Usage

ALS and Communiation

When evaluating communication function, a speech-language pathologist may evaluate communication ability along a Speech Staging System For ALS (Yorkston, Beukelman, Strand & Bell,1999).

This system describes speaking ability in the following stages:

• Stage 1 No detectable speech disorder
• Stage 2 Noticeable speech disturbance, but still intelligible speech
• Stage 3 Reduction in speech intelligibility
• Stage 4 Use of Augmentative and Alternative Communication (AAC)
• Stage 5 No functional or natural speech.

With communication training from a speech-language pathologist and other professionals, PALS and their families can maximize communication function in almost every situation. Training may initially include education to address identified communication needs and what to expect with decreases in verbal communication over time. Communication strategies can be used by the speaker and listener, and range from no-tech to high-tech solutions.

Using an eye gaze speech generating device is a high-tech, robust communication access point that is safe, easy and comfortable to use, and appropriate for long-term use throughout the day and night with minimal effort on the user. The Eyegaze Edge is a robust speech generating device that uses the minimal amount of infrared light needed for gaze point accuracy, and compensates for challenges specific to the ALS community–that of having dry eyes, ptosis of the eyelids and specific positioning needs to facilitate energy conservation.

Pauline and Reggie are a loving couple taking control of their communication with the Eyegaze Edge®.

Over time, people with ALS may have a decreased blink rate. The eye’s surface (cornea) is normally moistened by tears, which are spread around by blinking. As the blink reflex decreases, the cornea dries out, and does not reflect infrared illumination as well. Eye trackers need to see a corneal reflection in order to function. Using over-the-counter artificial tears eye drops will typically provide adequate moisture. The Eyegaze Edge ECS Settings program includes a diagnostic tool to help determine the presence of dry eyes. The Eyegaze Edge calculates the user’s distance from the screen precisely. When Focus Range Compensation is active and the user has dry eyes, congealed tears on the surface of the cornea will affect the range prediction, causing the eye image to display changes in color to alert the user that his eyes may be dry. The eye image will alternate between red and green as it tries to find the correct range. If turning off the Focus Range Compensation results in a return to normal Eyegaze function it has diagnosed the problem.

Limited eye movement in some people with very advanced ALS makes it difficult or impossible for them to perform the more complex Eyegaze functions, such as typing, on traditional Direct-select Eyegaze keyboards. Two solutions are included in every Eyegaze Edge: a large-key two-stroke keyboard and a scanning keyboard with an eye motion switch. Additionally, the  Eyeworld program makes it possible to create custom screens that can accommodate limited eye movement.