There’s been a lot of buzz about the iPad’s potential as an augmentative, alternative communication (AAC) device since Apple introduced the revolutionary, tablet-sized machine in April. For many users with speech disabilities, the iPad’s portability, varied functionality, large touch screen and relatively cheap price — not to mention the “cool” factor — make it an attractive alternative to more traditional communication devices.
But how well does the iPad work for a person who has received a diagnosis of ALS? MDA asked several people with ALS who are using the device, as well as speech therapists and other experts, and found there are a number of factors to consider. Although an excellent alternative to an AAC device in a number of ways, the iPad may not be able to accommodate the needs of people with ALS as their symptoms progress.
Portability: The iPad is lighter than a laptop, netbook or traditional AAC device, but users with diminished hand strength may find that, at 1.5 pounds (1.75 with a speaker), it’s still too heavy to lift. One man with ALS had the iPad mounted on his power chair so he could access it easily and not have to worry about it falling out of his lap while he was driving.
Functionality: Text-to-speech applications (apps) for the iPhone, including Proloquo2Go and Speak It!, are also available for the iPad. One enthusiastic user is New Yorker Tom Burke, 64, who received an ALS diagnosis in 2009. Burke still has use of his arms and hands but can’t speak clearly. For face-to-face conversations, he uses an iPad with either Proloquo2Go or Assistive Chat ($25 at the App store).
“Assistive Chat is pretty simple to operate and has the better word prediction feature,” Burke reports. “In some settings, I use the speaking feature and augment with a small external speaker if necessary. In other settings, I just type in large font and turn the iPad so that the person can read my words.”
Users report that the iPad’s volume and clarity of the synthesized speech is not quite as good as on a traditional AAC device but is adequate for most uses. If better sound is needed, Apple offers a small speaker ($20 from the iHome store).
|Text and images on an iPad can be viewed either horizontally or vertically.
In addition to serving as an AAC device, the iPad also can be used to access the Internet, watch movies, read books, play games, send and receive photos and e-mail, listen to music, and do other functions performed by computers or smart phones — except for taking pictures and making phone calls.
Touch screen: The iPad’s large touch screen (as compared to a phone) and virtual keyboard are popular selling points for people who have trouble manipulating their fingers. Big letters on the keyboard are one of the main reasons why the device has generated so much excitement among people with disabilities.
However, some users with ALS say the dexterity and finger-strength needed to type on the virtual keyboard is still a problem; Tom Burke, for example, finds it easier to type on a manual keyboard ($70, with docking station) that plugs into the iPad.
Cost: Ranging in price from $500 for a basic model to $830 for a model offering greater storage capacity and faster Internet connectivity, the iPad is much cheaper than traditional AAC devices, which run upward of $3,000.
The gold standard of text-to-speech apps, Proloquo2Go, costs $200, but some are able to get by with an app that costs far less such as Speak It!, which costs $2 on iTunes. Some other simple text-to-speech apps are free. Speech therapists recommend trying out the free and low-cost apps first to see if they will work for you, before investing in Proloquo2Go.
The iPad is not covered by insurance or Medicare, whereas traditional communication devices may be at least partly covered. But even without insurance reimbursment, generally an iPad with Proloquo2Go still costs thousands less than a traditional AAC device.
Social perception: “There is a definite ‘cool’ factor with the iPad that makes it fun to carry and use in public,” says Tom Burke. “The device is still so new that people of all ages express interest in seeing it and trying it. Teens in particular are drawn to it. When I use it in restaurants to place an order, the sense I get is that waiters assume I am doing it to show off the iPad rather than because I cannot speak.
“The comparison between using an iPad in public versus using an earlier stage type-to-talk device would basically be night and day.”
Downside: The main drawback of the iPad as a communication device for people with ALS is that it requires the use of the hands.
“Patients who require alternative access may not be able to use the iPad effectively,” says Winston Cheng, a speech-language pathologist at the Eleanor and Lou Gehrig MDA/ALS Research Center at Columbia University Medical Center in New York City. As a user’s needs and abilities change over time due to ALS, the iPad may not offer the versatility of a traditional AAC device in terms of having multiple alternatives in accessing it, such as through eyegaze, a switch or head mouse.
The verdict: For people like Tom Burke, whose ALS so far affects his speech but not so much his hands, the iPad offers a relatively inexpensive, easy-to-use and attractive means of communicating. Burke says those with even more limited hand function still may be able to use Proloquo2Go, since it can be preprogrammed and offers one-touch communication. However, the iPad can’t “voice bank” — a handy feature on many traditional AACs that allows you to record yourself saying phrases for playback later.
If possible, try out both the iPad and more traditional AAC devices before buying. While the iPad may be a better deal in the short run, if you ultimately end up having to buy a more expensive AAC device as well, it may not be worth it.
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