Communication aids for people with aphasia

In principle, aphasia is a disability to use language. No wonder therefore, that most aphasiologists both in research and in therapy tend to focus mainly on linguistic function. The most prominent symptom of aphasia usually is a deficiency of speech, and many laymen believe that speech exercises should be the therapy of choice, which is not always correct. However, to those suffering from aphasia their disorder first of all means restricted communication and thereby a risk of becoming isolated. Therefore, besides language and speech therapy, people with aphasia have an urgent need of compensations or substitutes for their loss of communication. The number and variation of available communication aids for aphasia is rapidly increasing, mainly because of almost general use of computerized techniques. The following text wants to draw attention not only to software and hardware useful to aiding communication in aphasia, but also to the large amount of helpful information available from the Internet. Last but not least, access to the Internet as such may become an important tool to breaking isolation. A person with aphasia may need special arrangements and support, however, to be able to use her/his computer to this end, e.g. for e-mailing, web-surfing or chatting. Before the computers came into common use, a number of low-tech devices to aid communication were available. Amongst them may be mentioned letter boards, personal ‘passports’ for presentation of the owner and information about his/her problem, and photo albums used, for example, to raise new topics in a conversation. Comprehensive so-called communication books are described in detail by Millar (1,2). They may contain generalized picture and/or symbol vocabularies, guidance for conversation partners, index pages, etc., besides personal material such as photos, drawings, or newspaper cuttings. For different reasons, well discussed by van de Sandt-Konderman (3), low-tech communication aids for people with aphasia have not become very popular. One reason could be that much of the material is designed to suit mainly children or aims foremost at other types of communication problems than aphasia, such as. dysarthria (see for example (4,5)). Unfortunately this seems to be the case also for a number of high-tech communication aids. These are basically machines that can talk, either by a digitized or by a synthesized speech output. Digitized speech may be used to play back previously recorded entire messages. Synthesized speech has a lower quality but is more flexible, so that new messages may be phrased, as long as the user is able to do this and also to master correct spelling. The input to the aids may be indicated either by text or by graphics such as symbols, icons or pictures. The market abounds with this type of devices and the Swedish Institute for Handicap has listed no less than 36 such electrical speech aids (6 /9). High-tech aids specifically designed for aphasia may be divided in disorder oriented, ‘prosthetic’ systems, aiding specific problems such as those of word finding or sentence construction, and genuine conversation aids aiming at communicative function as a whole (3). Similar to the above mentioned communication books these later aids may be used to fulfil a number of different communicative needs such as presentation, claiming needs, asking questions, raising conversation topics, etc. Typically, these devices consist of a computer showing