Speech Tech
Explore tools that support communication
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.
Items
Add an item
Saved on this device only. Never sent to us.
Simple ways to get started with this card. Use these as a checklist, add useful items to My Plan, or create your own.
Planning 3
- Clarify current communication needsConsider speaking, typing, device speech, and how you access each one.Why it matters: Naming the actual difficulty leads to a better match than starting from what technology exists.
- Ask for a communication assessmentSpeech pathology or assistive technology input can narrow the options.Why it matters: An assessment turns a wide and confusing market into a short list suited to you.
- Trial one option firstStart with something simple before committing to a larger setup.Why it matters: What works in a demonstration and what works in daily life are often different.
Your feedback on these suggested items
Are these useful starting items for Speech Tech? Reference an item by its title in your comment.
#
For many people with ALS/MND, speaking becomes harder at some point. For some it stays largely unaffected. When it does change, how much it changes and how quickly varies a great deal, and it can happen in different ways.
You might notice:
- speech becoming slower, quieter, or harder to understand (slurred)
- getting tired when talking, so longer conversations are harder
- speech being clear at home but harder for others to follow on the phone or in noisy places
- needing to repeat yourself, or relying on those close to you to "translate"
Alongside speech, other ways of communicating can also be affected. For example, weaker hands can make writing or typing harder. That is why support looks at the whole picture, not just the voice.
The important message is that communication can be supported throughout. Staying connected, understood and able to express yourself is one of the things that matters most, and there is a wide and growing range of tools to help. They range from simple aids to apps and devices that can speak for you, including ones controlled by eye movement.
This card covers those tools and how to access them. Related cards cover preserving your own voice (voice banking), simple low-tech backups, and eye-gaze technology in more depth. The key is to get support involved early, so the right tools are ready and familiar before they are needed.
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 2. How much speech changes, and how soon, varies a great deal from one person to another.
Qualifies this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Agrees the timing varies a great deal: speech is affected early in bulbar onset and only in the later stages for others. It also puts communication difficulty above 80 percent of people with MND at some point, so speech staying largely unaffected is the less common outcome.
“More than 80% of people with MND will experience communication difficulties at some point in the disease trajectory.”
Dysarthria & communicationLink checked August 2026
Statement 2 of 2. Involving speech and communication support early means the options are discussed and decisions planned ahead.
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Gives timely referral to a speech pathologist as the way to get the available options discussed early and decisions planned ahead.
“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
Used across the whole answer
#
There is a broad range of tools that help people stay connected when speaking gets harder. Together they are often called AAC (augmentative and alternative communication). They span from very simple to high-tech, and many people use a mix.
Roughly, the options include:
- Voice amplifiers. If your voice has become soft and hard to hear, a small amplifier can make you easier to hear. That applies whether the cause is changes in speech or weaker breathing muscles, which can also leave you breathless when talking. An amplifier does nothing for the breathing itself, so tell your MND team about breathlessness that is new or getting worse. The breathing cards cover what to report.
- Apps on a phone or tablet. Text-to-speech and symbol- or word-based apps can speak typed messages aloud, often using a chosen or banked voice.
- Speech-generating devices. Dedicated devices designed for communication, which can be controlled in different ways and may be sturdier than a general tablet.
- Different ways to control a device. Touch, a keyboard, switches, head movement, or eye-gaze (controlling the device by where you look), depending on what works best for you. Eye-gaze has its own card.
- Low-tech aids. Letter and word boards, symbol charts and simple yes/no systems, which are reliable backups that never run out of battery (covered on the alternative communication card).
The right tools depend on your speech, your hand function, your eyesight, your energy, and what you want to do. That might be quick everyday exchanges, longer conversations, phone calls, or using a computer.
You do not choose alone or all at once. A speech pathologist or AAC specialist assesses what suits you and helps you trial options. The other questions on this card cover when to get assessed, how to choose, and how this fits into daily life.
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 1. A voice amplifier can make someone easier to hear when their voice has become soft and hard to hear, whether the cause is deteriorating speech or reduced breathing strength.
Supports this. Speech Pathology Week: Communication aids and equipment — MND NSW · Practical guide · August 2024
Describes the portable amplifier it lends as being for people whose soft, hard-to-hear voice comes from deteriorating speech or reduced respiratory strength, which is the same indication and effect this bullet describes.
“A portable communication device that amplifies voice output for people with deteriorating speech or reduced respiratory strength causing a soft voice that can be difficult to hear or breathlessness when talking.”
Voice AmplifierLink checked August 2026
Used across the whole answer
#
A communication assessment, usually with a speech pathologist (and sometimes an AAC specialist), works out what helps you communicate and gets the right tools in place. As with several things in ALS/MND, earlier is usually better. An assessment can help even before there is a clear problem. There is no fixed timetable for this, and the point at which someone needs communication support varies a lot from person to person.
It is worth asking for an assessment if you notice:
- your speech becoming slower, quieter or harder to understand
- people asking you to repeat yourself more often
- finding talking tiring, or struggling on the phone or in noisy places
- relying more on family to be understood
- simply wanting to understand your options and plan ahead
If talking also leaves you breathless, tell your MND team about that as well as asking about a communication assessment. Breathlessness that is new or getting worse is a breathing symptom worth reporting, and the breathing cards cover what to report and to whom.
Getting assessed early often has practical advantages: there is time to trial options unhurried, to learn a device while communicating is easier, and to sort out any funding or supply (which can take time) before tools are urgently needed. It also pairs well with voice banking, which is best done while speech is still clear.
In many ALS/MND clinics, a speech pathologist is part of the team, so you may meet one as a matter of course. If not, it is completely reasonable to ask your neurologist, GP or clinic for a referral.
You do not have to wait until communicating is hard. Early input keeps you in control and means support is ready when you want it.
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 2. A communication assessment is usually suggested early, and is useful before speech is clearly a problem.
Supports this. NICE MND guideline — NICE · Clinical guideline
Treats speech and communication as something assessed as part of routine multidisciplinary appointments rather than only when speech becomes difficult, and requires the speech and language therapist to carry out that assessment and review without delay.
“Ensure that the assessment and review is carried out by a speech and language therapist without delay.”
1.12.1Link checked August 2026
Supports this. Dysarthria and communication in MND — MND Australia · Practical guide · June 2021
Puts the first assessment right after diagnosis rather than at the point speech becomes difficult, and asks for it to be repeated at every clinic visit.
“Speech and communication should be assessed by a speech pathologist soon after diagnosis and reviewed at each clinic visit.”
AssessmentLink checked August 2026
Qualifies this. Timing of communication and technology control support in ALS - a systematic review — Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · Research review · 2026
A review of 28 studies on when communication support should start. It found the point at which a communication aid is needed usually falls between one and five years after diagnosis and varies a great deal with where symptoms began, and that existing best-practice guidance does not tell clinicians how to judge the right moment. So early review is sensible, but there is no settled timetable.
Link checked August 2026
Statement 2 of 2. Voice banking works better when the recordings are made while speech is still clear, because the synthetic voice is built from them.
Supports this. ALS Voice Banking and Cloning — Your ALS Guide · Practical guide
Says the resulting computer voice resembles you more closely the clearer your speech was when you recorded, and advises banking sooner rather than later.
“If you are able to record your voice when you can still speak clearly, the computer-generated voice on your communication device or app will sound more like you.”
Computer-Generated Voice BankingLink checked August 2026
Used across the whole answer
#
Choosing communication tools works best as a guided, try-before-you-commit process rather than a one-off decision. A speech pathologist or AAC specialist helps match options to you.
Things that shape the choice:
- What you want to do. Quick everyday exchanges, longer conversations, phone or video calls, writing, controlling a computer, or all of these
- How you would control it. Touch, keyboard, switches, head movement or eye-gaze, based on your hand function, eyesight and energy
- Where and how you live. At home, out and about, mounted on a wheelchair, in bed
- How much it asks of you. Some tools are quick to learn, others more involved
- Your own voice. Whether a banked or chosen voice is used
The key step is trialling. Ask whether you can borrow or demo options, so you can see what actually suits you in real life, not just on paper. It is worth giving a tool a fair go, and being honest if it is not working. The aim is something you will genuinely use.
It also helps to think a little ahead. Choosing something that can adapt as your needs change (for example, a device that can later be controlled by eye-gaze) may save starting over.
There is no single "best" tool, and what suits one person may not suit another. Take your time, involve the people who communicate with you most, and lean on your speech pathologist to narrow the options and arrange any funding or supply.
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 2. Trying a device out matters, because how well it suits someone often cannot be judged from the initial assessment.
Supports this. Augmentative and Alternative Communication (Practice Portal) — American Speech-Language-Hearing Association · Organisation
The speech pathology professional body treats device trials as part of the treatment itself, on the grounds that an assessment does not reliably show whether a particular device will work for someone.
“Trials of specific devices are often a component of AAC treatment, and an individual's success with a specific device may not be effectively determined upon initial assessment.”
Assessment ConsiderationsLink checked August 2026
Statement 2 of 2. Which tool is right depends on the individual: the features of an AAC system are chosen against that person's own skills and needs.
Supports this. Augmentative and Alternative Communication (Practice Portal) — American Speech-Language-Hearing Association · Organisation
Sets out choosing a system as feature matching. The features to settle on, from the type of display and the way it is controlled to portability and how far it can be modified later, are determined from that individual's own assessed skills and needs, not from a ranked list of products.
Link checked August 2026
Used across the whole answer
#
Communication technology can do far more than produce speech. It can help you stay you: join conversations, make a call, message family, control your environment, or use a computer. For many people it becomes a genuine lifeline. It also takes some getting used to, and being honest about both sides helps.
What tends to help in daily life:
- Quick-access phrases. Saving greetings, needs and common replies speeds up everyday exchanges, which can otherwise feel slow.
- The right setup. Mounting a device on a wheelchair or bed, good positioning, and reliable charging make it part of life rather than a hassle.
- People around you adjusting too. Conversations work best when partners give you time, do not finish your sentences unless you want them to, and are patient with pauses.
- A backup. Technology can fail or run out of battery, so a simple low-tech option (a letter board, a yes/no system) is worth having alongside.
The honest other side: there can be a learning curve, communicating this way can be slower than speech, and it can be tiring or frustrating at first. Many people find it gets easier with practice and support, and that the connection it preserves is well worth it.
The aim is for the technology to fade into the background and just let you communicate. A speech pathologist and the people close to you can help make it feel natural. If a setup is not working for daily life, that is worth raising. It can usually be adjusted.
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. Communicating through a device can be slower than speaking.
Adds context. Using large language models to accelerate communication for eye gaze typing users with ALS — Nature Communications · Research review · 2024
Gives the size of the gap for one common way of using a device, typing by eye gaze: usually below ten words a minute, against ordinary speaking rates of up to about 190 words a minute. It does not measure touch, switch or head control, so it shows how large the gap can be rather than what it is for devices in general.
“However, gaze typing is slow (usually below 10 words per minute (WPM)), creating a gap of more than an order of magnitude below typical speaking rates (up to 190 WPM in English).”
IntroductionLink checked August 2026
Statement 2 of 3. How the other person behaves changes how well the conversation goes, which is why communication partners are trained too.
Supports this. Augmentative and Alternative Communication (Practice Portal) — American Speech-Language-Hearing Association · Organisation
Treats the person on the other side of the conversation as part of the intervention. Partner training covers active listening and allowing longer waiting time before taking a turn, and it notes that people abandon communication aids when partner input is left out.
Link checked August 2026
Statement 3 of 3. A simple non-electronic option is worth keeping alongside a device, because devices can stop working.
Supports this. Speech Pathology Week: Communication aids and equipment — MND NSW · Practical guide · August 2024
Lends a non-electronic perspex letter board for exactly this purpose, and gives its reason as having something to fall back on when the electronic device stops working.
“It is a great low-tech option to have as a backup when electronic communication devices stop working.”
Speech Pathology Week: Communication aids and equipmentLink checked August 2026
Used across the whole answer
#
A speech pathologist or AAC specialist can guide these. A few questions to bring:
What might help me
- Given how I communicate now, what tools would you suggest I look at?
- Can I trial or borrow options before committing?
- How would my own voice (banked or chosen) be used?
Practical
- How would I control the device, and what suits my hands, eyes and energy?
- Can it be mounted on my wheelchair or used in bed?
- If it fails, what backup should I have?
Getting it and keeping it going
- How do I obtain a device, and is there support with the cost?
- Who sets it up and teaches me and my family?
- Who do I contact for help or repairs later?
Planning ahead
- Will this still suit me if my needs change, or can it adapt?
It is fine to take your time, involve the people you talk with most, and ask for things to be demonstrated. The goal is a setup you will actually use and that keeps you connected.
Explained: what this word meansLived experience
Practical tips and experiences shared by people affected by MND. These are not medical advice and may not apply to everyone.
No lived-experience tips for this card yet.
Resources
Your review of the resources
Are these useful, trustworthy, relevant and the right level? Anything missing, too regional, or better on another card?
Notes
Personal Planning Notes
Private to you. Saved on this device only, never sent to us.
Improve this card
A short overall review of this whole card. You can also give feedback on individual answers, resources and steps in their tabs.
Have a resource or a practical tip to share instead? Share what you have learned.