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Augmentative/Alternative Communication

Various progressive diseases, such as ALS (also referred to as Lou Gehrig's disease), can result in the loss of verbal speech abilities. Sometimes strokes or other forms of brain injury can also result in temporary or permanent loss of voice and speech skills. However, loss of verbal speech does not have to result in loss of communication with loved ones. Several high and low tech alternative communication options are available to ensure continued communication despite physical impairments. 


Our SLPs at Swallowing and Neurological Rehabilitation have experience with alternative and augmentative communication. We are on the Tulsa MDA team, where we attend a multidisciplinary clinic to serve individuals with ALS and other progressive neuromuscular diseases falling under the muscular dystrophy diagnosis umbrella. 

Tulsa SNR AAC Therapy

When should you see a speech-language pathologist?


The sooner, the better! After a stroke or brain injury, the sooner therapy is initiated, the better the outcomes. With progressive disorders, early intervention is equally important. Often, when an individual is first diagnosed with a progressive condition such as ALS, their speech may be still relatively spared at that point. It is important to seek SLP services at this stage while voice is still relatively intact so that voice banking and device training can be completed early. By meeting with the SLP early, you can learn how to record your voice for use on a communication device if one may be needed later.

  • Voice Banking: Voice banking involves recording a large sample of a person’s speech that is then analyzed with a special software to create a synthetic voice that approximates the person’s natural speaking voice. This synthetic voice can then be later placed on a communication app or device, and the voice of the device will sound very much like the individual versus a computer-like voice and can be used to generate spontaneous messages on the device. In some cases if the voice is already incapable of being recorded by the time this process is initiated, a loved one with a similar voice may complete the voice banking process for the individual.

  • Message/Story Banking: Message banking involves recoding and storing words, phrases, sentences, and personally meaningful expressions in the individual’s natural speaking voice. These messages can then be played back later on a communication app or device, exactly word-for-word and in the person’s actual voice. Story banking involves recording whole stories so that these personal favorite stories are then available to share with others.

The process to order a speech generating device through insurance begins with an SLP evaluation to assess current and future communication needs to help you select the best device for your situation. A representative from a device manufacturer brings devices to the appointment for you to trial with the SLP. Once a device is decided upon, the SLP writes a report justifying medical necessity which is submitted for insurance approval of the device. Some payer sources have different requirements on this, but we will help navigate this process every step of the way. There are also some nonprofit assistance programs available for cases where no funding source is available, and there are loaner banks for equipment for individuals who qualify as well. We work closely with all of the local organizations with loaner closets and can help connect patients to these community resources.  

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