What is a communication aid?

See: Definitions and information at Communication Matters

Note: different types of AAC equipment are listed on the Communication Matters website and the ACE Centre SpeechBubble database

What is a Communication Aid?

A communication aid helps an individual to communicate more effectively with people around them.

Communication aids are also referred to as AAC devices. AAC refers to Augmentative and Alternative Communication, which Communication Matters define as,

… a huge range of techniques which support or replace spoken communication. These include gesture, signing, symbols, word boards, communication boards and books, as well as Voice Output Communication Aids (VOCAs).

There are two main types of AAC system: Unaided Communication and Aided Communication.

Unaided communication does not use additional equipment. Body language, gesture, vocalisation, signing are typically used.

Aided communication uses equipment, but this ranges from low-tech to high-tech methods, with pictures and symbols often used instead of, or together with words and with alternative hardware options available to provide access. Whilst a low-tech method of communication like a simple, laminated communication book to carry around with a few pages of pictures or symbols would be a communication aid, the term ‘device’ would only describe a more high-tech solution. An electronic communication aid can be a dedicated device built for that job, which does nothing else, or it can be a standard computer running specialist communication aid software as well – this includes Apple tablets which are increasingly being used to help people communicate.

AAC equipment – hardware and software - may also be referred to as ‘AAC systems’. Each has pros and cons and what is suitable for one individual will not necessarily suit another person. A low-tech solution is not inferior to a high-tech solution. Selection will depend on personal preference, as well as abilities and needs, with method of access, environmental factors and funding also primary considerations. A specialist assessment through a speech & language therapist or communication aid centre will help to identify the most appropriate AAC system or systems for an individual.

Communication aid hardware and software is not the full picture, however. Training and ongoing support are vital factors in determining successful use of a communication aid for any individual.

Useful Links:


Although this information is believed to be accurate, you are strongly advised to make your own independent enquiries.

December 2012

aided communication

The right communication aid?

Deciding on the right communication aid

There are many things to think about here and it is important to get some specialist help to make the decision. There are lots of things available on the market and in many instances more than one communication aid would be appropriate, so it may come down to personal preference.

Here are just some of the the other key considerations:

e.g. are you just learning to use written words, or are you too young for that at present, or have you lost the ability to read easily following an illness?

Would it help if you had another way of selecting letters, words or pictures?

Things you may want to look into: assessment, SpeechBubble, funding


Although this information is believed to be accurate, you are strongly advised to make your own independent enquiries.

December 2012

access & equipment

Funding for communication aids

Several suppliers of AAC equipment provide useful funding information, which applies to the wider issue of funding and not just their own equipment:

Note: other suppliers of AAC equipment are listed on the Communication Matters website and the ACE Centre SpeechBubble database

Funding a communication aid?

The information provides general advice on funding an individual AAC device for children, young adults and adults. It looks at local government agencies and lists charities that either fundraise for communication aids or may be able to provide information and advice and some private fundraising ideas. Advice is also given if your funding application is initially rejected, with a list of organisations to contact.

The Funding picture in the UK is very mixed and what is available largely depends on the age of the person who requires AAC, as well as individual disability, location and the timing of an application.

For children, if the requirement for a communication aid has been included on the child’s Statement of Special Educational Needs then the Local Education Authority is obliged to provide equipment; although in practice this is problematic, with education budgets often inadequate to fund expensive high-tech devices. Legal documents can be used to support an application for this funding. The information links above include letter templates which you can use to contact your Local Education Authority to request a statutory assessment of special educational needs as well as to challenge an assessment.

For young adults, a Disabled Student Allowance (DSA) may be available for specialist equipment required during college or university study.

For adults, the GP should be the first point of contact, who will be able to refer you to NHS specialist equipment services units, or to health professionals who may be able to help: speech and language therapists, occupational therapists  and physiotherapists. Funding may come from the NHS, from charities or from the government’s Access to Work scheme.




Although this information is believed to be accurate, you are strongly advised to make your own independent enquiries.

December 2012

aided communication

Factsheet - What is a stroke?

Useful information available at

December 2012


Factsheet - What is Aphasia?


Factsheet - Dysarthria: Causes

Information taken from http://en.wikipedia.org/wiki/Dysarthria#Causes.


[Note that a speech and language therapist is referred to as a speech and language pathologist in the USA] 

The causes of dysarthria can be many, including toxic, metabolic, degenerative diseases (such as Parkinsonism, ALS, Huntington's Disease, Niemann Pick disease, Ataxia etc.), traumatic brain injury, or thrombotic or embolic stroke. These result in lesions to key areas of the brain involved in planning, executing, or regulating motor operations in skeletal muscles (i.e. muscles of the limbs), including muscles of the head and neck (dysfunction of which characterises dysarthria).

These can result in dysfunction, or failure of the motor or somatosensory cortex of the brain, corticobulbar pathways, the cerebellum, basal nuclei, brainstem (from which the cranial nerves originate), or the neuro-muscular junction which block the nervous system's ability to activate motor units and effect correct range and strength of movements.



You may want to read further in our factsheet - dysarthria and dysphasia


Last updated November 2012


Factsheet - Dysarthria and Dysphasia

This information is taken from http://www.patient.info/doctor/Dysarthria-and-Dysphasia.htm because it provides useful technical descriptions and easy access leaflets,

Dysarthria and Dysphasia

Dysarthria is a disorder of speech 

  • Speech is the process of articulation and pronunciation. It involves the bulbar muscles and the physical ability to form words.

Dysphasia is a disorder of language

  • Language is the process in which thoughts and ideas become spoken. It involves the selection of words to be spoken, called semantics, and the formulation of appropriate sentences or phrases, called syntax.

Strictly speaking, the words anarthria and aphasia mean a total absence of ability to form speech or language but they are often used when dysarthria and dysphasia would be more correct.

Dysphasia can be receptive or expressive. Receptive dysphasia is difficulty in comprehension, whilst expressive dysphasia is difficulty in putting words together to make meaning. In reality there is usually considerable overlap of these conditions but a person who has pure dysarthria without dysphasia would be able to read and write as normal and to make meaningful gestures, provided that the necessary motor pathways are intact.

Inability to write is agraphia or dysgraphia if incomplete. Inability to manipulate numbers is acalculia or dyscalculia if incomplete. Difficulty reading is dyslexia.

Dominant hemisphere

The speech area is in the left, dominant side of the brain in about 99% of right-handed people. The remaining 1% may represent inherent left-handers who have been forced to write with their right.

In left-handed people, the right hemisphere is the dominant side in only 30%. Thus impairment of the speech area with a stroke, causing left-sided weakness, is rare. It will occur in virtually no right-handers and in only 30% of left-handers.

As a general rule, a lesion of the left hemisphere will cause dysphasia whilst, in the right hemisphere, it will cause neglect, visuo-spatial and cognitive problems.


The aetiology is damage or disease of the brain and so it is most common in old people. Disease is usually vascular, neoplastic or degenerative. Around 85% of cases arise from a stroke and around 1 person in 3, who has a stroke, will have dysphasia. In younger people it is usually a result of head injury.


Causes of dysarthria

Dysarthria is caused by upper motor neurone lesions of the cerebral hemispheres or lower motor neurone lesions of the brain stem. It also results from disruption to the integrated action of upper motor neurones, basal ganglia and cerebellum.

Features of dysarthria

There may be some variation depending upon the site of the lesion

  • Slurred and weak articulation with a weak voice is typical of pseudobulbar palsy from a stroke. Other neurological signs are usually unilateral with a right-sided hemiplegia (left side of brain). It may be on the left in a minority of left-handers. Brain stem stroke may lead to bilateral signs with dysarthria or anarthria.
  • Slurred, scanning and staccato speech caused by cerebellar lesions is typical of multiple sclerosis.
  • A dysrhythmic, dysphonic and monotonous voice is caused by disease of the extrapyramidal system in Parkinson's disease. Movement is rigid and stiff in Parkinson's disease and that includes phonation.
  • Indistinct articulation, hypernasality and bilateral weakness caused by lower motor neurone disorders can occur with motor neurone disease. 

Management of dysarthria

Speech and language therapy is required to assess and treat the bulbar and facial muscles. A programme of exercises is developed to improve muscle tone and movement to match the individual's needs. Be patient with a dysarthric person and try to make out what is being said. This encourages effort rather than opting out. If this fails they may write or use an electronic communicator if they have one.


Causes of dysphasia

Dysphasia is impaired ability to understand or use the spoken word. It is due to a lesion of the dominant hemisphere and may include impaired ability to read, write and use gestures. The commonest cause is cerebrovascular disease but it can arise from a space occupying lesion, head injury or dementia.

Features of dysphasia

Dysphasia can be seen as a disruption in the links between thought and language. The diagnosis is made only after excluding sensory impairment of vision or hearing, perceptual impairment (agnosia), cognitive impairment (memory), impaired movement (apraxia) or thought disturbance, as in dementia or schizophrenia. When testing for dysarthria and dysphasia, the patient's ability to repeat or produce difficult phrases or tongue twisters can be indicative.

  • People with receptive dysphasia often have language that is fluent with a normal rhythm and articulation but it is meaningless as they fail to comprehend what they are saying.
  • People with expressive dysphasia are not fluent and have difficulty forming words and sentences. There are grammatical errors and difficulty finding the right word. In severe cases they do not speak spontaneously but they usually understand what is said to them.

Specific types of aphasia are associated with damage to particular cortical regions but in practice distinctions are not always clear. Language is a complex activity involving many cortical and sub-cortical areas and lesions do not dissect clearly-demarcated anatomical areas. Generally, expressive dysphasia suggests an anterior lesion while receptive dysphasia suggests a posterior lesion. There are a number of sub types. They are:

  • Sensory (Wernicke's) aphasia - lesions are located in the left posterior perisylvian region and primary symptoms are general comprehension deficits, word retrieval deficits and semantic paraphasias. Lesions in this area damage the semantic content of language while leaving the language production function intact. The consequence is a fluent or receptive aphasia in which speech is fluent but lacking in content. Patients lack awareness of their speech difficulties. Semantics is the meaning of words. Semantic paraphrasia is the substitution of a semantically related but incorrect word.
  • Production (Broca's) aphasia - lesions are located in the left pre-central areas. This is a non-fluent or expressive aphasia since there are deficits in speech production, prosody and syntactic comprehension. Patients will typically exhibit slow and halting speech but with good semantic content. Comprehension is usually good. Unlike Wernicke's aphasia, Broca's patients are aware of their language difficulties. Prosody is the study of the meter of verse. Here it means the rhythm of speech.
  • Conduction aphasia - lesions are around the arcuate fasciculus, posterior parietal and temporal regions. Symptoms are naming deficits, inability to repeat non-meaningful words and word strings, although there is apparently normal speech comprehension and production. Patients are aware of their difficulties.
  • Deep dysphasia - lesions are in the temporal lobe especially those mediating phonological processing. Symptoms are word repetition problems and semantic paraphasia (semantically related word substituted when asked to repeat a target word).
  • Transcortical sensory aphasia - lesions are in the junction areas of the temporal, parietal and occipital areas of left hemisphere. Symptoms are impaired comprehension, naming, reading, writing and semantic irrelevancies in speech.
  • Transcortical motor aphasia - lesions are located between Broca's area and supplementary motor area. Symptoms are transient mutism, telegrammatic, and dysprosodic speech. Telegrammatic means omitting unimportant words, as was done when sending a telegram. Dysprosodic speech is monotone.
  • Global aphasia - occurs with extensive damage to the left perisylvian region, white matter, basal ganglia and thalamus. Symptoms are extensive and generalised deficits in comprehension, repetition, naming and speech production.

Examining patients with dysphasia

Tests for receptive dysphasia may include asking patients to read words or a passage and then asking them to explain it. Comprehension of spoken material is assessed by asking the patient to listen to a passage and explain it or, alternatively, by asking them to follow certain instructions such as, "point to the door".

Tests for expressive dysphasia include:

  • Asking the patient to name a series of objects and some of their parts. For example, ask the patient, "What is this?", pointing to a pen, your tie and watch in turn. Then ask, "What part of the watch is this?", pointing to the strap and then the face or hands.
  • If language is limited then dysphasia may be tested by holding up a pen and asking, "Is this a pen?" If the patient says, "Yes", then point to your watch and ask, "Is this a pen?" This demands a different reply. Look out for difficulty in finding the right word and perseveration. This is inappropriate repetition of the same word or phrase.
  • Can the patient talk spontaneously on a familiar topic? "Tell me about your family." "Tell me about the work you used to do".
  • Can the patient count numbers or recite days of the week?
  • Write a brief dictated passage?
  • Write a brief spontaneous passage?
  • Copy a short passage?

All tests of literacy and numeracy must be interpreted in the light of pre-morbid function For example, impairment in numeracy in a former accountant probably represents a substantial decline.

Management of dysphasia

Referral to speech and language therapy is the usual practice for dysphasia where a thorough assessment of the nature of the problem is followed by exercises to encourage the recovery of fluent speech and understanding. Therapy tends to be tailored to the needs of the individual patient. The value of these interventions has been assessed by a Cochrane review that concluded that, whilst there was no good evidence to support such management, there was none to refute it either. The problem is a shortage of good-quality research to assess the value of speech and language therapy.


Aphasia may have a severe, debilitating effect on the everyday life of the patient. Severe aphasias are likely to show little improvement but other forms can show rapid improvement. The probability of recovery following trauma is higher than following stroke. Around one third of aphasics recover fully within three months but complete recovery is unlikely after six months. When language returns in a person who was an immigrant but has spoken English for many years, it tends to return in the native language. There is a possibility that some drugs may enhance the ability to learn and hence to recover language after a stroke but this is still very much in the experimental stage.


Last updated November 2012


Role of the Occupational Therapist

This information about the role of an occupational therapist (OT) has been taken from information provided by College of Occupational Therapists, NHS Careers, Great Ormond Street Hospital.

What does an occupational therapist (OT) do?

Occupational therapy is the assessment and treatment of physical, psychological, social and environmental needs using specific, purposeful activity to prevent disability and help to increase people’s independence and satisfaction in all aspects of daily life.

The College of Occupational Therapists say that OTs can help with the everyday things in life when we have difficulty with these things.

Occupational therapy provides practical support to people with physical and mental illness, disability, long term condition, or those experiencing the effects of ageing, to do the things they need or want to do. It enables people of all ages to carry out practical and purposeful activities (often referred to as ‘occupation’). This could be essential day to day tasks - such as dressing, cooking, going shopping, to the things that make us who we are - our job, interests, hobbies and relationships.

OTs work closely with people to enable them to lead full and satisfying lives as independently as possible and achieve personal goals. This therapy offers valuable support and minimises the impact of disease and disability through the use of purposeful activity.


Examples of when an OT can help?

Examples of how an OT can help?

The starting point will be for the OT to make an assessment of what the client is able to do and prepare a treatment plan that describes the support they need.


Where do occupational therapists work?

Occupational therapists work in hospital and in the community. They work with people of all ages to help them overcome the effects of disability caused by physical or psychological illness, ageing or accident.

Support roles are assistant practitioner/ occupational therapy assistants/ clinical support workers/ rehabilitation assistants/ technical instructors.


How can I find an Occupational Therapist?

Your GP will refer you to an occupational therapist if appropriate, or you may be advised to contact the social services department of your local council to arrange an occupational therapist home visit (Social work departments in Scotland / Department of Health, Social Services and Public Safety in Northern Ireland).

You can find a private occupational therapist by searching the list of independent Occupational Therapy Practitioners at the College of Occupational Therapists.

College of Occupational Therapists
Education Department
106-114 Borough High Street
Tel: 020 7357 6480
Website: http://www.cot.org.uk/


Although this information is believed to be accurate, you are strongly advised to make your own independent enquiries.

December 2012


Role of the Speech & Language Therapist

This information about the role of a speech and language therapist (SLT) has been taken from information provided by Royal College of Speech and Language Therapists (RCSLT), Association of Speech and Language Therapists in Independent Practice (ASLTIP), NHS Careers.

What does a speech and language therapist (SLT) do?

The Royal College of Speech and Language Therapists (RCSLT) describe speech and language therapy as

concerned with the management of disorders of speech, language, communication and swallowing in children and adults.

A speech and language therapist will assess and treat children and/or adults with specific speech, language and communication problems to enable them to communicate to the best of their ability:

An SLT works directly with the client and provides support to them and their carers: as allied health professionals they work closely with parents, carers and other professionals, including teachers, nurses and occupational therapists.

There are around 13,000 practising SLTs in the UK and around 2.5 million people in the UK have a speech or language difficulty:

In the US the term used is speech and language pathologist (SLP).


Examples of when an SLT can help?





Where do speech and language therapists work?

Speech and language therapists work in hospital and in the community. They work with people of all ages to help with speech, language, communication and swallowing difficulties.

Support roles are assistant practitioner, assistant speech and language therapist, support worker, bi-lingual co-worker.


How can I find a speech and language therapist?

You can refer yourself to your local speech and language therapy service: you do not have to wait for someone else to refer you. If you think you, a family member or a relative needs to see a speech and language therapist you should ask your GP, district nurse, health visitor, nursery staff or teacher for a referral.

Services vary across the UK. A speech and language therapist or assistant may contact you after referral to find out more about your situation. If the wait for an appointment is unacceptable you should contact the SLT department and, if problems continue, your PCT to discuss the situation.

NHS Therapists are members of The Royal College of Speech and Language Therapists (Cert.MRCSLT) and are registered with the Health and Care Professions Council (HCPC) as a condition of their employment.  

Independent (private) speech and language therapists can usually offer an immediate appointment for assessment, followed by therapy to suit the client. Many will carry out therapy in schools or homes if required. Some independent therapists offer specialisation in specific areas of communication difficulties, including:

You can find a private SLT at the Association of Speech and Language Therapists in Independent Practice (ASLTIP).

ASLTIP members are certified members of The Royal College of Speech and Language Therapists (Cert.MRCSLT) and are registered with the Health and Care Professions Council (HCPC).

Royal College of Speech and Language Therapists
2 White Hart Yard
Tel: 020 7378 1200
Fax: 020 7403 7254
Email: [email protected]
Website: www.rcslt.org.uk


Although this information is believed to be accurate, you are strongly advised to make your own independent enquiries.

March 2013