Alt Communication
Use low-tech communication methods
Review status: Waiting for team review. An AI editorial check was completed on 2026-08-14 by claude-opus-5. It checks clarity, attribution and scope against the sources, and it is not a Compass team or clinical sign-off. Waiting for clinical review. Last updated 2026-08-14.
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Planning 3
- Identify backup communication needsNote the times when speech is hardest to be understood, such as when you are tired or on the phone.Why it matters: Having a fallback ready matters most on the days speech is hardest, which are rarely the days to start planning.
- Choose one simple method firstA yes or no system or a communication board may be enough to begin.Why it matters: One method everyone actually uses beats a sophisticated setup nobody has practised.
- Make sure regular supports know itTeach family and caregivers how to use it with you.Why it matters: A communication method only works if the people around you already know it, not if it has to be explained mid-conversation.
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Not all communication support is high-tech. Simple, low-tech methods are reliable, cost little, never run out of battery, and work anywhere. That makes them valuable both on their own and as a backup to a device.
Common low-tech options:
- Yes/no systems. An agreed way to signal yes and no, such as a nod, a blink, looking up or down, or a thumb. Simple but powerful for quick exchanges.
- Alphabet and word boards. You point to, or look at, letters to spell words, or point to common words and phrases. A partner can also read the letters aloud while you signal.
- Picture and symbol charts. Boards with pictures or symbols for common needs, useful for quick requests.
- Writing or typing. Pen and paper, a whiteboard, or notes on a phone, if hand function allows.
- Partner-assisted scanning. Someone reads out options (letters, words or choices) and you signal when they reach the right one. Helpful when pointing is difficult.
- Gestures and expressions. Agreed signs for common things.
- A way to call someone. A bell, buzzer, adapted call button, pager or intercom. Getting attention is a separate need from being understood, and the other options here only work once someone is with you.
These can be tailored to you. For example, a board with your most-used phrases, or a yes/no signal that suits your movement. A speech pathologist can help design something that fits.
Even if you use a communication device, having a low-tech method ready is genuinely important: it is your fallback if the technology fails, is charging, or is not to hand. The next questions cover why a backup matters, how to set one up, and how those around you can help.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 3. Low-tech methods are worth using in their own right, not only as a fallback when a device is unavailable.
Supports this. Lite Tech — Your ALS Guide · Practical guide
Says lite-tech options can serve as either the person's main communication method or their backup, which is both halves of this statement.
“These lite-tech options are portable, accessible, and can be used either as your primary or backup communication method.”
Lite-Tech OptionsLink checked August 2026
Adds context. NICE MND guideline — NICE · Clinical guideline
NICE treats low-level technologies such as alphabet, word and picture boards as AAC equipment to be provided in its own right, alongside high-level technologies. It is silent on using them as a backup, so it supports the first half of this statement and not the contrast.
“The use of both low‑level technologies, for example, alphabet, word or picture boards and high‑level technologies, for example, PC or tablet‑based voice output communication aids may be helpful.”
1.12.2Link checked August 2026
Statement 2 of 3. Partner-assisted scanning helps when the person cannot select the letters or words themselves.
Supports this. ALS & Communication — Les Turner ALS Foundation · Practical guide
Gives being unable to physically select a word or phrase as the reason to use partner-assisted scanning, which is the situation this clause describes.
“Partner-assisted scanning can be used to communicate if you cannot physically select a word or phrase”
Low Tech AACLink checked August 2026
Statement 3 of 3. A low-tech method is what you fall back on when a communication device fails, is charging, or is out of reach.
Supports this. Lite Tech — Your ALS Guide · Practical guide
Says a manual board is still needed at times even by people who have a speech-generating device, and names the same situations: a power cut, a flat battery, transfers, bathing and bright sunlight.
“Even if you have a speech-generating device, you may still need to use your manual communication board in certain situations, such as if the power goes out or your battery loses its charge.”
Lite-Tech OptionsLink checked August 2026
Supports this. Managing Speech Changes — ALS Network · Organisation
States the same point as a general principle: a paper board is the backup a speech-generating device needs, not an optional extra.
“Low-tech communication systems, like paper communication boards, are an essential backup to your high-tech speech generating device.”
When Speech Doesn't Meet All Communication NeedsLink checked August 2026
Used across the whole answer
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Even the best communication device can be unavailable at the moment you need it. (in the bath, in hospital, half-asleep at night). A simple backup makes it far less likely that you are left unable to make yourself understood.
A backup matters most in the situations that matter most:
- At night, when reaching for or setting up a device is hard
- In an emergency or in hospital, where staff may not know your setup
- During care, to signal comfort, pain, or a need quickly
- When the technology lets you down, as all technology sometimes does
A backup does not need to be clever. An agreed yes/no signal, a letter board, or a card explaining how you communicate can cover a lot. But getting someone's attention is a separate problem from being understood, and a signal or a board only works once someone is with you, so keep a bell, buzzer or call button alongside your backup for the night and for emergencies. The point is that it is to hand and that the people around you know it.
It is worth setting this up before you need it, while it is easy to agree and practise, rather than working it out in a stressful moment. Many people also keep a short written note that tells others (especially in hospital) how best to communicate with them. This is sometimes called a communication passport.
The next questions cover how to put a simple system in place, including a way to call for help, and how family and caregivers can support it. A speech pathologist can help make sure your backup genuinely works for you.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 2 of 3. A backup for being understood does not cover getting someone's attention, so an alerting device such as a bell or buzzer is needed as well.
Supports this. ALS & Communication — Les Turner ALS Foundation · Practical guide
Treats getting attention as its own problem, with a section on emergency communication devices separate from its boards and partner-assisted scanning, and gives noise-making items as the answer to it.
“Use noise-making items like a bell or buzzer to get the attention of others in case of an emergency.”
Low Tech AACLink checked August 2026
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Closes its communication support strategies by saying care alerters matter, and names adapted door chimes and intercoms, pendant-type back to base alerters and pressure buzzers.
“Care alerters are very important as they give the person with MND a greater sense of security.”
Communication support strategiesLink checked August 2026
Statement 3 of 3. It is better to set up and practise a backup while things are calm than to work one out at the moment it is needed.
Supports this. Lite Tech — Your ALS Guide · Practical guide
Says these options should be learned and practised before they are really needed, which covers both the setting up and the practising.
“It is important to learn about these options and begin practicing them before you really need them.”
Lite-Tech OptionsLink checked August 2026
Adds context. Managing Speech Changes — ALS Network · Organisation
Describes the same timing from the service side: a proactive approach gets the parts of an AAC system together and customised before the person has to depend on them. It says nothing about practising.
“A proactive approach to AAC involves obtaining and customizing the components of a complete AAC system prior to a time when you may need to rely on it for communication.”
When Changes in Speech Begin Causing Challenges in CommunicationLink checked August 2026
Used across the whole answer
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Setting up a simple communication system does not need to be complicated. The aim is something you and the people around you can use easily and reliably.
A practical way to start:
- Agree a clear yes/no signal. Pick a movement you can make consistently, such as a nod, blink, look up/down, or thumb. Make sure everyone who helps you knows it.
- Make or get a letter/word board. A simple alphabet board, or a board with your most-used words and phrases, covers a lot. Keep one where you spend time, and a spare in your bag or by the bed.
- Add quick-need cards or symbols for common things like pain, position, drink, toilet, and suction. That makes urgent needs fast.
- Write a short "how to communicate with me" note. List your yes/no signal, your usual methods, and any tips. This is invaluable in hospital or with new carers.
- Agree a way to call for help. A board or signal only works once someone is with you. A bell, buzzer, adapted call button, pager or intercom lets you get attention when nobody is in the room, including at night or in an emergency. An occupational therapist can help find a call device you can operate.
- Practise together while it is easy, so it feels natural before it is really needed.
Keep it where it is needed, such as bedside, wheelchair, or bag. Review it now and then, since what works can change.
A speech pathologist can help design boards and signals that suit your movement and needs, and can make sure your system is robust. But you do not have to wait for that to put the basics in place. Even a simple agreed signal and a letter board make a real difference, and can be improved over time.
Explained: what this word meansEvidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 4. Agreeing a gesture or signal for yes and one for no is one of the recognised strategies for keeping communication going in MND.
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Lists establishing gestures or signals for yes and no among its communication support strategies for MND, alongside asking questions that need only a yes or no answer. It gives these as one option among eight, in no particular order, so it establishes that this is standard practice and not that it comes first.
Link checked August 2026
Statement 2 of 4. A means of alerting someone, such as a bell, buzzer, adapted call device or intercom, is part of a communication system, because getting attention is a separate need from being understood.
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Closes its communication support strategies by saying care alerters matter, and names switches adapted onto door chimes and intercoms, pendant-type back to base alerters and pressure buzzers as alert systems.
“Care alerters are very important as they give the person with MND a greater sense of security.”
Communication support strategiesLink checked August 2026
Supports this. ALS & Communication — Les Turner ALS Foundation · Practical guide
Gives noise-making items as the way to get someone's attention, in a section on emergency communication devices that sits alongside its low-tech boards and scanning. It also names a caregiver pager and a wearable alert device.
“Use noise-making items like a bell or buzzer to get the attention of others in case of an emergency.”
Low Tech AACLink checked August 2026
Statement 3 of 4. An occupational therapist can work out the best way for the person to operate a call device or intercom.
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Names the occupational therapist as the person who finds how someone can best operate a call device or intercom.
“An occupational therapist can help to find the person's best means of operating a call device or intercom.”
Communication support strategiesLink checked August 2026
Statement 4 of 4. Simple low-tech measures of this kind are recognised communication supports in their own right, not a stopgap.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE names alphabet, word and picture boards as low-level technologies that may help, and tells services to provide AAC equipment without delay so the person can keep taking part in daily life.
“The use of both low‑level technologies, for example, alphabet, word or picture boards and high‑level technologies, for example, PC or tablet‑based voice output communication aids may be helpful.”
1.12.2Link checked August 2026
Supports this. Lite Tech — Your ALS Guide · Practical guide
Calls a communication or alphabet board an essential tool that helps at any stage, and describes boards holding letters, words, phrases, symbols and pictures that are selected by pointing, nodding, gesturing or blinking.
“A communication board, sometimes called an alphabet board, is an essential tool that can be helpful at any stage of the disease.”
Lite-Tech OptionsLink checked August 2026
Used across the whole answer
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How the people around you communicate makes a big difference. A good "communication partner" can turn a frustrating exchange into an easy one. This advice is for family, friends and caregivers. It is worth sharing with anyone who spends time with the person.
Things that help:
- Give time. Allow pauses and do not rush. Communicating may take longer, and that is okay.
- Do not finish their sentences unless they want you to. Guessing can speed things up but can also take over. Ask first, and let them lead.
- Ask yes/no questions when things are hard, to narrow down quickly, but still allow open expression when there is time.
- Check you have understood. Repeat back what you think was said, and confirm. Getting it wrong is easily fixed if you check.
- Reduce distractions. Quiet, good lighting, and facing the person make a real difference.
- Learn their tools. Know their yes/no signal, how their board or device works, and where the backup is.
- Keep including them. Talk to them, not about them, and keep them part of conversations and decisions.
It also helps to be patient with the feelings involved. That goes for everyone. Communication changes can be frustrating and tiring on both sides, and a bit of humour and grace goes a long way.
A speech pathologist can coach communication partners and suggest tips tailored to the person. Most of all, the message is simple: slow down, give space, and keep the person at the centre of their own conversations.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 1. Guessing at or finishing someone's sentences can take the conversation away from them, so ask before speaking for them.
Supports this. Partner Training (Jay S. Fishman ALS Augmentative Communication Program) — Boston Children's Hospital · Practical guide
Reports what people with ALS themselves asked of their communication partners. They ask not to be interrupted, and to be asked each time whether they want someone to speak for them, so that it stays clear who is leading.
“Even though you may know the requested information ALWAYS ask me if I want you to speak for me so everyone in the conversation is clear that I am in charge.”
Partner TrainingLink checked August 2026
Adds context. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Lists avoiding interruptions or trying to finish sentences among its communication support strategies for MND. It does not address the second half of this advice, asking first before speaking for someone.
Link checked August 2026
Used across the whole answer
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A speech pathologist can help set up reliable backups. A few questions to bring:
- What simple, reliable backup method would suit me best?
- Can you help us design a letter or word board and agree a clear yes/no signal?
- What should I have in place for night-time, hospital, and emergencies?
- How would I call someone if nobody is in the room? Who can help me find a call device I can operate?
- Could we make a short "how to communicate with me" note for carers and hospital staff?
- How can my family and carers best support me? Can you give them some coaching?
- What backup should I keep alongside a communication device, and where?
- How do we keep this working as things change?
It is worth sorting these basics early, while it is easy to agree and practise. An agreed signal, a board kept to hand, a way to call someone, and a note for others are simple steps. Together they make it far less likely that you are left unable to make yourself understood.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 1. Raising these questions early, rather than once communication is already hard, gives more room to choose and to plan.
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Says referral to a speech pathologist should happen in good time so that the options can be discussed early and decisions and planning can be made ahead of need.
“Timely referral to a speech pathologist is vital to ensure early discussion regarding options available and to support optimal decision making and planning ahead.”
Dysarthria & communicationLink checked August 2026
Adds context. NICE MND guideline — NICE · Clinical guideline
NICE requires that speech and communication assessment and review is carried out by a speech and language therapist without delay, which is the service side of asking early. It does not say what the person gains by raising these questions themselves.
“Ensure that the assessment and review is carried out by a speech and language therapist without delay.”
1.12.1Link checked August 2026
Used across the whole answer
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