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What are the different AAC Options?
Speech generating devices (SGDs) and Voice Output Communication Aids (VOCAs) are electronic augmentative and alternative communication (AAC) devices with speech output. There are also some methods of electronic communication that do not speak and only convey messages in writing. Electronic devices are generally powered by batteries and can have features that range from simple to very sophisticated.

Light Technology refers to boards, books and non- electronic AAC options. These types of communication systems may be used by themselves or with other AAC methods, including SGDs. Effective communication is multi modal.

Software programs can be used to create light technology / non-electronic systems and to produce resources to extend the effectiveness of electronic voice output devices. There are also communication software that convert computers and tablets into Speech Generating Devices.

Communication Apps for mobile technologies such as iPhones, iPads and Android devices can provide an alternative to Speech Generating Devices for some people or may be used to assist communication in particular situations.

A combination of gestures / signs, light technology (non-electronic) systems, mobile technology devices and speech generating devices can provide AAC users the most effective communication options to suit their individual needs.

Selecting a Speech Generating Device / Voice Output Communication Aid
The communication goals of the person using the assistive technology will determine the features required. For people with complex communication needs considering high cost devices, trialling the most appropriate communication aid in the person's environments where they will use the device prior to purchase is beneficial and may be required by government funding agencies. Trials allow time to identify suitability and whether additional equipment or alternatives may need to be considered.

To help select a device, it is important to carefully consider the needs and skills of the person who will use it, the person's environment - their daily settings at home, school, work and in the community, who the person will be using the device to communicate with and what kind of communication the device will be used for. The SETT Framework by Joy Zabela is an example of a research-based resource that can assist in decision making when selecting a communication device. Enable NSW has developed Prescription Guidelines for Speech Generating Devices. These are available at the Enable NSW website

Types of Communication Devices
SGDs / VOCAs include:
* Single message devices
* Single level devices. The pictures/ words on the display may be changed, to suit the vocabulary programmed into the device.
* Multi-level devices - these have one physical display, however the pictures/ words displayed on the device can be changed. The paper (overlay) these are on is a hard copy and needs to be physically changed. The device can have vocabulary programmed on more than one level.
* Static Display devices - these are devices where the display does not change. The device may be simple, where each key is used for one symbol. The user can sequence symbols or words to generate a message (phrase).
* Dynamic Display devices - the device is a tablet computer or similar with a touch screen for the display. Message pages on the display are created using the software program and can change using navigation keys and link buttons. A variety of access options may be available.
* Text to Speech devices - the device has a physical keyboard or an onscreen keyboard that enables the user to spell messages and it converts the text to synthesised speech. Text -to-speech devices may have additional features such as word prediction and abbreviation expansions. Some dynamic display devices include text-to-speech capabilities and use symbols as well as text.

Communication Device Features
There are a range of features to consider to help determine the most appropriate device. Some major features are described below. See also the information in Factors to Consider.

Speech Quality
* The type, quality and volume of the speech output can vary in devices. Generally there are two types of speech output in SGDs; Synthesised (computer produced) or Digitised (based on a recorded human voice).

* Synthesised Speech is artificial, computer-generated speech and is created instantly by the device. The quality of the voices created by modern speech synthesisers is excellent and you can choose from a range of gender or age-specific voices in many languages, including ones with Australian accents.

* Digitised Speech messages are words and messages recorded directly onto the communication aid. It's the same concept as recording on a tape recorder, except that the recorded words and messages are stored electronically. It is natural and can be age, gender and language appropriate whilst also being expressive. However, digitised speech provides challenges when recording a large vocabulary and only presents the recorded messages as speaking options, i.e. if it's not recorded, it can't be spoken be the person using the device.

* Speech generating devices have built-in speech amplification and the quality may vary from simpler to more sophisticated devices. It is important to ensure that speech quality is adequate to meet the user's needs in various environments where they are communicating.

* Ensuring your voice can be heard in the noisiest of environments and the ability to have discrete conversations can rely on good volume control.

Access Options
* The access method and the positioning of the device must be considered, particularly for people who have a physical disability.
* Direct access means the person has to reach and touch or press the keys to type in a message and/ or to activate the messages keys. Accessories that may assist with direct access can include keyguards, to make it physically easier to activate keys or a stylus to activate message keys, where it is difficult for a person to press and activate the key with their finger.
* Alternative access methods for people with a physical disability can include switches, scanning, head track or eye gaze modules, joysticks and other accessories that allow operation of the device through alternative means.
* Auditory scanning is another alternative access method to select messages for people with visual impairment, enabling them to listen to the message options using an earphone, then using a switch to activate the message they want to say, so it speaks outloud.
* An occupational therapist or assistive technology specialist can assist in selection of alternative access options to suit the needs of an individual.
* Seating may also require review, with adjustments or accommodations to meet the individual's needs, so a communication device can be mounted and / or positioned effectively for an individual who has a physical disability. Occupational therapists and some physiotherapists with experience in seating can assist with this, should this be needed.

Vocabulary / Language / Pre-stored Vocabulary
Speech generating devices range from simple one message devices to complex dynamic display devices. Some provide displays with symbols and text to represent words and phrases and allow access to a keyboard to spell out novel messages.

Features to consider, in relation to vocabulary are:
* Number of messages - does the device have sufficient vocabulary, to suit its purpose?
* Does the device have a spelling option, enabling the user to add in vocabulary and do their own programming?
* For symbol based devices, consider the type and number of symbols that can be used; is it a single level, multi-level or dynamic display device?
* Simple devices that rely on a physical overlay can have photos, pictures or any symbol set that the user and people supporting implementation of the device have access to.
* Symbol software may be built into the device or may be an additional purchase. With SGDs / VOCAs that have built in software, check whether it is compatible with a person's other communication systems, or will it be a new symbol set to learn?
* Does the device have pre-stored vocabularies? How comprehensive are these? For instance, do they enable spontaneous language generation? Do they enable the user to compose a variety of messages, such as comments, requests, negation, continuation of activities, social etiquette, information sharing, questions and humour?

Connectivity
* Some SGDs offer other types of communication such as SMS or social media, such as Facebook and Twitter. If these methods rely on the ability to connect to the internet, then built in Wi-Fi, cable or a connection to a telecom network is required. Often, speech generating device software will have embedded functions giving access to these features and other applications across the entire device.
* Simple SGDs may not have any additional connectivity capabilities.

Batteries / Charging
* Use only the batteries recommended for the device.
* Regular charging will usually be needed to ensure the device will operate throughout the day.
* When obtaining a new communication device, read the charging instructions carefully. Some batteries need to be fully charged the first time they are used, so they will work optimally.
* Check the operating manual for detailed information about a device when you are first using it and you can also ask advice from the supplier about the best ways to maintain battery life.

Manual and Support
User instructions or a manual will be provided when you purchase a SGD / VOCA. When trialing a device, make sure you have access to the instructions / user manual. Some devices will have a user manual built into the device.

Considerations

Hardware
SGDs / VOCAs vary from specific dedicated speech output devices , that have the capacity to record a limited amount of speech for a single message, to devices that use personal computers as the hardware to operate a dedicated communication software program. These may be MAC or PC operating systems.
When purchasing communication software, check on compatibility with the device it will be used on.

Access
* Using a SGD / VOCA is slower than speaking, even when using direct access.
It is essential to select an access method that will work as efficiently and easily as possible.
* Where alternative access is needed, assessment and trialing of access methods will assist in customising the set up of the device to best suit the needs of the user.
* Positioning of a device to best suit the access of the user is vital. This may require specialised mounting and advice from an occupational therapist.
* Seating may need to be reviewed and adjusted at the same time as a communication device is trialled and implemented. An occupational therapist or physiotherapist with experience in seating may need to be consulted.
* If a device can only be used in particular situations, such as when seated in a wheelchair, it is vital the person has other communication systems to enable their communication at other times.

Portability
For people who are mobile, device portability and how it will be carried is very important. For people who use mobility aids and wheelchairs, it will be important to ensuring the device can be carried with them, mounted and positioned appropriately when they want to use their communication device, and transported with them, when they are travelling.

Consider how a device will be available for the user across the various situations and activities they participate in. A light tech / low tech non-electronic system should always be available as a back-up system and for situations when using the SGD / VOCA is less efficient than the light tech system.

Durability
How robust is the equipment? Is it likely to be dropped?
Consider the user's needs and the environment where the communication device will be used when selecting a suitable device.

Vocabulary / Language / Pre-stored Vocabulary
Is the user a pre-intentional or intentional communicator?
Consider the person's current language skills (understanding and production of language) and their potential language development.
Does the system match the person's current language skills and does it allow for later language development?
Does the system require literacy skills?
Does the system allow access to literacy and literacy development?
How is language represented? (pictures, symbols, text etc..)
Can the individual compose novel messages?
Can vocabulary/messages provided be used across several contexts/situations?

Programming
* How easy or difficult is it to program the device? How time-consuming is it?
* Does the device come with pre-stored vocabulary or do you have to do the programming from scratch?
* Can you do programming on a computer and then transfer the programming to the device?
* How much memory for programming and/or for recording speech is available?
* Does the device have synthesised speech or do you have to record every message?
* What is involved in maintaining the aid? Who will take responsibility for looking after the device, programming and charging it?

Cost and Funding Support
SGDs / VOCAs vary in price, depending on how simple or complex the device is and how specialised the accessories required to operate the device are.

Many dedicated SGDs/ VOCAs are more expensive than mobile technologies, because they have been designed specifically for people with special needs and are not a univerally designed product. Development and manufacture can be alot more expensive in the more specialised market. However, dedicated SGD's / VOCAs can have features that make them best meet an individual's needs.

Funding support is available IN NSW for purchase of speech generating devices / Voice Output Communication Aids that cost more than $100. Please see the Enable NSW website for further information www.enable.health.nsw.gov.au.

With the advent of the National Disability Insurance Scheme and DisabilityCare, it is expected that consumers will have an increased capacity to fund the communication equipment they need.

Insurance & Warranty
When you purchase the device, do you have comprehensive home contents insurance? Will this cover the device? Do you need to take our insurance in case the device is lost or stolen?

What warranty is being offered by the supplier and manufacturer to fix the device if it is broken? Check this with your supplier when purchasing.

Assessment, Training and Support
* Communication assessment and intervention should be tailored to meet the needs of the individual.
* It may be appropriate to consult with an augmentative communication consultant or assistive technology specialist.

In NSW free advice can be obtained using the Assistive Technology Australia Infoline 1300 452 679; free advisory appointments can made at the Blacktown display in Sydney.

Assessment services for SGD's / VOCA's are provided by:
* The Computer Assistive Technology Services (CATS), Northcott Disability Services. This is a state-wide service; CATS will assess in regional areas.
* TASC, (Technology solutions for computer Access, Seating and Communications) Cerebral Palsy Alliance. TASC is also a state-wide service, with assessments in regional areas.
* In NSW, assistive technology advice and assessment services are available within Ageing, Disability and Home Care services and Catholic Education services.
* Some private speech pathologists and occupational therapists have experience in implementing SGD/ VOCA communication systems.

Disclaimer
Assistive Technology Australia does not sell equipment. Information is provided as a community service.

Prices on products in the Assistive Technology Australia database are provided by the equipment supplier and are subject to change without notice.

Note: Due to variances in the Australian dollar against worldwide currencies, pricing for overseas products listed on Assistive Technology Australia database might vary significantly from different suppliers

When purchasing equipment you need to confirm details, including specifications, with the supplier before purchasing.

Freight charges to regional areas may incur higher costs.

The provision of this information does not constitute a recommendation. Responsibility for final selection of any item rests with the individual.

Price Guide

See information about individual products for pricing information

Standards

Standards
Some assistive technology needs to meet Australian or other standards. Standards may relate to materials, manufacturing and installation. Products that meet Australian or international standards will have written certification. To find out if a product meets Australian Standards ask the supplier to show you the certificate. For more information about standards also see
http://at-aust.org/home/assistive_technology/standards.html

TGA
Many of the items on the Assistive Technology Australia website are categorised as a Medical Device. Medical devices that are approved for use in Australia have been entered into a national database called the Australian Register of Therapeutic Goods (ARTG), which is maintained by the Therapeutic Goods Administration (TGA). You can ask the supplier for the ARTG number for the device you wish to purchase and search the ARTG for the entry. To access information on the ARTG visit www.tga.gov.au

When buying a medical device it is advisable to only choose a medical device that is recommended by a healthcare professional and has been included on the ARTG.