Speech-generating devices (SGDs), also known as voice output communication aids, are electronic augmentative and alternative communication (AAC) systems used to supplement or replace speech or writing for individuals with severe speech impairments, enabling them to verbally communicate. SGDs are important for people who have limited means of interacting verbally, as they allow individuals to become active participants in communication interactions. They are particularly helpful for patients with amyotrophic lateral sclerosis (ALS) but recently have been used for children with predicted speech deficiencies. There are several input and display methods for users of varying abilities to make use of SGDs. Some SGDs have multiple pages of symbols to accommodate a large number of utterances, and thus only a portion of the symbols available are visible at any one time, with the communicator navigating the various pages. Speech-generating devices can produce electronic voice output by using digitized recordings of natural speech or through speech synthesis—which may carry less emotional information but can permit the user to speak novel messages. The content, organization, and updating of the vocabulary on an SGD is influenced by a number of factors, such as the user's needs and the contexts that the device will be used in. The development of techniques to improve the available vocabulary and rate of speech production is an active research area. Vocabulary items should be of high interest to the user, be frequently applicable, have a range of meanings, and be pragmatic in functionality. There are multiple methods of accessing messages on devices: directly or indirectly, or using specialized access devices—although the specific access method will depend on the skills and abilities of the user. SGD output is typically much slower than speech, although rate enhancement strategies can increase the user's rate of output, resulting in enhanced efficiency of communication. The first known SGD was prototyped in the mid-1970s, and rapid progress in hardware and software development has meant that SGD capabilities can now be integrated into devices like smartphones. Notable users of SGDs include Stephen Hawking, Roger Ebert, Tony Proudfoot, and Pete Frates (founder of the ALS Ice Bucket Challenge). Speech-generating systems may be dedicated devices developed solely for AAC, or non-dedicated devices such as computers running additional software to allow them to function as AAC devices. == History == SGDs have their roots in early electronic communication aids. The first such aid was a sip-and-puff typewriter controller named the patient-operated selector mechanism (Naman) prototyped by Reg Maling in the United Kingdom in 1960. POSSUM scanned through a set of symbols on an illuminated display. Researchers at Delft University in the Netherlands created the lightspot-operated typewriter (LOT) in 1970, which made use of small movements of the head to point a small spot of light at a matrix of characters, each equipped with a photoelectric cell. Although it was commercially unsuccessful, the LOT was well received by its users. In 1966, Barry Romich, a freshman engineering student at Case Western Reserve University, and Ed Prentke, an engineer at Highland View Hospital in Cleveland, Ohio, formed a partnership, creating the Prentke Romich Company. In 1969, the company produced its first communication device, a typing system based on a discarded Teletype machine. In 1979, Mark Dahmke developed software for a vocal communication aid program using the Computalker CT-1 analog speech synthesizer with a microcomputer. The software utilized phonemes to generate speech, assisting individuals with communication impairments in constructing words and sentences. Dahmke's work contributed to the advancement of assistive technology for people with disabilities. Notably, he designed the "Vocabulary Management System" for Bill Rush, a student with cerebral palsy. This early speech synthesis technology facilitated improved communication for Rush and was featured in a 1980 issue of LIFE Magazine. Dahmke's contributions have influenced the development of augmentative and alternative communication (AAC) technologies. During the 1970s and early 1980s, several other companies emerged that have since become prominent manufacturers of SGDs. Toby Churchill founded Toby Churchill Ltd in 1973, after losing his speech following encephalitis. In the US, Dynavox (then known as Sentient Systems Technology) grew out of a student project at Carnegie-Mellon University, created in 1982 to help a young woman with cerebral palsy to communicate. Beginning in the 1980s, improvements in technology led to a greatly increased number, variety, and performance of commercially available communication devices, and a reduction in their size and price. Alternative methods of access such as Target Scanning (also known as eye pointing) calibrate the movement of a user's eyes to direct an SGD to produce the desired speech. Scanning, in which alternatives are presented to the user sequentially, became available on communication devices. Speech output possibilities included both digitized and synthesized speech. Rapid progress in hardware and software development continued, including projects funded by the European Community. The first commercially available dynamic screen speech-generating devices were developed in the 1990s. Software was developed that allowed the computer-based production of communication boards. High-tech devices have continued to become smaller and lighter, while increasing accessibility and capability; communication devices can be accessed using eye-tracking systems, perform as a computer for word-processing and Internet use, and as an environmental control device for independent access to other equipment such as TV, radio and telephones. Stephen Hawking came to be associated with the unique voice of his particular synthesis equipment. Hawking was unable to speak due to a combination of disabilities caused by ALS, and an emergency tracheotomy. In the past 20 or so years SGD have gained popularity amongst young children with speech deficiencies, such as autism, Down syndrome, and predicted brain damage due to surgery. Starting in the early 2000s, specialists saw the benefit of using SGDs not only for adults but for children, as well. Neuro-linguists found that SGDs were just as effective in helping children who were at risk for temporary language deficits after undergoing brain surgery as it is for patients with ALS. In particular, digitized SGDs have been used as communication aids for pediatric patients during the recovery process. == Access methods == There are many methods of accessing messages on devices: directly, indirectly, and with specialized access devices. Direct access methods involve physical contact with the system, by using a keyboard or a touch screen. Users accessing SGDs indirectly and through specialized devices must manipulate an object in order to access the system, such as maneuvering a joystick, head mouse, optical head pointer, light pointer, infrared pointer, or switch access scanner. The specific access method will depend on the skills and abilities of the user. With direct selection a body part, pointer, adapted mouse, joystick, or eye tracking could be used, whereas switch access scanning is often used for indirect selection. Unlike direct selection (e.g., typing on a keyboard, touching a screen), users of Target Scanning can only make selections when the scanning indicator (or cursor) of the electronic device is on the desired choice. Those who are unable to point typically calibrate their eyes to use eye gaze as a way to point and blocking as a way to select desired words and phrases. The speed and pattern of scanning, as well as the way items are selected, are individualized to the physical, visual and cognitive capabilities of the user. == Message construction == Augmentative and alternative communication is typically much slower than speech, with users generally producing 8–10 words per minute. Rate enhancement strategies can increase the user's rate of output to around 12–15 words per minute, and as a result enhance the efficiency of communication. In any given SGD there may be a large number of vocal expressions that facilitate efficient and effective communication, including greetings, expressing desires, and asking questions. Some SGDs have multiple pages of symbols to accommodate a large number of vocal expressions, and thus only a portion of the symbols available are visible at any one time, with the communicator navigating the various pages. Speech-generating devices generally display a set of selections either using a dynamically changing screen, or a fixed display. There are two main options for increasing the rate of communication for an SGD: encoding, and prediction. Encoding permits a user to produce a word, sentence or phrase using only on
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