Stroke, brain injury, cerebral palsy, autism, ALS—these are just some of the conditions that can seriously impair people’s speech and language. Today, a growing number of people with such conditions are turning to speech generating devices (SGDs). These high-tech electronic devices are designed to do the speaking for them. And the devices are getting more sophisticated every day, thanks to advances spurred by booming popularity. If you’re thinking about getting an SGD, you have more options than ever. This means you also have to spend more time determining which SGD is the best fit for you. And that can be confusing. A speech-language pathologist (SLP) with expertise in this area can help. Here are some key factors to discuss with your SLP. What Are My Needs? SGDs are considered one form of augmentative and alternative communication (AAC)—an umbrella term for anything that’s used to supplement or replace speech. “The definition of an individual who needs AAC is someone who cannot meet his or her daily communication needs through natural speech,” says David Beukelman, Ph.D., professor of communication disorders at the University of Nebraska-Lincoln. Do you have a job that involves public speaking? Are you a student? Do you care for young children? These kinds of factors determine your daily communication needs. And those needs, in turn, affect the type of device you require. For example, if you have a job that involves lots of speaking, you might consider a text-to-speech device. These devices can say almost anything you want. You enter the message, and the device figures out how to pronounce it using a complex set of language rules. The device then “speaks” the words using synthesized speech—an artificial simulation of the real thing. What Are My Abilities? Your SLP will assess not only your speech and language, but also your thinking, movement, hearing, and vision. “We look at what your capabilities are and see how they match up with the capabilities that a particular device demands,” Dr. Beukelman says. For example, most SGDs are operated by typing on a keyboard or touching a screen. But if you have limited hand mobility, this won’t work for you. However, you might do well with a system that’s controlled by a foot switch or by a camera that tracks head movements. As another example, let’s say that you’ve lost your ability to spell words and string them together into sentences after a stroke. An SGD that requires you to do these things won’t work for you. However, you might do well with a system in which the opening screen shows pictures related to real-life situations. If you select a picture of a couple, for instance, you might then be offered several messages you can use to talk about your spouse. How Will I Pay for It? SGDs cost from $400 for the most basic models to more than $7,000 for the most advanced ones. Medicare and many insurance plans cover SGDs for qualified individuals. “But sometimes it’s not as automatic as benefits for routine medical services,” says Dr. Beukelman. Be sure to check in advance to find out what will be covered and what kind of authorization you’ll need. What if My Child Needs an SGD? A process called SETT—short for Student, Environment, Tasks, and Tools—is used to assess students in a school setting. The four key parts of the assessment are as follows: Student. The first thing considered is the student’s needs and abilities. The goal is to answer two questions: What are the most important things for this student to be able to do? And what are the barriers keeping the student from doing these things? Environment. This step involves considering the school itself—not only the classroom, but also the hallway, cafeteria, playground, and other settings. What classes, materials, equipment, and support services are available? And how is the student affected by the attitudes and expectations of others at the school? Tasks. The purpose of using AAC at school is to allow the student to take part in activities that build knowledge and skills. This step involves identifying such activities. Tools. The final step involves identifying AAC tools and strategies that are a good match for the student, environment, and tasks. In the case of an SGD, the goal is to find a device with the right set of features.