Communication devices — when speech becomes difficult

Reviewed by the How To Help Your Elders editorial team

Losing the ability to speak doesn't mean losing the ability to communicate. From simple writing pads and picture boards to sophisticated text-to-speech devices and eye-gaze technology, communication tools give your parent back a functional voice. The right approach depends on what's causing the speech difficulty and what your parent can still do.

Communication Is Possible Even When Speech Fails

The AARP reports that more than 2 million Americans live with aphasia alone, and millions more have speech difficulties from Parkinson's disease, ALS, stroke, and other conditions. Speech difficulty can come from many sources. Stroke damages the language centers of the brain. Parkinson's weakens the muscles used for speaking. Advanced dementia destroys the ability to form and retrieve words. Laryngeal cancer may require removal of part of the vocal apparatus. ALS progressively paralyzes the muscles needed for speech.

Speech problems aren't all the same. Some people have aphasia, where the brain's language centers are damaged. They may understand what people say but struggle to produce words. Dysarthria is different; the language centers are fine, but the muscles used for speech are weak or uncoordinated. Apraxia of speech means the connection between the brain and the motor movements for speech is broken. Voice loss means someone can't produce sound at all. Each situation requires different approaches.

Low-Tech Communication Strategies

Not every solution requires a device. Writing works well if your parent's hand function is adequate. A notepad and pen let them communicate their actual thoughts when speech production is difficult. It takes time, so patience is needed.

Picture boards or conversation boards display images or words representing common requests. Your parent points to what they need. This limits communication to what's on the board, but even limited communication is valuable when speech is severely affected.

Gestures and facial expressions convey meaning. Nodding and head shaking for yes and no. Hand signals for common needs. Alphabet boards let your parent spell out words by pointing to letters. It's slow, but it preserves the ability to communicate actual thoughts rather than being limited to pre-set options.

Speech-language pathologists teach techniques to improve speech clarity or compensate for difficulties. Some techniques involve slowing speech and concentrating on articulation. Others use different breathing patterns. Practice exercises help carry these improvements into daily life.

High-Tech Communication Devices

Text-to-speech devices let your parent type or select words, and the device speaks the text aloud. These can be specialized devices or apps on tablets. Predictive text features speed the process as the device learns your parent's communication patterns. Eye-gaze devices let someone control a screen by where they look, which is life-changing for someone with severe physical limitations who can still move their eyes.

Voice-generating devices come in different forms. Some use the person's natural voice if they recorded samples before losing speech. Others use synthesized voices. Some let your parent customize the voice to match their gender and approximate age. Personal amplifiers help people who speak but are hard to hear by magnifying their own voice.

Getting Your Parent to Use Communication Tools

The technology exists, but actual use is a different matter. Some people resist because using a device feels like admitting their speech isn't normal anymore. That grief over losing their natural voice is worth acknowledging. Some find devices frustrating because text-to-speech is slow and conversational moments pass before the message is delivered.

Getting your parent to practice with the device builds speed and comfort. Using it consistently at home before trying social situations helps. Adjusting voice settings to something your parent prefers matters. A speech-language pathologist helps integrate the device into communication effectively.

Supporting Communication Every Day

Give your parent time. Don't rush. If they're struggling with words, resist filling in the blanks unless they ask. Ask yes-or-no questions when it makes sense, but don't limit them to yes and no if they have more to say. Listen actively. Make eye contact. If you don't understand, ask them to repeat or use their device. Pretending to understand when you don't is disrespectful and increases isolation. Include your parent in conversation. Speak directly to them. Ask questions. Invite their participation.

Losing the ability to speak is a significant loss. Your parent loses not just mechanics but part of their identity and spontaneity. Your job isn't to make this okay or fix the grief. Your job is to help them find ways to keep communicating and connecting, treating them as the full person they still are even though their speech has changed.

Frequently Asked Questions

Does Medicare cover communication devices? Medicare Part B covers augmentative and alternative communication devices when prescribed by a doctor as medically necessary. A speech-language pathologist typically evaluates your parent's needs and recommends the appropriate device. Coverage varies by device type and plan.

What's the best communication device for someone with aphasia? It depends on the type and severity of aphasia. Someone who understands language but can't produce words may do well with a text-to-speech device. Someone with comprehension difficulties may benefit from picture-based communication. A speech-language pathologist can assess and recommend the best fit.

Can someone with Parkinson's disease improve their speech? Yes. Speech therapy programs like LSVT LOUD are specifically designed for Parkinson's and have strong evidence for improving speech volume and clarity. Personal amplifiers also help by magnifying the voice without requiring the person to strain.

My parent had a stroke and can't speak. Will they ever talk again? Recovery varies widely depending on the type and location of the stroke. Many people recover some speech, especially with intensive speech therapy in the first months after a stroke. A speech-language pathologist can assess the potential for recovery and recommend appropriate communication strategies in the meantime.

How do I help someone communicate who has advanced dementia? Focus on nonverbal communication. Tone of voice, facial expressions, touch, and body language communicate more than words. Simplify your language. Use short sentences. Watch for emotional cues rather than trying to have complex conversations. Your calm, loving presence communicates care even when words no longer work.