Should you become unable to speak, a speech-generating device (SGD) can speak for you. You can use eye-gaze technology to select specific letters, words, and messages on a digital screen by looking at them or blinking.

Other access methods include moving your head to operate a head mouse or optical head pointer, using your hands to touch the screen, typing on a keyboard, and moving a joystick. ​
There are different speech-generating devices on the market, so ask your speech language pathologist (SLP) which ones might be best for you. Ask to try multiple devices. The most common speech-generating devices for ALS are:

“The writing process takes me away to another time and place. When I'm writing, it's the same state as before I was diagnosed. I'm grateful for the technology that allows me to continue to do it. Bring a patient attitude. If you persevere, the world remains open to you.”

​     — Tim Green, author living with ALS
Medicare will only cover one speech-generating device every five years, so you will want to make sure to get the right one for you. Tell your SLP that you will want to find the device that will be best for you for the course of your ALS journey.

To get a dedicated speech generating device, you will need to meet with your ALS neurologist or physician and request an evaluation, which may take place at an SLP’s office, rehab center, or technology center.
A speech language pathologist who specializes in AAC—and ideally ALS—should conduct your evaluation and submit the request to the manufacturer, who will then submit the authorization to Medicare, Medicaid, or private insurance.
 
Speech-generating devices can be expensive. Medicare will cover 80% of the cost. The remaining 20% should be covered by private insurance or Medicaid. If you don’t have private insurance or Medicaid, you may have a co-pay. Keep in mind that Medicare will not pay for a speech-generating device if you are already enrolled in a skilled nursing facility or are already enrolled in hospice.

After you receive your speech-generating device, the manufacturer should send a professional to your home to help you set it up and train you and your caregiver how to use it. Your SLP may also help with device setup and training.
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If you do not have insurance, or have a co-pay that you can’t afford, ask your local ALS organization if they have a speech-generating device that you can borrow at no cost, or you can submit a request for assistance to Team Gleason. If an organization loans you a communication device, find out who will help you set it up and train you.

It will likely take some time to get used to using your new device, but the more you practice, the easier it will become. If you have questions or technical issues after your initial training, contact the device manufacturer for assistance.

Bridging Voice may also be able to help you troubleshoot.

Eye Health with Eye Gaze

If you are or will be using an eye gaze communication device, it is very important to learn about eye health and start using eye drops from the beginning. If you develop dry eyes, lose your tear layer, and develop damage to your cornea, you may lose the ability to use an eye gaze communication device entirely.

Many people do not report dry eyes until after irritation has started. Symptoms of dry eye include redness, stinging, light sensitivity, watery eyes, mucus near the eyes, blurry vision, and difficulty accessing eye gaze communication devices.

To learn how you can prevent and treat dry eyes, download this ALS and Eye Health with Eye Gaze PDF.