Communication is at the centre of everything. Relationships. Work. Medical appointments. Ordering a coffee. Telling someone you love them. When speech becomes difficult or impossible, the impact on life is profound — not just practically, but emotionally.
AAC stands for Augmentative and Alternative Communication. It refers to any method, tool or device that supports or replaces speech. This includes everything from a whiteboard with a marker to a sophisticated eye gaze device. It's not a last resort — it's a legitimate and effective way to communicate, used by millions of people around the world.
Adults need AAC for many different reasons. A stroke can affect the language centres of the brain. Motor neurone disease or ALS progressively affects the muscles used for speech. A traumatic brain injury can disrupt communication suddenly. Cerebral palsy or autism may mean speech was never reliable or comfortable. Each situation is different, and AAC looks different for each person.
Here's a guide to what's available — written for adults (and families of adults) who are exploring AAC for the first time, or looking to understand what's changed.
Understanding AAC — The Basics
AAC doesn't replace the desire to communicate. It supports it. The goal is always to give someone more ways to say what they want to say — not to replace their personality, their voice, or their relationships. AAC can be:
Unaided — using your own body. Gestures, facial expressions, sign language, eye pointing. These don't require any equipment and can never run out of battery. Many AAC users combine unaided and aided methods depending on the situation.
Low-tech aided — using simple, non-electronic tools. A communication board with pictures or words. An alphabet board for spelling. A whiteboard. A printed book of phrases. These are robust, reliable, inexpensive, and surprisingly effective. Don't underestimate them — many experienced AAC users keep a low-tech backup for when technology fails.
High-tech aided — speech-generating devices (SGDs) and communication apps on tablets. These are the most flexible and powerful AAC tools, offering synthetic or recorded voices, large vocabulary, and the ability to construct novel sentences.
How AAC Access Works
For many adults, the biggest question isn't which AAC system to choose — it's how to physically access it given their movement limitations.
Direct selection — touching the screen with a finger or stylus. This works for people with reliable hand or finger control.
Switch access — using one or more large switches (buttons) to scan through options on screen. The cursor moves from option to option and the person activates the switch when it lands on what they want. This is slower than direct selection but works for people with very limited movement — a knee, an elbow, the side of a hand.
Eye gaze — cameras track where the person is looking and activate the corresponding button. Modern eye gaze systems are accurate enough to support full communication. They're particularly important for people with motor neurone disease or other conditions that progressively affect movement.
Head tracking — a camera or sensor tracks head movement to control a cursor, used by people who don't have reliable hand function but can move their head consistently.
Your speech pathologist will assess which access method works best for you and can change as your needs change.
Apps and Devices — What's Available
The AAC technology market has grown enormously over the past decade. Here are the most widely used options for adults.
Proloquo2Go (iOS) is one of the most established AAC apps, originally developed for children but widely used by adults. It uses symbol-based navigation — you tap pictures to build messages — and the vocabulary system is designed to grow with the user. It supports both symbol-based and text-based communication and can be used with switch access or eye gaze.
TouchChat HD (iOS and Android) is another symbol-based AAC app with a strong reputation in adult populations. It supports multiple vocabulary systems and is known for being highly customisable to the individual user.
Grid 3 (Windows and iPad) by Smartbox is particularly popular in the UK and Australia and is often used with dedicated AAC devices. Grid 3 supports switch scanning and eye gaze, making it suitable for people with significant physical limitations. It also supports environmental control — meaning someone can control their smart home through the same device they use to communicate.
Snap Core First (iOS, Android, Windows) combines symbols and text and is designed to work across devices seamlessly — the same vocabulary on an iPad at home and a Windows device at school or work. Widely used in both paediatric and adult populations.
Tobii Dynavox makes both software (for iPads and Windows) and dedicated hardware devices. Their dedicated devices are purpose-built for AAC — ruggedised, with high-quality speakers, long battery life, and mounts for wheelchairs and beds. The I-Series range is the most widely prescribed for adults with progressive conditions.
Text-based AAC — for people who are literate and whose primary barrier is the physical act of speech, text-to-speech apps like Proloquo4Text, Verbally or the free Speechify are simpler and faster. You type what you want to say and the app speaks it. Word prediction reduces how much you need to type. Some people use Notes on their phone; others prefer a dedicated app with a better voice.
For Progressive Conditions
Motor neurone disease (MND/ALS) and other progressive conditions require a specific approach to AAC — planning ahead while speech and movement are still available.
Voice banking is the process of recording your own voice while you can still speak clearly, to create a synthesised voice that sounds like you. Apps like ModelTalker and VocaliD make this possible — you record hundreds of phrases and a personalised voice is built from your recordings. This means that even when speech is gone, the voice the device uses still sounds like you. This is profoundly important to many people — not just practically, but emotionally.
Message banking is related — recording specific phrases, stories, songs or expressions that matter to you. "I love you." "Don't worry." Your own laugh. These can't be recreated by synthesis but can be stored and played back. Starting the AAC conversation early — while speech is still present — is much easier than starting it in a crisis. Many speech pathologists who work with MND recommend beginning AAC exploration as early as diagnosis.
Funding AAC
AAC devices and apps can be expensive. Most countries have some form of funded pathway for people with communication disabilities.
Dedicated AAC devices can cost several thousand dollars. High-end eye gaze systems can cost significantly more. However, in many countries these are funded through disability funding schemes, national health services, or health insurance for people with a relevant diagnosis. The specific pathway varies by country and by condition — your speech pathologist will know the options available where you are.
Apps on an iPad are significantly cheaper than dedicated devices — often a few hundred dollars including the iPad. They're less robust and purpose-built than dedicated hardware, but for many adults they're sufficient.
Trials are important. Before committing to an app or device, a speech pathologist can arrange a trial period so you can see how it works in real life — in the situations that matter to you.
The Speech Pathologist's Role
A speech pathologist (also called a speech-language pathologist or speech therapist) who specialises in AAC is your most important ally in this process. They will:
Assess your communication strengths and needs in detail Trial different access methods and vocabulary systems Set up a device to match your vocabulary, interests and communication style Train you, your family and your support workers to use it Review and update as your needs change
AAC is not a set-and-forget solution. It requires ongoing support, particularly in the early stages. Investing in good specialist support makes an enormous difference to outcomes.
A Note on Identity
Some people feel reluctant about AAC — as if using a device means giving up on speech, or that it marks them as having something wrong with them. This is understandable, but worth examining.
AAC isn't giving up. It's adapting. People use glasses, hearing aids, and walking sticks without it defining them. Communication is the goal — the method is just the means.
Many people who use AAC report that it hasn't diminished how people relate to them — in fact, when communication is working, it often deepens relationships. Being able to say what you think, ask for what you need, crack a joke, or just have a chat — these things are worth having in whatever form they come.
This article is for general information. AAC assessment and prescription should always be done by a qualified speech pathologist. You can explore AAC tools for adults on Eazilee by searching for your condition or communication challenge.
