Communication devices — when speech becomes difficult

This article provides general information about communication devices and strategies for when speech becomes difficult. Your parent's speech and swallowing concerns should be evaluated by a speech-language pathologist or neurologist. Communication needs vary widely and require individual assessment.

My uncle's stroke didn't steal his intelligence or his sense of humor. It stole his ability to form words. He'd know exactly what he wanted to say. His mind was sharp. But the words wouldn't come out, or they'd come out scrambled and wrong. The frustration was immense. More than that, the isolation was immense. He couldn't express himself, couldn't participate in conversation the way he always had.

That was before he started working with a speech therapist and discovered that there were tools and techniques that could give him back a voice. Not his original voice, but a way to communicate his thoughts and maintain connection.

Speech difficulty can come from many sources. Stroke damages the language centers of the brain. Parkinson's disease weakens the muscles used for speaking. Advanced dementia destroys the ability to form and retrieve words. Laryngeal cancer requires removal of part of the vocal apparatus. ALS progressively paralyzes the muscles needed for speech. Any of these can make speaking difficult or impossible.

Understanding Different Types of Speech Difficulty

Speech problems aren't all the same. Your parent's specific difficulty affects what solutions might help.

Some people have aphasia, which means the brain's language centers are damaged. They might understand what people say to them but struggle to produce words. Or they might produce words but have difficulty understanding. Some people have Broca's aphasia, which affects word production. Some have Wernicke's aphasia, which affects comprehension. The same device won't work for someone who understands but can't speak and someone who speaks but doesn't comprehend.

Dysarthria is different. The language centers are fine, but the muscles used for speech are weak or uncoordinated. Your parent might speak very slowly or unclearly because their mouth and throat muscles don't work properly. They might be understood if people listen carefully, or they might be nearly impossible to understand.

Apraxia of speech means the connection between the brain and the motor movements needed for speech is broken. Your parent knows what they want to say but their body won't cooperate in producing the sounds in the right order.

Voice loss is simpler but also devastating. If your parent can't produce sound, they can't speak at all, no matter how intact their language skills are.

Each situation requires different approaches.

Low-Tech Communication Strategies

Not every solution requires devices. Sometimes the answer is simpler.

Writing is straightforward if your parent's hand function is adequate. A notepad and pen let them write what they can't say. This works well for people whose language skills are intact but speech production is difficult. It takes time, so patience is needed. But it preserves your parent's ability to communicate their actual thoughts.

Picture boards or conversation boards help some people. They display pictures or words representing common requests and topics. Your parent points to the picture instead of saying the word. This limits communication to what's on the board, but if your parent has significant speech difficulty, even limited communication is valuable.

Gestures and facial expressions convey meaning. Your parent might use nodding and head shaking for yes and no. They might use hand gestures to indicate what they need. You might develop custom signals together based on things they do regularly.

Alphabet boards let your parent spell out words by pointing to letters. It's slow, but for someone who can't speak, it preserves the ability to communicate their actual thoughts rather than being limited to yes and no or pointing at pictures.

Speech-language pathologists can teach your parent techniques to improve speech clarity or to compensate for speech difficulties. Some techniques involve slowing speech down and concentrating on clear articulation. Others involve using different breathing patterns. Carryover exercises help your parent practice these techniques at home.

High-Tech Communication Devices

When low-tech solutions aren't adequate, augmentative and alternative communication devices can give your parent back a functional voice.

Text-to-speech devices let your parent type or select words, and the device speaks the text aloud. These can be specialized communication devices or can be apps on tablets or computers. The advantage is that your parent can communicate anything they can type. The disadvantage is that it takes time, so conversation isn't as natural as spoken speech.

Predictive text features speed this up. The device learns what words your parent uses frequently and suggests the next word as they type. Your parent might type "How ar" and the device suggests "are you?" The more it learns their communication patterns, the faster the process becomes.Eye-gaze devices let your parent control the device by where they look on the screen. Someone who can't move their arms or hands but can move their eyes can select words by looking at them. These are expensive and require training to use effectively, but for someone with severe physical limitations, they can be lifesaving for communication.

Voice-generating devices come in different forms. Some look like small computers. Others are apps on iPads. Some can use the person's natural voice if they recorded voice samples before losing their speech. Others use synthesized voices that sound robotic but convey the message. Some let your parent customize the voice or even use voices that match their gender and approximate age.

Personal amplifiers help people who speak but are hard to hear. They magnify the person's own voice so they don't have to strain or shout. This is helpful for people with dysarthria or other conditions that make speech quiet or unclear.

Getting Your Parent to Use Communication Devices

The technology exists, but your parent actually using it is a different matter.

Some people resist because using a device feels like admitting that their speech isn't normal anymore. That's psychological reality worth acknowledging. Your parent might grieve the loss of their natural voice even as they're learning to use an alternative.

Some people find the devices frustrating. Text-to-speech is slow. Conversation that used to happen at the speed of thought now requires deliberate input. Your parent says something, waits for the device to synthesize it, and by then the conversational moment has passed. This is genuinely difficult.

Getting your parent to practice with the device helps build speed and comfort. Using it consistently at home before trying it in social situations helps. Adjusting voice settings to something your parent prefers helps. Some people want the most natural-sounding synthesized voice available. Others prefer something that's clearly artificial but faster.

A speech-language pathologist can help your parent learn to use the device and integrate it into communication in the most effective way possible.

Supporting Your Parent's Communication

You can make communication with your parent easier and more successful with some simple strategies. Give them time. Don't rush. If they're speaking slowly or struggling with words, resist the urge to fill in the blanks unless they ask you to. They need to work their brain in trying to retrieve the words. Jumping in prevents that practice.

Ask yes or no questions when it makes sense. It's faster than having your parent formulate longer responses. But don't limit them to yes and no if they have more to say. Give them the option to say more.

Listen actively. Concentrate on what they're saying rather than being distracted. Make eye contact. Show that you're focused on understanding them. If you don't understand, ask them to repeat or use their communication device. Pretending to understand when you don't is disrespectful and makes your parent feel more isolated.

Include your parent in conversation. People sometimes exclude those with speech difficulties from conversation, talking about them rather than to them. Speak directly to your parent. Ask them questions. Invite their participation. They might speak in single words or use their device, but they're still part of the conversation.

The Emotional Reality

Losing the ability to speak is a significant loss. Your parent loses not just the mechanics of speech but part of their identity. They can't be spontaneous. They can't joke as easily. They can't express complex thoughts the way they used to. Some of them never regain speech despite all the therapy and devices.

Your job isn't to make this okay or to fix the grief. Your job is to help your parent find ways to keep communicating and connecting. Sometimes that means learning to use new devices. Sometimes it means becoming very good at understanding your parent's attempts at speech. Sometimes it means giving them time and patience and treating them as the full person they still are, even though their speech has changed.

Your parent might say deep things using a communication device that they never would have said before. The slowness forces intentionality. The limitations focus thought. Communication becomes something deliberately chosen rather than reflexive. That has value, even in the context of a genuine loss.

Speech and communication difficulties require evaluation by a speech-language pathologist, who can assess your parent's specific needs and recommend appropriate strategies and devices. Communication devices vary widely in complexity, cost, and effectiveness depending on your parent's specific difficulties and capabilities. Some devices are covered by insurance or Medicare, though coverage is inconsistent. A qualified speech-language pathologist can help determine what your parent needs and work through insurance coverage. Encourage your parent to practice with any device or strategy, as comfort and speed increase with consistent use.