Talking with Your Hands and Eyes:
Communication Boards As Low-Tech Alternatives

By Leslie Aedo and Molly Doyle
Rancho Los Amigos National Rehabilitation Center
Center for Applied Rehabilitation Technology (CART)

September, 2009

Communication boards can be useful tools if you are no longer able to depend on speech or writing for all your communication needs. Some boards are “ready-made” whereas others can be custom-made to fit your needs and physical abilities. If you need to spell out messages, an alphabet board can be created. The layout of the letters can be customized and organized so that it is comfortable for you. For example, some individuals prefer that the layout resemble a computer keyboard, while others prefer the layout in alphabetical order.

EZ Picture Board by Vidatak

Some individuals prefer that frequently used words and phrases be placed on the board along with the alphabet. This allows you to select words and phrases as well as letters to increase your speed of communication. Examples of words or phrases that may be on a communication board can include frequently requested wants and needs, or names of family members.
 
At times, it may be difficult to place all words, phrases and letters on one board because of a limited ability to point to these items. For some individuals, having several boards can be very useful. Boards can be created with vocabulary and phrases specific to an activity, or specific to a topic. For example, a person with ALS (PALS) interested in sports may have a board created with names of teams, players, etc. 

Boards are not only customized for content, but also how they will be accessed. If you have limited movement and it is difficult to reach all the letters and words on a large board, a smaller board may be created so that little movement is required to select each target. Often it is easier to reach a board that has been propped up at an angle rather than lying down on a surface.
 
If you are having difficulty pointing with your finger, partner assisted scanning, eye linking or eye pointing may be used to help you access letters and messages. Partner assisted scanning involves the listener pointing to each row of letters or words written on the board. The PALS then indicates when the listener reaches the desired target in that row by showing a positive response. This response could be a head nod, a lift of a finger, closing of the eye, etc. Once the row is determined, the listener begins to point to the items in that row until he receives a positive response from the PALS that the target letter, word or phrase has been selected. Listeners who are very familiar with the layout of the board may recite the rows or letters out loud and no longer require the physical board.

A couple of excellent demonstrations of partner assisted scanning are available on YouTube by clicking here.

Eye linking is another approach that may be used when pointing with your finger is physically difficult. Boards can be specifically set up to allow the PALS to look towards the letters or words he desires to communicate. Letters and words can be spaced on a board to make it easier for the listener to determine at which letter or word the PALS is “looking.” For eye linking, letters and words are placed on a clear, see-through board, such as one made of Plexiglas. The board is positioned between the face of the PALS and the listener, at a fairly close distance, so that the listener can easily see the eye movements of the PALS. The PALS looks towards the desired letters or words, and the listener determines the message by interpreting where the PALS is looking. Sometimes eye linking is used in combination with partner assisted scanning to speed up communication.

A patient uses a special communication board to indicate his level of pain

Eye pointing is a similar approach that also may be used. For some individuals, placing the letters, words and phrases into four quadrants of a communication board is preferred because it is easier for the listener to “read” the ALS patient’s eye movements. Once the quadrant is determined, the PALS looks towards a portion of the board to indicate the position of the letter or word within the quadrant. Partner assisted scanning also may be used to determine the specific item within the quadrant.

The design and layout of a communication board will be influenced by your needs, who you communicate with, and how you physically access your messages. A communication board that works well for one person may not have the optimal layout for another person. Your ALS Association Greater Los Angeles Chapter case managers may have some boards available for you to try. There are also various prefabricated boards available for purchase or at no cost (see Resources below). An evaluation by a speech pathologist and occupational therapist can be helpful to determine the best layout for and access to a communication board. These therapists can also help you decide what type of electronic or speech generating device may be appropriate for your needs.

Resources: 
 
Eyelink: A Low Tech Communication Aid (approximately $18.00 each)
Communication Independence for the Neurologically Impaired
http://www.cini.org/

Eye Pointing Board (approximately $165.00 each)
Frenchay ETRAN
http://www.liberator.co.uk/index.php/products-1/low-tech-communication-aids/

EZ Word or Picture Board (approximately $17 each)
HealthcareInspirations.com
http://www.healthcareinspirations.com/index.html

Eye Language Communication Board 
ALS Care
http://www.alscare.com/pdf/abc_board.pdf

Buddy Boards
Buddy Speak LLC
http://buddyspeak.com/xcart/customer/home.php

Leslie Aedo MS CCC and Molly Doyle MS CCC are speech language pathologists at the Center for Applied Rehabilitation Technology (CART) at the Rancho Los Amigos National Rehabilitation Center. If you have questions regarding this article, please contact CART at (562) 401-6800 or visit our website at www.rancho.org/cart.