Many Eyegaze Edge users are People with ALS (PALS). These individuals have specific communication needs and abilities that change over time. Let’s discuss a few factors to consider when looking for the right assistive technology to help.

For PALS, we may see changes generally in the areas of respiration (breathing), resonance (sound), articulation (clarity) and phonation (voice). Specific changes may include decreases in the ability to move the oral and laryngeal musculature, sustain phonation with adequate breath support, and may result in slurred speech, reduction in rate and speech intelligibility and dysarthric speech characteristics such as imprecise consonants, harsh or strained vocal quality, and pitch variation. For many PALS, these changes lead to aphonia, or complete loss of voice. The use of augmentative and alternative communication (AAC) strategies is a dynamic process that should be implemented early and gradually over the course of the disease.  
When evaluating communication function, a speech-language pathologist may evaluate communication using the “Severe dysarthria due to Amyotrophic Lateral Sclerosis” scale.  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 family 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.  

No-tech options include implementing a writing system, using an alphabet letter spelling board, providing written choices for the PALS to select with gestures, or asking yes/no questions with a physiological response (e.g., look up for ‘yes’, down for ‘no’). Depending on speaking ability, the speaker can actively use compensatory speech and conversation repair strategies as well as energy conservation techniques to communicate their most important utterances. Just as important, teaching listening strategies to a conversation partner will be equally as important.  Some families use a letter or picture icon board with partner-assisted scanning to spell words or ideas, or a static eye gaze board (e.g., e-tran board) to spell words, letter by letter.  Other individuals may benefit from mid-tech options such as use of a voice amplifier or palatal lift to increase speech volume and intelligibility.  These techniques can provide PALS with many communication options according to their level of ability.  

PALS have many talents and gifts to continue giving, even though their communication function declines! 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 system Eye gaze AAC 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 and ptosis of the eyelids.
The Benefits of using Eye Gaze AAC
ALS and eye tracking
People with ALS are generally very successful operating eye tracking devices, and particularly the Eyegaze Edge.  Consideration must be made for potential eye challenges as a result of the progression of the disease.  Users with ALS may in time experience droopy eyelids, dry eyes, or limited range of eye movement.  Adjustments to the Eyegaze Edge hardware and software may often accommodate these issues.  Droopy Eyelid Compensation in the Eyegaze Edge will automatically accommodate users with ptosis of the eyelids.  
Over time, people with ALS may also have a decreased blink rate.  The eye surfaces (corneas) are normally moistened by tears, which are spread around by blinking.  As the blink reflex decreases, the corneas dry out, and do not reflect infrared light accurately.  Eye trackers need to see a corneal reflection in order to function.  Using over-the-counter artificial tears or eye drops will typically provide adequate moisture to solve this problem.  LC Technologies’ ECS Settings program even includes a diagnostic tool to help determine the presence of dry eyes! Limited eye movement in some people with advanced stage ALS makes it difficult or impossible for them to perform the more complex Eyegaze functions such as typing on traditional direct-select eye gaze keyboards. For these individuals, 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 optional Grid 3 program makes it possible to easily create custom screens that can accommodate limited eye movement.

LC Technologies, Inc. has a 30-year history of serving the ALS community and their families, and have learned a few things along the way! With our support network of eye tracking pioneers and distributors, we hope to make life a little better for our friends with ALS, their families and communities.