Communication and ALS

Nothing here asks you to stop speaking. Keep using your voice as much as you want. This section is about keeping options open, not replacing anything.

A yes/no signal costs nothing, and it’s easiest to agree while it’s still easy to talk about.

There are two different ways to keep something of your voice, and they’re often confused:

Many people do some of each. Some services can work from recordings you already have, or from speech that has already changed, so it’s worth asking what’s possible rather than assuming the moment has passed. On compatible Apple devices, Personal Voice is one built-in option, in supported languages.

Who provides communication support varies by country. It may be a speech therapist, an AAC or assistive-technology service, or your ALS clinic. If you’re not sure, ask your clinic where to start.

It also helps to write down the names, words and phrases that matter to you. They’ll be useful whatever you end up using.

Pen and paper still counts. A simple alphabet or word board and a computer-based communication aid are both real options — one isn’t a lesser version of the other.

A basic writing tablet can be a good bridge while handwriting is still comfortable.

Kids digital writing tablet — a simple bridge →

A phone, tablet or computer you already own may already have useful text-to-speech or accessibility features built in, with nothing to buy.

There are also purpose-built AAC apps. For someone who reads and spells comfortably, text-based AAC may be a natural fit; other AAC approaches exist for different communication needs. A speech or AAC specialist can point you toward options that suit how you type and what device you have.

A switch is any device that sends a single signal — one press, one tap, one movement. That’s its whole job.

With scanning, the options are highlighted in turn, and you press the switch when the one you want is highlighted. A single reliable movement can sometimes be enough to use a whole communication system this way.

Scanning usually takes longer than selecting something directly, so the speed should suit the person using it.

You don’t need a specialist switch to start. If you have a keyboard, you already have a switch — which means this is something you can try before buying anything.

If switch access becomes an important way of communicating, specialist advice can help with the choice and positioning of the switch. Those details are individual, so they’re worth assessing rather than guessing.

If touch or switch access isn’t a good fit, other access methods exist.

Eye-gaze systems let someone select what they want on a screen using eye movement, and the device speaks it. Whether eye gaze suits a particular person is individual, and that can be reviewed as needs change.

Head tracking is another option. Some people use more than one access method and move between them during the day.

Dedicated speech-generating and AAC systems are made for this kind of use. A specialist assessment can help work out which combination of tool and access method fits. How these systems are funded and provided varies a great deal between countries and healthcare systems, so your clinic or a national ALS organisation is the quickest way to find out what applies where you live.

ALS organisations →

Keep a printed letter board somewhere it can be reached. The method is simple: the person helping points to each row in turn until you signal, then reads out the letters in that row until you signal again. Letter by letter, you spell. The signal can be a blink, a look up, a nod — whatever is clearest for you.

Free printable letter and number boards →

A clear yes/no signal is one of the simplest backups, because it needs no equipment.

Getting someone’s attention isn’t the same as saying something. A call button covers the first; you’ll still want a way to communicate a message.

Wireless doorbell — a simple call button →

Make sure everyone who helps knows your signals, including someone helping for the first time.

None of this is an emergency system. Keep a separate plan for that.

Important information →