and Physical Access: Options for Every Body 

It can be hard to touch a communication device. Sometimes we need more tools to help someone communicate.

Not everyone has an easy time pressing a button or interacting with a touchscreen device. How do we support access to AAC for folks who cannot point their finger and touch a screen?  There are several strategies and tools we can use for people with different abilities. These tools can help people with impairments impacting vision, hearing, cognition, fine motor skills, and complex physical disabilities. If you are breathing, we can find a way to access communication. 

Fine Motor Skills 

You don’t have to be able to perfectly point your finger to use AAC. There are several tools we can use to facilitate access. And really, does it have to be an index finger?  Some folks access their AAC systems using different body parts. For example, there are AAC users who navigate their devices using their toes!  We use whatever works.  


A keyguard allows the user to rest their hand to isolate better and access the vocabulary they want. First, once we know the software and the grid size of the vocabulary set, we can order a keyguard. A keyguard may have round or rectangular buttons. These can be 3D printed! We are doing this at TechOWL 

You can even create a keyguard and tactile cues using craft foam, acrylic sheets, and puffy paint. If you need some temporary tactile cues, you can add Wiki Sticks to the screen. There are lots of ways to add tactile cues to a screen protector or acrylic sheet.   

Stylii and Pointers 

People use stylus pens and different types of pointers to interact with a touchscreen on an AAC device. Some people can hold them in their fists, and others may benefit from using a strap made from Velcro brand Veltex.  

Device Positioning and Mounting 

Sometimes we can make a big difference just based on how we position the screen of a device. For example, something flat on the table can make it difficult to access the screen comfortably. It is usually better to have the screen at an angle, such as on a slant board. Many iPad cases come with built-in stands, but these are easy to find or make. Whatever we use to position the tablet, the goal is independent access. No one should have to hold it in the correct position. 

A person’s AAC should be available to them at all times, even when on the go.  Devices can be attached to a wheelchair by using mounts.  We can adjust most mount arms to the best height, distance, and angle for accessing the device.  Some mounts use a clamp to attach to wheelchairs, tables, bed frames, and other surfaces.  Other mounts are on wheeled stands.  Dedicated speech-generating devices will often come with a “mounting plate” on the back.  This allows for the device to be securely attached to the arm of the mounting system.  Alternatives to specialized mounts and accessories include gooseneck clamps and heavy-duty twist ties. 

Direct Access Without Physical Touch 

If the person has a complex body and cannot use the above tools to touch a device, it may still be possible for them to use a direct access modality. For example, eye gaze and head tracking are available for dedicated communication devices. These are slightly different means of activating vocabulary. With head tracking, a facial feature or a marker, such as a silver dot sticker, guides the cursor on the screen. Eye gaze systems use infrared cameras to track the position of the pupils on the screen. Eye gaze is often a better solution for someone who has very little head movements, such as someone with ALS.   

Head tracking has now come to the realm of consumer electronics. Some software allows users to use head tracking for communication on Apple devices with the True Depth camera. These apps include TouchChat and Jabberwocky AAC.  Head tracking and eye gaze are still forms of direct access because you are going directly to the word you want and selecting it. This is not an option for everyone. 

Indirect Access and Scanning 

Those who can’t use the above methods to speak their words may need to use switches to scan and select. There are many factors to consider when implementing switch scanning. The first is, which switch? There are a few main types of switches. These include: 

  • Mechanical switches (buddy button) 
  • Lever activated switches (wobble switch) 
  • Proximity switches (Candy corn) 
  • EM switches  (Neuronode) 
  • OM switches (Blink) 
  • Sip and Puff switches 

We recommend that the team, including an OT and a PT, work together to choose to position and place the switch.  

Another decision involves whether to use one switch or two. Again, this depends on several factors, including whether the individual has more than one reliable switch access site.  

After selecting the switch, you need to consider the scanning. On a high-tech device, scanning is how the cursor moves through the options on the system to choose the desired icon/letter/symbol/field/etc.  This involves some of the following considerations: 

  • Scanning pattern 
  • Scanning speed 
  • Vocabulary organization 

Different combinations of the above may require other skills. For example, an automatic scanning pattern can require the ability to time the activation of the switch(es). Proficient switch users can get quite fast, but this takes time. Vocabulary organization is critical.  

Consider organization.  AAC vocabularies are often organized in a left to right pattern, approximating English sentence structure. Will this work for scanning? 

You want words used often to appear early in the scanning pattern. By doing this, it is less work and faster communication. Think of the top-left position on the screen as being 1:1. After that, 1:2, 1:3, etc.  Scanning patterns and speeds are often highly customized to the individual.  Some patterns might start using row-column, column-row, quadrant, etc., and change to a new pattern as the person narrows down their selection. Scanning takes effort, and we want it to be efficient (and not exhausting!). 

Another thing to keep in mind is that some people will need more than one access method. For example, they may use eye gaze but change over to switches when they are tired. Someone with a degenerative disorder might start with direct access but switch to eye gaze or head tracking as their disease progresses.  A child might need partner-assisted scanning while they are learning how to use their switch. As with all things AAC, it depends on the needs and the preferences of the individual.