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Our goal

It is not our intent to review every app or media device that has been or will soon be released.  Rather our goal is to provide a framework, based upon well established clinical considerations for feature matching a person's strengths and needs to available tools and strategies (Shane and Costello, 1994), and apply that to comparing and selecting an  iDevice platform and apps (refer to Table). Only through an informed clinically based selection, can we minimize the emerging trend toward selecting communication apps  based on the robustness of media coverage, public testimonials or recommendations from well meaning friends and family.

To this end, a chart  was created to detail the features known to be vital considerations for a broad profile of people with complex communication needs.   Not all of these features currently exist in apps thus highlighting the need to match a person’s needs to the right tools and strategies and NOT try to fit a person to a specific platform or app.     In addition, this chart should be considered as dynamic ( the number of communication apps is constantly growing as is the scope of available features).

The Chart:


Feature Matching Communication Applications Chart (PDF)

To better understand the application of the chart, a case study will illustrate application of the assessment process and use of the app feature matching process/chart.

Case Study:

Nancy, a 69-year-old woman with Bulbar ALS was seen in August 2010 (Table 1.1 & 1.2)

Table 1.1: Key Needs/Features Based on Assessment Outcomes

Information gathered during assessment

Key App Features based on information gathered during the assessment

  • Text
  • Text
Rate Enhancement
  • Doesn’t not want to “write every letter out”
  • Word Prediction
  • Abbreviation Expansion
  • Logical Letter Encoding
  • Ability to store Phases/Retain Codes
Display Settings
  • Was able to navigate dynamic displays
  • Wants something with “little set up”
  • Able to use QWERTY keyboard
  • Increase font size
  • QWERTY Keyboard
  • Increase font size
  • Able to type on iPad and other devices
  • No current motor issues (yet could potentially have motor issues in the future)
  • Adjust dwell
  • Edit icon size and spacing
  • Direct Selection
Purpose of Use and Patients “requests”
  • Communication in multiple contexts
  • Wants voice output and a female’s voice
  • Synthesized Speech (voice output)
  • Female Voice
  • Adjust rate
  • Speak after selection

In Nancy’s case, the iPad is a tool that meets most of her communication needs, serving as her primary communication system.  Recommendations in addition to the iPad during the AAC consultation included use of pen and paper (for written messages) and a low-tech alphabet board. Yet the iPad will be used as her primary tool due to the voice output features, ability to pre-store messages, and word prediction (thus enhancing the rate of communicative interactions). Assistive Chat was selected as the primary communication app, matching key features that Nancy needs  within her price range (Table 1.2).

In Nancy’s case, both Prolqou2go and Easy Speak had just as many “matched” features to the final app choice. Yet in trialing them in the assessment with Nancy, she voiced a clear preference for Assistive Chat (due to quality of voice and what she described as “the best prediction”); thus stressing the importance of step four in Table 1.2.

Related articles

ASHA Perspectives, July, 2011
Using a Clinical Approach To Answer “What Communication Apps Should We Use?” (PDF)
Gosnell, Costello & Shane

ASHA Leader, October 11, 2011
Apps: An Emerging Tool for SLP's
Jessica Gosnell

Video demonstration of the Feature Matching Process for Nancy.

The Boston Children's Hospital service delivery model for patients who are Communication Vulnerable was recently highlighted in the AAC-RERC spotlight on Supporting Effective Patient-Provider Communication Across Health Care Setting


Alternative Access Assessment for AAC ASHA 2018

ASHA_ Station 1 Handout

ASHA_ Station 2 Handout

ASHA_ Station 3 Handout

ASHA 2018 - AAC ICU and Acute Care Settings - requirement for best care

Speech synthesis history current and future asha

First  then, 2018 (ACP Facebook download)

Costello, J. M. October 17, 2018 How to Establish Communication and Cooperation (Participation) with Non-speaking Children in ALL Environment

Presumed Competence

Family fun Day announcement

Communication Profile Template

Modular Hose

Cursor Access to keyboard and Mouse

Cursor Access to Keyboard and Mouse for MAC

CMS Letter

HeySiri info

Inpatient Communication Profile

Zangari and Soto Announcement 

AAC and VI #1

Inpatient AAC position

Welcome Peggy

Welcome Amaliya

Bilingual GoTalk Now

AAC and Trach Santiago ASHA 2015

inpatient Social story one

inpatient Social story two

Message Bank Resource

ALS Program two-pager.2

Aided Language Stimulation


Lisa Bardach Communication Needs Questionnaire

ALS Newfoundland full day lecture

ASHA 2016 Costello and Dellea

Visuals for Receptive Language A. O'Brien

Message banking and Legacy Message definitions and examples

BCH ALS Message bank, Legacy Message definition and examples 2017

Core Vocabulary and Literacy

Lisa Bardach app comparison

Katie O'Neil AAC, VI and Low Tech access to language

2017 Mass Down Syndrome Congress Rose and Grossman

ASHA 2014

ISAAC 2014 Lisbon, Portugal   July 19-24

Milano, Italy  Costello, J.M.  May 2013

Martha's Vineyard Workshops by Rebecca Therriault May 2013

NORWAY ISAAC  Costello, J.M. April 2013

ATIA January 2013 Caron, Buxton and Rice


HANDOUT: ISAAC July 2012 Preserving Legacy:  Message Banking

DRAFT GUIDE FOR MESSAGE BANK: This guide features the working definitions and terminology being used when introducing the concept of 'Message Banking"

MESSAGE BANKING:   Messages banked by many people with ALS in the event they need to use a speech generating device July 2012.    (part of the evolving BCH Augmentative Communication Protocol for Message Banking)

Allen Crocker Speaker Series.   Rebecca Therriault, AAC and Down Syndrome

MDSC 2012

AAC Division Conference - January 2011

AAC Highlights from ACP - January 8, 2011 

ASHA 2010

AAC in the ICU

AAC and the End of Life

Dynamic Display Examples

These PowerPoint "dynamic displays" were created to support our patients and families to have experience and practice with navigating dynamic pages while waiting to purchase a commercial software program or arrange a trial with a dynamic display speech generating device.

To access the slides missing from the 4/24 Needleman Conference "Evidence-Based Communication Treatment for Children with ASD," please click on the link below.

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