Assistive Technology Can Give a Voice to the Voiceless By: Sally Ouimet Waters

 Today, we welcome a new guest writer to The Voiceless Minority community. Thank you for joining the fight, Sally.

Sally Ouimet Waters, MA CCC-SLP, received her undergraduate and graduate degrees from the University of Florida. She completed her Clinical Fellowship at the Malcom Randall VA Hospital in Gainesville and has over ten years of clinical experience in the Ocala area, specializing in adult dysphagia and neurogenic cognitive-communication disorders. Sally utilizes current evidenced-based practice to inform her treatment programs for individuals who have experienced CVA, Traumatic Brain Injury, Voice Disorders, Parkinson’s Disease, and ALS to improve communication and swallow function according to the patient’s objectives.  She specializes in the evaluation and treatment of individuals who have experienced Head and Neck Cancer, including those with tracheostomy, laryngectomy, and post-radiation dysphagia. She advocates for the oncology team to recommend early intervention for the Head and Neck Cancer population soon after diagnosis and prior to radiation treatment for optimal outcomes in the preservation of swallow function. She works as the lead speech-language pathologist at Advent Health Rehab Sports Medicine in Ocala, Florida. We appreciate her willingness to provide a new perspective to our readers. Her article can be found below.

 

With the rapid advancement of technology for communication in the last thirty years (think Zach’s cell phone on Saved by the Bell to asking Siri to order General Tso’s from Uber Eats), the use of technology in communication aids has followed suit. People can benefit from communication devices for a variety of reasons. Sometimes, an individual may not have the respiratory drive or sufficient muscle movement required to produce intelligible speech; some individuals lack the anatomical structures to produce speech due to surgical resections of the larynx or tongue; sometimes, individuals may have difficulty verbally producing a word due to apraxia (when the muscles that produce speech do not receive the right motor plan for sequences of movements), even though the anatomy is intact and their muscles have adequate strength.

In every situation, the individual knows what the intended message that they want to communicate is, but the listener does not. From a normative social perspective, the onus of communicating the intended message is typically seen as one carried solely by the speaker. This, interestingly, is reversed if the listener has a hearing difference. That results in a society that puts the onus of communication on the person with the communication difference. The communication aids outlined here may help to reduce the tilted scales by improving the act of communication itself-transmitting an intended message to a listener, with the listener now bearing the responsibility of embracing the existing communication differences as well as the communication aid.

To produce intelligible speech (speech that is easy to understand by most listeners), a voice needs sufficient volume. Vocal volume is modulated by respiratory drive. In other words, the pressure and force of the air that comes from your lungs and passes through your vocal cords dictates how loud your voice will be. For individuals with decreased respiratory drive, volume tends to be lower, and speech is more difficult to understand. A voice amplifier is an assistive device that can be helpful. Voice amplifiers work by increasing the volume the individual produces just like a microphone. The mouthpiece is placed near the mouth usually on a head-phone-like mount, and the speaker is work around the neck or placed close to the chest of the speaker.

Recently, the Chicago Tribune published a review of voice amplifiers (5 Best Voice Amplifiers - Dec. 2024 - Chicago Tribune). They identified five amplifiers: Zoweetek, Shidu, two Winbridge devices, and Voice Booster. Some devices provide better amplification for those who need amplification for public speaking, like the voice booster, while others are more appropriate for smaller settings. Most are blue-tooth capable and have rechargeable batteries.

In addition to having good respiratory support, speech requires both adequate strength of the muscles involved in articulation (lips, tongue, soft palate), as well as a motor program (a message sent from the brain to the muscles telling them the sequence of how to move, when to move, how much to move). Without adequate strength of the muscles involved in articulation or without a correct motor program telling the muscles how to move, the intended communication message may not be received by the listener.  This is where Alternative Augmentative Communicate (AAC) devices can be helpful. AAC devices are devices that have different means of control for word selection depending on an individual’s needs. These devices can be controlled by head movement, eye gaze, or touch. The individual uses whatever means is most functional for them and selects words to build sentences so they can communicate across all settings. Many devices can also be programmed so that the individual can control light switches or door openings within the home through their preferred selection method. Voice-outputs can be customized to the patient’s preference, such as child-like voices for children and dialects and vernaculars can often be customized as well.

Some examples of AAC devices include the Tobii Dynavox brand, which offers high tech solutions like eye-gaze and some devices offer voice banking. Tobii Dynavox also offers apps that can be used to facilitate functional communication, providing common or “core” vocabulary that makes it easier to build sentences. Lingraphica is another company offering devices that provide a voice for the words and sentences selected by the individual. Many other types of AAC devices exist and most are covered by insurance when they are found to be medically necessary.

These specialized devices can help communication partners/listeners understand an individual's intended message, but so can that omnipresent iPhone we can’t seem to put down for more than thirty seconds. Many communication-based apps or accessibility settings offer user-friendly options to facilitate communication such as text to speech and text read-aloud. Natural language processing devices such as Siri and Alexa are improving every day on understanding words spoken by individuals with communication differences, although there is still room for improvement. If you are interested in finding out more about communication aids, a good place to start is with your local speech therapist to assist in identifying the communication tech that best suits your specific needs and the needs of your communication partners.